Influence of Preparation Design and Restorative Material on Fatigue and Fracture Strength of Restored Maxillary Premolars

Statement of Problem: Extensive carious lesions and/or large preexisting restorations possibly contribute to crack formation, ultimately resulting in a fracture that may lead to the loss of a tooth cusp. Hence, preparation design strategy in conjunction with the restorative material selected could be influential in the occurrence of a cuspal fracture. Purpose: The purpose of this in vitro study was to evaluate the fatigue behavior and fracture strength of maxillary premolars restored with direct composite and indirect ceramic inlays and overlays, with different preparation depths in the presence or absence of cuspal coverage, and analyze their failure types. Methods and Materials: Sound maxillary premolars (N=90; n=10) were divided into nine groups: group C: control; group DCI3: direct composite inlay 3 mm; group DCI5: direct composite inlay 5 mm; group ICI3: indirect ceramic inlay 3 mm; group ICI5: indirect ceramic inlay 5 mm; group DCO3: direct composite overlay 3 mm; group DCO5: direct composite overlay 5 mm; group ICO3: indirect ceramic overlay 3 mm; group ICO5: indirect ceramic overlay 5 mm. In indirect ceramic, lithium disilicate restoration groups, immediate dentin sealing was applied. After restoration, all specimens were tested in fatigue (1,200,000 cycles, 50 N, 1.7 Hz). Samples were critically appraised, and the specimens without failure were subjected to a load to failure test. Failure types were classified and the data analyzed. Results: Zero failures were observed in the fatigue testing. The following mean load to failure strengths (N) were recorded: group ICO5: 858 N; group DCI3: 829 N; group ICO3: 816 N; group C: 804 N; group ICI3: 681 N; group DCO5: 635 N; group DCI5: 528 N; group DCO3: 507 N; group ICI5: 482 N. Zero interaction was found between design-depth-material (p=0.468). However, significant interactions were found for the design-depth (p=0.012) and design-material (p=0.006). Within restorations at preparation depth of 3 mm, direct composite overlays obtained a significantly lower fracture strength in comparison to indirect ceramic onlays (p=0.013) and direct composite inlays (p=0.028). In restorations at depth 5 mm, significantly higher fracture load values were observed in indirect ceramic overlays compared with the inlays (p=0.018). Indirect ceramic overlays on 3 mm were significantly stronger than the deep inlays in ceramic (p=0.002) and tended to be stronger than the deep direct composite inlays. Severe, nonreparable fractures were observed with preparation depth of 5 mm within ceramic groups. Conclusions: The preparation depth significantly affected the fracture strength of tooth when restored with either composite or ceramic materials. Upon deep cavity preparations, cuspal coverage proved to be beneficial when a glass ceramic was used as the restorative material. Upon shallow cavity preparations, a minimally invasive approach regarding preparation design used in conjunction with a direct composite material was favorable

The Healthy Primary School of the Future:study protocol of a quasi-experimental study

Background: Unhealthy lifestyles in early childhood are a major global health challenge. These lifestyles often persist from generation to generation and contribute to a vicious cycle of health-related and social problems. This design article presents a study evaluating the effects of two novel healthy school interventions. The main outcome measure will be changes in children's body mass index (BMI). In addition, lifestyle behaviours, academic achievement, child well-being, socio-economic differences, and societal costs will be examined. Methods: In close collaboration with various stakeholders, a quasi-experimental study was developed, for which children of four intervention schools (n = 1200) in the southern part of the Netherlands are compared with children of four control schools (n = 1200) in the same region. The interventions started in November 2015. In two of the four intervention schools, a whole-school approach named 'The Healthy Primary School of the Future', is implemented with the aim of improving physical activity and dietary behaviour. For this intervention, pupils are offered an extended curriculum, including a healthy lunch, more physical exercises, and social and educational activities, next to the regular school curriculum. In the two other intervention schools, a physical-activity school approach called 'The Physical Activity School', is implemented, which is essentially similar to the other intervention, except that no lunch is provided. The interventions proceed during a period of 4 years. Apart from the effectiveness of both interventions, the process, the cost-effectiveness, and the expected legal implications are studied. Data collection is conducted within the school system. The baseline measurements started in September 2015 and yearly follow-up measurements are taking place until 2019. Discussion: A whole-school approach is a new concept in the Netherlands. Due to its innovative, multifaceted nature and sound scientific foundation, these integrated programmes have the potential to form a template for primary schools worldwide. The effects of this approach may extend further than the outcomes associated with well-being and academic achievement, potentially impacting legal and cultural aspects in our society. Trial registration: The study protocol was registered in the database ClinicalTrials.gov on 14-06-2016 with the reference number NCT02800616

Addressing risk factors for child abuse among high risk pregnant women: design of a randomised controlled trial of the nurse family partnership in Dutch preventive health care

<p>Abstract</p> <p>Background</p> <p>Low socio-economic status combined with other risk factors affects a person's physical and psychosocial health from childhood to adulthood. The societal impact of these problems is huge, and the consequences carry on into the next generation(s). Although several studies show these consequences, only a few actually intervene on these issues. In the United States, the Nurse Family Partnership focuses on high risk pregnant women and their children. The main goal of this program is primary prevention of child abuse. The Netherlands is the first country outside the United States allowed to translate and culturally adapt the Nurse Family Partnership into VoorZorg. The aim of the present study is to assess whether VoorZorg is as effective in the Netherland as in the United States.</p> <p>Methods</p> <p>The study consists of three partly overlapping phases. Phase 1 was the translation and cultural adaptation of Nurse Family Partnership and the design of a two-stage selection procedure. Phase 2 was a pilot study to examine the conditions for implementation. Phase 3 is the randomized controlled trial of VoorZorg compared to the care as usual. Primary outcome measures were smoking cessation during pregnancy and after birth, birth outcomes, child development, child abuse and domestic violence. The secondary outcome measure was the number of risk factors present.</p> <p>Discussion</p> <p>This study shows that the Nurse Family Partnership was successfully translated and culturally adapted into the Dutch health care system and that this program fulfills the needs of high-risk pregnant women. We hypothesize that this program will be effective in addressing risk factors that operate during pregnancy and childhood and compromise fetal and child development.</p> <p>Trial registration</p> <p>Current Controlled Trials <a href="http://www.controlled-trials.com/ISRCTN16131117">ISRCTN16131117</a></p

Language use in kindergarten science lessons:Language production and academic language during a video feedback coaching intervention in kindergarten science lessons

This paper aims to gain insight into language production and academic language of 4- and 5-year-old students and their teachers in the course of a teacher intervention during kindergarten science education. The study is based on videotaped classroom observations, and specifically focuses on the academic language use of students (Nintervention = 18, Ncontrols = 26) and teachers (Nintervention = 5, Ncontrols = 5). The results suggest that this general teacher intervention yields interesting changes in language use and production. Patterns of change over time confirm the idiosyncratic and non-linear nature of these changes. Science lessons represent an appropriate context in which to acquaint students with academic language, which can be used as a basis to build upon more sophisticated language skills

Progression From Paroxysmal to Persistent Atrial Fibrillation. Clinical Correlates and Prognosis

Objectives: We investigated clinical correlates of atrial fibrillation (AF) progression and evaluated the prognosis of patients demonstrating AF progression in a large population. Background: Progression of paroxysmal AF to more sustained forms is frequently seen. However, not all patients will progress to persistent AF. Methods: We included 1,219 patients with paroxysmal AF who participated in the Euro Heart Survey on AF and had a known rhythm status at follow-up. Patients who experienced AF progression after 1 year of follow-up were identified. Results: Progression of AF occurred in 178 (15%) patients. Multivariate analysis showed that heart failure, age, previous transient ischemic attack or stroke, chronic obstructive pulmonary disease, and hypertension were the only independent predictors of AF progression. Using the regression coefficient as a benchmark, we calculated the HATCH score. Nearly 50% of the patients with a HATCH score &gt;5 progressed to persistent AF compared with only 6% of the patients with a HATCH score of 0. During follow-up, patients with AF progression were more often admitted to the hospital and had more major adverse cardiovascular events. Conclusions: A substantial number of patients progress to sustained AF within 1 year. The clinical outcome of these patients regarding hospital admissions and major adverse cardiovascular events was worse compared with patients demonstrating no AF progression. Factors known to cause atrial structural remodeling (age and underlying heart disease) were independent predictors of AF progression. The HATCH score may help to identify patients who are likely to progress to sustained forms of AF in the near future. \ua9 2010 American College of Cardiology Foundation

Up to 12 years clinical evaluation of 197 partial indirect restorations with deep margin elevation in the posterior region

Objectives: Deep margin elevation (DME) relocates the cervical outline of large-sized cavity dimensions in the posterior area supragingivally, using a resin composite in a direct technique. The aim of this study is to evaluate the clinical performance of partial indirect restorations with DME and compare the effects of selected baseline variables on the (quality of) survival of the restorations. Methods: All teeth that were restored in combination with indirect restorations and DME between 2007 and 2016 were eligible for inclusion. Overall cumulative survival rates were calculated (Kaplan–Meier estimates) and compared among subsets of variables. Qualitative evaluation of all surviving restorations was performed using the modified United States Public Health Service (USPHS) criteria using Chi-square tests. Results: A total of 197 indirect restorations in 120 patients could be included. Restorations or teeth presenting with secondary caries, fracture of the restoration/tooth, debonding of the indirect restoration, root caries, severe periodontal breakdown or pulpal necrosis were considered as absolute failures (n = 8) leading to an overall cumulative survival rate of 95.9% (SE 2.9%) up to 12 years, with an average evaluation time of 57.7 months. Some indication of degradation of the restorations was seen over time. Indirect composite restorations showed more degradation compared to ceramic restorations (p = 0.000). More wear of the antagonist was observed when teeth were opposed to ceramic restorations (p = 0.04). Endodontic treatment negatively impacted the occurrence of fracture of restorations and teeth (p = 0.000). Conclusions: Indirect restorations with DME have a good survival rate in this study, however longer follow-up is needed as degradation of the restorations is seen over time. Clinical significance: This long-term study shows the possible clinical applicability of deep margin elevation

Up to 12 years clinical evaluation of 197 partial indirect restorations with deep margin elevation in the posterior region:up to 12 years evaluation

A Matemática é uma das disciplinas que mais apresenta dificuldades durante os anos escolares. Tais dificuldades podem ser evidenciadas na resolução de problemas matemáticos ligados ao estudo de equações. A aplicação sistemática de regras padronizadas de resolução de equações como único método de ensino torna-se limitante no processo de aprendizagem. Visando melhorar o ensino da Matemática, a visualização gráfica de equações de primeiro e segundo grau viabilizam a demonstração da dinâmica destas fornecendo uma melhor compreensão. A mesma colabora para que os alunos não somente reproduzam métodos mecanizados da Matemática, mas também fornece a eles uma nova interpretação de um mesmo fato. Assim sendo, o trabalho em questão visa desenvolver uma aplicação que represente de maneira didática a solução e a visualização gráfica de funções matemáticas de primeiro a quarto grau. Entre os recursos disponíveis na aplicação, temos: receber funções com diferentes variáveis, mas com uma incógnita somente; orientar o usuário sobre a devida sintaxe de equações presente no sistema; gerar gráficos com base na função de entrada quando igualamos a mesma a y; e, por fim, apresentar as raízes ? da equação quando igualamos a função a 0. O desenvolvimento dessa aplicação foi realizado utilizando-se de testes de viabilidade da ideia, processo de desenvolvimento incremental e remodulação do código.

Progression From Paroxysmal to Persistent Atrial Fibrillation Clinical Correlates and Prognosis

ObjectivesWe investigated clinical correlates of atrial fibrillation (AF) progression and evaluated the prognosis of patients demonstrating AF progression in a large population.BackgroundProgression of paroxysmal AF to more sustained forms is frequently seen. However, not all patients will progress to persistent AF.MethodsWe included 1,219 patients with paroxysmal AF who participated in the Euro Heart Survey on AF and had a known rhythm status at follow-up. Patients who experienced AF progression after 1 year of follow-up were identified.ResultsProgression of AF occurred in 178 (15%) patients. Multivariate analysis showed that heart failure, age, previous transient ischemic attack or stroke, chronic obstructive pulmonary disease, and hypertension were the only independent predictors of AF progression. Using the regression coefficient as a benchmark, we calculated the HATCH score. Nearly 50% of the patients with a HATCH score >5 progressed to persistent AF compared with only 6% of the patients with a HATCH score of 0. During follow-up, patients with AF progression were more often admitted to the hospital and had more major adverse cardiovascular events.ConclusionsA substantial number of patients progress to sustained AF within 1 year. The clinical outcome of these patients regarding hospital admissions and major adverse cardiovascular events was worse compared with patients demonstrating no AF progression. Factors known to cause atrial structural remodeling (age and underlying heart disease) were independent predictors of AF progression. The HATCH score may help to identify patients who are likely to progress to sustained forms of AF in the near future