Composition dependent mechanical behaviour of S53P4 bioactive glass putty for bone defect grafting.

Composition dependent mechanical behaviour of S53P4 bioactive glass putty for bone defect grafting.

J Mech Behav Biomed Mater. 2017 Jan 18;69:301-306

Authors: van Gestel NA, Hulsen DJ, Geurts J, Hofmann S, Ito K, Arts JJ, van Rietbergen B

Abstract
To improve the handling properties of S53P4 bioactive glass granules for clinical applications, bioactive glass putty formulations were developed. These formulations contain both granules and a synthetic binder to form an injectable material that is easy to shape. To explore its applicability in load-bearing bone defect grafting, the relation between the putty composition and its mechanical behaviour was assessed in this study. Five putty formulations with variations in synthetic binder and granule content were mechanically tested in confined compression. The results showed that the impaction strains significantly decreased and the residual strains significantly increased with an increasing binder content. The stiffness of all tested formulations was found to be in the same range as the reported stiffness of cancellous bone. The measured creep strains were low and no significant differences between formulations were observed. The stiffness significantly increased when the samples were subjected to a second loading stage. The residual strains calculated from this second loading stage were also significantly different from the first loading stage, showing an increasing difference with an increasing binder content. Since residual strains are detrimental for graft layer stability in load-bearing defects, putty compositions with a low binder content would be most beneficial for confined, load-bearing bone defect grafting.

PMID: 28131065 [PubMed - as supplied by publisher]

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Use of mixture design in drug-excipient compatibility determinations: Thymol nanoparticles case study.

Use of mixture design in drug-excipient compatibility determinations: Thymol nanoparticles case study.

J Pharm Biomed Anal. 2017 Jan 22;137:196-203

Authors: Pires FQ, Angelo T, Silva JK, Sá-Barreto LC, Lima EM, Gelfuso GM, Gratieri T, Cunha-Filho MS

Abstract
The objective of this work was to access thymol-excipient compatibility using an alternative protocol of mixture design subsidizing the development of nanostructures lipid carriers containing this drug. Simultaneous DTA-TG analyses associated with infrared spectroscopy were performed according to simplex centroid mixture designs with three components. Two designs were used: the design A containing stearic acid (SA), soybean lecithin (LC), and sodium taurodeoxycholate (TAU) and the design B, where TAU was replaced by polysorbate 80 (P80). Assays allowed for a quantitative evaluation of thermal events involved with thymol (TML) - melting and evaporation -, as well as events related to excipients decomposition and overall system stability. Although the anionic surfactant TAU did not interact with TML in solid state, chemical and physical stability were compromised after drug melting. Alternatively, nonionic surfactant P80 could be a good excipient option, as TML formulation stability was not influenced by it. Fatty acid SA did not compromise TML stability alone, but, when in combination with other formulation components, negative interaction leading to a possible decomposition of the system was observed. Finally, phospholipid LC solubilizes TML extending its evaporation to higher temperatures; hence, drug stability may be increased. In conclusion, the use of mixture design in the evaluation of multicomponent systems is a valuable tool for identification of synergistic effects of excipients, providing more complete information on formulation development. In addition, the association of techniques employed allowed inferring with certainty if thermal interactions could compromise formulation stability.

PMID: 28131059 [PubMed - as supplied by publisher]

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Iron-biofortified staple food crops for improving iron status: a review of the current evidence.

Iron-biofortified staple food crops for improving iron status: a review of the current evidence.

Curr Opin Biotechnol. 2017 Jan 25;44:138-145

Authors: Finkelstein JL, Haas JD, Mehta S

Abstract
Iron deficiency is the most common micronutrient deficiency globally and represents a major threat to public health. Biofortification, the process of enhancing micronutrient content and bioavailability in staple crops, represents an exciting sustainable food-based strategy to combat and prevent iron deficiency, particularly in resource-limited settings. In this review, we examine the evidence to date of the efficacy of iron-biofortified staple food crops on improving iron status in at-risk populations, including rice, pearl millet, and beans. Three randomized efficacy trials of iron biofortified interventions were included in this analysis, conducted in the Philippines, India, and Rwanda. Iron status (hemoglobin, serum ferritin, soluble transferrin receptor (sTfR), C-reactive protein, alpha-1 acid glycoprotein) was measured at enrollment, midline, and endline in each trial. The primary outcomes evaluated included hemoglobin, serum ferritin, sTfR, and total body iron. A meta-analysis using random effects models was conducted to examine the effects of interventions on hematological outcomes, with the DerSimonian and Laird method. In meta-analyses of data from the three trials, iron-biofortified interventions significantly increased serum ferritin concentrations and total body iron. Evidence to date from randomized trials suggest that iron-biofortified crops are an efficacious intervention to improve iron status. In particular, findings from all three trials also indicate that the effects of biofortified staple crops were highest among individuals who were iron deficient at baseline, suggesting the greatest potential to benefit. Assessment of functional outcomes and consideration of other high-risk populations such as young children, are warranted to elucidate the impact of iron-biofortified interventions on human health.

PMID: 28131049 [PubMed - as supplied by publisher]

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"Too much medicine": Insights and explanations from economic theory and research.

"Too much medicine": Insights and explanations from economic theory and research.

Soc Sci Med. 2017 Jan 18;176:77-84

Authors: Hensher M, Tisdell J, Zimitat C

Abstract
Increasing attention has been paid in recent years to the problem of "too much medicine", whereby patients receive unnecessary investigations and treatments providing them with little or no benefit, but which expose them to risks of harm. Despite this phenomenon potentially constituting an inefficient use of health care resources, it has received limited direct attention from health economists. This paper considers "too much medicine" as a form of overconsumption, drawing on research from health economics, behavioural economics and ecological economics to identify possible explanations for and drivers of overconsumption. We define overconsumption of health care as a situation in which individuals consume in a way that undermines their own well-being. Extensive health economics research since the 1960s has provided clear evidence that physicians do not act as perfect agents for patients, and there are perverse incentives for them to provide unnecessary services under various circumstances. There is strong evidence of the existence of supplier-induced demand, and of the impact of various forms of financial incentives on clinical practice. The behavioural economics evidence provides rich insights on why clinical practice may depart from an "evidence-based" approach. Moreover, behavioural findings on health professionals' strategies for dealing with uncertainty, and for avoiding potential regret, provide powerful explanations of why overuse and overtreatment may frequently appear to be the "rational" choice in clinical decision-making, even when they cause harm. The ecological economics literature suggests that status or positional competition can, via the principal-agent relationship in health care, provide a further force driving overconsumption. This novel synthesis of economic perspectives suggests important scope for interdisciplinary collaboration; signals potentially important issues for health technology assessment and health technology management policies; and suggests that cultural change might be required to achieve significant shifts in clinical behaviour.

PMID: 28131024 [PubMed - as supplied by publisher]

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Uniqueness of the anterior dentition three-dimensionally assessed for forensic bitemark analysis.

Uniqueness of the anterior dentition three-dimensionally assessed for forensic bitemark analysis.

J Forensic Leg Med. 2017 Jan 21;46:58-65

Authors: Franco A, Willems G, Souza P, Coucke W, Thevissen P

Abstract
The uniqueness of the human dentition (UHD) is an important concept in the comparative process in bitemark analysis. During this analysis, the incisal edges of the suspects' teeth are matched with the bitemarks collected from the victim's body or crime scenes. Despite playing an essential part to exclude suspects, the UHD contained in the involved incisal tooth edges remains an assumption on bitemark level. The present study was aimed, first, to investigate three-dimensionally (3D) the UHD within different quantities of dental material from the incisal edges; second, to test these outcomes in a bidimensional (2D) simulation. Four-hundred forty-five dental casts were collected to compose 4 study groups: I - randomly-selected subjects, II - orthodontically treated subjects, III - twins and IV - orthodontically treated twins. Additionally, 20 dental casts were included to create threshold groups on subjects from whom the dental impressions were taken at 2 different moments (Group V). All the dental casts were digitalized with an automated motion device (XCAD 3D(®) (XCADCAM Technology(®), São Paulo, SP, Brazil). The digital cast files (DCF) were integrated in Geomagic Studio(®) (3D Systems(®), Rock Hill, SC, USA) software package (GS) for cropping, automated superimposition and pair-wise comparisons. All the DCF were cropped remaining 3 mm (part 1), 2 mm (part 2) and 1 mm (part 3) from the incisal edges of the anterior teeth. For a 2D validation, slices of 1 mm, not including incisal edges (part 4), were also cropped. These procedures were repeated in Group V, creating specific thresholds for each of the study parts. The 4 study groups were compared with its respective threshold using ANOVA test with statistical significance of 5%. Groups I, II and III did not differ from the corresponding threshold (Group V) in all study parts (p > 0.05). Scientific evidence to support the UHD was not observed in the current study. Bitemark analysis should not be disregarded but considered carefully when the suspects present similar dental alignment and morphology, such as in orthodontically treated subjects and twins, respectively.

PMID: 28131012 [PubMed - as supplied by publisher]

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How Appropriate Is All This Data Sharing? Building Consensus Around What We Need to Know About Shared Electronic Health Records in Extended Circles of Care.

How Appropriate Is All This Data Sharing? Building Consensus Around What We Need to Know About Shared Electronic Health Records in Extended Circles of Care.

Healthc Q. 2017;19(4):28-36

Authors: McMurray J, Grindrod KA, Burns C

Abstract
BACKGROUND: The bulk of healthcare spending is on individuals who have complex needs related to age, income, chronic disease and mental illness. Care involves many different professions, and interoperable electronic health records (EHRs) are increasingly essential.
OBJECTIVES: The objective of this paper is to describe the use of a nominal group technique (NGT) to develop a stakeholder-centred research agenda for clinical interoperability in extended circles of care that include social supports.
METHODS: We held a day-long meeting with 30 stakeholders, including primary care providers, social supports, patient representatives, health region managers, technology experts, health organizations and experts in privacy, law and ethics. Participants considered, "What research needs to be done to better understand how EHRs should be shared across large healthcare teams that include social supports?" Following sensitizing presentations from researchers and participants, we used an NGT to generate and rank research questions on a 9-point Likert scale. We retained research questions that had a mean score of at least 6.5/9 by at least 70% of the participants over two rounds of consensus-building.
RESULTS: Participants identified and ranked 57 research questions. Five items achieved consensus, related to 1) the impact of information sharing on care team outcomes, 2) data quality/accuracy, 3) cost/benefit, 4) what processes use what data and 5) regulation/legislation.
CONCLUSION: Healthcare reforms are increasingly focused on systems that integrate and coordinate multidisciplinary care, facilitated by EHRs. Research prioritization will ensure common concerns and barriers are addressed and resolved.

PMID: 28130949 [PubMed - in process]

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Pediatric Insulin Pump Therapy: Reflecting on the First 10 Years of a Universal Funding Program in Ontario.

Pediatric Insulin Pump Therapy: Reflecting on the First 10 Years of a Universal Funding Program in Ontario.

Healthc Q. 2017;19(4):6-9

Authors: Shulman R, Miller FA, Stukel TA, Daneman D, Guttmann A

Abstract
We evaluated the universal funding program for pediatric insulin pumps in Ontario by examining the dynamics underlying patterns of pump use and adverse events using population-based health administrative data available at the Institute for Clinical Evaluative Sciences (ICES), supplemented by other data. We found that (1) pump use has increased steadily since 2006 with variation across centres and disparity in use by socioeconomic status; (2) pump discontinuation is uncommon; (3) physicians value pump therapy in numerous ways that provide important insights into patterns of uptake; and (4) the safety profile of pump therapy is, in general, very good; however, individuals of lower socioeconomic status are at an increased risk of acute diabetes complications, most frequently diabetic ketoacidosis. This comprehensive mixed-methods evaluation reveals the need to understand and intervene to reduce social disparities in the use and adverse outcomes of technologies used for diabetes management.

PMID: 28130944 [PubMed - in process]

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