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Introduction: Police-officers are in a strategic position of providing the first immediate response to a crisis as mental health frontliners. Objectives: In this nation-wide cross-sectional study, we explored knowledge and attitudes towards suicide in the local police force, a crucial first step in the design and implementation of effective suicide prevention programmes. Methods: An online, anonymous questionnaire was distributed to all local police-officers (n=2600). It contained questions about their demographics and their experience with suicide while on duty, along with 34 statements from the validated tool Attitudes Towards Suicide (ATTS) (Renberg & Jacobsson. Suicide Life Threat Behav. 2003; 33 52-64), scored on a 5-point Likert Scale (1 = Strongly Disagree, 5 = Strongly Agree). Results: The sub-scale " Suicide as a right " was positively correlated with " Tabooing " (r (201) =.25, p=<.001), " Normal-common " (r (201) =.29, p=<.001), and " Resignation " (r (201) =.47, p=<.001), but negatively correlated with " Incomprehensibility " (r (201) = -.26, p=<.001), and " Preparedness to Prevent " (r (201) = -.19, p=<.001), meaning such individuals had a more permissive attitude towards suicide. On the other hand, the subscale Preventability was found to be positively correlated with Incomprehensibility (r (201) =.21, p=<.001) and Preparedness to Prevent (r (201) =.30, p=<.001). Females scored higher in the sub-scale Non-communication (M=3.40, 95% CI [3.29, 3.51]) while males scored higher in Preventability (M=3.35, 95% CI [3.27, 3.44]). The higher the educational status of police-officers, the more they adopt a pro-prevention attitude to suicide (M=3.67, 95% CI [3.44, 3.89]) and the more likely they are to appreciate that suicidal thoughts and behaviour can be common (M=3.40, 95% CI [3.20, 3.60]). Participants with a mixed/different composition at home (M=4.05, 95% CI [3.86, 4.24]) and/or have experienced only between 0 to 2 situations related to suicide in the past one year alone (M=4.05, 95% CI [3.94, 4.16]), were the most likely to feel prepared to prevent suicide. Conclusions: This study brings out different attitudes police-officers hold towards different aspects of suicide, influenced by their gender, educational background, personal life at home and total exposure to suicide during their career. Training programmes can help improve their knowledge and attitudes towards suicide, leading to a more positive behavioural response to individuals in crisis and create a safer environment. Malta, through an EU-funded programme, is currently investing its resources on drafting a national suicide prevention strategy, and such educational opportunities for our frontliners will ensure we have the right tools in screening, identifying, treating, and saving more lives. Abbreviations: M: Mean score; CI: Confidence Interval Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Repetitive Transcranial Magnetic Stimulation (rTMS) has been approved by the FDA for treatment resistant, severe, non-psychotic unipolar affective disorder. The aim of this presentation is to share our experience setting up the rTMS clinic – a first on our small island. We will also be showing data of patients over the treatment period through individual comments made by patients as well as through established depression scales. Finally, a modus operandi of managing side effects, community monitoring and follow-up will be suggested. [ABSTRACT FROM AUTHOR]

Background: Despite global concerns of an opioid epidemic, there is no systematic literature review on how frequently these drugs are used in nursing home (NH) populations, including those living with dementia. Objective: This systematic review aims to describe the prevalence and incidence of opioid use in NHs. A secondary objective is to describe the use of these drugs in a subset of NH residents, namely among persons living with dementia. Methods: A systematic literature review was carried out using MEDLINE and Scopus (PROSPERO registration number CRD42021254210). Screening of title and abstract was carried out by 2 persons independently for studies published between January 1, 2011 and May 19, 2021. The main outcomes were annual prevalence, period prevalence, and duration of opioid use. Results: From a total of 178 identified studies, 29 were considered eligible for inclusion. The annual prevalence of any opioid use among all NH residents without any selection criteria ranged from 6.3% to 50% with a median annual prevalence of 22.9% (Q25-Q75: 19.5%-30.2%), based on 17 studies. Five studies measured the annual prevalence in NH residents living with dementia, finding that this ranged from 10% to 39.6%. Conclusions: More evidence is needed quantifying opioid use in NH, especially among persons living with dementia. Given that opioid use in NH is still a problem, implementation of a pain management protocol in NH or nationally would help improve clinical outcomes., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: C.B. has received honoraria and grant funding from Acadia Pharmaceuticals, Lundbeck, Takeda, and Axovant pharmaceutical companies, not related to this study. C.B. leads the Alzheimer’s disease psychosis (ADP) investigators group and has received honoraria from Lundbeck, Lilly, Otsuka, and Orion pharmaceutical companies, not related to this study. The other authors have no potential conflicts of interests to declare., (© The Author(s) 2023.)

Despite a generalized belief that women are protected from cardiovascular disease, this remains the leading cause of death in women. This review focuses on differences in symptomatology, diagnostic modalities and therapeutic strategies in women with regard to cardiovascular disease.

Introduction: EndoSequence BC Sealer (Brasseler, Savannah, GA) is a premixed tricalcium silicate-based root canal sealer that requires moisture from the root dentin to hydrate. The aim of this study was to investigate the setting of EndoSequence BC Sealer and other sealers in contact with human dentin in a simulated clinical environment., Methods: EndoSequence BC Sealer, MTA Fillapex (Angelus, Londrina, Brazil), Septodont Sealer (Septodont, Saint Maur-des-Fosses, France), and Apexit Plus (Ivoclar, Schaan, Lichtenstein) were assessed. Caries-free lower premolars extracted for orthodontic purposes in patients aged 13-16 years were standardized to a 10-mm root length and were filled with test sealers and set up in a dentin pressure model for 14 days. In addition, set sealers immersed in physiologic solution for 14 days were also assessed. The set materials in solution and materials retrieved from the dentin pressure setup were characterized by scanning electron microscopy and X-ray diffraction analysis. The setting time and radiopacity were assessed using ISO 6876:2002 specifications. Furthermore, mineral ion leaching was evaluated by inductively coupled plasma mass spectrometry., Results: All the sealers tested exhibited formation of a calcium phosphate phase when in contact with physiologic solution. Septodont Sealer and Apexit Plus did not exhibit the formation of a calcium phosphate phase in the dentin pressure setup. The fluid in the system was enough to allow the setting of EndoSequence BC Sealer, which did not set in a dry environment. All materials leached calcium with the Septodont Sealer, exhibiting double the calcium ion leaching compared with EndoSequence BC Sealer., Conclusions: Using the dentinal fluid pressure system resulted in an adequate flow of dentinal fluid that allowed EndoSequence BC Sealer to set inside the root canal. Although the sealers tested were tricalcium silicate based, the hydration reaction and bioactivity in the presence of dentinal fluid were different to hydration in vitro. Thus, clinically, material bioactivity cannot be assumed., (Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Purpose: Titanium dental implants have a high success rate; however, there are instances when a modified surface may be desirable. The aim of this article was to systematically review the different types of implant coatings that have been studied clinically, in vivo and in vitro, and the coating techniques being implemented., Materials and Methods: The literature was searched electronically and manually through The Cochrane Library, Medline, and PubMed databases to identify articles studying dental implant surfaces and coating techniques. The database search strategy revealed 320 articles, of which 52 articles were considered eligible--40 in relation to implant coatings and 12 to the coating technique. An additional 30 articles were retrieved by hand search., Results: Several materials were identified as possible candidates for dental implant coatings; these include carbon, bisphosphonates, bone stimulating factors, bioactive glass and bioactive ceramics, fluoride, hydroxyapatite (HA) and calcium phosphate, and titanium/titanium nitride. HA coatings still remain the most biocompatible coatings even though the more innovative bioglass suggests promising results. The most common coating techniques are plasma spraying and hydrocoating. More recent techniques such as the nanoscale technology are also discussed., Conclusions: Several implant coatings have been proposed, and some appear to give better clinical results and improved properties than others. Clinical trials are still required to provide compelling evidence-based results for their long-term successful outcomes.

Scimitar syndrome is a form of partial anomalous pulmonary venous drainage that is dramatically visible on plain chest radiography (CXR). In these individuals the entire venous drainage from the right lung enters a single anomalous large vein that descends to the inferior vena cava. This descending vein is visible on CXR as a curvilinear density along the right heart border and resembles the curved Turkish sword that gives the condition its name. Scimitar syndrome forms part of the large spectrum of associated conditions known as venolobar syndrome. These include right lung hypoplasia or sequestered segments of right lung, congenital heart disease and various others. We report the case of a young woman who presented incidentally, with a murmur, at 16 years of age. Full investigation including angiography showed a large atrial septal defect with right heart dilation and scimitar syndrome. She underwent surgical correction with uneventful and complete correction by baffling of the scimitar vein from its entry into the inferior vena to the left atrium through the enlarged atrial septal defect.

Objectives: We evaluated the sensitivity and specificity of exercise-induced ST segment elevation for the detection of residual myocardial viability., Background: Assessment of residual viability after myocardial infarction is relevant for establishing indication for revascularization. We have previously shown that exercise-induced ST segment elevation is a marker of residual viability., Methods: We studied 34 patients with a previous Q wave myocardial infarction (anterior in 21, inferior in 13) of whom 18 (group A) had exercise-induced ST segment elevation in more than one lead (mean [+/- SD] 1.8 +/- 0.9 mm, range 1 to 4) and 16 (group B) did not. All patients underwent rest technetium-99m methoxyisobutyl isonitrile single-photon emission computed tomography (SPECT), fluorine-18 (F-18) fluorodeoxyglucose positron emission tomography and coronary angiography. The time elapsed between the infarction and the viability study was 72 +/- 108 days (range 15 to 400) in group A and 516 +/- 545 days (range 14 to 1,800) in group B., Results: The presence and site of previous infarction were confirmed by SPECT studies in all 34 patients. Uptake of F-18 fluorodeoxyglucose within the infarcted area was present in 18 of 18 patients in group A but in only 9 (56%) of 16 in group B (p < 0.01). In patients with an anterior infarction, the sensitivity, specificity and predictive accuracy of exercise-induced ST segment elevation for detection of residual viability were 82%, 100% and 86%, respectively (95% confidence intervals 46% to 83.5%, 59% to 100% and 55.6% to 87.1%, respectively)., Conclusions: Exercise-induced ST segment elevation in infarct-related leads has a high specificity and acceptable sensitivity for detection of residual viability within the infarcted area.

Diazepam (DZP) is commonly used in treatment of patients with acute ischemic syndromes to allay anxiety, but benzodiazepines reduce myocardial contractility and increase myocardial blood flow. To investigate the antiischemic effect of DZP, we studied 13 patients with a positive exercise test and angiographically documented coronary artery disease. All patients were submitted to a randomized, placebo-controlled trial using 0.9% NaCl infusion as placebo and intravenous (i.v.) diazepam (0.1 mg/kg in 20 min). Exercise tests performed immediately after the infusions showed that as compared with placebo, DZP significantly prolonged time to 1-mm ST-segment depression (557 +/- 198 vs. 428 +/- 226 s, p < 0.0001) and total exercise duration (624 +/- 177 vs. 561 +/- 188 s, p < 0.007). Rate-pressure product (RPP) at 1-mm ST-segment depression was not significantly different with the two treatments. DZP significantly delays onset of exercise-induced myocardial ischemia in patients with coronary artery disease. Because RPP at onset of ischemia was similar to that recorded with placebo despite greater levels of external workload, the antiischemic action of DZP appears to be mediated, at least partially, by a reduction in myocardial oxygen consumption.

Neuropeptide Y (NPY injected into the paraventricular nucleus (PVN) of rats has a potent stimulatory effect specifically on carbohydrate intake. This study examined the behavioral effects of a newly synthesized NPY antagonist, PYX-2. After PVN injection of PYX-2 (50-900 pmoles) alone, a strong dose-dependent reduction in spontaneous carbohydrate intake at the onset of the dark cycle was observed in freely-feeding rats. Moreover, at even lower doses (12.5 and 25.0 pmoles), PYX-2 also blocked the stimulatory action of PVN NPY (100 pmoles) on carbohydrate ingestion. These results provide the first evidence for the existence of endogenous NPY receptors in mediating the action of exogenous NPY in the hypothalamus. They also constitute a crucial step in demonstrating a physiological function of these PVN NPY receptors specifically in controlling carbohydrate ingestion at the onset of the natural feeding cycle.

A hypertensive woman presented with asterixis ipsilateral to a cerebellar hemorrhage. Asterixis has not previously been described in association with a cerebellar lesion. The presence of asterixis in this patient may have been due to a reduction of afferent information through the loss of the dentato-thalamo-cortical input. Unilateral asterixis denotes a dysfunction of the mechanism underlying sustained muscular contraction and not a precise cerebral localisation.