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Abstract Background Poor oral health has been widely recognised as an ongoing public health issue. Patients with oral conditions may visit either a general practitioner (GP) or a dental practitioner for management. The aims of this study are to report (i) the GP management rate of oral health conditions by patient and GP demographics, (ii) what specific oral conditions were managed, and (iii) how GPs managed oral conditions. Methods Data from the Bettering the Evaluation and Care of Health study (2006 to 2016 inclusive) were analysed. Descriptive statistics with 95% confidence intervals around point estimates were used to summarise data. Multivariate logistic regression was performed to determine the independent effect of patient and GP characteristics. Results A total of 972,100 GP encounters were included in the dataset, with oral condition-related encounters managed at a rate of 1.19 oral conditions per 100 GP encounters. Patients who were aged 54 years or younger, resided in a socioeconomically disadvantaged area, came from a non-English speaking background or Indigenous background were more likely to have oral conditions managed by GPs. The most commonly reported oral conditions were dental and oral mucosa-related. Over 60% of oral conditions were managed by GPs through prescribed medications. Conclusions This study provided an overview of management of oral conditions by GPs in Australia. Patients from certain vulnerable demographic groups were more likely to attend a GP for management of oral conditions. Common oral conditions and management approaches were identified. The findings of this study contribute to public health and health policy discussions around optimising primary care provision in oral health.

Psychosocial and stress-related factors (PSFs), defined as internal or external stimuli that induce biological changes, are potentially modifiable factors and accessible targets for interventions that are associated with adverse pregnancy outcomes (APOs). Although individual APOs have been shown to be connected to PSFs, they are biologically interconnected, relatively infrequent, and therefore challenging to model. In this context, multi-task machine learning (MML) is an ideal tool for exploring the interconnectedness of APOs on the one hand and building on joint combinatorial outcomes to increase predictive power on the other hand. Additionally, by integrating single cell immunological profiling of underlying biological processes, the effects of stress-based therapeutics may be measurable, facilitating the development of precision medicine approaches.ObjectivesThe primary objectives were to jointly model multiple APOs and their connection to stress early in pregnancy, and to explore the underlying biology to guide development of accessible and measurable interventions.Materials and MethodsIn a prospective cohort study, PSFs were assessed during the first trimester with an extensive self-filled questionnaire for 200 women. We used MML to simultaneously model, and predict APOs (severe preeclampsia, superimposed preeclampsia, gestational diabetes and early gestational age) as well as several risk factors (BMI, diabetes, hypertension) for these patients based on PSFs. Strongly interrelated stressors were categorized to identify potential therapeutic targets. Furthermore, for a subset of 14 women, we modeled the connection of PSFs to the maternal immune system to APOs by building corresponding ML models based on an extensive single cell immune dataset generated by mass cytometry time of flight (CyTOF).ResultsJointly modeling APOs in a MML setting significantly increased modeling capabilities and yielded a highly predictive integrated model of APOs underscoring their interconnectedness. Most APOs were associated with mental health, life stress, and perceived health risks. Biologically, stressors were associated with specific immune characteristics revolving around CD4/CD8 T cells. Immune characteristics predicted based on stress were in turn found to be associated with APOs.ConclusionsElucidating connections among stress, multiple APOs simultaneously, and immune characteristics has the potential to facilitate the implementation of ML-based, individualized, integrative models of pregnancy in clinical decision making. The modifiable nature of stressors may enable the development of accessible interventions, with success tracked through immune characteristics.

Background: Internal hernias rarely lead to bowel obstruction; they are caused by a natural or unnatural opening within the peritoneal cavity. Defects in the peritoneum are extremely rare. Patients present with features of intestinal obstruction and most cases are diagnosed during surgery. Case Presentation: A 47-year-old woman with a history of multiple abdominal surgeries had a small bowel hernia through a peritoneal defect of the anterior abdominal wall. She presented with abdominal pain and distension and was taken to the operating room, where findings revealed an intact fascia and small bowel herniation through a midline peritoneal defect. Conclusion: Herniation of small bowel through the peritoneum is a rare type of internal hernia that can manifest in a patient with extensive history of abdominal surgeries. This type of clinical picture warrants a high degree of suspicion for prompt and proper management. Surgery should not be delayed, to avoid increased morbidity and mortality.

Abstract In the present study, green synthetic pathway was adapted to synthesize CuO–ZnO bimetallic nanoparticles (BNPs) using Eryngium foetidum leaf extract and their anti-cancer activity against MCF7 breast cancer cell lines, anti-microbial activity and in vitro anti-oxidant activity were evaluated. Various bio-active compounds present in leaf extract were responsible for the reduction of CuO–ZnO NPs from respective Cu2+ and Zn2+ metal precursors. In the present study, the involvement of bio-active compounds present in E. foetidum extract before and after green synthesis of BNPs were evaluated for the first time. Rod-shaped and spherical structural morphology of synthesized BNPs were revealed by using FESEM, TEM, and XRD analysis with particle size ranged from 7 to 23 nm with an average size of 16.49 nm. The distribution of Cu and Zn were confirmed by elemental mapping. The green synthesized CuO–ZnO NPs showed significant cytotoxic effect with the inhibition rate 89.20 ± 0.03% at concentration of 500 μg/mL. Again, good antioxidant activity with IC50; 0.253 mg/mL and antimicrobial activity of BNPs were also evaluated with the increasing order of MIC; E. coli (7.81 μg/mL)

Objetivo: Describir las características clínicas y demográficas de los sujetos con esclerosis múltiple (EM) que asisten a un instituto de rehabilitación en la Ciudad Autónoma de Buenos Aires. Materiales y métodos: Estudio observacional, descriptivo y transversal. Se incluyeron sujetos mayores de 18 años con diagnóstico de EM. Las variables sociodemográficas fueron el sexo, la edad al momento del diagnóstico, la edad al ingreso y la posesión del Certificado Único de Discapacidad. Las variables clínicas y demográficas incluidas abarcaron los tiempos de evolución e ingreso a los servicios, así como aquellas variables clínicas consideradas de mayor impacto en la rehabilitación. Resultados: De un total de 39 sujetos, 21 (53,8 %) eran de sexo masculino. La media de edad fue de 45,5 años (DE 9,9). La mediana del tiempo de evolución de la enfermedad fue de 9 años (mín.-máx. 4-17). Además, el 67,6 % de los sujetos realizaban marcha, y la mayoría necesitaba algún dispositivo de ayuda para esta actividad. Conclusión: Se describieron algunas de las características clínicas y sociodemográficas de los sujetos con EM que asistieron a un instituto de rehabilitación en la Ciudad Autónoma de Buenos Aires.

Abstract Background This report describes how we refined a protocol for a pragmatic comparative effectiveness study of two models of an evidence-based diabetes shared medical appointment intervention and used the PRECIS-2 rating system to evaluate these adaptations. Methods We report primary data collected between June and August 2019, and protocol refinements completed between 2018 and 2020. Twenty-two members of the study team collaborated in protocol refinement and completed the PRECIS-2 ratings of study pragmatism. We discuss study design refinements made to achieve the desired level of pragmatism vs. experimental control for each of the nine PRECIS-2 dimensions. Study team members received training on PRECIS-2 scoring and were asked to rate the study protocol on the nine PRECIS-2 dimensions. Ratings were compared using descriptive statistics. Results In general, the PRECIS-2 ratings revealed high levels of pragmatism, but somewhat less pragmatic ratings on the categories of Delivery and Organization (costs and resources). This variation was purposeful, and we provide the rationale for and steps taken to obtain the targeted level of pragmatism on each PRECIS-2 dimension, as well as detail design changes made to a) make the design more pragmatic and b) address COVID-19 issues. There was general agreement among team members and across different types of stakeholders on PRECIS-2 ratings. Conclusions We discuss lessons learned from use of PRECIS-2 and experiences in refining the study to be maximally pragmatic on some dimensions and less so on other dimensions. This paper expands on prior research by describing actions to achieve higher levels of pragmatism and revise our protocol fit to the changed context. We make recommendations for future use of PRECIS-2 to help address changing context and other strategies for the planning of and transparent reporting on pragmatic research and comparative effectiveness research. Trial registration Clinicaltrials.gov Registration ID: NCT03590041 .

Abstract Background The diagnosis of malaria, using microscopy or rapid diagnostic tests (RDTs), requires the collection of capillary blood. This procedure is relatively simple to perform but invasive and poses potential risks to patients and health workers, arising from the manipulation of potentially infectious bodily fluids. Less or non-invasive diagnostic tests, based on urine, saliva or requiring no sampling, have the potential to generate less discomfort for the patient and to offer simpler and less risky testing procedures that could be safely performed by untrained staff or even self-performed. To explore the potential acceptance and perceived value of such non-invasive tests, an online, international survey was conducted to gather feedback from National Malaria Control Programme (NMCP) representatives. Methods An online survey comprising nineteen questions, available in English, French or Spanish, was emailed to 300 individuals who work with NMCPs in malaria-endemic countries. Answers were collected between November and December 2017; responses were qualitatively analysed to identify key themes and trends and quantitatively analysed to determine average values stratified by region. Results Responses were received from 70 individuals, from 33 countries. Approximately half of the respondents (52 %) considered current blood-based tests for malaria to be minimally invasive and non-problematic in their setting. For these participants, non-invasive tests would only be of interest if they brought additional performance improvements, as compared with the performance of microscopy and RDTs. Most respondents were of the view that saliva-based (80 %) and urine-based (66 %) tests would be more readily acceptable among children than blood-based tests. Potential use-case scenarios of interest for both saliva- and urine-based tests were ease-of-testing by community health workers, additional surveillance, self-testing, and outbreak investigation. Many respondents (41 %) thought that if saliva-based tests retailed at

Background: Human displacement is a social problem that has occupational implications. There is a significant gap in the research focusing on the refugee experience and the impact of this experience on their occupations as they transition to living in the US. This study seeks to capture the experience of refugees and the impact of this transition to the US on a broad array of occupations. Method: This research is a qualitative study. Data was collected through semi-structured interviews with two participants who have legal status as refugees living in the US. Results: Thematic analysis generated three themes: (a) contextual barriers to occupation, (b) belonging, and (c) adaptation. Refugees experienced a variety of contextual barriers, both systemic and socio-cultural, that impacted their ability to engage in meaningful occupation leading to a lack of belonging. Refugees adapted to these barriers by adapting their occupations. In addition, the researchers found social networks to be important for positive occupational engagement throughout country transition. Conclusion: This research adds to occupational science literature regarding the occupational impact of the refugee experience, as well as supporting occupational therapists to address issues of occupational deprivation with refugee populations.

Abstract Background In malaria elimination settings, the very low levels of transmission now being attained present challenges that demand new strategies to identify and treat low-density infections in both symptomatic and asymptomatic populations. Accordingly, passive case detection activities need to be supplemented by active case detection (ACD) strategies with more sensitive diagnostic tools. Malaria rapid diagnostic tests (RDTs) have provided low- and middle-income countries with unprecedented access to malaria diagnostics. Nevertheless, conventional RDTs miss a potentially important proportion of sub-microscopic infections. Therefore, new combination highly sensitive (HS-)RDTs, able to detect low parasite densities and identify all infected individuals, could support countries implementing ACD strategies for radical cure to accelerate malaria elimination. To address this need, an on-line survey was conducted to gather information from malaria control programme representatives to guide the development of next-generation RDTs. Results Most of respondents confirmed that ACD was a common activity in their programmes (56/75; 75%). Although microscopy was the preferred method in case management and reactive case detection, RDTs were the primary diagnostic tests used in proactive case detection (31/75; 41%). In terms of preferences for species detection in a new combination HS-RDT, data was not one-directional. Survey respondents slightly preferred the Pf/Pv/Pan combination (42%; 21/50), while Pf/Pan was more popular among end-users. Survey respondents also valued a low-cost (

Measurement of malaria specific antibody responses represents a practical and informative method for malaria control programs to assess recent exposure to infection. Technical advances in recombinant antigen production, serological screening platforms, and analytical methods have enabled the identification of several target antigens for laboratory based and point-of-contact tests. Questions remain as to how these serological assays can best be integrated into malaria surveillance activities to inform programmatic decision-making. This report synthesizes discussions from a convening at Institut Pasteur in Paris in June 2017 aimed at defining practical and informative use cases for serology applications and highlights five programmatic uses for serological assays including: documenting the absence of transmission; stratification of transmission; measuring the effect of interventions; informing a decentralized immediate response; and testing and treating P. vivax hypnozoite carriers.

Maintaining quality, competitiveness and innovation in global health technology is a constant challenge for manufacturers, while affordability, access and equity are challenges for governments and international agencies. In this paper we discuss these issues with reference to rapid diagnostic tests for malaria. Strategies to control and eliminate malaria depend on early and accurate diagnosis. Rapid diagnostic tests for malaria require little training and equipment and can be performed by non-specialists in remote settings. Use of these tests has expanded significantly over the last few years, following recommendations to test all suspected malaria cases before treatment and the implementation of an evaluation programme to assess the performance of the malaria rapid diagnostic tests. Despite these gains, challenges exist that, if not addressed, could jeopardize the progress made to date. We discuss recent developments in rapid diagnostic tests for malaria, highlight some of the challenges and provide suggestions to address them.

Angelman syndrome (AS) is a neurogenetic disorder caused by loss of maternal UBE3A expression or mutation-induced dysfunction of its protein product, the E3 ubiquitin–protein ligase, UBE3A. In humans and rodents, UBE3A/Ube3a transcript is maternally imprinted in several brain regions, but the distribution of native UBE3A/Ube3a1 protein expression has not been comprehensively examined. To address this, we systematically evaluated Ube3a expression in the brain and peripheral tissues of wild-type (WT) and Ube3a maternal knockout mice (AS mice). Immunoblot and immunohistochemical analyses revealed a marked loss of Ube3a protein in hippocampus, hypothalamus, olfactory bulb, cerebral cortex, striatum, thalamus, midbrain, and cerebellum in AS mice relative to WT littermates. Also, Ube3a expression in heart and liver of AS mice showed greater than the predicted 50% reduction relative to WT mice. Co-localization studies showed Ube3a expression to be primarily neuronal in all brain regions and present in GABAergic interneurons as well as principal neurons. These findings suggest that neuronal function throughout the brain is compromised in AS.

Antibody-functionalized carbon nanotube devices have been suggested for use as bacterial detectors for monitoring of food purity in transit from the farm to the kitchen. Here we report progress towards that goal by demonstrating specific detection of Salmonella in complex nutrient broth solutions using nanotube transistors functionalized with covalently-bound anti-Salmonella antibodies. The small size of the active device region makes them compatible with integration in large-scale arrays. We find that the on-state current of the transistor is sensitive specifically to the Salmonella concentration and saturates at low concentration (