Academic literature on the topic 'FJ. Knowledge management'

Nasopharyngeal carcinoma (NPC) is a highly metastatic cancer prevalent in Southern China and Southeast Asia. The current knowledge on the molecular pathogenesis of NPC is still inadequate to improve disease management. Using gene expression microarrays, we have identified the four-jointed box 1 (FJX1) gene to be upregulated in primary NPC tissues relative to nonmalignant tissues. An orthologue of human FJX1, the four-jointed (fj) gene in Drosophila and Fjx1 in mouse, has reported to be associated with cancer progression pathways. However, the exact function of FJX1 in human is not well characterized. The overexpression of FJX1 mRNA was validated in primary NPC tissue samples, and the level of FJX1 protein was significantly higher in a subset of NPC tissues (42%) compared to the normal epithelium, where no expression of FJX1 was observed (p=0.01). FJX1 is also found to be overexpressed in microarray datasets and TCGA datasets of other cancers including head and neck cancer, colorectal, and ovarian cancer. Both siRNA knockdown and overexpression experiments in NPC cell lines showed that FJX1 promotes cell proliferation, anchorage-dependent growth, and cellular invasion. Cyclin D1 and E1 mRNA levels were increased following FJX1 expression indicating that FJX1 enhances proliferation by regulating key proteins governing the cell cycle. Our data suggest that the overexpression of FJX1 contributes to a more aggressive phenotype of NPC cells and further investigations into FJX1 as a potential therapeutic target for NPC are warranted. The evaluation of FJX1 as an immunotherapy target for NPC and other cancers is currently ongoing.

Abstract A changing picture of oral lesions associated with HIV/AIDS has been documented. With the use of antiretroviral therapy, salivary gland swellings and other less common conditions associated with HIV/AIDS are now becoming more common. Our review of the literature showed the presence of parotid swelling in HIV-1 infection has increased from a range of 5-10% to 20% in AIDS. However, to the best of our knowledge, none from sub-Saharan Africa, which is the epicenter of the HIV infection and where access to antiretroviral therapy is poorest, has been primarily reported in literature. This report documents five cases of bilateral parotid gland enlargement as the presenting clinical manifestation of HIV/AIDS. The combination of a fine needle aspiration (FNA) biopsy, ultrasound imaging, and histological diagnosis increased the accuracy of diagnosis. While two patients had access to antiretroviral therapy, other modes of management were cystic aspiration and parotidectomy. One of the patients treated with parotidectomy had facial nerve injury, and the short-term aesthetic outcome between surgical treatment and antiretroviral therapy did not appear different. However, all our patients were lost to follow-up within a 2-year period. For a resource-constrained environment like Nigeria where stigma and discrimination is high and access to antiretroviral therapy is limited, there is a need to understand how best to manage a lymphoepithelial lesion in HIV/AIDS patients. Citation Owotade FJ, Fatusi OA, Adebiyi KE, Ajike SO, Folayan MO. Clinical Experience with Parotid Gland Enlargement in HIV Infection: A Report of Five Cases in Nigeria. J Contemp Dent Pract 2005 February;(6)1:136-145.

BackgroundThe demand for and provision of health care is in constant change. People live longer and have more complex health requirements, challenging the functioning of the health care system in responding adequately to present and future needs. For persons with hand osteoarthritis (HOA), access to recommended treatment is poor (1) and what can be offered in primary health care is not optimal. A reorganization of the workforce through task- shifting can be a solution where the aim is to use existing human resources in health in more efficient ways. Through task- shifting, tasks and knowledge can be shifted between health professionals, between levels of the health care system, and from health professionals to service users, changing the current division of labor (2).ObjectivesThe aim of this study is to gain a broader understanding of the distribution of tasks among health professionals and service users in HOA care from the perspective of service users to guide future task- shifting initiatives.MethodsIn- depth interviews with 21 service users with HOA were conducted, including 15 women and six men from 47 to 86 years of age. All had received services from primary and specialized health care services. A theme based semi- structured interview guide was used. All interviews were audio- recorded and subsequently transcribed verbatim. Reflexive thematic analysis was used to generate codes and develop three main themes.ResultsTasks by different professionals: service users describe general practitioners (GPs) as entry points to health service provision. Contact is initiated with the aim to have signs and symptoms recognized for referrals to diagnostic tests and specialized services. As such, tasks beyond referrals are not expected by service users in primary health care in their encounters with GPs. Upon entering specialized health care services, service users describe diagnostics and prescription of medication for pain as key tasks of the rheumatologists, highlighting the role of the rheumatologists in ruling out severe pathology. Service users attribute the tasks of providing information about the condition, exercises, and assistive devices to occupational therapists (OTs). A lack of familiarity with the OT- profession prior to consultations is also expressed. This shows how patients attribute different tasks to GPs, rheumatologists, and OTs based on experiences in consultations.Profession secondary to competence about HOA and interpersonal skills: service users say they do not have preferences related to who executes what professional tasks in addressing their needs. On the contrary, service users highlight competence about HOA as a key factor independent of whether the health professional is a GP, rheumatologist, or OT, saying professional orientation is secondary to professional knowledge about HOA. At the same time, service users underline interpersonal skills of health professionals as another key element, further downplaying the specific professional background of health professionals and levels of the health care system in meeting service user needs.Transfer of tasks to service users: service users experience that they are presented with few treatment options beyond self- management in encounters with health professionals, leaving service users to cater for their own needs through the self- administration of exercises, medicines, and assistive devices.ConclusionIn the division of labor, service users highlight the importance of professional knowledge and skills within the field and interpersonal skills independent of professional background and levels of the health care system. They also underline few treatment opportunities beyond self- management resulting in task- shifting to service users.References[1]Kloppenburg M, Kroon FP, Blanco FJ, et al. 2018 update of the EULAR recommendations for the management of hand osteoarthritis. Annals of the Rheumatic Diseases 2019; 78:16-24.[2]European Commission Expert Panel on effective ways of investing in Health (EXPH). Task shifting and health system design, 26 June 2019.Disclosure of InterestsNone declared

<p>A model for long-term analysis of the influence of timber production on lichens for reindeer grazing (Cladina, Alectoria, Bryoria spp and others) in Sweden is presented. The annual production of and demand for lichens are estimated and compared. Production of these lichens is presumed to set the upper limit for the reindeer population. Reindeer graze on both ground and tree lichens, which both must be accessible in sufficient amounts and at the right times of the year if reindeer husbandry is to succeed without supplementary feeding. The model is based mainly on existing data, and uses are estimations from the National Forest Survey and the Hugin system for calculation of longterm potential cut (Bengtsson, 1981). Geographically the study is limited to Vasterbotten and Norrbotten, the northernmost counties in Sweden, where most reindeer husbandry in Sweden is located, and where reindeer grazing takes place over almost the whole area. The calculations cover a period of one hundred years from 1980, and are based on a timber production programme which relies more on &laquo;multiple use&raquo; than the current Swedish forest policy (Bengtsson, 1986). The annual production of ground lichens is calculated by multiplying the area covered with ground lichens by their increment as estimated from their rate of biomass increase, which in turn depends on site factors and age of the stand. The estimation of the area is based on data from the National Forest Survey. Sample plots with ground lichens are assumed to maintain lichens during the whole hundred year period. Areas with stands that have been thinned within ten years and stands younger than 20 years are excluded due to logging residues from thinnings and packed snow. Some of the remaining area cannot practically be utilized for reindeer grazing. Representatives of three communities of reindeer herders classified 212 plots from the National Forest Survey with ground lichens and assessed that 3/4 of the plots can be utilized. The reduction was because of location (near buildings, roads, railroads, and recreation facilities), or because the area with lichens was too small and isolat&eacute;d. Demand for ground lichens is calculated as the daily demand for ground lichens by the reindeer multiplied by the number of days every year that reindeer depend on this forage. Figures used are based upon estimations from persons with great experience of reindeer farming. The annual production of tree lichens consists of two parts, i.e., tree lichens within reach of the reindeer, and tree lichens which become accessible after falling down from the trees onto the snow. Forest stands dominated by conifers and older than one hundred years are assumed to bear tree lichens. This area is also reduced to 75 per cent for reasons of practical accessibility. Annual production of lichens in reach of the reindeer is then estimated as the area multiplied by the increment rate of the biomass. One quarter of the annually fallen tree lichens is assumed to be available as fodder during late winter/early spring. The demand for tree lichens is principally estimated in the same way as for ground lichens, but the number of days per years is lower because tree lichens are mainly considered to be fodder in distress periods. Two sources of uncertainty are present in the results, namely the influence of factors not included in the models, and the influence of uncertainty in factors included in the models. The models used to estimate production and demand obviously imply simplifactions of true relations. These simplifications are mainly due to a basic lack of knowledge, one example being that variation, i.e. in volume per hectare, might very well influence the production of lichens, but is not taken into consideration in the models. One example of uncertainty in data used is the increment rate of lichen fodder. Another example is the estimation of biomass of lichens, here based upon investigations (Eriksson, unpubl.) with other purposes than to provide data about grazing availability in the large geographic regions used in this study. The possibilities for drawing reliable conclusions will increase when better estimations of input data and relationship are available. The geographic division into four regions is a result of the design of the National Forest Survey. However, great differences may be present within these geographic areas, each containing a number of communities of reindeer herders. Thus, results are not applicable to single communities of reindeer herders. The study illustrates a method of revealing how lichen fodder for reindeer will develop in relation to timber production. The results of the calculations, however, are too uncertain to allow reliable conclusions to be drawn. Nonetheless, the results indicate that in some areas there is already a shortage of lichen fodder for the number of reindeer assumed in this study. The calculations hint that production will decrease in the future. These indications should motivate more research in this topic. If the results of this study are accurate and if forestry develops according to the assumptions, the owners of the reindeer will have to continue or increase the supplementary feeding and/or reduce the number of reindeer significantly. They will also have to utilize all of the areas that are possible to graze, even if some of them today are considered to be of marginal value for reindeer grazing. Another way to improve the balance of production and demand is to adjust forest management on areas with lichens to a greater extent than has been done in the timber production alternative analysed in this study.</p><p>Virkesproduktionens inverkan p&aring; renskotselns lavbete - En metodstudie.</p><p>Abstract in Swedish / Sammanfattning: En modell for l&aring;ngsiktig analys av virkesproduktionens inverkan p&aring; renskotselns lavbete(Cladina, Alectoria, Bryoria spp mfl) i Sverige presenteras. Modellen ber&aring;knar &aring;rlig produktion och behov av lavbete, ef^ersom tillg&aring;ngen p&aring; dessa lavar bedoms begr&aring;nsa renpopulationen. B&aring;de tr&aring;d- och marklavar betas av renarn&pound;| och m&aring;ste finnas tillg&aring;ngliga i tillr&aring;cklig m&aring;ngd och vid r&aring;tt tidpunkt under &aring;ret om renskotseln skall klara sig utan stodutfordring. Modellen bygger huvudsakligen p&aring; redan existerande data. Skattningarna av areal gors med data fr&aring;n riksskogstaxeringen och fr&aring;n ber&aring;kningar med Hugin-systemet for l&aring;ngsiktiga analyser av avverkningsmojlighe-terna (Bengtsson, 1981). Studien begr&aring;nsas geografiskt till Norr- och V&aring;sterbottens l&aring;n. Ber&aring;kningarna gors for en hun^ra&aring;rsperiod med start 1980, och bygger p&aring; ett virkesproduktionsprogram i A VB-85 som syftar till mera m&aring;ngbruk an dagens skogspolitik (Bengtsson, 1986). Den &aring;rliga produktionen av marklav skattas som produkten av m&aring;ngden marklav per hektar, dess till-v&aring;xtprocerit och arealen med marklav. M&aring;ngden marklav per hektar beror av st&aring;ndortsforh&aring;llanden och bes-t&aring;nds&aring;ldern. Skattningen av arealen baseras p&aring; uppgifter fr&aring;n riksskogstaxeringen. Provytor med marklav antas vara layb&aring;rande under hela prognosperioden. Provytor d&aring;r best&aring;nds&aring;ldern &aring;r l&aring;gre &aring;n 20 &aring;r, samt provytor som i awerkningsber&aring;kningen rojts eller gallrats under senaste tio&aring;rsperiod r&aring;knas dock bort. Orsaken &aring;r att snopacknirig och kvarl&aring;mnade stammar och ris forsv&aring;rar eller omojliggor for renen att komma &aring;t laven. Hela den &aring;terst&aring;ende arealen kan dock inte nytt jas for planerad renskotsel. Representanter for tre samebyar bedomd)e 212 av riksskogstaxeringens provytor med marklav med avseende p&aring; om de kan nytt jas for planerad renskotsel. Resultatet blev att 3/4 av provytorna ans&aring;gs kunna utnyttjas. Provytor r&aring;knades bort p&aring; grund av bel&aring;genlhet n&aring;ra byggnader, v&aring;gar, j&aring;rnv&aring;gar och friluftsanl&aring;ggningar, eller pga att arealen med marklav var for liten och isolerad for att kunna utnyttjas. Behovet av marklav ber&aring;knas som produkten av det genomsnittliga dygnsbehovet for en ren, antalet renar samt det ailital dagar per &aring;r som renarna bedoms ha behov av detta foder. De tv&aring; senare uppgifterna grundas p&aring; uppskattningar av personer med stor erfarenhet av renskotsel. Den &aring;rliga produktionen av tr&aring;dlavar best&aring;r dels av lavtillv&aring;xten i det betningsbara hojdintervallet, dels av tr&aring;dlav som faller ner p&aring; snon. Barrdominerade best&aring;nd aldre &aring;n hundra &aring;r antas vara tr&aring;dlavb&aring;rande, men &aring;ven denna areal reduceras med h&aring;nsyn till praktisk tillg&aring;nglighet. &Aring;rlig produktion av tr&aring;dlav inom r&aring;ckh&aring;ll for renen skattas som produkt av m&aring;ngden tr&aring;dlav, dess tillv&aring;xtprocent och arealen. Av den tr&aring;dlav som &aring;rli-gen faller n)er p&aring; marken antas en fj&aring;rdedel vara tillg&aring;nglig under v&aring;rvintern. Efterfr&aring;gan p&aring; tr&aring;dlav ber&aring;knas p&aring; i princip samma s&aring;tt som efterfr&aring;gan p&aring; marklav, men antal betningsda-gar per &aring;r &aring;k l&aring;gre eftersom tr&aring;dlav huvudsakligen &aring;r ett visserligen hogkvalitativt och l&aring;ttillg&aring;ngligt, men dock nodfoder. Resultaten &aring;r os&aring;kra av tv&aring; huvudorsaker. Dels pga inverkan av faktorer som inte ing&aring;r i modellen, dels os&aring;kerhetejn i de faktorer som ing&aring;r i modellen. Modellen inneh&aring;ller uppenbart forenklingar av verkliga samband. Dessa forenklingar beror huvudsakligen p&aring; viss brist p&aring; grunddata. Mojligheterna att dra s&aring;kre slutsatser kommer att oka i takt med b&aring;ttre kunskap om utnyttjade samband och uppgifter. Den geografiska indelningen i l&aring;nsdelar beror p&aring; utformningen av riksskogstaxeringen. Forh&aring;llandena kan givetvis variera inom dessa l&aring;nsdelar, som var och en best&aring;r av ett flertal samebyar. Resultaten f&aring;r s&aring;ledes inte till&aring;mpas p&aring; enskilda samebyar. Studien visar p&aring; en metod for att belysa hur renskotselns lavbete kommer att utvecklas i relation till virkes-produktionen. Resultaten &aring;r dock allt for os&aring;kra for att man skall kunna dra n&aring;gra s&aring;kra slutsatser. Resultaten antyder emellertid att for vissa omr&aring;den finns redan i dag en brist p&aring; lavbete for den renpopulation som kalkylerats med i denna studie. Ber&aring;kningarna antyder att produktionen av lavbete kommer att minska i framtiden, vilket bor motivera mer forskning inom omr&aring;det. Om resultaten i denna studie &aring;r riktiga och om det virkesproducerande skogsbruket utvecklas enligt exemplet, m&aring;ste ren&aring;garna forts&aring;tta med eller utoka stodutfodringen och/eller minska antalet renar betydligt. De tvingas ocks&aring; utnyttja alla betningsbara omr&aring;den, &aring;ven s&aring;dana som for n&aring;rvarande anses vara marginella. Ett annat s&aring;tt att forb&aring;ttra balansen &aring;r att modifiera det virkesproducerande skogsbruket p&aring; arealer med lavbete i storre utstr&aring;ckning &aring;n vad som gors i det alternativ som analyseras h&aring;r.</p><p>Puuntuotannon vaikutus j&auml;k&auml;l&auml;laitumiin.</p><p>Abstract in Finnish / Yhteenveto: Artikkelissa esitet&aring;&aring;n pitk&aring;naikav&aring;lin analyysimalli puuntuotannon vaikutuksista ruotsin j&aring;k&aring;l&aring;-laitumille (Cladina, Alectoria, Bryoria spp. ym.). Koska j&aring;k&aring;lien saantia pidet&aring;&aring;n porojenlukum&aring;&aring;r&aring;&aring; rajoittava, laskee malli j&aring;k&aring;l&aring;laidunten vuotuisen tuoton ja tarpeen. Porot laiduntavat sek&aring; puussa ett&aring; maassa kasvavia j&aring;k&aring;li&aring;, ja nit&aring; molempia on oltava saatavilla, sek&aring; tarvittava m&aring;&aring;r&aring;, ett&aring; oikeaan aikaan vuodesta, jos poronhoito aikoo selviyty&aring; ilman tukiruokintaa. Malli rakentuu p&aring;&aring;siassa jo aikaisemmin hankittuihin tietoihin. Pinta-ala arviot tehd&aring;&aring;n valtakunnanmets&aring;narvioinnin tietojen, ja hakkuumahdollisuuksien pitk&aring;naikav&aring;lin analysoimiseksi perustetun Hugin-systeemin laskelmien avulla (Bengtsson, 1981). Maantieteellisesti tutkielma rajoittuu Norrbotte-nin ja V&aring;sterbottenin l&aring;&aring;neihin. Laskelmat tehd&aring;&aring;n sadanvuoden aikav&aring;lille alkaen 1980, perustuen yhteen AVB-85:en puuntuotantoohjelmaan, joka t&aring;ht&aring;&aring; t&aring;m&aring;np&aring;iv&aring;ist&aring; laajempaan metsien moninaisk&aring;yttoon (Bengtsson, 1986). Vuotuinen maassa kasvavien j&aring;k&aring;lien tuotanto arvioidaan j&aring;k&aring;lien hehtaarim&aring;&aring;rien, sen kasvuprosentin ja pinta-alan tulona. J&aring;k&aring;lien m&aring;&aring;r&aring; hehtaaria kohti on riippuvainen kasvupaikan ja metsikon i&aring;st&aring;. Pinta-ala arviot perustuvat valtakunnanmets&aring;narvioinnin tietoihin. J&aring;k&aring;l&aring;&aring; kasvavien koealojen odotetaan pit&aring;v&aring;n j&aring;k&aring;-l&aring;kasvustonsa koko prognoosiajan. Koealat, joissa metsikon ik&aring; on alle 20 vuotta, sek&aring; koealat, jotka hak-kuulaskelmissa on perattu tai harvennettu viimeisen kymmenen vuoden aikana, on j&aring;tetty huomioimatta. Syyn&aring; t&aring;h&aring;n on lumenpakkaantuminen, sek&aring; j&aring;ljelle j&aring;tetyt rungot ja oksat, jotka vaikeuttavat tai tekev&aring;t po-rojen j&aring;k&aring;l&aring;n saannin mahdottomaksi. Vuotuinen puussa kasvavien j&aring;k&aring;lien tuotanto koostuu, osittain poron ulottuvilla olevasta, ja osittain lu&not;melle putoavasta jak&aring;l&aring;st&aring;. Yli sata vuotta vanhojen havupuuvaltaisten metsikkojen oletetaan tuottavan puussa kasvavia j&aring;k&aring;li&aring;, mutta myos t&aring;m&aring; pinta-ala pienenee k&aring;yt&aring;nnon syist&aring;. Vuotuinen poronulottuvilla puussa kasvavien j&aring;k&aring;li&aring; tuotanto arvioidaan j&aring;k&aring;l&aring;n m&aring;&aring;r&aring;n, sen kasvuprosentin ja pinta-alan tulona. Yksi nelj&aring;nnesosa siit&aring; vuosittain lumelle tippuvasta j&aring;k&aring;l&aring;m&aring;&aring;r&aring;st&aring; oletetaan olevan saatavilla kev&aring;ttalvella. Puussa kasvavien j&aring;k&aring;lien kysynt&aring; lasketaan periaatteessa samalla tavoin kuin maassa kasvavien j&aring;k&aring;lien ky-synt&aring;, paitsi ett&aring; vuorokausien m&aring;&aring;r&aring; vuodessa on pienempi, koska puussa kasvavavien j&aring;k&aring;lien katsotaan p&aring;-&aring;asiassa olevan h&aring;t&aring;ravintoa. Tulokset ovat ep&aring;varmoja kahdesta p&aring;&aring;syyst&aring;. Osittain niiden tekijoiden vuoksi, jotka eiv&aring;t sis&aring;lly malliin, osittain niiden tekijoiden ep&aring;tarkkuudesta, jotka sis&aring;ltyv&aring;t malliin. Malli sis&aring;lt&aring;&aring; selvi&aring; todellisten yhteyksien yksinkertaistamisia. N&aring;m&aring; yksinkertaistamiset johtuvat p&aring;&aring;asiassa perustietojen puutteesta. Esimerkkin&aring; voidaan mainita, ett&aring; mets&aring;n tila muuttuu paljolti prognoosikauden aikana. T&aring;t&aring; vaihtelua esimerkiksi puus-tossa ei kuitenkaan mallissa huomioida. Esimerkki niiden tekijoiden ep&aring;tarkkuudesta, jotka sis&aring;ltyv&aring;t malliin, on j&aring;k&aring;l&aring;laidunten kasvuprosentti. Toinen esimerkki on j&aring;k&aring;l&aring;m&aring;&aring;rien arviot, jotka t&aring;ss&aring; perustuvat tutkielmiin (Eriksson, julkaisematon), joilla on ollut toinen tarkoitusper&aring; kuin t&aring;ss&aring; tutkimuksessa k&aring;sitelt&aring;vien l&aring;&aring;ninosien laiduntamahdollisuuksien arvioiminen. Mahdollisuudet varmojen johtop&aring;&aring;tosten tekoon lis&aring;&aring;ntyv&aring;t yhdess&aring; parempien perustietojen myot&aring; k&aring;ytetyist&aring; yhteyksist&aring; ja tiedoista. Maantieteellinen jako l&aring;&aring;ninosiin johtuu valtakunnanmets&aring;narvioinin rakenteesta. Olosuhteet voivat tie-tysti vaihdella n&aring;iden l&aring;&aring;ninosien sis&aring;ll&aring;, joista jokainen sis&aring;lt&aring;&aring; useamman paliskunnan. Tuloksia ei siis saa tulkita paliskunta kohtaisesti. Tutkielma esitt&aring;&aring; tavan valoittaa kuinka porohoidon j&aring;k&aring;l&aring;laitumet kehittyv&aring;t suhteessa puuntuotantoon. Tulokset ovat kuitenkin liian ep&aring;varmoja, jotta niist&aring; voitaisiin vet&aring;&aring; varmoja loppup&aring;&aring;telmi&aring;. Tulokset viittaavat kuitenkin, ett&aring; tietyill&aring; alueilla on jo talla hetkell&aring; pula j&aring;k&aring;l&aring;laitumista niill&aring; porom&aring;&aring;rill&aring;, joilla tassa tutkielmassa on laskettu. Laskelmat viittaavat, ett&aring; tuotanto v&aring;henee tulevaisuudessa, mink&aring; pit&aring;isi motivoida laajempaa tutkimukseen t&aring;ll&aring; alueella. Jos tulokset t&aring;ss&aring; tutkimuksessa ovat oikeat ja jos puuntuotannollinen mets&aring;talous kehittyy esimerkin mu-kaisesti, pit&aring;&aring; poronomistajien jatkaa tai lis&aring;t&aring; tukiruokintaa ja/tai v&aring;hent&aring;&aring; porojen lukum&aring;&aring;r&aring;&aring; huomatta-vasti. He joutuvat my os hyodynt&aring;m&aring;&aring;n kaikki laiduntamiskelpoiset alueet, my os sellaiset jotka t&aring;ll&aring; hetkell&aring; ovat v&aring;hemm&aring;n t&aring;rkeit&aring;. Toinen tapa par ant aa tasapainoa on sopeuttaa j&aring;k&aring;l&aring;alueiden puuntuotannollinen mets&aring;talous suuremmassa m&aring;&aring;rin kuin t&aring;ss&aring; analysoitavassa vaihtoehdossa tehd&aring;&aring;n.</p>

Introdução: A avulsão dentária caracteriza-se pelo total deslocamento do dente para fora do seu alvéolo representando uma lesão complexa e dramática que pode afetar múltiplos tecidos. Representa uma situação de urgência, e o prognóstico depende de um tratamento rápido e apropriado. Objetivo: Este estudo tem como objetivo avaliar o nível de conhecimento dos alunos do curso de Odontologia do primeiro ano da Universidade Estadual de Maringá (UEM) sobre a avulsão dentária, abordando a forma de atuação clínica e conduta que deve ser adotada frente a esse tipo de traumatismo dentário. Material e método: Elaborou-se um questionário, contendo dados gerais e informações relacionadas a avulsão dentária. O questionário foi aplicado na aula de introdução à Endodontia aos acadêmicos do primeiro ano. As informações obtidas foram tabuladas e analisadas por meio de uma estatística descritiva. Resultados: Os resultados sugerem que o conhecimento sobre o manejo de dentes avulsionados é insuficiente entre os estudantes do primeiro ano de Odontologia. Conclusão: Dessa forma, a educação odontológica deve focar nas orientações sobre primeiros socorros em lesões odontológicas e enfatizar a necessidade de disseminar programas de treinamento e educação para os estudantes de Odontologia.Descritores: Traumatismos Dentários; Avulsão Dentária; Odontologia.ReferênciasAndreasen JO, Andreasen FM. Texto e Atlas colorido de traumatismo dental. 3ª ed. Porto Alegre: Artes Médicas; 2001.Gutmann JL, Gutmann M. Cause, incidence, and prevention of trauma to teeth. Dent Clin North Am. 1995;39:1-13.Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM. Replantation of 400 avulsed permanent incisors. Factors related to periodontal ligament healing. Endod Dent Traumatol. 1995;11:76-89.Chan AWK, Wong TKS, Cheung GSP. Lay knowledge of physical education teachers about the emergency management of dental trauma in Hong Kong. Dent Traumatol 2001;17:77-85.Pohl Y, Filippi A, Kirschner H. Results after replantation of avulsed permanent teeth. II. Periodontal healing and the role of physiologic storage and antiresorptive - regenerative therapy. Dent Traumatol. 2005;21:93-101.Cohenca, N. Knowledge of oral health professionals of treatment of avulsed teeth. Dent Traumatol. 2006;296-30.Malmgren B, Malmgren O. Rate of infraposition of reimplanted ankylosed incisors related to age and growth in children and adolescents. Dent Traumatol.2002; 18:28-36.Flores MT, Andreasen JO, Bakland LK, Feiglin B, Gutmann JL, Oikarinen K et al. International Association of Dental Traumatology. Guidelines for the evaluation and management of traumatic dental injuries. Dent Traumatol. 2001;17:193-8. Ingle JI, Bakland LK, Baumgartner JC. Ingle’s endodontics. 6th ed. Hamilton, ON: B.C. Decker Inc; 2008.Lekic P, Kenny D, Moe HK, Barretti E, McCulloch CA. Relationship of clonogenic capacity to plating efficiency and vital dye staining of human periodontal ligament cells: implications for tooth replantation. J Periodontal Res. 1996;31:294-300.Lekic PC, Kenny DJ, Barrett EJ. The influence of storage conditions on the clonogenic capacity of periodontal ligament cells: implications for tooth replantation. Int Endod J. 1998;31:137-40.Layug ML, Barrett EJ, Kenny DJ. Interim storage of avulsed permanent teeth. J Can Dent Assoc. 1998;64:357-63.Lin DG, Kenny DJ, Barrett EJ, Lekic P, McCulloch CA. Storage conditions of avulsed teeth affect the phenotype of cultured human periodontal ligament cells. J Periodontal Res. 2000;35:42–50.Andreasen JO, Andreasen FM, Andersson L. Textbook and colour atlas of traumatic injuries to the teeth, 4th edn. Oxford: Blackwell Munksgaard; 2007. Andersson L, Bodin I. Avulsed human teeth replanted within 15 minutes – a long term clinical follow-up study. Endod Dent Traumatol. 1990;6:37-42.Courts FJ, Mueller WA, Tabeling HJ. Milk as an interim storage medium for avulsed teeth. Pediatr Dent. 1983;5:183-6.Ashkenazi M, Marouni M, Sarnat H. In vitro viability, mitogenicity and clonogenic capacity of periodontal ligament cells after storage in four media at room temperature. Endod Dent Traumatol. 2000;16:63-70.Hammarström L, Pierce A, Blomlöf L, Feiglin B, Lindskog S. Tooth avulsion and replantation – a review. Endod Dent Traumatol. 1986;2:1-8.Hiltz J, Trope M. Vitality of human lip fibroblasts in milk, hanks balanced salt solution and viaspan storage media. Dent Traumatol. 1991;7:69-72.Blomlöf L. Milk and saliva as possible storage media for traumatically exarticulated teeth prior to replantation. Swed Dent J Suppl. 1981;8:1-26.Huang SC, Remeikis NA, Daniel JC. Effects of long-term exposure of human periodontal ligament cells to milk and other solutions. J Endod. 1996;22:30-3.Khademi AA, Saei S, Mohajeri MR et al. A new storage medium for an avulsed tooth. J Contemp Dent Pract. 2008;9:25-32.Krasner PR. Avulsed teeth: improving the diagnosis. Dent Prod Rep. 2007;2:52-64.Fagade OO. Extra-alveolar storage media for tooth autotransplants and replants. Internet J Dent Sci. 2005;2:1-10.Udoye CI, Jafarzadeh H, Abbott PV. Transport media for avulsed teeth: A review. Aust Endod J. 2012;38:129-136.Blomlöf L, Andersson L, Lindskog S, Hedström KG, Hammarström L. Periodontal healing of replanted monkey teeth prevented from drying. Acta Odontol Scand. 1983;41:117-23.Bibby KJ, McCulloch CA. Regulation of cell volume and [Ca2+ ] in attached human fibroblasts responding to anisosmotic buffers. Am J Physiol. 1994;266:39-49Gopikrishna V, Baweja PS, Venkateshbabu N, Thomas T, Kandaswamy D. Comparison of coconut water, propolis, HBSS, and milk on PDL cell survival. J Endod. 2008;34:587-589.Gopikrishna V, Thomas T, Kandaswamy D. A quantitative analysis of coconut water: a new storage media for avulsed teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105:61-65.Moreira-Neto JJS, Gondim JO, Raddi MSG, Pansani CA. Viability of human fibroblasts in coconut water as storage medium. Intern Endod J. 2009;42:827-830.Thomas T, Gopikrishna V, Kandaswamy D. Comparative evaluation of maintenance of cell viability of an experimental transport media “coconut water” with Hank’s balanced salt solution and milk, for transportation of an avulsed tooth: an in vitro cell culture study. J Conserv Dent. 2008;11:22-29.Souza BDM, Luckemeyer DD, Reyes-Carmona JF, Felippe WT, Simões CMO, Felippe MCS. Viability of human periodontal ligament fibroblasts in milk, Hank’s balanced salt solution and coconut water as storage media. Int Endod J. 2011; 44:111-115.Pearson RM, Liewehr FR, West LA, Patton WR, McPherson JC, Runner RR. Human periodontal ligament cell viability in milk and milk substitutes. J Endod. 2003; 29:184-186.

Background: The optimal antithrombotic regimen for patients with coexistent atrial fibrillation (AF) and coronary artery disease (CAD) requiring percutaneous coronary intervention (PCI) remains controversial.Methods: We performed a chart review of 2,645 consecutive patients with non-ST elevation or ST elevation myocardial infarction at a regional cardiac centre, to examine the clinical characteristics and discharge antithrombotic medications of patients with coexistent AF (known or new onset AF with CHADS2 ≥1), treated with PCI.Results: Among 2,645 patients, 94 eligible patients were analyzed and 30 (32%) were prescribed triple therapy (TT) at hospital discharge. CHADS2 score was the major predictor of the decision to prescribe TT (P =0.002).Conclusion: Approximately one-third of the patients with AF undergoing PCI were prescribed TT at hospital discharge. Clinicians are generally following national guidelines and internationally-developed consensus statements, and focus on stroke risk despite the risks of bleeding and insufficient evidence supporting the benefits of TT. RésuméContexte : Le régime optimal antithrombotique pour les patients atteints à la fois de fibrillation atriale (FA) et d’une coronaropathie nécessitant une angioplastie coronarienne percutanée (ACP) demeure controversé.Méthodologie: Dans un centre régional de cardiologie, nous avons examiné les dossiers médicaux de 2645 patients ayant subi un infarctus du myocarde avec ou sans sus‑décalage du segment ST. Le but consistait à analyser les caractéristiques cliniques des patients présentant une FA concomitante (ancienne ou nouvelle, avec un indice CHADS2 ≥ 1) traitée par ACP, et les médicaments antithrombotiques prescrits au moment de leur sortie de l’hôpital.Résultats: Parmi les 2645 dossiers, 94 patients admissibles ont été analysés. Trente (32 %) s’étaient vus prescrire une trithérapie (TT) à leur sortie de l’hôpital. L’indice CHADS2 était le principal indicateur prévisionnel pris en compte dans la décision de prescrire la TT (P = 0,002).Conclusion : Environ un tiers des patients atteints de FA et ayant subi une ACP se sont vus prescrire une TT à leur sortie de l’hôpital. En général, les cliniciens suivent les directives nationales et les protocoles consensuels élaborés à l’international et se concentrent sur le risque d’ictus, malgré les risques de saignements et le manque de données probantes soutenant les avantages d’une TT.BACKGROUNDDual antiplatelet therapy (DAPT) including Aspirin and a P2Y12 receptor antagonist is recommended for patients who undergo percutaneous coronary intervention (PCI) with stent implantation.1,2 DAPT is superior to oral anticoagulants (OAC) in preventing stent thrombosis, 3while OAC is superior to DAPT in reducing stroke in patients with atrial fibrillation (AF).4,5 It is estimated that 5–8% of patients sustaining an acute coronary syndrome (ACS) have concomitant AF.6,7 The optimal antithrombotic regimen for patients with coexistent AF and coronary artery disease (CAD) requiring PCI remains controversial. In patients with AF and CHADS2 stroke risk score ≥1, consensus statements suggest that triple therapy (TT), defined as a combination of DAPT + OAC, be utilized in patients undergoing PCI with ACS.8,9 However, there is data indicating no improved efficacy of treatment with TT compared with DAPT alone, while exposing patients to increased bleeding risk.7,10,11 Major bleeding has been proven to be independently associated with death in patients following an ACS.12 Therefore, balancing the thromboembolic and bleeding risk is critical in patients with a recent ACS.Large randomized trials have indicated that compared with warfarin, novel oral anticoagulants (NOAC’s) are at least as effective as, and are associated with reduced rates of major, fatal and intracranial bleeding in patients with non-valvular AF.13 Due to the favourable safety profile, NOACs are being evaluated against warfarin in patients with AF undergoing PCI. Three of these trials are ongoing (RE-DUAL PCI, AUGUSTUS, ENTRUST-AF-PCI),14–16 and the fourth is the recently published PIONEER AF-PCI trial, which showed that reduced-dose rivaroxaban combined with clopidogrel lowered the risk of bleeding compared with TT with warfarin.17Despite the emergence of these recent data, the highest risk patients remain excluded from large randomized trials, and thus sound clinical judgment will remain the cornerstone in caring for these patients. In the current study, we aim to describe the local practice patterns of clinicians making treatment decisions for patients with new or existing AF, who present with an ACS and undergo PCI.METHODSA retrospective and prospective chart review was performed on 2,645 consecutive patients presenting with ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial elevation (NSTEMI) to 3 academic hospitals affiliated with McMaster University and 8 community hospitals located in Local Health Integrated Network (LHIN) 4, Ontario, Canada from January to December 2014. Of those, 1,458 patients had undergone PCI with stent implantation; and, 124 patients were identified to have concomitant AF (Figure 1). Inclusion criteria for our study were: admission to hospital for either STEMI or NSTEMI, known or new onset AF with CHADS2 ≥ 1, coronary angiography demonstrating at least one epicardial coronary artery with a ≥70% stenosis, and successful PCI with stent implantation. Patients who expired before discharge were excluded from the analysis. Clinical and demographic characteristics of patients were summarized. DAPT and TT groups were identified by reviewing medication records from discharge summaries or copies of discharge prescriptions. DAPT was defined as Aspirin plus clopidogrel (75 mg once daily) or ticagrelor (90 mg twice daily), while TT was defined as DAPT plus an OAC; including either warfarin or novel oral anticoagulants (NOAC). We analyzed the CHADS2 and ATRIA (Anticoagulation and Risk factors in Atrial fibrillation) scores according to treatment groups.18,19 Statistical analysis was performed using SAS/STAT version 9.3 (SAS Institute Inc., Cary, NC). Categorical data was compared using Chi-square testing. Continuous data comparison was performed applying the Wilcoxon test and Cochran-Armitage test for trends. A binary logistic regression model was developed to identify the clinical predictors of discharge groups based on their CHADS 2 and ATRIA scores (Figure 2 and Figure 3). The cut-off for statistical significance was a P-value of <0.05.Figure 1. Flow chart of study cohort. Figure 2. Use of triple therapy versus dual antiplatelet therapy at the time of discharge in different stroke risk groups predicted by their CHADS2 score. Figure 3. Use of triple therapy versus dual antiplatelet therapy at the time of discharge in different bleeding risk groups predicted by their ATRIA score. RESULTSDemographic and clinical characteristics of patients are described in Table 1. Ninety four out of 124 patients with ACS and a prior or new diagnosis of AF were included in the final analysis. The mean (s.d.) age was 74 years (10 years) and 55.3% were male. In our cohort, 59.6% of patients sustained a STEMI and 54.3% had single vessel CAD. Overall, 32% (n = 30) of patients were discharged on TT of whom 55.6% were prescribed a combination of DAPT and a NOAC while the remaining patients were prescribed conventional TT (DAPT+warfarin) (Table 2). The median CHADS2 score in the DAPT and TT groups were 2 and 3, respectively (P = 0.001). The median ATRIA bleeding risk in DAPT and TT groups were 3 and 4, respectively (P = 0.008). The P-value for trend of CHADS 2 and ATRIA scores were <0.0001 and 0.001, respectively. However, these 2 trends were not significantly different from one another (P = 0.26). In a logistic regression analysis with both CHADS 2 and ATRIA scores included in the model, the CHADS2 score was significantly different between both groups (P = 0.002), while the ATRIA score was not (P = 0.58). In patients who were prescribed TT, 36.6% had a history of stroke or TIA compared with 10.9% in the DAPT group (P = 0.005). Additionally, the patients who were discharged on TT were more likely to have been treated with an OAC prior to admission, compared with those in the DAPT group (70% vs 17.1%; P < 0.001). We observed that there was proportionally more use of a BMS in patients with AF (41.5% of the 94 patients) compared with BMS being used in the whole cohort (15% of the 1,458 patients).There was no statistically significant difference in the likelihood of being discharged on TT based on whether patients were hospitalized at a community or academic hospital (44% vs. 56%, P = 0.42). Academic hospitals had the availability of a thrombosis service and they provided a consultation on 18% of the patients analyzed at those hospitals. The thrombosis service was generally involved in the care of patients with higher CHADS2 scores,and the involvement of the thrombosis service was associated with a significantly increased use of TT (P = 0.002). DISCUSSIONOur results indicate that approximately one-third of patients were prescribed TT at hospital discharge, while the remaining patients received DAPT alone. No patients received a combination of single antiplatelet therapy and an OAC. Although both the CHADS2 and ATRIA scores were significantly higher in the TT group, the CHADS2 score more strongly predicted the use of TT in our local practice. Our results also showed that OAC use prior to admission increased the probability of TT use upon discharge. Furthermore, the current study reveals that in patients discharged on TT, a combination of Aspirin, a P2Y12 inhibitor and NOAC were prescribed more often than conventional TT with warfarin despite the lack of clear evidence about their safety profile. 20,21An analysis of the AVIATOR registry, which included patients with a similar mean CHADS2 score as in our study (2.7 in the AVIATOR registry vs. 2.3 in our cohort) reported that 41.2% of patients were prescribed TT at discharge,22 compared with 31.9% in our cohort. This indicates that some practice variability exists among clinicians when considering treatment with TT in patients with similar risk profiles. The AVIATOR registry data also demonstrated that patients who were discharged on TT had a higher risk of stroke defined by their CHADS2 score but in contrast to our results, their bleeding risk score was not higher than the DAPT group. Our results were, however, consistent with another retrospective study within a large registry, which reported greater use of OAC at discharge among patients with both higher stroke and bleeding risk. 23 This observation highlights the important point that many major predictors of stroke, such as advanced age, are also important risk factors for bleeding.TT in our local clinical practice was used more selectively and was predominantly for those patients with a high CHADS2 score (≥3). Our data also show that clinicians favoured use of TT even in patients with higher bleeding risk despite the lack of robust evidence.24Our study was designed to describe practice patterns only, and therefore, one limitation was the inability to report patient outcomes following hospital discharge. Secondly, given the observational and retrospective nature of our study and the relatively small study cohort we are only able to describe associations. Thirdly, there are unmeasured variables such as frailty, patients’ overall goals of care, and personal preferences that could contribute to the ultimate decision for a given antithrombotic regimen, which were not captured in our study. Fourthly, the type and dose of NOAC were not collected in our study. Our study was unique in assessing practice parameters such as discharge settings (academic versus community hospitals) and describing the effect of the involvement of a thrombosis service in making treatment decisions.The choice of the most favourable antithrombotic regimen in patients with AF and ACS undergoing PCI remains an area of clinical debate. There were no patients in our study cohort discharged on a combination of a P2Y 12 inhibitor and warfarin alone, a regimen evaluated in the previously published WOEST trial.25 This observation indicates either a knowledge gap or reluctance among clinicians in applying the results of the WOEST study. The results of the PIONEER AF-PCI trial suggest that a WOEST study type strategy of reduced-dose rivaroxaban with single antiplatelet therapy (clopidogrel) is an attractive alternative to warfarin because of the substantial reduction in major bleeding. This trial has been criticized because it was not powered for ischemic events, had an open-label design, and tested doses of rivaroxaban that had not been previously evaluated.26 However, PIONEER AF-PCI and ongoing trials in this area will hopefully strengthen the body of evidence and lead to more informed clinical decision making and improved patient care. Despite the growing evidence in this area, the uptake will remain slow among clinicians until emergence of further robust evidence and variability of practice will persist as partially reflected in the current study.DisclosureThere was no dedicated funding for this study.None of the authors have any disclosures relevant to this study.REFERENCES1. Tanguay JF, Bell AD, Ackman ML, et al. Focused 2012 Update of the Canadian Cardiovascular Society Guidelines for the Use of Antiplatelet Therapy. Can J Card 2013; 29(11):1334–34.2. Windecker S, Kolh P, Alfonso F, et al. European Society of Cardiology Working Group on Thrombosis. 2014 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2014;35(37):2541–619.3. Schomig A, Neumann FJ, Kastrati A, et al. A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary artery stents. N Engl J Med 1996;334:1084–9.4. Connolly S, Pogue J, Hart R, et al. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet 2006;367:1903–12.5. Verma A, Cairns JA, Mitchell LB, et al. 2014 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation. Can J Card 2014;30(10):1114–30.6. McManus DD, Huang W, Domakonda KV, et al. Trends in atrial fibrillation in patients hospitalized with an acute coronary syndrome. Am J Med 2012;125(11):1076–84.7. Chen CF, Chen B, Zhu J, et al. Antithrombotic therapy after percutaneous coronary intervention in patients requiring oral anticoagulant treatment. Herz 2015;40(8):1070–83.8. Faxon DP, Eikelboom JW, Berger PB, et al. Consensus document: antithrombotic therapy in patients with atrial fibrillation undergoing coronary stenting: A North-American perspective. Thromb Haemost 2011;106:572–84.9. Lip GY, Windecker S, Huber K, et al. Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary or valve interventions: a joint consensus document of the European Society of Cardiology Working Group on Thrombosis, European Heart Rhythm Association(EHRA), European Association of Percutaneous Cardiovascular Interventions (EAPCI) and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS) and Asia-Pacific Heart Rhythm Society (APHRS). Eur Heart J 2014;35:3155–79.10. Hess CH, Peterson ED, Peng SA, et al. Use and outcomes of triple therapy among older patients with acute myocardial infarction and atrial fibrillation. J Am Coll Cardiol 2015;66:616–27.11. Lamberts M, Olesen JB, Ruwald MH, et al. Bleeding after initiation of multiple antithrombotic drugs, including triple therapy, in atrial fibrillation patients following myocardial infarction and coronary intervention: a nationwide cohort study. Circulation 2012;126(10):1185–93.12. Eikelboom JW, Mehta SR, Anand SS, et al. Adverse impact of bleeding on prognosis in patients with acute coronary syndromes. Circulation 2006;114(8):774–82.13. Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials.14. ClinicalTrials.gov. Evaluation of Dual Therapy with Dabigatran vs. Triple Therapy with Warfarin in Patients with AF That Undergo a PCI with Stenting (REDUAL-PCI). Lancet. 2014 Mar 15;383(9921):955–62. doi: 10.1016/S0140-6736(13)62343-0. Epub 2013 Dec 4. Available at: https://clinicaltrials.gov/ct2/show/NCT02164864 .15. ClinicalTrials.gov. A Study of apixaban in patients with atrial fibrillation, not caused by a heart valve problem, who are at risk for thrombosis (blood clots) due to having had a recent coronary event, such as a heart attack or a procedure to open the vessels of the heart. Available at: https://clinicaltrials.gov/ct2/show/NCT02415400 16. ClinicalTrials.gov. Edoxaban Treatment Versus Vitamin K Antagonist in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention (ENTRUST-AF-PCI). Available at: https://clinicaltrials.gov/ct2/show/NCT02866175 17. Gibson CM, Mehran R, Bode C, et al. Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N Engl J Med 2016;375:2423–3418. Gage BF, Waterman AD, Shannon W, et al. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001;285:2864–70.19. Fang MF, Go AS, Chang Y, et al. A new risk scheme to predict warfarin-associated hemorrhage, the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation Study). J Am Coll Cardiol 2011;58(4):395–401.20. Tsu LV, Dager WE. Safety of new oral anticoagulants with dual antiplatelet therapy in patients with acute coronary syndromes. Ann Pharmacother 2013;47(4):573–7.21. Oldgren J, Wallentin L, Alexander JH, et al. New oral anticoagulants in addition to single or dual antiplatelet therapy after an acute coronary syndrome:a systematic review and meta-analysis. Eur Heart J 2013;34(22): 1670–80.22. Mennuni MG, Halperin JL, Bansilal S, et al. Balancing the risk of bleeding and stroke in patients with atrial fibrillation after percutaneous coronary intervention (from the AVIATOR Registry). Am J Cardiol 2015;116:37–42.23. Lopes RD, Li L, Granger CB, et al. Atrial fibrillation and acute myocardial infarction: antithrombotic therapy and outcomes. Am J Med 2012; 125:897–905.24. Skanes A, Healey JS, Cairns JA, et al. Focused 2012 Update of the Canadian Cardiovascular Society Atrial Fibrillation Guidelines: Recommendations for Stroke Prevention and Rate/Rhythm Control. Can J Cardiol. 2012 May;28(3):396.25. Dewilde WJ, Oirbans T, Verheugt FW, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomized, controlled trial. Lancet 2013;381:1107–15.26. Jolly SS, Natarajan MK. Atrial fibrillation and PCI — do we still need aspirin? N Engl J Med 2016; 375:2490–92.

The study aimed to identify the Reference Management Software and the advantages and disadvantages of each, Reference Management Systems, and applied reference citations; as well as provide an open-source Reference Management Software in Arabic; The study Field showed the reality of many sides related to Reference Management Software, which helped to obtain many of the results, which Led to obtain the appropriate set of recommendations to Reroutes services of those programs, in order to achieve the main objective of the study " Reference Management Software- A comparative analysis study " and to identify the best of these programs that can be used in the formulation of reference citations, by studying the difference between programs and to identify to functions and operations of these programs, as well as identify the Standard which used by these programs.

The present work shows the operation of a practical community in an academic library and how workers have tacit knowledge that allows them to contribute to the problem of the availability of materials.

The primary objective of this research has been to promote the transformation of a university library based in a working model that integrates information management and knowledge management. The main results are consolidated in the design of a knowledge management strategy informed by the particular characteristics and needs of an academic community, in order to promote the creation, flow, exchange and use of knowledge from the main information unit in this academic institution: the library.

This research proposes the necessary elements for construction of open access policies in Brazilian universities through a critical debate using Sandra Braman’s concept of Information Policy Regime also used by other theorists in order to analyse the Institutional Repositories (Irs) . From the concept of information policy,this research discusses open-access policies in higher education and research institutions in Brazil. The methodological procedure adopted was the literature review within the library economy’s and information science’s domains of scientific databases and repositories on the following themes: repositories, policies, and policy Regime Information. In addition, from the OpenDOAR and ROAR MAP’s records, it has been chosen the institutional repositories in Brazil that composed this study’s empirical corpus. This study examined the policies of these Irs on the basis of the four characteristics of information policy: transparency, networks such as organizational principles, shared responsibilities between public and private sectors and informational power as a dominant power. As a complementary methodology managers’ interviews were conducted aiming at understanding the building policies’ process, as well as the implementation of these universities’ repositories. It is concluded that the open access policy makers should follow four guidelines, namely: prioritization of informational transparency; recognition that an institutional policy is an outcome of a dialogue between the various sectors of the University; build a dialogue between the University and the private sector; show that informational power has governed institutional actions. The present research proposes further investigation on topics such as the national policy of open access, digital preservation policy and informational modes of a democratic science promotion. This research intended to contribute as theoretical and methodological basis to the proposition of open access policies, which aim at the implementation of Institutional Repositories in Brazilian universities.

This work describes the state of the organization of the Arnoldo Janssen Library collection belonging to the Missionary Congregation of the Servants of the Holy Spirit. As a result, the underlying problems in the search and retrieval of information by users were visualized, applying solutions to organize the collection and facilitate the search, applying Library criteria, and through the implementation of an Integrated System of Management of Open Source Libraries (PMB).

This research work carries out a documentary investigation on the trends of documentary languages ​​in the Colombian panorama, from the perspective of different authors specialized in the investigation of documentary languages ​​and the discernment about the future of these tools in the face of technological advances. and the constant growth of information. It seeks to analyze the perspective of information professionals in the design, use and implementation of documentary languages ​​in order to develop a matrix of documentary language trends and the impact it can have on the organization and retrieval of information through based on good practices in response to an identified skill or need. This will allow professionals focused on the area of ​​information analysis, description, cataloging and other related processes to see documentary languages ​​as an integral component of their operations and these can be complemented with the technological advances that have been developed to solve the problem. problems of organization and recovery of knowledge.

The doctoral research diagnosed insufficient scientific training of university professors in relation to the communication of research results, which limits their professional performance; situation revealed as a scientific problem. The object of research was the permanent training process of the university professor in science communication and, the field of action, the management of this process from the communication of open science (COS) oriented to sustainable development (SD). The objective was the development of a strategy, based on a model of this management, to enhance their professional performance. The main contributions are the proposed model and strategy, which were successfully applied at the Universidad de Oriente, Cuba. The scientific novelty consists in having revealed the integrative logic of the management of the permanent training of the university professor in COS, based on the assessment of the needs for improvement and its planning, in relation to the systematization and professionalization in management of the dissemination and dissemination of investigative results oriented to SD. The social impact lies in having favored the achievement of superior results in the permanent training of the university professor in COS oriented to SD, from the application of the strategy provided, increasing their professional performance.

Social Sciences have a relevant importance, because they assist individuals to make sense of the social world and to situate their ideas, fears, interests, values ​​and relationships at the center of the social processes they reflect and configure. However, a diagnosis made in the main doctoral programs of the Pedagogical Sciences in Cuba revealed deficiencies and deficiencies that led to the formulation of the scientific problem of the present investigation: insufficiencies in the process of interpretation of the social reality, in relation to its qualitative and complex nature, which limits the scientific performance of professionals. The object of the research is, therefore, the scientific research process of the Social Sciences and its field of action: the dynamics of information processing in the Social Sciences research process. The main research results are: a model of the dynamics of information processing in social investigations, which becomes an integrative didactic method for such processing, as a theoretical contribution, and a system of methodological procedures for processing information in the social investigations, as a practical contribution. It is revealed as essential regularity, the integrating logic between the understanding of the validity and reliability of social information and the systematization of the synthesis and the concretion of this information, consistent with a qualitative and quantitative processing of it. The pertinence and scientific feasibility of the research results was assessed satisfactorily through a consultation with experts and the corroboration of the partial application of the system of methodological procedures.

The context of the scientific community of researchers belonging to the academic units of Engineering and Medicine of the National University of the Northeast is analyzed, with the purpose of knowing its structure, composition and tradition in relation to the practices and preferences in the process.

From the end of the XX century the librarian field has been revising and reinventing an educative aspect, which is known in Spain as “users' training” or "users' education" (formación de usuarios), giving birth to a new expert knowledge called information literacy. Information literacy is conventionally conceived as a protocolized process, a set of stages (determine the need, access, evaluate and use and communicate information), which seeks to make users competent in the use, process and efficient management of information. From the field of librarianship, information literacy is usually seen as a given, natural, reality and it is generally studied from technical and managerial perspectives that are not used to leave the field itself (the analysis focus on standards and indicators, models, strategies of applicability, assessment, etc.). From our point of view, this is an insufficient optic to understand the social and political significance of both the library institution, the activity of its staff and the discursive constructions it produces. Among the contributions of the study, one which really stands out is that information literacy, that new expert knowledge made up into different models from the end of XX century, is seen not as something natural or a necessary result of the evolution of the librarian world, but as a social construct, which arises in a specific time. The whole of meanings, practices, values, knowledge, etc., that different social groups and agents assign to this new literacy is identified as informational discourse.