Outcome measures of the surgery first approach for orthognathic correction of dentofacial deformities

Background: In the surgery-first approach (SFA) the orthognathic surgery is performed without the need for presurgical orthodontic treatment. Aim: This study was aimed at assessing the treatment durations and occlusal outcomes for a consecutive cohort of patients, with a range of dentofacial deformities, who have completed orthognathic treatment using the SFA. Methodology: The duration of orthognathic treatment was measured. The overall change in occlusion, and the quality of the final occlusion, were evaluated using the patients’ study casts. A single independent, calibrated, operator carried out the occlusal scores, using the validated Peer Assessment Rating (PAR) index. This was repeated to test intra-operator reliability. Results: A total of 51 patients completed surgery-first treatment during the study period. The mean age at surgery was 23.3 years. The pre-treatment skeletal jaw relationship was Class III in 39 cases, and Class II in 12 cases. The mean overall treatment duration was 11.7 months (SD = 5.7). The intra-examiner reliability of assessing the occlusion was high. The PAR scores confirmed a significant improvement in the quality of occlusion at the completion of treatment, which compares favourably with previous studies on the conventional orthodontics-first approach. Conclusion: The SFA can be effective at correcting both Class 2 and Class 3 malocclusion types with reduced treatment times

Improvement in facial aesthetics of orthognathic patients after surgery-first approach

Background: Facial appearance significantly affects psychosocial well-being, and improvement in facial aesthetics is considered an essential outcome of orthognathic treatment. The surgery-first approach (SFA) has emerged as a promising alternative to the conventional orthodontics-first approach (OFA), due to its potential advantages in reducing treatment duration and cost, delivering early aesthetic improvement, and increasing patient satisfaction. However, the impact of the SFA on final facial aesthetics, and how it compares with the OFA, has not yet been investigated. Method: This retrospective study aimed to compare the improvement in facial aesthetics after orthognathic surgery, in an SFA and an OFA group. Pre- and postoperative three-dimensional stereophotogrammetry facial images for 40 patients were evaluated by five professional assessors using the Global Aesthetic Improvement Scale (GAIS). Results: Similar aesthetic improvement outcomes were found for both the SFA and OFA groups. The GAIS score was significantly correlated with the following facial variables: upper lip projection, chin prominence, facial proportions, para-nasal hollowing, lip competence, mandibular projection, and facial profile. No significant correlation was found between the change in aesthetic score and the surgical variables. There was a positive association between the overall GAIS score and the gender and experience level of the individual assessors. Conclusion: This study suggests that the facial aesthetic improvement achieved with the SFA is satisfactory and comparable to that of the OFA

Mixed-Method Evaluation of a Community Pharmacy Antimicrobial Stewardship Intervention (PAMSI)

The community pharmacy antimicrobial stewardship intervention (PAMSI) is multi-faceted and underpinned by behavioural science, consisting of the TARGET Antibiotic Checklist, staff e-Learning, and patient-facing materials. This mixed-method study evaluated the effect of PAMSI on community pharmacy staffs' self-reported antimicrobial stewardship (AMS) behaviours. Data collection included staff pre- and post-intervention questionnaires, qualitative interviews, and TARGET Antibiotic Checklists. Quantitative data were analysed by a multivariate ordinal linear mixed effect model; qualitative data were analysed thematically. A total of 101 staff participated from 66 pharmacies, and six completed semi-structured interviews. The statistical model indicated very strong evidence ( < 0.001) that post-intervention, staff increased their antibiotic appropriateness checks and patient advice, covering antibiotic adherence, antibiotic resistance, infection self-care, and safety-netting. Staff reported feeling empowered to query antibiotic appropriateness with prescribing clinicians. The TARGET Antibiotic Checklist was completed with 2043 patients. Topics patients identified as requiring advice from the pharmacy team included symptom duration, alcohol and food consumption guidance, antibiotic side-effects, and returning unused antibiotics to pharmacies. Pharmacy staff acknowledged the need for improved communication across the primary care pathway to optimise antimicrobial use, and PAMSI has potential to support this ambition if implemented nationally. To support patients not attending a pharmacy in person, an online information tool will be developed

Addressing climate change with behavioral science: a global intervention tournament in 63 countries

Effectively reducing climate change requires marked, global behavior change. However, it is unclear which strategies are most likely to motivate people to change their climate beliefs and behaviors. Here, we tested 11 expert-crowdsourced interventions on four climate mitigation outcomes: beliefs, policy support, information sharing intention, and an effortful tree-planting behavioral task. Across 59,440 participants from 63 countries, the interventions’ effectiveness was small, largely limited to nonclimate skeptics, and differed across outcomes: Beliefs were strengthened mostly by decreasing psychological distance (by 2.3%), policy support by writing a letter to a future-generation member (2.6%), information sharing by negative emotion induction (12.1%), and no intervention increased the more effortful behavior—several interventions even reduced tree planting. Last, the effects of each intervention differed depending on people’s initial climate beliefs. These findings suggest that the impact of behavioral climate interventions varies across audiences and target behaviors

Constraining the rp-process by measuring 23

The 23Al(p, γ)24Si stellar reaction rate has a significant impact on the light-curve emitted in X-ray bursts. Theoretical calculations show that the reaction rate is mainly determined by the properties of direct capture as well as low-lying 2+ states and a possible 4+ state in 24Si. Currently, there is little experimental information on the properties of these states. In this proceeding we will present a new experimental study to investigate this reaction, using the surrogate reaction 23Al(d,n) at 47 AMeV at the National Superconducting Cyclotron Laboratory (NSCL). We will discuss our new experimental setup which allows us to use full kinematics employing the Gamma-Ray Energy Tracking In-beam Nuclear Array (GRETINA) to detect the γ-rays following the de-excitation of excited states of the reaction products and the Low Energy Neutron Detector Array (LENDA) to detect the recoiling neutrons. The S800 was used for identification of the 24Si recoils. As a proof of principle to show the feasibility of this concept the Q-value spectrum of 22Mg(d,n)23Al is reconstructed

Study of ordered hadron chains with the ATLAS detector

La lista completa de autores que integran el documento puede consultarse en el archivo

Altimetry for the future: Building on 25 years of progress

In 2018 we celebrated 25 years of development of radar altimetry, and the progress achieved by this methodology in the fields of global and coastal oceanography, hydrology, geodesy and cryospheric sciences. Many symbolic major events have celebrated these developments, e.g., in Venice, Italy, the 15th (2006) and 20th (2012) years of progress and more recently, in 2018, in Ponta Delgada, Portugal, 25 Years of Progress in Radar Altimetry. On this latter occasion it was decided to collect contributions of scientists, engineers and managers involved in the worldwide altimetry community to depict the state of altimetry and propose recommendations for the altimetry of the future. This paper summarizes contributions and recommendations that were collected and provides guidance for future mission design, research activities, and sustainable operational radar altimetry data exploitation. Recommendations provided are fundamental for optimizing further scientific and operational advances of oceanographic observations by altimetry, including requirements for spatial and temporal resolution of altimetric measurements, their accuracy and continuity. There are also new challenges and new openings mentioned in the paper that are particularly crucial for observations at higher latitudes, for coastal oceanography, for cryospheric studies and for hydrology. The paper starts with a general introduction followed by a section on Earth System Science including Ocean Dynamics, Sea Level, the Coastal Ocean, Hydrology, the Cryosphere and Polar Oceans and the ‘‘Green” Ocean, extending the frontier from biogeochemistry to marine ecology. Applications are described in a subsequent section, which covers Operational Oceanography, Weather, Hurricane Wave and Wind Forecasting, Climate projection. Instruments’ development and satellite missions’ evolutions are described in a fourth section. A fifth section covers the key observations that altimeters provide and their potential complements, from other Earth observation measurements to in situ data. Section 6 identifies the data and methods and provides some accuracy and resolution requirements for the wet tropospheric correction, the orbit and other geodetic requirements, the Mean Sea Surface, Geoid and Mean Dynamic Topography, Calibration and Validation, data accuracy, data access and handling (including the DUACS system). Section 7 brings a transversal view on scales, integration, artificial intelligence, and capacity building (education and training). Section 8 reviews the programmatic issues followed by a conclusion

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020