Antimicrobial Resistance, One Health Interventions and the Least Restrictive Alternative Principle.

Antimicrobial resistance (AMR) is increasingly recognised as a threat to human, animal and environmental health. In an effort to counter this threat, several intervention plans have been proposed and implemented by states and organisations such as the WHO. A One Health policy approach, which targets multiple domains (healthcare, animal husbandry and the environment), has been identified as useful for curbing AMR. Johnson and Matlock have recently argued that One Health policies in the AMR context require special ethical justification because of the so-called least restrictive alternative principle. This article analyses and rejects two assumptions that this argument relies on. The first assumption is that One Health policies are generally more restrictive than their alternatives because they target more domains and impact more people. The second assumption is that the least restrictive alternative principle has a special normative importance in that it establishes a systematic presumption in favour of the least restrictive policy options. Once these assumptions are rejected, the use of One Health policies on AMR can be justified more easily than Johnson and Matlock argue.

Environmental risk and market approval for human pharmaceuticals.

This paper contributes to the growing discussion about how to mitigate pharmaceutical pollution, which is a threat to human, animal, and environmental health as well as a potential driver of antimicrobial resistance. It identifies market approval of pharmaceuticals as one of the most powerful ways to shape producer behavior and highlights that applying this tool raises ethical issues given that it might impact patients' access to medicines. The paper identifies seven different policy options that progressively give environmental considerations increased priority in the approval process, identifies ethically relevant interests affected by such policies, and makes explicit tensions and necessary tradeoffs between these interests. While arguing that the current European regulation gives insufficient weight to environmental considerations, the paper highlights concerns with the strongest policy options, on the grounds that these may very well endanger patients' access to effective medication.

Pharmaceutical Pollution from Human Use and the Polluter Pays Principle.

Human consumption of pharmaceuticals often leads to environmental release of residues via urine and faeces, creating environmental and public health risks. Policy responses must consider the normative question how responsibilities for managing such risks, and costs and burdens associated with that management, should be distributed between actors. Recently, the Polluter Pays Principle (PPP) has been advanced as rationale for such distribution. While recognizing some advantages of PPP, we highlight important ethical and practical limitations with applying it in this context: PPP gives ambiguous and arbitrary guidance due to difficulties in identifying the salient polluter. Moreover, when PPP does identify responsible actors, these may be unable to avoid or mitigate their contribution to the pollution, only able to avoid/mitigate it at excessive cost to themselves or others, or excusably ignorant of contributing. These limitations motivate a hybrid framework where PPP, which emphasizes holding those causing large-scale problems accountable, is balanced by the Ability to Pay Principle (APP), which emphasizes efficiently managing such problems. In this framework, improving wastewater treatment and distributing associated financial costs across water consumers or taxpayers stand out as promising responses to pharmaceutical pollution from human use. However, sound policy depends on empirical considerations requiring further study.

Rough Implants in Vertically Augmented Bone: A Retrospective Study with 4 to 15 Years of Follow-up

Although vertical guided bone regeneration (v-GBR) is a popular technique for treating alveolar bone deficiency, there are no long-term studies analyzing the longevity and success of the results. This retrospective study analyzes the clinical and radiographic outcomes of oxidized implants placed after v-GBR, with a follow-up period of 4 to 15 years. The study considers 41 v-GBR patients receiving one or more dental implants between 2001 and 2013 (115 implants total). Clinical and radiographic outcomes were recorded during follow-up visits. A multiple logistic regression model was used to analyze the correlation between peri-implantitis and demographic, surgical, and clinical variables, as well as the length of the follow-up period. The cumulative survival rate of the implants over the mean follow-up period of 9.6 ± 3.4 years was 95.7%, with peri-implantitis observed in 26.1% of the implants. The variables that correlated with the occurrence of peri-implantitis were smoking (OR = 8.5, 95% CI = 1.6 to 44.5, P < .01), posterior mandible implant position (OR = 2.1, 95% CI = 1.2 to 3.9, P < .01), and the length of the follow-up period (OR = 1.5, 95% CI = 1.1 to 2.2, P < .01). In this study, smoking, time since the surgery, and the implant position were associated with peri-implantitis developing on rough surface implants. Along with with previous long-term follow-up studies, this suggests that oxidized surface implants have a higher risk of peri-implantitis than machined ones.

Coherent Fiber-Optic Sensor for Ultra-Acoustic Crack Emissions.

A coherent optical fiber sensor with adequate sensitivity for detecting the acoustic emission (AE) during the propagation of a crack in a ferrous material is presented. The proposed fiber optic sensor is successfully compared in terms of the SNR (Signal to Noise Ratio) and detectable AE energy levels to commercially available AE piezo-transducers sensors and is proven to be an effective and advantageous alternative for sensing and monitoring fatigue damage in structural applications.

Sustainability principle for the ethics of healthcare resource allocation.

We propose a principle of sustainability to complement established principles used for justifying healthcare resource allocation. We argue that the application of established principles of equal treatment, need, prognosis and cost-effectiveness gives rise to what we call negative dynamics: a gradual depletion of the value possible to generate through healthcare. These principles should therefore be complemented by a sustainability principle, making the prospect of negative dynamics a further factor to consider, and possibly outweigh considerations highlighted by the other principles. We demonstrate how this principle may take different forms, and show that a commitment to sustainability is supported by considerations internal to the ethical principles already guiding healthcare resource allocation. We also consider two objections. The first of these, we argue, is either based on implausible assumptions or begs the question, whereas the second can be adequately accommodated by the principle we propose.

Decontamination of Customized Laser-Microtextured Titanium Abutments: A Comparative in Vitro Study of Different Cleaning Procedures.

The aim of this study was to evaluate different cleaning procedures for customized laser-microtextured titanium abutments. A total of 20 customized laser-microtextured abutments were randomized into four groups: no cleaning (control group), ultrasonic treatments + autoclave cycle (group 1), ultrasonic treatments + argon plasma (group 2), and only argon plasma (group 3). Surface contaminants were assessed through scanning electron microscopy and energy-dispersive x-ray spectroscopy microanalysis. In the control group, 99.96% of the abutment surfaces were contaminated with organic and inorganic pollutants. Group 3 showed the second highest contamination percentage, with almost 23% of the analyzed surfaces polluted. Samples in groups 1 and 2 were almost clean, with negligible traces of microparticles (0.009% and 0.047% of the surfaces were contaminated, respectively). These results were statistically significant for differences between control and test groups, and between groups 1 and 2 in comparison to 3 (P < .001). Abutment decontamination with argon plasma alone might not be as effective on laser-microtextured surfaces as other cleaning protocols.

Failed Blade Implant After 25 Years in Function: Case Description and Histologic Analysis.

This report describes a failed blade implant after 25 years in function in the left maxilla and the results of histologic analysis of peri-implant tissues. The blade was retrieved, and histologic findings revealed that it was not osseointegrated despite being successfully in function for so many years. The long-term function of blade implants without osseointegration can be attributed to biotolerance exhibited by the implant rather than actual osseointegration.

Reproducibility of a Digital Method to Evaluate Soft Tissue Modifications: A study of Inter and Intra-Operative Measurement Concordance.

BACKGROUND: The soft tissue healing and quality around dental implant is a current debated topic in the recent literature. The free gingival margin and the quantity and quality of the mucosa around teeth and surrounding dental implants still determine the hard and soft tissue healing status. OBJECTIVE: The aim of this study is to assess inter and intra-operative measurement concordance of a method aimed at evaluating the apico-coronal migration of free gingival margin, using intra-oral photography. METHODS: The method was tested on peri-implant tissues that were treated with a connective tissue graft on the second stage surgery. Thirty-eight measurements on 13 implants in 8 patients were recorded. An intra-oral photograph was taken for the graft and the provisional crown, which enclosed a circular landmark with a previously determined diameter. The landmark was prepared with a red-resin by the same technician. Before crown cementation, the landmark was calibrated with a digital calibrator by the main investigator, to determine the precise diameter up to two decimal numbers. RESULTS: On the intra-oral photograph, the distance was measured from the most apical point of the determined landmark to the zenith of the gingiva, using an image-processing program designed for scientific multidimensional images (Image J). Three independent examiners took these measurements. CONCLUSION: The main advantage of the present non-invasive technique is that the spatial plane of the prosthetic landmarks is the same of the tooth unlike the utilization of periodontal probe, which is generally positioned on different plans in the space (generally more vestibular).

Fast photocatalytic degradation of pharmaceutical micropollutants and ecotoxicological effects.

Aqueous solutions of ciprofloxacin (CP) and ibuprofen (IBP) in the presence of LaFeO3 photocatalyst, of H2O2, and of both LaFeO3 and H2O2 were irradiated under visible light. The degradation rate in the presence of both LaFeO3 and H2O2 after 5 h irradiation was more than 90 % for CP and 40 % for IBP, much higher than that with only H2O2 under visible light. For the sake of comparison, the experiments were also carried out in the dark, and both CP and IBP were not significantly converted. The degradation rate was enhanced by the simultaneous presence of small concentration of LaFeO3 (130 mg L-1) and H2O2 (0.003 M). However, tests on the aquatic acute toxicity indicate that the degradation products of CP and IBP induce toxic effects on aquatic organisms, consequently indicating incomplete detoxification after 5 h irradiation. The main degradation product of IBP was 4-isobutylacetophenone (4-IBAP), detected in the irradiated solutions by using UV/vis spectrophotometry. 4-IBAP was more toxic and showed a slower photocatalytic degradation than the parent compound. On the contrary, the toxicity of CP degradation products, although not negligible, was comparable to that of CP itself.