Prescription audit of patients attendees in public health facilities in Maharashtra, India with special reference to rational use of antibiotics

2015-12-09T00-52-20Z
Source: International Journal of Research in Medical Sciences
Uddhao Gawande, Sona Deshmukh, Suhas Kadam, Gurudatt Potdar, Hrushikesh Salvitthal.
Background: As soon as a doctor examines the patient, he/she writes the treatment for the illness on a piece of paper and that is called as Prescription. Prescription is a document through which doctor, patient and pharmacist are communicated to each other but many a times if these documents are not properly written or misinterpreted it can affect management of patients. World Health Organization (WHO) has established prescribing indicators to analyze the prescription and promoted rational use of drugs and better management of patients. Prescription audit captures the current practices and identifies opportunities for improvement in patient care and along with the mechanisms for realizing them. The main objective is to analyze the prescription of drugs given to the patients in OPD and IPD of the primary and secondary level public health facilities in Maharashtra. Methods: The study was a cross-sectional and observational based on both qualitative and quantitative data. It comprises of secondary data obtained from copies of prescription collected from selected Rural Hospitals (RHs)/Sub-district Hospitals (SDHs) and District Hospitals (DHs)/ Women Hospitals (WHs) of Maharashtra comprising on prescribing practice, rational use of drugs and antibiotics, patient care and facility specific indicators. The Prescribing patterns were analyzed using WHO guidelines with regard to prescribing, patient care and health facility indicators. Qualitative) data collected on perceptions of the patients attending OPD as regard of doctor's consultation and dispensing of medicine; as well as perceptions of pharmacists regarding working environment that measures the ability to prescribe drugs rationally. The copies of the prescriptions from the patients attending OPD / IPD at the above mentioned public health institutions (PHCs, RHs, SDHs and DHs/ DWHs) were obtained. Statistical analysis of study was analyzed using the frequencies and cross tabs by using MS-Office Excel and SPSS Version 20. Results: This exercise showed that there is a scope for improvement in prescribing patterns in areas of writing generic names of drugs, essential drugs, writing legible and complete prescriptions. Conclusions: The present study clearly indicates that there is a great need of interventions like distribution of antibiotic guidelines and running workshops and seminars on rational drug use to prescribers to improve the prescribing behaviour in the state of Maharashtra. This can be enforced through introducing such concepts and those of rational prescribing in curriculum of medical schools. E-prescriptions can be started in E-Aushadhi software with periodic clinical meetings to learn from the evidence.


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A study of the correlation between ventilator associated pneumonia and mortality rate of traumatic in patients in intensive care units

2015-12-09T00-52-20Z
Source: International Journal of Research in Medical Sciences
Farshid Rahimi Bashar, Nahid Manuchehrian, Mohammad Hossein Jarahzadeh.
Background: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection among the traumatic in-patients in Intensive Care Units (ICUs). Trauma is a risk factor for the incidence of VAP, yet, the association between VAP and outcome is not clear in traumatic in-patients in ICUs. This study investigated the correlation between ventilator-associated pneumonia and mortality rate of traumatic in-patients in ICUs in Be'that Hospital in Hamedan, western Iran. Methods: This observational prospective study was conducted in the ICU of Be'that Hospital, Hamedan, Iran, during 1 year (March 2013 until February 2014). The population under study included traumatic in-patients aged less than 18 year who were in need of invasive mechanical ventilation for more than 48 h with APACHE SCORE II of less than 25. They were studied for the incidence or lack of incidence of VAP. Results: Of 154 patients under study, 114 cases (74%) suffered from multiple traumata, 32 cases (20.8%) were affected with head trauma, 5 cases (3.2%) sustained spinal cord injury, and 3 cases (1.9%) suffered from thoracic trauma. Also, 47 cases (30.5%) were affected with VAP. Compared to the non-VAP group, the patients in VAP group had longer ICU stay (18.5±6.21 days vs. 9.21±2.91 days, P


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Comparison of interlaminar epidural steroid versus caudal steroid injection for low back pain with radiculopathy due to disc prolapse

2015-12-09T00-52-20Z
Source: International Journal of Research in Medical Sciences
Sunil Nikose, Gurminder Singh, Pradeep K Singh, Sohael Khan, Devashree Nikose, Mahendra Gudhe.
Background: Low back pain is a common entity with a lifetime prevalence of 65 to 80 percent in general population, and usually disrupts work, social activity and activity of daily living. The purpose of our study was to evaluate the results of interlaminar epidural steroid injection versus caudal steroid injection for patients of lower back pain with radiculopathy, due to disc prolapse or disc degeneration in terms of pain relief and complications. Methods: A total of 272 subjects having low back pain with radicular leg pain and MRI evidence of single or double level disc prolapse were chosen. Out of 272, patients were randomly assigned to two group; the first group having 131 patients and second group having 141 patients. The first group received caudal steroid injection, and second group received interlaminar epidural steroid under fluoroscopy control. Follow up for both groups was at 1 week, 6 weeks, and 12 weeks. Results: The change in pain scores were rated as mild, moderate and excellent. The interlaminar epidural steroid injection fared excellent in earlier follow up, getting to moderate at 12 weeks time. The caudal steroid injection produced moderate relief in early phase at 12 weeks time. Conclusions: The caudal steroid injection is cost effective, easy to administer and is having much less complications as compared to interlaminar steroid injection. Both these procedures are safe, well tolerated procedures, and can be performed as outpatient procedures.


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Audit of prescription notes from a tertiary health centre, AIMS, BG Nagar, India: a cross-sectional study

2015-12-09T00-52-20Z
Source: International Journal of Research in Medical Sciences
Shwetha Shivamurthy, Ghorpade Voomojirao Anand Prakash, Vinay Hosagavi Ramalingaiah.
Background: Prescription is a written order from physician to pharmacist which contains name of the drug, its dose and its method of dispensing and advice over consuming it. The frequencies of drug prescription errors are high. Prescription error contributes significantly towards adverse drug events. The present study was undertaken to understand the current prescription writing practices and to detect the common errors in them at a tertiary health care centre situated in BG Nagar, Mandya, Karnataka, India. Methods: A cross sectional study was conducted in Adichunchanagiri Institute of medical Sciences, BG nagar, Mandya, India during April- May 2015. 187 prescriptions were analyzed. Important information regarding the patient, doctor, drug and the general description of the prescription were obtained. Results: All the prescriptions were on the hospital pad. A significant number of the prescriptions were written in illegible (11%) or barely legible (20%) handwriting. The name, age and sex of the patient were not mentioned in majority of the prescriptions. All the prescriptions (100%) failed to demonstrate the presence of address, height and weight of the patient. Brand name of the drugs was mentioned in all the prescriptions with only 8% of them having the generic name. The quantity, dose and medicinal form were found missing in 1.7%, 29.5%, and 2.2% of the prescriptions. Conclusions: The findings of our study show that there is a need for improvement in the quality of prescriptions written by the doctors. The adoption of a computer aided prescribing system would go a long way in achieving this objective.


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Knowledge, attitude and practice of basic life support among junior doctors and students in a tertiary care medical institute

2015-12-09T00-52-20Z
Source: International Journal of Research in Medical Sciences
Md. Yunus, Animesh Mishra, Habib M. R. Karim, Vandana Raphael, Ghazal Ahmed, Catherine E. Myrthong.
Background: Basic life support (BLS) is an integral part of health care. However, teaching of BLS is not yet a part of protocolized curriculum and uniform throughout. The present study is designed to assess the knowledge, attitude and practice of BLS and compare it among trained and untrained medical students and junior doctors in a medical institute. Methods: After approval from Institute Ethical Committee and informed consent from the participant, the present study was conducted among the undergraduate-level medical and nursing students and junior doctors. A questionnaire consisting of 30 questions based on knowledge, attitude and practice of BLS was used to collect data which is evaluated as per scale defined for this study. Statistical significance was assessed using INSTAT software (GraphPad Software, Inc., La Zolla, USA). Results: Only 16.41% of all participants and 52% of doctors have received class and/or hands on training. The untrained participants have scored poorly as compared to trained participants in theoretical knowledge and practice of BLS (24.36 % and 53.45% versus 9.25 % and 24.07%) respectively. The mean score for both theoretical knowledge and practice of BLS for trained students was higher than that of the untrained participants and the statistical difference was highly significant - p


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Palliation of advanced/metastatic carcinoma esophagus with radiotherapy

2015-12-09T00-52-20Z
Source: International Journal of Research in Medical Sciences
R. K. Spartacus, Rajan Paliwal, Pradeep Gaur.
Background: Esophageal carcinoma carries an overall poor prognosis. Most patients present with lo¬cally advanced, unresectable or metastatic disease. The main objective in advanced disease is the palliation of dysphagia. Treatment options include surgery (bypass, resection), laser, stent placement, external beam radiotherapy (EBRT), brachytherapy and systemic chemotherapy. We have focused on our experience with EBRT followed by brachytherapy. Methods: From January 2013 to December 2014, 29 patients of advanced/metastatic esophageal cancer were treated by HDR Brachytherapy following EBRT. All patients received 2# of 5Gy HDR brachytherapy. EBRT was 40Gy/20# (18 patients) and 36Gy/12# (11 patients). Disease remission and relief of dysphagia along with toxicity assessment were carried out at 1, 3 and 6 months after completion of treatment. Results: Evaluation at 1 month after brachytherapy showed complete remission (CR) of the disease in 6 patients, partial remission (PR) in 17 patients and no remission (NR) in 6. Overall improvement in swallowing status was seen in 22(75.86%) patients. 7 patients showed no improvement and 1 reported worsening of dysphagia score at 1 month after ILRT. The improvement in swallowing was maintained by 55.17% of patients at 6 months. Strictures had developed in 5 patients, ulceration in 3 patients and fistula in 1. Conclusions: A combination of EBRT and HDR brachytherapy affords effective palliation in advanced esophageal cancer with acceptable toxicity.


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Prevalence of thyroid dysfunction in patients with diabetes mellitus

2015-12-09T00-52-20Z
Source: International Journal of Research in Medical Sciences
Sriram Shanmugam, Suresh Damodharan, Jipin Thomas Jacob.
Background: Diabetes mellitus (DM) and thyroid dysfunction (TD) are the two most common endocrine disorders in clinical practice. Various studies have found that diabetes and thyroid disorders mutually influence each other and both disorders tend to coexist. The objective of this study was to investigate the prevalence of thyroid dysfunction in patients with type 1 and type 2 diabetes mellitus. Methods: This is a prospective descriptive study which was conducted on 186 patients of diabetes mellitus who attended the outpatient diabetic clinic of Sri Ramakrishna Hospital, Coimbatore, Tamil Nadu from January 2015 to June 2015. All patients underwent a clinical and laboratory evaluation. The correlation of prevalence of thyroid disorder with gender distribution, age distribution, HbA1C, duration of diabetes, hypertension, family history of thyroid disorder, and dyslipidemia was then done. The observations and interpretations were recorded and results obtained were statistically analyzed. Results: The prevalence of thyroid dysfunction in diabetic patients was found to be 21.5%, in which the most common thyroid disorder being the subclinical hypothyroidism(12.4%) followed by subclinical hyperthyroidism (6.5%) which was followed by primary hyperthyroidism (2.7%) and primary hypothyroidism (0%).Prevalence of thyroid disorders was found to be more in males(n=95) than in females(n=91), highest in the age group of


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Effect of ticlopidine on acute and subacute models of inflammation in male wistar rats: an experimental study

2015-12-09T00-52-20Z
Source: International Journal of Research in Medical Sciences
Netravathi Basavaraj Angadi, Shrishail V. Hiremath, Vijaylakshmi V. Suranagi.
Background: Atherosclerosis and its complications remains the major cause of death and premature disability. Atherogenesis involves elements of inflammation, a process that now provides a unifying theme in the pathogenesis of the disease. Anti-platelet drugs are currently used in the treatment of atherosclerosis and its complications. Our study evaluated the influence of ticlopidine on acute and sub-acute models of inflammation in male Wistar rats. Methods: Male wistar rats (150-200g) were divided into three groups i.e. control, Aspirin and ticlopidine (n=6 animals in each group). The effect of ticlopidine, administered orally, on inflammation was studied using acute (carrageenan induced rat paw edema) and sub-acute (cotton pellet granuloma and histopathological examination of grass piths) models. Experiment was conducted according to the Committee for the Purpose of Control and Supervision on Experiments on Animals (CPCSEA) guidelines. Analysis was done using one way ANOVA followed by Post Hoc Test of Dunnets. P


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Comparing hypertonic saline and xylometazoline in allergic rhinitis

2015-12-09T00-52-20Z
Source: International Journal of Research in Medical Sciences
O. N. Sinha, Monika Deswal.
Background: Allergic rhinitis (AR) affects productivity, quality of life and performance at work. Pharmacological agents are widely used and nasal irrigation using hypertonic saline is underused. Methods: All consecutive patients presenting at the outpatient clinic with complaints of AR at Santosh Medical College Hospital from August 1, 2014 to August 31, 2015 were included in the study. Patients were randomly assigned to either xylometazoline nasal drops (0.1%, three times a day, brand Otrivin) or hypertonic seawater saline (2.2%, three times a day, brand Physiomer). They were followed for a period of 2 months. Symptom change was assessed at the start of the treatment and at the end using the Nasal Index Score (NIS), which comprised of grading blocked nose, runny nose, sneezing and eye itching on a 4-point severity scale. Results: 85 patients were included in the final analysis. On the NIS, patients receiving hypertonic nasal drops showed a decrease in mean score by 0.7, 0.5, 0.7 and 0.7 for blocked nose, runny nose, sneezing and eye irritation respectively, all of which were statistically significant. Additionally, more side effects like bloody nasal discharge, respiratory infections and headache were seen with xylometazoline nasal drops. Conclusion: Our findings suggest that using hypertonic nasal drops can reduce the dependence on pharmacological agents like xylometazoline, improve symptoms and quality of life with fewer adverse reactions.


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Pattern visual evoked potential in newly diagnosed hypertensive individuals

2015-12-09T00-52-20Z
Source: International Journal of Research in Medical Sciences
Anitha Achuthan, Girija S.
Background: Neuronal dysfunction in hypertension with multifactorial aetiology involves white matter involvement and strongly associated with presence of retinal micro vascular lesions. Cortical lesions associated with optic nerve damage and retinopathy leads to visual disturbances. VEPs are the potential changes recorded from the scalp in response to visual stimuli. Since optic nerve is considered to be the part of brain, its subclinical involvement is likely hypertension. It is in this connection the present study involving visual evoked potential was done to see if there was any change in functional integrity of visual pathways in hypertension. The aim of the study was to evaluate the visual evoked potential in newly diagnosed hypertensive patients who have not taken any antihypertensive drugs before. Methods: 50 cases were selected based on inclusion and exclusion criteria and compared with 50 age, sex matched controls. Study was conducted after getting informed consent, by using the Medicaid polyrite instrument and VEP readings had been taken by standard procedure. Results: Study shows significant P100 latency when analysed through Levenes test for equality of variances having p100 latencies for right eye 4.19±0.4 with p value of 0.003 and left eye 5.30±0.02 with p value of 0.000 substantiating prechiasmal lesion. Conclusions: Statistically significant delay in p100 suggests that the development of hypertensive retinopathy sub clinically, occurs in very early stages of Hypertension, which is not detectable on routine clinical examination. VEP can be suggested for screening in high-risk individuals to evaluate the functional integrity of visual pathway in hypertension and as a key to unravel the mystery of hidden Hypertensive Morbidity and Mortality.


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Knowledge and attitude towards family planning practices among non-acceptors in a rural area in Bangalore, India

2015-12-09T00-52-20Z
Source: International Journal of Research in Medical Sciences
Hemavarneshwari S., Mangala S., Subrahmanyam G..
Background: India became the first country in the country to launch a National family planning programme in 1952. Population explosion is still a prime problem in the country. The rate of contraceptive use is 40.4% in 2011 which is far below the National goal of Couple protection rate of 60% by 2000 A.D. The present study was carried out in a rural area, Bangalore, India. The objective of the study was to assess the knowledge and attitude towards family planning practices among non-acceptors and to find out the factors associated with non-acceptance of family planning among married women in the rural field practice area of Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India. Methods: A cross sectional study was carried out in the rural field practice area. Out of 33 villages in the rural health centre area, a total of 6 villages were selected and using cluster sampling method 235 eligible couples who were not using contraceptives were included in the study. A semi- structured questionnaire was used to collect the data during house to house visits from August to October 2012. Results: Among the 235 eligible couples, 218(92.7%) had knowledge about contraception and it was significantly associated with the level of literacy (p


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A comparative study of rapid urease test and dilute carbol fuchsin staining technique for diagnosis of Helicobacter pylori infection

2015-12-09T00-52-20Z
Source: International Journal of Research in Medical Sciences
Saleem M., Marudavanan R., Gopal R., Sunil S shivekar, Mangaiyarkarasi T..
Background: Helicobacter pylori (H.pylori) is a gram negative spiral bacilli associated with acid peptic disease (APD) and gastric carcinoma. A rapid urease test is the most common test performed for a quick clinical diagnosis with or without histopathological examination of antral biopsy specimens. Methods: In this study we evaluated the utility of a simple dilute carbol fuchsin stain (DCF) for identifying the spiral or curved forms of H.pylori in the direct smears of antral biopsy samples for diagnosis of H.pylori infection and compared the results with rapid urease test (RUT). Results: Sums of 100 cases were included in the study from which 61 (61%) were positive for urease production and shown typical spiral or curved bacilli by D.C.F stain. Conclusions: DCF stain was found to be an excellent stain for direct microscopic evaluation and compared well with RUT.


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Assessment of propranolol efficacy on pediatric haemangioma: an experimental study

2015-12-09T00-52-21Z
Source: International Journal of Research in Medical Sciences
Afshin Fathi, Mehrdad Mirzarahimi.
Background: Hemangioma is the most common vascular tumor in infancy. Recent studies show Propranolol efficacy on hemangioma treatment due to its rapid effect and a few side effects. The aim of this study was to assessment the efficacy of Propranolol on pediatric haemangioma. Methods: This quasi-experimental study was done on 20 children refer to Bu-Ali hospital. Treatment indications were multiple hemangioma, organ malfunction and enlarging hemangioma. Treatment of patients was started with 1 mg/kg/day and then increased to 3 mg/kg/day and continued for 6 month. Collected data analyzed by statistical methods in SPSS-19. Results: Patients mean age was 23.2 ± 11.2 months. 65% of them were female and 35% were male. The mean size of damages was 4.9 ± 3.3 cm. 70% of patients had acceptable response with more than 50% and 30% had partial response with less than 50% decrease in size. This effect is similar to corton effect (about 84%) but with less side effects. Conclusions: This study showed that Propranolol has acceptable effect on decreasing size of hemangioma and could be recommended as a first choice of hemangioma treatment.


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Prevalence of obesity and overweight among school children of Pune city, Maharashtra, India: a cross sectional study

2015-12-09T00-52-21Z
Source: International Journal of Research in Medical Sciences
Swati Ghonge, P. S. Adhav, Jyoti Landge, Nilesh Thakor.
Background: Obesity is associated with an increased risk of morbidity and mortality as well as reduced life expectancy. The last two decade of previous century have witnessed dramatic increase in health care cost due to obesity and related issues among children and adolescents. The objective of the study was to find out prevalence of obesity and overweight among school children. Methods: The present cross sectional study was undertaken during July 2009 to April 2011 in randomly selected 4 schools of Pune city. Total 1281 children between the age group of 10 to 15 years were examined after taking written informed consent of their parents using pre-designed, pre-tested, semi-structured performa. Anthropometric measurements were taken and BMI were calculated. The prevalence of overweight and obesity were determined based on the IOTF (International Obesity Task Force) criteria. Thus collected data was analyzed using Microsoft Excel and Open- Epi Software. (Version 2.3) Results: Out of 1281 children, 704 were from government schools and 577 were from private schools. Out of total children 54.09% were males. According to Modified Kuppuswamy Classification, all children of Private Schools belonged to Upper Class whereas it was so only in 27.41% of Government School children who belonged maximally to Upper Middle Class 378 (67.5%). Prevalence of obesity and overweight among children of government school was 2.98% and 8.23% respectively. Prevalence of obesity and overweight among children of private school was 8.83% and 12.13% respectively. Prevalence of both obesity and overweight was found to be maximum in 15 years age group both in Government schools and private schools. Overall prevalence of obesity and overweight was 5.62% and 9.99% respectively. Conclusions: High prevalence of obesity and overweight in school children indicate an urgent need to increase awareness via education and motivation of all stakeholders. This will go a long way in preventing childhood obesity and thus ultimately stemming the rising tide of non-communicable diseases such as diabetes and cardio vascular disease in India.


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Visual evoked potential changes in patients with diabetes mellitus without retinopathy

2015-12-09T00-52-21Z
Source: International Journal of Research in Medical Sciences
Sangeeta Gupta, Gaurav Gupta, V.K. Deshpande.
Background: Diabetes mellitus is a metabolic disorder, associated with a great deal of morbidity in the patients due its chronic complications including diabetic retinopathy. Visual evoked potentials (VEPs), which assess the functional integrity of the visual functions from retina to visual cortex, can prove to be a sensitive tool to study the possible effects that diabetes may exert on the visual system. In patients without clinically evident retinopathy, electrophysiological evidence of visual dysfunction can help in early detection of the visual involvement. Hence, this study attempted to detect the presence of such visual dysfunctions in the diabetics without retinopathy by pattern- reversal visual evoked potentials (PRVEPs). Methods: PRVEP was recorded in 116 subjects (64 diabetics without retinopathy and 52 controls). P100 latency, N75-P100 amplitude and interocular latency differences were compared between the diabetics and the controls. The parameters were compared among the groups with different duration of the disease as well as those with different glycaemic status. Results: The study has demonstrated significant prolongation of mean P100 latency, reduction in N75-P100 amplitudes and increased interocular latency difference in the diabetics as compared to the control group. The duration of the illness was found to alter the mean P100 latency while the glycaemic status of the diabetics was not found to be correlated with the PRVEP abnormalities. Conclusions: VEP responses are deranged in diabetic patients before the development of retinopathy. VEP measurements can be used for the early diagnosis of visual dysfunctions in the diabetes for a better prognosis of the condition.


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The study of laparoscopic cholecystectomy and its conversion to open cholecystectomy: analysis of 100 cases in Navi Mumbai, India

2015-12-09T00-52-21Z
Source: International Journal of Research in Medical Sciences
Nandkishor Narwade, Tanveer Shaikh, Rishabh Jain, Naseem Khan, Mithilesh Ghosalkar, Sharique Ansari, Yashashvi Sharma.
Background: Laparoscopic cholecystectomy has now become a better option instead of open cholecystectomy for the treatment of cholelithiasis that is it has become a gold standard for cholelithiasis condition. Last century has been the most fruitful era for the treatment of biliary tract disease as it saw the progress from open to laparoscopic surgery with single port surgery etc. Methods: The purpose of our study is grading of Laparoscopic cholecystectomy and studying the outcome of problematic and challenging Laparoscopic cholecystectomy cases, its complication and management, to decide when to convert Laparoscopic cholecystectomy to open cholecystectomy. This study analyzes the conversion rate of laparoscopic cholecystectomy to open cholecystectomy in Navi Mumbai, India. This is a retrospective study of 100 patients conducted from October 2012 to October 2014. Results: Out of the 100 cases 98 got successfully operated by Laparoscopic cholecystectomy. Only 2 cases out of 100 got converted from Laparoscopic to open cholecystectomy and they belonged to grade E with empyema. Conclusions: Laparoscopic cholecystectomy has become the procedure of choice for management of symptomatic gall bladder. Laparoscopic cholecystectomy intra operatively for grade A to E where Grade A is very easy level of performing Gall bladder surgery to Grade E where conversion is 100% due to bad.


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Assessment of ferritin and its association with C - reactive protein and malondialdehyde in acute myocardial infarction

2015-12-09T00-52-21Z
Source: International Journal of Research in Medical Sciences
Vijaya Bhaskar M., Srilekha S., Saranya M., Balu Mahendran K., Madhulatha M..
Background: There is increasing evidence that moderately elevated body iron stores, below levels commonly found in genetic hemochromatosis, may be associated with adverse health outcomes. Ferritin status has been implicated in atherosclerotic cardiovascular disease and hypothesis is that high iron status is associated with increased oxidation of LDL. The main objective of study is to evaluate the ferritin status and its association with C - reactive protein, malondialdehyde and serum lipids in acute myocardial infarction patients compared with healthy volunteers. Methods: Sixty seven acute myocardial infarction (AMI) patients in the age group of 30 to 50 years were selected for this study and 40 healthy age matched subjects were selected as control group. Diagnosis of AMI was made using guidelines of American College of Cardiology and European Society of Cardiology. The comprised group of 67 consecutive patients was divided based on the C - reactive protein (CRP) level into two groups (Group I


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Acid fast bacillus pulmonary and extra pulmonary in a laboratory of university hospital center in Antananarivo, Madagascar since 2003-2014

2015-12-09T00-52-21Z
Source: International Journal of Research in Medical Sciences
Andry M. Andrianarivelo, Lalaina M. Rakotondraoelina, Solofo S. Rafaramalala, Tojoniaina H. Andriamandimbisoa, Rado L. Randriamboavonjy, C. Rafalimanana, A. Rasamindrakotroka.
Background: Tuberculosis has even been a grave public health problem in Madagascar, one of the main causes responsible for death at the hospital for active and productive people. Methods: It was a descriptive and analytical retrospective study of patient records admitted for the research of acid-fast bacillus (AFB) pulmonary and extra pulmonary from January 2003 to December 2014 at the microbiology laboratory of the University Hospital Joseph Ravoahangy Andrianavalona (HU-JRA) Antananarivo, Madagascar. We did this study in order to describe the epidemiology of pulmonary and extra pulmonary tuberculosis at the laboratory. All of the requests about researching AFB for bacterial analysis have been received. Incomplete folders have been rejected. Age, sex, clinic information and the results of AFB research have been analyzed. Results: During 12 years, 1060 requests have been received to research AFB with 89 cases (8.39%) of positivity. Patients were between 9 months and 93 years old. The middle patient age was 41.7 years. Sex-ratio of infected patients was 1.36. There was a significant difference between gender and positive cases (p=0,001). 82 positive cases (93.77%) were pulmonary localization and 7 cases of extra pulmonary (6.23%). Conclusions: Despite the lack of screening, the high rate of bacillary pulmonary tuberculosis found was one of the great epidemiological importances because of their contagiousness. It is obvious that only health actions cannot solve the problem of tuberculosis.


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Knowledge and awareness of tuberculosis in caregivers of paediatric tuberculosis patients of north Gujarat region, India: a cross sectional study

2015-12-09T00-52-21Z
Source: International Journal of Research in Medical Sciences
Yagnavalkya Jani, G.D. Bhambhani, Nilesh Thakor.
Background: Tuberculosis (TB) continues to be one of the most important public health problems worldwide. Children are especially vulnerable to the effects of tuberculosis, which is often difficult to diagnose and therefore difficult to treat effectively. The compliance for treatment can be increased if caregivers of paediatric TB patients are well aware about the disease, treatment and preventive measures. Methods: This cross sectional observational, descriptive epidemiological study was conducted at GMERS medical college and hospital Dharpur-Patan located in north Gujarat during January 2015 to June 2015. The study was conducted among all the 151 pediatric TB patients who were currently under treatment at selected hospital. Caregivers of the patients were informed about the purpose of the study and their informed written consent was taken. By interviewing them on the basis of pre-designed and pre tested preform, information regarding socio demographic profile, knowledge and awareness regarding TB was collected. The collected data was analyzed using statistical package for social science (SPSS 17 Trial version). Results: Only 68 (45.0 %) caregivers of patients had knowledge regarding mode of spread of TB infection to others. 89 (58.9%) caregivers of patients knew about curability of the disease. 104 (68.9%) caregivers of patients had knowledge regarding DOTS (Directly Observed Treatment Short course chemotherapy) centre for TB treatment under RNTCP (Revised National Tuberculosis Control Programme). 32.3% caregivers of the patients knew that TB can be prevented by BCG vaccine. The literacy status had a significant influence on awareness about TB. Conclusions: Apart from pharmacological treatment poor knowledge of tuberculosis in caregivers of the paediatric TB patients also needs great attention for better control and prevention of TB in paediatric age group.


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Context matters: faculty norms on binge drinking relate to binge drinking behaviour in higher education

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The maternal nutrition and offsprings' epigenome (MANOE) study: a prospective, monicentric, observational study

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Teacher educators' professional development: conceptualisation and operationalisation of teacher educators' researcherly disposition

From the beginning of the twenty-first century, workplace learning receives increased attention in both research literature and policy documents. In this respect, teacher educators are often perceived as a unique vocational group with specific vocational needs. Focusing on these specific needs and characteristics, teacher educators' professional development can be conceptualized as the development of a researcherly disposition. This refers to teacher educators' habit of mind to engage in research – as both a consumer of research and a producer of research to improve their own practice and to contribute to the knowledge base on teacher education. In the current study, this concept is operationalized into a valid and reliable measurement instrument 'The Teacher Educators' Researcherly Disposition Scale – TERDS' enabling the measurement of teacher educators' professional development. Taking into account the shortcomings in the emerging research field on teacher educators' professional development - which is largely characterized by small-scaled and qualitative studies - a large-scale quantitative survey study (n = 944) was conducted. An exploratory factor analysis (n= 472) and a confirmative factor analysis (n=472) revealed a valid and reliable four-factor structure of teacher educators' researcherly disposition consisting of: (1) 'Valuing research as a teacher educator'(α= .86), (2) 'Being a smart consumer of research' (α= .89), (3) 'Being able to conduct research as a teacher educator'(α= .82), and (4) 'Conducting research as a teacher educator'(α= .87). Goodness of fit estimates were calculated, all indicating good fit. To conclude, implications for further research and practices on teacher educators' professional development are discussed.

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Sociopolitical determinants of international health policy

For decades, two opposing logics have dominated the health policy debate: a comprehensive health care approach, with the 1978 Alma Ata Declaration as its cornerstone, and a private competition logic, emphasizing the role of the private sector. We present this debate and its influence on international health policies in the context of changing global economic and sociopolitical power relations in the second half of the last century. The neoliberal approach is illustrated with Chile's health sector reform in the 1980s and the Colombian reform since 1993. The comprehensive public logic is shown through the social insurance models in Costa Rica and in Brazil and through the national public health systems in Cuba since 1959 and in Nicaragua during the 1980s. These experiences emphasize that health care systems do not naturally gravitate toward greater fairness and efficiency, but require deliberate policy decisions.

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Molecular epidemiology of tuberculosis in Havana, Cuba, 2009

Objectives: To estimate the proportion of tuberculosis cases attributable to recent transmission and the risk factors possibly associated with tuberculosis clustering. Methods: Population-based study combining information from epidemiological investigation of tuberculosis cases notified to the National Tuberculosis Control Program in Havana, Cuba, in 2009 with the results of genotyping of Mycobacterium tuberculosis isolates with variable number tandem repeat of mycobacterial interspersed repetitive units (MIRU-VNTR) typing. Results: Of 186 cases, 61 were genotyped: 33 patterns and five clusters with 19, 7, 3, 2 and 2 cases were found. The proportion of cases due to recent transmission was 45% (95% confidence interval 33-58%). Routine contact investigation failed to identify a substantial number of epidemiological links. A history of living in a closed setting was strongly associated with clustering. Conclusions: The proportion of cases due to recent transmission in Havana in 2009 is high. The existing control measures in closed settings should be strengthened. A study on a larger number of cases and for a longer time period should be carried out to obtain more precise estimates. Further studies on the utility and cost-effectiveness of the addition of molecular epidemiology techniques to support the progress towards tuberculosis elimination in Cuba, a low-incidence resource-limited setting, are also needed.

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Metaplastic carcinoma of the breast with widespread telangiectatic form of osteosarcomatous differentiation

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Application of international norms to social media: cases of Egypt and Libya

2015-12-09T00-29-48Z
Source: Case Study and Case Report
Young Joon Lim.
With respect to the initial stage of the Tunisian revolution until today‟s Syrian uproar, it is worth noting that the emergence of social media such as Twitter, Facebook and TouTube played a partial or paramount role depending on who evaluates social media‟s role in eliciting rapid and crucial international social changes among aforementioned countries.


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Revival of nitrogen-containing bisphosphonate-induced inhibition of osteoclastogenesis and osteoclast function by water-soluble microfibrous borate glass

Publication date: Available online 8 December 2015
Source:Acta Biomaterialia
Author(s): He Yuan, Li-na Niu, Kai Jiao, Dan-dan Pei, Chandrani Pramanik, Ji-yao Li, Regina Messer, Satish Kumar, David H. Pashley, Franklin R. Tay
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious skeletal complication associated with the long-term oral or intravenous use of nitrogen-containing bisphosphonates (N-BPs). Here, we investigated the effects of an ionic cocktail prepared from water-soluble microfibrous borate glass on neutralizing the inhibitory effects of two heterocyclic N-BPs, risedronate or zoledronic acid, on osteoclastogenesis, apoptosis of differentiated osteoclasts and osteoclast function. Cell growth and proliferation assays were first performed on RAW 264.7 cells to optimize the concentrations of the ionic cocktail and N-BPs to be used for static cell culture. The pre-osteoclasts were then stimulated with RANKL to differentiate into osteoclasts. The effects of the ionic cocktail and N-BPs on osteoclast differentiation, apoptosis and function were subsequently examined using 3 series of experiments conducted at the gene, protein, morphological and functional levels. After concentration optimization, the ionic cocktail was found to partially reverse N-BP-induced inhibition of osteoclastogenesis, stimulation of osteoclasts apoptosis and reduction of osteoclast resorptive activity. Ultrastructural examination of osteoclasts that had been exposed to either N-BP identified classical features of late apoptosis and secondary necrosis, while osteoclasts exposed simultaneously to the concentration-optimized ionic cocktail and N-BPs exhibited only signs of early apoptosis that were possibly reversible. Taken together, the results of the 4 series of experiments indicate that the ionic cocktail produced from dissolution of borate glass dressings has the potential to rescue the adverse effects of heterocyclic N-BPs on osteoclast differentiation and function. These results warrant further confirmation using dynamic cell culture and small animal BRONJ models.

Graphical abstract

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Modulation of MAPK signalling by immobilized adhesive peptides: effect on stem cell response to BMP-9-derived peptides

Publication date: Available online 8 December 2015
Source:Acta Biomaterialia
Author(s): Sabrina Beauvais, Olivier Drevelle, Marc-Antoine Lauzon, Alex Daviau, Nathalie Faucheux
Biomimetic materials were developed to regulate stem cell behaviour. We have analysed the influence of polycaprolactone (PCL) films, functionalized with adhesive peptides derived from fibronectin (pFibro) or bone sialoprotein (pBSP), on the response of murine multipotent C3H10T1/2 cells to bone morphogenetic protein-9 (BMP-9) and its derived peptides (pBMP-9 and SpBMP-9). PCL-pFibro promoted better cell cytoskeleton organization and faster focal adhesion kinase activation than did PCL-pBSP. PCL-pFibro also promoted MAPK signalling to improve the cell response to BMP-9 by inactivating ERK1/2 and stimulating p38 and JNK. BMP-9, pBMP-9 and SpBMP-9 induced greater phosphorylation of Smad1/5/8 in cells attached to PCL-pFibro than in cells on PCL-pBSP. These phosphorylated Smad1/5/8 were translocated to the nucleus. BMP-9 and its derived peptides restored the phosphorylation of JNK in cells on PCL-pBSP, but it remained less phosphorylated than in cells on PCL-pFibro stimulated with pBMP-9 and SpBMP-9. Cells attached to PCL-pFibro contained more Runx2, essential for stem cell commitment to become osteoblasts, than did cells on PCL-pBSP when incubated with BMP-9 and its derived peptides. Runx2 was no longer detected when the cells were pre-treated with JNK inhibitor. Therefore pFibro plus BMP-9 and its derived peptides may be a promising strategy to develop biomimetic materials.

Graphical abstract

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A mechanistic study of the interaction of water-soluble borate glass with apatite-bound heterocyclic nitrogen-containing bisphosphonates

Publication date: Available online 8 December 2015
Source:Acta Biomaterialia
Author(s): Chandrani Pramanik, Parveen Sood, Li-na Niu, He Yuan, Sushanta Ghoshal, Walter Henderson, Yaodong Liu, Seung Soon Jang, Satish Kumar, David H. Pashley, Franklin R. Tay
Long-term oral and intravenous use of nitrogen-containing bisphosphonates (N-BPs) is associated with osteonecrosis of the jaw. Although N-BPs bind strongly to bone surfaces via non-covalent bonds, it is possible for extrinsic ions to dissociate bound N-BPs from mineralized bone by competitive desorption. Here, we investigate the effects and mechanism of using an ionic cocktail derived from borate bioactive glass for sequestration of herterocyclic N-BPs bound to apatite. By employing solid-state and solution-state analytical techniques, we confirmed that sequestration of N-BPs from bisphosphonate-bound apatite occurs in the presence of the borate-containing ionic cocktail. Simulations by density functional theory computations indicate that magnesium cation and borate anion are well within the extent of the risedronate or zoledronate anion to form precipitate complexes. The sequestration mechanism is due to the borate anion competing with bisphosphonates for similar electron-deficient sites on the apatite surface for binding. Thus, application of the borate-containing ionic cocktail represents a new topical lavage approach for removing apatite-bound heterocyclic N-BPs from exposed necrotic bone in bisphosphonate-related osteonecrosis of the jaw.

Graphical abstract

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Developing high strength and ductility in biomedical Co–Cr cast alloys by simultaneous doping with nitrogen and carbon

Publication date: Available online 8 December 2015
Source:Acta Biomaterialia
Author(s): Kenta Yamanaka, Manami Mori, Akihiko Chiba
There is a strong demand for biomedical Co−Cr-based cast alloys with enhanced mechanical properties for use in dental applications. We present a design strategy for development of Co−Cr−W-based cast alloys with very high strength, comparable to that of wrought Co−Cr alloys, without loss of ductility. The strategy consists of simultaneous doping of nitrogen and carbon, accompanied by increasing of the Cr content to increase the nitrogen solubility. The strategy was verified by preparing Co−33Cr−9W−0.35N−(0.01−0.31)C (mass%) alloys. We determined the carbon concentration dependence of the microstructures and their mechanical properties. Metal ion release of the alloys in an aqueous solution of 0.6% sodium chloride (NaCl) and 1% lactic acid was also evaluated to ensure their corrosion resistance. As a result of the nitrogen doping, the formation of a brittle σ-phase, a chromium-rich intermetallic compound, was significantly suppressed. Adding carbon to the alloys resulted in finer-grained microstructures and carbide precipitation; accordingly, the strength increased with increasing carbon concentration. The tensile ductility, on the other hand, increased with increasing carbon concentration only up to a point, reaching a maximum at a carbon concentration of ∼0.1 mass% and decreasing with further carbon doping. However, the alloy with 0.31 mass% of carbon exhibited 14% elongation and also possessed very high strength (725 MPa in 0.2% proof stress). The addition of carbon did not significantly degrade the corrosion resistance. The results show that our strategy realizes a novel high-strength Co−Cr-based cast alloy that can be produced for advanced dental applications using a conventional casting procedure.

Graphical abstract

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Titanium Surface Characteristics, Including Topography and Wettability, Alter Macrophage Activation

Publication date: Available online 7 December 2015
Source:Acta Biomaterialia
Author(s): Kelly M. Hotchkiss, Gireesh B. Reddy, Sharon L. Hyzy, Zvi Schwartz, Barbara D. Boyan, Rene Olivares-Navarrete
Biomaterial surface properties including chemistry, topography, and wettability regulate cell response. Previous studies have shown that increasing surface roughness of metallic orthopaedic and dental implants improved bone formation around the implant. Little is known about how implant surface properties can affect immune cells that generate a wound healing microenvironment. The aim of our study was to examine the effect of surface modifications on macrophage activation and cytokine production. Macrophages were cultured on seven surfaces: tissue culture polystyrene (TCPS) control; hydrophobic and hydrophilic smooth Ti (PT and oxygen-plasma-treated (plasma) PT); hydrophobic and hydrophilic microrough Ti (SLA and plasma SLA), and hydrophobic and hydrophilic nano-and micro-rough Ti (aged modSLA and modSLA). Smooth Ti induced inflammatory macrophage (M1-like) activation, as indicated by increased levels of interleukins IL-1β, IL-6, and TNFα. In contrast, hydrophilic rough titanium induced macrophage activation similar to the anti-inflammatory M2-like state, increasing levels of interleukins IL-4 and IL-10. These results demonstrate that macrophages cultured on high surface wettability materials produce an anti-inflammatory microenvironment, and this property may be used to improve the healing response to biomaterials.

Graphical abstract

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Controlled Cell Growth and Cell Migration in Periodic Mesoporous Organosilica/Alginate Nanocomposite Hydrogels

Nanocomposite (NC) hydrogels with different periodic mesoporous organosilica (PMO) concentrations and a NC hydrogel bilayer with various PMO concentrations inside the layers of the hydrogel matrix are prepared. The effect of the PMO concentration on cell growth and migration of cells is reported. The cells migrate in the bilayer NC hydrogel towards higher PMO concentrations and from cell culture plates to NC hydrogel scaffolds.

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Osteotomising the fibular free flap: an anatomical perspective

Publication date: Available online 8 December 2015
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A.M. Fry, Dave Laugharne, Keith Jones
Multiple osteotomies with the help of 3-dimensional planning have improved the accuracy of reconstructions, and the reliability and versatility of the fibular free flap is well recognised. To investigate the periosteal blood supply of the fibula and to define safe limits for the size of bony segments, we performed a cadaveric study on 10 fresh frozen lower limbs using a combined barium latex mixture. We modelled cuts at intervals of 1.0, 1.5, and 2.0cm, and assessed the number of periosteal vessels. After virtual dissections using DICOM data obtained from high-resolution computed tomograms (CT), on average we found 12.8 periosteal branches, with a mean (SD) distance between them of 1.36 (0.18)cm. In 34.9% of the 1cm segments there were no visible periosteal vessels. Vascularity seemed to be more reliable in longer segments, with 83.4% of those 1.5cm long, and 94% of those of over 2cm containing at least one branch.



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Mapping fear of crime as a context-dependent everyday experience that varies in space and time

Solymosi, R; Bowers, K; Fujiyama, T; (2015) Mapping fear of crime as a context-dependent everyday experience that varies in space and time. Legal and Criminological Psychology , 20 (2) 193- 211. 10.1111/lcrp.12076 .

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Trust in Mediated Interactions

Riegelsberger, J; Sasse, A; McCarthy, JD; (2009) Trust in Mediated Interactions. In: Joinson, AM and McKenna, KYA and Postmes, T and Reips, UD, (eds.) Oxford Handbook of Internet Psychology. Oxford University Press: Oxford, UK. Green open access

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Calcium peroxide from ambient to high pressures

Nelson, JR; Needs, RJ; Pickard, CJ; (2015) Calcium peroxide from ambient to high pressures. Physical Chemistry Chemical Physics , 17 (10) pp. 6889-6895. 10.1039/c4cp05644b . Green open access

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Academic drug discovery within the United Kingdom: a reassessment

Shanks, E; Ketteler, R; Ebner, D; (2015) Academic drug discovery within the United Kingdom: a reassessment. Nature Reviews Drug Discovery , 14 (7) p. 510. 10.1038/nrd4661 .

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Application guide for omics approaches to cell signaling

Yao, Z; Petschnigg, J; Ketteler, R; Stagljar, I; (2015) Application guide for omics approaches to cell signaling. Nature Chemical Biology , 11 (6) pp. 387-397. 10.1038/nchembio.1809 .

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Towards a global terrestrial species monitoring program

Schmeller, DS; Julliard, R; Bellingham, PJ; Böhm, M; Brummitt, N; Chiarucci, A; Couvet, D; Schmeller, DS; Julliard, R; Bellingham, PJ; Böhm, M; Brummitt, N; Chiarucci, A; Couvet, D; Elmendorf, S; Forsyth, DM; Moreno, JG; Gregory, RD; Magnusson, WE; Martin, LJ; McGeoch, MA; Mihoub, J-B; Pereira, HM; Proença, V; van Swaay, CAM; Yahara, T; Belnap, J; - view fewer (2015) Towards a global terrestrial species monitoring program. [Review]. Journal for Nature Conservation , 25 pp. 51-57. 10.1016/j.jnc.2015.03.003 .

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The educational impacts of young people's participation in organised sport: a systematic review

Schucan Bird, K; Tripney, J; Newman, M; (2013) The educational impacts of young people's participation in organised sport: a systematic review. Journal of Children's Services , 8 (4) pp. 264-275.

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The interfascicular matrix enables fascicle sliding and recovery in tendon, and behaves more elastically in energy storing tendons

Thorpe, CT; Godinho, MS; Riley, GP; Birch, HL; Clegg, PD; Screen, HR; (2015) The interfascicular matrix enables fascicle sliding and recovery in tendon, and behaves more elastically in energy storing tendons. Journal of the Mechanical Behavior of Biomedical Materials , 52 pp. 85-94. 10.1016/j.jmbbm.2015.04.009 . Green open access

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Upregulation of gingival tissue miR-200b in obese periodontitis subjects

Kalea, AZ; Hoteit, R; Suvan, J; Lovering, RC; Palmen, J; Cooper, JA; Khodiyar, VK; Kalea, AZ; Hoteit, R; Suvan, J; Lovering, RC; Palmen, J; Cooper, JA; Khodiyar, VK; Harrington, Z; Humphries, SE; D'Aiuto, F; - view fewer (2015) Upregulation of gingival tissue miR-200b in obese periodontitis subjects. Journal of Dental Research , 94 (3 Supp) 59S-69S. 10.1177/0022034514568197 .

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Pharmacist's review and outcomes: Treatment-enhancing contributions tallied, evaluated, and documented (PROTECTED-UK)

Shulman, R; McKenzie, CA; Landa, J; Bourne, RS; Jones, A; Borthwick, M; Tomlin, M; Shulman, R; McKenzie, CA; Landa, J; Bourne, RS; Jones, A; Borthwick, M; Tomlin, M; Jani, YH; West, D; Bates, I; - view fewer (2015) Pharmacist's review and outcomes: Treatment-enhancing contributions tallied, evaluated, and documented (PROTECTED-UK). Journal of Critical Care , 30 (4) pp. 808-813. 10.1016/j.jcrc.2015.04.008 .

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Visualizing the molecular recognition trajectory of an intrinsically disordered protein using multinuclear relaxation dispersion NMR

Schneider, R; Maurin, D; Communie, G; Kragelj, J; Hansen, DF; Ruigrok, RW; Jensen, MR; Schneider, R; Maurin, D; Communie, G; Kragelj, J; Hansen, DF; Ruigrok, RW; Jensen, MR; Blackledge, M; - view fewer (2015) Visualizing the molecular recognition trajectory of an intrinsically disordered protein using multinuclear relaxation dispersion NMR. Journal of the American Chemical Society , 137 (3) pp. 1220-1229. 10.1021/ja511066q .

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Electrospun medicated shellac nanofibers for colon-targeted drug delivery

Wang, X; Yu, DG; Li, XY; Bligh, SW; Williams, GR; (2015) Electrospun medicated shellac nanofibers for colon-targeted drug delivery. International Journal of Pharmaceutics , 490 (1-2) pp. 384-390. 10.1016/j.ijpharm.2015.05.077 .

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Teachers' classroom feedback: still trying to get it right

Hargreaves, E; (2012) Teachers' classroom feedback: still trying to get it right. Pedagogies: An International Journal , 7 (1) pp. 1-15. 10.1080/1554480X.2012.630454 .

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Characterisation of four Drosophila proteins involved in regulation of gene expression.

Andersen, D.S.; (2008) Characterisation of four Drosophila proteins involved in regulation of gene expression. Doctoral thesis, University of London. Green open access

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A constellation scaling approach to vector perturbation for adaptive modulation in MU-MIMO

Li, A; Masouros, C; (2015) A constellation scaling approach to vector perturbation for adaptive modulation in MU-MIMO. IEEE Wireless Communications Letters , 4 (3) pp. 289-292. 10.1109/LWC.2015.2410271 . Green open access

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Physiological phenotyping of dementias using emotional sounds

Fletcher, PD; Nicholas, JM; Shakespeare, TJ; Downey, LE; Golden, HL; Agustus, JL; Clark, CN; Fletcher, PD; Nicholas, JM; Shakespeare, TJ; Downey, LE; Golden, HL; Agustus, JL; Clark, CN; Mummery, CJ; Schott, JM; Crutch, SJ; Warren, JD; - view fewer (2015) Physiological phenotyping of dementias using emotional sounds. Alzheimer's and Dementia: Diagnosis, Assessment and Disease Monitoring , 1 (2) pp. 170-178. 10.1016/j.dadm.2015.02.003 . Green open access

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Efficient integration of synaptic events by NMDA receptors in three-dimensional neuropil

Zheng, K; Rusakov, DA; (2015) Efficient integration of synaptic events by NMDA receptors in three-dimensional neuropil. Biophysical Journal , 108 (10) pp. 2457-2464. 10.1016/j.bpj.2015.04.009 . Green open access

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