Cost Effectiveness of Tooth Replacement Strategies for Partially Dentate Elders

Objectives: This study aimed to compare the cost effectiveness of conventional treatment using partial dentures with functionally-orientated treatment based on the shortened dental arch concept to replace missing teeth for partially dentate elders.
Methods: 44 partially dentate patients aged 65 years and older were recruited following routine dental assessment at a university dental hospital. Patients consented to and were randomly assigned to the two treatment arms. The conventional treatment group received a removable partial denture to replace all missing natural teeth. The functionally-orientated group were restored to a shortened dental arch of 10 occluding contacts using resin bonded bridgework. The costs associated with each treatment were recorded including laboratory charges, treatment time and opportunity costs. The impact on quality of life (OHRQoL) was measured using the 14-item Oral Health Impact Profile.
Results: Both groups reported improvements in OHRQoL after completion of treatment. For the conventional group, the mean OHIP-14 score decreased from 12.4 pre-operatively to 3.3 post-operatively (p<0.001). In the functionally-orientated group the OHIP-14 score decreased from 11.4 to 1.8 following treatment (p<0.001). On average the conventional treatment group required 8.3 clinic visits as compared to 4.4 visits for the functionally-orientated group. The mean total treatment time was 183 minutes 19 seconds for the conventional group versus 124 minutes 8 seconds for the functionally-orientated group. The conventional treatment group had an average of 6.33 teeth replaced at a laboratory cost of 337.31 Euros. The functionally-orientated group had an average of 2.64 teeth replaced at a laboratory cost of 244.05 Euros.
Conclusions: Restoration to a shortened dental arch using functionally-orientated treatment resulted in a similar improvement in OHRQoL with fewer clinic visits, less operative time and at a lower laboratory cost compared with conventional treatment.

An Adaptive Predictive Control Strategy for RMPPT under Partially Shaded Conditions

As one of key technologies in photovoltaic converter control, Maximum Power Point Tracking (MPPT) methods can keep the power conversion efficiency as high as nearly 99% under the uniform solar irradiance condition. However, these methods may fail when shading conditions occur and the power loss can over as much as 70% due to the multiple maxima in curve in shading conditions v.s. single maximum point in uniformly solar irradiance. In this paper, a Real Maximum Power Point Tracking (RMPPT) strategy under Partially Shaded Conditions (PSCs) is introduced to deal with this kind of problems. An optimization problem, based on a predictive model which will change adaptively with environment, is developed to tracking the global maxima and corresponding adaptive control strategy is presented. No additional circuits are required to obtain the environment uncertainties. Finally, simulations show the effectiveness of proposed method.

Oral rehabilitation for partially dentate elders: a qualitative analysis

Aims: This study aimed to gain insight into patient’s perceptions of natural tooth loss and explored their experiences of oral rehabilitation according to a functionally orientated approach (SDA) and Removable Partial Dentures (RPD).
Study Design: For this qualitative study, a purposive sample of 15 partially dentate older patients
were recruited from Cork Dental School and Hospital. These patients had previously participated in a randomised controlled clinical trial (RCT) where they were provided with either SDA treatment using adhesive bridgework or provided with Cobalt Chromium framework RPDs. In- depth interviews were undertaken and thematic analysis was utilised to interpret the data.
Results: The findings of this study indicated strong satisfaction with SDA treatment. Patients referred to the ease in which they adapted to the adhesive prostheses as they were “lightweight”, “neat” and “fixed”. Irrespective of treatment option, patients indicated that they felt
their new prostheses were durable and an improvement on previous treatments. Most patients indicated that, previous to the RCT, they had not attended a general dentist for a number of years and only then for acute issues. They had concerns that treatment which was provided to them as part of the RCT would not be available to them in primary care. Interestingly, although they do not want their condition to dis-improve, if their prostheses failed they stated that they would not seek alternative treatment but would revert back
to adopting previous coping mechanisms.
Conclusion: This study illustrates that partially dentate older patients were very satisfied with oral rehabilitation according to a functionally orientated approach. Unfortunately they did not believe that this treatment would currently be made available to them in a primary care setting.

Tooth replacement for partially dentate elders: a willingness-to-pay analysis

Objectives: The primary aim of this study was to investigate partially dentate elders’ willingness-to-pay (WTP) for two different tooth replacement strategies: using Removable Partial Dentures (RPDs) and, functionally orientated treatment (SDA). The secondary aim was to measure the same patient group’s WTP for dental implants. Methods: Patients who had completed a previous RCT comparing two tooth replacement strategies (RPDs and SDA) were recruited. 59 patients were asked to indicate their WTP for treatment to replace missing teeth in a number of hypothetical scenarios using the payment card method of contingency evaluation coupled to different costs. Data were collected on patients’ social class, longest held occupation, income levels and social circumstances. Results: The median age for the patient sample was 72.0 years (IQR: 71-75 years). Patients who had previously been provided with RPDs indicated that their WTP for this treatment strategy was significantly higher than those patients who had received SDA treatment (Mann-Whitney U Test: p<0.001). This group were also WTP a higher price for SDA treatment than those patients who had previously been treated according to this modality (Mann-Whitney U Test: p=0.005). The results indicated that patients’ age was not correlated with WTP but both social class and current income levels were significantly correlated (Spearman’s rank correlation: p<0.05). Patients in both treatment groups exhibited llittle WTP for dental implant treatment with a median price recorded which was lower than either RPD or SDA treatment. Conclusions: Amongst this patient cohort previous treatment experience had a strong influence on WTP as did social class and current income levels. The patients’ WTP indicated that they did not value dental implants over simpler forms of tooth replacement such as RPDs or a SDA approach.

Tooth replacement for partially dentate elders: a willingness-to-pay analysis

Objectives: The primary aim of this study was to investigate partially dentate elders’ willingness-to-pay (WTP) for two different tooth replacement strategies: using Removable Partial Dentures (RPDs) and, functionally orientated treatment (SDA). The secondary aim was to measure the same patient group’s WTP for dental implants.Methods: Patients who had completed a previous RCT comparing two tooth replacement strategies (RPDs and SDA) were recruited. 59 patients were asked to indicate their WTP for treatment to replace missing teeth in a number of hypothetical scenarios using the payment card method of contingency evaluation coupled to different costs. Data were collected on patients’ social class, longest held occupation, income levels and social circumstances.Results: The median age for the patient sample was 72.0 years (IQR: 71-75 years). Patients who had previously been provided with RPDs indicated that their WTP for this treatment strategy was significantly higher than those patients who had received SDA treatment (Mann-Whitney U Test: p<0.001). This group were also WTP a higher price for SDA treatment than those patients who had previously been treated according to this modality (Mann-Whitney U Test: p=0.005). The results indicated that patients’ age was not correlated with WTP but both social class and current income levels were significantly correlated (Spearman’s rank correlation: p<0.05).Patients in both treatment groups exhibited llittle WTP for dental implant treatment with a median price recorded which was lower than either RPD or SDA treatment.Conclusions: Amongst this patient cohort previous treatment experience had a strong influence on WTP as did social class and current income levels. The patients’ WTP indicated that they did not value dental implants over simpler forms of tooth replacement such as RPDs or a SDA approach.

Partially Ordered Preferences in Decision Trees: Computing Strategies with Imprecision in Probabilities

Partially ordered preferences generally lead to choices that do not abide by standard expected utility guidelines; often such preferences are revealed by imprecision in probability values. We investigate five criteria for strategy selection in decision trees with imprecision in probabilities: “extensive” Γ-maximin and Γ-maximax, interval dominance, maximality and E-admissibility. We present algorithms that generate strategies for all these criteria; our main contribution is an algorithm for Eadmissibility that runs over admissible strategies rather than over sets of probability distributions.

Addiction to Runx1 is partially attenuated by loss of p53 in the Eµ-Myc lymphoma model

The Runx genes function as dominant oncogenes that collaborate potently with Myc or loss of p53 to induce lymphoma when over-expressed. Here we examined the requirement for basal Runx1 activity for tumor maintenance in the Eµ-Myc model of Burkitt's lymphoma. While normal Runx1fl/fl lymphoid cells permit mono-allelic deletion, primary Eµ-Myc lymphomas showed selection for retention of both alleles and attempts to enforce deletion in vivo led to compensatory expansion of p53null blasts retaining Runx1. Surprisingly, Runx1 could be excised completely from established Eµ-Myc lymphoma cell lines in vitro without obvious effects on cell phenotype. Established lines lacked functional p53, and were sensitive to death induced by introduction of a temperature-sensitive p53 (Val135) allele. Transcriptome analysis of Runx1-deleted cells revealed a gene signature associated with lymphoid proliferation, survival and differentiation, and included strong de-repression of recombination-activating (Rag) genes, an observation that was mirrored in a panel of human acute leukemias where RUNX1 and RAG1,2 mRNA expression were negatively correlated. Notably, despite their continued growth and tumorigenic potential, Runx1null lymphoma cells displayed impaired proliferation and markedly increased sensitivity to DNA damage and dexamethasone-induced apoptosis, validating Runx1 function as a potential therapeutic target in Myc-driven lymphomas regardless of their p53 status.

Host-symbiont interactions in the deep-sea vent mussel Bathymodiolus azoricus : a molecular approach

Tese de Doutoramento, Ciências do Mar, especialidade de Biologia Marinha, 19 de Dezembro de 2015, Universidade dos Açores.

BTLA mediates inhibition of human tumor-specific CD8+ T cells that can be partially reversed by vaccination.

The function of antigen-specific CD8+ T cells, which may protect against both infectious and malignant diseases, can be impaired by ligation of their inhibitory receptors, which include CTL-associated protein 4 (CTLA-4) and programmed cell death 1 (PD-1). Recently, B and T lymphocyte attenuator (BTLA) was identified as a novel inhibitory receptor with structural and functional similarities to CTLA-4 and PD-1. BTLA triggering leads to decreased antimicrobial and autoimmune T cell responses in mice, but its functions in humans are largely unknown. Here we have demonstrated that as human viral antigen-specific CD8+ T cells differentiated from naive to effector cells, their surface expression of BTLA was gradually downregulated. In marked contrast, human melanoma tumor antigen-specific effector CD8+ T cells persistently expressed high levels of BTLA in vivo and remained susceptible to functional inhibition by its ligand herpes virus entry mediator (HVEM). Such persistence of BTLA expression was also found in tumor antigen-specific CD8+ T cells from melanoma patients with spontaneous antitumor immune responses and after conventional peptide vaccination. Remarkably, addition of CpG oligodeoxynucleotides to the vaccine formulation led to progressive downregulation of BTLA in vivo and consequent resistance to BTLA-HVEM-mediated inhibition. Thus, BTLA activation inhibits the function of human CD8+ cancer-specific T cells, and appropriate immunotherapy may partially overcome this inhibition.

T Cell Priming by Activated Nlrc5-Deficient Dendritic Cells Is Unaffected despite Partially Reduced MHC Class I Levels.

NLRC5, a member of the NOD-like receptor (NLR) protein family, has recently been characterized as the master transcriptional regulator of MHCI molecules in lymphocytes, in which it is highly expressed. However, its role in activated dendritic cells (DCs), which are instrumental to initiate T cell responses, remained elusive. We show in this study that, following stimulation of DCs with inflammatory stimuli, not only did NLRC5 level increase, but also its importance in directing MHCI transcription. Despite markedly reduced mRNA and intracellular H2-K levels, we unexpectedly observed nearly normal H2-K surface display in Nlrc5(-/-) DCs. Importantly, this discrepancy between a strong intracellular and a mild surface defect in H2-K levels was observed also in DCs with H2-K transcription defects independent of Nlrc5. Hence, alongside with demonstrating the importance of NLRC5 in MHCI transcription in activated DCs, we uncover a general mechanism counteracting low MHCI surface expression. In agreement with the decreased amount of neosynthesized MHCI, Nlrc5(-/-) DCs exhibited a defective capacity to display endogenous Ags. However, neither T cell priming by endogenous Ags nor cross-priming ability was substantially affected in activated Nlrc5(-/-) DCs. Altogether, these data show that Nlrc5 deficiency, despite significantly affecting MHCI transcription and Ag display, is not sufficient to hinder T cell activation, underlining the robustness of the T cell priming process by activated DCs.

Simultaneous extraction of order parameters and orientational distribution fuctions from 31[superscript]P NMR spectra of magnetically partially oriented phospholipid bilayers

Order parameter profiles extracted from the NMR spectra of model membranes are a valuable source of information about their structure and molecular motions. To al1alyze powder spectra the de-Pake-ing (numerical deconvolution) ~echnique can be used, but it assumes a random (spherical) dist.ribution of orientations in the sample. Multilamellar vesicles are known to deform and orient in the strong magnetic fields of NMR magnets, producing non-spherical orientation distributions. A recently developed technique for simultaneously extracting the anisotropies of the system as well as the orientation distributions is applied to the analysis of partially magnetically oriented 31p NMR spectra of phospholipids. A mixture of synthetic lipids, POPE and POPG, is analyzed to measure distortion of multilamellar vesicles in a magnetic field. In the analysis three models describing the shape of the distorted vesicles are examined. Ellipsoids of rotation with a semiaxis ratio of about 1.14 are found to provide a good approximation of the shape of the distorted vesicles. This is in reasonable agreement with published experimental work. All three models yield clearly non-spherical orientational distributions, as well as a precise measure of the anisotropy of the chemical shift. Noise in the experimental data prevented the analysis from concluding which of the three models is the best approximation. A discretization scheme for finding stability in the algorithm is outlined

Developing a numerical inverse-theory-based extraction of orientation-dependent relaxation rates from partially- relaxed spectra

Second-rank tensor interactions, such as quadrupolar interactions between the spin- 1 deuterium nuclei and the electric field gradients created by chemical bonds, are affected by rapid random molecular motions that modulate the orientation of the molecule with respect to the external magnetic field. In biological and model membrane systems, where a distribution of dynamically averaged anisotropies (quadrupolar splittings, chemical shift anisotropies, etc.) is present and where, in addition, various parts of the sample may undergo a partial magnetic alignment, the numerical analysis of the resulting Nuclear Magnetic Resonance (NMR) spectra is a mathematically ill-posed problem. However, numerical methods (de-Pakeing, Tikhonov regularization) exist that allow for a simultaneous determination of both the anisotropy and orientational distributions. An additional complication arises when relaxation is taken into account. This work presents a method of obtaining the orientation dependence of the relaxation rates that can be used for the analysis of the molecular motions on a broad range of time scales. An arbitrary set of exponential decay rates is described by a three-term truncated Legendre polynomial expansion in the orientation dependence, as appropriate for a second-rank tensor interaction, and a linear approximation to the individual decay rates is made. Thus a severe numerical instability caused by the presence of noise in the experimental data is avoided. At the same time, enough flexibility in the inversion algorithm is retained to achieve a meaningful mapping from raw experimental data to a set of intermediate, model-free

Multipole Theory Analysis of Cutoff Wavenumbers of Waveguides Partially Filled with Dielectric

A new approach, the multipole theory (MT) method, is presented for the computation of cutoff wavenumbers of waveguides partially filled with dielectric. The MT formulation of the eigenvalue problem of an inhomogeneous waveguide is derived. Representative computational examples, including dielectric-rod-loaded rectangular and double-ridged waveguides, are given to validate the theory, and to demonstrate the degree of its efficiency

GABA and 5-HT chitosan nanoparticles enhanced liver cell proliferation and neuronal survival in partially hepatectomised rats: GABAB and 5-HT2A receptors functional

Nanoparticulate drug delivery systems provide wide opportunities for solving problems associated with drug stability or disease states and create great expectations in the area of drug delivery (Bosselmann & Williams, 2012). Nanotechnology, in a simple way, explains the technology that deals with one billionth of a meter scale (Ochekpe, et al., 2009). Fewer side effects, poor bioavailability, absorption at intestine, solubility, specific delivery to site of action with good pharmacological efficiency, slow release, degradation of drug and effective therapeutic outcome, are the major challenges faced by most of the drug delivery systems. To a great extent, biopolymer coated drug delivery systems coupled with nanotechnology alleviate the major drawbacks of the common delivery methods. Chitosan, deacetylated chitin, is a copolymer of β-(1, 4) linked glucosamine (deacetylated unit) and N- acetyl glucosamine (acetylated unit) (Radhakumary et al., 2005). Chitosan is biodegradable, non-toxic and bio compatible. Owing to the removal of acetyl moieties that are present in the amine functional groups of chitin, chitosan is readily soluble in aqueous acidic solution. The solubilisation occurs through the protonation of amino groups on the C-2 position of D-glucosamine residues whereby polysaccharide is converted into polycation in acidic media. Chitosan interacts with many active compounds due to the presence of amine group in it. The presence of this active amine group in chitosan was exploited for the interaction with the active molecules in the present study. Nanoparticles of chitosan coupled drugs are utilized for drug delivery in eye, brain, liver, cancer tissues, treatment of spinal cord injury and infections (Sharma et al., 2007; Li, et a., 2009; Paolicelli et al., 2009; Cho et al., 2010). To deliver drugs directly to the intended site of action and to improve pharmacological efficiency by minimizing undesired side effects elsewhere in the body and decrease the long-term use of many drugs, polymeric drug delivery systems can be used (Thatte et al., 2005).