Powered vs manual tooth brushing in patients with fixed orthodontic appliances:A systematic review and meta-analysis

Objective: The objective of this systematic review and meta-analysis was to compare powered and manual toothbrushes for oral hygiene maintenance in orthodontic patients.Methods: Electronic databases, including MEDLINE, Scopus, Google scholar, PubMed, Web of Science, the Cochrane Oral Health Group's Trials Register, and CENTRAL, were searched without language restrictions. Randomized clinical trials directly comparing manual and powered toothbrushing including patients with fixed orthodontic appliances reporting predefined outcomes with a follow-up period of at least 4 weeks were included. Using predefined data extraction forms, 2 authors independently undertook data extraction with conflict resolution by the third author. Quality assessment was based on the Cochrane Risk of Bias tool, and overall evidence base was assessed using the Grading of Recommendations Assessment, Development and Evaluation system. A random effects meta-analysis combined the treatment effects across studies.Results: Five trials were considered appropriate for inclusion in the meta-analysis with 8 trials excluded. There are slight differences in plaque index reduction of 0.05 (−0.04, 0.13) and 0.11 (−0.10, 0.33) at 4 week and 8 week follow up, respectively, favoring manual toothbrushing, but this was not statistically significant. There are slight differences in gingival index reduction of −0.02 (−0.06, 0.02) and −0.01 (−0.05, 0.02) at 4 week and 8 week follow up, respectively, favoring powered brushing, but again, this was not statistically significant. The overall quality of evidence was very low to moderate for the primary outcomes.Conclusions: Using manual or powered tooth brushing with fixed orthodontic appliances does not reduce plaque or gingival indexes at 4 weeks and 8 weeks. This conclusion is, however, based on low quality of evidence from few studies. Greater standardization of the methodology used is desirable in future trials to increase our confidence in these findings.</p

Parental awareness regarding pediatric antibiotic use in Madinah, Saudi Arabia

Purpose: To determine the level of awareness of antibiotic use in children in Madinah, Saudi Arabia, and to identify factors associated with parental decisions regarding it. Methods: Using a multiple-choice-question-based questionnaire survey, 1256 forms were distributed to visitors of major shopping malls in Madinah City to obtain socio-demographic and antibiotics knowledgebased data from October 2017 to January 2018. Differences in scores between and within groups on knowledge of parents about antibiotics were determined. Results: Most participants (67 %) had good basic knowledge of antibiotics: 69 and 40 % of respondents were aware of their side effects and antibacterial resistance, respectively. Participants in high age groups (&gt; 46 years old) have a significantly higher mean knowledge score (55.4 ± 20.1, p &lt; 0.05) than those in younger groups. Educational status increased the mean knowledge score by approximately 60 %, with the most educated group having a mean score of 61.2 ± 16.4 (p &lt; 0.05). Conclusion: These results reveal the importance of awareness campaigns on antibiotic use and the role of healthcare professionals in the education of patients and parents on correct use of antibiotics, as well as the significance of antibacterial resistance. Keywords: Antibiotics misuse, Pediatrics, Patient education, Antibacterial resistanc

Development of an assessment tool to measure communication skills among family medicine residents in the context of electronic medical record use

Background: The introduction of the electronic medical record (EMR) has led to new communication skills that need to be taught and assessed. There is scarce literature on validated instruments measuring electronic-specific communication skills. The aim is to develop an assessment checklist that assesses the general and EMR-specific communication skills and evaluates their content validity and reliability. Methods: Using the SEGUE theoretical framework for communication skills, the assessment checklist items were developed by the Communication Skills Working Group (CSWG) at the family medicine department using a literature review about the positive and negative aspects of EMR use on physician-patient communication. A group of faculty members rated real resident-patient encounters on two occasions, three weeks apart. Patients were asked to fill out the Communication Assessment Tool (CAT) at the end of the encounter. Results: A total of 8 residents agreed to participate in the research, with 21 clinical encounters recorded. The average total score was 65.2 ± 6.9 and 48.1 ± 9.5 for the developed scale and the CAT scale, respectively. The scale reliability was good, with a Cronbach alpha of 0.694. The test-retest reliability was 0.873, p < 0.0001. For the total score on the developed checklist, the intraclass correlation coefficient between raters (ICC) was 0.429 [0.030,0.665], p-value of 0.019. The level of agreement between any two raters on the cumulative score of the 5 subsections ranged from 0.506 (interpersonal skills) to 0.969 (end encounter). Conclusion: This checklist is a reliable and valid instrument that combines basic and EMR-related communication skills. © 2023, The Author(s)

Disparities in rheumatoid arthritis disease activity according to gross domestic product in 25 countries in the QUEST-RA database

Objective: To analyse associations between the clinical status of patients with rheumatoid arthritis ( RA) and the gross domestic product (GDP) of their resident country. Methods: The Quantitative Standard Monitoring of Patients with Rheumatoid Arthritis (QUEST-RA) cohort includes clinical and questionnaire data from 6004 patients who were seen in usual care at 70 rheumatology clinics in 25 countries as of April 2008, including 18 European countries. Demographic variables, clinical characteristics, RA disease activity measures, including the disease activity score in 28 joints (DAS28), and treatment-related variables were analysed according to GDP per capita, including 14 high GDP countries with GDP per capita greater than US$24 000 and 11 low GDP countries with GDP per capita less than US$ 11 000. Results: Disease activity DAS28 ranged between 3.1 and 6.0 among the 25 countries and was significantly associated with GDP (r = -0.78, 95% CI -0.56 to -0.90, r(2) = 61%). Disease activity levels differed substantially between high GDP and low GDP countries at much greater levels than according to whether patients were currently taking or not taking methotrexate, prednisone and/or biological agents. Conclusions: The clinical status of patients with RA was correlated significantly with GDP among 25 mostly European countries according to all disease measures, associated only modestly with the current use of antirheumatic medications. The burden of arthritis appears substantially greater in low GDP than in high GDP countries. These findings may alert healthcare professionals and designers of health policy towards improving the clinical status of patients with RA in all countries

Computerised building cost estimating system

Estimating is an important process in order to prepare cost estimating for a proposed project. Cost estimate will give client an overview towards the total cost needed to be spent based on design. Due to the importance of the cost estimate for a proposed project, the utilization of computer to prepare cost estimate should therefore be practiced. The entry of computer technology in the estimating practice is a major event in the improvement of the traditional estimating method by reducing estimate preparation time, reducing the amount of paperwork required for the conventional data storage, and improving the quality of documentation. However, the actual use of the computer varies. Some companies use the computer for all projects and others do not use at all. The software are under-utilized due to its inefficiency in terms of difficulty, cost and because the program does not match with the company’s style of estimate This study is intended to identify estimating techniques used by contractors for cost estimate, to identify problem causes using that techniques and to develop a computerized cost estimating system for contractors. The study has found out that most of the contractors were using approximate quantity estimating technique for their cost estimations using computers. However, some of them still prefer to use manual technique as it is easier to apply. Microsoft Excel is the popular software used by contractors to prepare estimate. However, there are disadvantages in using Microsoft Excel is that users have to create suitable format for each estimating work. A computer-aided-project-cost-estimating system has been created to fulfill the needs mentioned. The result of this research was a cost estimating system application named as COES (Cost Estimating System) With the fulfill utilization Microsoft Access 2003 and other Microsoft Access functions, COES has been able to produce cost estimating automatically. This system serves as a systematic framework comprising elements of building works in order to help contractors to prepare a more precise and systematic cost estimat

FÖRFRÅGNINGSUNDERLAG-TOTALENTREPRENAD : BYGGNATION AV DUBBELSPÅRFUNKTION GODSSTRÅKET HALLSBERG- DEGERÖN DELEN STENKUMLA-DUNSJÖ

Turnkey contract is a commonly used form of contract for procurement of projects, however not so common when it comes to rail infrastructure, because railway installations are so complex and makes greater demands on availability and traffic safety. Performance contracts have occurred in railway projects for a long time. The Swedish Transport Administration has received directives from the government to push for increased productivity and increased degree of innovation in the construction industry. The Swedish Transport Administration has the ambition to transform its role as a client to create the conditions for the market and its driving forces for increased innovation and productivity by handing over a greater commitment and responsibility to the contractors. A strategic primary focus is to increase the proportion of turnkey projects within the construction industry. Contracts relating to investments between 25-500 million will be procured through turnkey projects. The purpose of this report is to identify how the market views the specifications with emphasis on object-specific technical description, its calculability, structure and clarity. The section that has been analyzed in this report is the construction of the freight line between Stenkumla - Dunsjö that is part of the whole distance between Hallsberg - Degerön. Interviews were conducted with entrepreneurs who have participated in the bidding contest. The purpose of the interviews was to get the contractors' views on the specifications that can be taken into account in future projects. Responses will be analyzed by the Swedish Transport Administration and taken into account for the development of future specifications in turnkey contracts for the construction industry. OTB for the route Stenkumla - Dunsjö, entrepreneurs are not allowed to come up with innovative solutions, since the specifications contain many technical solutions specified by the Swedish Transport Administration. The contractors want more freedom in the specifications in order to provide innovative solutions. One reason that there are many technical solutions in this project is because, the project was meant to be procured as performance contract and Traffic Authority had already planned a lot before they decided to purchase it as Turnkey contract.Totalentreprenader är vanligt förekommande entreprenadformen vid upphandling av projekt dock inte så vanligt när det gäller järnvägsanläggningar eftersom järnvägsanläggningar är så komplexa och ställer större krav på tillgänglighet och trafiksäkerhet. Utförandeentreprenader har varit entreprenadformen som har förekommit vid järnvägsprojekt under en längre tid. Trafikverket har fått direktiv från regering att verka för ökad produktivitet och ökad innovationsgrad i anläggningsbranschen. Trafikverket har som ambition att förändra sin roll som beställare för att skapa förutsättningar för marknaden och dess drivkrafter till ökas innovation och produktivitet genom att överlämna ett större åtagande och ansvar till entreprenörerna.   En strategisk huvudinriktning är att öka andelen totalentreprenader inom anläggningsbranschen. Entreprenader som avser investeringar mellan 25 – 500 Mkr ska 50 % av entreprenaderna upphandlas genom totalentreprenader. Syftet med denna rapport är att kartlägga hur marknaden ser på förfrågningsunderlaget med tonvikt på det objektspcifik tekniska beskrivningen, dess kalkylbarhet, struktur och tydlighet. Sträckan som har i denna rapport analyserat är byggnationen av godsstråket mellan Stenkumla – Dunsjö som är en del av hela sträckan mellan Hallsberg – Degerön. Intervjuer har utförts med entreprenörerna som har deltagit i anbudstävlingen. Syftet med intervjuerna har varit för att få entreprenörernas synpunkter på förfrågningsunderlaget som kan tas hänsyn till i kommande projekt.  Svaren kommer analyseras av Trafikverket och tas i hänsyn till utvecklingsarbetet av framtida förfrågningsunderlag inom totalentreprenader för anläggningsbranschen. OTB för just sträckan Stenkumla – Dunsjö, tillåts inte entreprenörerna komma med innovativa lösningar eftersom förfrågningsunderlaget innehåller många tekniska lösningar som angivits av Trafikverket. Entreprenörerna vill ha mer frihet i förfrågningsunderlagen för att kunna bidra med innovativa lösningar. En anledning till att det finns många tekniska lösningar i detta projekt är att det finns en beslutad järnvägsplan. Järnvägsplanen styr utformningen av anläggningen

Spectrophotometric Determination of Ni+2 by 3- ((2- Hydroxyphenyl) imino) indolin- 2- one: التقدير الطيفي لـــ Ni+2 بواسطة 3- (2- هيدروكسي فنيل) إيمينو إندولين 2- ون

3- ((2- Hydroxyphenyl) imino) indolin- 2- one was prepared by reacting isatin with 2- aminophenol(HIAP),The reagent was characterized by IR, H 1NMR spectrum, This reagent with a nickel complex forms a violet color (1: 2) at pH = 9.0, λmax =575nm and room temperature using sodium tetraborate buffer solution, The molar absorptivity 1.43 10+4 L mol- 1 cm- 1 and Sandell’s sensitivity value is 0.03800 μg cm- 2 and The Beer’s law is obeyed in the range 0.50- 5.28 μg mL- 1 of nickel (II) and the Calibration curve equation y = 0.0663x + 0.0749, R² = 0.9988.</jats:p