A method of evaluating psychomotor tooth preparation skills in preclinical dental programs

Preclinical and clinical tooth important and significant aspect of preparation is an a dental student's education. The associated procedures rely heavily on the development of particular psychomotor skills. The most common format of instruction and evaluation in tooth preparation at many Dental Faculties, emphasizes the product (tooth preparation) and associates performance with characteristics of this product. This integrated study examines which skills should be developed and how a course of instruction can best be structured to develop the necessary skills. The skills which are identified are those necessary for tooth preparation are selected from a psychomotor taxonomy. The purpose of evaluating these skills is identified. Behavioral objectives are set for student performance and the advisability of establishing standards of performance is examined. After reviewing studies related to learning strategy for dental psychomotor the most suitable tasks as well as articles on instructor effectiveness a model is proposed. A pilot project at the University of Toronto, based on this proposed model is described. The paper concludes wi th a discussion of the implications of this proposed model.

Analytical modelling of bacterial migration and accumulation with rate-limited sorption in discrete fractures

An analytical model for bacterial accumulation in a discrete fractllre has been developed. The transport and accumlllation processes incorporate into the model include advection, dispersion, rate-limited adsorption, rate-limited desorption, irreversible adsorption, attachment, detachment, growth and first order decay botl1 in sorbed and aqueous phases. An analytical solution in Laplace space is derived and nlln1erically inverted. The model is implemented in the code BIOFRAC vvhich is written in Fortran 99. The model is derived for two phases, Phase I, where adsorption-desorption are dominant, and Phase II, where attachment-detachment are dominant. Phase I ends yvhen enollgh bacteria to fully cover the substratllm have accllillulated. The model for Phase I vvas verified by comparing to the Ogata-Banks solution and the model for Phase II was verified by comparing to a nonHomogenous version of the Ogata-Banks solution. After verification, a sensitiv"ity analysis on the inpllt parameters was performed. The sensitivity analysis was condllcted by varying one inpllt parameter vvhile all others were fixed and observing the impact on the shape of the clirve describing bacterial concentration verSllS time. Increasing fracture apertllre allovvs more transport and thus more accllffilliation, "Vvhich diminishes the dllration of Phase I. The larger the bacteria size, the faster the sllbstratum will be covered. Increasing adsorption rate, was observed to increase the dllration of Phase I. Contrary to the aSSllmption ofllniform biofilm thickness, the accllffilliation starts frOll1 the inlet, and the bacterial concentration in aqlleous phase moving towards the olitiet declines, sloyving the accumulation at the outlet. Increasing the desorption rate, redllces the dliration of Phase I, speeding IIp the accllmlilation. It was also observed that Phase II is of longer duration than Phase I. Increasing the attachment rate lengthens the accliffililation period. High rates of detachment speeds up the transport. The grovvth and decay rates have no significant effect on transport, althollgh increases the concentrations in both aqueous and sorbed phases are observed. Irreversible adsorption can stop accllillulation completely if the vallIes are high.

Paragenetic history of the Ordovician Trenton Group carbonates, Southwestern Ontario

Geochemical examination of the rock matrix and cements from core material extracted from four oil wells within southwestern Ontario suggest various stages of diagenetic alteration and preservation of the Trenton Group carbonates. The geochemical compositions of Middle Ordovician (LMC) brachiopods reflect the physicochemical water conditions of the ambient depositional environment. The sediments appear to have been altered in the presence of mixed waters during burial in a relatively open diagenetic microenvironment. Conodont CAl determination suggests that the maturation levels of the Trenton Group carbonates are low and proceeded at temperatures of about 30 - 50°C within the shallow burial environment. The Trenton Group carbonates are characterized by two distinct stages of dolomitization which proceeded at elevated temperatures. Preexisting fracture patterns, and block faulting controlled the initial dolomitization of the precursor carbonate matrix. Dolomitization progressed In the presence of warm fluids (60 75°C) with physicochemical conditions characteristic of a progressively depleted basinal water. The matrix is mostly Idiotopic-S and Idiotopic-E dolomite, with Xenotopic-A dolomite dominating the matrix where fractures occur. The second stage of dolomitization involved hydrothermal basinal fluid(s) with temperatures of about 60 - 70°C. These are the postulated source for the saddle dolomite and blocky calcite cements occurring in pore space and fractures. Rock porosity was partly occluded by Idiotopic-E type dolomite. Late stage saddle dolomite, calcite, anhydrite, pyrite, marcasite and minor sphalerite and celestite cements effectively fill any remaining porosity within specific horizons. Based on cathode luminescence, precipitation of the different diagenetic phases probably proceeded in open diagenetic systems from chemically homogeneous fluids. Ultraviolet fluorescence of 11 the matrix and cements demonstrated that hydrocarbons were present during the earliest formation of saddle dolomite. Oxygen isotope values of -7.6 to -8.5 %0 (PDB), and carbon isotope values of - 0.5 and -3.0 %0 (PDB) from the latest stage dog-tooth calcite cement suggest that meteoric water was introduced into the system during their formation. This is estimated to have occurred at temperatures of about 25 - 40°C. Specific facies associations within the Trenton Group carbonates exhibit good hydrocarbon generating potential based on organic carbon preservation (1-3.5%). Thermal maturation and Lopatin burial-history evaluations suggest that hydrocarbons were generated within the Trenton Group carbonates some time after 300 Ma . Progressively depleted vanadium trends measured from hydrocarbon samples within southwestern Ontario suggests its potential use as a hydrocarbon migration indicator on local (within an oilfield) and on regional scales.

Localización del locus de la enfermedad de Charcot-Marie-Tooth tipo1A : asociación de esta enfermedad con una duplicación de DNA

Tesis (Doctorado en Ciencias con Especialidad en Biología Molecular e Ingeniería Genética) UANL

Évaluation de l'utilisation des agents prévenant la résorption osseuse en situation réelle et impact de la non-adhésion au traitement sur la survenue de fractures ostéoporotiques : l'utilisation et les coûts directs des soins de santé

Thèse diffusée initialement dans le cadre d'un projet pilote des Presses de l'Université de Montréal/Centre d'édition numérique UdeM (1997-2008) avec l'autorisation de l'auteur.

Indirect Bonding Method: in vitro Comparison of the Shear Bond Strength between Metallic Orthodontic Brackets and Different Porcelain Surface Preparations

Introduction : La force d’adhésion à l'interface métal-céramique avec les résines auto-polymérisantes destinées au collage indirect des boîtiers orthodontiques n'a pas été évaluée à ce jour et un protocole clinique basé sur la littérature scientifique est inexistant. Objectifs : 1) Comparer la force de cisaillement maximale entre des boîtiers métalliques et des surfaces en porcelaine préparées selon différentes méthodes; 2) Suggérer un protocole clinique efficace et prévisible. Matériel et méthodes : Quatre-vingt-dix disques en leucite (6 groupes; n = 15/groupe) ont été préparés selon 6 combinaisons de traitements de surface : mécaniques (+ / - fraisage pour créer les rugosités) et chimiques (acide fluorhydrique, apprêt, silane). Des bases en résine composite Transbond XT (3M Unitek, Monrovia, California) faites sur mesure ont été collées avec le système de résine adhésive auto-polymérisante Sondhi A + B Rapid Set (3M Unitek, Monrovia, California). Les échantillons ont été préservés (H2O/24hrs), thermocyclés (500 cycles) et testés en cisaillement (Instron, Norwood, Massachusetts). Des mesures d’Index d’adhésif résiduel (IAR) ont été compilées. Des tests ANOVAs ont été réalisés sur les rangs étant donné que les données suivaient une distribution anormale et ont été ajustés selon Tukey. Un Kruskall-Wallis, U-Mann Whitney par comparaison pairée et une analyse de Weibull ont aussi été réalisés. Résultats : Les médianes des groupes varient entre 17.0 MPa (- fraisage + acide fluorhydrique) à 26.7 MPa (- fraisage + acide fluorhydrique + silane). Le fraisage en surface ne semble pas affecter l’adhésion. La combinaison chimique (- fraisage + silane + apprêt) a démontré des forces de cisaillement significativement plus élevées que le traitement avec (- fraisage + acide fluorhydrique), p<0,05, tout en possédant des forces similaires au protocole typiquement suggéré à l’acide fluorhydrique suivi d’une application de silane, l’équivalence de (- fraisage + acide fluorhydrique + silane). Les mesures d’IAR sont significativement plus basses dans le groupe (- fraisage + acide fluorhydrique) en comparaison avec celles des 5 autres groupes, avec p<0,05. Malheureusement, ces 5 groupes ont des taux de fracture élévés de 80 à 100% suite à la décimentation des boîtiers. Conclusion : Toutes les combinaisons de traitement de surface testées offrent une force d’adhésion cliniquement suffisante pour accomplir les mouvements dentaires en orthodontie. Une application de silane suivie d’un apprêt est forte intéressante, car elle est simple à appliquer cliniquement tout en permettant une excellente adhésion. Il faut cependant avertir les patients qu’il y a un risque de fracture des restorations en céramique lorsque vient le moment d’enlever les broches. Si la priorité est de diminuer le risque d’endommager la porcelaine, un mordançage seul à l’acide hydrofluorique sera suffisant.

Isolated greater tuberosity fractures of the proximal humerus : validation and clinical implications for a new radiologic measurement method and classification

Pre-publication drafts are reproduced with permission and copyright © 2013 of the Journal of Orthopaedic Trauma [Mutch J, Rouleau DM, Laflamme GY, Hagemeister N. Accurate Measurement of Greater Tuberosity Displacement without Computed Tomography: Validation of a method on Plain Radiography to guide Surgical Treatment. J Orthop Trauma. 2013 Nov 21: Epub ahead of print.] and copyright © 2014 of the British Editorial Society of Bone and Joint Surgery [Mutch JAJ, Laflamme GY, Hagemeister N, Cikes A, Rouleau DM. A new morphologic classification for greater tuberosity fractures of the proximal humerus: validation and clinical Implications. Bone Joint J 2014;96-B:In press.]

Concordance entre les interventions de l’infirmière et de médecins spécialistes dans la prise en charge des fractures de fragilisation

Introduction. L’ostéoporose est une maladie chronique habituellement asymptomatique jusqu’à ce qu’il y ait fracture de fragilisation (FF). Ces fractures engendrent des coûts importants dont une partie pourrait être évitée par la prise en charge de ces patients pour l’ostéoporose. L’implantation d’un programme de prévention des fractures subséquentes géré par des infirmières en orthopédie pourrait permettre de parer à ces problèmes. Objectifs. L’objectif principal de ce projet était de déterminer si une infirmière peut gérer de façon efficace et sécuritaire un service de liaison pour fracture. Méthode. Les décisions cliniques d’infirmières entre 2010 et 2012 pour 525 patients d’un service de liaison pour fracture à l’étude ont été évaluées par deux médecins spécialistes indépendants avec expertise dans les soins pour l’ostéoporose. Résultats. Les infirmières ont pu identifier la totalité des sujets à risque et référer 26.7% de ceux-ci à un spécialiste. L’accord entre chacun des évaluateurs et les infirmières était de >97%. Les évaluateurs ont donné les mêmes réponses à >96% pour chaque type de décision et le niveau d’accord inter-juge était presque parfait (AC1 >0.960). Aucune référence n’a été jugée inutile. Les comorbidités majeures ont toutes été prises en charge. Conclusion. L’accord élevé entre les décisions cliniques des infirmières et des médecins évaluateurs démontre que la prise en charge par une infirmière est sécuritaire et recommandable pour les patients avec FF. Ce type d’intervention pourrait contribuer à résoudre les problèmes d’accessibilité aux soins chez les patients avec fragilité osseuse, ainsi qu’à diminuer le fardeau économique que représente le traitement des FF pour la société.

Spectroscopic Investigation of Tooth Caries and Demineralization

Dental caries persists to be the most predominant oral disease in spite of remarkable progress made during the past half- century to reduce its prevalence. Early diagnosis of carious lesions is an important factor in the prevention and management of dental caries. Conventional procedures for caries detection involve visual-tactile and radiographic examination, which is considered as “gold standard”. These techniques are subjective and are unable to detect the lesions until they are well advanced and involve about one-third of the thickness of enamel. Therefore, all these factors necessitate the need for the development of new techniques for early diagnosis of carious lesions. Researchers have been trying to develop various instruments based on optical spectroscopic techniques for detection of dental caries during the last two decades. These optical spectroscopic techniques facilitate noninvasive and real-time tissue characterization with reduced radiation exposure to patient, thereby improving the management of dental caries. Nonetheless, a costeffective optical system with adequate sensitivity and specificity for clinical use is still not realized and development of such a system is a challenging task.Two key techniques based on the optical properties of dental hard tissues are discussed in this current thesis, namely laser-induced fluorescence (LIF) and diffuse reflectance (DR) spectroscopy for detection of tooth caries and demineralization. The work described in this thesis is mainly of applied nature, focusing on the analysis of data from in vitro tooth samples and extending these results to diagnose dental caries in a clinical environment. The work mainly aims to improve and contribute to the contemporary research on fluorescence and diffuse reflectance for discriminating different stages of carious lesions. Towards this, a portable and compact laser-induced fluorescence and reflectance spectroscopic system (LIFRS) was developed for point monitoring of fluorescence and diffuse reflectance spectra from tooth samples. The LIFRS system uses either a 337 nm nitrogen laser or a 404 nm diode laser for the excitation of tooth autofluorescence and a white light source (tungsten halogen lamp) for measuring diffuse reflectance.Extensive in vitro studies were carried out on extracted tooth samples to test the applicability of LIFRS system for detecting dental caries, before being tested in a clinical environment. Both LIF and DR studies were performed for diagnosis of dental caries, but special emphasis was given for early detection and also to discriminate between different stages of carious lesions. Further the potential of LIFRS system in detecting demineralization and remineralization were also assessed.In the clinical trial on 105 patients, fluorescence reference standard (FRS) criteria was developed based on LIF spectral ratios (F500/F635 and F500/F680) to discriminate different stages of caries and for early detection of dental caries. The FRS ratio scatter plots developed showed better sensitivity and specificity as compared to clinical and radiographic examination, and the results were validated with the blindtests. Moreover, the LIF spectra were analyzed by curve-fitting using Gaussian spectral functions and the derived curve-fitted parameters such as peak position, Gaussian curve area, amplitude and width were found to be useful for distinguishing different stages of caries. In DR studies, a novel method was established based on DR ratios (R500/R700, R600/R700 and R650/R700) to detect dental caries with improved accuracy. Further the diagnostic accuracy of LIFRS system was evaluated in terms of sensitivity, specificity and area under the ROC curve. On the basis of these results, the LIFRS system was found useful as a valuable adjunct to the clinicians for detecting carious lesions.

Factors associated to avascular necrosis of the femoral head and non-union in patients younger than 65 years old with displaced femoral neck fractures treated with reduction and internal fixation.

Pocos estudios han evaluado el tratamiento de las fracturas desplazadas de cuello femoral en pacientes menores de 65 años de edad, y no han sido claramente definidos los factores de riesgo para necrosis avascular o no-unión dentro de este rango de edad. Para determinar los factores asociados a la necrosis avascular de la cabeza femoral (AVN) y no-unión en pacientes menores de 65 años de edad con fracturas desplazadas del cuello femoral tratados con reducción y fijación interna, se realizó un estudio retrospectivo de 29 fracturas desplazadas del cuello femoral en 29 pacientes consecutivos tratados en una sola institución. La influencia de la edad, la energía del trauma, tipo de reducción, y el tiempo entre la fractura y el tratamiento en desarrollo de la AVN y no-unión fueron evaluados. Los pacientes que desarrollaron NAV fueron significativamente mayores y sufrieron un trauma de más baja energía que en los casos sin AVN. Ninguna variable fue asociada con la no-unión. La regresión logística determinó que sólo la edad se asoció de forma independiente a NAV. La edad es un buen predictor para el desarrollo de NAV, con un C-estadístico de 0.861, y un mejor corte-determinado en 53,5 años. Conclusión: Los pacientes de entre 53,5 y 65 años presentan un riesgo más alto de NAV. La artroplastia primaria se debe considerar en este subgrupo.

Cosim fractures

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Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses

OBJECTIVES: To evaluate the evidence for strategies to prevent falls or fractures in residents in care homes and hospital inpatients and to investigate the effect of dementia and cognitive impairment. DESIGN: Systematic review and meta-analyses of studies grouped by intervention and setting (hospital or care home). Meta-regression to investigate the effects of dementia and of study quality and design. DATA SOURCES: Medline, CINAHL, Embase, PsychInfo, Cochrane Database, Clinical Trials Register, and hand searching of references from reviews and guidelines to January 2005. RESULTS: 1207 references were identified, including 115 systematic reviews, expert reviews, or guidelines. Of the 92 full papers inspected, 43 were included. Meta-analysis for multifaceted interventions in hospital (13 studies) showed a rate ratio of 0.82 (95% confidence interval 0.68 to 0.997) for falls but no significant effect on the number of fallers or fractures. For hip protectors in care homes (11 studies) the rate ratio for hip fractures was 0.67 (0.46 to 0.98), but there was no significant effect on falls and not enough studies on fallers. For all other interventions (multifaceted interventions in care homes; removal of physical restraints in either setting; fall alarm devices in either setting; exercise in care homes; calcium/vitamin D in care homes; changes in the physical environment in either setting; medication review in hospital) meta-analysis was either unsuitable because of insufficient studies or showed no significant effect on falls, fallers, or fractures, despite strongly positive results in some individual studies. Meta-regression showed no significant association between effect size and prevalence of dementia or cognitive impairment. CONCLUSION: There is some evidence that multifaceted interventions in hospital reduce the number of falls and that use of hip protectors in care homes prevents hip fractures. There is insufficient evidence, however, for the effectiveness of other single interventions in hospitals or care homes or multifaceted interventions in care homes.

A review of vertebroplasty for osteoporotic and malignant vertebral compression fractures

Vertebral compression fractures are a common clinical problem and the incidence of them will increase with the ageing population. Traditionally management has been conservative; however, there has been a growing trend towards vertebroplasty as an alternative therapy in patients with persisting severe pain. NICE produced guidance in 2003 recommending the procedure after 4 weeks of conservative management. Recent high-quality studies have been contradictory and there is currently a debate surrounding the role of the procedure with no agreement in the literature. We examine the evidence in both osteoporotic and malignant vertebral compression fractures; we also describe the benefits and side effects, alternative treatment options and the cost of the procedure. Finally, we recommend when vertebroplasty is most appropriately used based on the best available evidence.

A refined sampling strategy for intra-tooth stable isotope analysis of mammalian enamel

Serial sampling and stable isotope analysis performed along the growth axis of vertebrate tooth enamel records differences attributed to seasonal variation in diet, climate or animal movement. Because several months are required to obtain mature enamel in large mammals, modifications in the isotopic composition of environmental parameters are not instantaneously recorded, and stable isotope analysis of tooth enamel returns a time-averaged signal attenuated in its amplitude relative to the input signal. For convenience, stable isotope profiles are usually determined on the side of the tooth where enamel is thickest. Here we investigate the possibility of improving the time resolution by targeting the side of the tooth where enamel is thinnest. Observation of developing third molars (M3) in sheep shows that the tooth growth rate is not constant but decreases exponentially, while the angle between the first layer of enamel deposited and the enamel–dentine junction increases as a tooth approaches its maximal length. We also noted differences in thickness and geometry of enamel growth between the mesial side (i.e., the side facing the M2) and the buccal side (i.e., the side facing the cheek) of the M3. Carbon and oxygen isotope variations were measured along the M3 teeth from eight sheep raised under controlled conditions. Intra-tooth variability was systematically larger along the mesial side and the difference in amplitude between the two sides was proportional to the time of exposure to the input signal. Although attenuated, the mesial side records variations in the environmental signal more faithfully than the buccal side. This approach can be adapted to other mammals whose teeth show lateral variation in enamel thickness and could potentially be used as an internal check for diagenesis.