Fissure Seal or Fluoride Varnish? A Randomized Trial of Relative Effectiveness

Fissure sealant (FS) and fluoride varnish (FV) are effective in preventing dental caries when compared with a no-treatment control. However, the relative clinical effectiveness of these interventions is uncertain. The objective of the study was to compare the clinical effectiveness of FS and FV in preventing dental caries in first permanent molars (FPMs) in 6- to 7-y-olds. The study design was a randomized clinical trial, with 2 parallel arms. The setting was a targeted-population program that used mobile dental clinics in schools located within areas of high social and economic deprivation in South Wales. A total of 1,016 children were randomized 1:1 to receive either FS or FV. Resin-based FS was applied to caries-free FPMs and maintained at 6-mo intervals. FV was applied at baseline and at 6-mo intervals for 3 y. The main outcome measures were the proportion of children developing caries into dentine (D4-6MFT) on any 1 of up to 4 treated FPMs after 36 mo. At 36 mo, 835 (82%) children remained: 417 in the FS arm and 418 in the FV arm. A smaller proportion of children who received FV (n = 73, 17.5%) versus FS (n = 82, 19.6%) developed caries into dentine on at least 1 FPM (odds ratio [OR] = 0.84; 95% CI, 0.59 to 1.21; P = 0.35), a nonstatistically significant difference between FS and FV treatments. The results were similar when the number of newly decayed teeth (OR = 0.86; 95% CI, 0.60 to 1.22) and tooth surfaces (OR = 0.85; 95% CI, 0.59 to 1.21) were examined. In a community oral health program, semiannual application of FV resulted in caries prevention that was not significantly different from that obtained by applying and maintaining FS after 36 mo (EudraCT: 2010-023476-23; ISRCTN: ISRCTN17029222)

Продовольственный вопрос в деятельности органов власти и управления Томской губернии (1920-1921 гг.)

Purpose – Research into the communication skills of individuals with Cornelia de Lange syndrome (CdLS) is extremely limited. This paper aims to evaluate the nature of these skills and impairments in CdLS using a detailed informant assessment of pre-verbal communication skills. Design/methodology/approach – The study used the Pre-verbal Communication Schedule to evaluate communication skills in individuals with CdLS (n=14), aged five to14 years. The group was compared with a contrast group of individuals with Cri du Chat syndrome (CdCS; n=14) who were matched for age and intellectual ability. Findings – A significant difference was identified in understanding non-vocal communication (p&lt;0.005), with the CdLS group showing a greater deficit. These findings indicate the presence of a syndrome-specific deficit in understanding non-verbal communication in individuals with CdLS and suggest that there may be a dissociation between the processing of verbal and non-verbal communication. Originality/value – The findings indicate that, in many ways, these two syndrome groups are not dissimilar in terms of their communication skills. However, individuals with CdLS show a syndrome-specific deficit in understanding non-vocal communication relative to the CdCS group. </jats:sec

Community structure and feeding ecology of mesopelagic fishes in the slope waters of King-George Island (South Shetland Islands, Antarctica)

The role of mesopelagic fishes in the Southern Ocean ecosystem and more particular their trophic effect on the standing stock of mesozooplankton is at present poorly understood. To get a deeper insight in the Antarctic mid-water ecosystem the mesopelagic fish community of the King George Island slope (South Shetland Islands) was sampled with a pelagic trawl in 1996. The community structure was analysed and the feeding ecology was studied of the five most abundant species. A total of 18 mesopelagic fish species in 10 families was identified. Of these, the Myctophidae was the most important family by species number (9 species), individual number (98.5% of all individuals)and fish wet weight (87.3% of the total weight). The assemblage was numerically dominated by four myctophids (Electrona antarctica, Gymnoscopelus braueri, Gymnoscopelus nicholsi,Protomyctophum bolini) and one gempilyd (Paradiplospinus gracilis). Multivariate statisticalanalysis of the mesopelagic fish data reveals two major groups of stations according to the sampleddepth: a shallow group of stations (295â450 m depth) and a deeper group of stations (440â825 mdepth). The change in relative abundance of mesopelagic fish species at 440â450 m coincides withthe presence of warmer and denser Circumpolar Deep Water at and below these depths. Deeperstations were characterized by a higher density and increased diversity of mesopelagic fish species.The community patterns identified correlated well with the vertical depth distribution of the mostabundant species. Dietary analysis reveals that myctophids are mostly zooplanktivorous, while thegempilyd P. gracilis is classified as a piscivorous predator. The small P. bolini feed mainly oncopepods of the species Metridia gerlachei, while the most important prey item of the largermyctophids E. antarctica, G. braueri, and G. nicholsi were various species of euphausiids.Investigation of feeding chronology showed that G. nicholsi and P. bolini were feeding day andnight. Daily ration estimates for myctophid species ranged from 0.28% to 3.3% of dry body weight(0.5â5.94% of wet body weight). Krill (Euphausia superba) were the most important food of E.antarctica and G. nicholsi, accounting for 53.1% and 58.3% of the total food weight, respectively.The annual removal from the krill stock by both species was estimated to amount to 11.1â26.7% inthe South Shetland Islands region. This estimate emphasizes the important role of mesopelagic fish inthe Antarctic ecosystem as a prevalent consumer of krill

Effect of protocolized weaning with early extubation to noninvasive ventilation vs invasive weaning on time to liberation from mechanical ventilation among patients With respiratory failure: The Breathe randomized clinical trial

Importance In adults in whom weaning from invasive mechanical ventilation is difficult, noninvasive ventilation may facilitate early liberation, but there is uncertainty about its effectiveness in a general intensive care patient population. Objective To investigate among patients with difficulty weaning the effects of protocolized weaning with early extubation to noninvasive ventilation on time to liberation from ventilation compared with protocolized invasive weaning. Design, Setting, and Participants Randomized, allocation-concealed, open-label, multicenter clinical trial enrolling patients between March 2013 and October 2016 from 41 intensive care units in the UK National Health Service. Follow-up continued until April 2017. Adults who received invasive mechanical ventilation for more than 48 hours and in whom a spontaneous breathing trial failed were enrolled. Interventions Patients were randomized to receive either protocolized weaning via early extubation to noninvasive ventilation (n = 182) or protocolized standard weaning (continued invasive ventilation until successful spontaneous breathing trial, followed by extubation) (n = 182). Main Outcomes and Measures Primary outcome was time from randomization to successful liberation from all forms of mechanical ventilation among survivors, measured in days, with the minimal clinically important difference defined as 1 day. Secondary outcomes were duration of invasive and total ventilation (days), reintubation or tracheostomy rates, and survival. Results Among 364 randomized patients (mean age, 63.1 [SD, 14.8] years; 50.5% male), 319 were evaluable for the primary effectiveness outcome (41 died before liberation, 2 withdrew, and 2 were discharged with ongoing ventilation). The median time to liberation was 4.3 days in the noninvasive group vs 4.5 days in the invasive group (adjusted hazard ratio, 1.1; 95% CI, 0.89-1.40). Competing risk analysis accounting for deaths had a similar result (adjusted hazard ratio, 1.1; 95% CI, 0.86-1.34). The noninvasive group received less invasive ventilation (median, 1 day vs 4 days; incidence rate ratio, 0.6; 95% CI, 0.47-0.87) and fewer total ventilator days (median, 3 days vs 4 days; incidence rate ratio, 0.8; 95% CI, 0.62-1.0). There was no significant difference in reintubation, tracheostomy rates, or survival. Adverse events occurred in 45 patients (24.7%) in the noninvasive group compared with 47 (25.8%) in the invasive group. Conclusions and Relevance Among patients requiring mechanical ventilation in whom a spontaneous breathing trial had failed, early extubation to noninvasive ventilation did not shorten time to liberation from any ventilation. Trial Registration ISRCTN Identifier: ISRCTN15635197</p

Effect of protocolized weaning with early extubation to noninvasive ventilation vs invasive weaning on time to liberation from mechanical ventilation among patients With respiratory failure: The Breathe randomized clinical trial

Importance In adults in whom weaning from invasive mechanical ventilation is difficult, noninvasive ventilation may facilitate early liberation, but there is uncertainty about its effectiveness in a general intensive care patient population. Objective To investigate among patients with difficulty weaning the effects of protocolized weaning with early extubation to noninvasive ventilation on time to liberation from ventilation compared with protocolized invasive weaning. Design, Setting, and Participants Randomized, allocation-concealed, open-label, multicenter clinical trial enrolling patients between March 2013 and October 2016 from 41 intensive care units in the UK National Health Service. Follow-up continued until April 2017. Adults who received invasive mechanical ventilation for more than 48 hours and in whom a spontaneous breathing trial failed were enrolled. Interventions Patients were randomized to receive either protocolized weaning via early extubation to noninvasive ventilation (n = 182) or protocolized standard weaning (continued invasive ventilation until successful spontaneous breathing trial, followed by extubation) (n = 182). Main Outcomes and Measures Primary outcome was time from randomization to successful liberation from all forms of mechanical ventilation among survivors, measured in days, with the minimal clinically important difference defined as 1 day. Secondary outcomes were duration of invasive and total ventilation (days), reintubation or tracheostomy rates, and survival. Results Among 364 randomized patients (mean age, 63.1 [SD, 14.8] years; 50.5% male), 319 were evaluable for the primary effectiveness outcome (41 died before liberation, 2 withdrew, and 2 were discharged with ongoing ventilation). The median time to liberation was 4.3 days in the noninvasive group vs 4.5 days in the invasive group (adjusted hazard ratio, 1.1; 95% CI, 0.89-1.40). Competing risk analysis accounting for deaths had a similar result (adjusted hazard ratio, 1.1; 95% CI, 0.86-1.34). The noninvasive group received less invasive ventilation (median, 1 day vs 4 days; incidence rate ratio, 0.6; 95% CI, 0.47-0.87) and fewer total ventilator days (median, 3 days vs 4 days; incidence rate ratio, 0.8; 95% CI, 0.62-1.0). There was no significant difference in reintubation, tracheostomy rates, or survival. Adverse events occurred in 45 patients (24.7%) in the noninvasive group compared with 47 (25.8%) in the invasive group. Conclusions and Relevance Among patients requiring mechanical ventilation in whom a spontaneous breathing trial had failed, early extubation to noninvasive ventilation did not shorten time to liberation from any ventilation. Trial Registration ISRCTN Identifier: ISRCTN15635197</p

Medical theses and derivative articles: dissemination of contents and publication patterns

Doctoral theses are an important source of publication in universities, although little research has been carried out on the publications resulting from theses, on so-called derivative articles. This study investigates how derivative articles can be identified through a text analysis based on the full-text of a set of medical theses and the full-text of articles, with which they shared authorship. The text similarity analysis methodology applied consisted in exploiting the full-text articles according to organization of scientific discourse IMRaD (Introduction, Methodology, Results and Discussion) using the TurnItIn plagiarism tool. The study found that the text similarity rate in the Discussion section can be used to discriminate derivative articles from non-derivative articles. Additional findings were: the first position of the thesis’s author dominated in 85 % of derivative articles, the participation of supervisors as coauthors occurred in 100 % of derivative articles, the authorship credit retained by the thesis’s author was 42 % in derivative articles, the number of coauthors by article was 5 in derivative articles versus 6.4 coauthors, as average, in non-derivative articles and the time differential regarding the year of thesis completion showed that 87.5 % of derivative articles were published before or in the same year of thesis completion.</p

Doctoral program types and legitimacy of models: different forms for different purposes

Globally, there has been a shift in Higher Education. The rise in the number of nontraditional students and the educational inclusiveness obligations of universities has seen the development of differentiated doctoral pedagogies to meet the demand for flexible enrolments. The shift in university thinking that occurred due to student demand and political interference into higher education financially and socially has necessitated a change in traditional doctoral pedagogy to provide for the educational motivations of these students. This chapter will explore these factors relative to the doctoral degree models that have evolved in various countries in response to student, industrial, and political requirements