Staff-led interventions for improving oral hygiene in patients following stroke

Background For people with limitations due to neurological conditions such as stroke, the routine practice of oral care may become a challenge. Evidence-based supported oral care intervention is essential for this patient group. Objectives To compare the effectiveness of staff-led oral care interventions with standard care for ensuring oral hygiene for individuals after a stroke. Search strategy We searched the trials registers of the Cochrane Stroke Group and Oral Health Group (August 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2006), MEDLINE (1966 to February 2006), CINAHL (1982 to February 2006), Research Findings Electronic Register (February 2006), National Research Register (Issue 1, 2006), ISI Science and Technology Proceedings (August 2005), Dissertation Abstracts and Conference Papers Index (August 2005). We scanned reference lists from relevant papers and contacted authors and researchers in the field. Selection criteria We identified randomised controlled trials that evaluated one or more interventions designed to improve oral hygiene. Trials based on a mixed population were included, provided it was possible to extract the data specific to the individuals post stroke. Data collection and analysis Two review authors independently classified identified trials according to the inclusion and exclusion criteria, assessed the trial quality and extracted data. Clarification was sought from study authors when required. Main results Eight eligible randomised controlled trials were identified but only one provided stroke-specific information. It compared an oral health care education training programme (OHCE) delivered to nursing home care assistants to delayed training intervention in the control group. Comparisons were made at one and six months after the intervention, using the primary outcome measures dental plaque and denture plaque, and three secondary outcomes. The data available for the 67 individuals with a stroke (obtained from the larger cluster randomised controlled trial) showed that denture plaque scores were significantly reduced up to six months (P &lt; 0.00001) after the intervention. Staff knowledge (P = 0.0008) and attitudes (P = 0.0001) towards oral care also improved significantly. Authors' conclusions Based on one study with a small number of stroke survivors, providing oral care training for carers in a nursing home setting improves their knowledge of and attitudes towards the provision of oral care. In turn, residents' dentures were cleaner, though other oral hygiene measures did not change. Further evidence relating to oral care interventions is severely lacking, in particular with reference to care in hospital for those following stroke. This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2011, Issue 7. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.</p

Congenital Toxoplasmosis in Austria: Prenatal Screening for Prevention is Cost-Saving

Background: Primary infection of Toxoplasma gondii during pregnancy can be transmitted to the unborn child and may have serious consequences, including retinochoroiditis, hydrocephaly, cerebral calcifications, encephalitis, splenomegaly, hearing loss, blindness, and death. Austria, a country with moderate seroprevalence, instituted mandatory prenatal screening for toxoplasma infection to minimize the effects of congenital transmission. This work compares the societal costs of congenital toxoplasmosis under the Austrian national prenatal screening program with the societal costs that would have occurred in a No-Screening scenario. Methodology/Principal Findings: We retrospectively investigated data from the Austrian Toxoplasmosis Register for birth cohorts from 1992 to 2008, including pediatric long-term follow-up until May 2013. We constructed a decision-analytic model to compare lifetime societal costs of prenatal screening with lifetime societal costs estimated in a No-Screening scenario. We included costs of treatment, lifetime care, accommodation of injuries, loss of life, and lost earnings that would have occurred in a No-Screening scenario and compared them with the actual costs of screening, treatment, lifetime care, accommodation, loss of life, and lost earnings. We replicated that analysis excluding loss of life and lost earnings to estimate the budgetary impact alone. Our model calculated total lifetime costs of €103 per birth under prenatal screening as carried out in Austria, saving €323 per birth compared with No-Screening. Without screening and treatment, lifetime societal costs for all affected children would have been €35 million per year; the implementation costs of the Austrian program are less than €2 million per year. Calculating only the budgetary impact, the national program was still cost-saving by more than €15 million per year and saved €258 million in 17 years. Conclusions/Significance: Cost savings under a national program of prenatal screening for toxoplasma infection and treatment are outstanding. Our results are of relevance for health care providers by supplying economic data based on a unique national dataset including long-term follow-up of affected infants

Dissociation rates of J/psi's with comoving mesons - thermal vs. nonequilibrium scenario

We study J/psi dissociation processes in hadronic environments. The validity of a thermal meson gas ansatz is tested by confronting it with an alternative, nonequilibrium scenario. Heavy ion collisions are simulated in the framework of the microscopic transport model UrQMD, taking into account the production of charmonium states through hard parton-parton interactions and subsequent rescattering with hadrons. The thermal gas and microscopic transport scenarios are shown to be very dissimilar. Estimates of J/psi survival probabilities based on thermal models of comover interactions in heavy ion collisions are therefore not reliable.Comment: 12 pages, 6 figure

Week 96 efficacy and safety results of the phase 3, randomized EMERALD trial to evaluate switching from boosted-protease inhibitors plus emtricitabine/tenofovir disoproxil fumarate regimens to the once daily, single-tablet regimen of darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) in treatment-experienced, virologically-suppressed adults living with HIV-1

Darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) 800/150/200/10 mg was investigated through 96 weeks in EMERALD (NCT02269917). Virologically-suppressed, HIV-1-positive treatment-experienced adults (previous non-darunavir virologic failure [VF] allowed) were randomized (2:1) to D/C/F/TAF or boosted protease inhibitor (PI) plus emtricitabine/tenofovir-disoproxil-fumarate (F/TDF) over 48 weeks. At week 52 participants in the boosted PI arm were offered switch to D/C/F/TAF (late-switch, 44 weeks D/C/F/TAF exposure). All participants were followed on D/C/F/TAF until week 96. Efficacy endpoints were percentage cumulative protocol-defined virologic rebound (PDVR; confirmed viral load [VL] >= 50 copies/mL) and VL = 50 copies/mL (VF) (FDA-snapshot analysis). Of 1141 randomized patients, 1080 continued in the extension phase. Few patients had PDVR (D/C/F/TAF: 3.1%, 24/763 cumulative through week 96; late-switch: 2.3%, 8/352 week 52-96). Week 96 virologic suppression was 90.7% (692/763) (D/C/F/TAF) and 93.8% (330/352) (late-switch). VF was 1.2% and 1.7%, respectively. No darunavir, primary PI, tenofovir or emtricitabine resistance-associated mutations were observed post-baseline. No patients discontinued for efficacy-related reasons. Few discontinued due to adverse events (2% D/C/F/TAF arm). Improved renal and bone parameters were maintained in the D/C/F/TAF arm and observed in the late-switch arm, with small increases in total cholesterol/high-density-lipoprotein-cholesterol ratio. A study limitation was the lack of a control arm in the week 96 analysis. Through 96 weeks, D/C/F/TAF resulted in low PDVR rates, high virologic suppression rates, very few VFs, and no resistance development. Late-switch results were consistent with D/C/F/TAF week 48 results. EMERALD week 96 results confirm the efficacy, high genetic barrier to resistance and safety benefits of D/C/F/TAF

Signatures of Quark-Gluon-Plasma formation in high energy heavy-ion collisions: A critical review

A critical review on signatures of Quark-Gluon-Plasma formation is given and the current (1998) experimental status is discussed. After giving an introduction to the properties of QCD matter in both, equilibrium- and non-equilibrium theories, we focus on observables which may yield experimental evidence for QGP formation. For each individual observable the discussion is divided into three sections: first the connection between the respective observable and QGP formation in terms of the underlying theoretical concepts is given, then the relevant experimental results are reviewed and finally the current status concerning the interpretation of both, theory and experiment, is discussed. A comprehensive summary including an outlook towards RHIC is given in the final section.Comment: Topical review, submitted to Journal of Physics G: 68 pages, including 39 figures (revised version: only minor modifications, some references added

Strange Messages: Chemical and Thermal Freeze-out in Nuclear Collisions

Thermal models are commonly used to interpret heavy-ion data on particle yields and spectra and to extract the conditions of chemical and thermal freeze-out in heavy-ion collisions. I discuss the usefulness and limitations of such thermal model analyses and review the experimental and theoretical evidence for thermalization in nuclear collisions. The crucial role of correlating strangeness production data with single particle spectra and two-particle correlation measurements is pointed out. A consistent dynamical picture for the heavy-ion data from the CERN SPS involves an initial prehadronic stage with deconfined color and with an appreciable isotropic pressure component. This requires an early onset of thermalization.Comment: 15 pages, 2 figures, talk given at Strange Quark Matter '98, Padova, Italy, 20-24 July 1998, to be published in J. Phys. G 25; final version with updated reference

Centrality dependence of charged hadron production in deuteron+gold and nucleon+gold collisions at sqrt(s_NN)=200 GeV

We present transverse momentum (p_T) spectra of charged hadrons measured in deuteron-gold and nucleon-gold collisions at \sqrts = 200 GeV for four centrality classes. Nucleon-gold collisions were selected by tagging events in which a spectator nucleon was observed in one of two forward rapidity detectors. The spectra and yields were investigated as a function of the number of binary nucleon-nucleon collisions, \nu, suffered by deuteron nucleons. A comparison of charged particle yields to those in p+p collisions show that the yield per nucleon-nucleon collision saturates with \nu for high momentum particles. We also present the charged hadron to neutral pion ratios as a function of p_T.Comment: 330 authors, 15 pages text, 16 figures, 3 tables. Submitted to Phys. Rev. Lett. v2 has minor changes to reflect revisions during review process. Plain text data tables for the points plotted in figures for this and previous PHENIX publications are (or will be) publicly available at http://www.phenix.bnl.gov/papers.htm

High-pT pi^zero Production with Respect to the Reaction Plane in Au + Au Collisions at sqrt(s_NN) = 200 GeV

Measurements of the azimuthal anisotropy of high-\pT neutral pion neutral pion production in Au+Au collisions at sqrt(s_NN) = 200 GeV by the PHENIX experiment are presented. The data included in this paper were collected during the 2004 RHIC running period and represent approximately an order of magnitude increase in the number of analyzed events relative to previously published results. Azimuthal angle distributions of pi^0s detected in the PHENIX electromagnetic calorimeters are measured relative to the reaction plane determined event-by-event using the forward and backward beam-beam counters. Amplitudes of the second Fourier component (v_2) of the angular distributions are presented as a function of pi^0 transverse momentum p_T for different bins in collision centrality. Measured reaction plane dependent pi^0 yields are used to determine the azimuthal dependence of the pi^0 suppression as a function of p_T, R_AA (Delta phi,p_T). A jet-quenching motivated geometric analysis is presented that attempts to simultaneously describe the centrality dependence and reaction plane angle dependence of the pi^0 suppression in terms of the path lengths of hypothetical parent partons in the medium. This set of results allows for a detailed examination of the influence of geometry in the collision region, and of the interplay between collective flow and jet-quenching effects along the azimuthal axis.Comment: 344 authors, 35 pages text, RevTeX-4, 24 figures, 8 tables. Submitted to Physical Review