Immediately loaded zygomatic implants used for a functional and aesthetic rehabilitation following a combined maxillectomy and rhinectomy

Malignancies of the nasal vestibule are rare, yet may result in massive destruction of the face if left untreated. The position and extent of the resulting defects is not only a rehabilitative challenge but also a major psychological burden for the patient. This paper describes a technique for designing and fabricating an immediate surgical obturator and nasal prosthesis to help minimize the post-surgical impact following a total rhinectomy and partial maxillectomy procedure in a patient diagnosed with a squamous cell carcinoma of the nasal septum. The restoration consisted of bilateral zygomatic implants attached to a resin framework housing a central magnet. The latter was used to retain the nasal prosthesis and help support an interim maxillary obturator. Conventional impressions of the dentition and a moulage of the nasal defect were taken. The master casts were poured and used for design and fabrication of the obturator and nasal wax pattern Colour matching of the nose and facial areas was performed with the aid of a digital spectrophotometer (Quickweigh; Spectromatch Ltd., UK), and a silicone nasal prosthesis was fabricated. This case demonstrated how both a functional rehabilitation and reduced psychological impact was achieved by delivering an immediate surgical obturator and facial prosthesis

A BUSINESS CASE STUDY FOR COMPARING THE MANUFACTURING OF IMPLANT-SUPPORTED DENTURE FRAMES THROUGH DIRECT METAL LASER SINTERING TO CONVENTIONAL CASTING AND MACHINING PROCESSES

Conference ProceedingsRetaining dentures in edentulous patients is a common problem which can be overcome through the use of implant-supported denture frames. These frames are conventionally manufactured through the lost wax investment casting processes or through computer aided machining in cobalt chrome. Although Additive Manufacturing (AM) processes are now commonly used in the manufacturing of crowns and bridges in dentistry, the manufacturing of implant-supported denture frames is less common. This study aimed to investigate the feasibility of manufacturing these frames through AM from a business point of view compared to conventional casting and machining. A case study is presented where a full overdenture frame is designed and manufactured in Titanium-6Aluminium-4Vanadium (Ti-6Al-4V) alloy through the Direct Metal Laser Sintering (DMLS) process. This is compared to manufacturing the same frame in cobalt chrome through traditional processes in terms of manufacturing time and cost. Results from the study showed that it is more expensive and takes longer to produce overdenture frames through DMLS compared to conventional manufacturing techniques. Although costs and time can be reduced by producing a number of frames simultaneously on the DMLS machine’s building platform, the manufacturing process is still not considered viable for overdenture frames from a business point of view

What factors explain the number of physical therapy treatment sessions in patients referred with low back pain; a multilevel analysis

BACKGROUND: It is well-known that the number of physical therapy treatment sessions varies over treatment episodes. Information is lacking, however, on the source and explanation of the variation. The purposes of the current study are: 1) to determine how the variance in the number of physical therapy treatment sessions in patients with non-specific low back pain (LBP) in the Netherlands is distributed over patient level, therapist level and practice level; and 2) to determine the factors that explain the variance. METHODS: Data were used from a national registration network on physical therapy. Our database contained information on 1,733 patients referred with LBP, treated by 97 therapists working in 41 practices. The variation in the number of treatment sessions was investigated by means of multilevel regression analyses. RESULTS: Eighty-eight per cent of the variation in the number of treatment sessions for patients with LBP is located at patient level and seven per cent is located at practice level. It was possible to explain thirteen per cent of all variance. The duration of the complaint, prior therapy, and the patients' age and gender in particular are related to the number of physical therapy treatment sessions. CONCLUSION: Our results suggest that the number of physical therapy treatment sessions in patients with LBP mainly depends on patient characteristics. More variation needs to be explained, however, to improve the transparency of care. Future research should examine the contribution of psychosocial factors, baseline disability, and the ability to learn motor behavior as possible factors in the variation in treatment sessions

11 x 11 Domineering is Solved: The first player wins

We have developed a program called MUDoS (Maastricht University Domineering Solver) that solves Domineering positions in a very efficient way. This enables the solution of known positions so far (up to the 10 x 10 board) much quicker (measured in number of investigated nodes). More importantly, it enables the solution of the 11 x 11 Domineering board, a board up till now far out of reach of previous Domineering solvers. The solution needed the investigation of 259,689,994,008 nodes, using almost half a year of computation time on a single simple desktop computer. The results show that under optimal play the first player wins the 11 x 11 Domineering game, irrespective if Vertical or Horizontal starts the game. In addition, several other boards hitherto unsolved were solved. Using the convention that Vertical starts, the 8 x 15, 11 x 9, 12 x 8, 12 x 15, 14 x 8, and 17 x 6 boards are all won by Vertical, whereas the 6 x 17, 8 x 12, 9 x 11, and 11 x 10 boards are all won by Horizontal

The Familial Clustering of Age at Menarche in Extended Twin Families

The timing of puberty is complex, possibly involving many genetic factors that may interact with environmental influences. Familial resemblance for age at menarche was studied in a sample of 4,995 female twins, 1,296 sisters, 2,946 mothers and 635 female spouses of male twins. They had indicated their age at menarche as part of a larger longitudinal survey. We assessed assortative mating for age at menarche, gene–environment interaction effects and estimated the heritability of individual differences in pubertal timing. There was significant evidence of gene–environment interaction, accounting for 1.5% of the variance. There was no indication of consistent mate assortment on age at menarche. Individual differences in age at menarche are highly heritable, with additive genetic factors explaining at least 70% of the true variation. An additional 1.5% of the variation can be explained by a genotype–environment interaction effect where environmental factors are more important in individuals genetically predisposed for late menarche

The perilous state of seagrass in the British Isles

Seagrass ecosystems face widespread threat from reduced water quality, coastal development and poor land use. In recent decades, their distribution has declined rapidly, and in the British Isles, this loss is thought to have been extensive. Given increasing knowledge of how these ecosystems support fisheries production, the understanding of their potential rapid loss, and the difficulty in restoring them, it is vital we develop an understanding of the risks they are under, so that management actions can be developed accordingly. Developing an understanding of their environmental status and condition is therefore critical to their long-term management. This study provided, to our knowledge, the first examination of the environmental health of seagrass meadows around the British Isles. This study used a bioindicator approach and involved collecting data on seagrass density and morphology alongside analysis of leaf biochemistry. Our study provides, to the best of our knowledge, the first strong quantitative evidence that seagrass meadows of the British Isles are mostly in poor condition in comparison with global averages, with tissue nitrogen levels 75% higher than global values. Such poor status places their long-term resilience in doubt. Elemental nutrient concentrations and morphological change suggest conditions of excess nitrogen and probable low light, placing many of the meadows sampled in a perilous state, although others, situated away from human populations were perceived to be healthy. Although some sites were of a high environmental health, all sites were considered at risk from anthropogenic impacts, particularly poor water quality and boating-based disturbances. The findings of this study provide a warning of the need to take action, with respect to water quality and disturbance, to prevent the further loss and degradation of these systems across the British Isles

A Calculation of the Full Neutrino Phase Space in Cold+Hot Dark Matter Models

This paper presents a general-relativistic N-body technique for evolving the phase space distribution of massive neutrinos in linear perturbation theory. The method provides a much more accurate sampling of the neutrino phase space for the HDM initial conditions of N-body simulations in a cold+hot dark matter universe than previous work. Instead of directly sampling the phase space at the end of the linear era, we first compute the evolution of the metric perturbations by numerically integrating the coupled, linearized Einstein, Boltzmann, and fluid equations for all particle species. We then sample the phase space shortly after neutrino decoupling at redshift z=10^9 when the distribution is Fermi-Dirac. To follow the trajectory of each neutrino, we subsequently integrate the geodesic equations for each neutrino in the perturbed background spacetime from z=10^9 to z=13.55, using the linearized metric found in the previous calculation to eliminate discreteness noise. The positions and momenta resulting from this integration represent a fair sample of the full neutrino phase space and can be used as HDM initial conditions for N-body simulations of nonlinear structure evolution in this model. A total of 21 million neutrino particles are used in a 100 Mpc box, with Omega_cdm=0.65, Omega_hdm=0.30, Omega_baryon=0.05, and Hubble constant H_0=50. We find that correlations develop in the neutrino densities and momenta which are absent when only the zeroth-order Fermi-Dirac distribution is considered.Comment: 20 pages, AAS LaTeX v3.0, figures and/or postscript available by anonymous ftp to arcturus.mit.edu, MIT CSR-93-1

Laser-heated capillary discharge plasma waveguides for electron acceleration to 8 GeV

A plasma channel created by the combination of a capillary discharge and inverse Bremsstrahlung laser heating enabled the generation of electron bunches with energy up to 7.8 GeV in a laser-driven plasma accelerator. The capillary discharge created an initial plasma channel and was used to tune the plasma temperature, which optimized laser heating. Although optimized colder initial plasma temperatures reduced the ionization degree, subsequent ionization from the heater pulse created a fully ionized plasma on-axis. The heater pulse duration was chosen to be longer than the hydrodynamic timescale of ≈ 1 ns, such that later temporal slices were more efficiently guided by the channel created by the front of the pulse. Simulations are presented which show that this thermal self-guiding of the heater pulse enabled channel formation over 20 cm. The post-heated channel had lower on-axis density and increased focusing strength compared to relying on the discharge alone, which allowed for guiding of relativistically intense laser pulses with a peak power of 0.85 PW and wakefield acceleration over 15 diffraction lengths. Electrons were injected into the wake in multiple buckets and times, leading to several electron bunches with different peak energies. To create single electron bunches with low energy spread, experiments using localized ionization injection inside a capillary discharge waveguide were performed. A single injected bunch with energy 1.6 GeV, charge 38 pC, divergence 1 mrad, and relative energy spread below 2% full-width half-maximum was produced in a 3.3 cm-long capillary discharge waveguide. This development shows promise for mitigation of energy spread and future high efficiency staged acceleration experiments

Adherence to Tuberculosis Therapy among Patients Receiving Home-Based Directly Observed Treatment: Evidence from the United Republic of Tanzania.

\ud \ud Non-adherence to tuberculosis (TB) treatment is the leading contributor to the selection of drug-resistant strains of Mycobacterium tuberculosis and subsequent treatment failure. Tanzania introduced a TB Patient Centred Treatment (PCT) approach which gives new TB patients the choice between home-based treatment supervised by a treatment supporter of their own choice, and health facility-based treatment observed by a medical professional. The aim of this study was to assess the extent and determinants of adherence to anti-TB therapy in patients opting for home-based treatment under the novel PCT approach. In this cross-sectional study, the primary outcome was the percentage of patients adherent to TB therapy as detected by the presence of isoniazid in urine (IsoScreen assay). The primary analysis followed a non-inferiority approach in which adherence could not be lower than 75%. Logistic regression was used to examine the influence of potentially predictive factors. A total of 651 new TB patients were included. Of these, 645 (99.1%) provided urine for testing and 617 patients (95.7%; 90%CI 94.3-96.9) showed a positive result. This result was statistically non-inferior to the postulated adherence level of 75% (p<0.001). Adherence to TB therapy under home-based Directly Observed Treatment can be ensured in programmatic settings. A reliable supply of medication and the careful selection of treatment supporters, who preferably live very close to the patient, are crucial success factors. Finally, we recommend a cohort study to assess the rate of adherence throughout the full course of TB treatment