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Place of training was also a significant predictor internationally trained dentists perceived it easier to discuss eating disorders, substance abuse, and physical abuse while Canadian trained were more at ease to discuss STIs and sexual behaviors.

This exploratory study identified that a large proportion of dentists are not comfortable discussing sensitive health issue with their patients. There are numerous opportunities for intervention in Canadian dental curriculums, continuing education programs, and communication practices to support dentists' discussions with patients about these important health concerns.

This exploratory study identified that a large proportion of dentists are not comfortable discussing sensitive health issue with their patients. There are numerous opportunities for intervention in Canadian dental curriculums, continuing education programs, and communication practices to support dentists' discussions with patients about these important health concerns.We assessed the validity of coded healthcare data to identify cases of haemophagocytic lymphohistiocytosis (HLH). Hospital Episode Statistics (HES) identified 127 cases within five hospital Trusts 2013-2018 using ICD-10 codes D76.1, D76.2 and D76.3. Hospital records were reviewed to validate diagnoses. Out of 74 patients, 73 were coded D76.1 or D76.2 (positive predictive value 89·0% [95% Confidence Interval CI 80·2-94·9%]) with confirmed/probable HLH. For cases considered not HLH, 44/53 were coded D76.3 (negative predictive value 97·8% [95% CI 88·2-99·9%]). D76.1 or D76.2 had 68% sensitivity in detecting HLH compared to an established active case-finding HLH register in Sheffield. Office for National Statistics (ONS) mortality data (2003-2018) identified 698 patients coded D76.1, D76.2 and D76.3 on death certificates. Five hundred and forty-one were coded D76.1 or D76.2 of whom 524 (96·9%) had HLH in the free-text cause of death. Of 157 coded D76.3, 66 (42·0%) had HLH in free text. D76.1 and D76.2 codes reliably identify HLH cases, and provide a lower bound on incidence. Non-concordance between D76.3 and HLH excludes D76.3 as an ascertainment source from HES. Our results suggest electronic healthcare data in England can enable population-wide registration and analysis of HLH for future research.

To evaluate the delivery rate in the occiput posterior position according to the result of manual rotation performed in the case of persistent occiput posterior position. Secondary objectives were perinatal outcomes.

This was a prospective cohort study conducted in two French tertiary care units. All women with a singleton pregnancy after 37weeks of gestation with a fetus in persistent occiput posterior position and an attempt of manual rotation were included. The main outcome was the occiput position at delivery. The secondary outcomes were duration of labor, mode of delivery, and perineal tears. Two groups were compared according to the result of manual rotation.

In total, 460 women were included, with a manual rotation success of 62.4%. The success was significantly associated with a decrease in occiput posterior position at vaginal delivery (1.4% vs 57.2%, P<0.0001), cesarean (0.7% vs 17.9%, P<0.0001), operative vaginal delivery (40.1% vs 78%, P<0.0001), episiotomy (40.1% vs 54.9%, P<0.0001), and obstetric anal sphincter injury (3.1% vs 8.7%, P=0.008) compared with a failure.

An attempt of manual rotation in the case of persistent occiput posterior position is associated with decreased rates of occiput posterior position at delivery, operative delivery, and anal sphincter injuries.

An attempt of manual rotation in the case of persistent occiput posterior position is associated with decreased rates of occiput posterior position at delivery, operative delivery, and anal sphincter injuries.

To examine the associations of primary care physician (PCP) care continuity with cancer-specific survival and end-of-life care intensity.

Surveillance, epidemiology, and end results linked to Medicare claims data from 2001 to 2015.

Cox proportional hazards models with mixed effects and hierarchical generalized logistic models were used to examine the associations of PCP care continuity with cancer-specific survival and end-of-life care intensity, respectively. PCP care continuity, defined as having visited the predominant PCP (who saw the patient most frequently before diagnosis) within 6 months of diagnosis.

We identified Medicare patients diagnosed at age 66.5-94 years with stage-III or IV poor-prognosis cancer during 2001-2012 and followed them up until 2015. Patients who died within 6months after diagnosis were excluded.

Primary study cohort consisted of 85,467 patients (median survival 22 months), 71.7% of whom had PCP care continuity. Patients with PCP care continuity tended to be older, married, nonblack, non-Hispanic, and to have fewer comorbid conditions (p< 0.001 for all). Patients with PCP care continuity had lower cancer-specific mortality (adjusted hazard ratio 0.93; 95% confidence interval [CI] 0.91 to 0.95; p= 0.001) than did those without PCP care continuity. Findings of the 2001-2003 cohorts (nearly all of whom died by 2015) show no associations of overall end-of-life care intensity measures with PCP care continuity (adjusted marginal effects 0.005; 95% CI -0.016 to 0.026; p= 0.264).

Among Medicare beneficiaries with advanced poor-prognosis cancer, PCP continuity was associated with modestly improved survival without raising overall aggressive end-of-life care.

Among Medicare beneficiaries with advanced poor-prognosis cancer, PCP continuity was associated with modestly improved survival without raising overall aggressive end-of-life care.We aimed to assess the risk factors of venous thrombosis (VT) and arterial thrombosis (AT) in adults with primary immune thrombocytopenia (ITP), particularly in relation to treatments. The population comprised all incident primary ITP adults in France between 2009 and 2017 (FAITH cohort; NCT03429660) built in the national health database. Outcomes were the first hospitalisation for VT and AT. Multivariable Cox regression models included baseline risk factors, time-varying exposure to ITP drugs, splenectomy and to cardiovascular drugs. The cohort included 10 039 patients. A higher risk of hospitalisation for VT was observed with older age, history of VT, history of cancer, splenectomy [hazard ratio (HR) 3·23, 95% confidence interval (CI) 2·26-4·61], exposure to corticosteroids (HR 3·55, 95% CI 2·74-4·58), thrombopoietin-receptor agonists (TPO-RAs; HR 2·28, 95% CI 1·59-3·26) and intravenous immunoglobulin (IVIg; HR 2·10, 95% CI 1·43-3·06). A higher risk of hospitalisation for AT was observed with older age, male sex, a history of cardiovascular disease, splenectomy (HR 1·50, 95% CI 1·12-2·03), exposure to IVIg (HR 1·85, 95% CI 1·36-2·52) and TPO-RAs (HR 1·64, 95% CI 1·26-2·13). Rituximab was not associated with an increased risk. These findings help to estimate the risk of thrombosis in adult patients with ITP and to select treatment.

In addition to binding to the classical high-affinity extracellular benzodiazepine binding site of the GABA

receptor, some benzodiazepines occupy transmembrane inter-subunit anesthetic sites that bind etomidate (β

/α

sites) or the barbiturate derivative R-mTFD-MPAB (α

/β

and γ

/β

sites). We aimed to define the functional effects of these interactions on GABA

receptor activity and animal behavior.

With flumazenil blocking classical high-affinity extracellular benzodiazepine site effects, modulation of GABA-activated currents by diazepam, midazolam, and flurazepam was measured electrophysiologically in wildtype and M2-15' mutant α

β

γ

GABA

receptors. Zebrafish locomotive activity was also assessed in the presence of each benzodiazepine plus flumazenil.

In the presence of flumazenil, micromolar concentrations of diazepam and midazolam both potentiated and inhibited wildtype GABA

receptor currents. β

N265M (M2-15´ in the β

/α

sites) and α

S270I (M2-15´ in the α

/β

site), respectively. Crenolanib Selectivity for these sites may contribute to the distinct GABAA receptor and behavioral actions of different benzodiazepines, particularly at high (i.e. anesthetic) concentrations.

The COVID-19 pandemic has put an exceptional strain on intensive care units worldwide. During the first year, the survival of patients with acute hypoxaemic respiratory failure appears to have improved. We aimed to describe the mortality rates, management characteristics and two pandemic waves during the first year at three non-academic rural intensive care units in Sweden.

We retrospectively analysed all cases of COVID-19 admitted to intensive care units in Region Jönköping County during 1year. The primary endpoint was 30-day mortality.

Between 14th March 2020 and 13th March 2021, 264 patients were admitted to undergo intensive care with confirmed SARS-CoV-2 infection. The 30-day mortality rate after the initial intensive care admission was 12.9%, and this rate remained unchanged during both pandemic waves. However, we found several distinct differences between the two pandemic waves, including an increase in the use of high-flow nasal oxygen but a decrease in invasive mechanical ventilation use, biochsed knowledge and improved therapeutic options.The relationship between fish functional diversity and fishing levels at which its baselines shift is important to identify the consequences of fishing in ecosystem functioning. For the first time, the authors of this study implemented a trait-based approach in the Argentine Patagonian Sea to identify the vulnerability and spatiotemporal changes in functional diversity of fish assemblages incidentally captured by a trawling fleet targeting the Argentine red shrimp Pleoticus muelleri (Spence Bate, 1888) between 2003 and 2014. The authors coupled seven fish trophic traits to a reconstructed fish assemblage for the study area and by-catch and evaluated changes in fish species richness and four complementary functional diversity measures (functional richness, redundancy, dispersion and community trait values) along with fishing intensity, temporal use, latitudinal location and depth of fishing grounds, and vessel length. Resident fishes larger than 30 cm in length, with depressed and fusiform bodies, intermediate to high trophic levels, and feeding in benthic, demersal and midwater areas were vulnerable to by-catch. In addition, fish assemblages exhibited a low functional trait redundancy, likely related to species influxes in a biogeographic ecotone with tropicalisation signs. Significant increases in fish trait richness and dispersion poleward and deep suggested new functional roles in these grounds, matching trends in community body size, reproductive load, maximum depth and trophic level. Finally, a temporal increase in fish species and functional trait removal in fishing grounds led to trait homogenisation since 2003. The authors identified that tipping points in temperate fish functional trait diversity showed the importance of trait-based approaches within ecosystem-based fisheries management.