Indiana University-Purdue University Indianapolis (IUPUI) / In 1973 the state of Indiana initiated a program to fluoridate the water in rural school systems to a concentration of 4.0 ppm. Today, the optimal concentration is 3.5 ppm. When it was initiated, school water fluoridation was a popular method of providing fluoride supplementation to children who didn't have access to community-fluoridated water. Today, only Indiana runs a school water fluoridation program, and the CDC has stated that continuation of these efforts should be based on caries risk, alternate preventive measures, and periodic evaluation of program effectiveness. The purpose of this study was to assess the efficacy of the Indiana school water fluoridation program in order to determine if children participating in the program develop less caries with no increased risk of fluorosis. Four hundred sixty students were examined from Northwestern Consolidated School Corporation in Shelby County (fluoridated school) and North Knox School Corporation in Knox County (non-fluoridated school). Three hundred ninety-one students were statistically evaluated, 204 from the fluoridated school and 187 from the non-fluoridated school. A thorough visual examination was conducted by the same examiner collecting data on DMFS, defs, and fluorosis in grades 1-6. DMFS scores were 28 percent less for fluoridated students compared with non-fluoridated students (0.95 versus 1.32). Although the effect of fluoridation status on caries in permanent teeth is not statistically significant, the author believes this difference may be clinically significant. Analysis of defs scores showed fluoridated students with 6 percent less defs than non-fluoridated students, although the results were not statistically significant. Only 3.92 percent of the students at the fluoridated school showed fluorosis, while 10.16 percent showed signs of mild fluorosis at the non-fluoridated school. Conclusion: While not statistically significant, children attending the school fluoridated with 3.5 ppm of fluoride developed less caries and suffered no increase of fluorosis compared with children attending schools not participating in the school fluoridation program. Further analysis is necessary through statewide blind examinations at numerous school systems to further assess the efficacy of the Indiana School Water Fluoridation Program.

Tuberculosis (TB) is one of the most deadly diseases worldwide. In the United States, TB disproportionately affects foreign-born individuals, individuals living in congregate settings, people with human immunodeficiency virus, and people who use illicit drugs. In 2005, a large homeless shelter outbreak in San Joaquin County resulted in 67 individuals diagnosed with TB with links to a homeless shelter. It is hypothesized that by using bed analysis to identify contacts that have been exposed to TB during this outbreak will allow for better identification of exposed high-risk individuals than screening alone. Demographics, exposure, screening, and QuantiFERON-Tuberculosis results were analyzed using bed assignments from the homeless shelter database and data from a homeless shelter screening (HSS) program. Individuals diagnosed with active TB disease were on average more likely to be identified through bed analysis than HSS, 95.08% versus 59.02%. Utilizing both bed analysis and HSS allows for improvement of identification and continuous testing of individuals exposed to TB.

Background World Health Organization reports that there are no exact statistics of how many older adults worldwide suffer from malnutrition, but available data suggest that about 15–60 percent of older adults cared for in hospitals, nursing homes and home-care programmes are suffering from malnutrition. It is important that the registered nurse is aware of different interventions and how they can be implemented in order to improve the nutritional status of the older adult. Aim The aim of this study was to examine nursing interventions used to treat and prevent malnutrition in older adults at hospitals and nursing homes. Method The study design was a literature review with 15 scientific articles included. The data collection was done in the databases PubMed and CINAHL. The result articles were a mix of both qualitative- and quantitative studies. Intergraded data analysis was used to compile the 15 articles. Results The interventions had an overall positive effect on the nutritional status of the older adults. Oral nutritional supplements were the most common intervention. Both environmental and social factors had effect on the mealtime experience. The older adult was not often involved in the nutritional care and the evaluation of the outcome of the interventions was scarce. The teamwork between health professionals, relatives and the older adult was inadequate. Conclusions Malnutrition in older adults is a prevalent problem and is often de-prioritized in nursing care. The most common intervention used was oral nutritional supplements but there are other interventions that also provide positive results and provide more individual care and are often disregarded by the RN’s. The older adults’ involvement in the nutritional care can be increased and improved as well as involvement of relatives. The importance of treating and preventing malnutrition is a topic that could be emphasized more within the geriatric care. / Bakgrund Världshälsoorganisationen rapporterar att det inte finns någon exakt statistik över hur många äldre personer över hela världen som lider av undernäring, men tillgängliga data tyder på att cirka 15–60 procent av de äldre personer som vårdas på sjukhus, särskilt boende och inom hemsjukvården lider av undernäring. Det är viktigt att den legitimerade sjuksköterskan är medveten om olika omvårdnadsåtgärder och hur de kan genomföras för att förbättra den äldre personens näringsstatus. Syfte Syftet med denna studie var att undersöka tillämpade omvårdnadsåtgärder för att förebygga och behandla undernäring hos äldre personer på sjukhus och särskilt boende. Metod Studiedesignen var en litteraturöversikt med 15 vetenskapliga artiklar inkluderade. Datainsamlingen gjordes i databaserna PubMed och CINAHL. Resultatartiklarna var en blandning av både kvalitativa och kvantitativa artiklar. En integrerad analys utfördes för att sammanställa de 15 artiklarna. Resultat Omvårdnadsåtgärderna hade en övergripande positiv effekt på de äldre personernas näringsstatus. Näringsdrycker var den vanligaste åtgärden. Både miljömässiga och sociala faktorer påverkade matupplevelsen. Den äldre personen var sällan involverad i sin nutritionsvård och utvärdering av omvårdnadsåtgärderna var sällsynt. Samarbetet mellan vårdpersonal, anhöriga och den äldre personen var otillräckligt. Slutsats Undernäring hos äldre personer är ett vanligt förekommande problem som ofta bortprioriteras inom vården. Den vanligaste åtgärden var insättande av näringsdryck men det finns andra åtgärder som ger goda resultat och är mer individanpassade som ofta förbises av sjuksköterskan. Den äldre personens medverkan i sin vård gällande nutrition kan ökas och förbättras, såväl som medverkan av anhöriga. Vikten av att behandla och förebygga undernäring är ett ämne som skulle kunna betonas mer inom geriatrisk vård.

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A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfillment of the requirements for the degree of Doctor of Philosophy (PhD) in Bioethics and Health Law Johannesburg, 2019 / Road traffic injuries and deaths (RTID) are a global public health crisis affecting the ethically charged road traffic system, and disproportionately affect the poor. By world standards South Africa has extremely high crash rates and in many respects is failing to apply road safety best practice, despite being a signatory to the UN Decade of Action for Road Safety 20112020. In the economic hub of Johannesburg the minibus taxi industry (MTI) is a dominant mode of paratransit (informal public transport) which offers flexible and affordable services and helps reduce the social divide caused by the lingering spatial realities of apartheid. It is also a source of economic empowerment and much-needed jobs – however, as with paratransit systems elsewhere, unsafe driving is common and many of the taxis are elderly or defective. Frequent MTI crashes contribute to Johannesburg’s road deaths being more than triple the international city average. Members of the public tend to vilify MTI drivers and ascribe a high degree of moral responsibility to them, but this intuitive reasoning seems to disregard their work conditions and how these affect their driving behavior. It also fails to take into account the South African road safety status quo and the possibility that MTI drivers are akin to an indicator species in relation to the ills of our road traffic system. Prevailing views of road safety are shaped by the Vision Zero philosophy and the Safe System approach, which assign responsibilities both to road users and to system designers. In line with this, my study addresses the question of what moral responsibilities should be ascribed, and to whom, in relation to reducing RTID in the Johannesburg MTI. I answer this bioethical question by means of a dual descriptive-normative inquiry. My descriptive inquiry is based on my mixed-methods empirical research with drivers, aimed at addressing the dearth of knowledge of their work conditions and tapping their views on crash causation and road safety responsibilities. My results, viewed against the backdrop of road safety best practice, lead me to label the operating principles of the Johannesburg MTI ‘contra-constitutional’ due to their violating the drivers’ labour rights as well as the human rights of drivers, passengers and other road users alike. I also analyse the South African road safety situation with regards to road safety best practice and comparative information from three groups of reference countries: the BRICS, our African neighbours (and two other African countries with similar paratransit), and several aspirational countries with very low RTID. This analysis leads me to develop the term ‘crashogenic’ to describe our road traffic system. My normative inquiry draws on arguments which have been made by other authors focusing on moral considerations in relation to road safety. It applies Nihlen Falquist’s moral responsibility ascription framework – developed with regards to Sweden’s Vision Zero policy – in a novel fashion, employing graphical representation in addition to narrative reasoning. Thus, I use her three categories of blame responsibility, causal responsibility and forwardlooking responsibility and ascribe specific moral responsibilities to identified rolepayers, with a view to reducing RTID in the Johannesburg MTI. My study makes an original contribution to the bioethical debate on road safety, with a unique South African perspective. It also extends the existing knowledge base regarding drivers’ work conditions in paratransit systems. / MT 2019

INTRODUCTION: For persons with diabetes, surgery is fraught with complications; of primary concern is postoperative infection. A postoperative infection rate of up to 13% has been noted in patients with diabetes undergoing elective surgical procedures compared with less than 3% in nondiabetic populations. OBJECTIVE: The objective of this study was to provide preliminary evaluation of the efficacy of a novel bioresorbable microfilm matrix (20 µm thick) containing very low amounts of silver (0.16 mg/in²) in preventing surgical site infections when placed at the level of subcutaneous tissue and dermis prior to primary closure in the patient with diabetes undergoing elective surgery. MATERIALS AND METHODS: Twenty-two patients with diabetes undergoing nonemergent or elective foot or ankle surgery and who met at least 1 of the following 6 criteria were included in the study: neuropathy, infection, open wound, history of recurrent infection, nonhealing wound, or peripheral vascular disease. Patients underwent amputation, removal of exostosis, midfoot bone removal, Achilles tendon repair, bunionectomy, or an elevating osteotomy with primary closure of the wound. After hemostasis was obtained and subcutaneous closure achieved, if applicable, the bioresorbable microfilm matrix was applied just deep to the incision at the level of subcutaneous tissue and dermis, and the incision primarily closed. A nonadherent cover dressing was applied over the suture line, and routine follow-up was scheduled for 3 to 5 days later. RESULTS: No patient exhibited signs of infection at initial follow-up, and all adherent patients achieved complete healing during the 3-month follow-up period. Eighteen patients healed at a rate typical for the respective procedure. In 2 patients, time to healing was delayed secondary to weight-bearing dehiscence. Two patients were not included in the results secondary to multiple infractions of nonadherence with the postoperative protocol. CONCLUSIONS: The application of microfilm matrix in surgical incisions at the level of subcutaneous tissue and dermis prior to primary closure is safe for and has the potential to prevent postoperative surgical site infections in at-risk patients with diabetes..

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No / Anti-vascular effects of the novel Vinca alkaloid, vinflunine have been investigated in the MAC 15A transplantable murine colon adenocarcinoma model and compared with those induced by the most recently identified clinically useful third generation Vinca. Administration of the maximum tolerated dose of either vinflunine (50 mg kg-1) or vinorelbine (8 mg kg-1) resulted in significant tumour growth delay with subsequent histological analysis revealing substantial haemorrhagic necrosis. This suggested possible anti-vascular effects and these were confirmed by Hoechst 33342 perfusion studies. Vinflunine, currently undergoing Phase I trials in Europe, was found to be at least as effective as the clinically active vincristine and vinorelbine in this model and, remarkably, produced anti-vascular effects at doses much lower than the maximum tolerated dose. Although vinflunine caused apoptosis in HUVEC monolayer cultures this event did not occur within the first 8 hours of exposure whereas vascular shutdown in vivo was observed within the first 4 hours.