Workplace oral health promotion activities among community-aged care workers: A qualitative exploration

BACKGROUND

The workplace is an ideal-and priority-setting for health promotion activities. Developing and implementing workplace health promotion interventions, including oral health promotion activities, can help create health-supporting workplace environments.

OBJECTIVE

To pilot workplace oral health promotion activities among staff working in the aged care sector, report their impact and explore participants' views on the factors that contribute to participation and effectiveness.

METHODS

This study comprised three phases: (i) the development and face validation of the resources, (ii) a 3-h educational session and (iii) five interview sessions with participants 4-6 weeks following the education session. The recorded interviews were transcribed verbatim and analysed thematically.

RESULTS

Eleven community-aged care workforce were invited to five feedback sessions. Ten participants were female and ranged in age from 18 to 64. All participants gave favourable comments about the content and delivery of the training session and accompanying resources. The participants felt that the benefits of WOHP include improved staff knowledge, awareness and oral care routine, the ability to share (and put into practice) the gained knowledge and information with their dependants, a lower risk of having poor oral health that adversely affects their well-being and work tasks, and potentially beneficial impacts on the organization's staff roster. Their attendance in the WOHP was facilitated by being paid to attend and scheduling the sessions during work time. Future WOHP suggestions include the possibility of a one-stop dental check-up at the workplace or staff dental care discounts from local dental practitioners and combining oral health with other health promotion activities.

CONCLUSIONS

Planning and implementing WOHP was deemed acceptable and feasible in this study context and successfully achieved short-term impacts among community-aged care workers. Appropriate times and locations, organizational arrangements and a variety of delivery options contributed to successful programme planning and implementation.

Metabolism of serine/glycine lipids by human gingival cells in culture

Porphyromonas gingivalis produces five classes of serine/glycine lipids that are recovered in lipid extracts from periodontitis-afflicted teeth and diseased gingival tissues, particularly at sites of periodontitis. Because these lipids are recovered in diseased gingival tissues, the purpose of the present study was to evaluate the capacity of cultured human gingival fibroblasts (HGF), keratinocytes, and macrophages to hydrolyze these lipids. We hypothesize that one or more of these cell types will hydrolyze the serine/glycine lipids. The primary aim was to treat these cell types for increasing time in culture with individual highly enriched serine/glycine lipid preparations. At specified times, cells and culture media samples were harvested and extracted for hydrolysis products. The serine/glycine lipids and hydrolysis products were quantified using liquid chromatography-mass spectrometry (LC-MS) and free fatty acids were quantified using gas chromatograph-mass spectrometer. LC-MS analysis used two different mass spectrometric methods. This study revealed that treatment of HGF or macrophage (THP1) cells with lipid (L) 654 resulted in breakdown to L342 and subsequent release into culture medium. However, L654 was converted only to L567 in gingival keratinocytes. By contrast, L1256 was converted to L654 by fibroblasts and macrophages but no further hydrolysis or release into medium was observed. Gingival keratinocytes showed no hydrolysis of L1256 to smaller lipid products but because L1256 was not recovered in these cells, it is not clear what hydrolysis products are produced from L1256. Although primary cultures of gingival fibroblasts and macrophages are capable of hydrolyzing specific serine/glycine lipids, prior analysis of lipid extracts from diseased gingival tissues revealed significantly elevated levels of L1256 in diseased tissues. These results suggest that the hydrolysis of bacterial lipids in gingival tissues may reduce the levels of specific lipids, but the hydrolysis of L1256 is not sufficiently rapid to prevent significant accumulation at periodontal disease sites.

Openness to church-based firearm safety interventions among Protestant Christian firearm owners

OBJECTIVES

Protestant Christians are more likely to own firearms and not store them locked/unloaded compared to those from other religions. This study examines how Protestant Christians view the relationship between their religious and firearm beliefs and how that informs openness to church-based firearm safety interventions.

STUDY DESIGN

Grounded theory analysis of 17 semi-structured interviews with Protestant Christians.

METHODS

Interviews, conducted August-October 2020, focused on firearms owned, carrying/discharge/storage behaviors, Christian belief compatibility with firearm ownership, and openness to church-based firearm safety interventions. Audio-recorded interviews were transcribed verbatim and analyzed using grounded theory techniques.

RESULTS

Participant perspectives varied on firearm ownership motivations and compatibility of Christian values with firearm ownership. Variation in these themes and in openness to church-based firearm safety interventions resulted in clustering of participants into three groups. Group 1 owned firearms for collecting/sporting purposes and intricately connected their Christian identity with firearm ownership, but they were not open to intervention due to perceived high firearm proficiency. Group 2 did not connect their Christian identity to their firearm ownership; some believed these identities were incompatible, so were also not open to intervention. Group 3 owned firearms for protection and believed church, as a community hub, was an excellent location for firearm safety interventions.

CONCLUSIONS

The clustering of participants into groups varying in openness to church-based firearm safety interventions suggests it is feasible to identify Protestant Christian firearm owners open to intervention. This study presents a first step in coupling firearm owner characteristics with community-based, tailored interventions with promise for efficacy.

Long-term functional outcomes after total wrist arthrodesis

Current literature surrounding functional outcomes after total wrist arthrodesis is limited by short follow-up or limited use of validated patient reported outcome measures (PROMs). The primary aim of this study was to describe long-term functional outcomes following wrist arthrodesis. Secondary aims were to describe the incidence of complications and patient satisfaction. This was a retrospective single-center study. Patients with a minimum of 10-year follow-up completed a questionnaire including the Patient-Rated Wrist Evaluation (PRWE), the Quick version of the Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score, the EQ-5D-5L score, and a question assessing satisfaction. Presence of a complication was also assessed. During the study period 66 patients underwent total arthrodesis. At a median follow-up of 15 years, complete patient reported outcomes were available for 34 patients. Thirty-two patients were lost to follow-up. Mean age at surgery was 49 and 16 patients were female. Mean PRWE and Quick-DASH scores were 44.8 (SD 27.7; range 0-96) and 41.9 (SD 23.6; range 2.3-97.7) respectively. Twenty-eight patients were satisfied. Nine patients reported complications. There were six cases of hardware removal and two cases of prominent metalwork. One patient underwent revision surgery for non-union. Presence of a complication did not affect the Quick-DASH or PRWE scores. Median EQ-5D-5L score was 0.7. This long-term follow-up suggests high levels of patient satisfaction and health related quality of life, despite significant functional disability. The complication rates are not insignificant, although the presence of a complication did not affect functional outcomes.

"That future age of which we can only dream": Exploring the origins of the climate crisis in the Story of Progress

The principal source of the ecological ruptures planet Earth is currently experiencing-the unfolding climate emergency above all-is a story a small subset of humans have been telling themselves and living according to the precepts for about 300 years. Slowly and often reluctantly the number of adherents to this story has grown until there are few places on the planet where the story does not hold at least partial sway. Over the past 300 years, the Story of Progress has evolved from a possibility to an article of faith. Examining the history of the Story of Progress makes visible the degree to which the idea of Progress has become woven into language itself, making it difficult to articulate other possibilities-and, therefore, difficult to escape the story that has produced a catastrophic climate crisis.

Medical equipment trends during the UK military exercise SAIF SAREEA 3 in Oman

Introduction

Ex SAIF SAREEA 3 was a joint British-Omani military exercise involving approximately 5500 British personnel deployed to Oman over a 6-month period. Role 1 medical care was provided by medical treatment facilities (MTFs) deployed with medical equipment as per the UK 300 medical module.

Method

Retrospective analysis was undertaken of prospectively collected equipment usage data from two Role 1 MTFs in Duqm (MTF 1) and Muaskar Al Murtafa (MTF 2) camps over a period of 6–8 weeks. Data were analysed alongside routinely collected epidemiological data (EPINATO) during the deployment. Equipment used in addition to the module was also recorded.

Results

MTF 1 used 50 out of the 179 different items from the module over the 8-week period. MTF 2 used 45 out of the 179 different items from their module over the 6-week period. The most commonly used items across the sites were non-sterile examination gloves, plastic aprons, tympanic thermometer probe covers, disinfectant wipes and self-adhesive plasters. Extramodular items (blunt fill needle, water pump sprayer, Jelonet gauze and stool specimen pot) accounted for 5% of all equipment used in MTF 1.

Conclusion

The study showed that the 300 module accommodates 95% of Role 1 patients’ needs but highlights the requirement for dedicated equipment for the treatment of heat casualties if deemed likely and blunt fill/filter needles for the administration of parenteral medication. Commanders must perform a thorough medical estimate and risk assessment prior to deployment to ensure that the 300 medical module is likely to provide the necessary equipment and supplement the module if required.

A novel phosphoglycerol serine-glycine lipodipeptide of Porphyromonas gingivalis is a TLR2 ligand

Porphyromonas gingivalis is a Gram-negative anaerobic periodontal microorganism strongly associated with tissue-destructive processes in human periodontitis. Following oral infection with P. gingivalis, the periodontal bone loss in mice is reported to require the engagement of Toll-like receptor 2 (TLR2). Serine-glycine lipodipeptide or glycine aminolipid classes of P. gingivalis engage human and mouse TLR2, but a novel lipid class reported here is considerably more potent in engaging TLR2 and the heterodimer receptor TLR2/TLR6. The novel lipid class, termed Lipid 1256, consists of a diacylated phosphoglycerol moiety linked to a serine-glycine lipodipeptide previously termed Lipid 654. Lipid 1256 is approximately 50-fold more potent in engaging TLR2 than the previously reported serine-glycine lipid classes. Lipid 1256 also stimulates cytokine secretory responses from peripheral blood monocytes and is recovered in selected oral and intestinal Bacteroidetes organisms. Therefore, these findings suggest that Lipid 1256 may be a microbial TLR2 ligand relevant to chronic periodontitis in humans.

Managing mental health on a prolonged deployment: UK military exercise SAIF SAREEA 3

INTRODUCTION

This paper presents the burden of mental health cases throughout UK military exercise SAIF SAREEA 3 (SS3), a low-tempo armoured brigade exercise in Oman from June to November 2018, and aims to discuss ways that mental health may be better managed on future large exercises.

METHODS

A retrospective review of all attendances at army medical facilities and relevant computerised medical records was undertaken.

RESULTS

14 mental health cases were identified, which required 51 follow-up presentations throughout the duration of SS3. This represented 1.2% of all first patient presentations, and 6.3% of all follow-up work. 64% had diagnoses which predated deployment and could all be classified within 10th revision of International Statistical Classification of Diseases and Related Health Problems as either F30-F39 mood (affective) disorders, or F40-F48 neurotic, stress-related and somatoform disorders; all new diagnoses made while deployed were adjustment disorders. The medical officer spent an average of 147 min total clinical care time per patient. Six patients were aeromedically evacuated (AE), which represented 26% of all AE cases from SS3.

CONCLUSIONS

Presentations were low, but time consuming and with poor disposal outcomes. Most conditions predated the exercise, and could have been predicted to worsen through the deployment. Given the disproportionate burden that mental health cases afforded during SS3, future brigade-sized deployments should include deployed mental health professionals in order to offer evidence-based therapy which should lead to improved disposal outcomes and a reduced AE burden.

Smoking habits of UK military personnel on deployment: Exercise SAIF SAREEA 3

INTRODUCTION

Changes of environment brought about by deployments are often attributed to an increase in smoking of service personnel. Electronic cigarettes are recognised as being a viable aid to quitting smoking but are currently banned from sale in Oman and were therefore banned during exercise SAIF SAREEA 3 (SS3). This paper sought to establish whether smoking increased on this exercise and for what reasons. Also, if deployed smoking cessation services are likely to be used, if available.

METHODS

Questionnaires were distributed to deployed troops at various locations in theatre for data collection.

RESULTS

Smoking prevalence increased by 5.2% (29) in the deployed population by the end of the exercise. The largest increase was seen in those smoking 20 cigarettes a day or more, rising by 269.8% (73) with a mean increase of 9 cigarettes per day. During the exercise the number of personnel using electronic cigarettes decreased and individuals' rate of electronic cigarette use also decreased. Those who smoked less during the exercise did mainly through choice (56.8%). 50% (280) of all individuals who increased smoking habits during the exercise did so out of boredom.

CONCLUSIONS

During exercise SS3 the number of individuals who smoked and the quantity they smoked increased. The ban on electronic cigarettes in Oman and while on exercise potentially had an effect on the increased smoking habits. There is an argument to include smoking cessation material in medical modules to prevent ex-smokers from restarting, continue to aid those quitting and potentially lessen severity of increasing smoking habits while deployed.

Command application of UK military climatic guidance on Exercise SAIF SAREEA 3

Health and risk management of personnel in hot climates remains a Commander's responsibility, with Joint Service Publication 539 Heat Illness and Cold Injury: Prevention and Management (JSP 539) being the guiding document for the UK military. This policy can be challenging to interpret occasionally, needing medical professionals to provide ongoing advice to commanders. This is to achieve a shared understanding of scientific concepts and risks to allow a more informed decision-making by commanders. This then leads to the appropriate mitigation of risks to as low as reasonably practical. Exercise SAIF SAREEA 3 saw commanders and medical cooperation at all levels with a practical and pragmatic application of the principles articulated in joint policy. The elements which saw enhanced cooperation included pathophysiology, work rates and work:rest ratios, rest and sleep periods, uniform, acclimatisation, and hydration and electrolyte balance. This approach was exhibited throughout the planning, deployment and execution of Exercise SAIF SAREEA 3, which saw extremely low levels of heat injury throughout the exercise when compared with SAIF SAREEA 2 and related exercises. This personal view aims to describe the command and medical interaction on SAIF SAREEA 3 which the authors feel contributed to those successes against climatic effects.

Epidemiology of UK Military Exercise SAIF SAREEA 3: future planning for hot climates

Introduction

Epidemiological data captured from military exercises and operations can highlight treatment requirements specific to operating in certain environmental conditions. Such data is invaluable to enable accurate planning for future exercises. Epidemiological data were collected during Exercise SAIF SAREEA 3 (SS3) to provide an insight into medical provision requirements for low-tempo military operations in hot, desert climates.

Method

Epidemiological data was collected from all consultations conducted during the exercise within the LAND Medical Reception Station, 24 August–14 November 2018, using Epi-NATO surveillance systems.

Results

Of the 1414 total consultations recorded, 759 were first presentations and 665 were follow-up consultations, with 35 referrals made to hospitals. 1348 days of limited duties were given and 258 working days were lost. The most common coding reported for consultations were ‘non-battle non-sport related injuries’, ‘sport related injuries’ and ‘dermatological'.

Discussion

The data highlight the most common cause of injuries and the role of assets such as dental, sexual and mental health services for future deployments. A number of explanations are considered in relation to the patterns identified and the effect on future planning for working in hot climates. Furthermore, Exercise SS3 had reduced numbers of personnel requiring deployed Role 2 or host nation hospital services, which again raises further considerations for future deployments.

Structuring a UK military role 1 medical treatment facility for a sustained mobile exercise in a hot desert environment: UK military exercise SAIF SAREEA 3

Exercise SAIF SAREEA 3 (SS3) is a triservice combined joint training military Exercise between the UK and the Omani Armed forces. SS3 represented a rare opportunity to exercise a complete role 1 medical reception station (MRS) in a tented platform for a prolonged period providing 'real life support', as opposed to an exercise without casualties. This article is a discursive paper making recommendations for amendments to the established structure for the MRS within static high-temperature deployments. Considering the facility blueprint, recognising and implementing improvements to patient flow and increasing infection prevention control measures resulted in limiting the spread of disease outbreak. During the deployment there were considerable challenges delivering care in extreme heat above 50°C these included the use of environmental control units, white liners and refrigerator units which allowed care to be delivered throughout the day, and for the appropriate care of both casualties and medication. Finally, the article covers improved patient service with a paper-based triage system supporting innovative ideas to deliver care.

Effects of heat: UK exercise Saif Sareea 3 and interpreting military climatic guidance

Introduction

Over recent years much research, both civilian and military, has occurred in the field of heat illness. This has helped force health protection and medical management of service personnel operating in hot climates. Exercise Saif Sareea 3 in Oman saw a collection of presentations to the deployed UK medical treatment facilities due to the effects of heat.

Method

This paper aims to describe the case series of 24 casualties that presented to the deployed primary care facilities and 17 that were admitted to the deployed secondary care facility due to the effects of heat.

Results

Only 10 casualties fulfilled the in-theatre diagnostic criteria for heat illness, of which two were of moderate severity and required aeromedical evacuation to the UK.

Conclusions

Commanders appeared extremely well read on Joint Service Publication 539 (JSP539; May 2017) Heat Illness and Cold Injury: Prevention and Management, following the Brecon enquiry, and were proactive in managing their force in preventative measures. This likely contributed towards the low numbers of patients with heat illness seen on the exercise. JSP539 did, however, appear to have some limitations when trying to apply it to all patients seen within the operational patient care pathway, and some areas for development are discussed.

A UK Military nurse practitioner on Exercise SAIF SAREEA 3: the first Overseas deployment

As the Queen Alexandra’s Royal Army Nursing Corps celebrates its 70th Anniversary, army nursing continues to advance patient care delivery to new levels. Advanced level nursing practice has moved from the relatively ‘calm’ confines of the NHS to the austere desert of Oman. This article will provide a personal account of the first deployment of a military nurse practitioner since it was formally introduced in 2012 to frontline medicine, leading an armoured prehospital treatment team.

Prescribing in the prehospital environment: a review of the pharmaceutical Module 501 on UK Military Exercise SAIF SAREEA 3. Can such analysis assist with the scaling of healthcare assets?

INTRODUCTION

Module 501 provides core medications which are fundamental to the capability of a prehospital treatment team (PHTT). The quantities of each medication in the module inventory undergo regular review, but these do not correspond to a population at risk (PAR) figure or deployment length for which they intend to be used. This article proposes how the quantities of Module 501 drugs can be scaled for a given deployment, in this example using statistics taken from static PHTTs on Exercise Saif Sareea 3 (SS3).

METHODS

The statistics were gathered using a custom-built search of electronic records from the Deployed Defence Medical Information Capability Programme in addition to written record-keeping, which were aligned to the weekly PAR at each PHTT location throughout their full operational capability periods. A quotient was then derived for each module item using a formula.

RESULTS

Among the 10 most commonly prescribed drugs were four analgesics and three antimicrobials. 42 of the 110 studied drugs were not prescribed during SS3.

DISCUSSION

The data from SS3 reflect the typical scope of disease encountered in the deployed land setting. Employing these data, the use of a formula to estimate the drug quantities needed to sustain a Strike Armoured Infantry Brigade over a 28-day period is demonstrated.

RECOMMENDATIONS

Further study of Module 501 across varied deployment environments would be valuable in evolving this approach to medicinal scaling if proven effective for the warm desert climate. It could then be applied to other modules to further inform future Strike medical planning.

LIMITATIONS

Several considerations when drawing deductions from the data are mentioned, including the inaccuracy of predictor variables taken from the EpiNATO-2 reports.

CONCLUSION

The proposed formula provides an evidence-based framework for scaling drug quantities for a deployment planning. This may improve patient safety and confer logistical, storage and fiscal benefits.

Role of the pre-hospital treatment team on the UK military exercise SAIF SAREEA 3

The prehospital treatment team (PHTT) involves a small team working under the clinical supervision of a clinical lead. The clinical lead can be a general duties medical officer (Post Foundation Years Doctor), military nurse practitioner or more senior clinician. The team is mounted in vehicles appropriate to the environment they expect to operate in. A PHTT is closely located to the front line reducing transportation timelines from the point of wounding to more definitive care. The PHTT can provide medical support on the move or when time is available; a more permanent fully erected treatment facility can be established. Either configuration can provide both trauma and primary care. The size of the team allows for multiple trauma subteams enabling care to casualties that arrive simultaneously. The PHTT can move independently which could leave the team vulnerable as there is no integral force protection within the current structure. In such a small team, the right balance of medical and soldiering skills among team members is essential to success. Exercise SAIF SAREEA 3 represented a large-scale battlegroup exercise to the Middle East in the austere desert of Oman. This provided an ideal environment for employing the PHTT concept is a large deployed force undertaking dynamic activity.

Conservative surgery for ovarian torsion in young women: perioperative complications and national trends

OBJECTIVE

To analyse populational trends and perioperative complications following conservative surgery versus oophorectomy in women <50 years of age with ovarian torsion.

DESIGN

Population-based retrospective observational study.

SETTING

Nationwide Inpatient Sample in the USA (2001-2015).

POPULATION

In all, 89 177 ovarian torsions including 20 597 (23.1%) conservative surgeries and 68 580 (76.9%) oophorectomies.

METHODS

(1) Trend analysis to assess utilisation of conservative surgery over time, (2) multivariable binary logistic regression to identify independent factors associated with conservative surgery and (3) inverse probability of treatment weighting with a generalised estimating equation to analyze perioperative complications.

MAIN OUTCOME MEASURES

Trends, characteristics and complications related to conservative surgery.

RESULTS

Performance of conservative surgery increased from 18.9 to 25.1% between 2001 and 2015 (32.8% relative increase, P = 0.001) but decreased steadily after age 15, and sharply declined after age 35 (P < 0.001). On multivariable analysis, younger age exhibited the largest effect size for conservative surgery among the independent factors (adjusted odds ratios 3.39-7.96, P < 0.001). In the weighted model, conservative surgery was associated with an approximately 30% decreased risk of perioperative complications overall (10.0% versus 13.6%, odds ratio 0.73, 95% confidence interval 0.62-0.85, P < 0.001) and was not associated with venous thromboembolism (0.2 versus 0.3%, P = 0.457) or sepsis (0.4 versus 0.3%, P = 0.638).

CONCLUSION

There has been an increasing utilisation of conservative surgery for ovarian torsion in the USA in recent years. Our study suggests that conservative surgery for ovarian torsion may not be associated with increased perioperative complications.

TWEETABLE ABSTRACT

Conservative surgery for ovarian torsion may not be associated with increased perioperative complications.

Treasure hunt for peptides with undefined chemical modifications: Proteomics identification of differential albumin adducts of 2-nitroimidazole-indocyanine green in hypoxic tumor

2-Nitroimidazole is a well-known chemical probe targeting hypoxic environments of solid tumors, and its derivatives are widely used as imaging agents to investigate tissue and tumor hypoxia. However, the underlying chemistry for the hypoxia-detection capability of 2-nitroimidazole is still unclear. In this study, we deployed a biotin conjugate of 2-nitroimidazole-indocyanine green (2-nitro-ICG) for the investigation of in vivo hypoxia-probing mechanism of 2-nitro-ICG compounds. By implementing mass spectrometry-based proteomics and exhaustive data mining, we report that 2-nitro-ICG and its fragments modify mouse serum albumin as the primary protein target but at two structurally distinct sites and possibly via two different mechanisms. The identification of probe-modified peptides not only contributes to the understanding of the in vivo metabolism of 2-nitroimidazole compounds but also demonstrates a competent analytical workflow that enables the search for peptides with undefined modifications in complex proteome digests.

Phagosomal Copper-Promoted Oxidative Attack on Intracellular Mycobacterium tuberculosis

Copper (Cu) ions are critical in controlling bacterial infections, and successful pathogens like Mycobacterium tuberculosis (Mtb) possess multiple Cu resistance mechanisms. We report, as proof of concept, that a novel Cu hypersensitivity phenotype can be generated in mycobacteria, including Mtb, through a peptide, DAB-10, that is able to form reactive oxygen species (ROS) following Cu-binding. DAB-10 induces intramycobacterial oxidative stress in a Cu-dependent manner in vitro and during infection. DAB-10 penetrates murine macrophages and encounters intracellular mycobacteria. Significant intracellular Cu-dependent protection was observed when Mtb-infected macrophages were treated with DAB-10 alongside a cell-permeable Cu chelator. Treatment with the Cu chelator reversed the intramycobacterial oxidative shift induced by DAB-10. We conclude that DAB-10 utilizes the pool of phagosomal Cu ions in the host-Mtb interface to augment the mycobactericidal activity of macrophages while simultaneously exploiting the susceptibility of Mtb to ROS. DAB-10 serves as a model with which to develop next-generation, multifunctional antimicrobials.

Oral Manifestations of Menopause: An Interprofessional Intervention for Dental Hygiene and Physician Assistant Students

Purpose: Interprofessional education (IPE) is a means of fostering integration and collaboration between health care professions. The purpose of this study was to evaluate the effect of an IPE educational module on dental hygiene (DH) and physician assistants (PA) students' knowledge of the oral manifestations of menopause and overall confidence in treating these conditions.Methods: A convenience sample of DH and PA students was used for this mixed-method study. Quantitative data was collected with pre- and post-tests using a modified Readiness for Interprofessional Learning Survey (RIPLS) and a principle investigator (PI)-designed knowledge of menopause test, to determine the students' attitudes and learning levels. Students participated in a one-time workshop that included an educational presentation on the oral manifestations of menopause and a case study exercise using a pseudo-standardized patient. Students from both disciplines, worked in preselected groups to create a patient care plan addressing the oral manifestations of menopause. Qualitative data was collected from student comments.Results: Study results indicate an increase in participants' knowledge of the oral manifestations of menopause (p<0.05). Results also suggest improved attitudes toward interprofessional teamwork and collaboration (p<0.05), positive professional identity (p<0.05), roles and responsibilities (p<0.05) for IPEC core competencies RR1, RR2, RR3, RR4, interprofessional communication (p<0.05) for IPEC core competencies CC3, CC4, CC 6. Qualitative data from interprofessional care plan formulation and debriefing demonstrated facilitation of gained confidence in applying new skills related to the oral manifestations of menopause.Conclusion: Patients experiencing menopause are susceptible to oral manifestations. Implementation of an IPE intervention demonstrated correlation between an IPE experience and participants' knowledge, attitudes and confidence. Preparing students to meet the needs of menopausal women may ultimately decrease oral discomfort and improve overall quality of life.

Deposition and hydrolysis of serine dipeptide lipids of Bacteroidetes bacteria in human arteries: relationship to atherosclerosis

Multiple reaction monitoring-MS analysis of lipid extracts from human carotid endarterectomy and carotid artery samples from young individuals consistently demonstrated the presence of bacterial serine dipeptide lipid classes, including Lipid 654, an agonist for human and mouse Toll-like receptor (TLR)2, and Lipid 430, the deacylated product of Lipid 654. The relative levels of Lipid 654 and Lipid 430 were also determined in common oral and intestinal bacteria from the phylum Bacteroidetes and human serum and brain samples from healthy adults. The median Lipid 430/Lipid 654 ratio observed in carotid endarterectomy samples was significantly higher than the median ratio in lipid extracts of common oral and intestinal Bacteroidetes bacteria, and serum and brain samples from healthy subjects. More importantly, the median Lipid 430/Lipid 654 ratio was significantly elevated in carotid endarterectomies when compared with control artery samples. Our results indicate that deacylation of Lipid 654 to Lipid 430 likely occurs in diseased artery walls due to phospholipase A2 enzyme activity. These results suggest that commensal Bacteriodetes bacteria of the gut and the oral cavity may contribute to the pathogenesis of TLR2-dependent atherosclerosis through serine dipeptide lipid deposition and metabolism in artery walls.

Convergent synthesis of a deuterium-labeled serine dipeptide lipid for analysis of biological samples

Bacterial serine dipeptide lipids are known to promote inflammatory processes and are detected in human tissues associated with periodontal disease or atherosclerosis. Accurate quantification of bacterial serine lipid, specifically lipid 654 [((S)-15-methyl-3-((13-methyltetradecanoyl)oxy)hexadecanoyl)glycyl-l-serine, (3S)-l-serine] isolated from Porphyromonas gingivalis, in biological samples requires the preparation of a stable isotope internal standard for sample supplementation and subsequent mass spectrometric analysis. This report describes the convergent synthesis of a deuterium-substituted serine dipeptide lipid, which is an isotopically labeled homologue that represents a dominant form of serine dipeptide lipid recovered in bacteria.

An active contour ImageJ plugin to monitor daughter cell size in 3D during cytokinesis

Controlling relative daughter cell size is key during cytokinesis. Uncontrolled size asymmetries can lead to aneuploidy and division failure. At the same time, precisely regulated size asymmetries are of crucial importance in many divisions during embryonic development. Therefore, being able to monitor daughter cell size is important in cytokinesis studies. However, freely available tools allowing to effectively measure the size of daughter cells in three dimensions during cytokinesis are missing. Here, we describe an open-access plugin for ImageJ or Fiji based on an active contour surface representation of the cells. Our method provides a user-friendly and accurate way to monitor the size of the two daughter cells throughout cytokinesis.

Targeting tumor hypoxia: a third generation 2-nitroimidazole-indocyanine dye-conjugate with improved fluorescent yield

Tumor hypoxia is associated with the rapid proliferation and growth of malignant tumors, and the ability to detect tumor hypoxia is important for predicting tumor response to anti-cancer treatments. We have developed a class of dye-conjugates that are related to indocyanine green (ICG, ) to target tumor hypoxia, based on in vivo infrared fluorescence imaging using nitroimidazole moieties linked to indocyanine fluorescent dyes. We previously reported that linking 2-nitroimidazole to an indocyanine dicarboxylic acid dye derivative () using an ethanolamine linker (ethanolamine-2-nitroimidazole-ICG, ), led to a dye-conjugate that gave promising results for targeting cancer hypoxia in vivo. Structural modification of the dye conjugate replaced the ethanolamine unit with a piperazineacetyl unit and led a second generation dye conjugate, piperzine-2-nitroimidazole-ICG (). This second generation dye-conjugate showed improved targeting of tumor hypoxia when compared with . Based on the hypothesis that molecules with more planar and rigid structures have a higher fluorescence yield, as they could release less absorbed energy through molecular vibration or collision, we have developed a new 2-nitroimidazole ICG conjugate, , with two carbon atoms less in the polyene linker. Dye-conjugate was prepared from our new dye (), and coupled to 2-nitroimidazole using a piperazine linker to produce this third-generation dye-conjugate. Spectral measurements showed that the absorption/emission wavelengths of 657/670 were shifted ∼100 nm from the second-generation hypoxia dye of 755/780 nm. Its fluorescence quantum yield was measured to be 0.467, which is about 5 times higher than that of (0.083). In vivo experiments were conducted with balb/c mice and showed more than twice the average in vivo fluorescence intensity in the tumor beyond two hours post retro-orbital injection as compared with . These initial results suggest that may significantly improve in vivo tumor hypoxia targeting.

Just a routine operation: a critical discussion

This article has summarised a critical discussion of the human factors that contributed to the death of a patient from a failure to respond appropriately to a 'can't intubate, can't ventilate' scenario. The contributory factors included the clinical team's inability to communicate, prioritise tasks and demonstrate effective leadership and assertive followership. The film Just a routine operation has now been in circulation for several years. When a system is designed and introduced with the intention of making a change to clinical practice, it can quickly become just another component of an organisation's architecture and complacency around its use can develop. This article has been written specifically for perioperative practitioners to renew the debate around the human factors that contribute to patient harm. By critically discussing Just a routine operation and attempting to review why the incident occurred, this article has attempted to emphasise that some of the conditions and behaviours that contributed to the death of Elaine Bromiley may be latent within our organisations and teams, and may continue to contribute to failures that affect patient safety.

Bubble-detector measurements of neutron radiation in the international space station: ISS-34 to ISS-37

Bubble detectors have been used to characterise the neutron dose and energy spectrum in several modules of the International Space Station (ISS) as part of an ongoing radiation survey. A series of experiments was performed during the ISS-34, ISS-35, ISS-36 and ISS-37 missions between December 2012 and October 2013. The Radi-N2 experiment, a repeat of the 2009 Radi-N investigation, included measurements in four modules of the US orbital segment: Columbus, the Japanese experiment module, the US laboratory and Node 2. The Radi-N2 dose and spectral measurements are not significantly different from the Radi-N results collected in the same ISS locations, despite the large difference in solar activity between 2009 and 2013. Parallel experiments using a second set of detectors in the Russian segment of the ISS included the first characterisation of the neutron spectrum inside the tissue-equivalent Matroshka-R phantom. These data suggest that the dose inside the phantom is ∼70% of the dose at its surface, while the spectrum inside the phantom contains a larger fraction of high-energy neutrons than the spectrum outside the phantom. The phantom results are supported by Monte Carlo simulations that provide good agreement with the empirical data.

Response of the bubble detector to neutrons of various energies

A series of Monte-Carlo simulations has been performed in order to investigate the response of the bubble detector to monoenergetic neutrons of various energies. The work was driven by the need to better understand the energy dependence of the detector for applications in space, where the neutron spectrum has a significant component with energy of >20 MeV. The response to neutrons in the range of a few keV to 500 MeV has been calculated, and good agreement between the simulations and experimental data is demonstrated over the entire energy range.

Bubble-detector measurements in the Russian segment of the International Space Station during 2009-12

Measurements using bubble detectors have been performed in order to characterise the neutron dose and energy spectrum in the Russian segment of the International Space Station (ISS). Experiments using bubble dosemeters and a bubble-detector spectrometer, a set of six detectors with different energy thresholds that is used to determine the neutron spectrum, were performed during the ISS-22 (2009) to ISS-33 (2012) missions. The spectrometric measurements are in good agreement with earlier data, exhibiting expected features of the neutron energy spectrum in space. Experiments using a hydrogenous radiation shield show that the neutron dose can be reduced by shielding, with a reduction similar to that determined in earlier measurements using bubble detectors. The bubble-detector data are compared with measurements performed on the ISS using other instruments and are correlated with potential influencing factors such as the ISS altitude and the solar activity. Surprisingly, these influences do not seem to have a strong effect on the neutron dose or energy spectrum inside the ISS.

Photoacoustic imaging enhanced by indocyanine green-conjugated single-wall carbon nanotubes

A photoacoustic contrast agent that is based on bis-carboxylic acid derivative of indocyanine green (ICG) covalently conjugated to single-wall carbon nanotubes (ICG/SWCNT) is presented. Covalently attaching ICG to the functionalized SWCNT provides a more robust system that delivers much more ICG to the tumor site. The detection sensitivity of the new contrast agent in a mouse tumor model is demonstrated in vivo by our custom-built photoacoustic imaging system. The summation of the photoacoustic tomography (PAT) beam envelope, referred to as the "PAT summation," is used to demonstrate the postinjection light absorption of tumor areas in ICG- and ICG/SWCNT-injected mice. It is shown that ICG is able to provide 33% enhancement at approximately 20 min peak response time with reference to the preinjection PAT level, while ICG/SWCNT provides 128% enhancement at 80 min and even higher enhancement of 196% at the end point of experiments (120 min on average). Additionally, the ICG/SWCNT enhancement was mainly observed at the tumor periphery, which was confirmed by fluorescence images of the tumor samples. This feature is highly valuable in guiding surgeons to assess tumor boundaries and dimensions in vivo and to achieve clean tumor margins to improve surgical resection of tumors.

Targeting tumor hypoxia with 2-nitroimidazole-indocyanine green dye conjugates

Tumor hypoxia is a major indicator of treatment resistance to chemotherapeutic drugs, and fluorescence optical tomography has tremendous potential to provide clinically useful, functional information by identifying tumor hypoxia. The synthesis of a 2-nitroimidazole-indocyanine green conjugate using a piperazine linker (piperazine-2-nitroimidazole-ICG) capable of robust fluorescent imaging of tumor hypoxia is described. In vivo mouse tumor imaging studies were completed and demonstrate an improved imaging capability of the new dye relative to an earlier version of the dye that was synthesized with an ethanolamine linker (ethanolamine-2-nitroimidazole-ICG). Mouse tumors located at imaging depths of 1.5 and 2.0 cm in a turbid medium were imaged at various time points after intravenous injection of the dyes. On average, the reconstructed maximum fluorescence concentration of the tumors injected with piperazine-2-nitroimidazole-ICG was twofold higher than that injected with ethanolamine-2-nitroimidazole-ICG within 3 h postinjection period and 1.6 to 1.7 times higher beyond 3 h postinjection. The untargeted bis-carboxylic acid ICG completely washed out after 3 h postinjection. Thus, the optimal window to assess tumor hypoxia is beyond 3 h postinjection. These findings were supported with fluorescence images of histological sections of tumor samples and an immunohistochemistry technique for identifying tumor hypoxia.

Pertuzumab for the treatment of patients with previously untreated HER2-positive metastatic breast cancer

Pertuzumab is a humanized monoclonal antibody directed at the dimerization domain of the receptor tyrosine-protein kinase erbB-2 (HER2) receptor. It possesses a unique and complimentary mechanism of action compared to trastuzumab, which has historically been the cornerstone of therapy for HER2-amplified breast cancer. Clinical trials demonstrate improved outcomes, with minimal increases in toxicity with the addition of pertuzumab to trastuzumab in patients with HER2-positive metastatic breast cancer, indicating the advantage of dual HER2 receptor blockade. Pertuzumab is approved as first-line therapy in combination with trastuzumab and docetaxel for HER2-positive metastatic breast cancer, with future opportunities to investigate its efficacy in other stages of breast cancer, as well as in the treatment of other malignancies.

An Introduction to Survival, Evasion, Resistance, and Escape (SERE) Medicine

When an individual finds himself/herself in a survival, evasion, resistance, or escape (SERE) scenario, the ability to treat injuries/illnesses can be the difference between life and death. SERE schools are responsible for preparing military members for these situations, but the concept of SERE medicine is not particularly well defined. To provide a comprehensive working description of SERE medicine, operational and training components were examined. Evidence suggests that SERE medicine is diverse, injury/illness patterns are situationally dependent, and treatment options often differ from conventional clinical medicine. Ideally, medical lessons taught in SERE training are based on actual documented events. Unfortunately, the existing body of literature is dated and does not appear to be expanding. In this article, four distinct facets of SERE medicine are presented to establish a basis for future discussion and research. Recommendations to improve SERE medical curricula and data-gathering processes are also provided.