Assessment of burnout, resilience, and thriving among academic health professionals: findings from an international study

Introduction

Burnout, resilience, and thriving significantly impact academics, particularly in health professions, where responsibilities are extensive. This study aimed to explore these constructs among academic health professionals, examining sociodemographic and work-related factors influencing these outcomes.

Methods

A cross-sectional study was conducted among academic health professionals via web-based professional networks from August 2022 to February 2023. Validated tools were used, and descriptive and inferential statistics were applied.

Results

505 participants were included, predominantly female (63%), with a mean age of 38.15 ± 9.6 years. High burnout was reported by 10.9%, 13.7% experienced exhaustion, and 6.3% were disengaged. Resilience and thriving were moderate at 59.2 and 51.9%, respectively. Age correlated negatively with burnout (r = -0.131, p = 0.003) but positively with resilience (r = 0.178, p < 0.001). Females reported higher exhaustion (p = 0.014), while males showed greater resilience (p = 0.016). Instructors exhibited lower resilience compared to assistant professors (p < 0.001) and associate professors (p < 0.001). Those at public universities reported higher exhaustion than those at private universities (p < 0.001).

Conclusion

Variable levels of burnout, resilience, and thriving were observed among academic health professionals, influenced by sociodemographic and work-related factors. Interventions targeting resilience and thriving may mitigate burnout risk and enhance engagement among academics in health professions.

Experimental observation of the ν1+3ν3 combination bands of 16O14N18O and 18O14N18O in the near infrared spectral region

The first observation of the ν1+3ν3 combination band of the nitrogen dioxide isotopologue 16O14N18O is presented. The band was measured using Fourier-Transform Incoherent Broad-Band Cavity Enhanced Absorption Spectroscopy (FT-IBBCEAS) in the region between 5870 cm-1 and 5940 cm-1. To confirm the assignment, the band was simulated using a standard asymmetric top Watson Hamiltonian using extrapolated rotational and centrifugal distortion constants. Furthermore, the first experimental observation of the ν1+3ν3 band of the 18O14N18O isotopologue is also reported. The positions of ro-vibrational lines of the ν1+3ν3 band of the naturally most abundant isotopologue 16O14N16O were used for wavenumber calibration of line positions.

Evaluation of grit and its associated factors among undergraduate pharmacy students from 14 Asian and Middle Eastern countries amid the COVID-19 pandemic

Introduction

Grit is proposed as an essential trait for academic achievement. Thus, evaluating its current status and the associated factors could aid academic support planning.

Objective

The present study aimed to assess grit level and its related factors among undergraduate pharmacy students from 14 countries amid the COVID-19 pandemic.

Methods

A cross-sectional survey-based study was conducted among pharmacy students from 14 countries in Asia and the Middle East. A 31-item questionnaire was developed, validated, and pilot-tested, including the validated short scale for grit assessment. The data was collected between 1 February and 15 April 2022. Descriptive and inferential statistics were employed as appropriate.

Results

A total of 2665 responses were received, mainly from females (68.7 %), living in urban areas (69.2 %) and studying at private universities (59.1 %). The average grit score on a scale of 5 was 3.15 ± 0.54. The responses revealed higher favourable responses to items on the perseverance of efforts (34.9 % to 54 %) compared to items on the consistency of interests (26.5 % to 31.1 %). Students who did not exercise (AOR: 0.47, 95 %CI: 0.33-0.67) or exercised irregularly (AOR: 0.64, 95 %CI: 0.45-0.90) were less likely to have higher grit scores than those who exercised regularly. Additionally, students who did not receive COVID-19 vaccination (AOR: 0.50, 95 %CI: 0.36-0.71) or received only one dose (AOR: 0.67, 95 %CI: 0.46-0.99) were less likely to have higher grit scores than those who received their booster vaccination. Interestingly, students who chose the pharmacy program as their only available or reasonable choice (AOR: 0.33, 95 %CI: 0.17-0.62) and students from public universities (AOR: 0.82, 95 %CI: 0.68-0.98) were less likely to have higher grit scores. On the other hand, students who did not face educational challenges with online learning (AOR: 1.19, 95 %CI: 1.003-1.416) and students with excellent (AOR: 2.28, 95 %CI: 1.57-3.31) and very good (AOR: 2.16, 95 %CI: 1.53-3.04) academic performance were more likely to have higher grit scores.

Conclusion

The findings revealed moderate grit levels. Higher grit levels were thought to be associated with several personal, lifestyle and academic factors. Further interventions to support students' grit attributes are required, particularly concerning the consistency of interests.

Assessment of mental wellbeing of undergraduate pharmacy students from 14 countries: The role of gender, lifestyle, health-related, and academic-related factors

Background

Pharmacy students will assume future roles as frontline healthcare providers. Therefore, evaluating their current state of mental wellbeing and its associated factors is essential for better planning students' support initiatives. This study aimed to assess mental wellbeing and its associated factors among undergraduate pharmacy students from 14 countries during the pandemic.

Methods

A cross-sectional study was conducted among undergraduate pharmacy students in 14 countries in Asia and the Middle East. The validated Warwick-Edinburgh Mental Wellbeing Scale (the 14-item WEMWBS) was adopted to assess mental wellbeing. Data collection was performed online between February and April 2022. Descriptive and inferential statistics were used as appropriate.

Results

A total of 2,665 responses were received, mainly from females (68.7%) with a higher presence of private universities (59.1%). About 34.9% had low mental wellbeing levels, while 57 and 8.1% had medium, and high levels, respectively. Binary logistic regression showed that males (AOR: 1.34; CI 95%: 1.11-1.61; p < 0.01) and students with no chronic illnesses (AOR: 2.01; CI 95%: 1.45-2.80; p < 0.001) were more likely to have higher mental wellbeing. Also, participants who did not engage in any exercise (AOR: 0.71; CI 95%: 0.52-0.98; p = 0.04) and those in public universities (AOR: 0.82; CI 95%: 0.69-0.97; p = 0.02) were less likely to have higher mental wellbeing. Additionally, students who had interest/passion for pharmacy (AOR: 1.69; CI 95%: 1.07-2.68; p = 0.02), and those who known pharmacists inspired (AOR: 1.81; CI 95%: 1.06-3.12; p = 0.03), were more likely to have higher mental wellbeing compared with those who had no specific reason for their choice to study pharmacy. The participants with excellent (AOR: 1.87; CI 95%: 1.29-2.70; p = 0.001) or very good self-reported academic performance (AOR: 1.57; CI 95%: 1.12-2.22; p = 0.01) were more likely to have higher mental wellbeing compared to those with fair academic performance.

Conclusion

More than a third of the participants had low mental wellbeing. Various demographic, lifestyle, medical and academic factors appeared to affect students' mental wellbeing. Careful consideration of these factors and their integration into the pharmacy schools' plans for student support services and academic advising would be essential to improve students' mental wellbeing.

Hydrogeochemical characteristics of surface and groundwater: suitability for human consumption and irrigated agriculture purposes in Suruliyar sub basin, South India

The Suruliyar sub basin in Tamil Nadu, India, was monitored for the assessment of water and soil quality. Surface water, groundwater, and soil samples were collected during the pre-monsoon (June 2016) and post-monsoon (December 2016) seasons within the sub basin area and analyzed for various physical, chemical, and biological properties, namely, pH, electrical conductivity, total dissolved solids (TDS), calcium, magnesium, sodium, nitrate, sulfate, fluoride, chloride, biological oxygen demand, chemical oxygen demand, and total and fecal coliform. All the values were compared with Indian and global standards, and the values for each parameter were within the permissible limits. However, some samples were edging toward the upward limit. Fecal coliforms (14 to 36 counts per 100 ml) were present in the river water, thus indicating anthropogenic contamination. Correlation analysis confirmed that TDS was significantly positively correlated with most of the cations and anions. Groundwater was assessed using several indices, such as the Piper diagram, United States Salinity Laboratory diagram, sodium adsorption ratio, and sodium percentage. Results showed that all the groundwater samples could be used for irrigation purposes; however, the chloride contents exceeded the permissible limit. Soil analysis results showed that all nutrients were within the permissible limits. Drought assessment showed the existence of both dry and wet years occurring most frequently, which might have a strong influence on the quality of water and soil parameters. This study suggests that the monitoring of surface, groundwater, and soil parameters is essential to maintain the sub basin area for ensuring sustainable development in the future.

The Barts Health NHS Trust COVID-19 cohort: characteristics, outcomes and risk scoring of patients in East London

BACKGROUND: Barts Health National Health Service Trust (BHNHST) serves a diverse population of 2.5 million people in London, UK. We undertook a health services assessment of factors used to evaluate the risk of severe acute respiratory coronavirus 2 (SARS-CoV-2) infection.METHODS: Patients with confirmed polymerase chain reaction (PCR) test results admitted between 1 March and 1 August 2020 were included, alongwith clinician-diagnosed suspected cases. Prognostic factors from the 4C Mortality score and 4C Deterioration scores were extracted from electronic health records and logistic regression was used to quantify the strength of association with 28-day mortality and clinical deterioration using national death registry linkage.RESULTS: Of 2783 patients, 1621 had a confirmed diagnosis, of whom 61% were male and 54% were from Black and Minority Ethnic groups; 26% died within 28 days of admission. Mortality was strongly associated with older age. The 4C mortality score had good stratification of risk with a calibration slope of 1.14 (95% CI 1.01-1.27). It may have under-estimated mortality risk in those with a high respiratory rate or requiring oxygen.CONCLUSION: Patients in this diverse patient cohort had similar mortality associated with prognostic factors to the 4C score derivation sample, but survival might be poorer in those with respiratory failure.

Experimental investigation of strain rate dependent damage mechanisms in DP1000 automotive steel

Present study aims to investigate the effect of stress state and loading rates on the damage mechanisms in a DP1000 steel using a welldesigned series of experiments. A specimen family comprising of central hole, in-plane shear and plane strain samples is applied to characterise damage under well-controlled stress states. The optimization of the specimen geometries is achieved using finite element simulations. To assess the influence of strain rate, quasi-static, intermediate and dynamic tests are performed on the designed samples. Local strain fields are obtained by digital image correlation. After testing, scanning electron microscopy is employed to systematically analyse the micromechanisms driving the damage in the investigated material. The underlying damage mechanisms are ferrite-martensite interphase debonding, martensite cracking and debonding at ferrite-ferrite grain boundaries. Stress state and strain rate are found to have distinct influences on triggering the underlying damage mechanisms.

Experimental study of the stress state and strain rate dependent mechanical behaviour of TRIP-assisted steels

This paper presents an investigation into the effect of different stress states and strain rates on the austenite-to-martensite transformation during plastic straining of a Q&P steel. Different stress states are imposed to the steel using purposed-designed samples. The sample geometries, including in-plane shear, dogbone and plane strain samples, are optimised by finite element modelling. Tensile tests are performed at different strain rates of 0.001 s-1, 10 s-1 and 500 s-1. Digital image correlation is used to capture the strain fields during the entire deformation process. The mechanical results indicate a positive strain rate sensitivity for both the shear and plane strain specimens and a negative strain rate sensitivity for the dogbone sample. In addition, the influence of the strain rate on the strain level is more pronounced for the shear than for the plane strain specimens and for the dogbone samples.

Comparison of Regenerative Potential of Platelet-rich Fibrin Alone and in Combination with Bovine Bone Graft in Intraosseous Defect by Single Flap Approach: A Clinical and Radiographic Study

AIM

To compare the regenerative potential of platelet-rich fibrin alone and in combination with bovine bone graft in intraosseous defect by the single flap approach.

MATERIALS AND METHODS

A total of 32 sites of intrabony defects were selected and were treated with platelet-rich fibrin (PRF) alone or in combination with bovine bone graft. Clinical parameters [Gingival index (GI), probing depth (PD), clinical attachment level (CAL), Gingival recession, and radiographic parameters (defect fill, alveolar crest level, and defect depth)] were recorded at baseline, 3 months, and 6 months.

RESULTS

Statistical analysis was done by independent and paired t-test. There were statistically significant changes in GI, PD reduction, CAL gain, defect fill, alveolar crest level changes, and defect depth resolution from baseline, 3 months, and 6 months in both the groups (P < 0.001). On intergroup comparison, Group II showed statistically significant changes in a reduction in pocket depth and defect depth resolution at P < 0.001.

CONCLUSION

PRF in combination with bovine bone graft was more effective in the treatment of intrabony defects.

Spatial transcriptomics identifies spatially dysregulated expression of GRM3 and USP47 in amyotrophic lateral sclerosis

AIMS

The mechanisms underlying the selective degeneration of motor neurones in amyotrophic lateral sclerosis (ALS) are poorly understood. The aim of this study was to implement spatially resolved RNA sequencing in human post mortem cortical tissue from an ALS patient harbouring the C9orf72 hexanucleotide repeat expansion to identify dysregulated transcripts that may account for differential vulnerabilities of distinct (i) cell types and (ii) brain regions in the pathogenesis of ALS.

METHODS

Using spatial transcriptomics (ST) we analysed the transcriptome of post mortem brain tissue, with spatial resolution down to 100 μm. Validation of these findings was then performed using BaseScope, an adapted, in situ hybridization technique with single-transcript single-cell-resolution, providing extensive regional and cell-type specific confirmation of these dysregulated transcripts. The validation cohort was then extended to include multiple post mortem brain regions and spinal cord tissue from an extended cohort of C9orf72, sporadic ALS (sALS) and SOD1 ALS cases.

RESULTS

We identified sixteen dysregulated transcripts of proteins that have roles within six disease-related pathways. Furthermore, these complementary molecular pathology techniques converged to identify two spatially dysregulated transcripts, GRM3 and USP47, that are commonly dysregulated across sALS, SOD1 and C9orf72 cases alike.

CONCLUSIONS

This study presents the first description of ST in human post mortem cortical tissue from an ALS patient harbouring the C9orf72 hexanucleotide repeat expansion. These data taken together highlight the importance of preserving spatial resolution, facilitating the identification of genes whose dysregulation may in part underlie regional susceptibilities to ALS, crucially highlighting potential therapeutic and diagnostic targets.

1398. Clinical Performance of Film Array Meningitis/Encephalitis Multiplex PCR Panel in CNS Infection

Background

Rapid identification of pathogen is important in the management of meningoencephalitis. A fully-automated multiplex PCR, the FilmArray (FA) meningitis/encephalitis (ME) panel, detects 14 pathogens simultaneously in an hour. As there is not much data on this, we undertook this study to understand its performance.

Methods

A retrospective analysis was done on patients, both adult and pediatric, admitted with meningitis/encephalitis syndrome between December 2016 and 2018 and who underwent the FA–ME panel (BioFire Diagnostics, USA) multiplex PCR test on CSF. The performance of the FA- ME panel was compared with that of routine tests done on CSF which is cell count, biochemistry, gram stain, bacterial culture, and other relevant tests.

Results

FA- ME panel was done in 259 patients and it detected pathogen in 61 (23.6%) patients with ME syndrome. Viruses accounted for 70.4%, bacteria 24.5%, and 2 patients had 2 organisms in a single sample (enterovirus and H. influenzae on both occasions). Enterovirus was the commonest accounting for 29 cases, followed by varicella in 11, pneumococci in 9. HHV 6, H. influenzae, Strep agalactiae and Listeria were the rest. Enterovirus meningitis showed seasonal prevalence; 24 out of 29 cases occurred during October till December. CSF bacterial culture yield was low, positive only in 8 (3%) cases and matched with FA ME panel in one sample which grew pneumococci; 7 other cultures grew either Gram-negative pathogens, rare organisms/ contaminants not included in FA ME panel. CNS tuberculosis was diagnosed in 6, 7 patients had aseptic meningitis due to tropical infections, 5 of which were dengue fever, 2 were scrub typhus. Overall, 191 patients (73.7%) were treated as CNS infection through FA ME panel were negative in 130 of these, rest had alternative diagnosis. Antibiotic de-escalation was better in the group with positive FA ME panel result.

Conclusion

FA-ME panel has better diagnostic yield compared with culture (26.3% vs. 3%). Viruses were commoner and majority were enteroviruses showing seasonal prevalence. Those bacteria that grew in CSF culture but not identified by FA ME panel were Gram-negative or unusual pathogens. Additional tests need to be used when considering post-traumatic or nosocomial meningitis, tuberculosis, and tropical infections.

Disclosures

All authors: No reported disclosures.

P6381Cardiac arrest patients presenting to hospitals at weekends are not subject to the weekend effect: insights from ACALM big data, United Kingdom

Introduction

Patients presenting to hospital with a cardiac arrest are associated with significant mortality in the United Kingdom. The evidence for the weekend affect involving cardiac arrests is unclear and we investigated this further with ACALM big data.

Methods

Anonymous information on patients presenting to hospital with a cardiac arrest was obtained from several hospitals in UK between 2000–2014. ICD-10 and OPCS-4 codes were used to trace patients coded for primary cardiac arrest, co-morbidities and mortality data.

Results

Details of 4803 patients presenting with cardiac arrest is shown in Table1. Cox regression model including age, gender, ethnic group, Charlson score and the top ten causes of death in the UK showed that weekend presentation did not contribute to increased mortality (OR 1.01; 95%C.I 0.94–1.11; p=0.692)

Table 1. Demographics and co-morbidities of cardiac arrest patients presenting on weekdays and weekends Weekday Weekend N (%) 3892 (81.0) 919 (19.0) Mean age ± S.D (years) 67.7±16.6 67.4±17.5 Male, % 55.4 54.1 Co-morbidities   Mean Charlson Index 1.52 1.33   Heart Failure % 21.4 20.4   IHD % 38.4 37.1   Cancer (Lung, Breast or Colon) % 5.2 3.8   Cerebrovascular Disease % 6.4 6.3   COPD % 15.0 12.0   CKD % 9.4 7.7   Dementia % 4.7 2.6   Pneumonia % 14.7 14.4 Outcomes   Crude 30 day mortality % 25.4* 32.8*   Crude 1 year mortality % 41.0* 44.3* *Cox regression analyses showed no significant differences in mortality between weekend and weekday presentation.

Conclusion

We have demonstrated that the “weekend effect” is not present in patients admitted to hospital with cardiac arrest. Our findings can perhaps be explained by the presence of 24/7 cardiac arrest teams present in acute hospitals.

Neuronal clusterin expression is associated with cognitive protection in amyotrophic lateral sclerosis

AIMS

Clusterin is a topologically dynamic chaperone protein with the ability to participate in both intra- and extacellular proteostasis. Clusterin has been shown to be upregulated in the spinal cord of patients with amyotrophic lateral sclerosis (ALS) and has been shown to protect against TDP-43 protein misfolding in animal and cell models. Previous studies have demonstrated an association between the pathological burden of TDP-43 misfolding and cognitive deficits in ALS, demonstrating high specificity, but correspondingly low sensitivity owing to a subset of individuals with no evidence of cognitive deficits despite a high burden of TDP-43 pathology, called mismatch cases.

METHODS

Hypothesizing that differences in the ability to cope with protein misfolding in these cases may be due to differences in expression of protective mechanisms such as clusterin expression, we assessed the spatial expression of clusterin and another chaperone protein, HspB8, in post mortem brain tissue of mismatch cases. We employed a modified in situ hybridization technique called BaseScope, with single cell, single transcript resolution.

RESULTS

Mismatch cases demonstrated differential spatial expression of clusterin, with a predominantly neuronal pattern, compared to cases with cognitive manifestations of their TDP-43 pathology who demonstrated a predominantly glial distribution of expression.

CONCLUSIONS

Our data suggest that, in individuals with TDP-43 pathology, predominantly neuronal expression of clusterin in extra-motor brain regions may indicate a cell protective mechanism delaying clinical manifestations such as cognitive dysfunction.

Invasive paediatric Elizabethkingia meningoseptica infections are best treated with a combination of piperacillin/tazobactam and trimethoprim/sulfamethoxazole or fluoroquinolone

Objectives

Elizabethkingia meningoseptica is a multi-drug-resistant organism that is associated with high mortality and morbidity in newborn and immunocompromised patients. This study aimed to identify the best antimicrobial therapy for treating this infection.

Methods

A retrospective descriptive study was conducted from 2010 to 2017 in a tertiary paediatric hospital in Singapore. Paediatric patients aged 0 to 18 years old with a positive culture for E. meningoseptica from any sterile site were identified from the hospital laboratory database. The data collected included clinical characteristics, antimicrobial susceptibility and treatment, and clinical outcomes.

Results

Thirteen cases were identified in this study. Combination therapy with piperacillin/tazobactam and trimethoprim/sulfamethoxazole or a fluoroquinolone resulted in a cure rate of 81.8  %. The mortality rate was 15.4  % and neurological morbidity in patients with bacteraemia and meningitis remained high (75 %).

Conclusions

Treatment with combination therapy of piperacillin/tazobactam and trimethoprim/sulfamethoxazole or a fluroquinolone was effective in this study, with low mortality rates being observed.

'Pai Syndrome' with anterior alveolar polyp: A variant of a rare clinical entity

'Pai syndrome' (PS) is a rare congenital syndrome. Presented here, a new-born baby-girl who exhibited the characteristic features of having a midline nasal (septal) polyp, an anterior alveolar process polyp, and a pericallosal lipoma associated with corpus callosum dysgenesis of the brain. Both polyps were lined with stratified-squamous epithelium. The overall features were largely consistent with those described by Pai et al., in 1987. A midline cleft-lip (with or without cleft-alveolus) is one of the most common features of the syndrome which was however absent in this case. Instead, an anterior alveolar polyp is present, which is relatively rare.

Open path incoherent broadband cavity-enhanced measurements of NO3 radical and aerosol extinction in the North China Plain

We describe the observation of the NO₃ radical using an incoherent broadband cavity-enhanced absorption spectrometer in an open-path configuration (OP-IBBCEAS) in a polluted summer environment in continental China. The instrument was installed 17 m above the ground at the top of a residential complex near the CAREBeijing-NCP 2014 site in Wangdu, Hebei province, about 200 km southwest of Beijing over the period 28 to 30 June 2014. The separation between the transmitter and receiver components of the instrument was 335 cm and the effective pathlength in clean reference air was ~3.4 km. NO₃ was detected above the detection limit on all three nights when the instrument was operational. The maximum mixing ratio measured was ~175 pptv with a detection sensitivity of ~36 pptv for measurements with an average acquisition time of 10 min. While most extractive instruments try to avoid interferences arising from aerosol extinction, the open path configuration has advantages owing to its ability to detect trace gases even in the presence of aerosol loading. Moreover, concurrent retrieval of aerosol optical extinction is possible from analysis of the absorption magnitude of the oxygen B-band at 687 nm. The experimental setup, its calibration, data acquisition, and analysis procedure are discussed, and the results presented here demonstrate the sensitivity and specificity that can be achieved at high spatial and temporal resolution using the novel configuration of IBBCEAS in the open path.

Troponin-T as a biomarker in neonates with perinatal asphyxia

BACKGROUND

Troponin-T is a commonly used cardiac biomarker, which could be useful in perinatal asphyxia. We aimed to analyze troponin-T concentrations in asphyxiated neonates and to correlate the concentrations with clinical outcomes.

METHODS

Data were collected from electronic medical records of neonates diagnosed with perinatal asphyxia over a period of four years.

RESULTS

There were 63 neonates with moderate to severe encephalopathy, in whom serial troponin-T concentrations had been done on days 1, 3, and 7. 53 (84%) asphyxiated infants had troponin-T concentration >100 pg/ml at 2-4 h of life.The difference in troponin-T concentrations between moderate and severe encephalopathy was not statistically significant (173 vs. 263 pg/ml, p value 0.40). The difference in the concentrations at 72 hours between cooled and non-cooled neonates was not significant (48.5 vs. 62.5 pg/ml, p value 0.22). Troponin-T concentration was significantly higher in babies with hypotensive shock and hepatic injury, but not acute kidney injury. There was no significant correlation between troponin-T and the extent of resuscitation needed.Troponin-T concentration on day 1 of life was significantly higher in babies who died than who survived (407 vs. 168 pg/ml, p value 0.03). ROC curve for troponin-T to predict mortality had an area under the curve (AUC) of 0.803; the best cut-off value (190 pg/ml) had 82% sensitivity and 80% specificity.

CONCLUSION

There was no significant difference in troponin-T concentrations between cooled and non-cooled neonates. Troponin-T concentration had a good predictive accuracy for mortality before discharge.

Dynamic fracture of a dual phase automotive steel

Dynamic testing of sheet metals has become more important due to the need for more reliable vehicle crashworthiness assessments in the automotive industry. The study presents a comprehensive set of experimental results that covers a wide range of stress states on a dual phase automotive sheet steel. Split Hopkinson bar tensile (SHBT) tests are performed on dogbone shaped samples to obtain the plastic hardening properties at high strain rates. A set of purpose designed sample geometries comprising of three notched dogbone tension samples is tested at high strain rates to characterise the dynamic damage and fracture properties under well controlled stress states. The geometry of the samples is optimised with the aid of finite element analysis. During the tests, high speed photography together with digital image correlation are implemented to acquire full field measurements and to gain more insight into the localisation of strains at high strain rates. An experimental-numerical approach is proposed to effectively determine the fracture characteristics of the dual phase steel under extreme conditions. A modified Bai-Wierzbicki model is implemented to assess the damage initiation and subsequent failure. Additionally, the fracture mechanisms are studied utilizing scanning electron microscopy.

To Evaluate and Compare Periodontal Disease and Smoking as a Parallel Risk Factor for Systemic Health by Gauging the Serum C-Reactive Protein Levels

INTRODUCTION

Physiologic and metabolic changes that occur immediately after a damage or disease are known as Acute Phase Reaction (APR). Acute Phase Proteins (APP) are blood proteins secreted by hepatocytes during APR C-Reactive Protein (CRP) being the important one.

AIM

Present study was designed to estimate and compare the levels of the serum CRP in current smokers, former smokers and non-smokers, with and without periodontitis.

MATERIALS AND METHODS

An experimental study was planned on 165 subjects who were divided into four groups. Group 1- nonsmokers with periodontitis. Group 2- smokers without periodontitis. Group 3- smokers with periodontitis. Group 4- former smokers without periodontitis. Healthy controls were not included in the study as the normal range of CRP in health is already established. Periodontal examination was done and serum CRP was measured. After getting the acceptance to be a part of the study, written informed consent was taken from each participant. Data analysis was done by ANOVA and post-hoc tests.

RESULTS

Highest level of CRP was found in smokers with periodontitis followed by non-smokers with periodontitis and smokers without periodontitis. Former smokers had minimum CRP compared to the other groups (p-value=0.03).

CONCLUSION

Periodontitis alone and in combination with smoking increases the systemic inflammatory burden and associated cardiovascular risk. This fact should be communicated thoroughly to the general population, general dentist, physicians and cardiovascular specialist to enhance early screening and multidisciplinary treatment.

Comparative Evaluation of the Efficacy of Platelet-rich Fibrin and Calcium Phosphosilicate Putty alone and in Combination in the Treatment of Intrabony Defects: A Randomized Clinical and Radiographic Study

Background:

Combination of platelet-rich fibrin (PRF) and bone substitutes for the treatment of intrabony pockets is based on sound biologic rationale. The present study aimed to explore the clinical and radiographic effectiveness of autologous PRF and calcium phosphosilicate (CPS) putty alone and in combination in treatment of intrabony defects.

Materials and Methods:

A total of 45 intrabony defects were selected and randomly divided into three groups. In Group I, mucoperiosteal flap elevation followed by placement of PRF was done. In Group II, mucoperiosteal flap elevation followed by placement of CPS putty was done. In Group III, mucoperiosteal flap elevation followed by placement of PRF and CPS putty was done. Clinical parameters such as gingival index (GI), pocket depth (PD), clinical attachment level (CAL), gingival marginal position and radiographic parameters such as bone fill, changes in crestal bone level, and defect depth resolution were recorded at baseline and after 6 months postoperatively.

Results:

Statistically significant changes in GI, PD reduction, CAL gain, defect fill, and defect depth resolution from baseline to 6 months were seen in all the three groups (P < 0.05). On intergroup comparison, no statistically significant changes were seen in all clinical parameters. However, the difference in defect fill and defect depth resolution between the Groups I and III and Group II and III was significant.

Conclusion:

Within limitations of study, combination of PRF and CPS putty showed a significant improvement in PD reduction, CAL gain, and bone fill.

Adaptive preconditioning in neurological diseases - therapeutic insights from proteostatic perturbations

In neurological disorders, both acute and chronic neural stress can disrupt cellular proteostasis, resulting in the generation of pathological protein. However in most cases, neurons adapt to these proteostatic perturbations by activating a range of cellular protective and repair responses, thus maintaining cell function. These interconnected adaptive mechanisms comprise a 'proteostasis network' and include the unfolded protein response, the ubiquitin proteasome system and autophagy. Interestingly, several recent studies have shown that these adaptive responses can be stimulated by preconditioning treatments, which confer resistance to a subsequent toxic challenge - the phenomenon known as hormesis. In this review we discuss the impact of adaptive stress responses stimulated in diverse human neuropathologies including Parkinson׳s disease, Wolfram syndrome, brain ischemia, and brain cancer. Further, we examine how these responses and the molecular pathways they recruit might be exploited for therapeutic gain. This article is part of a Special Issue entitled SI:ER stress.

Clay/Polyaniline Hybrid through Diazonium Chemistry: Conductive Nanofiller with Unusual Effects on Interfacial Properties of Epoxy Nanocomposites

The concept of conductive network structure in thermoset matrix without sacrificing the inherent mechanical properties of thermoset polymer (e.g., epoxy) is investigated here using "hairy" bentonite fillers. The latter were prepared through the in situ polymerization of aniline in the presence of 4-diphenylamine diazonium (DPA)-modified bentonite (B-DPA) resulting in a highly exfoliated bentonite-DPA/polyaniline (B-DPA/PANI). The nanocomposite filler was mixed with diglycidyl ether of bisphenol A (DGEBA), and the curing agent (4,4'-diaminodiphenylsulfone) (DDS) at high temperature in order to obtain nanocomposites through the conventional melt mixing technique. The role of B-DPA in the modification of the interface between epoxy and B-DPA/polyaniline (B-DPA/PANI) is investigated and compared with the filler B/PANI prepared without any diazonium modification of the bentonite. Synergistic improvement in dielectric properties and mechanical properties points to the fact that the DPA aryl groups from the diazonium precursor significantly modify the interface by acting as an efficient stress transfer medium. In DPA-containing nanocomposites, unique fibril formation was observed on the fracture surface. Moreover, dramatic improvement (210-220%) in fracture toughness of epoxy composite was obtained with B-DPA/PANI filler as compared to the weak improvement of 20-30% noted in the case of the B/PANI filler. This work shows that the DPA diazonium salt has an important effect on the improvement of the interfacial properties and adhesion of DGEBA and clay/PANI nanofillers.

Complications of Ultrasound-Guided Renal Transplant Biopsies

Renal transplant biopsies to diagnose transplant pathology are routinely performed using ultrasound guidance. Few large studies have assessed the rate and risk factors of major biopsy complications. This study is a single-center 5-year retrospective cohort analysis of 2514 biopsies. Major complications occurred in 47 of 2514 patients (1.9%) and included hospitalization, transfusion of blood products, operative exploration and interventional radiology procedures. The complication rate among "cause" biopsies was significantly higher than in "protocol" biopsies (2.7% vs. 0.33%, p < 0.001). Complications presented on postbiopsy days 0-14, with the majority diagnosed on the same day as the biopsy and manifested by hematocrit drop, although the presence of such delayed presentation of complications occurring >24 h after the biopsy on days 2-14 is previously unreported. Specific patient characteristics associated with increased risk of a complication were increased age and blood urea nitrogen, decreased platelet count, history of prior renal transplant, deceased donor transplant type and use of anticoagulant medications but not aspirin.

Risk factors for mortality in Down syndrome

BACKGROUND

Down syndrome is a genetic condition that contributes to a significantly shorter life expectancy compared with the general population. We investigated the most common comorbidities in a population of acute hospital patients with Down syndrome and further explored what the most common risk factors for mortality are within this population.

METHOD

From our database of one million patients admitted to National Health Service (NHS) Trusts in northern England, we identified 558 people who had Down syndrome. We compared this group with an age- and gender-matched control group of 5580 people.

RESULTS

The most prevalent comorbid diseases within the Down's population were hypothyroidism (22.9%) and epilepsy (20.3%). However, the conditions that had the highest relative risks (RRs) in the Down's population were septal defects and dementia. Respiratory failure, dementia and pneumonia were the most significantly related comorbidities to mortality in the Down syndrome population. In the control population, respiratory failure, dementia and renal failure were the most significant disease contributors. When these contributors were analysed using multivariate analysis, heart failure, respiratory failure, pneumonia and epilepsy were the identified risk factors for in-hospital mortality in the Down syndrome population. Respiratory failure was the sole risk factor for mortality in the Down syndrome population [RR = 9.791 (1.6-59.9) P ≤ 0.05], when compared with the risk factors for mortality in the control population.

CONCLUSIONS

There is significant medical morbidity in Down syndrome. This morbidity contributes to the lower life expectancy. Respiratory failure is a risk factor for mortality in Down syndrome. We need to thoroughly investigate people with Down syndrome to ensure any treatable illnesses are well managed.

Surgical Management of a Non-healing Intra-alveolar Root Fracture Associated with Pulpal Calcification and Root Resorption: A Case Report

Radicular fractures are very challenging to address due to various complications like periodontal communication, increased mobility, and continued pulpal infection leading to necrosis and its long term sequelae like root resorption and pulp canal obliteration. This paper present a case of a long standing horizontal mid root fracture with root resorption and pulp canal obliteration, which was preserved functionally and aesthetically by surgical approach using MTA (mineral trioxide aggregate) and PRF (platelet rich fibrin).

Real-time quantitative monitoring of hiPSC-based model of macular degeneration on Electric Cell-substrate Impedance Sensing microelectrodes

Age-related macular degeneration (AMD) is the leading cause of blindness in the developed world. Humanized disease models are required to develop new therapies for currently incurable forms of AMD.

In this work, a tissue-on-a-chip approach was developed through combining human induced pluripotent stem cells, Electric Cell–substrate Impedance Sensing (ECIS) and reproducible electrical wounding assays to model and quantitatively study AMD. Retinal Pigment Epithelium (RPE) cells generated from a patient with an inherited macular degeneration and from an unaffected sibling were used to test the model platform on which a reproducible electrical wounding assay was conducted to model RPE damage. First, a robust and reproducible real-time quantitative monitoring over a 25-day period demonstrated the establishment and maturation of RPE layers on the microelectrode arrays. A spatially controlled RPE layer damage that mimicked cell loss in AMD disease was then initiated. Post recovery, significant differences (P<0.01) in migration rates were found between case (8.6±0.46 μm/h) and control cell lines (10.69±0.21 μm/h). Quantitative data analysis suggested this was achieved due to lower cell–substrate adhesion in the control cell line. The ECIS cell–substrate adhesion parameter (α) was found to be 7.8±0.28 Ω^1/2 cm for the case cell line and 6.5±0.15 Ω^1/2 cm for the control. These findings were confirmed using cell adhesion biochemical assays. The developed disease model-on-a-chip is a powerful platform for translational studies with considerable potential to investigate novel therapies by enabling real-time, quantitative and reproducible patient-specific RPE cell repair studies.

•

hiPSC-RPE model was established and characterised on ECIS microelectrode arrays.

•

A reproducible electrical wound healing assay was used to mimic RPE cell damage.

•

Significant differences in migration rates were found between case and control.

•

Cells recovered through mesenchymal migration mirrored by impedance fluctuations.

•

Case cell line showed significantly higher adhesion than the control cell line.

Laser: The torch of freedom for ankyloglossia

The tongue is an important oral structure that affects speech, position of teeth, periodontal tissues, nutrition, swallowing, nursing, and certain social activities. Ankyloglossia or tongue-tie, is a congenital anomaly characterized by an abnormally short lingual frenulum, which restricts mobility of the tongue. Though the ankyloglossia is not a serious condition, it may lead to a host of problems including infant feeding difficulties, speech disorders, and various mechanical and social issues related to the inability of the tongue to protrude. Hence, management of ankyloglossia should be considered at any age considering the risk-benefit evaluation. Tongue being highly vascular and mobile structure, laser-assisted lingual frenectomy is the simplest, safest and less traumatic of all the treatment modalities available, with most promising results in minimally invasive dentistry. Here, a case of ankyloglossia is reported with its management by diode laser.

Compatibilizing action and localization of clay in a polypropylene/natural rubber (PP/NR) blend

The compatibilizing action of clay in polypropylene (PP)/natural rubber (NR) blends and its effect on mechanical properties have been investigated.