Relevant Aspects in the Mechanical and Aging Degradation of NiTi Alloy with R-Phase in Endodontic Files.

One of the most important challenges in endodontics is to have files that have excellent flexibility, toughness, and high fatigue life. Superelastic NiTi alloys have been a breakthrough and the new R-phase NiTi alloys promise to further optimize the good properties of NiTi alloys. In this work, two austenitic phase endodontic files with superelastic properties (Protaper and F6) and two austenitic phase files with the R-phase (M-wire and Reciproc) have been studied. The transformation temperatures were studied by calorimetry. Molds reproducing root canals at different angles (30, 45, and 70°) were obtained with cooling and loads simulating those used in the clinic. Mechanical cycles of different files were realized to fracture. Transformation temperatures were determined at different number of cycles. The different files were heat treated at 300 and 500 °C as the aging process, and the transformation temperatures were also determined. Scanning and transmission electron microscopy was used to observe the fractography and precipitates of the files. The results show that files with the R-phase have higher fracture cycles than files with only the austenitic phase. The fracture cycles depend on the angle of insertion in the root canal, with the angle of 70° being the one with the lowest fracture cycles in all cases. The R-Phase transformation increases the energy absorbed by the NiTi to produce the austenitic to R-phase and to produce the martensitic transformation causing the increase in the fracture cycles. Mechanical cycling leads to significant increases in the transformation temperatures Ms and Af as well as Rs and Rf. No changes in the transformation temperatures were observed for aging at 300 °C, but the appearance of Ni4Ti3 precipitates was observed in the aging treatments to the Nickel-rich files that correspond to those with the R transition. These results should be considered by endodontists to optimize the type of files for clinical therapy.

Dynamics of organizational climate and job satisfaction in healthcare service practice and research: a protocol for a systematic review.

Organizational climate and job satisfaction have been established as fundamental pillars of research and practice in organizational behavior and organizational psychology, inspiring many explanations and operationalizations over time. In most sectors, global trends such as labor shortages, high rates of turnover and absenteeism, the need to increase productivity, and the interest in new work models concur to keep climate and job satisfaction on top of the research agenda. The situation is particularly acute in the healthcare sector, where related factors have the capacity to influence all aspects of care provision, including patient safety and the physical and mental health of care providers. Nevertheless, a gap in knowledge persists regarding climate, job satisfaction, and their relationships in healthcare services. This protocol describes a study that aims to examine the dynamics of climate and job satisfaction in healthcare organizations from the practice and research perspectives. The protocol complies with PRISMA-P. PRISMA will be used to report the results of the study. Databases will be searched for published studies in May 2023, and we expect to complete the study by December 2024. A framework based on a multi-dimensional concept of quality in research will be used to examine the quality of any studies before inclusion. The results will be disseminated in two systematic reviews. We will describe proposed models depicting the dynamics of climate and job satisfaction in healthcare organizations. We will systematize and discuss available evidence regarding the outcomes of climate and job satisfaction in healthcare work environments. We will synthesize information on research designs and methodological options of included studies. We will identify measures of climate and job satisfaction used in healthcare settings, assess their psychometric properties, and appraise the overall quality of underlying studies. Finally, we expect to identify areas in need of further research.

Effect of Stabilized Martensite on the Long-Term Performance of Superelastic NiTi Endodontic Files.

One of the most used rotary files in endodontics is NiTi files due to their superelastic properties. This property means that this instrument has extraordinary flexion that can adapt to large angles inside the tooth canals. However, these files lose their superelasticity and fracture during use. The aim of this work is to determine the cause of fracture of the endodontic rotary files. For this purpose, 30 NiTi F6 SkyTaper® files (Komet, Germany) were used. Their chemical composition was determined by X-ray microanalysis, and their microstructure was determined by optical microscopy. Successive drillings were carried out with artificial tooth molds at 30, 45, and 70°. These tests were carried out at a temperature of 37 °C with a constant load controlled by a high sensitivity dynamometer of 5.5 N, and every five cycles were lubricated with an aqueous solution of sodium hypochlorite. The cycles to fracture were determined, and the surfaces were observed by scanning electron microscopy. Transformation (austenite to martensite) and retransformation (martensite to austenite) temperatures and enthalpies were determined by Differential Scanning Calorimeter at different endodontic cycles. The results showed an original austenitic phase with a Ms temperature of 15 °C and Af of 7 °C. Both temperatures increase with endodontic cycling, indicating that martensite forms at higher temperatures, and the temperature must be increased with cycling to retransform it to austenite. This fact indicates the stabilization of martensite with cycling, which is confirmed by the decrease in both transformation and retransformation enthalpies. The martensite is stabilized in the structure due to defects and does not retransform. This stabilized martensite has no superelasticity and, therefore, fractures prematurely. It has been possible to observe the stabilized martensite by studying the fractography, observing that the mechanism is by fatigue. The results showed that the files fracture earlier the greater the angle applied (for the tests at 70° at 280 s, at 45° at 385 s, and at 30° at 1200 s). As the angle increases, there is an increase in mechanical stress, and, therefore, the martensite stabilizes at lower cycles. To destabilize the martensite, a heat treatment can be carried out at 500 °C for 20 min, and the files recovers all its superelasticity.

Perforación iatrogénica de la arteria pulmonar por drenaje torácico en un paciente con Covid-19 / Iatrogenic Perforation of the Pulmonary Artery by Chest Drain in a Covid-19 Patient

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The law of demand and the loss of confidence effect: An experimental study.

The aim of this article is to examine the possibility that a market demand function (curve) might not be monotonically decreasing in its entire domain according to the consumer theory neoclassical as assumed by the law of demand (for normal goods). This may happen due to limited rationality of (some) consumers and the anchor price effect. When a price of a good decreases to some point, the amount demanded might stops increasing due to the loss of confidence effect: consumers' unwillingness to buy a too cheap product. The existence of this effect was examined via questionnaire on a sample of 377 undergraduate university students from the Czech Republic, Ecuador and Spain. The main result of this experimental study is that the loss of confidence effect appeared at all three locations, which indicates that the law of demand may not be valid in its entire domain. Furthermore, the results of this study imply that a significant percentage of people make decisions of limited rationality even when facing a very simple task. In addition, statistically significant difference in rational behavior with respect to gender was found.

Variability in the prescription of drugs with uncertain effectiveness. The case of SYSADOA in the Basque Country.

Background: The majority of clinical practice guidelines do not recommend the use of SYSADOA (Symptomatic Slow Action Drugs for Osteoarthritis) for the treatment of osteoarthritis because of the lack of evidence or uncertainty around their efficacy. Nevertheless, the Spanish Public Health Service continues funding these drugs. Aim: The aim of this study is to describe the prescription status of SYSADOA in the primary care units of the Basque Country during 2011; to determine if variability exists among them; and to examine if the variability could be explained by the health care region each PC unit belongs to. Methods: Prescription data for SYSADOA during 2011 was obtained from the Basque Ministry for Health. In the Basque Country, primary care is divided into seven regions, each region consisting of several primary care units, which were used as the unit of analysis. Defined daily doses (DDD) per 1,000 inhabitant-days (DHD) were calculated. Data were standardized by sex and age using the total population of the Basque Country as the reference population. Small area statistics were calculated (extremal quotient, coefficient of variation and systematic component of variation). The influence of the region to which primary care units belonged was also analysed. R software (version R-2.15.0) was used for the analysis. Results: SYSADOA prescription during 2011 accounted for an expense of 4.5 million euros for the Basque Health Service. The crude rate of consumption of SYSADOA was 7.81 DDD per 1,000 inhabitant-days. The obtained external quotient was 13.67. The prescription of SYSADOA of the primary care units located in the 95th percentile was six times higher than the ones located in the 5th percentile. The region to which units belonged accounted for 57% of the observed variability. Discussion: The uncertainty around these drugs could be reflected in the existing variability of their prescription level. The analysis of the variability in the prescription of drugs with no demonstrated efficacy could help in allocating resources into other services or health technologies supported by evidence, thereby contributing to the improvement of health outcomes.

Medical irehab shoulder rotator cuff: una app para ayudar en los procesos de rehabilitación / Medical irehab shoulder rotator cuff: an app to rehabilitation processes help

Medical iRehab Shoulder Rotator Cuff es una aplicación móvil desarrollada por un médico deportivo y entrenador de atletismo, que proporciona muchos ejercicios y terapias con el objetivo de mejorar los procesos de rehabilitación tras lesiones del manguito de los rotadores. Estas lesiones son comunes en ciertos deportes como los de combate, la natación, el balonmano, el culturismo, los lanzamientos de atletismo, el rugby o el fútbol. El objetivo de este artículo de opinión es analizar la app Medical iRehab Shoulder Rotator Cuff, señalando sus posibles aplicaciones médicas, sus ventajas e inconvenientes, y sus detalles técnicos(AU)

Medical iRehab Shoulder Rotator Cuff is a mobile application developed by a sports doctor and athletic trainer, which provides many exercises and therapies with the aim of improving rehabilitation processes after rotator cuff injuries. These injuries are common in certain sports such as combat, swimming, handball, bodybuilding, athletic throwing, rugby or football. The objective of this article of opinion is to analyze the Medical iRehab Shoulder Rotator Cuff app, pointing out its possible medical applications, its advantages and disadvantages, and its technical details(AU)

Marketing social y su influencia en la solución de problemas de salud / Social marketing and its influence in the solution of health problems

Introducción: El marketing social es una disciplina de la mercadotecnia dirigida a influir en el comportamiento de las personas a fin de que mejoren su bienestar y el de la sociedad. Por sus características tiene potencialidades de influir en la solución de problemas de salud a nivel individual, grupal y social, en especial desde el punto de vista de las acciones de comunicación a aplicarse, como las actividades sociales, campañas sociales, charlas, relaciones públicas, ruedas de prensa, entre otras. Objetivo: El objetivo del artículo es valorar a partir del criterio de expertos, la influencia que puede ejercer el marketing social en la solución de problemas de salud en Ecuador. Métodos: Se aplicó un cuestionario para conocer el criterio de 10 especialistas de las ciencias médicas y administrativas de Ecuador, en función de la influencia que pueden ejercer los instrumentos y estrategias de comunicación de marketing social en la solución de problemas de salud. El procesamiento de los datos se realizó con Microsoft Excel, para determinar el comportamiento descriptivo de los mismos y de forma inferencial a través del Coeficiente R de Pearson. Resultados: A partir del criterio de los expertos se determinó la importancia de las actividades sociales para la solución de problemas de salud en Ecuador, en especial las campañas sociales explicativas y de desmotivación de vicios, así como los mensajes de motivación. Destacan como principales objetos de las campañas las enfermedades epidémicas y del desarrollo, y el gobierno nacional como principal agente de marketing social. Mientras que la comunidad tiene una baja participación y negativas relaciones con otras variables estudiadas. El control del proceso de comunicación limita la efectividad de las acciones de marketing social. Conclusiones: El análisis empírico desarrollado a partir del criterio de expertos permitió diagnosticar la influencia que ejerce el marketing social en la solución de problemas de salud, así como los principales instrumentos de comunicación que se emplean, los agentes más activos y algunas insuficiencias en el proceso(AU)

Introduction: Social marketing is a discipline of marketing aimed at influencing people's behavior in order to improve their well-being and that of society. Because of its characteristics, it has the potential to influence the solution of health problems at the individual, group and social level, especially from the point of view of communication actions to be applied, such as social activities, social campaigns, talks, public relations, press conferences, among others. Objective: The objective of the article is to evaluate, based on the criterion of experts, the influence that social marketing can exert on solving health problems in Ecuador. Methods: A questionnaire was applied to know the criteria of 10 specialists from the medical and administrative sciences of Ecuador, depending on the influence that can be exerted on the instruments and strategies of communication of social marketing in the solution of health problems. The data processing was done with Microsoft Excel, to determine the descriptive behavior of the same and inferential form through Pearson R Coefficient. Results: Based on the criteria of the experts, the importance of social activities for the solution of health problems in Ecuador was determined, especially the explanatory social campaigns and demotivation of vices, as well as motivational messages. The epidemic and developmental diseases are highlighted as the main objects of the campaigns, and the national government is the main agent of social marketing. While the community has low participation and negative relationships with other variables studied. Controlling the communication process limits the effectiveness of social marketing actions. Conclusions: The empirical analysis developed from the expert criterion allowed to diagnose the influence of social marketing in the solution of health problems, as well as the main communication tools used, the most active agents and some shortcomings in the process(AU)

Accessory Joint and Neural Mobilizations for Shoulder Range of Motion Restriction After Breast Cancer Surgery: A Pilot Randomized Clinical Trial.

OBJECTIVE: The aim of this study was to assess the methods to conduct a substantive clinical trial to evaluate the effects of accessory joint mobilization (AJM) vs neural mobilization (NM) techniques for shoulder motion restriction after breast cancer surgery. METHODS: This pilot study was a prospective randomized and double-blind clinical trial in which 18 women who underwent unilateral breast cancer surgery and axillary lymph node dissection participated. The study was conducted at the Women's Health Research Group at the Physical Therapy Department of Alcalá University, Madrid, Spain. The intervention was AJM vs NM, with a 6-month follow-up. Primary outcomes included recruitment, adherence to treatment and retention rates, assessment procedures, and implementation of the 2 manual therapy techniques. Secondary outcomes included range of motion, sensory disturbance, pain, and upper limb functionality. RESULTS: All participants accepted to be randomly assigned to study groups. One hundred percent retention was attained with all participants attending the 3-month and 6-month assessments. Adherence with treatment attendance was excellent. At 6-month follow-up, flexion range of motion had a mean change of 38.4° (±28.9) (P = .002) in the AJM group and a mean change of 36.8° (±21.8) (P = .002) in the NM group. Abduction range of motion had a median change of 52.4° (±43.6) (P = .004) in AJM group and a median change of 44° (±17.5) (P = .012). CONCLUSIONS: These preliminary results of the effects of AJM and NM techniques in breast cancer survivors indicate that a full clinical trial will be worthwhile. The research methods tested and the modifications proposed within this pilot study offer a suitable foundation to conduct a substantive clinical trial.

Spontaneous switch from Agamma- to beta-globin promoter activity in a stable transfected dual reporter vector.

Here it is analyzed the expression of a mini locus dual reporter construct composed by a micro-LCR and by the promoters for (A)gamma- and beta-globin gene, each one linked to a different Luciferase, in stably transfected GM979 cells for as long as 1-2 years from transfection. The transfected GM979 cells rapidly (within 1 month) evolved into a stable population which expresses constant levels of reporters for more than a year of continuous bulk culture. No silencing of the inserted construct was observed over time. In contrast, after 1 month, the reporter activity (both from (A)gamma- and beta-promoter) expressed per cell increased over time. The analysis of the Luciferase contained in single cell clones indicated that the higher reporter activity was due to increased gene expression per cell rather than to clonal selection of the most expressing clones. Since the activity driven by the beta-promoter increased 10-fold more than that driven by the (A)gamma one, the ratio between (A)gamma-driven/((A)gamma-driven + beta-driven) reporter activity in the cells decreased after 1 month and became similar to the gamma/(gamma + beta) globin mRNA ratio expressed by adult erythroid cells. Moreover, although both cells from early and late bulk culture responded to incubation with butyric acid, a known inducer of fetal globin gene expression, by increasing the reporter activity driven by the (A)gamma-promoter, only cells from late bulk culture decreased, as normal primary erythroblasts do, the activity of the reporter driven by the beta-promoter. These results suggest that the rapid changes in activity driven by the (A)gamma- and beta-globin promoters occurring during the first month after transfection may represent a novel in vitro model to study epigenetic regulation of the (A)gamma- and beta-promoter during the fetal to adult hemoglobin switch and confirm GM979 cells stably transfected with the dual reporter construct as a reliable assay for automated screening of chemical inducers of fetal globin gene activation.

5-azacytidine reactivates the erythroid differentiation potential of the myeloid-restricted murine cell line 32D Ro.

32D cells grown for 1 year in interleukin-3 (IL-3) and granulocyte colony-stimulating factor (G-CSF) generated the 32D Ro cell line which retained the parental mast cell phenotype but lost ability to generate erythroid cells in response to erythropoietin (EPO). In order to clarify the mechanisms underlying such restriction, we compared 32D and 32D Ro cells for their capacity to express erythroid-specific transcription factors (Gata1, Gata2, Scl, Nef2, Eklf, and Id) and the capacity of short exposure to 5-azacytidine (5-AzaC) to reactivate erythroid differentiation potential in 32D Ro cells. By Northern analysis, the two cell lines expressed similar levels of all these genes. However, after being treated with 5-AzaC, 32D Ro cells acquired the ability to generate EPO-dependent clones (1 clone/10(4) cells) which gave rise to EPO-dependent cell lines. All the 10 EPO-responsive cell lines independently isolated from 5-AzaC-treated 32D Ro cells had erythroid morphology and expressed high levels of alpha- and beta-globin. In contrast, none of the IL-3-dependent and granulocyte/macrophage colony-stimulating factor-dependent clones concurrently isolated, as a control, showed erythroid properties. Therefore, 5-AzaC treatment reactivates the potential of the myeloid-restricted 32D Ro cells to generate EPO-responsive erythroid clones suggesting that gene methylation played an important role in the G-CSF-mediated restriction/activation of the differentiation potential of these cells.