How to Intervene in the Caries Process in Older Adults: A Joint ORCA and EFCD Expert Delphi Consensus Statement

Aim: To provide recommendations for dental clinicians for the management of dental caries in older adults with special emphasis on root caries lesions. Methods: A consensus workshop followed by a Delphi consensus process were conducted with an expert panel nominated by ORCA, EFCD, and DGZ boards. Based on a systematic review of the literature, as well as non-systematic literature search, recommendations for clinicians were developed and consented in a two-stage Delphi process. Results: Demographic and epidemiologic changes will significantly increase the need of management of older adults and root caries in the future. Ageing is associated with a decline of intrinsic capacities and an increased risk of general diseases. As oral and systemic health are linked, bidirectional consequences of diseases and interventions need to be considered. Caries prevention and treatment in older adults must respond to the patient’s individual abilities for self-care and cooperation and often involves the support of caregivers. Systemic interventions may involve dietary counselling, oral hygiene instruction, the use of fluoridated toothpastes, and the stimulation of salivary flow. Local interventions to manage root lesions may comprise local biofilm control, application of highly fluoridated toothpastes or varnishes as well as antimicrobial agents. Restorative treatment is often compromised by the accessibility of such root caries lesions as well as the ability of the senior patient to cooperate. If optimum restorative treatment is impossible or inappropriate, longterm stabilization, e.g., by using glass-ionomer cements, and palliative treatments that aim to maintain oral function as long and as well as possible may be the treatment of choice for the individual

How to Intervene in the Caries Process in Older Adults: A Joint ORCA and EFCD Expert Delphi Consensus Statement

Aim: To provide recommendations for dental clinicians for the management of dental caries in older adults with special emphasis on root caries lesions. Methods: A consensus workshop followed by a Delphi consensus process were conducted with an expert panel nominated by ORCA, EFCD, and DGZ boards. Based on a systematic review of the literature, as well as non-systematic literature search, recommendations for clinicians were developed and consented in a two-stage Delphi process. Results: Demographic and epidemiologic changes will significantly increase the need of management of older adults and root caries in the future. Ageing is associated with a decline of intrinsic capacities and an increased risk of general diseases. As oral and systemic health are linked, bidirectional consequences of diseases and interventions need to be considered. Caries prevention and treatment in older adults must respond to the patient's individual abilities for self-care and cooperation and often involves the support of caregivers. Systemic interventions may involve dietary counselling, oral hygiene instruction, the use of fluoridated toothpastes, and the stimulation of salivary flow. Local interventions to manage root lesions may comprise local biofilm control, application of highly fluoridated toothpastes or varnishes as well as antimicrobial agents. Restorative treatment is often compromised by the accessibility of such root caries lesions as well as the ability of the senior patient to cooperate. If optimum restorative treatment is impossible or inappropriate, long-term stabilization, e.g., by using glass-ionomer cements, and palliative treatments that aim to maintain oral function as long and as well as possible may be the treatment of choice for the individual

How to Intervene in the Caries Process in Children: A Joint ORCA and EFCD Expert Delphi Consensus Statement

This paper provides recommendations for dentists for the treatment of dental caries in children, with an emphasis on early childhood caries (ECC), primary teeth, and occlusal surfaces in permanent teeth. A consensus workshop followed by an e-Delphi consensus process was conducted with an expert panel nominated by the European Organization for Caries Research (ORCA) and European Federation of Conservative Dentistry (EFCD)/German Association of Conservative Dentistry (DGZ) boards. Based on 3 systematic reviews and a nonsystematic literature search, recommendations were developed. The caries decline has led to a more polarized disease distribution in children and adolescents along social gradients which should be taken into account when managing the caries process at all levels, such as the individual, the group, or a population. The control or reduction of caries activity is the basis for successful caries management. In children, caries management requires adequate daily oral hygiene and fluoride application via toothpaste, ensured by caregivers, and especially for ECC prevention an emphasis on sugar intake reduction is needed. These noninvasive interventions are also suitable to arrest or control initial or even cavitated dentine caries lesions in the absence of irreversible pulpitis. Fluoride varnish or silver diammine fluoride can be added as supplementary agents. In pits and fissures, composite resin materials can be used as preventive sealants and for defect-oriented minimally invasive restorations. In primary molars, preformed metal crowns are more successful than multisurface fillings, especially in caries-active patients. With persisting high caries activity, multiple lesions, and limited cooperation, caries control should consist of robust measures with high success rates, even including extraction in selected cases. This applies especially to treatments performed under general anesthesia

Be Free? The European Union's post-Arab Spring Women's Empowerment as Neoliberal Governmentality

This article analyses post-Arab Spring EU initiatives to promote women's empowerment in the Southern Mediterranean region. Inspired by Foucauldian concepts of governmentality, it investigates empowerment as a technology of biopolitics that is central to the European neoliberal model of governance. In contrast to dominant images such as normative power Europe that present the EU as a norm-guided actor promoting political liberation, the article argues that the EU deploys a concept of functional freedom meant to facilitate its vision of economic development. As a consequence, the alleged empowerment of women based on the self-optimisation of individuals and the statistical control of the female population is a form of bio-power. In this regard, empowerment works as a governmental technology of power instead of offering a measure to foster fundamental structural change in Middle Eastern and North African (MENA) societies. The EU therefore fails in presenting and promoting an alternative normative political vision distinct from the incorporation of women into the hierarchy of the existing market society

Structure and Thermotropic Behavior of the Staphylococcus aureus Lipid Lysyl-Dipalmitoylphosphatidylglycerol

We have characterized the structural and thermotropic properties of one of the most important lipids in the cell membrane of Staphylococcus aureus, lysyl-dipalmitoylphosphatidylglycerol (lysyl-DPPG). applying differential scanning calorimetry and small- and wide-angle x-ray scattering. Microcalorimetry revealed that under physiological conditions (phosphate buffer, 20 mM NaPi, 130 mM NaCl, pH 7.4), the synthetic lysyl-DPPG resembles the features of the parent dipalmitoylphosphatidylglycerol (DPPG) with respect to its melting behavior. However, in contrast to DPPG, lowering the pH did not significantly affect the main transition temperature (∼40°C) of lysyl-DPPG, which can be explained by its difference in protonization because of the lysine group. X-ray experiments yielded the first information on chain packing and morphology of lysyl-DPPG. We found that lysyl-DPPG forms an interdigitated lamellar phase below the chain-melting transition. This can be explained by the large headgroup area of lysyl-DPPG as a result of its charged lysine group, especially if the headgroup is arranged parallel to the bilayer plane. Additionally, lysyl-DPPG degradation products, such as lysine and free fatty acids, had significant influences on the melting behavior and led to a multicomponent melting transition. Our results indicate that the degradation of lysyl-DPPG takes place mainly during the hydration process but also depends on lipid storage time, pH, and thermal treatment. Detailed temperature-resolved experiments at pH 5.0 demonstrated the formation of a lamellar gel phase with tilted hydrocarbon chains and a ripple phase, coexisting with the interdigitated lysyl-DPPG bilayers

Mechanism of the Lamellar/Inverse Hexagonal Phase Transition Examined by High Resolution X-Ray Diffraction

For the first time the electron density of the lamellar liquid crystalline as well as of the inverted hexagonal phase could be retrieved at the transition temperature. A reliable decomposition of the d-spacings into hydrophobic and hydrophilic structure elements could be performed owing to the presence of a sufficient number of reflections. While the hydrocarbon chain length, d(C), in the lamellar phase with a value of 14.5 Å lies within the extreme limits of the estimated chain length of the inverse hexagonal phase 10 Å < d(C) < 16 Å, the changes in the hydrophilic region vary strongly. During the lamellar-to-inverse hexagonal phase transition the area per lipid molecule reduces by ∼25%, and the number of water molecules per lipid increases from 14 to 18. On the basis of the analysis of the structural components of each phase, the interface between the coexisting mesophases between 66 and 84°C has been examined in detail, and a model for the formation of the first rods in the matrix of the lamellar phospholipid stack is discussed. Judging from the structural relations between the inverse hexagonal and the lamellar phase, we suggest a cooperative chain reaction of rod formation at the transition midpoint, which is mainly driven by minimizing the interstitial region

SParC-LES: Enabling large eddy simulations with parallel sparse matrix computation tools

We discuss the design and development of a parallel code for Large Eddy Simulation (LES) by exploiting libraries for sparse matrix computations. We formulate a numerical procedure for the LES of turbulent channel flows, based on an approximate projection method, in terms of linear algebra operators involving sparse matrices and vectors. Then we implement the procedure using general-purpose linear algebra libraries as building blocks. This approach allows to pursue goals such as modularity, accuracy and robustness, as well as easy and fast exploitation of parallelism, with a relatively low coding effort. The parallel LES code developed in this work, named SParC-LES (Sparse Parallel Computation-based LES), exploits two parallel libraries: PSBLAS, providing basic sparse matrix operators and Krylov solvers, and MLD2P4, providing a suite of algebraic multilevel Schwarz preconditioners. Numerical experiments, concerning the simulation by SParC-LES of a turbulent flow in a plane channel, confirm that the LES code can achieve a satisfactory parallel performance. This supports our opinion that the software design methodology used to build SParC-LES yields a very good tradeoff between the exploitation of the computational power of parallel computers and the amount of coding effort