Tag Archives: acetylcholine receptor

Ethical beliefs refers to the beliefs of ethical

Ethical beliefs refers to the beliefs of ethical principles that include autonomy, beneficence/non-malfeasance and justice (Black, 2007; Beauchamp and Childress, 2001). It was important to identify the ethical beliefs of the students in relation to HIV/AIDS and PLWHAs in an attempt to explain their attitudes and their future dealing with this group of vulnerable population. The first part of the ethical beliefs questionnaire addressed the students’ beliefs towards HIV/AIDS testing, confidentiality/disclosure and environment of care provided for PLWHAs. Testing for HIV is essential to facilitate early diagnosis and management of the condition in order to prolong lifespan of the patient and to prevent the transmission of the disease. However, the acetylcholine receptor associated with HIV/AIDS and the confidentiality concerns have become a barrier to testing with subsequent missing of opportunities to receive early treatment (Mudhovozi et al., 2012). In this study, approximately one-third of the participants believed that it is appropriate to test a patient for HIV even without the patient’s permission. This could be attributed to the students’ intentions to know about patients’ HIV status so that they can protect themselves. Testing for HIV without consent is considered as a breach of autonomy that states that HIV testing is voluntary and it is ethically mandatory to obtain informed consent from the patient prior to it (UNAIDS, 2004; Huang and Hussein, 2004). The response of the students in regards to this item reflects that almost one third of the students’ were unfamiliar with the ethical protocol related to HIV testing. Confidentiality of HIV/AIDS patient was not being considered by more than half of the students where they agreed to inform relatives and sexual partners about the condition of the patient without patient’s consent. General Dental Council (GDC) has issued recommendation that dentists should not disclose patients’ information without consent (CouncilGDC GD, 1997). This could be due to the reason that partners’ notification is an effective strategy to prevent HIV transmission to sexual partners and to prompt treatment for those who were infected with HIV (Hogben et al., 2007). On the other hand it can be caused by the feel of obligation to notify the partners. However, partners’ notification without consent can incur undesirable consequences such as marital disharmony and divorce (VanDevanter et al., 2012; Deribe et al., 2008). Despite facing ethical dilemmas between respecting patients’ confidentiality and disclosing HIV status to their sexual partners, dental students should not breach patients’ confidentiality in their future practices. Instead, they should try to encourage or counsel HIV patients on the importance of disclosing HIV status to their sexual partner. As such, these practices protect patients’ right to privacy and decision making with regards to disclosure of patients’ HIV status (CouncilGDC GD, 1997). In regards to the environmental care offered to HIV/AIDs patients, more than half of the students reported the preference to clearly mark the rooms /beds and the charts of the patients. Literature revealed that such disclosure practices in healthcare setup may not decrease stigmatization, as stigma is affected by the way the patients contract the disease rather than having segregated units for the HIV/AIDS patients. Similar findings and preference of segregation was reported by nurses in several studies (Surlis and Hyde, 2001; Schietinger and Daniels, 1996). If the segregation and the isolation of patients were actualised in the dental practice, it may result in unethical behaviours and discriminatory practices with subsequent violation of equality and justice resulting in an infringement of HIV-infected individuals’ human rights. Another effect of segregation can be the non-disclosure of HIV status (Relf et al., 2009; Petrak et al., 2001).
Ethical beliefs towards policies in healthcare setup revealed that majority of the students felt that the healthcare professional should be informed if the patient is HIV-positive. More than half of the students reported that if health care workers are HIV-infected they should not be allowed to work in the field or carry-on invasive procedures requiring direct patient contact. Guidelines in regards to HIV-infected dentists and whether they are allowed to practice after being diagnosed with the disease is under reviewing and varies worldwide. UK advisory panel for health care workers infected with blood-borne viruses (UKAP) – under department of health UK – in 2007 banned HIV- infected dentists from treating patients as it defined all dental procedures as exposure-prone procedures (EPPS) where a risk of injury to the worker may result in exposure of the patient’s open tissues to the blood of the worker (McGoldrick, 2012). In 2009 The British Dental Association (BDA) endorsed the Beijing Declaration and announced that the ruling is “unfair and unlawful” giving the reason that dentistry in general, does not involve situations where the blood from clinician and patient mixes (Erridge, 2007). While in U.S and according to Centers for Disease Control and Prevention (CDC) the guidelines regarding the HIV-infected health care workers (HCW) including the dentists are state-based where every state has its own regulation (CDC, 2008) The states seemed to recognize that the risk of transmission from HCWs to patients was extremely low, especially when the universal precautions already in place are followed (Henderson et al., 2010).

br Materials and methods br Results The mean pH

Materials and methods

Results
The mean pH values for Control and PMR cows for each measurement in a 24-h acetylcholine receptor over the duration of the 14-day measurement period are shown in Fig. 1. The typical daily pattern involved a drop in ruminal pH following the morning feed, followed by a small increase in pH before the afternoon feed. A second drop after the afternoon feed was followed by a slow return to maximum values overnight. Daily ruminal pH values are summarised in Table 1. There were no significant differences between means for Control and PMR groups, and no effect of feeding rate for any of the outcomes.
The mean (±SD) corrected serum Hp concentration was 0.062 ± 0.27 mg/mL for Control cows (n = 62) and 0.053 ± 0.20 mg/mL for PMR cows (n = 64). There was no effect of feeding method (P = 0.98) or feeding rate (P = 0.74). None of the 15 rumen-fistulated cows had serum concentrations of Hp >0.009 mg/mL (lowest detectable concentration) whereas 17/110 non-fistulated cows did.

Discussion
The percentage of time that the pH is < 6.0 and 5.6 have both been reported to be relevant for determining sub-optimal rumen function and the presence of SARA, respectively (Mould et al., 1983; Nocek, 1997; Olson, 1997). The indwelling pH boluses allowed normal behaviour of the cows and could record many more values of pH than would have been possible using manual sampling so parameters of time below pH 5.6 and 6 could be precisely evaluated as well as the ‘area’ (time × pH) under those values. This gave a measurement of not only how low the pH went, but for how long it was at this low value. Gozho et al. (2005) defined SARA as a ruminal pH < 5.6 for > 3 h/day. This is 12.5% of the day and, by this definition, even though there was no significant difference between PMR and Control cows in the time spent below the defined ruminal pH thresholds, 12/15 rumen-fistulated cows in the study had SARA. However, there were no health problems recorded in these cows.
Working with the same cows, Auldist et al. (2014) also found no difference between PMR and Control cows for milk yield or composition, body condition score, liveweight or ruminal volatile fatty acid and ammonia concentrations. All of these parameters have been well-described as potential indicators of SARA, or at least of sub-optimal rumen function. (Kolver and de Veth, 2002; Kleen et al., 2003; Nordlund et al., 2004). Additionally, Auldist et al. (2014) measured ruminal pH manually at 2-h intervals for a 24-h period during the same experiment and found no difference in ruminal pH parameters between PMR and Control cows, apart from PMR cows recording a higher maximum pH. Those authors did report that with increasing level of supplement, the area under pH 6 increased. This also highlights the problem of having a defined threshold for SARA when the dynamic nature of the rumen and its pH (and also the way the cow is able to adapt to fluctuations in the pH over time) means that an absolute threshold of optimal ruminal pH or a level of pH defining SARA may be less clear than is often assumed.
The results from this experiment indicate that lower ruminal pH values or more time spent below pH 5.6 were not associated with increased concentrations of Hp. In the time period from 8 days before to 7 days after blood collection, 9/126 blood sampled cows were sick (eight with mastitis, one lame). Four of the eight cows with mastitis during that period were found to have Hp concentrations greater than the upper limit of the normal reference range (<0.1 mg/mL; Ceciliani et al., 2012), whereas only seven of the remaining 118 cows with no signs of clinical disease had serum Hp concentrations >0.1 mg/mL. This supports the evidence in the literature that for conditions resulting in high levels of acute inflammation, such as mastitis (Eckersall et al. 2001), serum Hp concentrations may be a useful marker.

br Recently dynamic chest radiography using a flat

Recently, dynamic chest radiography using a flat panel detector (FPD) system with a large field of view was introduced for clinical use. This technique can provide sequential chest radiographs with high temporal resolution during respiration (17), and the acetylcholine receptor dose is much lower than that of CT. Also, whereas CT and MRI are performed in the supine or prone position, dynamic chest radiology can be performed in a standing or sitting position, which is physiologically relevant. To the best of our knowledge, no detailed study has analyzed diaphragmatic motion during tidal breathing by using dynamic chest radiography.

The purpose of this study was to evaluate diaphragmatic motion during tidal breathing in a standing position in a health screening center cohort using dynamic chest radiography in association with participants\’ demographic characteristics.

Materials and Methods

Study Population

This cross-sectional study was approved by the institutional review board, and all the participants provided written informed consent. From May 2013 to February 2014, consecutive 220 individuals who visited the health screening of our hospital and met the following inclusion criteria for the study were recruited: age greater than 20 years, scheduled for conventional chest radiography, and underwent pulmonary function test. Patients with any of the following criteria were excluded: pregnant (n  =  0), potentially pregnant or lactating (n  =  0), refused to provide informed consent (n  =  22), had incomplete datasets of dynamic chest radiography (n  =  3), had incomplete datasets of pulmonary function tests (n  =  1), could not follow tidal breathing instructions (eg, holding breath or taking a deep breath) (n  =  18), or their diaphragmatic motion could not be analyzed by the software described next (n  =  4). Thus, a total of 172 participants (103 men, 69 women; mean age 56.3 ± 9.8 years; age range 36–85 years) were finally included in the analysis ( Fig 1). The data from 47 participants of this study population were analyzed in a different study (under review). The heights and weights of the participants were measured, and the body mass index (BMI, weight in kilograms divided by height squared in meters) was calculated.

Figure 1. Flow diagram of the study population.Figure optionsDownload full-size imageDownload high-quality image (83 K)Download as PowerPoint slide

Imaging Protocol of Dynamic Chest Radiology (“Dynamic X-Ray Phrenicography”)

Posteroanterior dynamic chest radiography (“dynamic X-ray phrenicography”) was performed using a prototype system (Konica Minolta, Inc., Tokyo, Japan) composed of an FPD (PaxScan 4030CB, Varian Medical Systems, Inc., Salt Lake City, UT, USA) and a pulsed X-ray generator (DHF-155HII with Cineradiography option, Hitachi Medical Corporation, Tokyo, Japan). All participants were scanned in the standing position and instructed to breathe normally in a relaxed way without deep inspiration or expiration (tidal breathing). The exposure conditions were as follows: tube voltage, 100 kV; tube current, 50 mA; pulse duration of pulsed X-ray, 1.6 ms; source-to-image distance, 2 m; additional filter, 0.5 mm Al + 0.1 mm Cu. The additional filter was used to filter out soft X-rays. The exposure time was approximately 10–15 seconds. The pixel size was 388 × 388 µm, the matrix size was 1024  × 768, and the overall image area was 40 × 30 cm. The gray-level range of the images was 16,384 (14 bits), and the signal intensity was proportional to the incident exposure of the X-ray detector. The dynamic image data, captured at 15 frames/s, were synchronized with the pulsed X-ray. The pulsed X-ray prevented excessive radiation exposure to the subjects. The entrance surface dose was approximately 0.3–0.5 mGy.