Periodontal treatment in private dental practice: a case-based survey

BACKGROUND

This study aimed to assess the management and referral patterns of Victorian general dental practitioners based on periodontal diagnosis.

METHODS

Following ethics approval, Victorian general dental practitioners were invited to complete five randomized text-based periodontitis scenario questionnaires. Based on their diagnosis, respondents were asked for their management options and asked to specify who would perform these treatments. Respondents were also asked about referral procedures.

RESULTS

One hundred and thirty-five dentists attempted the survey. Most were in group practice and based in Melbourne. Of the total respondents, 22.5% worked in a practice employing a hygienist. The management of periodontal disease was appropriate, and treatment options increased with severity. As severity increased, patients were more likely to be referred to a periodontist. Periodontal services referred by general dentists to dental hygienists increased with the number of days the hygienists worked within a practice. Over- and underdiagnosis did not markedly affect management. The recommendation of antibiotics, mouthwashes and periodontal surgery varied depending on year and school of graduation.

CONCLUSIONS

The general dentists that completed the survey are managing periodontal conditions appropriately and according to current guidelines.

Hypnotic Drugs in Hospital. Evaluation of Their use: From Prescription to Administration

In 2015, a French agency, Haute Autorité de santé (HAS), published recommendations for the use of hypnotic drugs. We evaluated the compliance with good practice in prescription and administration studying 3 hypnotics (lormetazepam, zolpidem, zopiclone) referenced in our establishment (psychiatry, rehabilitation, recuperative and long-term care) and melatonin (immediate release hospital preparation). Prescriptions were analyzed on a given day (dosage, length of treatment, prescription modalities). Night nursing practices were collected. Amongst 423 hospitalized patients, 105 had a hypnotic monotherapy, 3 an association melatonin/zopiclone and 6 a melatonin monotherapy. The most prescribed molecule was zopiclone (79%). Prevalence of hypnotic prescription was 25.5%. 17.6% of these prescriptions were for less than 28 days, 82.5% were at maximum dosage, 46.3% were in systematic mode and 53.7% in conditional mode. Amongst the 22 patients over 65 years old, only 8 received half hypnotic dose. Concerning the 9 prescriptions of melatonin, dosage varied from 3 to 9 mg, 1 was in conditional and only 1 specified terms of use. All 15 nurses met, adapt administration to the patient's bedtime. Five nurses have already woken up patients to give them hypnotics. The prevalence of patients with hypnotics is higher than the general French population (6.4%). HAS recommendations are not all followed: duration of prescription greater then 28 days, few dosage adaptations. Nurses generally respect hypnotic administration rules. Melatonin is not often prescribed and has no prescription or administration recommendations. Our results confirm the need to spread hypnotic and melatonin recommendations in health facilities. Hospital pharmacists can relay such recommendations.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The Development of a High Strength Cementitious Tooling/Molding Material

The composition and fabrication of a high strength cementbased composite containing graded stainless steel aggregate and fine silica are described. The microstructure, physical properties and temperature cycling durability of this material are examined and some examples are given of technological applications as a molding/tooling material.

Early mother-infant reciprocity

By three weeks of age, the human neonate demonstrates behaviours which are quite different with an object and with a human interactant. He also demonstrates an expectancy for interaction with his caregiver which has clearly defined limits, as demonstrated behaviourally. In microanalysis of videotape, we saw regularly a set of interactive behaviours which were demonstrable in optimal face-to-face interaction between infants and their mothers. All parts of the infant's body move in smooth circular patterns as he attends to her. His face-to-face attention to her is rhythmic with approach-withdrawal cycling of extremities. The attention phase and build-up to her cues are followed by turning away and a recovery phase in a rhythm of attention-non-attention which seems to define a cyclical homeostatic curve of attention, averaging several cycles per minute. When she violates his expectancy for rhythmic interaction by presenting a still, unresponsive face to him, he becomes visibly concerned, his movements become jerky, he averts his face, then attempts to draw her into interaction. When repeated attempts fail, he finally withdraws into an attitude of helplessness, face averted, body curled up and motionless. If she returns to her usual interactive responses, he comes alive after an initial puzzled period, and returns to his rhythmic cyclical behaviour which has previously characterized their ongoing face-to-face interaction. This attentional cycling may be diagnostic of optimal mother-infant interactions and seems not to be present in more disturbed interactions.

Traumatic axonal damage in the brain can be detected using beta-APP immunohistochemistry within 35 min after head injury to human adults

Immunohistochemistry staining for beta-amyloid precursor protein (beta-APP) is a sensitive method to detect early axonal damage in traumatic brain injury, which was previously estimated to be of minimum 60-90 min after head injury. We present seven cases of well-documented posttraumatic survival of 35-60 min where beta-APP detects early axonal damage. Cases were selected from routine work where documentation about survival is judged to be accurate. These are divided into three groups: group 1: severe head injury (n = 7) with documented survival between 35 and 60 min. Group 2: severe head injury (n = 4) with documented survival of less than 30 min. Group 3: cases (n = 4) where death was not due to head injury but survival is documented between 45 and 109 min. The brains were fixed in formalin for 4 weeks and six regions (frontal lobe with anterior corpus callosum, parietal lobe with deep white matter, basal ganglia with posterior limb of internal capsule, cerebellum with white matter and middle cerebellar peduncle and pons with basis pontis and superior cerebellar peduncle) were sampled. All blocks were stained for haematoxylin and eosin and beta-APP and selected ones for CD68, using antigen retrieval method. In group 1 sections revealed beta-APP immunoreactivity in forms of small globules and granules and occasionally as thin and short filaments. These were detected in the pons, corpus callosum, internal capsule and cerebral white matter, with some variation in localization and intensity. In groups 2 and 3 all the sections were negative for beta-APP staining. None of the cases showed evidence of severe brain swelling, increased intracranial pressure, ischaemia or infection. Using the antigen retrieval method, beta-APP immunohistochemistry can detect axonal damage within 35 min after severe head injury. These results may have an implication in the consideration of minimal survival time after traumatic head injury in medico-legal practice.

Computer simulation of glioma growth and morphology

Despite major advances in the study of glioma, the quantitative links between intra-tumor molecular/cellular properties, clinically observable properties such as morphology, and critical tumor behaviors such as growth and invasiveness remain unclear, hampering more effective coupling of tumor physical characteristics with implications for prognosis and therapy. Although molecular biology, histopathology, and radiological imaging are employed in this endeavor, studies are severely challenged by the multitude of different physical scales involved in tumor growth, i.e., from molecular nanoscale to cell microscale and finally to tissue centimeter scale. Consequently, it is often difficult to determine the underlying dynamics across dimensions. New techniques are needed to tackle these issues. Here, we address this multi-scalar problem by employing a novel predictive three-dimensional mathematical and computational model based on first-principle equations (conservation laws of physics) that describe mathematically the diffusion of cell substrates and other processes determining tumor mass growth and invasion. The model uses conserved variables to represent known determinants of glioma behavior, e.g., cell density and oxygen concentration, as well as biological functional relationships and parameters linking phenomena at different scales whose specific forms and values are hypothesized and calculated based on in vitro and in vivo experiments and from histopathology of tissue specimens from human gliomas. This model enables correlation of glioma morphology to tumor growth by quantifying interdependence of tumor mass on the microenvironment (e.g., hypoxia, tissue disruption) and on the cellular phenotypes (e.g., mitosis and apoptosis rates, cell adhesion strength). Once functional relationships between variables and associated parameter values have been informed, e.g., from histopathology or intra-operative analysis, this model can be used for disease diagnosis/prognosis, hypothesis testing, and to guide surgery and therapy. In particular, this tool identifies and quantifies the effects of vascularization and other cell-scale glioma morphological characteristics as predictors of tumor-scale growth and invasion.

Smoking enhances absorption of insulin but reduces glucodynamic effects in individuals using the Lilly-Dura inhaled insulin system

AIM

To quantify the pharmacokinetic (PK) and glucodynamic (GD) impact of smoking on inhaled and subcutaneous (SC) insulin administration in healthy subjects.

METHODS

This study employed the euglycemic clamp procedure in a four-period, four-way randomized crossover design. Eight smoking and eight non-smoking healthy males were given SC insulin on two occasions and human insulin inhalation powder (HIIP) on two other occasions.

RESULTS

Smokers exhibited greater insulin exposure (AUC(0-t')) than non-smokers, following both routes of insulin administration (HIIP, P = 0.003, 58% increase; SC, P = 0.006, 24% increase). The maximum insulin concentration (C(max)) following HIIP was greater in smokers by 172% (P = 0.001) compared with non-smokers. The glucodynamic effects were greater in smokers following HIIP, consistent with the insulin concentration difference observed. However, maximum glucose response (R(max)) following SC was decreased by 36% (P = 0.001) and obtained later [time of maximum glucose response (TR(max)); P < 0.001] in smokers than in non-smokers. Smokers appeared less sensitive to insulin [total glucose infused during the clamp procedure normalised by total insulin exposure (G(tot))/AUC(0-t')] than non-smokers following both SC (P = 0.001) and inhaled (P = 0.011) routes of administration.

CONCLUSION

Smokers had substantially increased peak HIIP insulin concentration, but the glucodynamic effect was partially offset, most likely because of increased insulin resistance.

Upper limits on a stochastic background of gravitational waves

The Laser Interferometer Gravitational-Wave Observatory has performed a third science run with much improved sensitivities of all three interferometers. We present an analysis of approximately 200 hours of data acquired during this run, used to search for a stochastic background of gravitational radiation. We place upper bounds on the energy density stored as gravitational radiation for three different spectral power laws. For the flat spectrum, our limit of omega0 < 8.4 x 10(-4) in the 69-156 Hz band is approximately 10(5) times lower than the previous result in this frequency range.

Limits on gravitational-wave emission from selected pulsars using LIGO data

We place direct upper limits on the amplitude of gravitational waves from 28 isolated radio pulsars by a coherent multidetector analysis of the data collected during the second science run of the LIGO interferometric detectors. These are the first direct upper limits for 26 of the 28 pulsars. We use coordinated radio observations for the first time to build radio-guided phase templates for the expected gravitational-wave signals. The unprecedented sensitivity of the detectors allows us to set strain upper limits as low as a few times 10(-24). These strain limits translate into limits on the equatorial ellipticities of the pulsars, which are smaller than 10(-5) for the four closest pulsars.

Nosocomial transmission of Mycobacterium tuberculosis from an extrapulmonary site

OBJECTIVE

To assess the extent of nosocomial transmission and risk factors associated with tuberculin skin test (TST) conversions among healthcare workers (HCWs) exposed to a patient with genitourinary Mycobacterium tuberculosis.

DESIGN

Retrospective cohort study of exposed HCWs.

SETTING

A 275-bed community hospital in Middle Tennessee.

PARTICIPANTS

A total of 128 exposed HCWs and the index patient, who required drainage of a prostatic abscess and bilateral orchiectomy and expired after a 27-day hospitalization. Disseminated tuberculosis was diagnosed at autopsy.

METHODS

Contact tracing was performed on exposed HCWs. Logistic regression was used to identify independent risk factors associated with TST conversion.

RESULTS

A total of 128 HCWs were exposed to the index patient. There was no evidence of active pulmonary tuberculosis throughout the patient's hospitalization; TST conversions occurred only among HCWs who were exposed to the patient during or after his surgical procedures. A total of 12 (13%) of 95 exposed HCWs who were previously nonreactive had newly positive TST: 6 of 28 nurses, 3 of 3 autopsy personnel, 2 of 17 respiratory therapists, and 1 of 12 surgical staff. By logistic regression, irrigation or packing of the surgical site was the only independent risk factor associated with TST conversion among nurses (odds ratio, 9; 95% confidence interval, 1.2-67; P=.03).

CONCLUSION

Manipulation of infected tissues of the genitourinary tract can result in nosocomial transmission of tuberculosis.

Sequences within Pr160gag-pol affecting the selective packaging of primer tRNA(Lys3) into HIV-1

The selective packaging of the primer tRNA(Lys3) into HIV-1 particles is dependent upon the viral incorporation of the Pr160gag-pol precursor protein. In order to map a tRNA(Lys3) binding site within this precursor, we have studied the effects of mutations in Pr160gag-pol upon the selective incorporation of tRNA(Lys3). Many of these mutations were placed in a protease-negative HIV-1 proviral DNA to prevent viral protease degradation of the mutant Gag-Pol protein. C-terminal deletions of protease-negative Gag-Pol that removed the entire integrase sequence and the RNase H and connection subdomains of reverse transcriptase did not inhibit the incorporation of either the truncated Gag-Pol or the tRNA(Lys3), indicating that these regions are not required for tRNA(Lys3) binding. On the other hand, larger C-terminal deletions, which also remove the thumb subdomain sequence, did prevent tRNA(Lys3) packaging, without inhibiting viral incorporation of the truncated Gag-Pol, indicating a possible interaction between thumb subdomain sequences and tRNA(Lys3). While point mutations K249E, K249Q, and R307E in the primer grip region of the thumb subdomain have been reported to inhibit the in vitro interaction of mature reverse transcriptase with the anticodon loop of tRNA(Lys3), we find that these mutations do not inhibit tRNA(Lys3) packaging into the virus, which supports other work indicating that the anticodon loop of tRNA(Lys3) is not involved in interactions with Pr160gag-pol during tRNA(Lys3) packaging.

Recurrent short rib-polydactyly syndrome with unusual associations

Short rib-polydactyly syndrome (SRPS) is manifested by short-limb dwarfism, short ribs with thoracic hypoplasia, and polydactyly. This inheritable syndrome has distinct imaging findings on prenatal sonography, and ancillary findings on both pre- and postnatal assessments may enable individual cases to be classified into 1 of 4 subtypes. In this report, we present a recurrent case of SRPS that was associated with a cystic hygroma and choroid plexus cysts. Although cystic hygromas are not uncommonly seen in skeletal dysplasias, the presence of concomitant cystic hygroma and choroid plexus cysts suggests a chromosomal abnormality such as trisomy 18.

Assessment of resident knowledge: subjective assessment versus performance on the ACR in-training examination

RATIONALE AND OBJECTIVES

The authors assessed the ability of faculty and residents to predict the ranked performance of residents on the American College of Radiology (ACR) In-Training Examination.

MATERIALS AND METHODS

Radiology faculty at Penn State Geisinger Health System (PSGHS), the Medical College of Virginia (MCV), and the University of Virginia (UVA) and residents at PSGHS and MCV ranked the expected performances of residents taking the 1997 ACR In-Training Examination. Surveyed faculty and residents were blinded to the actual performances on the examination. Forty-nine residents took the examination (21 at PSGHS, 22 at MCV, six at UVA), and 37 faculty members (11 at PSGHS, 11 at MCV, 15 at UVA) participated in the study. Correlation analysis was performed to assess the agreement between the subjective and actual ranking of residents in each residency class.

RESULTS

Faculty were moderately accurate in the overall ranking of resident performances (r = 0.34). High levels of concordance for ranking individual residents correlated with accuracy in only certain cases. Differences in agreement and accuracy of the respondents existed between PSGHS and MCV (P = .0001 and .0014, respectively). The concordance of respondents increased significantly from the 1st- to the 2nd-year class at MCV (P = .0002), whereas accuracy increased significantly between these classes for the PSGHS (P = .042).

CONCLUSION

Faculty are only moderately successful in ranking resident performances on the ACR In-Training Examination, and a high level of agreement is not necessarily indicative of increased accuracy. The concordance and accuracy of subjective rankings differ among residency programs and classes.

Localized hypertrophic neuropathy: magnetic resonance imaging findings and long-term follow-up

Four patients with painless, progressive focal neurological deficits that localized to peripheral nerve or plexus were eventually found to have the relatively rare condition of localized hypertrophic neuropathy or intraneural perineurioma. Magnetic resonance imaging (MRI) was an excellent tool for aiding in the precise localization of the lesion, if specifically tailored with regard to imaging planes and specific MRI sequences. Fat-saturated T2-weighted and fat-saturated T1-weighted postgadolinium images provided the best visualization, particularly with a high-field magnet and phase array body coil. Two patients stabilized following resection of the lesion and sural nerve grafting, and 1 had partial improvement in a proximal muscle following neurolysis.

Normal glucose-induced suppression of glucose production but impaired stimulation of glucose disposal in type 2 diabetes: evidence for a concentration-dependent defect in uptake

The present studies were undertaken to determine whether people with type 2 diabetes are resistant to the effects of glucose as well as insulin. Diabetic and nondiabetic subjects were studied on three occasions. Hormone secretion was inhibited with somatostatin. Insulin concentrations were kept at "basal" levels (referred to as low insulin infusion) from 0 to 180 min then increased to approximately 200 pmol/l from 181 to 360 min (referred to as high insulin infusion). Glucose concentrations were clamped at either approximately 95, approximately 130, or approximately 165 mg/dl on each occasion. In the presence of basal insulin concentrations, a progressive increase in glucose from 95 to 130 to 165 mg/dl was accompanied by a comparable and progressive decrease (P = 0.001 to 0.003 by analysis of variance [ANOVA]) in endogenous glucose production (measured with [6-(3)H]glucose) and total glucose output (measured with [2-(3)H]glucose) and incorporation of 14CO2 into glucose (an index of gluconeogenesis) in both diabetic and nondiabetic subjects, indicating normal hepatic (and perhaps renal) response to glucose. In the nondiabetic subjects, an increase in glucose concentration from 95 to 130 to 165 mg/dl resulted in a progressive increase in glucose disappearance during both the low (19.9 +/- 1.8 to 23.6 +/- 1.8 to 25.4 +/- 1.6 micromol x kg(-1) x min(-1); P = 0.003 by ANOVA) and high (36.4 +/- 3.1 to 47.6 +/- 4.5 to 61.1 +/- 7.0 micromol x kg(-1) x min(-1); P = 0.001 by ANOVA) insulin infusions. In contrast, in the diabetic subjects, whereas an increase in glucose from 95 to 130 mg/dl resulted in an increase in glucose disappearance during both the low (P = 0.001) and high (P = 0.01) dose insulin infusions, a further increase in glucose concentration to 165 mg/dl had no further effect (P = 0.41 and 0.38) on disappearance at either insulin dose (low: 14.2 +/- 0.8 to 18.2 +/- 1.1 to 18.7 +/- 2.4 micromol x kg(-1) x min(-1); high: 21.0 +/- 3.2 to 33.9 +/- 6.4 to 32.5 +/- 8.0 micromol x kg(-1) x min(-1) for 95, 130, and 165 mg/dl, respectively). We conclude that whereas glucose-induced stimulation of its own uptake is abnormal in type 2 diabetes, glucose-induced suppression of endogenous glucose production and output is not. The abnormality in uptake occurs in the presence of both basal and high insulin concentrations and is evident at glucose concentrations above but not below 130 mg/dl, implying a defect in a glucose-responsive step.

Assessment of hepatic sensitivity to glucagon in NIDDM: use as a tool to estimate the contribution of the indirect pathway to nocturnal glycogen synthesis

NIDDM is associated with excessive rates of endogenous glucose production in both the postabsorptive and postprandial states. To determine whether this is due to an intrinsic increase in hepatic sensitivity to glucagon, 9 NIDDM and 10 nondiabetic subjects were studied on three occasions. On each occasion, glycogen was labeled the evening before the study with subjects ingesting meals containing [6-3H]galactose. Beginning at 6:00 A.M. on the following morning, somatostatin was infused to inhibit endogenous hormone secretion. Insulin concentrations were maintained constant at basal levels (defined as that necessary to keep glucose at approximately 5 mmol/l) in each individual. On one occasion, glucagon was infused at a rate of 0.65 ng x kg(-1) x min(-1) throughout the experiment, resulting in glucagon concentrations of approximately 130 pg/ml and a slow but comparable fall in endogenous glucose production with time in both groups. On the other two occasions, the glucagon infusion was increased at 10:00 A.M. to either 1.5 or 3.0 ng x kg(-1) x min(-1), resulting in an increase in glucagon concentrations to approximately 180 and 310 pg/ml, respectively. The increment in endogenous glucose production (i.e., area above basal) did not differ in diabetic and nondiabetic subjects during either the 1.5 ng x kg(-1) x min(-1) (0.75 +/- 0.055 vs. 0.78 +/- 0.048 mmol/kg) or 3.0 ng x kg(-1) x min(-1) (1.06 +/- 0.066 vs. 1.10 +/- 0.073 mmol/kg) glucagon infusions. In contrast, the amount of [6-3H]glucose released from glycogen was lower (P < 0.05) in the diabetic than nondiabetic subjects during both glucagon infusions. The specific activity of glycogen, calculated as the integrated release of [6-3H]glucose divided by the integrated release of unlabeled glucose, was lower (P < 0.05) in diabetic subjects than in nondiabetic subjects during both the 1.5 ng x kg(-1) x min(-1) (19.0 +/- 3.9 vs. 41.4 +/- 5.7 dpm/micromol) and 3.0 ng x kg(-1) x min(-1) (19.1 +/- 3.1 vs. 36.5 +/- 7.2 dpm/micromol) glucagon infusions, implying that a greater portion of the glucose released from glycogen was derived from the indirect pathway. We concluded that although NIDDM is not associated with an intrinsic alteration in hepatic sensitivity to glucagon, it does alter the relative contributions of the direct and indirect pathways to nocturnal glycogen synthesis.

Effects of hepatic glycogen content on hepatic insulin action in humans: alteration in the relative contributions of glycogenolysis and gluconeogenesis to endogenous glucose production

Hepatic glycogen content varies by almost 2-fold during the day, generally increasing from a nadir before breakfast to a peak 4-5 h after supper. To determine whether differences in hepatic glycogen content of this magnitude alter hepatic insulin action, nine subjects were studied on two occasions. On one occasion saline was infused, whereas on the other occasion an infusion of glucose [16.4 micromol/kg lean body mass (-lbm) x min] was started immediately after supper and continued throughout the night so as to spare hepatic glycogen. The nocturnal glucose infusion resulted in higher (P < 0.05) plasma glucose (6.0 +/- 0.1 vs. 5.1 +/- 0.1 mmol/L) and insulin (127 +/- 38 vs. 49 +/- 9 pmol/L) concentrations, and lower (P < 0.05) plasma glucagon concentrations (74 +/- 11 vs. 97 +/- 20 pg/mL) than did saline infusion. As anticipated, endogenous glucose production (EGP) was substantially lower (P < 0.001) during the glucose than during the saline infusion (7.0 +/- 0.9 vs. 19.4 +/- 1.3 micromol/kg-lbm x min). After discontinuation of the glucose infusion, glucose and insulin concentrations fell to levels that no longer differed from those observed during the saline infusion. In contrast, EGP increased to rates that were higher (P < 0.05) than those observed over the same interval after overnight saline infusion (19.2 +/- 1.2 vs. 16.5 +/- 0.7 micromol/kg-lbm x min). Despite higher EGP, the rate of incorporation of 14CO2 into glucose was lower (P < 0.001) after glucose than that after saline infusion (9.8 +/- 1.2% vs. 24.4 +/- 3.0%), implying a reciprocal relationship between hepatic glycogen content and gluconeogenesis. On the other hand, when differences in basal rates were taken into account, insulin-induced suppression of both EGP and incorporation of 14CO2 into glucose did not differ on the two occasions. Thus, whereas hepatic glycogen content influences both the absolute rate of EGP and the percent contribution of gluconeogenesis to EGP, it does not alter hepatic insulin action.

Constructing regions for small area analysis: material deprivation and colorectal cancer

BACKGROUND

This paper is about constructing small areas for the analysis of health data with the aims of health service delivery in mind. The areal framework should enable the analyst to link health data and census data and the areas should have large enough populations to ensure that rates are reliable and be homogeneous with respect to important socio-economic attributes.

METHODS

An information-based statistic is used for the construction of regions in Sheffield based on the Townsend deprivation index. Enumeration districts are used as the geographical building blocks for the regions. The new regional framework is used for computing Bayes adjusted standardized incidence rates for colorectal cancer (CRC) across Sheffield. The paper then examines the statistical relationship between CRC incidence and deprivation across the set of regions using bivariate regression.

RESULTS

The method yields regions that are considerably more homogeneous in terms of deprivation than wards, and using this framework it is shown that there is a (weak) statistical association at the regional scale between deprivation and CRC.

CONCLUSION

We conclude that statistical tools can be employed to provide regions that meet the criteria for small area analysis of health data and the analyst does not have to be tied to large administrative units such as wards. There are some benefits to executing this work within a Geographic Informative System. The method should be of interest to those concerned with health service delivery and the identification of 'problem regions'.