Women Want Choices: Opinions from the Share.Learn.Shape Global Internet Survey About Multipurpose Prevention Technology (MPT) Products in Development.

Women need multipurpose prevention technologies (MPTs) to simultaneously prevent sexually transmitted infections (STIs), including HIV, with or without contraception. User feedback early in product development is critical for maximizing uptake and continuation. Our global online survey (April 2017-December 2018) explored women's opinions about MPT formulations in development (e.g., fast-dissolving vaginal inserts, vaginal films, intravaginal rings, injectables, implants), preferences for long-acting or "on-demand" methods, and interest in a contraceptive MPT versus products for HIV/STI prevention alone. Of the 630 women in our final analysis (mean 30 years old; range 18-49), 68% were monogamous, 79% completed secondary education, 58% had ≥ 1 child, 56% were from sub-Saharan Africa and 82% preferred a cMPT versus HIV/STI prevention alone. There were no clear preferences for any specific product or product type (long-acting, on-demand, daily). No single product will appeal everyone, however, adding contraception is likely to increase uptake of HIV/STI prevention methods for most women.

RESUMEN: Las mujeres necesitan tecnologías de prevención multipropósito (TPM) para prevenir simultáneamente las infecciones de transmisión sexual (ITS), incluido el VIH, con o sin anticoncepción. Las opiniones de los usuarios cuando un producto comienza a desarrollarse son fundamentales para maximizar la adopción y continuación de dicho producto. Nuestra encuesta global realizada en internet (abril de 2017­diciembre de 2018) exploró las opiniones de las mujeres sobre diferentes fórmulas o dispositivos de TPM que se están desarrollando (ej., insertos vaginales de disolución rápida, láminas vaginales, anillos intravaginales, inyectables, implantes). En esta encuesta se indagó acerca de las preferencias en términos de período de acción (prolongado o breve) y propósito del uso (anticonceptivo, productos para la prevención del VIH/ITS, o ambos). De las 630 mujeres (media de 30 años; rango 18­49) en el análisis final, el 68% eran monógamas, el 79% completaron la educación secundaria, el 58% tenían ≥ 1 hijo, el 56% eran del África subsahariana y el 82% preferían una TPM con componente anticonceptivo en vez de un producto para la prevención de VIH/ITS exclusivamente. No hubo preferencias claras por ningún producto o tipo de producto específico (de acción prolongada, de acción breve, de uso diario). Ningún producto por sí solo logró abarcar todas las preferencias; sin embargo, es probable que la inclusión de métodos anticonceptivos en una TPM aumente el uso de métodos de prevención del VIH/ITS en la mayoría de las mujeres.

The People Living with HIV (PLHIV) Resilience Scale: Development and Validation in Three Countries in the Context of the PLHIV Stigma Index.

Supporting resilience among people living with HIV (PLHIV) is crucial to their sustained uptake of HIV services as well as psychological and social wellbeing. However, no measures exist to assess resilience specifically in relation to living with HIV. We developed the PLHIV Resilience Scale and evaluated its performance in surveys with 1207 PLHIV in Cameroon, Senegal and Uganda as part of the PLHIV Stigma Index-the most widely used tool to track stigma and discrimination among PLHIV worldwide. Factor analyses demonstrated satisfactory psychometric properties and reliability (alphas = 0.81-0.92). Levels of resilience (e.g., whether one's self-respect has been positively, negatively, or not affected by one's HIV status) varied substantially within and across countries. Higher resilience was associated with less depression in each country (all p < 0.001), and, in Cameroon and Uganda, better self-rated health and less experience of stigma/discrimination (all p < 0.001). The final 10-item PLHIV Resilience Scale can help inform interventions and policies.

Dental panoramic radiographic evaluation in bisphosphonate-associated osteonecrosis of the jaws.

OBJECTIVES: To determine the extent to which clinical and radiographic features of bisphosphonate-associated osteonecrosis of the jaw (BONJ) are correlated. DESIGN: Retrospective case review. METHODS: The records of 39 patients diagnosed with BONJ and examined by panoramic radiography were retrospectively evaluated. The arches were divided into sextants (n = 234) and evaluated for the following signs: sclerosis, surface irregularity, sockets, fragmentation and lysis. MAIN OUTCOME MEASURES: The McNemar, Kruskall-Wallis and equivalency tests were performed to analyze the association between clinical and radiographic signs and BONJ severity. RESULTS: Sixty-two out of 234 sextants were abnormal by clinical criteria and 61 out of 234 sextants demonstrated at least one radiographic abnormality. There was agreement between clinical and radiographic detection in 41 sextants. The data showed equivalency between BONJ diagnosis and both sclerosis and surface irregularity. The correlation between number of clinical sites and any radiographic finding was significant in the maxilla (P < 0.001) but not in the mandible (P = 0.178). The total number of radiographic signs per patient increased with BONJ stage. CONCLUSION: Focal panoramic radiographic findings of sclerosis and surface irregularity correlate with clinical sites of BONJ. This may be a useful and reliable tool to detect early changes of BONJ or to confirm a clinical diagnosis.

Microbicide trials for preventing HIV/AIDS in South Africa: phase II trial partricipants' experiences and psychological needs.

The Microbicide Division of the Department of Medical Microbiology at MEDUNSA, South Africa, recently completed a phase II expanded safety trial of the candidate microbicide Carraguard. A microbicide is a vaginal product that women might use, if proven safe and effective, to protect themselves from HIV and possibly other sexually transmitted infections (STIs). The study participants were from Ga-Rankuwa and its neighbouring areas, an historically disadvantaged residential township near Pretoria. We conducted six focus group discussions with phase II trial participants to evaluate their experiences with trial participation and their psychological needs. Participants spontaneously talked about their experiences with the study gel and speculum examinations. They felt that they had received high quality medical care. They indicated that their personal hygiene and knowledge of the female reproductive system, HIV and other STIs had improved, which helped their familie and empowered them as women. Participants valued being able to discuss their anxiety about HIV/AIDS wit study staff. They felt that the study provided them with a supportive environment in which their personal problems (not necessarily restricted to HIV/AIDS) could be addressed. Some recommended that the study staf improve their professionalism and punctuality. They suggested the formation of participant support groups, an expressed a preference to remain involved in the trial. Some participants appeared to have become dependent o services provided during the trial. We have taken the results of these focus group discussions into account during planning for a phase III efficacy trial of Carraguard to be conducted in the same and other similar communities.

Acceptability and feasibility of Micralax applicators and of methyl cellulose gel placebo for large-scale clinical trials of vaginal microbicides.

OBJECTIVE(S): To evaluate the feasibility and acceptability of the Micralax applicator and of methyl cellulose placebo gel for use in vaginal microbicide clinical trials. DESIGN: A two-centre prospective study following women for 2 months. SETTING: Two primary health care clinics in South Africa. PATIENTS, PARTICIPANTS: Female volunteers (n = 28) 18 years or older who were HIV negative and had no clinically detectable genital tract abnormalities or reproductive tract infections. INTERVENTIONS: Participants used pre-filled Micralax applicators to apply methyl cellulose gel every other day, as well as up to 1 h before to every episode of vaginal sex. MAIN OUTCOME MEASURE(S): Consistency in the weight of gel dispensed per application; side-effects attributed to applicator or gel use; and acceptability of the applicator and of the gel. RESULTS: Over a 2 month follow-up period the 22 women completing the study reported no adverse events related to gel or applicator use. The Micralax applicator proved acceptable. The gel was not too messy and did not reduce sexual frequency or pleasure. On average, the applicator dispensed 4.7 ml per use (close to the 4 ml planned). CONCLUSIONS: The Micralax applicator performs well as a delivery system for potential vaginal microbicides; and methyl cellulose is an appropriate placebo for future microbicide trials.

Use of rotational tomography for assessing internal resorption.

The authors describe the use of tomography, a relatively simple and well-established radiographic technique, for determining the buccolingual extent of internal resorptive lesions. The procedure may be a useful adjunct in selected cases to determine whether root canal therapy for the treatment of internal resorption followed by restoration of the tooth is likely to be successful.

Men's attitudes towards a potential vaginal microbicide in Zimbabwe, Mexico and the USA.

Vaginal microbicides are being developed in an attempt to expand women's and men's options for protecting themselves against HIV and other sexually transmitted infections. Taking account of men's attitudes during product development and introduction could increase the likelihood that products are acceptable and used. To capture the perspectives of urban and rural men from a range of cultural settings, we conducted focus group discussions with taxi drivers and farmers in Zimbabwe, Mexico and the USA. These explored HIV/STD risk perception and prevention strategies, desirable characteristics of vaginal products and of a microbicide, and attitudes towards use of a potential product. Men were generally supportive of the idea of a microbicide; urban somewhat more than rural men. Most thought microbicides would be preferable to condoms though many raised concerns about potential side effects. The men wanted these products to be as inexpensive and readily available as condoms, and differed as to whether a woman should have permission from her partner to use it. For them to be widely used, the men thought these products must not only be safe and effective, but should also have no negative effect on sexual pleasure. When a product becomes available, introductory messages must explain the limits on its effectiveness and encourage use with condoms. Further research is needed on definitions of pleasurable sex and the ramifications of this for microbicide formulation, and on partner communication around issues of sexuality and prevention of infection.

Clinical radiological issues in orthodontic practice.

Radiology has long played a critical role in the treatment planning of the orthodontic patient. The focus of this article is on common issues that confront the orthodontist and how a basic understanding of radiological techniques and simple radiological procedures can be used to resolve them. The article addresses the advantages and shortcomings of the two most common films, the cephalogram and the panoramic view, taken by orthodontists. It goes on, however, to discuss other views that can easily be taken in the private office to supplement these radiographs.

Incidental finding of an enlarged sella turcica on a lateral cephalogram.

The lateral cephalogram is a film that is routinely used in orthodontics. Orthodontists should therefore be familiar with the normal radiographic appearance of the skull as seen on the lateral cephalogram. We present a case of an enlarged sella turcica that was discovered during routine orthodontic workup. Referral and further investigation led to a diagnosis of a prolactinoma.

A probable case of a cysticercosis presenting as an incidental intracranial calcification on a lateral cephalogram.

A 42-year-old female in whom intracranial calcifications were incidentally identified on a lateral cephalogram is presented. Follow-up CT scans and her social history led to the most probable diagnosis of cysticercosis, an infestation by larva of the tapeworm Taenia solium, of the brain. A differential diagnosis of intracranial calcifications on plain film skull views is presented.

Carteolol hydrochloride: controlled evaluations of its ocular hypotensive efficacy relative to its vehicle, and, in combination with pilocarpine, relative to timolol.

Carteolol is a noncardioselective beta-adrenoceptor antagonist with intrinsic sympathomimetic activity. In the two studies presented in this report, we sought (a) to evaluate the absolute efficacy of carteolol (i.e., vs. its vehicle) over an extended period and (b) to evaluate the utility of carteolol versus that of timolol when used concomitantly with pilocarpine. Study 1 was a double-masked, randomized, 6-week evaluation conducted in 64 patients of 1% carteolol HCl, 2% carteolol HCl, and its vehicle given twice daily in both eyes. From an unmedicated baseline intraocular pressure (IOP) of 23-25 mm Hg, mean reductions in the carteolol treatment groups ranged from 5.8 to 6.6 mm Hg (23-26% reduction). Mean reductions in heart rate were six to seven beats/min, two beats/min, and one beat/min in the 1% carteolol, 2% carteolol, and vehicle groups, respectively. Study 2 was a double-masked, randomized, 12-week evaluation of 1% carteolol HCl, 2% carteolol HCl, and 0.5% timolol in combination with pilocarpine, either 2% or 4%, in 67 patients. From an unmedicated baseline IOP of 24-29 mm Hg, mean reductions from this unmedicated baseline with combination beta-adrenoceptor antagonist/pilocarpine treatment ranged from 6 to 10 mm Hg in all groups (24-40%). Mean decreases in heart rate ranged from one to six beats/min, with no meaningful differences among the treatment groups. Based on the efficacy of twice-daily carteolol in reducing IOP by approximately 25%, as well as its efficacy when used concomitantly with pilocarpine, we suggest that clinicians may find carteolol a useful addition to their pharmacopeia in the treatment of elevated IOP.

In vitro antiviral activity of a peptide-nucleic acid solution against the human immunodeficiency virus and influenza A virus.

A peptide-nucleic acid solution which had previously been reported to show in vivo efficacy in several viral infections (i.e. influenza, hepatitis, mumps, encephalitis, etc) was tested in three independent laboratories, including the US National Institutes of Health by specific in vitro methods for HIV and Influenza A. The results of these studies demonstrated significant anti-viral activity of the peptide-nucleic acid solution against the Human Immunodeficiency Virus (HIV) and the Influenza A virus.

The regulation of dental licensing: the dark ages?

Current state laws regulating the licensure of dentists place severe restrictions upon the freedom of movement of practitioners. Most state laws were enacted during a period when a strong rationale for regulating public health and welfare existed. Today, these laws hamper the free movement of dentists and are anachronisms in an era of national standards and practices. The authors contend that the extant laws rest upon outdated assumptions and serve economic and protectionist goals rather than public health and safety. This Article examines the history and application of the traditional justifications for state licensure and their present ramifications. The authors suggest that replacing the current regulatory system with a national clinical examination and a national licensure program will best serve the interests of the public and the dental profession.