Explore the vast range of titles available.

Dental anxiety creates significant problems for both patients and the dental profession. Some distraction interventions are already used by healthcare professionals to help patients cope with unpleasant procedures. The present study is novel because it a) builds on evidence that natural scenery is beneficial for patients, and b) uses a Virtual Reality (VR) representation of nature to distract participants. Extending previous work that has investigated pain and anxiety during treatment, c) we also consider the longer term effects in terms of more positive memories of the treatment, building on a cognitive theory of memory (Elaborated Intrusions). Participants (n = 69) took part in a simulated dental experience and were randomly assigned to one of three VR conditions (active vs. passive vs. control). In addition, participants were distinguished into high and low dentally anxious according to a median split resulting in a 3×2 between-subjects design. VR distraction in a simulated dental context affected memories a week later. The VR distraction had effects not only on concurrent experiences, such as perceived control, but longitudinally upon the vividness of memories after the dental experience had ended. Participants with higher dental anxiety (for whom the dental procedures were presumably more aversive) showed a greater reduction in memory vividness than lower dental-anxiety participants. This study thus suggests that VR distractions can be considered as a relevant intervention for cycles of care in which people's previous experiences affect their behaviour for future events.

Background Aspiration of foreign bodies is not uncommon in the pediatric setting, and the consideration and recognition of an aspiration event are vital to prompt management. Pointed and sharp-edged foreign bodies have the potential to lodge in the airway and increase the difficulty of identification and removal. Here, we describe a fatal aspiration of a push pin that was unrecognized prior to death. Methods Review of police and medical records was completed prior to postmortem CT imaging and full pediatric autopsy with high resolution photography. Case presentation A 15-month-old boy was playing at home when he acutely vomited and then became unresponsive. Paramedic and hospital physicians performed pediatric CPR protocols, including intubation, without success. Postmortem radiographic imaging revealed a metallic foreign body at the level of the larynx. Autopsy demonstrated a push pin fully occluding the trachea at the level of the vocal cords. Conclusions The diagnosis of aspirated FBs may be elusive, and clinicians and autopsy pathologists ought to be mindful that children with FBs may have atypical presentations. Use of postmortem radiologic imaging can assist in the diagnosis and allow for a targeted autopsy approach to best visualize the offending foreign body.

Methadone remains the most common form of pharmacological therapy for opioid dependence; however, there is a lack of explanation for the reports of its relatively low success rate in achieving complete abstinence. One hypothesis is that in vivo binding of methadone to the plasma glycoprotein alpha-1-acid glycoprotein (AGP), to a degree dependent on the molecular structure, may render the drug inactive. This study sought to determine whether alterations present in the glycosylation pattern of AGP in patients undergoing various stages of methadone therapy (titration < two weeks, harm reduction < one year, long-term > one and a half years) could affect the affinity of the glycoprotein to bind methadone. The composition of AGP glycosylation was determined using high pH anion exchange chromatography (HPAEC) and intrinsic fluorescence analysed to determine the extent of binding to methadone. The monosaccharides galactose and N-acetyl-glucosamine were elevated in all methadone treatment groups indicating alterations in AGP glycosylation. AGP from all patients receiving methadone therapy exhibited a greater degree of binding than the normal population. This suggests that analysing the glycosylation of AGP in patients receiving methadone may aid in determining whether the therapy is likely to be effective.

Martin Zenker, Corinne Antignac, Friedhelm Hildebrandt and colleagues report that mutations in OSGEP , TP53RK , TPRKB and LAGE3 , genes encoding KEOPS-complex subunits, cause Galloway–Mowat syndrome, a recessive disease characterized by early-onset steroid-resistant nephrotic syndrome and microcephaly. Functional studies suggest that the phenotypes result from impaired protein translation, thus leading to endoplasmic reticulum stress and apoptosis. Galloway–Mowat syndrome (GAMOS) is an autosomal-recessive disease characterized by the combination of early-onset nephrotic syndrome (SRNS) and microcephaly with brain anomalies. Here we identified recessive mutations in OSGEP , TP53RK , TPRKB , and LAGE3 , genes encoding the four subunits of the KEOPS complex, in 37 individuals from 32 families with GAMOS. CRISPR–Cas9 knockout in zebrafish and mice recapitulated the human phenotype of primary microcephaly and resulted in early lethality. Knockdown of OSGEP , TP53RK , or TPRKB inhibited cell proliferation, which human mutations did not rescue. Furthermore, knockdown of these genes impaired protein translation, caused endoplasmic reticulum stress, activated DNA-damage-response signaling, and ultimately induced apoptosis. Knockdown of OSGEP or TP53RK induced defects in the actin cytoskeleton and decreased the migration rate of human podocytes, an established intermediate phenotype of SRNS. We thus identified four new monogenic causes of GAMOS, describe a link between KEOPS function and human disease, and delineate potential pathogenic mechanisms.

Selection was initially site-dependent, which then evolved into a partially voluntary basis, made in collaboration with the Post-Graduate Medical Education Office (PGME), AP Residency Program Committee, and the AP resident body. Resident representatives noted that these were due to technical reasons such as lack of appropriate hardware, spotty connectivity, and the inconsistent use of different devices ranging from smartphones to desktop computers. [...]in-person teaching with glass slides became challenging as sign-outs using multiheaded microscopes were discontinued across most training sites. A recent review on the psychological impacts of COVID-19 on health care workers found that depression, anxiety, and other psychological distresses affect a quarter to a third of health care workers.4 Our program widely promoted and supported formal and informal wellness initiatives, including online wellness resources, a virtual trivia night, distribution of jackets with the U of T AP logo to all trainees, physically distanced outdoor and virtual parties for incoming and graduating residents, and a wellness photo social media competition. Carlo Hojilla, MD, PhD1,2; Susan Armstrong, MD, PhD1; Cherry Pun, MD1; Tyler Bruce Malcolm Hickey, MD, PhD1,3; Ozgur Mete, MD14; Rachel Han, MD1; Elan Hahn, MD1; Sameer Shivji, MD2; Susan Done, MA, MB, BChir MBA, PhD1,4; Fang-I Lu, MD1,5 1Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada; 2Department of Pathology & Laboratory Medicine, Sinai Health System, Toronto, Ontario, Canada; 3Ontario Forensic Pathology Service, Toronto, Ontario, Canada; 4Laboratory Medicine Program, Department of Anatomical Pathology, University Health Network, Toronto, Ontario, Canada; 5Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Accepted for publication April 8, 2021.

Objective To assess the efficacy and safety of dentist-prescribed, home-applied tooth whitening agents Data sources Medline 1989–1999 inclusive Study selection Placebo controlled clinical trials of 10% carbamide peroxide using a custom-fitted tray, which reported efficacy using a change in shade guide units were included. Data extraction and synthesis Shade guide unit change was evaluated to reflect efficacy, and both gingival and plaque indices to reflect safety. All 3 were analysed for the significance of 4 variables: treatment group, daily application time, the duration of treatment, and brand of bleach were examined . Number needed to treat was calculated. Results 28 trials evaluated tooth bleaching, 20 of which were dentists-prescribed, and patient applied agents. 7 met all the criteria. The data indicated that home-applied agents using a 10% carbamide peroxide gel delivered in a custom-fitted tray whitened teeth significantly, when compared to a placebo control. Conclusions Within the caveats discussed in the paper, the results indicate that, on average, dentist-prescribed, home-applied tooth whitening will whiten teeth 2 shade guide steps for six months, and neither adversely nor beneficially affect the gingiva or plaque.

THE controversy surrounding the idea that neutral mutations dominate protein evolution 1 is attributable in part to the inadequacy of the tools available to evolutionary investigators. With a few exceptions 2 , most investigations into the force driving protein evolution 3 have relied on indirect criteria for distinguishing neutral and non-neutral variants. To investigate a particular pathway of molecular evolution, we have reconstructed by site-directed mutagenesis likely ancestral variants of the lysozymes of modern game birds (order Galliformes ), tested their activity and thermostability and determined their three-dimensional structure. We focused on amino acids at three positions that are occupied in all known game birds either by the triplet Thr 40, He 55, Ser 91, or by the triplet Ser 40, Val 55, Thr 91. We have synthesized proteins representing intermediates along the possible three-step evolutionary pathways between these triplets. Although all of these are active and stable, none of these intermediates is found in known lysozymes. A comparison of the stuctures and thermostabilities of the variants reveals a linear correlation between the side-chain volume of the triplet and the thermostability of the protein. Each pathway connecting the two extant triplet sequences includes a variant with a thermostability outside the range of the extant proteins. This observation is consistent with a non-neutral evolutionary pathway. The existence of variants that are more stable than the extant proteins suggests that selection for maximum thermostability may not have been an important factor in the evolution of this enzyme.

To compare the characteristics of heroin, cocaine and amphetamine users having no history of contact with services with those of a group in contact. Multiple agency sampling and field work which included 'snowballing' using 'privileged access interviewers'. Each subject underwent a structured interview which included the Severity of Dependency Scale (SDS), and completed a confidential, self-report questionnaire. Three contrasting provincial urban locations. Five hundred and eighty-one regular users of the target drugs. Of these, 380 (65%) denied any contact with police or helping agencies in connection with drug use. Most zero-contact users (79%) expressed little or no concern about their drug use, and no wish for help or advice. They were much more likely to use stimulants only; less likely ever to inject any drug or, for those that did, to share equipment; less likely to use opioids, amphetamine or cocaine powder on a daily basis; more likely to use Ecstasy; and yielded significantly lower SDS scores for all target drugs save crack. Prevalence of crack use was lower, but the proportion of daily users was the same as in the contact group. Most (69%) contact users remained concerned about their drug use, but 58% expressed little or no confidence that local services could meet their needs. In both groups, SDS scores for cocaine powder were comparable to those for cannabis, LSD and Ecstasy. Of the 495 cannabis smokers identified (85% of the sample), 72% reported daily consumption. The findings are consistent with the hypothesis that 'visible' and 'invisible' drug users are distinct populations in terms of behavioral characteristics, vulnerability to compulsive use, and prevalence of drug-related problems or concern. Purchasers and providers with limited resources should concentrate on improving the range and quality of services for users already in contact rather than attempting to uncover invisible populations. On the basis of SDS scores, cocaine HCI seems to have a relatively modest addictive potential.

The first complete field guide to the exotic amphibians and reptiles established in the continental United States and Hawai'i, this volume covers 74 species that are not native to the country and 29 species that are native but occur beyond their original geographic range. Dispersed from their former habitats by human activity, many of these species are invasive in their new environments, causing ecological or economic harm.  Ideal for naturalists of all levels, Exotic Amphibians and Reptiles of the United States details each species' taxonomy, distribution, history, and ecology and portrays each one with vibrant photographs. Drawing on county-level distribution maps from 2,908 published records, this guide provides an in-depth understanding of local factors that drive the success of exotic species. It connects species-specific information to conservation issues as it explores human causes of exotic and invasive establishment. The book also includes eight invited essays which provide regional perspectives on scientific, economic, and management-related aspects of this phenomenon.  As ecological pressures on native species and habitats increase, understanding the histories and roles of exotic species is becoming more and more important for conservation efforts. Providing practical identification skills and an awareness of the environmental impacts of these amphibians and reptiles, this indispensable guide equips readers to confront the unusual biodiversity crisis of exotic species.