Dental health status of Hong Kong preschool children

Objectives. To describe the dental health status of preschool children in Hong Kong, and to investigate the e!ects of selected socio-demographic factors and oral health–related behaviors on the dental health of the children. Methods. The study population was Chinese preschool children. The sampling frame was kindergartens with an enrolment of 70 children or more, located on Hong Kong Island. Through strati'ed random sampling, 12 kindergartens were selected. All children attending grades 1 and 2 in the kindergartens were invited. Children with parental consent were clinically examined in the kindergartens in March 2007 by one of two calibrated examiners using a disposable mouth-mirror attached to an intraoral LED light and a ball-ended probe. Diagnostic criteria for dental caries followed those recommended by the World Health Organization. A questionnaire on the child’s socio-demographic background and oral health–related behaviors was completed by the parents. Results. A total of 1513 children were invited and 1343 (89%) were examined. Their mean (standard deviation) age was 3.9 (0.7) years and 51% were boys. Around one third (35%) of the children had experienced dental caries. The mean decayed, missing or 'lled teeth (dmft) score was 1.5, increasing from 1.2 at age 3 to 2.0 at age 5 (analysis of variance, P=0.016). Active decay (dt) accounted for 90% of the dmft score. Higher dmft scores were found in children who were born in Mainland China or came from lower socio-economic classes. Children who had poorer dietary or toothbrushing habits also had more dental caries. Conclusion. Prevalence of dental caries among the Hong Kong preschool children was not high but the severity of caries varied with the children’s socio-demographic background, and their dietary and toothbrushing habits.published_or_final_versio

On the color stability of phosphor-converted white LEDs under DC, PWM, and bilevel drive

Most commercial white LEDs are made from nitride-based blue LEDs coated with yttrium aluminium garnet phosphor, which produce spectra that shift in opposite directions under the influences of drive current and junction temperature changes. This property gives rise to different emitted spectra, hence chromaticity properties, when the LED is driven/dimmed by different current waveforms. By using a commercial white LED sample, LUXEON K2, the effects of drive current and junction temperature on the changes of chromaticity coordinates are studied experimentally. The impact of dc, pulse width modulation (PWM), and bilevel current waveform is discussed through a graphical analysis, followed by experimental verification. It is proven that dc offers the best color stability over dimming due to the counteracting influences of drive current and junction temperature variations, whereas an LED constantly suffers from noneliminable chromaticity changes when driven by the PWM. Theoretical explanations are given to justify these cases, and it is found that, for the case of dc drive, an ideal heat sinks thermal resistance can be selected based on a simple equation to minimize the overall chromaticity change over dimming. This paper provides an in-depth discussion on the relations between the chromaticity properties of phosphor-converted (pc) white LEDs and the driving/dimming methods used. © 2011 IEEE.published_or_final_versio

Stationary and adaptive color-shift reduction methods based on the bilevel driving technique for phosphor-converted white LEDs

The bilevel driving technique has realized a 2-D control of the luminosity and emitted color of white LEDs with duty cycle and forward current levels. Unfortunately, various combinations of these dimming control parameters can lead to significant changes in junction temperature, which further modify the luminosity and emitted color of LEDs. In this paper, the theoretical aspects of these complex interactions and the impact of bilevel drive on the color-shift properties of white LEDs are discussed in detail by using a mathematical color-shift model. Two color-shift reduction methods are proposed based on the insights obtained from this model. This study shows that a heat sinks thermal resistance that minimizes the overall color shift over dimming can be uniquely determined from the knowledge of some measurable LED parameters, and gives rise to a global minimum color shift. If such a thermal resistance cannot be realized due to practical limitations, the second method that utilizes an adaptive change of forward current levels over dimming can be adopted. Based on their nature, these methods are classified as stationary and adaptive methods, respectively. Their validity is supported by experimental measurements on a commercial white LED. © 2011 IEEE.published_or_final_versio

A comparison of computerized versus pen-and-paper cognitive tests for monitoring electroconvulsive therapy-related cognitive side effects

Objective Cognitive side effects are a common unintended outcome of electroconvulsive therapy (ECT). Routine cognitive assessment is important for monitoring patient outcomes, although it can pose challenges in busy clinical settings. Computerized cognitive testing has advantages that can facilitate routine monitoring. This study explored the construct and criterion validity of computerized cognitive testing compared with standard pen-and-paper tests for monitoring cognition in ECT patients. Methods The study included 24 participants with major depression who received an acute course of ECT. Cognition was assessed at pretreatment and at posttreatment with 3 computerized tests from the CogState battery (International Shopping List task, One-Card Learning, and One-Back Task) and 3 conceptually matched pen-and-paper-administered neuropsychological tests. Results At pretreatment, only performance on the computer-administered test of verbal anterograde memory (International Shopping List task) was significantly correlated with the analogous pen-and-paper measure, whereas the other computerized tests were not. Of the computerized measures, only the International Shopping List task showed significant changes from pretreatment to posttreatment (P 1.0). In contrast, all the pen-and-paper-administered tests showed significant changes from pretreatment to posttreatment (P < 0.01, Cohen d range, 0.8-1.2). Pretreatment to posttreatment cognitive changes on the computerized measures were not correlated with changes on the pen-and-paper-administered tests. Conclusion Construct and criterion validity and tolerability varied between the computerized measures. The results highlighted potentially important issues related to the interpretation and utility of computerized tests in this patient population

Transcranial Direct Current Stimulation Modulates Working Memory Maintenance Processes in Healthy Individuals

The effects of transcranial direct current stimulation (tDCS) at the pFC are often investigated using cognitive paradigms, particularly working memory tasks. However, the neural basis for the neuromodulatory cognitive effects of tDCS, including whi ch subprocesses are af f ected by sti mul ati on, i s not completely understood. We investigated the effects of tDCS on working memory task-related spectral activity during and after tDCS to gain better insights into the neurophysiological changes associated with stimulation. We reanalyzed data from 100 healthy participants grouped by allocation to receive either sham (0 mA, 0.016 mA, and 0.034 mA) or active (1 mA or 2 mA) stimulation during a 3-back task. EEG data were used to analyze event-related spectral power in frequency bands associated with working memory performance. Frontal theta event-related synchronization (ERS) was significantly reduced post-tDCS in the active group. Participants receiving active tDCS had slower RTs following tDCS compared with sham, suggesting interference with practice effects associated with task repetition. Theta ERS was not significantly correlated with RTs or accuracy. tDCS reduced frontal theta ERS poststimulation, suggesting a selective disruption to working memory cognitive control and maintenance processes. These findings suggest that tDCS selectively affects specific subprocesses during working memory, which may explain heterogenous behavioral effects

Association between neighbourhood walkability and metabolic risk factors influenced by physical activity: a cross-sectional study of adults in Toronto, Canada.

OBJECTIVE: To determine whether neighbourhood walkability is associated with clinical measures of obesity, hypertension, diabetes and dyslipidaemia in an urban adult population. DESIGN: Observational cross-sectional study. SETTING: Urban primary care patients. PARTICIPANTS: 78 023 Toronto residents, aged 18 years and over, who were formally rostered or had at least 2 visits between 2012 and 2014 with a primary care physician participating in the University of Toronto Practice Based Research Network (UTOPIAN), within the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). MAIN OUTCOME MEASURES: Differences in average body mass index (BMI), systolic and diastolic blood pressure, fasting blood glucose, haemoglobin A1c (HbA1C), total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein and triglyceride between residents in the highest versus the lowest quartile of neighbourhood walkability, as estimated using multivariable linear regression models and stratified by age. Outcomes were objectively measured and were retrieved from primary care electronic medical records. Models adjusted for age, sex, smoking, medications, medical comorbidities and indices of neighbourhood safety and marginalisation. RESULTS: Compared with those in the lowest walkability quartile, individuals in the highest quartile had lower mean BMI (-2.64 kg/m2, 95% CI -2.98 to -2.30; p<0.001), systolic blood pressure (-1.35 mm Hg, 95% CI -2.01 to -0.70; p<0.001), diastolic blood pressure (-0.60 mm Hg, 95% CI 1.06 to -0.14; p=0.010) and HbA1c (-0.063%, 95% CI -0.11 to -0.021; p=0.003) and higher mean HDL (0.052 mmol/L, 95% CI 0.029 to 0.075; p<0.001). In age-stratified analyses, differences in the mean BMI were consistently observed for adults aged 18 to under 40 (-4.44 kg/m2, 95% CI -5.09 to -3.79; p<0.001), adults aged 40-65 (-2.74 kg/m2, 95% CI -3.24 to -2.23; p<0.001) and adults aged over 65 (-0.87 kg/m2, 95% CI -1.48 to -0.26; p=0.005). CONCLUSIONS: There was a clinically meaningful association between living in the most walkable neighbourhoods and having lower BMI in adults of all ages

Pharmacological treatment approaches to difficult-to-treat depression

In the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial of almost 3000 patients with depression in the United States, 50% responded to the initial trial of a selective serotonin reuptake inhibitor antidepressant, but only a third achieved remission (nil or minimal depressive symptoms). The final remission rate, even after four potential treatment steps, was only 70%. This finding reflects the reality of clinical practice and highlights the need to employ the best available evidence in the management of people with complex depression. Before adopting a pharmacological strategy for a patient with difficult-to-treat depression, general clinical issues (such as missed psychiatric diagnoses, unresolved psychological issues and treatment non-adherence) should be considered. While there is no strong evidence for the order of implementing evidence-based pharmacological strategies for difficult-to-treat depression, we recommend: i) increase antidepressant dose; ii) switch to different antidepressant; iii) augment with a non-antidepressant agent; and iv) combine antidepressants. Sometimes it may be more appropriate to consider augmentation before switching antidepressants. The use of psychological interventions or other physical treatments such as electroconvulsive therapy should be considered at each step in management

The left anterior right temporal (LART) placement for electroconvulsive therapy: A computational modelling study

Electrode placement in electroconvulsive therapy (ECT) has a major impact on treatment efficacy and cognitive side effects. Left Anterior Right Temporal (LART) is a lesser utilised bilateral montage which may produce more optimal clinical outcomes relative to standard bitemporal ECT. In this study we used computational modelling to explore how stimulation effects from LART and two novel variants (LART – F3 and LART – Frontal) compared to the more common bilateral placements of bitemporal and bifrontal ECT. High resolution finite element human head models were generated from MRI scans of three subjects with Major Depressive Disorder. Differences in regional stimulation were examined through parametric tests for regions of interest and subtraction maps. Compared to bitemporal ECT, LART – Original resulted in significantly greater stimulation of the left cingulate gyrus (hypothesised to be associated with treatment efficacy), and relatively reduced stimulation of the bilateral hippocampi (potentially associated with cognitive side effects). No additional clinical benefit was suggested with the novel LART placements compared to the original LART. The original LART placement is a promising montage for further clinical investigation

A novel approach for targeting the left dorsolateral prefrontal cortex for transcranial magnetic stimulation using a cognitive task

Repetitive transcranial magnetic stimulation (rTMS) has the potential to be developed as a novel treatment for cognitive dysfunction. However, current methods of targeting rTMS for cognition fail to consider inter-individual functional variability. This study explored the use of a cognitive task to individualise the target site for rTMS administered to the left dorsolateral prefrontal cortex (L-DLPFC). Twenty-five healthy participants were enrolled in a sham-controlled, crossover study. Participants performed a random letter generation task under the following conditions: no stimulation, sham and active ‘online’ rTMS applied to F3 (International 10–20 System) and four standardised surrounding sites. Across all sites combined, active ‘online’ rTMS was associated with significantly reduced performance compared to sham rTMS for unique trigrams (p = 0.012), but not for unique digrams (p > 0.05). Using a novel localisation methodology based on performance outcomes from both measures, a single optimal individualised site was identified for 92% [n = 23] of participants. At the individualised site, performance was significantly poorer compared to a common standard site (F3) and both control conditions (ps < 0.01). The current results suggest that this localisation methodology using a cognitive task could be used to individualise the rTMS target site at the L-DLPFC for modulating and potentially enhancing cognitive functioning