The Role of the Dental Therapists and Oral Hygienists in the Immediate Response to Traumatic Dental Injuries

Dental Therapists and Oral Hygienists receive training in dental trauma in their curriculum. When they are in their workspace however, many are not confident enough to provide treatment for patients presenting with dental trauma in the oral health setting. As members of the dental team they play an important role in the management of patients who present with traumatic dental injuries. It is therefore important that guidelines are developed for them to understand the role they need to play when providing oral health treatment. The chapter will focus on the etiology of dental trauma to assist the oral health clinicians to prepare for a diagnosis. The classification of traumatic dental injuries will be explained. This will lead to the description of the classified injuries and their management. Clear guidelines and management for the patients will thereafter be provided. The prevention of traumatic dental injuries will also be discussed so that the treatment provided to the patients is improved.

Assessing Romiplostim Dose and Platelet Response-Guided Titration to Support Use of Romiplostim in ITP Patients Less Than 12 Months from Diagnosis

Background: Romiplostim, a subcutaneous treatment for adult ITP, uses a platelet response-guided dose adjustment algorithm (USPI dosing, Table 1) to maintain patients' platelet count (PC). Romiplostim was recently approved for patients with ITP ≤ 12 months from diagnosis. Objectives: The primary objective of this analysis was to confirm the appropriateness of romiplostim dose and platelet response-guided titration for patients with ITP ≤ 12 months from diagnosis using a model based approach. Methods: Data from 268 adult patients with ITP ≤ 12 months from diagnosis was extracted from 7 previously conducted clinical studies and used to develop a model based on a previously published model of romiplostim dose-response in ITP patients (Perez-Ruixo et al, 2012). Following the model update, patient characteristics (time from diagnosis, PC at baseline, sex, age, weight, number of prior therapies, region, and use of rescue medications) were assessed to identify any potential factors influencing dose or platelet response in ITP patients ≤ 12 months from diagnosis. The model was qualified for simulation using standard methods modified to account for response-guided dosing. Additionally, observed and predicted platelet responses (incidence of durable response, sustained response, and duration of response) were compared for patients stratified by time from ITP diagnosis (<3, 3 to ≤ 6, and 6 to ≤ 12 months). Simulations were then conducted using prescribed dosing guidance to predict PC and romiplostim doses over 52 weeks of treatment in patients ≤ 6 months and > 6 to ≤ 12 months from diagnosis. Results: The analysis dataset included 7854 PC from 268 patients (with median baseline PC of 18 x 10 9/L and median time since diagnosis of 3 months) receiving romiplostim weekly for up to 3 years at doses ranging from 1 to 15 mg/kg. The updated model (Figure 1) consisted of a drug-sensitive progenitor cell compartment (Pre), 4 maturation compartments (Transit), and a peripheral blood compartment (Circ). Romiplostim increased production of platelet precursors in Pre in 2 ways: 1. linearly with romiplostim exposure (immediate response), and 2. as a function of cumulative administered dose. Response to romiplostim was bimodal with approximately 50% of patients more sensitive to romiplostim treatment with drug sensitivity proportional to time since diagnosis. In the other 50% of patients, immediate response was reduced and there was no cumulative effect of romiplostim dosing on platelet response over time. Age was associated with average platelet transit time where a patient of 30, 60, or 90 years would have a platelet transit time of 6.3, 7.5, and 8.3 days respectively. No other covariates were found to influence any model parameters. Model predicted and observed platelet responses were similar for ITP patients stratified by time from ITP diagnosis (<3, 3 to ≤ 6 and 6 to ≤ 12 months). Simulations (Figure 2) showed that romiplostim prescribed dosing is effective in maintaining PC of 50 - 250 x 10 9/L following titration (approximately 65% of subjects) and minimizing the proportion <20 or >400 x 10 9/L regardless of time since ITP diagnosis or sensitivity to romiplostim treatment. The predicted <35% of subjects above 400 x 10 9/L is consistent with what was observed in the adult ITP safety datasets. Conclusions: An updated model of romiplostim dose and platelet response was developed using data from ITP patients ≤12 months from diagnosis. Clinical trial simulations using the updated model predicted that weekly dosing of romiplostim according to the dose titration rules in the label adequately maintained platelet counts in patients with ITP ≤ 12 months from diagnosis. Figure 1 Figure 1. Disclosures Gibiansky: Amgen: Consultancy. Serrano Castillo: Amgen: Current Employment, Current equity holder in publicly-traded company. Saad: Amgen: Current Employment, Current equity holder in publicly-traded company. Chow: Amgen: Current Employment, Current equity holder in publicly-traded company. Doshi: Amgen: Current equity holder in publicly-traded company; Amgen: Current Employment.

Diversity, Status and Phenology of the Dragonflies and Damselflies of Cyprus (Insecta: Odonata)

Based on literature data, unpublished material and the results of the year-round monitoring at selected sites island-wide by the Cyprus Dragonfly Study Group since 2013, we acquired an excellent knowledge of the diversity and status of the Odonata of Cyprus. Altogether, 37 species are on the island’s checklist. Ischnura pumilio, Aeshna affinis and Brachythemis impartita were only very rarely recorded in the past but are considered to be no longer present. The single record of Calopteryx virgo from 1930 is in our opinion a misidentification and has been removed from the checklist. The island has a rather impoverished odonate fauna compared to neighbouring countries. There are no endemic species, but the island is home to some range of restricted species of which Ischnura intermedia is the most important. Flight seasons determined for the 31 species with sufficient data were generally found to be longer than reported for other countries in the Eastern Mediterranean. This may be due to intensive year-round monitoring but could also result from Cyprus’ warmer climate. Very wide annual variations were found in the abundance of all species over the seven years and show an almost immediate response to the wide fluctuations in Cyprus’ annual rainfall levels.

PREDIKSI KASUS COVID-19 DI INDONESIA MENGGUNAKAN METODE BACKPROPAGATION DAN REGRESI LINEAR

The emergence of COVID-19 first attacked humans in Wuhan, China, while in Indonesia itself, it began to attack on March 2, 2020 when two people were confirmed positive. From these cases every day has a relatively significant increase. The corona virus is spreading very quickly, therefore the WHO or the World Health Organization decided that the COVID-19s will become a pandemic off March 11, 2020. The corona virus is rising very fast, so immediate response is needed. The corona virus can easily spread and can attack humans regardless of age. Seeing the rapid spread of the virus, finally the governments of some countries have decided to impose a lockdown. Until now, we have not found a drug or vaccine that can be used to overcome the spread of the COVID-19 virus. The purpose of this research is to be able to estimate the number of active cases in the addition of COVID-19 cases in Indonesia. This research will be tried using Backpropagation and Linear Regression methods. The results of prediction of active cases with Backpropagation gave the results of additions and decreases that were not too significant, while the results of prediction of active cases with Linear Regression showed that the addition of cases for each day experienced an increase in active cases.