Posterior Vertical Bite Reconstructions of Erosively Worn Dentitions and the "Stamp Technique" - A Case Series with a Mean Observation Time of 40 Months

PURPOSE In the present case series, the authors report on seven cases of erosively worn dentitions (98 posterior teeth) which were treated with direct resin composite. MATERIALS AND METHODS In all cases, both arches were restored by using the so-called stamp technique. All patients were treated with standardized materials and protocols. Prior to treatment, a waxup was made on die-cast models to build up the loss of occlusion as well as ensure the optimal future anatomy and function of the eroded teeth to be restored. During treatment, teeth were restored by using templates of silicone (ie, two "stamps," one on the vestibular, one on the oral aspect of each tooth), which were filled with resin composite in order to transfer the planned, future restoration (ie, in the shape of the waxup) from the extra- to the intraoral situation. Baseline examinations were performed in all patients after treatment, and photographs as well as radiographs were taken. To evaluate the outcome, the modified United States Public Health Service criteria (USPHS) were used. RESULTS The patients were re-assessed after a mean observation time of 40 months (40.8 ± 7.2 months). The overall outcome of the restorations was good, and almost exclusively "Alpha" scores were given. Only the marginal integrity and the anatomical form received a "Charlie" score (10.2%) in two cases. CONCLUSION Direct resin composite restorations made with the stamp technique are a valuable treatment option for restoring erosively worn dentitions.

Digital Vertical Aerial Camera System for High-resolution Site Inspections in Conservation Easment Monitoring

A three-level satellite to ground monitoring scheme for conservation easement monitoring has been implemented in which high-resolution imagery serves as an intermediate step for inspecting high priority sites. A digital vertical aerial camera system was developed to fulfill the need for an economical source of imagery for this intermediate step. A method for attaching the camera system to small aircraft was designed, and the camera system was calibrated and tested. To ensure that the images obtained were of suitable quality for use in Level 2 inspections, rectified imagery was required to provide positional accuracy of 5 meters or less to be comparable to current commercially available high-resolution satellite imagery. Focal length calibration was performed to discover the infinity focal length at two lens settings (24mm and 35mm) with a precision of O.1mm. Known focal length is required for creation of navigation points representing locations to be photographed (waypoints). Photographing an object of known size at distances on a test range allowed estimates of focal lengths of 25.lmm and 35.4mm for the 24mm and 35mm lens settings, respectively. Constants required for distortion removal procedures were obtained using analytical plumb-line calibration procedures for both lens settings, with mild distortion at the 24mm setting and virtually no distortion found at the 35mm setting. The system was designed to operate in a series of stages: mission planning, mission execution, and post-mission processing. During mission planning, waypoints were created using custom tools in geographic information system (GIs) software. During mission execution, the camera is connected to a laptop computer with a global positioning system (GPS) receiver attached. Customized mobile GIs software accepts position information from the GPS receiver, provides information for navigation, and automatically triggers the camera upon reaching the desired location. Post-mission processing (rectification) of imagery for removal of lens distortion effects, correction of imagery for horizontal displacement due to terrain variations (relief displacement), and relating the images to ground coordinates were performed with no more than a second-order polynomial warping function. Accuracy testing was performed to verify the positional accuracy capabilities of the system in an ideal-case scenario as well as a real-world case. Using many welldistributed and highly accurate control points on flat terrain, the rectified images yielded median positional accuracy of 0.3 meters. Imagery captured over commercial forestland with varying terrain in eastern Maine, rectified to digital orthophoto quadrangles, yielded median positional accuracies of 2.3 meters with accuracies of 3.1 meters or better in 75 percent of measurements made. These accuracies were well within performance requirements. The images from the digital camera system are of high quality, displaying significant detail at common flying heights. At common flying heights the ground resolution of the camera system ranges between 0.07 meters and 0.67 meters per pixel, satisfying the requirement that imagery be of comparable resolution to current highresolution satellite imagery. Due to the high resolution of the imagery, the positional accuracy attainable, and the convenience with which it is operated, the digital aerial camera system developed is a potentially cost-effective solution for use in the intermediate step of a satellite to ground conservation easement monitoring scheme.

Evaluating the impact of vertical integration on health system peformance

Vertical integration is grounded in economic theory as a corporate strategy for reducing cost and enhancing efficiency. There were three purposes for this dissertation. The first was to describe and understand vertical integration theory. The review of the economic theory established vertical integration as a corporate cost reduction strategy in response to environmental, structural and performance dimensions of the market. The second purpose was to examine vertical integration in the context of the health care industry, which has greater complexity, higher instability, and more unstable demand than other industries, although many of the same dimensions of the market supported a vertical integration strategy. Evidence on the performance of health systems after integration revealed mixed results. Because the market continues to be turbulent, hybrid non-owned integration in the form of alliances have increased to over 40% of urban hospitals. The third purpose of the study was to examine the application of vertical integration in health care and evaluate the effects. The case studied was an alliance formed between a community hospital and a tertiary medical center to facilitate vertical integration of oncology services while maintaining effectiveness and preserving access. The economic benefits for 1934 patients were evaluated in the delivery system before and after integration with a more detailed economic analysis of breast, lung, colon/rectal, and non-malignant cases. A regression analysis confirmed the relationship between the independent variables of age, sex, location of services, race, stage of disease, and diagnosis, and the dependent variable, cost. The results of the basic regression model, as well as the regression with first-order interaction terms, were statistically significant. The study shows that vertical integration at an intermediate health care system level has economic benefits. If the pre-integration oncology group had been treated in the post-integration model, the expected cost savings from integration would be 31.5%. Quality indicators used were access to health care services and research treatment protocols, and access was preserved in the integrated model. Using survival as a direct quality outcome measure, the survival of lung cancer patients was statistically the same before and after integration. ^

Control of Vertical Dimension During Rapid Palatal Expansion Using a High Pull Chin

Submitted in partial fulfillment of the requirements for a Certificate in Orthodontics, Dept. of Orthodontics, University of Connecticut Health Center, 1986

NRAS and BRAF mutations in primary cutaneous melanoma: A comparison of mutation rates between radial and vertical growth phases in individual tumors

Primary cutaneous melanoma is a cancer arising from melanocytes in the skin. In recent decades the incidence of this malignancy has increased significantly. Mortality rates are high for patients with tumors measuring over a few millimeters in thickness. Response rates to conventional radiation and chemotherapy are very low in patients with metastatic melanoma. New therapies targeting melanoma’s aberrant cell signaling pathways such as the MAP Kinase pathway are being developed. Mutations of NRAS and BRAF genes are quite common in cutaneous melanoma and lead to constitutive activation of the MAP Kinase pathway. This study tests the hypothesis that NRAS and BRAF mutations increase as a tumor progresses from the noninvasive radial growth phase (RGP) to the invasive vertical growth phase (VGP). Laser capture microdissection was used to obtain separate, pure tumor DNA samples from the RGP and VGP of thirty primary cutaneous melanomas. PCR was used to amplify NRAS exon 2 and BRAF exon 15 tumor DNA. The amplified DNA was sequenced and analyzed for mutations. An overall mutation rate of 74% was obtained for the twenty-three melanomas in which there were complete sequence results. With the exception of one melanoma NRAS and BRAF mutations were mutually exclusive. All seven NRAS exon 2 mutations involved codon 61. Three of these melanomas had mutations in both the RGP and VGP. The remaining four tumors were wild type for NRAS exon 2 in the RGP but mutated in the VGP. Of the fifteen BRAF exon 15 mutated melanomas all but one involved codon 600. Twelve of the fifteen BRAF exon 15 mutations were the T1799A type. Nine of the fifteen BRAF mutated tumors had the same mutation in both the RGP and VGP. Five of fifteen melanomas had wild type RGP DNA and BRAF exon 15 mutated VGP DNA. A single melanoma had BRAF exon 15 mutated DNA in the RGP and wild type DNA in the VGP. Overall, these results suggest a trend toward the acquisition of NRAS and BRAF mutations as cutaneous melanomas change from a noninvasive to an invasive, potentially deadly cancer.^