To fill or not to fill: a qualitative cross-country study on dentists' decisions in managing non-cavitated proximal caries lesions

BACKGROUND: This study aimed to identify barriers and enablers for dentists managing non-cavitated proximal caries lesions using non- or micro-invasive (NI/MI) approaches rather than invasive and restorative methods in New Zealand, Germany and the USA. METHODS: Semi-structured interviews were conducted, focusing on non-cavitated proximal caries lesions (radiographically confined to enamel or the outer dentine). Twelve dentists from New Zealand, 12 from Germany and 20 from the state of Michigan (USA) were interviewed. Convenience and snowball sampling were used for participant recruitment. A diverse sample of dentists was recruited. Interviews were conducted by telephone, using an interview schedule based on the Theoretical Domains Framework (TDF). RESULTS: The following barriers to managing lesions non- or micro-invasively were identified: patients' lacking adherence to oral hygiene instructions or high-caries risk, financial pressures and a lack of reimbursement for NI/MI, unsupportive colleagues and practice leaders, not undertaking professional development and basing treatment on what had been learned during training, and a sense of anticipated regret (anxiety about not restoring a proximal lesion in its early stages before it progressed). The following enablers were identified: the professional belief that remineralisation can occur in early non-cavitated proximal lesions and that these lesions can be arrested, the understanding that placing restorations weakens the tooth and inflicts a cycle of re-restoration, having up-to-date information and supportive colleagues and work environments, working as part of a team of competent and skilled dental practitioners who perform NI/MI (such as cleaning or scaling), having the necessary resources, undertaking ongoing professional development and continued education, maintaining membership of professional groups and a sense of professional and personal satisfaction from working in the patient's best interest. Financial aspects were more commonly mentioned by the German and American participants, while continuing education was more of a focus for the New Zealand participants. CONCLUSIONS: Decisions on managing non-cavitated proximal lesions were influenced by numerous factors, some of which could be targeted by interventions for implementing evidence-based management strategies in practice

Nondissipative Drag Conductance as a Topological Quantum Number

We show in this paper that the boundary condition averaged nondissipative drag conductance of two coupled mesoscopic rings with no tunneling, evaluated in a particular many-particle eigenstate, is a topological invariant characterized by a Chern integer. Physical implications of this observation are discussed.Comment: 4 pages, no figure. Title modified and significant revision made to the text. Final version appeared in PR

Self-adapting method for the localization of quantum critical points using Quantum Monte Carlo techniques

A generalization to the quantum case of a recently introduced algorithm (Y. Tomita and Y. Okabe, Phys. Rev. Lett. {\bf 86}, 572 (2001)) for the determination of the critical temperature of classical spin models is proposed. We describe a simple method to automatically locate critical points in (Quantum) Monte Carlo simulations. The algorithm assumes the existence of a finite correlation length in at least one of the two phases surrounding the quantum critical point. We illustrate these ideas on the example of the critical inter-chain coupling for which coupled antiferromagnetic S=1 spin chains order at T=0. Finite-size scaling relations are used to determine the exponents, $\nu=0.72(2)$ and $\eta=0.038(3)$ in agreement with previous estimates.Comment: 5 pages, 3 figures, published versio

Second order gauge invariant gravitational perturbations of a Kerr black hole

We investigate higher than the first order gravitational perturbations in the Newman-Penrose formalism. Equations for the Weyl scalar $\psi_4,$ representing outgoing gravitational radiation, can be uncoupled into a single wave equation to any perturbative order. For second order perturbations about a Kerr black hole, we prove the existence of a first and second order gauge (coordinates) and tetrad invariant waveform, $\psi_I$, by explicit construction. This waveform is formed by the second order piece of $\psi_4$ plus a term, quadratic in first order perturbations, chosen to make $\psi_I$ totally invariant and to have the appropriate behavior in an asymptotically flat gauge. $\psi_I$ fulfills a single wave equation of the form ${\cal T}\psi_I=S,$ where ${\cal T}$ is the same wave operator as for first order perturbations and $S$ is a source term build up out of (known to this level) first order perturbations. We discuss the issues of imposition of initial data to this equation, computation of the energy and momentum radiated and wave extraction for direct comparison with full numerical approaches to solve Einstein equations.Comment: 19 pages, REVTEX. Some misprints corrected and changes to improve presentation. Version to appear in PR

Structural Determinants and Children's Oral Health: A Cross-National Study

Much research on children's oral health has focused on proximal determinants at the expense of distal (upstream) factors. Yet, such upstream factors-the so-called structural determinants of health-play a crucial role. Children's lives, and in turn their health, are shaped by politics, economic forces, and social and public policies. The aim of this study was to examine the relationship between children's clinical (number of decayed, missing, and filled teeth) and self-reported oral health (oral health-related quality of life) and 4 key structural determinants (governance, macroeconomic policy, public policy, and social policy) as outlined in the World Health Organization's Commission for Social Determinants of Health framework. Secondary data analyses were carried out using subnational epidemiological samples of 8- to 15-y-olds in 11 countries ( N = 6,648): Australia (372), New Zealand (three samples; 352, 202, 429), Brunei (423), Cambodia (423), Hong Kong (542), Malaysia (439), Thailand (261, 506), United Kingdom (88, 374), Germany (1498), Mexico (335), and Brazil (404). The results indicated that the type of political regime, amount of governance (e.g., rule of law, accountability), gross domestic product per capita, employment ratio, income inequality, type of welfare regime, human development index, government expenditure on health, and out-of-pocket (private) health expenditure by citizens were all associated with children's oral health. The structural determinants accounted for between 5% and 21% of the variance in children's oral health quality-of-life scores. These findings bring attention to the upstream or structural determinants as an understudied area but one that could reap huge rewards for public health dentistry research and the oral health inequalities policy agenda

Cancer and changes in facial appearance : a meta-ethnography of qualitative studies

Introduction: Living with an altered facial appearance as a result of treatment for cancer requires considerable psychological adjustment. As such it is essential that health care professionals understand the lived experience of people affected. This systematic review provides a metaethnography of studies that have explored the experience of changed facial appearance as a result of cancer. Methods: A search of four databases (Web of Science, CINAHL, PsycInfo and Scopus) took place using terms relating to qualitative research, cancer, and changed facial appearance. Thirteen studies were identified, appraised and included in the synthesis. The findings and interpretations within the studies were subject to meta-ethnography procedures so as to elicit novel cross cutting themes. Findings: The experience of changed facial appearance after cancer was clustered into three contexts. In the context of the disease, subthemes were the primacy of survival, the changing relationship with the disease and the impact of the care team on the experience of changed appearance. In the context of the social world, subthemes were positive reactions, negative reactions and coping strategies. In the context of the self, subthemes were the self under attack, self-to-self relating, the self in the world and rebuilding the self. Conclusions: The findings indicate that healthcare professionals must conduct holistic assessments, so as to fully recognise and where necessary address the impact upon self. The meta-ethnography shows that the experience of facial appearance change following cancer is complex and requires awareness of a number of theoretical areas including identity construction, social support, stigmatisation, and the specific literature on visible difference

A Unified Algebraic Approach to Few and Many-Body Correlated Systems

The present article is an extended version of the paper {\it Phys. Rev.} {\bf B 59}, R2490 (1999), where, we have established the equivalence of the Calogero-Sutherland model to decoupled oscillators. Here, we first employ the same approach for finding the eigenstates of a large class of Hamiltonians, dealing with correlated systems. A number of few and many-body interacting models are studied and the relationship between their respective Hilbert spaces, with that of oscillators, is found. This connection is then used to obtain the spectrum generating algebras for these systems and make an algebraic statement about correlated systems. The procedure to generate new solvable interacting models is outlined. We then point out the inadequacies of the present technique and make use of a novel method for solving linear differential equations to diagonalize the Sutherland model and establish a precise connection between this correlated system's wave functions, with those of the free particles on a circle. In the process, we obtain a new expression for the Jack polynomials. In two dimensions, we analyze the Hamiltonian having Laughlin wave function as the ground-state and point out the natural emergence of the underlying linear $W_{1+\infty}$ symmetry in this approach.Comment: 18 pages, Revtex format, To appear in Physical Review

Psychometric assessment of the short-form Child Perceptions Questionnaire: an international collaborative study.

OBJECTIVE: To examine the factor structure and other psychometric characteristics of the most commonly used child oral-health-related quality-of-life (OHRQoL) measure (the 16-item short-form CPQ11-14 ) in a large number of children (N = 5804) from different settings and who had a range of caries experience and associated impacts. METHODS: Secondary data analyses used subnational epidemiological samples of 11- to 14-year-olds in Australia (N = 372), New Zealand (three samples: 352, 202, 429), Brunei (423), Cambodia (244), Hong Kong (542), Malaysia (439), Thailand (220, 325), England (88, 374), Germany (1055), Mexico (335) and Brazil (404). Confirmatory factor analysis (CFA) was used to examine the factor structure of the CPQ11-14 across the combined sample and within four regions (Australia/NZ, Asia, UK/Europe and Latin America). Item impact and internal reliability analysis were also conducted. RESULTS: Caries experience varied, with mean DMFT scores ranging from 0.5 in the Malaysian sample to 3.4 in one New Zealand sample. Even more variation was noted in the proportion reporting only fair or poor oral health; this was highest in the Cambodian and Mexican samples and lowest in the German sample and one New Zealand sample. One in 10 reported that their oral health had a marked impact on their life overall. The CFA across all samples revealed two factors with eigenvalues greater than 1. The first involved all items in the oral symptoms and functional limitations subscales; the second involved all emotional well-being and social well-being items. The first was designated the 'symptoms/function' subscale, and the second was designated the 'well-being' subscale. Cronbach's alpha scores were 0.72 and 0.84, respectively. The symptoms/function subscale contained more of the items with greater impact, with the item 'Food stuck in between your teeth' having greatest impact; in the well-being subscale, the 'Felt shy or embarrassed' item had the greatest impact. Repeating the analyses by world region gave similar findings. CONCLUSION: The CPQ11-14 performed well cross-sectionally in the largest analysis of the scale in the literature to date, with robust and mostly consistent psychometric characteristics, albeit with two underlying factors (rather than the originally hypothesized four-factor structure). It appears to be a sound, robust measure which should be useful for research, practice and policy

Treatment outcomes in trigeminal neuralgia–a systematic review of domains, dimensions and measures

Background Trigeminal neuralgia (TN) is a painful disorder characterized by sudden electric shock–like pain. It is a rare condition for which multiple treatments are available, including medical and surgical. The best treatment option is yet to be defined, and this is related to the lack of definition in the treatment outcomes and outcome measures. The aim of this systematic review was to summarize all the outcomes and outcomes measures that have been published to date and highlight variability in their use. Methods We have conducted a literature search using a wide range of databases (1946–2019 for medical and 2008–2019 for surgical treatment), for all intervention studies in TN. Four hundred and sixty-seven studies were selected for data extraction on TN classification, data collection method, intervention, and treatment outcomes mapped to the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT guidelines). Results Most studies collected data on pain (n = 459) and side effects (n = 386) domains; however, very few collected data on the impact of treatment on physical (n = 46) and emotional functioning (n = 17) and on patient satisfaction (n = 35). There was high variability on outcome measures used for pain relief (n = 10), pain intensity (n = 9), and frequency of pain episodes (n = 3). Conclusions A clear definition of what are the important outcomes for patients with TN is essential. The choice of standardized outcome measures allowing for consistent reporting in TN treatment will allow for comparison of studies and facilitate treatment choice for patients and clinicians thus, improving health outcomes and reducing health care cost

4pi Models of CMEs and ICMEs

Coronal mass ejections (CMEs), which dynamically connect the solar surface to the far reaches of interplanetary space, represent a major anifestation of solar activity. They are not only of principal interest but also play a pivotal role in the context of space weather predictions. The steady improvement of both numerical methods and computational resources during recent years has allowed for the creation of increasingly realistic models of interplanetary CMEs (ICMEs), which can now be compared to high-quality observational data from various space-bound missions. This review discusses existing models of CMEs, characterizing them by scientific aim and scope, CME initiation method, and physical effects included, thereby stressing the importance of fully 3-D ('4pi') spatial coverage.Comment: 14 pages plus references. Comments welcome. Accepted for publication in Solar Physics (SUN-360 topical issue