Validation of a new method for building a three-dimensional physical model of the skull and dentition

We present a new method for replicating the skull and occlusal surface with an accurate physical model that could be used for planning orthognathic surgery. The investigation was made on 6 human skulls, and a polyvinyl splint was fabricated on the dental cast of the maxillary dentition in each case. A cone beam computed tomogram (CBCT) was taken of each skull and a three-dimensional replica produced. The distorted dentition (as a result of magnification errors and streak artefacts) was removed from the three-dimensional model and replaced by new plaster dentition that was fabricated using the polyvinyl splint and a transfer jig replication technique. To verify the accuracy of the method the human skulls and the three dimensional replica model, with the new plaster dentition in situ, were scanned using a laser scanner. The three-dimensional images produced were superimposed to identify the errors associated with the replacement of the distorted occlusal surface with the new plaster dentition. The overall mean error was 0.72 and SD was (0.26) mm. The accuracy of the method encouraged us to use it clinically in a case of pronounced facial asymmetry

The D/H Ratio in the Interstellar Medium toward the White Dwarf PG0038+199

We determine the D/H ratio in the interstellar medium toward the DO white dwarf PG0038+199 using spectra from the Far Ultraviolet Spectroscopic Explorer (FUSE), with ground-based support from Keck HIRES. We employ curve of growth, apparent optical depth and profile fitting techniques to measure column densities and limits of many other species (H2, NaI, CI, CII, CIII, NI, NII, OI, SiII, PII, SIII, ArI and FeII) which allow us to determine related ratios such as D/O, D/N and the H2 fraction. Our efforts are concentrated on measuring gas-phase D/H, which is key to understanding Galactic chemical evolution and comparing it to predictions from Big Bang nucleosynthesis. We find column densities log N(HI) = 20.41+-0.08, log N(DI)=15.75+-0.08 and log N(H2) = 19.33+-0.04, yielding a molecular hydrogen fraction of 0.14+-0.02 (2 sigma errors), with an excitation temperature of 143+-5K. The high HI column density implies that PG0038+199 lies outside of the Local Bubble; we estimate its distance to be 297 (+164,-104)pc (1 sigma). D/[HI+2H2] toward PG0038+199 is 1.91(+0.52,-0.42) e-5 (2 sigma). There is no evidence of component structure on the scale of Delta v > 8 km/s based on NaI, but there is marginal evidence for structure on smaller scales. The D/H value is high compared to the majority of recent D/H measurements, but consistent with the values for two other measurements at similar distances. D/O is in agreement with other distant measurements. The scatter in D/H values beyond ~100pc remains a challenge for Galactic chemical evolution.Comment: 59 pages, 7 tables, 18 figures (1 standalone), accepted by ApJ v2 minor typos correcte

Pain and analgesic use associated with skeletal-related events in patients with advanced cancer and bone metastases

PURPOSE: Bone metastases secondary to solid tumors increase the risk of skeletal-related events (SREs), including the occurrence of pathological fracture (PF), radiation to bone (RB), surgery to bone (SB), and spinal cord compression (SCC). The aim of this study was to evaluate the impact of SREs on patients' pain, analgesic use, and pain interference with daily functioning. METHODS: Data were combined from patients with solid tumors and bone metastases who received denosumab or zoledronic acid across three identically designed phase 3 trials (N = 5543). Pain severity (worst pain) and pain interference were assessed using the Brief Pain Inventory at baseline and each monthly visit. Analgesic use was quantified using the Analgesic Quantification Algorithm. RESULTS: The proportion of patients with moderate/severe pain and strong opioid use generally increased in the 6 months preceding an SRE and remained elevated, while they remained relatively consistent over time in patients without an SRE. Regression analysis indicated that all SRE types were significantly associated with an increased risk of progression to moderate/severe pain and strong opioid use. PF, RB, and SCC were associated with significantly greater risk of pain interference overall. Results were similar for pain interference with emotional well-being. All SRE types were associated with significantly greater risk of pain interference with physical function. CONCLUSIONS: SREs are associated with increased pain and analgesic use in patients with bone metastases. Treatments that prevent SREs may decrease pain and the need for opioid analgesics and reduce the impact of pain on daily functioning

Pain and analgesic use associated with skeletal-related events in patients with advanced cancer and bone metastases

PURPOSE: Bone metastases secondary to solid tumors increase the risk of skeletal-related events (SREs), including the occurrence of pathological fracture (PF), radiation to bone (RB), surgery to bone (SB), and spinal cord compression (SCC). The aim of this study was to evaluate the impact of SREs on patients' pain, analgesic use, and pain interference with daily functioning. METHODS: Data were combined from patients with solid tumors and bone metastases who received denosumab or zoledronic acid across three identically designed phase 3 trials (N = 5543). Pain severity (worst pain) and pain interference were assessed using the Brief Pain Inventory at baseline and each monthly visit. Analgesic use was quantified using the Analgesic Quantification Algorithm. RESULTS: The proportion of patients with moderate/severe pain and strong opioid use generally increased in the 6 months preceding an SRE and remained elevated, while they remained relatively consistent over time in patients without an SRE. Regression analysis indicated that all SRE types were significantly associated with an increased risk of progression to moderate/severe pain and strong opioid use. PF, RB, and SCC were associated with significantly greater risk of pain interference overall. Results were similar for pain interference with emotional well-being. All SRE types were associated with significantly greater risk of pain interference with physical function. CONCLUSIONS: SREs are associated with increased pain and analgesic use in patients with bone metastases. Treatments that prevent SREs may decrease pain and the need for opioid analgesics and reduce the impact of pain on daily functioning

Oxygen Gas Phase Abundance Revisited

We present new measurements of the interstellar gas-phase oxygen abundance along the sight lines towards 19 early-type galactic stars at an average distance of 2.6 kpc. We derive O {\small I} column densities from {\it HST}/STIS observations of the weak 1355 \AA intersystem transition. We derive total hydrogen column densities [N(H {\small I})+2N(H$_2$)] using {\it HST}/STIS observations of \lya and {\it FUSE} observations of molecular hydrogen. The molecular hydrogen content of these sight lines ranges from f(H$_2$) = 2N(H$_2$)/[N(H {\small I})+2N(H$_2$)] = 0.03 to 0.47. The average $$ of 6.3$\times10^{21}$ cm$^{-2}$ mag$^{-1}$ with a standard deviation of 15% is consistent with previous surveys. The mean oxygen abundance along these sight lines, which probe a wide range of galactic environments in the distant ISM, is 10$^6$ \oh = $408 \pm 13$ (1 $\sigma$ in the mean). %$({\rm O/H})_{gas} = 408 \pm 14$(1 $\sigma$). We see no evidence for decreasing gas-phase oxygen abundance with increasing molecular hydrogen fraction and the relative constancy of \oh suggests that the component of dust containing the oxygen is not readily destroyed. We estimate that, if 60% of the dust grains are resilient against destruction by shocks, the distant interstellar total oxygen abundance can be reconciliated with the solar value derived from the most recent measurements %by Holweger and by Allende Prieto, Lambert & Asplund: of 10$^6$ \oh$_\odot$ = 517 $\pm$ 58 (1 $\sigma$). We note that the smaller oxygen abundances derived for the interstellar gas within 500 pc %by Meyer, Cardelli & Jura or from nearby B star surveys are consistent with a local elemental deficit.Comment: 9 figures, 37 page

Just a beta....

Traditional implementation of clinical information systems follows a predictable project management process'. The selection, development, implementation, and evaluation of the system and the project management aspects of those phases require considerable time and effort. The purpose of this paper is to describe the beta site implementation of a knowledge-based clinical information system in a specialty area of a southeastern hospital that followed a less than traditional approach to implementation. Highlighted are brief descriptions of the hospital's traditional process, the nontraditional process, and key findings from the experience. Preliminary analysis suggests that selection of an implementation process is contextual. Selection of elements from each of these methods may provide a more useful process. The non-traditional process approached the elements of communication, areas of responsibility, training, follow-up and leadership differently. These elements are common to both processes and provide a focal point for future research

Distribution and Kinematics of O VI in the Galactic Halo

FUSE spectra of 100 extragalactic objects are analyzed to obtain measures of O VI absorption along paths through the Milky Way thick disk/halo. Strong O VI absorption over the approximate velocity range from -100 to 100 km/s reveals a widespread but highly irregular distribution of thick disk O VI, implying the existence of substantial amounts of hot gas with T ~ 3x10^5 K in the Milky Way halo. Large irregularities in the distribution of the absorbing gas are found to be similar over angular scales extending from less than one to 180 degrees, indicating a considerable amount of small and large scale structure in the gas. The overall distribution of Galactic O VI is not well described by a symmetrical plane-parallel layer of patchy O VI absorption. The simplest departure from such a model that provides a reasonable fit to the observations is a plane-parallel patchy absorbing layer with a scale height of 2.3 kpc, and a 0.25 dex excess of O VI in the northern Galactic polar region. The O VI absorption has a Doppler parameter b = 30 to 99 km/s, with an average value of 60 km/s . Thermal broadening alone cannot explain the large observed profile widths. The average O VI absorption velocities toward high latitude objects range from -46 to 82 km/s, with a sample average of 0 km/s and a standard deviation of 21 km/s. O VI associated with the thick disk moves both toward and away from the plane with roughly equal frequency. A combination of models involving the radiative cooling of hot fountain gas, the cooling of supernova bubbles in the halo, and the turbulent mixing of warm and hot halo gases is required to explain the presence of O VI and other highly ionized atoms found in the halo. (abbreviated)Comment: 70 pages, single-spaced, PDF format. Bound copies of this manuscript and two accompanying articles are available upon request. Submitted to ApJ

Far-ultraviolet Spectroscopy of Venus and Mars at 4 A Resolution with the Hopkins Ultraviolet Telescope on Astro-2

Far-ultraviolet spectra of Venus and Mars in the range 820-1840 A at 4 A resolution were obtained on 13 and 12 March 1995, respectively, by the Hopkins Ultraviolet Telescope (HUT), which was part of the Astro-2 observatory on the Space Shuttle Endeavour. Longward of 1250 A, the spectra of both planets are dominated by emission of the CO Fourth Positive band system and strong OI and CI multiplets. In addition, CO Hopfield-Birge bands, B - X (0,0) at 1151 A and C - X (0,0) at 1088 A, are detected for the first time, and there is a weak indication of the E - X (0,0) band at 1076 A in the spectrum of Venus. The B - X band is blended with emission from OI 1152. Modeling the relative intensities of these bands suggests that resonance fluorescence of CO is the dominant source of the emission, as it is for the Fourth Positive system. Shortward of Lyman-alpha, other emission features detected include OII 834, OI lambda 989, HI Lyman-beta, and NI 1134 and 1200. For Venus, the derived disk brightnesses of the OI, OII, and HI features are about one-half of those reported by Hord et al. (1991) from Galileo EUV measurements made in February 1990. This result is consistent with the expected variation from solar maximum to solar minimum. The ArI 1048, 1066 doublet is detected only in the spectrum of Mars and the derived mixing ratio of Ar is of the order of 2%, consistent with previous determinations.Comment: 8 pages, 5 figures, accepted for publication in ApJ, July 20, 200

Pain outcomes in patients with bone metastases from advanced cancer: assessment and management with bone-targeting agents

Bone metastases in advanced cancer frequently cause painful complications that impair patient physical activity and negatively affect quality of life. Pain is often underreported and poorly managed in these patients. The most commonly used pain assessment instruments are visual analogue scales, a single-item measure, and the Brief Pain Inventory Questionnaire-Short Form. The World Health Organization analgesic ladder and the Analgesic Quantification Algorithm are used to evaluate analgesic use. Bone-targeting agents, such as denosumab or bisphosphonates, prevent skeletal complications (i.e., radiation to bone, pathologic fractures, surgery to bone, and spinal cord compression) and can also improve pain outcomes in patients with metastatic bone disease. We have reviewed pain outcomes and analgesic use and reported pain data from an integrated analysis of randomized controlled studies of denosumab versus the bisphosphonate zoledronic acid (ZA) in patients with bone metastases from advanced solid tumors. Intravenous bisphosphonates improved pain outcomes in patients with bone metastases from solid tumors. Compared with ZA, denosumab further prevented pain worsening and delayed the need for treatment with strong opioids. In patients with no or mild pain at baseline, denosumab reduced the risk of increasing pain severity and delayed pain worsening along with the time to increased pain interference compared with ZA, suggesting that use of denosumab (with appropriate calcium and vitamin D supplementation) before patients develop bone pain may improve outcomes. These data also support the use of validated pain assessments to optimize treatment and reduce the burden of pain associated with metastatic bone disease