Agreement of the clinician’s choice of archwire selection on conventional and virtual models

Objectives: To compare archwire selection on dental casts with archwire selection using a three-dimensional (3D) software program (OrthoAid) and assess agreement between clinicians. Materials and Methods: The best-fitting archwires were selected for dental casts of 100 patients with malocclusion using two approaches by three orthodontists. The first method was to visually determine the fitness of five preformed nickel titanium archwires to the arch form on a dental cast (subjective method). The second method was archwire selection on a virtual image of the same cast by means of 3D software (objective method). Agreement between selections performed by the orthodontists was calculated using Kappa statistics. The accuracy of fit of the archwires to the curves fitted to the arch form was also calculated or reversely assessed by means of the root mean square (RMS) for both methods using the Dahlberg formula. Results: The mean RMS of the distances between the patient arch forms and the archwires for the subjective method was 1.163–1.366 mm. The agreement of selections between orthodontists was 42%–58% (Kappa ranged from .074 to .382). Using the 3D software (objective method), the mean RMS decreased to 0.966–1.171 mm, and agreement increased to 47% to 84% (Kappa ranged from .444 to .747). Conclusions: The use of 3D computer software for archwire selection in patients with malocclusion provided better adaptation and interexaminer reliability

The role of temporary accommodation buildings for post-disaster housing reconstruction

The number of houses damaged or destroyed after disasters is frequently large, and re-housing of homeless people is one of the most important tasks of reconstruction programmes. Reconstruction works often last long and during that time, it is essential to provide victims with the minimum conditions to live with dignity, privacy, and protection. This research intends to demonstrate the crucial role of temporary accommodation buildings to provide spaces where people can live and gradually resume their life until they have a permanent house. The study also aims to identify the main problems of temporary accommodation strategies and to discuss some principles and guidelines in order to reach better design solutions. It is found that temporary accommodation is an issue that goes beyond the simple provision of buildings, since the whole space for temporary settlement is important. Likewise, temporary accommodation is a process that should start before a disaster occurs, as a preventive pre-planning. In spite of being temporary constructions, these housing buildings are one of the most important elements to provide in emergency scenarios, contributing for better recovery and reconstruction actions.The first author gratefully acknowledges the financial support of Fundacao para a Ciencia e a Tecnologia, FCT, through grant SFRH/BD/73853/2010

Randomized Clinical Trials and Observational Tribulations: Providing Clinical Evidence for Personalized Surgical Pain Management Care Models

Proving clinical superiority of personalized care models in interventional and surgical pain management is challenging. The apparent difficulties may arise from the inability to standardize complex surgical procedures that often involve multiple steps. Ensuring the surgery is performed the same way every time is nearly impossible. Confounding factors, such as the variability of the patient population and selection bias regarding comorbidities and anatomical variations are also difficult to control for. Small sample sizes in study groups comparing iterations of a surgical protocol may amplify bias. It is essentially impossible to conceal the surgical treatment from the surgeon and the operating team. Restrictive inclusion and exclusion criteria may distort the study population to no longer reflect patients seen in daily practice. Hindsight bias is introduced by the inability to effectively blind patient group allocation, which affects clinical result interpretation, particularly if the outcome is already known to the investigators when the outcome analysis is performed (often a long time after the intervention). Randomization is equally problematic, as many patients want to avoid being randomly assigned to a study group, particularly if they perceive their surgeon to be unsure of which treatment will likely render the best clinical outcome for them. Ethical concerns may also exist if the study involves additional and unnecessary risks. Lastly, surgical trials are costly, especially if the tested interventions are complex and require long-term follow-up to assess their benefit. Traditional clinical testing of personalized surgical pain management treatments may be more challenging because individualized solutions tailored to each patient’s pain generator can vary extensively. However, high-grade evidence is needed to prompt a protocol change and break with traditional image-based criteria for treatment. In this article, the authors review issues in surgical trials and offer practical solutions

Targeted emission reductions from global super-polluting power plant units

There are more than 30,000 biomass- and fossil-fuel-burning power plants now operating worldwide, reflecting a tremendously diverse infrastructure, which ranges in capacity from less than a megawatt to more than a gigawatt. In 2010, 68.7% of electricity generated globally came from these power plants, compared with 64.2% in 1990. Although the electricity generated by this infrastructure is vital to economic activity worldwide, it also produces more CO2 and air pollutant emissions than infrastructure from any other industrial sector. Here, we assess fuel- and region-specific opportunities for reducing undesirable air pollutant emissions using a newly developed emission dataset at the level of individual generating units. For example, we find that retiring or installing emission control technologies on units representing 0.8% of the global coal-fired power plant capacity could reduce levels of PM2.5 emissions by 7.7–14.2%. In India and China, retiring coal-fired plants representing 1.8% and 0.8% of total capacity can reduce total PM2.5 emissions from coal-fired plants by 13.2% and 16.0%, respectively. Our results therefore suggest that policies targeting a relatively small number of ‘super-polluting’ units could substantially reduce pollutant emissions and thus the related impacts on both human health and global climate

Long-term droughts may drive drier tropical forests towards increased functional, taxonomic and phylogenetic homogeneity

Tropical ecosystems adapted to high water availability may be highly impacted by climatic changes that increase soil and atmospheric moisture deficits. Many tropical regions are experiencing significant changes in climatic conditions, which may induce strong shifts in taxonomic, functional and phylogenetic diversity of forest communities. However, it remains unclear if and to what extent tropical forests are shifting in these facets of diversity along climatic gradients in response to climate change. Here, we show that changes in climate affected all three facets of diversity in West Africa in recent decades. Taxonomic and functional diversity increased in wetter forests but tended to decrease in forests with drier climate. Phylogenetic diversity showed a large decrease along a wet-dry climatic gradient. Notably, we find that all three facets of diversity tended to be higher in wetter forests. Drier forests showed functional, taxonomic and phylogenetic homogenization. Understanding how different facets of diversity respond to a changing environment across climatic gradients is essential for effective long-term conservation of tropical forest ecosystems

Advances in Vehicular Ad-hoc Networks (VANETs): challenges and road-map for future development

Recent advances in wireless communication technologies and auto-mobile industry have triggered a significant research interest in the field of vehicular ad-hoc networks (VANETs) over the past few years. A vehicular network consists of vehicle-to-vehicle (V2V) and vehicle-to-infrastructure (V2I) communications supported by wireless access technologies such as IEEE 802.11p. This innovation in wireless communication has been envisaged to improve road safety and motor traffic efficiency in near future through the development of intelligent transportation system (ITS). Hence, governments, auto-mobile industries and academia are heavily partnering through several ongoing research projects to establish standards for VANETs. The typical set of VANET application areas, such as vehicle collision warning and traffic information dissemination have made VANET an interesting field of mobile wireless communication. This paper provides an overview on current research state, challenges, potentials of VANETs as well as the ways forward to achieving the long awaited ITS

Impact of Systemic Inflammation and Autoimmune Diseases on apoA-I and HDL Plasma Levels and Functions

The cholesterol of high-density lipoproteins (HDLs) and its major proteic component, apoA-I, have been widely investigated as potential predictors of acute cardiovascular (CV) events. In particular, HDL cholesterol levels were shown to be inversely and independently associated with the risk of acute CV diseases in different patient populations, including autoimmune and chronic inflammatory disorders. Some relevant and direct anti-inflammatory activities of HDL have been also recently identified targeting both immune and vascular cell subsets. These studies recently highlighted the improvement of HDL function (instead of circulating levels) as a promising treatment strategy to reduce inflammation and associated CV risk in several diseases, such as systemic lupus erythematosus and rheumatoid arthritis. In these diseases, anti-inflammatory treatments targeting HDL function might improve both disease activity and CV risk. In this narrative review, we will focus on the pathophysiological relevance of HDL and apoA-I levels/functions in different acute and chronic inflammatory pathophysiological conditions