Impaired platelet aggregation and rebalanced hemostasis in patients with chronic hepatitis C virus infection

Increased risk of both cardiovascular disease (CVD) and bleeding has been found in patients with chronic hepatitis C (CHC) infection, and a re-balanced hemostasis has been proposed. The aim of this study was to investigate functional whole blood coagulation and platelet function in CHC infection. The prospective study included 82 patients with CHC infection (39 with advanced liver fibrosis and 43 with no or mild liver fibrosis) and 39 healthy controls. A total of 33 patients were treated for CHC infection and achieved sustained virological response (SVR). Baseline and post-treatment blood samples were collected. Hemostasis was assessed by both standard coagulation tests and functional whole blood hemostatic assays (thromboelastograhy (TEG), and platelet aggregation (Multiplate). Patients with CHC and advanced fibrosis had impaired platelet aggregation both compared to patients with no or mild fibrosis and to healthy controls. Patients with CHC and advanced fibrosis also had lower antithrombin, platelet count, and coagulation factors II-VII-X compared to healthy controls. In contrast, TEG did not differ between groups. In treated patients achieving SVR, post-treatment platelet count was higher than pre-treatment counts (p = 0.033) and ADPtest, ASPItest, and RISTOhightest all increased post treatment (all p < 0.05). All Multiplate tests values, however, remained below those in the healthy controls. CHC-infected patients displayed evidence of rebalanced hemostasis with only partly hemostatic normalization in patients achieving SVR. The implications of rebalanced hemostasis and especially the impact on risk of CVD and bleeding warrants further studies

Single-tooth replacement: factors affecting different prosthetic treatment modalities

<p>Abstract</p> <p>Background</p> <p>The choice between several treatment options for replacing a single missing tooth is influenced by clinical, dentist- and patient-immanent factors. This study aimed to determine the patient factors that would affect the treatment decision to replace a single missing tooth and to assess the satisfaction with several options.</p> <p>Method</p> <p>200 volunteers involved (121 females and 79 males) divided into four groups, Group A: consisted of patients with conventional fixed partial dentures or patients with resin bonded fixed partial dentures. Group B: consisted of patients who received removable partial dentures while Group C: consisted of patients who received a single implant supported crown, and a control group D: consisted of patients who received no treatment. Data were collected using a questionnaire.</p> <p>Results</p> <p>The highest percentage of males within groups (58%) was within the removable prostheses category. The majority of the subjects in the study reported that the main reason for replacing a missing tooth was for esthetic and function. Most important factor affecting the choice between treatment modalities was damaging the neighboring teeth. Pain, post operative sensitivity and dental phobia were important factors in choosing the prosthesis type and affected the control group patients not to have any treatment. The highest satisfaction percentage among groups studied was recorded for dental implants then FPD groups, while the least percentage were in both the control and RPD groups, for all aspects of function, esthetic and speech efficiency.</p> <p>Conclusions</p> <p>The final choice between FPD, RPD and implant depended on several factors which affected the decision making; among these is cost and patients' awareness of the different treatment options.</p

Adaptation to flood risk: Results of international paired flood event studies

As flood impacts are increasing in large parts of the world, understanding the primary drivers of changes in risk is essential for effective adaptation. To gain more knowledge on the basis of empirical case studies, we analyze eight paired floods, that is, consecutive flood events that occurred in the same region, with the second flood causing significantly lower damage. These success stories of risk reduction were selected across different socioeconomic and hydro-climatic contexts. The potential of societies to adapt is uncovered by describing triggered societal changes, as well as formal measures and spontaneous processes that reduced flood risk. This novel approach has the potential to build the basis for an international data collection and analysis effort to better understand and attribute changes in risk due to hydrological extremes in the framework of the IAHSs Panta Rhei initiative. Across all case studies, we find that lower damage caused by the second event was mainly due to significant reductions in vulnerability, for example, via raised risk awareness, preparedness, and improvements of organizational emergency management. Thus, vulnerability reduction plays an essential role for successful adaptation. Our work shows that there is a high potential to adapt, but there remains the challenge to stimulate measures that reduce vulnerability and risk in periods in which extreme events do not occur

Evaluating the Impact of Nature-Based Solutions: A Handbook for Practitioners

The Handbook aims to provide decision-makers with a comprehensive NBS impact assessment framework, and a robust set of indicators and methodologies to assess impacts of nature-based solutions across 12 societal challenge areas: Climate Resilience; Water Management; Natural and Climate Hazards; Green Space Management; Biodiversity; Air Quality; Place Regeneration; Knowledge and Social Capacity Building for Sustainable Urban Transformation; Participatory Planning and Governance; Social Justice and Social Cohesion; Health and Well-being; New Economic Opportunities and Green Jobs. Indicators have been developed collaboratively by representatives of 17 individual EU-funded NBS projects and collaborating institutions such as the EEA and JRC, as part of the European Taskforce for NBS Impact Assessment, with the four-fold objective of: serving as a reference for relevant EU policies and activities; orient urban practitioners in developing robust impact evaluation frameworks for nature-based solutions at different scales; expand upon the pioneering work of the EKLIPSE framework by providing a comprehensive set of indicators and methodologies; and build the European evidence base regarding NBS impacts. They reflect the state of the art in current scientific research on impacts of nature-based solutions and valid and standardized methods of assessment, as well as the state of play in urban implementation of evaluation frameworks

Subjective need for implant dentistry in a Swedish population aged 45-69 years

The present paper is part of a comprehensive study of dental conditions and attitudes in a Swedish county population aged 45-69 years. A questionnaire was mailed to 3000 randomly-sampled individuals. The response rate was 79.4%. Part of the questionnaire contained questions about subjective need for implant treatment. The subjects were informed of the clinical procedures as well as of the fees for implant treatment in the Swedish insurance system. The subjects wearing removable dentures were asked if, instead of their removable denture(s), they wanted dental implants if such treatment was possible. Of those wearing removable partial dentures, 23% answered "yes". The corresponding figure for subjects totally edentulous in one jaw was 17%; for subjects totally edentulous in both jaws 8%. The individuals who had reported missing teeth not replaced were asked if they wanted their missing teeth replaced by dental implants if such treatment were possible. The % answering "yes" was 21%. The subjects with all teeth remaining were hypothetically asked what kind of treatment they wanted if they would lose 1 or 2 of their teeth. The answer "dental implant" was given by 51%. Thus, subjective need for dental implants tended to decrease with poorer dental conditions. The major reason for not wanting dental implants was satisfaction with present dental conditions. Cost for treatment had some importance, while environmental and psychological factors showed only very limited influence

Competition between slicing and buckling underlies the erratic nature of paper cuts

By enabling the dissemination and storage of information, paper has been central to human culture for more than a millennium. Its use is, however, associated with a common injury: the paper cut. Surprisingly, the physics underpinning a flexible sheet of paper slicing into soft tissues remains unresolved. In particular, the unpredictable occurrence of paper cuts, often restricted to a limited thickness range, has not been explained. Here we visualize and quantify the motion, deformation, and stresses during paper cuts, uncovering a remarkably complex relationship between cutting, geometry, and material properties. A model based on the hypothesis that a competition between slicing and buckling controls the probability of initiating a paper cut is developed and successfully validated. This explains why paper with a specific thickness is most hazardous (65μm, corresponding, e.g., to dot matrix paper) and suggests a probabilistic interpretation of irregular occurrence of paper cuts. Stimulated by these findings, we finally show how a recyclable cutting tool can harness the surprising power of paper.</p