Biofilms: Formation, drug resistance and alternatives to conventional approaches.

Biofilms are aggregates of bacteria, in most cases, which are resistant usually to broad-spectrum antibiotics in their typical concentrations or even in higher doses. A trend of increasing multi-drug resistance in biofilms, which are responsible for emerging life-threatening nosocomial infections, is becoming a serious problem. Biofilms, however, are at various sensitivity levels to environmental factors and are versatile in infectivity depending on virulence factors. This review presents the fundamental information about biofilms: formation, antibiotic resistance, impacts on public health and alternatives to conventional approaches. Novel developments in micro-biosystems that help reveal the new treatment tools by sensing and characterization of biofilms will also be discussed. Understanding the formation, structure, physiology and properties of biofilms better helps eliminate them by the usage of appropriate antibiotics or their control by novel therapy approaches, such as anti-biofilm molecules, effective gene editing, drug-delivery systems and probiotics.

Exploring the Black Box of Managing Total Rewards for Older Professionals in the Canadian Financial Services Sector.

This study extends our knowledge about the management of older employees in the sector of financial services, which faces enormous transformational pressures (e.g., emergence of artificial intelligence, digital services). Based on the black box model of human resource management, we investigate how executives at 16 major financial institutions manage their total rewards to motivate their older professionals to stay at work longer. Top management's views towards older professionals underlie a firm's culture or climate, and more precisely, the extent of the perception that they are a strategic resource that needs focused management. Across firms, such adaptation (or lack thereof) is made through the following total rewards components: (1) flexibility in working time and place of work, (2) hiring of retirees, (3) hiring or promotion of older professionals, (4) role adjustment, (5) responsibilities and performance standards, (6) monetary rewards, benefits, and (7) recognition, succession planning, and support for retirement planning or preparation. The black box model should be used in future research to understand which reward components work best in which contextsto motivate older workers to stay at work longer.

What Does Honors Mean? National Analysis of Medical School Clinical Clerkship Grading.

OBJECTIVE: Medical Student Performance Evaluation (MSPE) letters provide critical comparative information about clerkship performance, and are a crucial part of the surgical residency application. The elimination of USMLE Step 1 numeric reporting increases the importance of transparency, standardization, and accessibility of comparative information reported on the MSPE. The objective of our study was to measure the variability in clerkship grade reporting on the MSPE from US medical schools, particularly focusing on the highest (honors) grades. DESIGN, SETTING, AND PARTICIPANTS: We identified representative MSPE letters from US medical schools and recorded the percentage of honors for 5 core clerkships. We grouped medical schools according to medical school rankings, geographic region, and number of grading categories RESULTS: Of 122 medical schools, 106 schools (87%) reported their grading scheme and percent honors. The most commonly used grading scheme was a 4-tier system (51/122; 42%). The percentage of honors was highly variable (from 1-91%) and did not vary by region. However, schools in the top 20 research ranking were less likely to report grade comparisons (30% vs. 10%), and more likely to award more students honors in 4 of the 5 clerkships. Schools in the top 20 primary care ranking were more likely to award more honors in the medicine clerkship. CONCLUSIONS: There is significant variability in the number of grading tiers used and the percentage of students awarded honors across US medical schools. Factors that correlated to higher grades included schools with higher rankings, and higher ranked schools were less likely to report comparative information at all.

Implementation of a High-Value Care Curriculum for General Surgery Residents.

INTRODUCTION: Healthcare expenditures account for more than 3.5 trillion dollars annually with estimates of nearly one-half being wasteful. High-value care (HVC) balances the benefits, harms, and costs of healthcare. Since 2012, the American College of Physicians and Accreditation Council for Graduate Medical Education developed a HVC curriculum and incorporated HVC into milestones for medicine residents. However, currently no HVC curriculum or milestones exist for general surgery residents (GSR). We sought to implement a HVC curriculum for GSR and evaluate awareness and attitudes toward HVC, hypothesizing improved resident awareness and attitudes toward HVC without affecting patient outcomes. METHODS: A prospective comparison between pre-HVC curriculum (7/1/2017-11/30/2017) and post-HVC curriculum (2/1/2018-6/30/2018) was performed. The curriculum included 6 didactic lectures with group discussions. A 14-question Likert-scale survey evaluating awareness, use of, and attitudes toward HVC was performed on all GSR. Additional patient outcomes were collected for all trauma patients cared for during the study period. Bivariate analysis using Mann-Whitney U test was performed. RESULTS: There were 38/38 GSR respondents (100% response rate) for the pre-HVC survey and 35/38 (92.1% response rate) for the post-HVC survey. More post-HVC respondents somewhat agreed (34.3% vs 5.3%) and less strongly disagreed (31.4% vs 52.6%) with improved knowledge of where to find costs of labs/imaging/treatment (p = 0.02) compared to the pre-HVC group. More post-HVC respondents strongly agreed they balanced the benefit of clinical care with costs and harm when treating patients (25.7% vs 21.1%; p = 0.01). More post-HVC respondents strongly agreed they customized care plans to incorporate patients' values/concerns after implementation of the curriculum (51.4% vs 23.7%, p = 0.0006). From 3254 trauma patients studied, 1722 (52.9%) were pre-HVC and 1532 (47.1%) post-HVC patients. There was no difference between the pre- and post-HVC-curriculum trauma patients in terms of demographics and outcomes such as mortality (3.6% vs 2.4%, p = 0.07) and median length of stay (2 vs 2 days, p = 0.6). CONCLUSIONS: Implementation of a HVC curriculum for GSR led to improved awareness regarding healthcare costs and customizing decision plans for patients, with no difference in trauma patient outcomes. Future research incorporating cost data is needed; however, with implementation of the 2020 general surgery milestones (addition of Systems-Based Practice-3), this curriculum could prove beneficial.

Selamento das perfurações na área de furca em molares humanos / Sealing ability of perfurations in furcation area of humans molars

A literatura demonstra que as perfurações de soalho de furca, ocasionadas por fatores diversos, representam uma das situações clínicas de difícil resolução. No presente trabalho, procurou-se avaliar o selamento marginal obtido com MTA, Super-EBA e Osteopur + Histoacryl em perfurações de furca em 55 molares inferiores humanos extraídos. Os dentes foram divididos, aleatoriamente, em três grupos (Grupo 1, Grupo 2 e Grupo 3). de 15 dentes cada, de acordo com o material empregado. Os espécimes restantes serviram de Grupos Controle positivo e negativo. Os espécimes foram clivados longitudinalmente, e avaliados através de um perfilômetro e os resultados aferidos em micrômetro digital. Os dados foram analisados estatisticamente pelo teste Anova e Teste de Tukey que demonstraram os menores graus de infiltração para os Grupos 1 (MTA) e 3 (Osteopur + Histoacry).

Sealing of furcation perforations in human molars. The literatures shows that perforations in furca’s root area, caused by different factors, are difficult to be solved. In the present work, the marginal sealing obtained from MTA, EBA-Super and bovine liofilized osseous plus Histoacryl is studied in furca's perforations in 55 human extracted inferior molars. The teeth were divided in three groups, with 15 teeth in each one, according to the material used. The rest of the elements were used as control group, positive and negative. The specimens were clived in a longitudinal way and evaluated by Profile Projector Nikon. The results were obtained from a digital micrometer, with milimetric scale. The data were statistically analyzed from Anova and Tuckey's Test which demonstrated less degree of infiltration for the Groups 1 (MTA) and 3 (Osteopur + Histoacryl).