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Clinical Director, Hackensack Meridian School of Medicine at Seton Hall University

The project included the following activities: (1) identification the oral health beliefs and behaviors of families muscle relaxant erowid generic 400mg carbamazepine otc, (2) providing oral health education to families spasms near tailbone 400mg carbamazepine overnight delivery, and (3) reassessing beliefs and behaviors in 3-6 months to document the impact of the education session muscle relaxant tincture discount carbamazepine 200 mg otc. Participants consisted of 81 families resulting in the data on 176 children and 4 pregnant women muscle relaxant machine cheapest carbamazepine. Of the 81 families, 40 representing 84 children completed the follow-up oral health questionnaire. These results provide further evidence that initiating a simple educational intervention can have a positive impact on oral health behaviors in groups that are at highest risk for developing dental disease in Hawai`i. Parental knowledge about fluoride was limited, with almost half stating they had no knowledge. Families were excluded if they could not speak English or were returning to their residence, not located on O`ahu, within the next 6 months. The initial visit consisted of parental consent, completion of the initial questionnaire, oral health education and provision of dental supplies (ie, toothbrush, toothpaste, dental floss) to the family. The oral health education included information on nutrition to reduce caries (ie, limit sugar, juices, eliminate bottle use by 14 months), proper dental hygiene (ie, brushing twice a day, floss daily), description of fluoride and proper use (ie, toothpaste, prescription, varnish), and the importance of preventive dental visits every 6 months. Educational brochures were provided to support this short 5-7­minute oral health education session. Clients willing to participate in the project were provided the appropriate informed consent form (ie, non-pregnant women with children received the child informed consent document and pregnant women received the perinatal informed consent document). For the variables, generalized estimating equations for repeated measures (ie, baseline vs. However, due to the small number of pregnant women, the analyses were restricted to the parents with children in this study. The ethnic and racial background of parents, mostly mothers, indicated that the majority of participants were non-Hispanic (93%) and identified as being more than one racial or cultural group. Results indicated that only 57% of parents were using fluoride toothpaste for their children, while 19% reported being unsure if the toothpaste they were using for their child contained fluoride. The results indicate among children old enough to receive fluoride supplements (ie, >6 months), over one-third were not given a fluoride prescrip- tion. Among parents given a prescription for their children, almost 70% gave it daily (Q9). Parents were asked if their child ever had fluoride varnish applied to their teeth (Q10). Results indicated that 50 of 151 (33%) of children >6 months old had not received any fluoride varnish application. Of those children who were at the recommended age of 1 year to receive preventive dental care (n=138), 64% were seen by a dentist during the past 3-6 months, 1% reported being seen 1-2 years previously, and 22% reported that their children had not been seen for a dental assessment (Q12). Results from the initial questionnaire revealed that 66% of mothers did not see a dentist during pregnancy and when asked to recall when they last had a dental evaluation the majority of mothers (65%) did not have routine dental care based on the American Dental Association recommendations. When their first tooth came in After one year After two years Teeth have not been cleaned (skip to Q8) My child does not have any teeth yet (skip to Q8) 86 (48. Oral Health Questionnaire at Baseline and Post Intervention (Continued) Question (Q) Q5 (Restricted to children aged 1 year). When their first tooth came in After one year After two years Teeth have not been cleaned (skip to Q8) My child does not have any teeth yet (skip to Q8) Q6. No Yes Too young (<6 months) Other Extremely important Moderately important Somewhat important Not important at all 50 (33%) 84 (56%) 16 (11%) 0 (0%) 170 (97%) 4 (2%) 2 (1%) 0 (0%) 16 (22%) 56 (76%) 1 (1%) 1 (1%) 82 (98%) 2 (2%) 0 (0%) 0 (0%). Oral Health Questionnaire at Baseline and Post Intervention (Continued) Question (Q) Q12. Within the past 6-12 months Within the past 1-2 years Over 2 years ago My child has never been seen by a dentist (skip to Q14) Too young (<1 year old) (skip to Q14) Not answered (skip to Q14) Q13. Within the past 6-12 months Within the past 1-2 years Over 2 years ago 62 (35%) 48 (27%) 66 (38%) 36 (43%) 18 (21%) 30 (36%). Of the 81 parents/guardians completing the initial questionnaire and receiving oral health education, 40 parents/guardians representing 84 children completed the follow-up questionnaire. This represents a completion rate of 49% (40 of 81) among families and 48% (84 of 176) among children. Overwhelmingly, 98% of parents stated they would give fluoride drops or tablets every day and 89% would support water fluoridation if they knew these actions would result in a reduction of caries for their children.

The bubonic form of the disease in humans is characterized by the abrupt onset of high fever muscle relaxant brand names discount carbamazepine online master card, painful local lymphadenopathy draining the exposure site (ie spasms on left side of chest cheap carbamazepine 200mg on-line, a bubo stomach spasms 6 weeks pregnant best purchase carbamazepine, the inflammatory swelling of one or more lymph nodes muscle relaxer jokes order carbamazepine 100 mg, usually in the groin, axillary, or cervical regions; the confluent mass of nodes, if untreated, may suppurate), and bacteremia. Septicemic plague can ensue from untreated bubonic plague or by passage of bacteria directly into the bloodstream bypassing the local lymph nodes. Patients with the bubonic and septicemic forms of the disease may develop secondary pneumonic plague, which can lead to human-to-human spread by the respiratory route. Cervical lymphadenitis has been noted in several human plague cases, including many fatal cases, and is often associated with the septicemic form of the disease. However, it is possible that these patients were exposed by the oral/aerosol route and developed pharyngeal plague that progressed into a systemic infection and cervical lymphadenitis. Mortality from endemic plague continues at low rates throughout the world despite the availability of effective antibiotics. Deaths resulting from plague occur not because the bacilli have become resistant but, most often, because physicians do not include plague in their differential diagnosis, or because treatment is absent or delayed. To be best prepared to treat plague in soldiers who are affected by endemic disease or a biological agent attack, military healthcare providers must understand the natural mechanisms by which plague spreads between species, the pathophysiology of disease in humans, and the diagnostic information necessary to begin treatment with effective antibiotics. No vaccine is available for plague in the United States, although candidates are undergoing clinical trials. A better understanding of the preventive medicine aspects of the disease will aid in the prompt diagnosis and effective treatment necessary to survive an enemy attack of plague and protect military and civilian personnel in plague endemic areas where military operations are underway. Enzootic refers to when plague is present in a small number of animals; the host, vector, and bacterium live in an apparent equilibrium in which mortality among rodent hosts is difficult to detect and not obviously resulting from plague. During an epizootic, which typically follows a longer period of enzootic maintenance, widespread plague infections frequently lead to death among susceptible host populations (ie, equivalent to an epidemic in a human population), an event that is often noticeable to residents in affected areas. The death of a rodent causes the living fleas to leave that host and seek other mammals, and when those other mammals die in large numbers, they may seek humans. Knowledge of these two concepts of enzootic and epizootic will help to clarify how and when humans may be infected, in endemic or biological warfare scenarios. When bales of these furs were opened in Astrakhan and Saray, hungry fleas jumped from the fur seeking the first available blood meal, often a human leg. During the 15th through the 18th centuries, 30% to 60% of the populations of major cities, such as Genoa, Milan, Padua, Lyons, and Venice, died of plague. Some believed that a viral hemorrhagic fever or unknown agent caused the Black Death instead of Y pestis. Physicians at the University of Paris theorized that a conjunction of the planets Saturn, Mars, and Jupiter at 1:00 pm on March 20, 1345, corrupted the surrounding atmosphere, which led to the plague. They grew to the size of a small apple or an egg, more or less, and were vulgarly called tumours. In a short space of time these tumours spread from the two parts named all over the body. Soon after this, the symptoms changed and black or purple spots appeared on the arms or thighs or any other part of the body, sometimes a few large ones, sometimes many little ones. Such was the terror this caused that seeing it take hold in a household, as soon as it started, nobody remained: everybody abandoned the dwelling in fear, and fled to another; some fled into the city and others into the countryside. Even though lice are not normal vectors, they are capable of transmitting Y pestis infection in rabbits, and presumably humans. The disease subsequently appeared in New York City and Washington state the same year. Among these numerous events, only the outbreaks in California appear to have spread inland, leading to the establishment of permanent plague foci in native rodent and flea populations in the interior of the western United States. After general rat control and hygiene measures were instituted in various port cities, urban plague vanished-only to spread into rural areas, where virtually all cases in the United States have been acquired since 1925. Some writers described bizarre neurological disorders (which led to the term "dance of death"), followed by anxiety and terror, resignation, blackening of the skin, and death. The sick emitted a terrible stench: "Their sweat, excrement, spittle, breath, [were] so foetid as to be overpowering" [in addition, their urine was] "turbid, thick, black, or red. The theories are all flawed to some extent, and the disappearance of plague from Europe remains one of the great epidemiological mysteries. Based on an analysis of Y pestis genomes from Black Death victims, no significant differences existed between 14th century and 21st century strains of the bacterium. Medical officers need to distinguish cases likely acquired from natural sources in a plague-endemic region from those occurring following exposure to a biological warfare agent.


Never oversimplify: When adding material to your research paper muscle relaxant bath generic 400mg carbamazepine visa, never go for oversimplification; this will definitely irritate the evaluator spasms all over body order generic carbamazepine on line. From raw data muscle relaxant elderly 400 mg carbamazepine for sale, filter the results spasmus nutans treatment purchase carbamazepine 200mg on line, and then conclude your studies based on measurements and observations taken. Justify your conclusion at the bottom sufficiently, which will probably include examples. Upon conclusion: Once you have concluded your research, the next most important step is to present your findings. Presentation is extremely important as it is the definite medium though which your research is going to be in print for the rest of the crowd. Care should be taken to categorize your thoughts well and present them in a logical and neat manner. A good quality research paper format is essential because it serves to highlight your research paper and bring to light all necessary aspects of your research. Informal Guidelines of Research Paper Writing Key points to remember: · · · Submit all work in its final form. Write your paper in the form which is presented in the guidelines using the template. Final points: One purpose of organizing a research paper is to let people interpret your efforts selectively. The journal requires the following sections, submitted in the order listed, with each section starting on a new page: the introduction: this will be compiled from reference matter and reflect the design processes or outline of basis that directed you to make a study. As you carry out the process of study, the method and process section will be constructed like that. The results segment will show related statistics in nearly sequential order and direct reviewers to similar intellectual paths throughout the data that you gathered to carry out your study. The discussion section: this will provide understanding of the data and projections as to the implications of the results. The use of good quality references throughout the paper will give the effort trustworthiness by representing an alertness to prior workings. Writing a research paper is not an easy job, no matter how trouble-free the actual research or concept. Practice, excellent preparation, and controlled record-keeping are the only means to make straightforward progression. General style: Specific editorial column necessities for compliance of a manuscript will always take over from directions in these general guidelines. In every section of your document, use standard writing style, including articles ("a" and "the"). Avoid use of extra pictures-include only those figures essential to presenting results. It should clearly and briefly explain the key findings reported in the manuscript and must have precise statistics. An abstract is a brief, distinct paragraph summary of finished work or work in development. In a minute or less, a reviewer can be taught the foundation behind the study, common approaches to the problem, relevant results, and significant conclusions or new questions. Write your summary when your paper is completed because how can you write the summary of anything which is not yet written? Use comprehensive sentences, and do not sacrifice readability for brevity; you can maintain it succinctly by phrasing sentences so that they provide more than a lone rationale. Consequences, including definite statistics-if the consequences are quantitative in nature, account for this; results of any numerical analysis should be reported. Concentrate on shortening results-limit background information to a verdict or two. Exact spelling, clarity of sentences and phrases, and appropriate reporting of quantities (proper units, important statistics) are just as significant in an abstract as they are anywhere else.

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Nonpreserved spasms pain rib cage cheap carbamazepine 100 mg on-line, single unit-dose tear substitutes are more costly for the manufacturer to produce muscle relaxant rocuronium carbamazepine 100 mg fast delivery, more costly for the patients to purchase knee spasms at night order 200mg carbamazepine mastercard, and less convenient to use than bottled ocular lubricants spasms throughout body cheap carbamazepine 400mg without a prescription. For patients with severe dry eye, even vanishing preservatives may not totally degrade, due to a decrease in tear volume, and may be irritating. The ideal lubricant would come in a multidose, easy-to-use bottle that contains a preservative that completely dissipates before reaching the tear film, or is completely nontoxic and nonirritating and maintains absolute sterility with frequent use. In general, ointments do not support bacterial growth and, therefore, do not require preservatives. Gels containing high molecular weight crosslinked polymers of acrylic acid (carbomers) have longer retention times than artificial tear solutions, but have less visual blurring effect than petrolatum ointments. Electrolyte Composition Solutions containing electrolytes and or ions have been shown to be beneficial in treating ocular surface damage due to dry eye. Because bicarbonate is converted to carbon dioxide when in contact with air and can diffuse through the plastic unit dose vials, foil packaging of the plastic vials is required to maintain stability. While crystalloid osmolarity is related to the presence of ions, colloidal osmolality is dependent largely on macromolecule content. Colloidal osmolarity, also known as oncoticpressure, is involved in the control of water transport in tissues. Differences in colloidal 166 osmolality affect the net water flow across membranes, and water flow is eliminated by applying hydrostatic pressure to the downside of the water flow. The magnitude of this osmotic pressure is determined by osmolality differences on the two sides of the membrane. Epithelial cells swell due to damage to their cellular membranes or due to a dysfunction in the pumping mechanism. Following the addition of a fluid with a high colloidal osmolality to the damaged cell surface, deturgescence occurs, leading to a return of normal cell physiology. Theoretically, an artificial tear formulation with a high colloidal osmolality may be of value. It is thought that the compatible solutes distribute between the tears and the intracellular fluids to protect against potential cellular damage from hyperosmolar tears. In the classical three-layered tear film model, the mucin layer is usually thought of as a surfactant or wetting agent, acting to lower the surface tension of the relatively hydrophobic ocular surface, rendering the corneal and conjunctival cells "wettable. This may explain why most of the available water-containing lubricants are only minimally effective in restoring the normal homeostasis of the ocular surface. In addition to washing away and diluting out irritating or toxic substances in the tear film, artificial lubricants hydrate gel-forming mucin. While some patients with dry eye have decreased aqueous lacrimal gland secretion, alterations or deficiencies involving mucin also cause dry eye. The addition of a viscosity agent increases residence time, providing a longer interval of patient comfort. It is known that rose bengal stains abnormal corneal and conjunctival epithelial cells expressing an altered mucin glycocalyx. Carboxymethyl cellulose has been found to bind to and be retained by human epithelial cells. The blurring of vision and esthetic disadvantages of caking and drying on eyelashes are drawbacks of highly viscous agents that patients with mild to moderate dry eye will not tolerate. Because patient compliance, comfort, and convenience are important considerations, a range of tear substitute formulations with varying viscosities are needed. Summary Although many topical lubricants, with various viscosity agents, may improve symptoms and objective findings, there is no evidence that any agent is superior to another. Most clinical trials involving topical lubricant preparations will document some improvement (but not resolution) of subjective symptoms and improvement in some objective parameters. The elimination of preservatives and the development of newer, less toxic preservatives have made ocular lubricants better tolerated by dry eye patients. However, ocular lubricants, which have been shown to provide some protection of the ocular surface epithelium and some improvement in patient symptoms and objective findings, have not been demonstrated in controlled clinical trials to be sufficient to resolve the ocular surface disorder and inflammation seen in most dry eye sufferers. Rationale While the concept of permanently occluding the lacrimal puncta with cautery to treat dry eye extends back 70 years,49 and, although the first dissolvable implants were used 45 years ago,50 the modern era of punctal plug use began in 1975 with the report by Freeman.

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