The measurement of craniofacial morphology head posture and nasal airflow in patients with congenital clefts of the lip and palate

The present study was both methodological and investigative in nature. This included the development of computerised rhinomanometry and establishment of cephalometric measurement apparatus together with a standardised lateral cephalometric radiography technique to record natural head posture.The method errors of both the measurement systems and the operator were tested by duplicate determinations and subsequent statistical analysis. Recordings for all the variables in the study were reproducible without systematic error and with a very small method error.Apparatus was used to record nasal respiratory resistance (NRR), craniofacial form and head posture in a control group for comparison with subjects with cleft lip (CL), cleft palate (CP), and unilateral cleft lip and palate (UCLP).The results of the rhinomanometric recording indicated that the bilateral nasal resistance did not differ significantly between the cleft samples and the controls. Unilateral measurements of nasal resistance showed higher values for the cleft side than for the non-cleft side, both in cleft lip (CL) and the unilateral cleft lip and palate (UCLP) samples. In the cleft palate (CP) sample as well as in the controls, unilateral nasal resistance did not differ between the two sides.Comparisons were made between cephalometric measurements for craniofacial form and head posture for each category of the clefting deformity and the controls and the statistically significant differences tabulated.Previous studies have demonstrated associations between cranio-cervical angulation and craniofacial morphology, and between airway adequacy and cranio-cervical angulation.In the present study, differences and correlations were calculated between face height, head posture and airway resistance which were in agreement with the predicted pattern of associations between cranio-cervical angulation and craniofacial morphology (face height) and between airway adequacy and cranio-cervical angulation

Growing a dental workforce for regional and remote Australia: tracking the paths of James Cook University's first graduates

Background: The purpose and vision of the regional dental school at James Cook University (JCU) was presented at the 2010 "Are you remotely interested?" conference. Preliminary data on the preferred destinations and current practice location of the first graduate cohort. Aims of Study: To identify the main reason JCU Bachelor of Dental Surgery graduates chose their first practice location and subsequent relocation if applicable. Method: Design and participants: This study invited the first 54 graduates from the JCU Bachelor of Dental Surgery to participate in a survey on completion of their degree. Follow-up through an email survey and phone contact provides additional recent data. Main outcome measures: Graduates' main reason for choosing their graduate location and subsequent relocation in their first practice year (2014). Their current place of practice will be compared with their preferred employment location on completion of the BDS. Any post-graduate training undertaken during the graduate year will also be captured. Results: Respondents to initial survey (n = 54; response rate = 100%) reported both personal factors and professional opportunities as the primary drivers for choice of employer and location. The follow-up survey is currently in progress and preliminary findings will be available in August. Conclusion: JCU is making a significant difference to the regional and remote dental workforce

Growing a dental workforce for regional and remote Australia: tracking the paths of James Cook University's first graduates

Background: The purpose and vision of the regional dental school at James Cook University (JCU) was presented at the 2010 "Are you remotely interested?" conference. Preliminary data on the preferred destinations and current practice location of the first graduate cohort. Aims of Study: To identify the main reason JCU Bachelor of Dental Surgery graduates chose their first practice location and subsequent relocation if applicable. Method: Design and participants: This study invited the first 54 graduates from the JCU Bachelor of Dental Surgery to participate in a survey on completion of their degree. Follow-up through an email survey and phone contact provides additional recent data. Main outcome measures: Graduates' main reason for choosing their graduate location and subsequent relocation in their first practice year (2014). Their current place of practice will be compared with their preferred employment location on completion of the BDS. Any post-graduate training undertaken during the graduate year will also be captured. Results: Respondents to initial survey (n = 54; response rate = 100%) reported both personal factors and professional opportunities as the primary drivers for choice of employer and location. The follow-up survey is currently in progress and preliminary findings will be available in August. Conclusion: JCU is making a significant difference to the regional and remote dental workforce

Risk factors for small pharyngeal airway dimensions in preorthodontic children:A three-dimensional study

Objective: To analyze which parameters, gathered from standard orthodontic diagnostic material, were most relevant for identifying small pharyngeal airway dimensions in preorthodontic children. Materials and Methods: The sample was composed of 105 cone beam computed tomography scans of healthy preorthodontic children (44 boys, 61 girls; mean age, 10.7 ± 2.4 years). Airway volume and minimal cross-sectional area were three-dimensionally assessed. Cephalometric features and skeletal maturity were assessed on generated two-dimensional cephalograms. Associations were analyzed and adjusted for age, gender, and skeletal maturity by multiple regression analyses. Results: Airway volume and minimal cross-sectional area were significantly smaller in prepubertal children (P < .001, P < .05, respectively) and positively associated with age (P < .001, P < .01, respectively). After adjustment of age, skeletal maturity and gender significant associations were found between pharyngeal airway dimensions and craniofacial morphology. Airway volume was positively associated with maxillary and mandibular width (P < .01; P < .001, respectively) and anterior face height (P < .05; P < .05, respectively). Minimal cross-sectional area was positively associated with maxillary and mandibular width (P < .01; P < .001, respectively) and negatively associated with sagittal jaw relationship (AnPg, P < .05). Mandibular width and age were the most relevant factors for airway volume (r2 = 0.36). Mandibular width and sagittal jaw relationship were the most relevant factors for minimal cross-sectional area (r2 = 0.16). Conclusion: Pharyngeal airway dimensions were significantly associated with age, skeletal maturity, and craniofacial morphology in all three planes. Children with a reduced mandibular width and increased sagittal jaw relationship are particularly at risk of having small pharyngeal airway dimensions

Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012

OBJECTIVE: To provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," last published in 2008. DESIGN: A consensus committee of 68 international experts representing 30 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict of interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. A stand-alone meeting was held for all subgroup heads, co- and vice-chairs, and selected individuals. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. METHODS: The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations as strong (1) or weak (2). The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. Recommendations were classified into three groups: (1) those directly targeting severe sepsis; (2) those targeting general care of the critically ill patient and considered high priority in severe sepsis; and (3) pediatric considerations. RESULTS: Key recommendations and suggestions, listed by category, include: early quantitative resuscitation of the septic patient during the first 6 h after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm a potential source of infection (UG); administration of broad-spectrum antimicrobials therapy within 1 h of the recognition of septic shock (1B) and severe sepsis without septic shock (1C) as the goal of therapy; reassessment of antimicrobial therapy daily for de-escalation, when appropriate (1B); infection source control with attention to the balance of risks and benefits of the chosen method within 12 h of diagnosis (1C); initial fluid resuscitation with crystalloid (1B) and consideration of the addition of albumin in patients who continue to require substantial amounts of crystalloid to maintain adequate mean arterial pressure (2C) and the avoidance of hetastarch formulations (1B); initial fluid challenge in patients with sepsis-induced tissue hypoperfusion and suspicion of hypovolemia to achieve a minimum of 30 mL/kg of crystalloids (more rapid administration and greater amounts of fluid may be needed in some patients (1C); fluid challenge technique continued as long as hemodynamic improvement is based on either dynamic or static variables (UG); norepinephrine as the first-choice vasopressor to maintain mean arterial pressure ≥65 mmHg (1B); epinephrine when an additional agent is needed to maintain adequate blood pressure (2B); vasopressin (0.03 U/min) can be added to norepinephrine to either raise mean arterial pressure to target or to decrease norepinephrine dose but should not be used as the initial vasopressor (UG); dopamine is not recommended except in highly selected circumstances (2C); dobutamine infusion administered or added to vasopressor in the presence of (a) myocardial dysfunction as suggested by elevated cardiac filling pressures and low cardiac output, or (b) ongoing signs of hypoperfusion despite achieving adequate intravascular volume and adequate mean arterial pressure (1C); avoiding use of intravenous hydrocortisone in adult septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability (2C); hemoglobin target of 7-9 g/dL in the absence of tissue hypoperfusion, ischemic coronary artery disease, or acute hemorrhage (1B); low tidal volume (1A) and limitation of inspiratory plateau pressure (1B) for acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure (PEEP) in ARDS (1B); higher rather than lower level of PEEP for patients with sepsis-induced moderate or severe ARDS (2C); recruitment maneuvers in sepsis patients with severe refractory hypoxemia due to ARDS (2C); prone positioning in sepsis-induced ARDS patients with a PaO (2)/FiO (2) ratio of ≤100 mm Hg in facilities that have experience with such practices (2C); head-of-bed elevation in mechanically ventilated patients unless contraindicated (1B); a conservative fluid strategy for patients with established ARDS who do not have evidence of tissue hypoperfusion (1C); protocols for weaning and sedation (1A); minimizing use of either intermittent bolus sedation or continuous infusion sedation targeting specific titration endpoints (1B); avoidance of neuromuscular blockers if possible in the septic patient without ARDS (1C); a short course of neuromuscular blocker (no longer than 48 h) for patients with early ARDS and a PaO (2)/FI O (2) 180 mg/dL, targeting an upper blood glucose ≤180 mg/dL (1A); equivalency of continuous veno-venous hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1B); use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding in patients with bleeding risk factors (1B); oral or enteral (if necessary) feedings, as tolerated, rather than either complete fasting or provision of only intravenous glucose within the first 48 h after a diagnosis of severe sepsis/septic shock (2C); and addressing goals of care, including treatment plans and end-of-life planning (as appropriate) (1B), as early as feasible, but within 72 h of intensive care unit admission (2C). Recommendations specific to pediatric severe sepsis include: therapy with face mask oxygen, high flow nasal cannula oxygen, or nasopharyngeal continuous PEEP in the presence of respiratory distress and hypoxemia (2C), use of physical examination therapeutic endpoints such as capillary refill (2C); for septic shock associated with hypovolemia, the use of crystalloids or albumin to deliver a bolus of 20 mL/kg of crystalloids (or albumin equivalent) over 5-10 min (2C); more common use of inotropes and vasodilators for low cardiac output septic shock associated with elevated systemic vascular resistance (2C); and use of hydrocortisone only in children with suspected or proven "absolute"' adrenal insufficiency (2C). CONCLUSIONS: Strong agreement existed among a large cohort of international experts regarding many level 1 recommendations for the best care of patients with severe sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for this important group of critically ill patients

Factor influencing orthodontic treatment uptake

A questionnaire-type survey to determine the factors that influence the lack of orthodontic treatment uptake was conducted on a sample of untreated Singaporean male adults (N=170, age=17-22 years) with objectively assessed orthodontic treatment need of IOTN-DHC grade 4 and 5. The findings of this study suggest that self-satisfaction with dental appearance and financial cost were the two most influential patient factors for the lack of orthodontic treatment uptake in this group of young male adults. Perceived embarrassment and parental objection associated with braces were found to be more common among non-Chinese than Chinese repondents (P<.05). In conclusion, a high level of objective orthodontic treatment was not met with a similar demand for treatment in young Singaporean male adults. A significant difference was found in the patient factors of differen ethnic groups

Effectiveness and duration of two-arch fixed appliance treatment

The aims of this study were to determine the effectiveness and duration of single-phase two-arch fixed appliance treatment and to evaluate factors that may influence these two variables. Data were collected from 177 consecutively completed cases at the Orthodontic Department, Government Dental Clinic, Singapore, during a three-month period. Pre-treatment and post-treatment models were assessed using the Peer Assessment Rating (PAR) index. The result showed that two-arch fixed appliance treatment reduced the malocclusions on average by 77.80 per cent over a period of 25 months. Multiple regression techniques revealed that 22 per cent of the variability in treatment effectiveness could be explained by the pre-treatment PAR score, the age at the start of treatment, the frequency of office visits and whether or not the treatment involved extractions. The variation in treatment duration was due to the frequency of office visits, the pre-treatment PAR score and whether or not the treatment involved extractions or headgear

Patient's perceptions, treatment need, and complexity of orthodontic re-treatment

The aim of the present study was to investigate the subjective perception and objective treatment need and complexity of patients seeking orthodontic re-treatment. One hundred subjects (66 females, 34 males, age 26.7 ± 8.2 years) seeking re-treatment were asked to complete a questionnaire which was constructed based on pilot interviews with 15 patients. The questions focussed on treatment experiences, retention procedures following the first course of treatment, and expectations of and motivations for re-treatment. A visual analogue scale (VAS 0–10) was used. The ‘re-treatment’ group was matched with an untreated control group by age, gender, and the first consultation date. The study models of both groups were scored with the Index of Complexity, Outcome, and Need (ICON). Analysis of variance was used for across-time comparisons of VAS scores of patient's perception of their dental appearance, paired t-test for comparisons of the motivation VAS scores between the first treatment and re-treatment, and Mann–Whitney test for comparisons between the re-treatment and control groups.\ud \ud Eighty-eight patients (26.3 ± 8.4 years) completed the questionnaire. After the initial treatment, 36 per cent of the patients did not have any retention measures. The mean VAS scores for dental aesthetics at the start and end of the initial treatment were 2.3 ± 2.1 and 6.6 ± 2.7, respectively. The scores for the present situation and expected results of re-treatment were 4.1 ± 2.7 and 8.8 ± 1, respectively. These scores differed significantly from each other. Seventy-nine pairs of models were matched for evaluation of treatment need and complexity. The mean ICON scores of the re-treatment group were significantly lower than the controls (45 ± 21 versus 57 ± 24), the aesthetic component being the main contributing factor to this difference (25 ± 16 versus 36 ± 18). Both groups showed a treatment need (ICON > 43), with the untreated controls having a relatively higher complexity. These results indicate that patients seeking re-treatment had a good perception of dental aesthetics, strong motivation, and an objective treatment need

Developing a strong foundation for life-long learning of biomedical and behavioural sciences in a modern dental curriculum

[Extract] The largest, single challenge within a dental curriculum is, within a 5 year program, that we produce competent and skilled clinicians who are capable of practicing independently. JCU addresses this challenge by providing: –the early development of dentistry skills within the Simulation Laboratory (Year 1) –early application of knowledge and skills through a school-based placement (Year