Fluorides, orthodontics and demineralization: a systematic review

Objectives: To evaluate the effectiveness of fluoride in preventing white spot lesion (WSL) demineralization during orthodontic treatment and compare all modes of fluoride delivery. Data sources: The search strategy for the review was carried out according to the standard Cochrane systematic review methodology. The following databases were searched for RCTs or CCTs: Cochrane Clinical Trials Register, Cochrane Oral Health Group Specialized Trials Register, MEDLINE and EMBASE. Inclusion and exclusion criteria were applied when considering studies to be included. Authors of trials were contacted for further data. Data selection: The primary outcome of the review was the presence or absence of WSL by patient at the end of treatment. Secondary outcomes included any quantitative assessment of enamel mineral loss or lesion depth. Data extraction: Six reviewers independently, in duplicate, extracted data, including an assessment of the methodological quality of each trial. Data synthesis: Fifteen trials provided data for this review, although none fulfilled all the methodological quality assessment criteria. One study found that a daily NaF mouthrinse reduced the severity of demineralization surrounding an orthodontic appliance (lesion depth difference –70.0 µm; 95% CI –118.2 to –21.8 µm). One study found that use of a glass ionomer cement (GIC) for bracket bonding reduced the prevalence of WSL (Peto OR 0.35; 95% CI 0.15–0.84) compared with a composite resin. None of the studies fulfilled all of the methodological quality assessment criteria. Conclusions: There is some evidence that the use of a daily NaF mouthrinse or a GIC for bonding brackets might reduce the occurrence and severity of WSL during orthodontic treatment. More high quality, clinical research is required into the different modes of delivering fluoride to the orthodontic patient

Optimization of the neutron yield in fusion plasmas produced by Coulomb explosions of deuterium clusters irradiated by a petawatt laser

The kinetic energy of hot (multi-keV) ions from the laser-driven Coulomb explosion of deuterium clusters and the resulting fusion yield in plasmas formed from these exploding clusters has been investigated under a variety of conditions using the Texas Petawatt laser. An optimum laser intensity was found for producing neutrons in these cluster fusion plasmas with corresponding average ion energies of 14 keV. The substantial volume (1-10 mm(3)) of the laser-cluster interaction produced by the petawatt peak power laser pulse led to a fusion yield of 1.6x10(7) neutrons in a single shot with a 120 J, 170 fs laser pulse. Possible effects of prepulses are discussed. DOI: 10.1103/PhysRevE.87.023106Glenn Focht Memorial FellowshipNNSA DE-FC52-08NA28512DOE Office of Basic Energy SciencesPhysic

The Texas Petawatt Laser And Current Experiments

The Texas Petawatt Laser is operational with experimental campaigns executed in both F/40 and F3 target chambers. Recent improvements have resulted in intensities of >2x10(21) W/cm(2) on target. Experimental highlights include, accelerated electron energies of >2 GeV, DD fusion ion temperatures >25 keV and isochorically heated solids to 10-50 eV.Physic

Exposure and Exposure Modeling

Exposure to contaminants in the environment is quantified through the ecological risk assessment (ERA) process which provides a framework for the development and implementation of environmental management decisions. The ERA uses available toxicological and ecological information to estimate the probability of occurrence for a specified undesired ecological event or endpoint. The level for these endpoints depends on the objectives and the constraints imposed upon the risk assessment process; therefore, multiple endpoints at different scales may be necessary. ERAs Ecotoxicology | Exposure and Exposure Assessment 1527Author\u27s personal copy often rely on the link between these undesired endpoints to a threshold of exposure to specific toxicants and toxicant mixtures. Oral reference doses (RfD), inhalation reference concentrations (RfC), and carcinogenicity assessments are the usual way these links are expressed in the ERA, and unfortunately most of these thresholds have been developed for human health assessments and not ecosystem integrity. However, since these studies often use animal models, in many cases the original empirical data can be used when trying to apply these findings to ecological consequences or to establish ecological screening values (ESVs). The ecological exposure assessment often begins by comparing constituent concentrations in media (surface water, sediment, soil) to ESVs. The ESVs are derived from ecologically relevant criteria and standards. For example, in the United States the United States Environmental Protection Agency (USEPA) Screening Values and National Ambient Water Quality Criteria (NAWQC) are often used based on ‘no observed adverse effect levels’ (NOAELs) or ‘lowest observed adverse effect levels’ (LOAELs) derived from literature to assess exposure. Radionuclide comparisons for ecological screening are typically dose-based for population level effects. In addition to the ecological threshold comparison, constituents that may bioaccumulate/bioconcentrate are identified during initial screening processes. This is done to account for toxicants that may not be present at levels exceeding ESVs, but must be considered due to trophic transfer of toxicants that may concentrate in higher-trophic-level organisms. Constituents that exceed ESV comparisons (present with means, maximums, or 95% upper confidence levels (UCLs)) are evaluated using a lines-of-evidence approach based on (1) a background evaluation, (2) a bioaccumulation/ bioconcentration potential and ecotoxicity evaluation, (3) a frequency and pattern-of-exceedances evaluation based on review of exceedances to the ESVs, and (4) an evaluation of existing biological data. From this information, ecosystems can be prioritized in terms of risk and focused for proper exposure assessments. This article presents a scientific overview and review of how toxicant exposure is estimated and applied to assess ecosystem integrity

A review of health utilities using the EQ-5D in studies of cardiovascular disease

RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are.Abstract Background The EQ-5D has been extensively used to assess patient utility in trials of new treatments within the cardiovascular field. The aims of this study were to review evidence of the validity and reliability of the EQ-5D, and to summarise utility scores based on the use of the EQ-5D in clinical trials and in studies of patients with cardiovascular disease. Methods A structured literature search was conducted using keywords related to cardiovascular disease and EQ-5D. Original research studies of patients with cardiovascular disease that reported EQ-5D results and its measurement properties were included. Results Of 147 identified papers, 66 met the selection criteria, with 10 studies reporting evidence on validity or reliability and 60 reporting EQ-5D responses (VAS or self-classification). Mean EQ-5D index-based scores ranged from 0.24 (SD 0.39) to 0.90 (SD 0.16), while VAS scores ranged from 37 (SD 21) to 89 (no SD reported). Stratification of EQ-5D index scores by disease severity revealed that scores decreased from a mean of 0.78 (SD 0.18) to 0.51 (SD 0.21) for mild to severe disease in heart failure patients and from 0.80 (SD 0.05) to 0.45 (SD 0.22) for mild to severe disease in angina patients. Conclusions The published evidence generally supports the validity and reliability of the EQ-5D as an outcome measure within the cardiovascular area. This review provides utility estimates across a range of cardiovascular subgroups and treatments that may be useful for future modelling of utilities and QALYs in economic evaluations within the cardiovascular area.Published versio

Mapping of the EQ-5D index from clinical outcome measures and demographic variables in patients with coronary heart disease.

RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are.BACKGROUND: The EuroQoL 5D (EQ-5D) is a questionnaire that provides a measure of utility for cost-effectiveness analysis. The EQ-5D has been widely used in many patient groups, including those with coronary heart disease. Studies often require patients to complete many questionnaires and the EQ-5D may not be gathered. This study aimed to assess whether demographic and clinical outcome variables, including scores from a disease specific measure, the Seattle Angina Questionnaire (SAQ), could be used to predict, or map, the EQ-5D index value where it is not available. METHODS: Patient-level data from 5 studies of cardiac interventions were used. The data were split into two groups - approximately 60% of the data were used as an estimation dataset for building models, and 40% were used as a validation dataset. Forward ordinary least squares linear regression methods and measures of prediction error were used to build a model to map to the EQ-5D index. Age, sex, a proxy measure of disease stage, Canadian Cardiovascular Society (CCS) angina severity class, treadmill exercise time (ETT) and scales of the SAQ were examined. RESULTS: The exertional capacity (ECS), disease perception (DPS) and anginal frequency scales (AFS) of the SAQ were the strongest predictors of the EQ-5D index and gave the smallest root mean square errors. A final model was chosen with age, gender, disease stage and the ECS, DPS and AFS scales of the SAQ. ETT and CCS did not improve prediction in the presence of the SAQ scales. Bland-Altman agreement between predicted and observed EQ-5D index values was reasonable for values greater than 0.4, but below this level predicted values were higher than observed. The 95% limits of agreement were wide (-0.34, 0.33). CONCLUSIONS: Mapping of the EQ-5D index in cardiac patients from demographics and commonly measured cardiac outcome variables is possible; however, prediction for values of the EQ-5D index below 0.4 was not accurate. The newly designed 5-level version of the EQ-5D with its increased ability to discriminate health states may improve prediction of EQ-5D index values

Using neighborhood-level census data to predict diabetes progression in patients with laboratory-defined prediabetes

Context Research on predictors of clinical outcomes usually focuses on the impact of individual patient factors, despite known relationships between neighborhood environment and health. Objective To determine whether US census information on where a patient resides is associated with diabetes development among patients with prediabetes. Design Retrospective cohort study of all 157,752 patients aged 18 years or older from Kaiser Permanente Northern California with laboratory-defined prediabetes (fasting plasma glucose, 100 mg/dL-125 mg/dL, and/or glycated hemoglobin, 5.7%-6.4%). We assessed whether census data on education, income, and percentage of households receiving benefits through the US Department of Agriculture’s Supplemental Nutrition Assistance Program (SNAP) was associated with diabetes development using logistic regression controlling for age, sex, race/ethnicity, blood glucose levels, and body mass index. Main Outcome Measure: Progression to diabetes within 36 months. Results Patients were more likely to progress to diabetes if they lived in an area where less than 16% of adults had obtained a bachelor’s degree or higher (odds ratio [OR] =1.22, 95% confidence interval [CI] = 1.09-1.36), where median annual income was below $79,999 (OR = 1.16 95% CI = 1.03-1.31), or where SNAP benefits were received by 10% or more of households (OR = 1.24, 95% CI = 1.1-1.4). Conclusion Area-level socioeconomic and food assistance data predict the development of diabetes, even after adjusting for traditional individual demographic and clinical factors. Clinical interventions should take these factors into account, and health care systems should consider addressing social needs and community resources as a path to improving health outcomes

Effect of an immunisation campaign in Natal and KwaZulu on vaccination coverage rates, 1990 - 1991

No Abstract