Evaluation of Remineralizing Capacity of Tricalcium Phosphate, Nano-Hydroxyapatite and Ozone Remineralizing Agents on the Artificial Carious Lesion.

BACKGROUND: Dental caries is a dynamic process. By using therapeutic agents, early, noncavitated lesions and caries limited to the enamel can be stopped or even remineralized. For the remineralization of the initial carious lesion, many nonfluoridated remineralizing agents were investigated. OBJECTIVES: An observational study to assess the remineralizing efficacy of tricalcium phosphate (TCP), nano-hydroxyapatite (nHAp) and ozone remineralizing agents on the artificial carious lesion. METHODOLOGY: In this observational research, the artificial carious lesion was produced on extracted 40 premolar teeth. Later, remineralizing agents (Group A: nHAp, Group B: TCP, Group C: Ozone remineralizing agents, Group D: Control group (Deionized water) were used to remineralize demineralized teeth. Utilizing the Vickers Hardness Number, the level of demineralization and remineralization was assessed. Later these readings were statistically assessed using the Tukey's HSD (honestly significant difference) and ANOVA tests in SPSS version 21.0. The P value was set at 0.05 or less. RESULTS: After demineralization, there was a decrease in enamel microhardness values, with 32% in Group A, 26% in Group B, 22% in Group C, and 21% in Group D, respectively. From the baseline to demineralization, there was a statistically significant decrease in microhardness across all groups. After remineralization, Groups A, B, and C experienced an increase in microhardness while Group D experienced no changes. This showed that Group A had the highest remineralization percentage, followed by Group B and Group C. CONCLUSION: nHAp and TCP had the greater remineralizing ability, which can be used to manage initial carious lesions.

Nicotine flux as a powerful tool for regulating nicotine delivery from e-cigarettes: Protocol of two complimentary randomized crossover clinical trials.

INTRODUCTION: Electronic cigarette (EC) use has increased rapidly in the last decade, especially among youth. Regulating nicotine delivery from ECs could help curb youth uptake and leverage EC use in harm reduction yet is complicated by varying device and liquid variables that affect nicotine delivery. Nicotine flux, the nicotine emission rate, is a parameter that incorporates these variables and focuses on the performance rather than the design of an EC. Nicotine flux therefore could be a powerful regulatory tool if it is shown empirically to predict nicotine delivery and subjective effects related to dependence. METHODS AND ANALYSIS: This project consists of two complementary clinical trials. In Trial I, we will examine the relationship between nicotine flux and the rate and dose of nicotine delivery from ECs, hence, impacting abuse liability. It will also examine the extent to which this relationship is mediated by nicotine form (i.e., freebase versus protonated). At Yale School of Medicine (YSM), study participants will puff EC devices under conditions that differ by flux and form, while arterial blood is sampled in high time resolution. In Trial II, we will assess the relationship between nicotine flux, form, and subjective effects. At the American University of Beirut (AUB), participants will use EC devices with varying nicotine fluxes and forms, while dependency measures, such as the urge to use ECs, nicotine craving, and withdrawal symptoms, will be assessed. We will also monitor puffing intensity and real-time exposure to toxicants. ETHICS AND DISSEMINATION: The protocol of Trial I and Trial II was approved by YSM and AUB IRBs, respectively. We will disseminate study results through peer-reviewed publications and conference presentations. TRIAL REGISTRATION: NCT05706701 for Trial I and NCT05430334 for Trial II.

A narrative review: Pharmacy intervention fidelity.

BACKGROUND: There has been a significant increase in the literature surrounding community-based pharmacy interventions. However, less is known about how researchers assured these interventions were implemented consistently and faithfully to the established protocol. OBJECTIVE: This narrative review aims to describe the nature and extent to which researchers reported intervention fidelity measures across depression and hypertension studies completed in community and ambulatory care settings. METHODS: Two research assistants used defined literature search criteria to identify manuscripts involving community pharmacist interventions in hypertension or depression care management. These research assistants independently evaluated each manuscript based on the nature and extent to which the studies described intervention training to support intervention fidelity, the intervention structure and content, the tools used to document intervention fidelity, and the extent to which the intervention was performed as expected. Manuscript authors were contacted for clarification of any details not clear from their published works. RESULTS: Of the 6 depression and 19 hypertension manuscripts, intervention training was described in only 2 and 9 depression and hypertension manuscripts, respectively. Other depression and hypertension manuscripts did not describe such training or gave unclear training information. Respectively, only 2 and 9 of the depression and hypertension manuscripts described a tool that was used to capture interventions made according to protocol. Two of the depression manuscripts and 6 of the hypertension manuscripts were known to have measured the extent to which the intervention was performed as expected. CONCLUSION: There is considerable variability in the nature and extent that intervention fidelity measures are reported in the literature. Researchers should be required to report key intervention fidelity measures when seeking publication of their research. Such additional reporting of fidelity results will enable the scientific community to have greater confidence in study results, conclusions, and implications.

Delirium in Critically Ill Cancer Patients With COVID-19.

BACKGROUND: COVID-19 has been a devastating pandemic with little known of its neuropsychiatric complications. Delirium is one of the most common neuropsychiatric syndromes among hospitalized cancer patients with incidence ranging from 25% to 40% and rates of up to 85% in the terminally ill. Data on the incidence, risk factors, duration, and outcomes of delirium in critically ill cancer patients with COVID-19 are lacking. OBJECTIVE: To report the incidence, risks and outcomes of critically ill cancer patients who developed COVID-19. METHODS: This is a retrospective single-center study evaluating delirium frequency and outcomes in all critically ill cancer patients with COVID-19 admitted between March 1 and July 10, 2020. Delirium was assessed by Confusion Assessment Method for Intensive Care Unit, performed twice daily by trained intensive care unit (ICU) nursing staff. Patients were considered to have a delirium-positive day if Confusion Assessment Method for Intensive Care Unit was positive at least once per day. RESULTS: A total of 70 patients were evaluated. Of those 70, 53 (75.7%) were found to be positive for delirium. Patients with delirium were significantly older than patients without delirium (median age 67.5 vs 60.3 y, P = 0.013). There were no significant differences in demographic characteristics, chronic medical conditions, neuropsychiatric history, cancer type, or application of prone positioning between the 2 groups. Delirium patients were less likely to receive cancer-directed therapies (58.5% vs 88.2%, P = 0.038) but more likely to receive antipsychotics (81.1% vs 41.2%, P = 0.004), dexmedetomidine (79.3% vs 11.8%, P < 0.001), steroids (84.9% vs 58.8%, P = 0.039), and vasopressors (90.6% vs 58.8%, P = 0.006). Delirium patients were more likely to be intubated (86.8% vs 41.2%, P < 0.001), and all tracheostomies (35.9%) occurred in patients with delirium. ICU length of stay (19 vs 8 d, P < 0.001) and hospital length of stay (37 vs 12 d, P < 0.001) were significantly longer in delirium patients, but there was no statistically significant difference in hospital mortality (43.4% vs 58.8%, P = 0.403) or ICU mortality (34.0% vs 58.8%, P = 0.090). CONCLUSIONS: Delirium in critically ill cancer patients with COVID-19 was associated with less cancer-directed therapies and increased hospital and ICU length of stay. However, the presence of delirium was not associated with an increase in hospital or ICU mortality.

Machine Boss: rapid prototyping of bioinformatic automata.

MOTIVATION: Many software libraries for using Hidden Markov Models in bioinformatics focus on inference tasks, such as likelihood calculation, parameter-fitting and alignment. However, construction of the state machines can be a laborious task, automation of which would be time-saving and less error-prone. RESULTS: We present Machine Boss, a software tool implementing not just inference and parameter-fitting algorithms, but also a set of operations for manipulating and combining automata. The aim is to make prototyping of bioinformatics HMMs as quick and easy as the construction of regular expressions, with one-line 'recipes' for many common applications. We report data from several illustrative examples involving protein-to-DNA alignment, DNA data storage and nanopore sequence analysis. AVAILABILITY AND IMPLEMENTATION: Machine Boss is released under the BSD-3 open source license and is available from http://machineboss.org/. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

In vitro Study Comparing Fracture Resistance of Nanocomposites with and without Fiber Reinforcement with Different Cavity Designs Used for Obliquely Fractured Incisal Edge Restoration.

AIM: The aim of the study is to evaluate fracture resistance of nanocomposites with and without fiber reinforcement with different cavity designs used for obliquely fractured incisal edge restoration. MATERIALS AND METHODS: In the present study, 60 sound extracted maxillary central incisors were mounted on autopolymerizable acrylic resin up to the cementoenamel junction, out of which, 10 intact teeth were kept as control (group 1) and the remaining 50 samples were reduced incisally in an oblique manner up to 3 mm. All incisally reduced samples were divided into five groups (n = 10) based on the restoration techniques as follows: group 2 (conventional bevel), group 3 (single central palatal slot on the incisal edge), group 4 (single palatal slot with central 2 mm fiber), group 5 (two palatal slots on the incisal edge with a distance of 0.5 mm to 1 mm between them), and group 6 (two slots on the incisal edge with two 2 mm fibers). All samples were built incrementally with nanocomposites followed by finishing and polishing. All samples including control were then stored in distilled water before their fracture resistance was measured using a universal testing machine. Failure modes were visually examined and the results were subjected to statistical analysis. RESULTS: The mean fracture resistance among the experimental groups was observed, group 4 with single fiber in the central position had the highest (832.68 N) followed by group 3 (490.84 N), group 5 (446.175), and group 2 (270.1359), and the least in group 6 (223.443). The mean fracture resistance of group 4 is comparable to intact teeth, i.e., group 1 (1096.40). The mean of all samples was compared using the one-way Anova test, and it was found that there is statistically significant difference in fracture resistance among groups (p < 0.001**). CONCLUSION: Fibers certainly have the reinforcing effect and the position of fibers determines their reinforcing effects. A single central slot with fiber (Ribbond) showed maximum fracture resistance almost equivalent to natural teeth. Modifying conventional beveled cavity design with an additional slot in the center also increases the fractural strength of restoration. CLINICAL SIGNIFICANCE: Nanocomposites reinforced with single fiber in the central palatal slot used for restoring fractured incisors provide strength almost equivalent to natural teeth. In case when the fiber is not available for preparing a single palatal slot also, we can increase the fracture resistance.