Biological materials in colorectal surgery: current applications and potential for the future.

Biological materials are increasingly used in abdominal surgery for ventral, pelvic and perineal reconstructions, especially in contaminated fields. Future applications are multi-fold and include prevention and one-step closure of infected areas. This includes prevention of abdominal, parastomal and pelvic hernia, but could also include prevention of separation of multiple anastomoses, suture- or staple-lines. Further indications could be a containment of infected and/or inflammatory areas and protection of vital implants such as vascular grafts. Reinforcement patches of high-risk anastomoses or unresectable perforation sites are possibilities at least. Current applications are based mostly on case series and better data is urgently needed. Clinical benefits need to be assessed in prospective studies to provide reliable proof of efficacy with a sufficient follow-up. Only superior results compared with standard treatment will justify the higher costs of these materials. To date, the use of biological materials is not standard and applications should be limited to case-by-case decision.

Wear of two artificial tooth materials in vivo: a 12-month pilot study.

STATEMENT OF PROBLEM: Wear of methacrylate artificial teeth resulting in vertical loss is a problem for both dentists and patients. PURPOSE: The purpose of this study was to quantify wear of artificial teeth in vivo and to relate it to subject and tooth variables. MATERIAL AND METHODS: Twenty-eight subjects treated with complete dentures received 2 artificial tooth materials (polymethyl methacrylate (PMMA)/double-cross linked PMMA fillers; 35%/59% (SR Antaris DCL, SR Postaris DCL); experimental 48%/46%). At baseline and after 12 months, impressions of the dentures were poured with improved stone. After laser scanning, the casts were superimposed and matched. Maximal vertical loss (mm) and volumetric loss (mm(3)) were calculated for each tooth and log-transformed to reduce variability. Volumetric loss was related to the occlusally active surface area. Linear mixed models were used to study the influence of the factors jaw, tooth, and material on adjusted (residual) wear values (alpha=.05). RESULTS: Due to drop outs (n=5) and unmatchable casts (n=3), 69% of all teeth were analyzed. Volumetric loss had a strong linear relationship to surface area (P<.001); this was less pronounced for vertical loss (P=.004). The factor showing the highest influence was the subject. Wear was tooth dependent (increasing from incisors to molars). However, these differences diminished once the wear rates were adjusted for occlusal area, and only a few remained significant (anterior versus posterior maxillary teeth). Another influencing factor was the age of the subject. CONCLUSIONS: Clinical wear of artificial teeth is higher than previously measured or expected. The presented method of analyzing wear of artificial teeth using a laser-scanning device seemed suitable.

Round robin test: wear of nine dental restorative materials in six different wear simulators - supplement to the round robin test of 2005.

OBJECTIVE: The purpose of the present study was to submit the same materials that were tested in the round robin wear test of 2002/2003 to the Alabama wear method. METHODS: Nine restorative materials, seven composites (belleGlass, Chromasit, Estenia, Heliomolar, SureFil, Targis, Tetric Ceram) an amalgam (Amalcap) and a ceramic (IPS Empress) have been submitted to the Alabama wear method for localized and generalized wear. The test centre did not know which brand they were testing. Both volumetric and vertical loss had been determined with an optical sensor. After completion of the wear test, the raw data were sent to IVOCLAR for further analysis. The statistical analysis of the data included logarithmic transformation of the data, the calculation of relative ranks of each material within each test centre, measures of agreement between methods, the discrimination power and coefficient of variation of each method as well as measures of the consistency and global performance for each material. RESULTS: Relative ranks of the materials varied tremendously between the test centres. When all materials were taken into account and the test methods compared with each other, only ACTA agreed reasonably well with two other methods, i.e. OHSU and ZURICH. On the other hand, MUNICH did not agree with the other methods at all. The ZURICH method showed the lowest discrimination power, ACTA, IVOCLAR and ALABAMA localized the highest. Material-wise, the best global performance was achieved by the leucite reinforced ceramic material Empress, which was clearly ahead of belleGlass, SureFil and Estenia. In contrast, Heliomolar, Tetric Ceram and especially Chromasit demonstrated a poor global performance. The best consistency was achieved by SureFil, Tetric Ceram and Chromasit, whereas the consistency of Amalcap and Heliomolar was poor. When comparing the laboratory data with clinical data, a significant agreement was found for the IVOCLAR and ALABAMA generalized wear method. SIGNIFICANCE: As the different wear simulator settings measure different wear mechanisms, it seems reasonable to combine at least two different wear settings to assess the wear resistance of a new material.

Psychometrics of the Dyadic Coping Inventory in three language groups

This article introduces the Dyadic Coping Inventory (DCI; Bodenmann, 2008) and aims (1) to investigate the reliability and aspects of the validity of the Italian and French versions of the DCI, and (2) to replicate its factor structure and reliabilities using a new Swiss German sample. Based on 216 German-, 378 Italian-, and 198 French-speaking participants, the factor structure of the original German inventory was able to be replicated by using principal components analysis in all three groups after excluding two items in the Italian and French versions. The latter were shown to be as reliable as the German version with the exception of the low reliabilities of negative dyadic coping in the French group. Confirmatory factor analyses provided additional support for delegated dyadic coping and evaluation of dyadic coping. Intercorrelations among scales were similar across all three languages groups with a few exceptions. Previous findings could be replicated in all three groups, showing that aspects of dyadic coping were more strongly related to marital quality than to dyadic communication. The use of the dyadic coping scales in the actor-partner interdependence model, the common fate model, and the mutual influence model is discussed.

The role of epilepsy in early language development in a child with a congenital lesion in the right hemisphere

Early epilepsy is known to worsen the developmental prognosis of young children with a congenital focal brain lesion, but its direct role is often very difficult to delineate from the other variables. This requires prolonged periods of follow-up with simultaneous serial electrophysiological and developmental assessments which are rarely obtained. We studied a male infant with a right prenatal infarct in the territory of the right middle cerebral artery resulting in a left spastic hemiparesis, and an epileptic disorder (infantile spasms with transient right hemihypsarrhythmia and focal seizures) from the age of 7 months until the age of 4 years. Pregnancy and delivery were normal. A dissociated delay of early language acquisition affecting mainly comprehension without any autistic features was documented. This delay was much more severe than usually expected in children with early focal lesions, and its evolution, with catch-up to normal, was correlated with the active phase of the epilepsy. We postulate that the epilepsy specifically amplified a pattern of delayed language emergence, mainly affecting lexical comprehension, reported in children with early right hemisphere damage.

Wear of two denture teeth materials in vivo-2-year results.

OBJECTIVE: (1) To quantify wear of two different denture tooth materials in vivo with two study designs, (2) to relate tooth variables to vertical loss. METHODS: Two different denture tooth materials had been used (experimental material=test; DCL=control). In study 1 (split-mouth, 6 test centers) 60 subjects received complete dentures, in study 2 (two-arm, 1 test center) 29 subjects. In study 1 the mandibular dentures were supported by implants in 33% of the subjects, in study 2 only in 3% of the subjects. Impressions of the dentures were taken and poured with improved stone at baseline and after 6, 12, 18 and 24 months. Each operator evaluated the wear subjectively. Wear analysis was carried out with a laser scanning device. Maximal vertical loss of the attrition zones was calculated for each tooth cusp and tooth. A mixed linear model was used to statistically analyse the logarithmically transformed wear data. RESULTS: Due to drop-outs and unmatchable casts, only 47 subjects of study 1 and 14 of study 2 completed the 2-year recall. Overall, 75% of all teeth present could be analysed. There was no statistically difference in the overall wear between the test and control material for either study 1 or study 2. The relative increase in wear over time was similar in both study designs. However, a strong subject effect and center effect were observed. The fixed factors included in the model (time, tooth, center, etc.) accounted for 43% of the variability, whereas the random subject effect accounted for another 30% of the variability, leaving about 28% of unexplained variability. More wear was consistently recorded in the maxillary teeth compared to the mandibular teeth and in the first molar teeth compared to the premolar teeth and the second molars. Likewise, the supporting cusps showed more wear than the non-supporting cusps. The amount of wear did not depend on whether or not the lower dentures were supported by implants. The subjective wear was correct in about 67% of the cases if it is postulated that a wear difference of 100μm should be subjectively detectable. SIGNIFICANCE: The clinical wear of denture teeth is highly variable with a strong patient effect. More wear can be expected in maxillary denture teeth compared to mandibular teeth, first molars compared to premolars and supported cusps compared to non-supported cusps. Laboratory data on the wear of denture tooth materials may not be confirmed in well-structured clinical trials probably due to the large inter-individual variability.

Conceptualisation et emploi du passé composé et de l'imparfait en français langue étrangère (L3) au Sri Lanka : l'impact du singhalais langue maternelle (L1) et de l'anglais langue seconde (L2)

Résumé: Notre étude chevauche deux domaines de recherche quasi indissociables : ceux de la linguistique et de la didactique des langues. Comme l'indique le sujet, elle examine la conceptualisation et l'emploi de deux notions aspecto-temporelles du français (le passé composé et l'imparfait), sous l'impact des connaissances grammaticales déjà acquises sur deux autres langues : le singhalais et l'anglais. Notre recherche relève des domaines de la psycholinguistique, de la linguistique acquisitionnelle et de la linguistique comparative. Toutefois, dans le cadre de cette étude, nous examinons ces notions grammaticales françaises et leurs équivalents présumés dans les deux autres langues comme étant des concepts relevant des langues à statuts sociaux spécifiques [à savoir, langue maternelle (L1), langue seconde (L2) et langue étrangère (L3)], dans un contexte particulier d'enseignement/apprentissage et d'acquisition de langue [à savoir, le contexte d'enseignement/apprentissage et d'acquisition du français langue étrangère (FLE) au Sri Lanka]. En ce sens, notre étude est également liée aux domaines de la sociolinguistique et de la didactique des langues, notamment, étrangères. Ce qui pourrait probablement distinguer cette recherche des autres, c'est qu'elle aborde certaines questions linguistiques et didactiques peu étudiées jusqu'ici. Entre autres, l'influence de deux langues sur l'enseignement/apprentissage d'une L3, l'enseignement/apprentissage des langues dans des contextes exolingues et le rôle des transferts dans la conceptualisation des notions grammaticales. Pourtant, lorsque nous avons choisi le contexte d'apprentissage du FLE au Sri Lanka comme terrain de recherche, nous avons également visé d'autres objectifs : examiner les systèmes verbaux de trois langues dont l'imbrication n'a pas encore été objet d'étude ; examiner le système verbal aspecto-temporel peu explicité du singhalais à la lumière des descriptions linguistiques occidentales ; vérifier certains préjugés concernant les liens de proximité et de distance entre les trois langues choisies et étudier les causes de ces préjugés. Notre corpus provient de plusieurs classes de FLE au Sri Lanka. Le public observé était constitué d'adolescents ou d'adultes bilingues ayant le singhalais en L1 et l'anglais en L2. Les cours choisis se distinguaient les uns des autres par plusieurs critères, mais travaillaient tous sur les notions du passé composé et de l'imparfait. A la conclusion de notre étude, nous avons constaté qu'un nombre important de nos hypothèses initiales se sont avérées véridiques. A titre d'exemples, les transferts entre les langues premières et la langue cible sont récurrents et non négligeables chez l'écrasante majorité des apprenants exolingues observés, et parfois, même chez leurs enseignants; si ces apprenants recourent à ces langues pour étayer leur apprentissage, ni leurs enseignants ni leurs manuels provenant de l'étranger ne les guident dans ce travail; les transferts ayant l'anglais pour origine l'emportent considérablement sur ceux provenant du singhalais. De même, suite à l'analyse contrastive des trois systèmes verbaux aspecto-temporels et à l'analyse du corpus, nous avons également eu un résultat imprévu : contrairement à une représentation répandue chez les apprenants singhalais, il existe des points convergents entre leur L1 et le français ; du moins, au niveau de l'emploi de certains temps du passé. Un fait dont on était jusqu'ici ignorants mais dont on peut sûrement profiter dans les cours de FLE au Sri Lanka. Suite à ces observations et à la fin de notre thèse, nous avons fait quelques recommandations didactiques afin d'améliorer les conditions d'enseignement/apprentissage des langues étrangères, au Sri Lanka et ailleurs. Abstract: Our research is related to the fields of both linguistics and didactics, two research areas which are almost inseparable. As the title shows, the thesis examines the issue of conceptualizing and using of two grammatical (aspectual and temporal) concepts of the French language (le passé composé and l'imparfait), under the influence of previously acquired grammatical knowledge of two other languages: Sinhalese and English. Thus, our research is linked to the domains of psycholinguistics, acquisitional linguistics and comparative linguistics. However, within the framework of this study, we will consider the above-mentioned two French grammatical concepts and their presumed equivalents in the other two languages as concepts belonging to three languages with specific social status [i.e. first language (L1), second language (L2) and foreign language (L3)], taught/learnt/acquired in a particular language teaching/learning context [the context of teaching/learning of French as a foreign language (FFL) in Sri Lanka]. In that sense, our study is also associated with the fields of sociolinguistics and language teaching, especially foreign language teaching. What could probably make this study outstanding is that it studies certain linguistic and didactic issues which have not yet been studied. For example, it examines, among other issues, the following: the influence of two languages (i.e. mother tongue -L1 & second language -L2) on the teaching/learning process of a third language (i.e. foreign language- L3); foreign language teaching and learning in an exolingual context (where the target language is not spoken outside the classroom); the role of language transfers in the process of grammatical notion conceptualization. However, in selecting the FFL teaching/learning context in Sri Lanka as our field of research, we had further objectives in mind : i.e. 1) studying the verb systems of three languages whose combination has never been studied before ; 2) studying the aspectual-temporal formation of the Sinhalese verb system (which is hardly taught explicitly) in the light of the linguistic descriptions of dominant European languages; 3) verifying certain preconceived ideas regarding the proximity and the distance between the three chosen languages, and 4) studying the causes for these preconceptions. Our corpus is obtained from a number of FFL classes in Sri Lanka. The observed student groups consisted of bilingual adolescents and adults whose first language (L1) was Sinhalese and the second language (L2) was English. The observed classes differed in many ways but in each of those classes, a common factor was that the students had been learning some aspect of the two grammatical concepts, le passé composé and l'imparfait. Having completed our study, we now see that a considerable number of our initial hypotheses are proven correct. For example, in the exolingual French language teaching/learning context in Sri Lanka where we carried out our research, language transfers between the first and target languages were recurrent and numerous in the work of the greater majority of the observed language learners, and even their teachers; these transfers were so frequent that they could hardly be ignored during the teaching/learning process ; although learners turned to their first languages to facilitate the learning process of a new language, neither their teachers, nor their text books helped them in this task; the transfers originating from English were far too numerous than those originating from Sinhalese; however, contrary to the popular belief among many Sinhalese learners of French, the contrastive analysis of the three aspectual-temporal verb systems and the study of our corpus helped us in proving that there are common linguistic features between the Sinhalese and the French languages ; at least, when it comes to using some of their past tenses. This is a fact which had been ignored up to now but which could probably be used to improve French teaching/learning in Sri Lanka. Taking all observations into account, we made some pedagogical recommendations in the concluding part of our thesis with the view of improving foreign language teaching/learning in Sri Lanka, and elsewhere.

How are "teaching the teachers" courses in evidence based medicine evaluated? A systematic review.

BACKGROUND: Teaching of evidence-based medicine (EBM) has become widespread in medical education. Teaching the teachers (TTT) courses address the increased teaching demand and the need to improve effectiveness of EBM teaching. We conducted a systematic review of assessment tools for EBM TTT courses.To summarise and appraise existing assessment methods for teaching the teachers courses in EBM by a systematic review. METHODS: We searched PubMed, BioMed, EmBase, Cochrane and Eric databases without language restrictions and included articles that assessed its participants. Study selection and data extraction were conducted independently by two reviewers. RESULTS: Of 1230 potentially relevant studies, five papers met the selection criteria. There were no specific assessment tools for evaluating effectiveness of EBM TTT courses. Some of the material available might be useful in initiating the development of such an assessment tool. CONCLUSION: There is a need for the development of educationally sound assessment tools for teaching the teachers courses in EBM, without which it would be impossible to ascertain if such courses have the desired effect.

Advanced trauma life support, 8th edition, the evidence for change.

The American College of Surgeons Committee on Trauma's Advanced Trauma Life Support Course is currently taught in 50 countries. The 8th edition has been revised following broad input by the International ATLS subcommittee. Graded levels of evidence were used to evaluate and approve changes to the course content. New materials related to principles of disaster management have been added. ATLS is a common language teaching one safe way of initial trauma assessment and management.

Surface deterioration of dental materials after simulated toothbrushing in relation to brushing time and load.

OBJECTIVES: (1) To evaluate the changes in surface roughness and gloss after simulated toothbrushing of 9 composite materials and 2 ceramic materials in relation to brushing time and load in vitro; (2) to assess the relationship between surface gloss and surface roughness. METHODS: Eight flat specimens of composite materials (microfilled: Adoro, Filtek Supreme, Heliomolar; microhybrid: Four Seasons, Tetric EvoCeram; hybrid: Compoglass F, Targis, Tetric Ceram; macrohybrid: Grandio), two ceramic materials (IPS d.SIGN and IPS Empress polished) were fabricated according to the manufacturer's instructions and optimally polished with up to 4000 grit SiC. The specimens were subjected to a toothbrushing (TB) simulation device (Willytec) with rotating movements, toothpaste slurry and at three different loads (100g/250g/350g). At hourly intervals from 1h to 10h TB, mean surface roughness Ra was measured with an optical sensor and the surface gloss (Gl) with a glossmeter. Statistical analysis was performed for log-transformed Ra data applying two-way ANOVA to evaluate the interaction between load and material and load and brushing time. RESULTS: There was a significant interaction between material and load as well as between load and brushing time (p<0.0001). The microhybrid and hybrid materials demonstrated more surface deterioration with higher loads, whereas with the microfilled resins Heliomolar and Adoro it was vice versa. For ceramic materials, no or little deterioration was observed over time and independent of the load. The ceramic materials and 3 of the composite materials (roughness) showed no further deterioration after 5h of toothbrushing. Mean surface gloss was the parameter which discriminated best between the materials, followed by mean surface roughness Ra. There was a strong correlation between surface gloss and surface roughness for all the materials except the ceramics. The evaluation of the deterioration curves of individual specimens revealed a more or less synchronous course suspecting hinting specific external conditions and not showing the true variability in relation to the tested material. SIGNIFICANCE: The surface roughness and gloss of dental materials changes with brushing time and load and thus results in different material rankings. Apart from Grandio, the hybrid composite resins were more prone to surface changes than microfilled composites. The deterioration potential of a composite material can be quickly assessed by measuring surface gloss. For this purpose, a brushing time of 10h (=72,000 strokes) is needed. In further comparative studies, specimens of different materials should be tested in one series to estimate the true variability.