Platelet rich fibrin and MTA in the treatment of teeth with open apices.

BACKGROUND: The present study aimed to evaluate the effectiveness of using platelet-rich fibrin (PRF) as the apical matrix for the placement of MTA in nonsurgical endodontic therapy for teeth with periapical lesions and open apices. METHODS: Twelve teeth from eleven patients with periapical periodontitis and open apices were enrolled in the study. Nonsurgical endodontic therapy was performed with the PRF used as an apical barrier and the MTA manipulated as an apical plug for further thermoplasticized gutta percha in the remaining part of the root canal. Clinical signs and periapical digital radiographs were recorded and analyzed to evaluate the curing progress after periodical follow-ups of 1, 3, and 6 months. The horizontal dimension of the periapical lesion was determined, and the changes in the dimensions were recorded each time. The Friedman test was used for statistical analysis, with P < .05 serving as the threshold for determining statistical significance. RESULTS: All patients had no clinical symptoms after the first month of treatment, with a significant reduction in the periapical lesion after periodical appointments. CONCLUSIONS: PRF is an effective barrier when combined with MTA for the treatment of teeth with periapical periodontitis and open apices.

What makes a good general practice consultation: an exploratory pilot study with people from a low socioeconomic background.

BACKGROUND: Whilst patients from low socioeconomic (SES) backgrounds are at increased risk of developing chronic health conditions, typically managed within general practice, they report less positive consultation experiences with general practitioners (GP). To our knowledge, existing research does not provide an in-depth understanding of GP conducts contribute to positive consultations. AIM: To identify the factors that patients from low SES backgrounds perceive as essential for creating good consultation experiences. DESIGN & SETTING: This qualitative research was performed in Melbourne GP clinics. METHOD: We used an appreciative inquiry approach, focused on positive consultation experiences, previously shown to be helpful for researching sensitive topics. Nine patients with low SES backgrounds who reported positive consultation experiences, undertook a semi-structured qualitative interview whilst watching the video-recording of their GP consultation. Four different GPs were captured in the recordings. Inductive thematic coding was performed by two researchers. RESULTS: Four categories were developed relating to: (1) the doctor's demeanour and the patient's feelings, (2) the therapeutic relationship, (3) the doctor's therapeutic skill set and (4) communication techniques. In each interview, the discussion about the video-recorded consultation often triggered reflections about previous consultations with the respective GP. CONCLUSION: For patients from low SES groups, positive consultation experiences were underpinned by perceived continuity of care with a specific GP who consistently showed good communication skills and key interpersonal characteristics. This research is a small step towards increasing our understanding of the experience of individuals with low SES backgrounds in primary care and the existing health inequities within this.

Promoting Respectful Maternity Care by Reducing Unnecessary Episiotomies: Experiences from Centers of Excellence for Breastfeeding in Vietnam.

(1) Background: Routine episiotomy is not recommended by international guidelines; however, it occurs at a high rate in Vietnam. (2) Methods: A process to reduce unnecessary episiotomies was developed and implemented as part of the Centers of Excellence for Breastfeeding initiative, which aims to deliver high-quality breastfeeding and early essential newborn care services within a supportive policy environment. The aim of this project report is to outline the steps undertaken to reduce episiotomies, the experience in pilot hospitals, and the process towards changing policy. (3) Results: During the 14 months following the change in episiotomy policy, pilot hospital records showed no infant death or injury. Monthly monitoring data from four pilot hospitals showed that the prevalence of episiotomy was substantially lower than the average in national hospitals in Vietnam. Facilitators to reducing the episiotomy rate include the incentive of Centers of Excellence for Breastfeeding designation and supportive hospital leadership. Challenges include the ambiguity of Vietnam's national guideline on episiotomy and lack of routine monitoring on the episiotomy rate and indications. (4) Discussion: Our experience suggests that through training and routine monitoring hospitals can apply a policy of selective episiotomy and reduce the practice, particularly among multiparous women, and improve breastfeeding rates.(5) Conclusions: Sharing our experience of implementing this process and offering four areas for action will hopefully contribute to expanded use of mother-friendly, evidence-based care as policy and routine practice in Vietnam and similar settings.

GP laughter in lifestyle behaviour consultations: A conversation analytical study of general practice.

OBJECTIVE: This study investigates laughter by General Practitioners (GPs) in response to patient laughter in lifestyle behaviour consultations. METHOD: We examined video-recorded consultations involving 44 patients of four GPs in Australia. After identifying 33 cases of patient laughter, we examined whether GPs laughed in response. We used Conversation Analysis to explore the appropriateness of GP laughter and non-laughter by investigating the talk before and after the occurrence of patient laughter. RESULTS: GP reciprocal laughter was found in thirteen occasions when patients unsolicitedly mentioned their behaviours, laughed and displayed their evaluative stances (whether the behaviours were positive or negative). On twenty occasions, patients laughed in response to GP enquiries, which worked to problematise particular behaviours. In this context, patient laughter was not usually reciprocated (19/20 cases) because reciprocal laughter may risk being interpreted as laughing at the patient, as evidenced by one deviant case. CONCLUSION: GP reciprocal laughter may be problematic when the behaviour issues are raised by GPs and patients' evaluative stances regarding their behaviour have not yet been revealed. PRACTICE IMPLICATIONS: To decide when it is appropriate to reciprocate laughter, GPs should consider the contexts that lead to patient laughter and patients' evaluative stances.

Placement educators' perspectives of international social work students' sociopragmatic communication skills.

International students who speak English as an additional language report experiencing communication issues while completing their studies and work-integrated learning placements in a range of Anglophone countries, including Canada, the United Kingdom, the United States of America and Australia. To address this issue, accreditation and registration bodies for a number of health professions, such as social work and nursing, have advocated for increasing the test score requirements for university English language entry. However, from a sociolinguistic perspective, decisions concerning ways to address communication challenges need to take into account the unique communication skills required for functioning in specific workplace settings. It is therefore essential to identify the types of communication issues occurring during work-integrated learning opportunities (e.g. placement) and to then assess whether these should be addressed by raising general English proficiency or providing structured learning opportunities for profession-specific communication development within the course content. The present study uses sociolinguistic theory to examine placement educators' perspectives on international students' communication issues using the context of social work placement. It draws on the thematic analysis of interviews with 15 placement educators in Australia. One major finding is that international students' general proficiency or ability to use specific linguistic tools (pragmalinguistic competence) is not a key area of concern for educators. The main challenge seems to involve the students' understanding of sociocultural norms underlying workplace communication (sociopragmatic competence). This finding suggests that, rather than increasing English language entry requirements, universities need to provide international students opportunities to develop their sociopragmatic competence both before and during placement. The paper concludes with a set of recommendations aimed at supporting international students who speak English as an additional language to develop their workplace communication during their studies.

Immunolocalization and functional analysis of Opisthorchis viverrini-M60-like-1 metallopeptidase in animal models.

Host mucins have crucial physical roles in preventing the parasitic establishment and maturation, and also in expelling the invading parasites. However, some parasites utilize mucinase enzymes to facilitate the infection. Recently, we have identified a mucinase enzyme of the liver fluke Opisthorchis viverrini, Ov-M60-like-1, which exhibits metallopeptidase activity against bovine submaxillary mucin substrate. Here, we aimed to study the localization of this enzyme in O. viverrini and the bile duct of hamsters using immunohistochemistry and functional analysis by mucin digestion in hamsters and mice tissues. The results showed that Ov-M60-like-1 was detected strongly in the tegument, tegumental cells, vitelline glands and mature eggs with miracidium. Expression in the gut, ovary and testis of the parasite was moderate while parenchyma showed slight colour intensity. In addition, the mucinase was also detected in the host biliary epithelial cells and goblet cells surrounding the worm. The mucinase assay revealed that the Ov-M60-like-1 could digest neutral mucin in the parenchyma, testis and seminal receptacle, but not the mucin in the tegument, tegumental cells and vitelline glands of the worm. The enzyme can also digest mucin in the cholangiocytes and modified the mixture type in the bile duct goblet cells of the infected hamsters, a susceptible host. In contrast, the enzyme was unable to digest neutral, acid and mixture mucin in the bile duct of the mice, a non-susceptible host. These findings indicate that Ov-M60-like-1 may have functions in both housekeeping tasks and host­parasite interactions, especially in modification of host susceptibility.

The Association between a Novel Baby-Friendly Hospital Program and Equitable Support for Breastfeeding in Vietnam.

Background: Rates of early initiation of breastfeeding are low in Southeast Asia, despite evidence that increased initiation of early breastfeeding would lead to better long-term infant and child health and decrease inequities in long-term health and well-being. In response, a novel performance-based, baby-friendly hospital program designates hospitals that adhere to evidence-based early essential newborn care (EENC) and breastfeeding interventions as Centers of Excellence for Breastfeeding (COE). This study examined whether hospital participation in the program was associated with better breastfeeding outcomes. Methods: Hospitals (n = 28) were invited into the program in December 2018. Hospitals developed an improvement plan for promoting a breastfeeding-friendly environment and meeting the standards of the COE accreditation process and were enrolled on a rolling basis over the course of a year. Post-partum surveys were conducted with parents (n = 9585) from January 2019 through April 2020 to assess their breastfeeding and post-partum experience. Segmented regression models were used to assess how breastfeeding outcomes evolved before and after hospital enrollment in the COE program. Results: Enrollment was associated with a 6 percentage-point (95% CI: 3, 9) increase in the level of early initiation of breastfeeding, which continued to increase in the post-enrollment period, and a 5 percentage-point (95% CI: 2, 9) increase in the level of exclusive breastfeeding during hospital stay. We did not observe evidence that enrollment was immediately associated with receipt of lactation counseling or exclusive breastfeeding at survey time. Conclusion: The prevalence of early and exclusive breastfeeding increased after enrollment in the COE program, suggesting that the program has the potential to improve breastfeeding initiation rates and longer-term child health and well-being. Further research should be conducted to examine whether the program has an impact on the overall duration of breastfeeding.

Identification, recombinant protein production, and functional analysis of a M60-like metallopeptidase, secreted by the liver fluke Opisthorchis viverrini.

The carcinogenic liver fluke Opisthorchis viverrini (O. viverrini) is endemic in Thailand and neighboring countries including Laos PDR, Vietnam and Cambodia. Infections with O. viverrini lead to hepatobiliary abnormalities including bile duct cancer-cholangiocarcinoma (CCA). Despite decades of extensive studies, the underlying mechanisms of how this parasite survives in the bile duct and causes disease are still unclear. Therefore, this study aims to identify and characterize the most abundant protein secreted by the parasite. Proteomics and bioinformatics analysis revealed that the most abundant secretory protein is a metallopeptidase, named Ov-M60-like-1. This protein contains an N-terminal carbohydrate-binding domain and a C-terminal M60-like domain with a zinc metallopeptidase HEXXH motif. Further analysis by mass spectrometry revealed that Ov-M60-like-1 is N-glycosylated. Recombinant Ov-M60-like-1 (rOv-M60-like-1) expressed in Escherichia coli (E. coli) was able to digest bovine submaxillary mucin (BSM). The mucinase activity was inhibited by the ion chelating agent EDTA, confirming its metallopeptidase identity. The enzyme was active at temperatures ranging 25-37 °C in a broad pH range (pH 2-10). The identification of Ov-M60-like-1 mucinase as the major secretory protein of O. viverrini worms warrants further research into the role of this glycoprotein in the pathology induced by this carcinogenic worm.

Motor deficits on a ladder rung task in male and female adolescent and adult CGG knock-in mice.

The fragile X premutation is a tandem CGG trinucleotide repeat expansion on the FMR1 gene between 55 and 200 repeats in length. A CGG knock-in (CGG KI) mouse with CGG trinucleotide repeat lengths between 70 and 350 has been developed and used to model the histopathology and cognitive deficits reported in carriers of the fragile X premutation. Previous studies have shown that CGG KI mice show progressive deficits in processing spatial and temporal information. To characterize the motor deficits associated with the fragile X premutation, male and female CGG KI mice ranging from 2 to 16 months of age with trinucleotide repeats ranging from 72 to 240 CGG in length were tested for their ability to perform a skilled ladder rung walking test. The results demonstrate that both male and female CGG KI mice showed a greater number of foot slips as a function of increased CGG repeat length, independent of the age of the animal or general activity level.