Standards in Dentistry and Medicine

Drug regulatory authorities in many developed countries have established spontaneous adverse reaction reporting schemes to monitor drug safety [1]. The United Kingdom yellowcard system, organised by the Committee on the Safety of Medicines (CSM), is one of the oldest and the most successful of these national schemes. With typical Anglo-Saxon self-deprecation however, both the medical profession and the lay press have tended to emphasise the limitations of the yellow-card scheme at the expense of its achievements. Spontaneous reporting schemes do indeed have substantial limitations [2]. Firstly, they rely on doctors reporting suspected (and not necessarily proven) adverse reactions. Few adverse reactions, however, are uniquely iatrogenic and an efficient spontaneous reporting scheme depends on doctors' professional skill and judgement in associating their patient's diseases with the drug(s) they have taken. Such schemes are therefore inherently more likely to detect those adverse reactions which occur soon after the start of treatment, and which produce syndromes commonly having an iatrogenic basis such as anaphylactoid reactions, dystonia-dyskinesias and various dermatoses. Conversely, reactions which have a long latency, or which are expressed as conditions only rarely having a recognised iatrogenic basis, may remain unrecognised by this technique. The delayed recognition of the oculomucocutaneous syndrome with practolol is a clear example of this. Secondly, in the United Kingdom (as elsewhere), only a small proportion of even serious adverse drug reactions are reported to the CSM [3]. Underreporting not only results in a substantial loss of useful scientific data, but may also lead to serious bias since reporting rates are conditioned both by manufacturers' promotional claims and by adverse publicity in the medical literature or the media. Thirdly, reporting rates tend to decline with time after a product has been marketed. To some extent this is inevitable: whilst the CSM asks doctors to report all suspected adverse reactions for newly (within three years) marketed drugs, it asks to be notified of only serious reactions to older ones since it would be unnecessarily burdensome (and of little real value) for doctors to continue indefinitely reporting bradycardia with digoxin, nausea with morphine, or dyspepsia with aspirin. Unfortunately, reporting rates of even serious reactions fall off with time. Thus, Inman [4] showed in 1977 that only five out of 44 (11 per cent) of patients dying from blood dyscrasias associated with phenylbutazone or oxyphenbutazone were reported to the CSM; and between 1964 and 1985 there have been only 192 reports [5] of gastrointestinal bleeding or perforation with aspirin! The number of adverse reaction reports for a particular drug will be a function of its usage, as well as its inherent toxicity. The evaluation of spontaneous reporting rates must therefore take into account the size of the exposed population. In the United Kingdom, reporting rates are

This study discusses the results of a national survey, conducted in 1999, designed to assess the perceptions of experienced construction practitioners regarding the “frequency” and “seriousness” of ethical transgressions within the construction industry. A questionnaire was sent to 1,450 systematically selected members of the Associated General Contractors. A total of 321 useable questionnaires were returned, or 22 percent. These construction practitioners were asked to consider 15 issues that may typically arise for those working in the construction industry in the normal course of operations. Contractors were asked how often they thought each of the issues occurred and, when they did occur, how serious did they consider them to be. In addition, the relationship between construction practitioners’ perceptions of ethical behavior and several demographic variables were analyzed. The results indicate that the four most frequently occurring ethical transgressions were Improper or Questionable Bidding Practices, Misrepresentation of Completed Work or Value of Work, Poor Quality Control or Quality of Work, and Technical Incompetence or Misrepresentation of Competence. The four most serious ethical transgressions were Alcohol or Drug Abuse; Improper or Questionable Bidding Practices; Failure to Protect Public Health, Safety, or Welfare; and Poor Quality Control or Quality of Work. Although several of the demographic variables analyzed were related to several of the individual ethical issues, only three - gender, region of country, and experience - were found to be significant when it came to the summated scores for perceived frequency and/or seriousness of ethical transgressions.

Chapter 11 - Artificial intelligence in dental research and practice

Comparison of melatonin products against USP's nutritional supplements standards and other criteria.

There is still surprisingly little basic research data to support widely repeated claims about the prevalence of drug counterfeiting. To meet the need for more reliable drug quality data, we designed a study framework that includes clear definitions of measured end points, sampling methods and assay technique. Our objective was to test this research design in Chennai (formerly Madras), India, using a joint Indian and Canadian team. The city was divided into ten areas along municipal lines. From each area, ten stores and pharmacies selling drugs were selected. At each of these 100 outlets, three study drugs (artesunate, ciprofloxacin and rifampicin) were purchased. The 300 samples were tested by Liquid Chromatography-Mass Spectrometry. Assay content was expressed as a percentage of stated tablet content. Based on assay results and their distribution, we developed drug quality definitions for normal manufacturing standards, counterfeiting, decomposition, poor quality control and adulteration. The group mean for ciprofloxacin was close to normal manufacturing limits (99·2 ± 7·1%) but rifampicin (91·6 ± 5·7%), and artesunate (80·1 ± 9·1%), were both below normal pharmaceutical standards. Overall, 43% of all samples fell below the widely accepted manufacturing range of 90-110% of stated content. No tablet from any sample contained less than 50% of the stated dose. The quality of at least some anti-infective drugs in Chennai is below commonly accepted standards but we found no evidence of criminal counterfeiting. Poor drug quality was most likely due to decomposition during storage or poor manufacturing standards. Our research methodology worked well under practical conditions and should hopefully be of value to others working in this area.

Employment for Pharmacists in the Federal Government

This review declares the chemical composition, pharmacological actions, clinical applications, adverse reactions and future prospects of Aloe vera (AV) in the field of dentistry. Literature pertinent to Aloe vera in dental practice was explored in databases like PubMed, Scopus and Google Scholar. The relevant literature was reviewed and critically appraised in this review. Aloe vera is a miracle plant that has been applied as herbal therapy for thousands of years due to its multiple health benefits. In dental practice, AV has different applications and it attracts the attention of researchers due to its natural origin, low cytotoxicity, and various biological actions like antimicrobial, immunomodulatory, anti-inflammatory, antioxidant, wound healing, and antineoplastic actions. Therefore, it has been used for treatment of oral lesions, endodontic lesions, periodontal disease, oral wounds, and alveolar osteitis as well as in tissue engineering, reduction of plaque formation, decontamination of Gutta percha, around dental implants and others. AV has been used in treatment and prevention of several oral and dental problems. Nevertheless, it has a lot to offer in the dental practice and future studies are recommended to maximize its beneficial role in the field of dentistry

In this study, the reliability of mobile system base stations (BTS) is assessed by analyzing data obtained on faults in about 200 BTS over a six-month period. Five BTSs with the highest number of failures and duration of failure were selected in these BTSs. Based on the data obtained, reliability parameters were calculated and compared. The study used Weibull’s dismissal process distribution method. The breakdown times of each BTS were sorted. In all five BTS, it was found that β(where the value of β is the approximate value obtained from the values of the smallest squares of the Weibull graph), thus reducing the failure rate. Defects can be caused by poor quality control, manufacturing defects, poor handling and various malfunctions. Detailed information on the problem was provided and described.

Building prefabrication is facing the challenge to reduce the life-cycle impact of construction, enhance material circularity, and increase the quality of building products and processes. The paper presents the first phase of the research CARES - CArdboard RElocatable School developed with the Italian brand Archicart by Area S.r.l with the aim to prototype a temporary school unit. The work presented is focused on the industrialization of a prefabricated building technology based on the use of cardboard panels (PACOTECTM Stre-Wall panels). Cardboard is a circular and environmentally sustainable material but currently the design and manufacturing process lacks digital integration, resulting in poor quality control, limited adaptability, and lack of material optimization. To address sustainability goals, the work implemented a “file-to-factory” approach to redesign the design-manufacturing process of prefabricated cardboard panels, integrating industry 4.0 paradigms in manufacturing (automation, high-precision manufacturing) and the use of BIM tools for design to achieve better product-process quality and predictability. The redesigned workflow allows achieving sustainability goals, such as reduction of errors, reduction of material wastes, cost and time predictability, product customization, and adaptability. The workflow will be verified and tested in the design and manufacturing of prefabricated cardboard panels to build a temporary school unit.

BackgroundEarly diagnosis of suspected malaria cases with a rapid diagnostic test (RDT) has been shown to be an effective malaria control tool used in many resource-constrained settings. However, poor quality control and quality assurance hinder the accurate reporting of malaria diagnoses. Recent use of a portable, battery operated RDT reader (Deki Reader™, Fio Corporation) has shown to have high agreement with visual inspection across diverse health centre settings, however evidence of its feasibility and usability during cross sectional surveys are limited. This study aimed to evaluate the performance of the Deki Reader™ in a cross-sectional survey of children from southwestern Uganda.MethodsA two-stage, stratified cluster sampling survey was conducted between July and October 2014 in three districts of southwestern Uganda, with varying malaria transmission intensities. A total of 566 children aged 6–59 months were included in the analysis. Blood samples were collected and tested for malaria using: the SD Bioline Malaria Ag Pf/Pan RDT and microscopy. Results were compared between visual inspection of the RDT and by the Deki Reader™. Diagnostic performance of both methods were compared to gold-standard microscopy.ResultsThe sensitivity and specificity of the Deki Reader™ was 94.1% (95% CI 69.2–99.6%) and 95.6% (95% CI 93.4–97.1%), respectively. The overall percent agreement between the Deki Reader™ and visual RDT inspection was 98.9% (95% CI 93.2–99.8), with kappa statistic of 0.92 (95% CI 0.85–0.98).ConclusionsThe findings from this study suggest that the Deki Reader™ is comparable to visual inspection and performs well in detecting microscopy-positive Plasmodium falciparum cases in a household survey setting. However, the reader’s performance was highly dependent on ensuring adequate battery life and a work environment free of dirt particles.

This paper examines the market for illegal recreational drugs. Under the present regime of illegality, the law acts as a barrier to entry of other firms. It also restricts the information available to consumers. Both of these effects increase the market power of traders. Other negative consequences of illegality include the use of violence to enforce contracts, poor quality control and the use of illegal activities to finance the purchase of drugs.

Lightweight concrete in highway bridges

Shimura A, Kanno T, Inoue T. Ultra-low-dose early night ramelteon administration for the treatment of delayed sleep-wake phase disorder: case reports with a pharmacological review. J Clin Sleep Med. 2022;18(12):2861-2865.

Allergy to ingested mycoprotein in a patient with mold spore inhalant allergy

Emergency Care Crisis in the United Kingdom and Ireland: Emergency Physician Exodus Looms in Wake of Pay Cuts, Staffing Shortages