Clavichord for Beginners by Joan Benson

Bernard Brauchli reviews and discusses Joan Benson\u27s 2014 work. Benson, Joan. Clavichord for Beginners. Bloomington: Indiana University Press, 2014. ISBN: 978-025301158

Telemedicine for improving access to health care in resource-constrained areas : from individual diagnosis to strengthening health systems

In many developing countries there is an acute shortage of trained medical specialists. This does not only hamper individual patients’ access to medical diagnostics but furthermore limits the development of health systems because a major role of the specialists is the provision of continuous medical education of health care personnel. The rapid development of information and communication technologies has enabled radically new forms of virtual collaboration at a distance. So-called telemedicine enables us today to transmit knowledge to the patient rather than to only transport patients to the centres where the knowledge is available; this has promising implications in particular for remote and under-served areas. Initiated by a request from a Swiss surgeon from Solomon Islands, a project for supporting the hospital in Honiara, capital of Solomon Islands, with pathology diagnoses was started between Honiara and the Department of Pathology in Basel in 2001. After a successful start this pilot project found broad interest, and the Internet platform that had been developed was soon utilised by projects from other countries and medical disciplines. Thus, questions arose about the diagnostic accuracy of such remote diagnoses as well as about their acceptance and impact on the local health care system. The work presented here was initiated on this background. It analyses the applicability of telemedicine in the context of resource-constrained areas and in particular the possibilities to extend its impact from improving individual diagnosis towards strengthening health care systems. A central part of this project was the development of iPath, an Internet- and email-based telemedicine platform, which facilitates medical consultations, knowledge exchange and continuous education on a global scale. A particular emphasis was put on the applicability and accessibility for users from developing countries with limited infrastructure and network connectivity. The complete software was released under an open-source licence in order to allow unrestricted reuse for other institutions. The diagnostic accuracy of this form of telemedicine was studied in two projects from the field of pathology. A retrospective review of over 200 glass slides from each project revealed complete diagnostic concordance between the telemedical diagnosis and review diagnosis in 69% and 85% respectively. Clinically relevant discrepancies were found in 8% and 3.3% of all examinations. Selection of images by the non-expert and communication were found to have the greatest impact on diagnostic accuracy. Both factors can be addressed by training and organisation of workflow. In comparison to submitting material for pathological examination by courier, the turn-around time could be reduced from weeks to days or hours. Besides the more rapid availability of diagnosis, telemedicine enabled a direct dialogue between the surgeon and the pathologist and thus facilitated an implicit permanent medical education. The educational aspects of telemedicine were studied within the scope of a tele-dermatology project in South Africa. Distance collaboration with a dermatologist empowered a general practitioner based in a rural area to diagnose and treat a majority of patients with dermatological problems. Besides the direct benefit of saving the patients the cost of transportation to visit the dermatologist, the general practitioner could strengthen his own diagnostic skills under direct guidance and quality control of a specialist. As a consequence he will be able to treat more patients locally, close to their homes and families. The whole project was implemented within the local health system in order to facilitate a future inclusion of other primary care facilities. Regional telemedicine networks play a major role to ensure relevance and acceptability of consultative and educational telemedicine. Within the scope of the Ukrainian Swiss Perinatal Health Program a telemedicine component was included, and it was found that the use of regional language as well as inclusion of the regional specialists are important for the acceptance of telemedicine and should not be neglected in a era of globalisation. The presented results demonstrate that save and reliable telemedicine can be implemented with limited resources. Telemedicine is suitable in particular to strengthen existing international collaborations and to support professionally isolated medical specialists. Regional collaboration and inclusion of regional specialists are desirable if telemedicine shall help to strengthen health care systems. The application of telemedicine should not only focus on providing care to individual patients, but should explicitly incorporate skills development and capacity building of primary care staff. Organisation of work flow and communication have been found to be the most challenging task for the implementation of telemedicine networks. Resources must be invested not only in technology but more importantly in training and organisation. Utilisation of existing technological infrastructure is advisable wherever possible and greatly reduces the complexity of providing support and maintenance. The presented telemedicine platform provides an efficient tool for the organisation of interdisciplinary, regional and international telemedicine networks. We hope that the unrestricted availability of the software developed during this project will enable other institutions to utilise it for their own purpose and that they will thus be able to allocate resources on the organisation of workflow rather than technology

Use of depot medroxyprogesterone acetate and fracture risk

Depot medroxyprogesterone acetate (DMPA), which has a high rate of use among teenagers in Europe and the United States, has been associated with impaired bone mineral acquisition during adolescence and accelerated bone loss in later life. Studies on the association between DMPA use and fracture risk are limited.; We aimed at evaluating the relationship between use of hormonal contraceptives, specifically DMPA, and fracture risk.; We conducted a case-control analysis using the United Kingdom-based General Practice Research Database.; Participants were females aged 20-44 yr with an incident fracture diagnosis between 1995 and 2008.; Odds ratios (OR) with 95% confidence intervals (CI) of incident fracture in relation to exposure to DMPA or combined oral contraceptives were assessed. Adjustments were made for smoking, body mass index, and additional potential confounders.; We identified 17,527 incident fracture cases and 70,130 control patients (DMPA exposure: 11 and 8%, respectively). Compared with nonuse, current use of one to two, three to nine, or 10 or more DMPA prescriptions yielded adjusted OR for fractures of 1.18 (95% CI = 0.93-1.49), 1.36 (95% CI = 1.15-1.60), and 1.54 (95% CI = 1.33-1.78), respectively. Fracture risk was highest after longer treatment duration (<2-3 yr), and there was no difference in patients below and above the age of 30 yr. For users of combined estrogen-containing oral contraceptives, the OR were around 1.; This population-based study suggests that use of DMPA is associated with a slightly increased risk of fractures

Influence of various polishing methods on pulp temperature: An in vitro study

Objective: After orthodontic debonding, adhesive removal can lead to rises in pulp temperature, causing histological changes or pulp necrosis. The objective of this study was to measure increases in pulp temperature during adhesive removal using different instruments and various cooling procedures. Materials and methods: A thermoelement was introduced into the pulp chamber of 10human incisors. The teeth were immersed in a 36°C water bath up to the cementoenamel junction. Two carbide burs, one polishing disk and two rubber points were used for polishing. All measurements were taken over a 10s period by a single investigator, under slight pressure and with constant motion. Three cooling procedures were examined: no cooling, air cooling and water cooling. Pulp temperatures were measured before polishing and after 10s of polishing. Results: Without cooling, the two rubber points revealed clinically relevant temperature increases of 6.1°C and 12.4°C. Cooling with air and with water reduced pulp temperature in conjunction with all polishing methods. Air cooling was most efficient, except in combination with the polishing disk. Conclusion: Under these study conditions, carbide burs and polishing disks can be used safely and without risk to the pulp, even without cooling. On the other hand, rubber points cause a marked increase in pulp temperature when used without coolin

Influence of material choice on the force delivery of bimaxillary tooth positioners on canine malpositions

Objective: Since their introduction in 1945, tooth positioners have been used to treat a range of malpositions. Although the original appliance was made of natural rubber, today's tooth positioners are fabricated from various elastic, transparent materials. It was the aim of this study to evaluate the forces and moments produced by current positioners on various upper canine malpositions. Material and methods: Seven positioners of different materials were tested on 11 upper canine malpositions: 0.25, 0.5, 1mm supraposition; 0.25, 0.5, 1mm infraposition; 5°, 10°, 20° mesiorotation; 5° mesioinclination, 5° buccal root torque. We measured forces and moments in vitro after bite closure by 0.5mm, and opening by 1mm using a three-dimensional robotic device. All measurements were taken in a temperature-controlled environment at 36°C. Results: The forces and moments measured at the canine varied greatly among the different positioners, with the thermoformed EVA positioner showing much greater forces and moments in almost all malpositions. At initial closure, we observed intrusive forces of 6-32N for suprapositions, 0-11N intrusive forces for infrapositions, 0-20Nmm for mesiorotations, 6-12Nmm for mesioinclinations, and − 23Nmm to 5Nmm for buccal root torque. All positioners were most effective on suprapositioned teeth. Very low or negligible correctional forces and moments in conjunction with all infrapositions and 5° with rotation were noted. Labial root torque led to unpredictable moments. Conclusion: Positioner material plays a major role in delivering forces to the teeth. However, tooth positioners did not induce corrective forces in all the malpositions tested. Clinically relevant correctional forces or moments in conjunction with all suprapositions, rotations of 10° and 20° as well as mesial tipping of the canine were observe

Shear bond strengths of seven self-etching primers after thermo-cycling

Objective: Self-etching primers are widely used in restorative dentistry. However, only one primer has been developed for orthodontic applications. The objective of this study was to assess the suitabiliy of restorative self-etching primers on unabraded enamel. Material and Methods: Seven self-etching primers (Transbond™ SEP +, Xeno®III, Clearfil™SE, Futurabond®NR, OneCoat, M-Bond and OptiBond®) were compared with two conventionally-etched control groups (Transbond™ MIP). All groups with the exception of one of the two control groups underwent thermo-cycling (1000x, 5-55°C). Bovine teeth stored in physiological saline solution were used for the purpose of this study. Results: Both before and after thermo-cycling, the control groups presented very similar shear strengths which did not differ significantly from each other or from the Transbond™ SEP +  and Clearfil™SE specimens. During thermo-cycling, all groups except the control group and the Transbond™ SEP +  specimens displayed losses from the shear bodies. These losses occurred on all of the OptiBond® samples. The adhesive remnant index (ARI) and enamel tear-outs correlated closely with the adhesive values. Conclusions: Our adhesive value assessments support the conclusion that only Transbond™ SEP +  and Clearfil™SE can be recommended for clinical us

The influence of dental loupes on the quality of adhesive removal in orthodontic debonding

Objective: Bracket bonding has been a major advance in orthodontic treatment. However, the method of debonding can lead to diverse problems such as enamel fractures, enamel loss and enamel scratching. In this clinical investigation we aimed to evaluate the influence of wearing dental loupes on enamel damage during the debonding procedure. Material and Methods: 22 consecutive patients were randomly assigned in a split-mouth study to evaluate adhesive removal with and without the use of dental loupes (2.5×, LED headlight). Tooth replicas in epoxy resin were made from silicone impressions. Electron microscopic images (50× magnification) of 394 buccal enamel surfaces were evaluated according to an enamel damage index (EDI), line angle grooves (LAG) and composite residues (CR) on anterior teeth, premolars and molars. Results: The EDI revealed highly significant advantages for debonding with dental loupes, with which the EDI was significantly higher for molars, while still less than without dental loupes. We detected no differences between the tooth groups without dental loupes. We found significantly fewer LAG on anterior teeth debonded with dental loupes. CR were fewer in the dental loupes group, and we noted no significant differences between the tooth groups. Conclusions: Dental loupes affect the quality of the debonding procedure, resulting in less enamel damage and composite residue, as well as fewer LAG compared to the control group. We therefore strongly recommend the use of dental loupes in orthodontic debonding procedure

Evolutionary Markovian Strategies in 2 x 2 Spatial Games

Evolutionary spatial 2 x 2 games between heterogeneous agents are analyzed using different variants of cellular automata (CA). Agents play repeatedly against their nearest neighbors 2 x 2 games specified by a rescaled payoff matrix with two parameteres. Each agent is governed by a binary Markovian strategy (BMS) specified by 4 conditional probabilities [p_R, p_S, p_T, p_P] that take values 0 or 1. The initial configuration consists in a random assignment of "strategists" among the 2^4= 16 possible BMS. The system then evolves within strategy space according to the simple standard rule: each agent copies the strategy of the neighbor who got the highest payoff. Besides on the payoff matrix, the dominant strategy -and the degree of cooperation- depend on i) the type of the neighborhood (von Neumann or Moore); ii) the way the cooperation state is actualized (deterministically or stochastichally); and iii) the amount of noise measured by a parameter epsilon. However a robust winner strategy is [1,0,1,1].Comment: 18 pages, 8 figures (7 of these figures contain 4 encapsulapted poscript files each