Comparison of success rate and onset time of two different anesthesia techniques

Background: Using local anesthetic is common to control the pain through blocking the nerve reversibly in dental procedures. Gow-Gates (GG) technique has a high success rate but less common. This study aimed to compare the onset time and success rate in GG and standard technique of inferior alveolar nerve block (IANB). Material and Methods: This descriptive, single blind study was consisted of 136 patients (59 males and 77 females) who were randomly received GG or IANB for extraction of mandibular molar teeth. Comparisons between the successes of two anesthetic injection techniques were analyzed with Chi-square test. Incidence of pulpal anesthesia and soft tissue anesthesia were analyzed with Kaplan-Meier method. Mean onset times of pulpal anesthesia, soft tissue and lip numbness were analyzed with Log-Rank test. Comparisons were considered significant at P ≤0.05 by using SPSS software ver.15. Results: The incidence of pulpal anesthesia in the IANB group (canine 49.3%, premolar 60.3%) were not significantly different from the GG group (canine 41.3%, premolar 74.6%) ( P =0.200 and P =0.723). The success rate in the IANB group (80.82%) was not significantly different from the GG group (92.02%) ( P =0.123). Furthermore, onset time of lip and buccal soft tissue numbness in GG group (3.25, 4.96 minutes) was quite similar to IANB group (3.22, 4.89 minutes) (all P values >0.05). Conclusions: Although this study demonstrated higher clinical success rate for GG than IANB technique, no significant differences in success rates and onset time were observed between two techniques

Surface acoustic waves induced micropatterning of cells in gelatin methacryloyl (GelMA) hydrogels

Acoustic force patterning is an emerging technology that provides a platform to control the spatial location of cells in a rapid, accurate, yet contactless manner. However, very few studies have been reported on the usage of acoustic force patterning for the rapid arrangement of biological objects, such as cells, in a three-dimensional (3D) environment. In this study, we report on a bio-acoustic force patterning technique, which uses surface acoustic waves (SAWs) for the rapid arrangement of cells within an extracellular matrix-based hydrogel such as gelatin methacryloyl (GelMA). A proof-of-principle was achieved through both simulations and experiments based on the in-house fabricated piezoelectric SAW transducers, which enabled us to explore the effects of various parameters on the performance of the built construct. The SAWs were applied in a fashion that generated standing SAWs (SSAWs) on the substrate, the energy of which subsequently was transferred into the gel, creating a rapid, and contactless alignment of the cells (<10 s, based on the experimental conditions). Following ultraviolet radiation induced photo-crosslinking of the cell encapsulated GelMA pre-polymer solution, the patterned cardiac cells readily spread after alignment in the GelMA hydrogel and demonstrated beating activity in 5–7 days. The described acoustic force assembly method can be utilized not only to control the spatial distribution of the cells inside a 3D construct, but can also preserve the viability and functionality of the patterned cells (e.g. beating rates of cardiac cells). This platform can be potentially employed in a diverse range of applications, whether it is for tissue engineering, in vitro cell studies, or creating 3D biomimetic tissue structures

Predicting the long-term impact of antiretroviral therapy scale-up on population incidence of tuberculosis.

OBJECTIVE: To investigate the impact of antiretroviral therapy (ART) on long-term population-level tuberculosis disease (TB) incidence in sub-Saharan Africa. METHODS: We used a mathematical model to consider the effect of different assumptions about life expectancy and TB risk during long-term ART under alternative scenarios for trends in population HIV incidence and ART coverage. RESULTS: All the scenarios we explored predicted that the widespread introduction of ART would initially reduce population-level TB incidence. However, many modelled scenarios projected a rebound in population-level TB incidence after around 20 years. This rebound was predicted to exceed the TB incidence present before ART scale-up if decreases in HIV incidence during the same period were not sufficiently rapid or if the protective effect of ART on TB was not sustained. Nevertheless, most scenarios predicted a reduction in the cumulative TB incidence when accompanied by a relative decline in HIV incidence of more than 10% each year. CONCLUSIONS: Despite short-term benefits of ART scale-up on population TB incidence in sub-Saharan Africa, longer-term projections raise the possibility of a rebound in TB incidence. This highlights the importance of sustaining good adherence and immunologic response to ART and, crucially, the need for effective HIV preventive interventions, including early widespread implementation of ART

Human Rights and the Global Climate Change Regime

This article discusses human rights implications of the market-based mechanisms operationalized under the global climate change regime. It examines greenhouse gas emissions rights created by the Kyoto Protocol and continued by the Paris Agreement. This article discusses implications of these rights for the protection and realization of human rights in the wake of climate change and argues that greenhouse gas emissions rights, as currently constituted, are incompatible with human rights protections. While the Paris Agreement’s recognition of human rights is a significant development, the protection and realization of human rights by states under a free-market approach to climate change remains a challenge. This article calls for allocation of carbon investment rights for developing countries as a means of promoting the climate justice platform identified by human rights proponents, and reducing the economic gulf between developed and developing countries

Systematic review of TST responses in people living with HIV in under-resourced settings: implications for isoniazid preventive therapy.

BACKGROUND: People living with HIV (PLWH) who have positive tuberculin skin tests (TST) benefit from isoniazid preventive therapy (IPT) whereas those testing TST-negative do not. Revised World Health Organization guidelines explicitly state that assessment of TST is not a requirement for initiation of IPT. However, it is not known what proportions of patients will benefit from IPT if implemented without targeting according to TST status. We therefore determined the proportions of PLWH who test TST-positive. METHODOLOGY/PRINCIPAL FINDINGS: We systematically reviewed the literature published between January 1990 and February 2012 to determine the proportions of patients without active tuberculosis attending HIV care services in low and middle-income countries who tested TST-positive (≥5 mm induration). Proportions were also determined for different CD4 count strata. Data from 19 studies with 9,478 PLWH from sub-Saharan Africa, Asia and Central and South America were summarized. The vast majority were not receiving antiretroviral therapy (ART). A sub-analysis was conducted of 5 studies (5,567 subjects) from high TB prevalence countries of PLWH with negative TB screens attending HIV care and treatment settings for whom CD4 stratified data were available. The median proportion of PLWH testing TST-positive overall was 22.8% (range, 19.5-32.6%). The median (range) proportions with CD4 cell counts of <200, 200-499 or ≥500 cells/µL who tested positive were 12.4% (8.2-15.3%), 28.4% (20.1-36.9%) and 37.4% (31.3-56.3%), respectively. Heterogeneity in the data precluded calculation of pooled summary estimates. CONCLUSIONS/SIGNIFICANCE: In most settings, if IPT is administered to PLWH pre-ART without assessment of TST status, only a minority of those treated are likely to benefit, especially among those with the lowest CD4 cell counts. This may be inefficient use of resources and cost-effectiveness analyses should take this into account. Local knowledge of TST response rates may help inform policies. New simple means of identifying those who will benefit from IPT are needed to permit appropriate targeting of this intervention

Contraceptive Use in Cambodia: A Multi-Method Examination of Determinants and Barriers to Modern Contraception

In Cambodia, 79% of married women of reproductive age wish to limit or delay births, yet only 27% are using a modern method of contraception. The purpose of this mixed-method dissertation is to examine the determinants and barriers to contraceptive use in this population. The two specific aims are to 1) use quantitative data examine the associations between social support and contraceptive use among Cambodian women of low vs. high parity; and 2) use qualitative data to understand the different characteristics and barriers to method use of women who use contraceptives, women who have discontinued contraceptive use and women who have never used a modern method. The quantitative study (aim 1) surveyed a representative sample of married women ages 15-49 from two rural provinces in Cambodia (Kampong Thom and Kampot) and measured current contraceptive use, demographic characteristics and items related to contraceptive social support of husbands, peers and elders. Multivariate logistic regression methods were used to measure the association between contraceptive use and social support and models were stratified by low (=3 live births), The qualitative study (aim 2) used in-depth interviews and focus group discussions with different contraceptive user types to understand unique barriers and motivations of users, discontinuers and non-users of contraceptive methods. The quantitative paper shows significant associations between husband's support and contraceptive use. For all women, a husband's positive attitude towards methods and ease of communication with the husband are associated with higher contraceptive use; however, when the husband has full decision-making power, the likelihood of method use decreases among high-parity women. For low-parity woman, perceiving that peers use modern methods increases the likelihood of contraception. In both groups elders' negative opinions about contraceptive use decrease actual use. The qualitative findings show that rumors of myths and misconceptions about side effects are main barriers to the use and were wide-spread among all women. Differences between the three user types show that positive husband support, access to health providers and a high degree of self-efficacy for contraceptive use contribute to successful initiation and continuation of modern methods

Estimating the costs for the treatment of abortion complications in two public referral hospitals: a cross-sectional study in Ouagadougou, Burkina Faso

Treatment costs of induced abortion complications can consume a substantial amount of hospital resources. This use of hospitals scarce resources to treat induced abortion complications may affect hospitals’ capacities to deliver other health care services. In spite of the importance of studying the burden of the treatment of induced abortion complications, few studies have been conducted to document the costs of treating abortion complications in Burkina Faso. Our objective was to estimate the costs of six abortion complications including incomplete abortion, hemorrhage, shock, infection/sepsis, cervix or vagina laceration, and uterus perforation treated in two public referral hospital facilities in Ouagadougou and the cost saving of providing safe abortion care services

Infant feeding experiences among teen mothers in North Carolina: Findings from a mixed-methods study

<p>Abstract</p> <p>Background</p> <p>Adolescent mothers in the U.S. are much less likely to initiate breastfeeding than older mothers, and teens who do initiate breastfeeding tend to breastfeed for shorter durations. The purpose of this mixed-methods study is to investigate breastfeeding practices, barriers and facilitators among adolescent mothers ages 17 and younger.</p> <p>Methods</p> <p>Quantitative descriptive analyses are conducted using data from the North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS). The population-based sample comprises 389 teens ages 13-17 giving birth to a live born infant in North Carolina in 2000 - 2005 and in 2007. Qualitative analyses are based on in-depth interviews with 22 Black, White and Hispanic teen mothers residing in rural and urban areas of North Carolina conducted between November 2007 and February 2009.</p> <p>Results</p> <p>In quantitative analyses, 52% (196 of 389) of North Carolina teen mothers initiated breastfeeding, but half of those who initiated breastfeeding (92/196) stopped within the first month postpartum. Hispanic teens (44/52 or 89%) were much more likely than Black (61/159 or 41%) or White teens (87/164 or 52%) to initiate breastfeeding and to continue for a longer duration. Nearly sixty two percent (29/52) of Hispanic respondents breastfed for greater than four weeks as compared to 16% (29/159) of Black respondents and 26% (39/164) of White respondents. Common barriers to breastfeeding initiation and continuation included not liking breastfeeding, returning to school, nipple pain, and insufficient milk. Qualitative data provided context for the quantitative findings, elucidating the barriers and facilitators to breastfeeding from the teens' perspective and insight into the ways in which breastfeeding support to teens could be enhanced.</p> <p>Conclusions</p> <p>The large number of adolescents ceasing breastfeeding within the first month points to the need for more individualized follow-up after hospital discharge in the first few days postpartum, to address common technical challenges and to provide assistance managing the transition back to school. Provision of an extra home visit or outpatient visit for teens within the first few days following hospital discharge, and advocacy to make schools more compatible with breastfeeding, could potentially help teens who desire to breastfeed to successfully continue. These interventions warrant further research to test their effectiveness among adolescents.</p

Determination of anterior femoral bowing to length ratio in Iranian population

Due to the existence of different races and ethnicities and their different life styles, anatomical structure of people vary from one region of the world to another. The goal of this study is to determine the anterior femoral bowing to length ratio, which can be useful for planning major medical and therapeutic projects as well as designing medical equipment (including nails, orthoses and prosthetics). Lateral X-rays of femur bones of 250 patients who referred to Taleghani hospital in recent years (2011-2016) were retrieved from hospital archives and studied. 150 patients were females and 100 were males, ages ranging from 16 to 57 years old. All patients were Iranians with different ethnical backgrounds that referred to radiology centers of Tehran and Taleghani hospital and their records were saved in these centers archive. Based on femoral length, X-rays were categorized into eight groups; 300mm, 320mm, 340mm, 360mm, 380mm, 400mm, 420mm and 440mm, which are standards for manufacturing femoral nails in Iran as well as imported nails to Iran. Results showed significant difference compared to available femoral nails on the Iranian market, which indicates that these nails are not standard for Iranian population. Data analysis was based on anterior femoral bowing to length ratio alone. Gender and age were not considered for data analysis in this study and results were conclusive for all ages and genders

Comparing the Effectiveness of Acceptance and Commitment Therapy (ACT), Drug Therapy, and the Combination of These Two Methods in the Treatment of Major Depression

Introduction: A large number of people are afflicted with major depressive disorder, leading to high societal costs. In addition, the treatment remains one of the most challenging and controversial issues in mental health. The main purpose of this study is to compare the effectiveness of acceptance and commitment therapy (ACT), pharmacotherapy, and a blend of the two methods in treating major depressive disorder. Methods: A sample of 60 subjects was selected randomly from the middle-aged patients suffering from major depressive disorder (based on DSM-V criteria) with illness duration of one year that referred to all outpatient clinics of the Modares hospital in Isfahan. The patients were divided into four experimental groups including: acceptance and commitment therapy (ACT), Drug Therapy, blend of the two aforementioned methods and control group. Statistical analysis was conducted using analysis of covariance. Results: Findings showed a significant difference in terms of depression among the three treatment groups. While the mean scores of depression in the posttest were 44.60 for the control group, the results for pharmacotherapy, ACT and combination group were 17.66, 26.53 and 15.13 respectively (p˂0.05). Discussion: Although, Pharmacotherapy and combined treatment are more effective than ACT alone, the combination of ACT and pharmacotherapy is the most effective with longer-lasting results in the treatment of adults with major depressive disorder in middle-aged Iranian patients. Declaration of Interest: None