Prognostic factors in apical surgery with root-end filling: a meta-analysis

INTRODUCTION: Apical surgery has seen continuous development with regard to equipment and surgical technique. However, there is still a shortage of evidence-based information regarding healing determinants. The objective of this meta-analysis was to review clinical articles on apical surgery with root-end filling in order to assess potential prognostic factors. METHODS: An electronic search of PubMed and Cochrane databases was performed in 2008. Only studies with clearly defined healing criteria were included, and data for at least two categories per prognostic factor had to be reported. Prognostic factors were divided into patient-related, tooth-related, or treatment-related factors. The reported percentages of healed teeth ("the healed rate") were pooled per category. The statistical method of Mantel-Haenszel was applied to estimate the odds ratios and their 95% confidence intervals. RESULTS: With regard to tooth-related factors, the following categories were significantly associated with higher healed rates: cases without preoperative pain or signs, cases with good density of root canal filling, and cases with absence or size < or = 5 mm of periapical lesion. With regard to treatment-related factors, cases treated with the use of an endoscope tended to have higher healed rates than cases without the use of an endoscope. CONCLUSIONS: Although the clinician may be able to control treatment-related factors (by choosing a certain technique), patient- and tooth-related factors are usually beyond the surgeon's power. Nevertheless, patient- and tooth-related factors should be considered as important prognostic determinants when planning or weighing apical surgery against treatment alternatives.

Distribution of radiodense contrast medium after perineural injection of the palmar and palmar metacarpal nerves (low 4-point nerve block): an in vivo and ex vivo study in horses

REASONS FOR PERFORMING STUDY: Evidence-based information is limited on distribution of local anaesthetic solution following perineural analgesia of the palmar (Pa) and palmar metacarpal (PaM) nerves in the distal aspect of the metacarpal (Mc) region ('low 4-point nerve block'). OBJECTIVES: To demonstrate the potential distribution of local anaesthetic solution after a low 4-point nerve block using a radiographic contrast model. METHODS: A radiodense contrast medium was injected subcutaneously over the medial or the lateral Pa nerve at the junction of the proximal three-quarters and distal quarter of the Mc region (Pa injection) and over the ipsilateral PaM nerve immediately distal to the distal aspect of the second or fourth Mc bones (PaM injection) in both forelimbs of 10 mature horses free from lameness. Radiographs were obtained 0, 10 and 20 min after injection and analysed subjectively and objectively. Methylene blue and a radiodense contrast medium were injected in 20 cadaver limbs using the same techniques. Radiographs were obtained and the limbs dissected. RESULTS: After 31/40 (77.5%) Pa injections, the pattern of the contrast medium suggested distribution in the neurovascular bundle. There was significant proximal diffusion with time, but the main contrast medium patch never progressed proximal to the mid-Mc region. The radiological appearance of 2 limbs suggested that contrast medium was present in the digital flexor tendon sheath (DFTS). After PaM injections, the contrast medium was distributed diffusely around the injection site in the majority of the limbs. In cadaver limbs, after Pa injections, the contrast medium and the dye were distributed in the neurovascular bundle in 8/20 (40%) limbs and in the DFTS in 6/20 (30%) of limbs. After PaM injections, the contrast and dye were distributed diffusely around the injection site in 9/20 (45%) limbs and showed diffuse and tubular distribution in 11/20 (55%) limbs. CONCLUSIONS AND POTENTIAL RELEVANCE: Proximal diffusion of local anaesthetic solution after a low 4-point nerve block is unlikely to be responsible for decreasing lameness caused by pain in the proximal Mc region. The DFTS may be penetrated inadvertently when performing a low 4-point nerve block.

What can be gained from comprehensive disaggregate surveillance? The Avon Surveillance System for Sexually Transmitted Infections

OBJECTIVE: To describe a new disaggregate surveillance system covering key diagnosed sexually transmitted infections in a UK locality. METHODS: The Avon System for Surveillance of Sexually Transmitted Infections (ASSIST) collects computerised person- and episode-based information about laboratory-diagnosed sexually transmitted infections from genitourinary medicine (GUM) clinics, the Avon Brook Clinic, and the Health Protection Agency and trust laboratories in primary care trusts in Avon. The features of the system are illustrated here, by describing chlamydia-testing patterns according to the source of test, age and sex, and by mapping the distribution of chlamydia across Bristol, UK. RESULTS: Between 2000 and 2004, there were 821,685 records of tests for sexually transmitted infections, with 23,542 positive results. The proportion of tests and positive results for chlamydia and gonorrhoea sent from general practice increased over time. Most chlamydia tests in both GUM and non-specialist settings were performed on women aged >25 years, but positivity rates were highest in women aged <25 years. The positivity rate remained stable between 2000 and 2004. Including data from all diagnostic settings, chlamydia rates were about twice as high as those estimated only from genitourinary clinic cases. CONCLUSIONS: The ASSIST model could be a promising new tool for planning and measuring sexual health services in England if it can become sustainable and provide more timely data using fewer resources. Collecting denominator data and including infections diagnosed in primary care are essential for meaningful surveillance.

The Internet and the oral healthcare professionals: potential and challenges of a new era

The Internet is increasingly used as a means of continuous education for healthcare practitioners. At the same time, a rapidly growing number of patients rely on the Internet for the search and acquisition of healthcare-related information and services. This fact has introduced new challenges for the oral healthcare personnel, which must not only often face the misperceptions of ill-informed patients but also be able to redirect them to quality sources of healthcare-related information. Consequently, there is a great need for the whole oral healthcare team to further understand the potential and dangers of Internet-based information. The present paper aimed to briefly discuss the major implications of Internet use from two distinct points of view: (a) potential and risks of Internet use for lifelong learning and quality assessment of the oral healthcare team and (b) potential and dangers from the Internet as a means of patients' education. (1) generic Internet search; (2) search within healthcare-related databases; and (3) principles quality assessment of information and resources.

How to Tango: a manual for implementing Spine Tango

The generic approach of the Spine Tango documentation system, which uses web-based technologies, is a necessity for reaching a maximum number of participants. This, in turn, reduces the potential for customising the Tango according to the individual needs of each user. However, a number of possibilities still exist for tailoring the data collection processes to the user's own hospital workflow. One can choose between a purely paper-based set-up (with in-house scanning, data punching or mailing of forms to the data centre at the University of Bern) and completely paper-free online data entry. Many users work in a hybrid mode with online entry of surgical data and paper-based recording of the patients' perspectives using the Core Outcome Measures Index (COMI) questionnaires. Preoperatively, patients can complete their questionnaires in the outpatient clinic at the time of taking the decision about surgery or simply at the time of hospitalisation. Postoperative administration of patient data can involve questionnaire completion in the outpatient clinic, the handing over the forms at the time of discharge for their mailing back to the hospital later, sending out of questionnaires by post with a stamped addressed envelope for their return or, in exceptional circumstances, conducting telephone interviews. Eurospine encourages documentation of patient-based information before the hospitalisation period and surgeon-based information both before and during hospitalisation; both patient and surgeon data should be acquired for at least one follow-up, at a minimum of three to six months after surgery. In addition, all complications that occur after discharge, and their consequences should be recorded.

Libre Courseware For Bayesian Decision Making

This paper describes the ideas and problems of the Edukalibre e-learning project, in which the author takes part. The basic objective of the project shares the development and exploitation of software components for web-based information systems applied to education as well as organizing of teaching material for them. The paper concerns a problem of the mathematical-oriented courseware and describes the experience in developing LaTeX-supporting online converting tool.

Language Learning in 3D Virtual World

Second Life (SL) is an ideal platform for language learning. It is called a Multi-User Virtual Environment, where users can have varieties of learning experiences in life-like environments. Numerous attempts have been made to use SL as a platform for language teaching and the possibility of SL as a means to promote conversational interactions has been reported. However, the research so far has largely focused on simply using SL without further augmentations for communication between learners or between teachers and learners in a school-like environment. Conversely, not enough attention has been paid to its controllability which builds on the embedded functions in SL. This study, based on the latest theories of second language acquisition, especially on the Task Based Language Teaching and the Interaction Hypothesis, proposes to design and implement an automatized interactive task space (AITS) where robotic agents work as interlocutors of learners. This paper presents a design that incorporates the SLA theories into SL and the implementation method of the design to construct AITS, fulfilling the controllability of SL. It also presents the result of the evaluation experiment conducted on the constructed AITS.

Not for Designers: On the Inadequacies of EU Design Law and How to Fix It

Design rights represent an interesting example of how the EU legislature has successfully regulated an otherwise heterogeneous field of law. Yet this type of protection is not for all. The tools created by EU intervention have been drafted paying much more attention to the industry sector rather than to designers themselves. In particular, modern, digitally based, individual or small-sized, 3D printing, open designers and their needs are largely neglected by such legislation. There is obviously nothing wrong in drafting legal tools around the needs of an industrial sector with an important role in the EU economy, on the contrary, this is a legitimate and good decision of industrial policy. However, good legislation should be fair, balanced, and (technologically) neutral in order to offer suitable solutions to all the players in the market, and all the citizens in the society, without discriminating the smallest or the newest: the cost would be to stifle innovation. The use of printing machinery to manufacture physical objects created digitally thanks to computer programs such as Computer-Aided Design (CAD) software has been in place for quite a few years, and it is actually the standard in many industrial fields, from aeronautics to home furniture. The change in recent years that has the potential to be a paradigm-shifting factor is a combination between the opularization of such technologies (price, size, usability, quality) and the diffusion of a culture based on access to and reuse of knowledge. We will call this blend Open Design. It is probably still too early, however, to say whether 3D printing will be used in the future to refer to a major event in human history, or instead will be relegated to a lonely Wikipedia entry similarly to ³Betamax² (copyright scholars are familiar with it for other reasons). It is not too early, however, to develop a legal analysis that will hopefully contribute to clarifying the major issues found in current EU design law structure, why many modern open designers will probably find better protection in copyright, and whether they can successfully rely on open licenses to achieve their goals. With regard to the latter point, we will use Creative Commons (CC) licenses to test our hypothesis due to their unique characteristic to be modular, i.e. to have different license elements (clauses) that licensors can choose in order to adapt the license to their own needs.”

Mammografie-Screening

Nur wenige Vorsorgeuntersuchungen sind so umfassend in randomisiert-kon- trollierten Studien (RCTs) untersucht worden wie das Screening auf Brustkrebs mit Hilfe der Mammografie. Es liegen derzeit acht große randomisiert-kontrol- lierte Studien und mehrere Meta-Analysen vor. Letztere kommen mehrheitlich zum Schluss, dass sich die Brustkrebssterblichkeit durch Mammografie-Screening um etwa 20 % senken lässt. Dies bedeutet im Schweizer Kontext, dass etwa 1 von 1'000 Frauen weniger an Brustkrebs stirbt, wenn Frauen ab dem 50. Lebensjahr zehn Jahre lang gescreent werden. Andererseits führt das Screening auch zu Überdiagnosen und Übertherapien. So nimmt die Zahl der Brustkrebsdiagnosen um etwa 20 % zu, was zu einer entsprechenden Zunahme an chirurgischen Ein- griffen, Strahlen- und Chemotherapien führt. Über zehn Jahre gerechnet, erhal- ten etwa 4 von 1'000 Frauen eine Brustkrebsdiagnose, die sie ohne Screening nicht erhalten hätten. Etwa 200 von 1'000 Frauen sind im Verlaufe von zehn Jahren (fünf Screening-Runden) mit abklärungsbedürftigen Befunden konfron- tiert, wobei es sich dabei mehrheitlich um falsch positive Befunde handelt. Gleichzeitig werden auch mit einem Screening-Programm 20 bis 30 % der Brust- krebse nicht im Screening erfasst. Die Information der Bevölkerung bezüglich des Mammografie-Screenings ist derzeit noch mangelhaft. Dies führt dazu, dass der mögliche Nutzen von den betroffenen Frauen überschätzt und der Schaden unterschätzt wird. Die Aufklärung der Bevölkerung im Hinblick auf Nutzen und Risiken des Mammografie-Screenings muss daher verbessert werden, denn Frau- en haben einen Anspruch auf evidenzbasierte Informationen und eine „infor- mierte Entscheidung“.

Veterinary Medical Libraries in the 21st Century

The purpose of this volume is to present a picture of information access and delivery by United States and Canadian academic veterinary medical libraries (VMLs) to the veterinary community and others with interests in the profession. This is done by discussing the resources that are available, as well as methods of delivery of that information. Our discussion of these topics will not only point out the unique aspects of these collections and services, but will also illustrate much that is in common with all medical collections and library services. As with all libraries, the goal of VMLs is to provide high quality service while looking after the information needs of their clientele through selection, acquisition, cataloging, and dissemination of materials and familiarizing their users with these resources. In the past decade, new challenges and opportunities for information specialists stem from the impact of technology on VMLs. Our goal with this volume is to be concise, but thorough about all of these topics.

Extraversion and short-term memory for chromatic stimuli: an event-related potential analysis.

The present study investigated extraversion-related individual differences in visual short-term memory (VSTM) functioning. Event related potentials were recorded from 50 introverts and 50 extraverts while they performed a VSTM task based on a color-change detection paradigm with three different set sizes. Although introverts and extraverts showed almost identical hit rates and reaction times, introverts displayed larger N1 amplitudes than extraverts independent of color change or set size. Extraverts also showed larger P3 amplitudes compared to introverts when there was a color change, whereas no extraversion-related difference in P3 amplitude was found in the no-change condition. Our findings provided the first experimental evidence that introverts' greater reactivity to punctuate physical stimulation, as indicated by larger N1 amplitude, also holds for complex visual stimulus patterns. Furthermore, P3 amplitude in the change condition was larger for extraverts than introverts suggesting higher sensitivity to context change. Finally, there were no extraversion-related differences in P3 amplitude dependent on set size. This latter finding does not support the resource allocation explanation as a source of differences between introverts and extraverts.

Keeping citizens, companies, and organizations informed by Web KnowARR

For the main part, electronic government (or e-government for short) aims to put digital public services at disposal for citizens, companies, and organizations. To that end, in particular, e-government comprises the application of Information and Communications Technology (ICT) to support government operations and provide better governmental services (Fraga, 2002) as possible with traditional means. Accordingly, e-government services go further as traditional governmental services and aim to fundamentally alter the processes in which public services are generated and delivered, after this manner transforming the entire spectrum of relationships of public bodies with its citizens, businesses and other government agencies (Leitner, 2003). To implement this transformation, one of the most important points is to inform the citizen, business, and/or other government agencies faithfully and in an accessible way. This allows all the partaking participants of governmental affairs for a transition from passive information access to active participation (Palvia and Sharma, 2007). In addition, by a corresponding handling of the participants' data, a personalization towards these participants may even be accomplished. For instance, by creating significant user profiles as a kind of participants' tailored knowledge structures, a better-quality governmental service may be provided (i.e., expressed by individualized governmental services). To create such knowledge structures, thus known information (e.g., a social security number) can be enriched by vague information that may be accurate to a certain degree only. Hence, fuzzy knowledge structures can be generated, which help improve governmental-participants relationship. The Web KnowARR framework (Portmann and Thiessen, 2013; Portmann and Pedrycz, 2014; Portmann and Kaltenrieder, 2014), which I introduce in my presentation, allows just all these participants to be automatically informed about changes of Web content regarding a- respective governmental action. The name Web KnowARR thereby stands for a self-acting entity (i.e. instantiated form the conceptual framework) that knows or apprehends the Web. In this talk, the frameworks respective three main components from artificial intelligence research (i.e. knowledge aggregation, representation, and reasoning), as well as its specific use in electronic government will be briefly introduced and discussed.

Incidence and risk factors for early adjacent vertebral fractures after balloon kyphoplasty for osteoporotic fractures: analysis of the SWISSspine registry

PURPOSE The SWISSspine registry (SSR) was launched in 2005 to assess the safety and effectiveness of balloon kyphoplasty (BKP). In the meantime, repeated reports on high rates of adjacent vertebral fractures (ASF) after BKP of vertebral insufficiency fractures were published. The causes for ASF and their risk factors are still under debate. The purpose of this study was to report the incidence and potential risk factors of ASF within the SSR dataset. METHODS The SSR data points are collected perioperatively and during follow-ups, with surgeon- and patient-based information. All patients documented with a monosegmental osteoporotic vertebral insufficiency fracture between March 2005 and May 2012 were included in the study. The incidence of ASF, significant associations with co-variates (patient age, gender, fracture location, cement volume, preoperative segmental kyphosis, extent of kyphosis correction, and individual co-morbidities) and influence on quality of life (EQ-5D) and back pain (VAS) were analyzed. RESULTS A total of 375 patients with a mean follow-up of 3.6 months was included. ASF were found in 9.9 % (n = 37) and occurred on average 2.8 months postoperatively. Preoperative segmental kyphosis >30° (p = 0.026), and rheumatoid arthritis (p = 0.038) and cardiovascular disease (p = 0.047) were significantly associated with ASF. Furthermore, patients with ASF had significantly higher back pain at the final follow-up (p = 0.001). No further significant associations between the studied co-variates and ASF were seen in the adjusted analysis. CONCLUSIONS The findings suggest that patients with a preoperative segmental kyphosis >30° or patients with co-morbidities like rheumatoid arthritis and a cardiovascular disease are at high risk of ASF within 6 months after the index surgery. In case of an ASF event, back pain levels are significantly increased. LEVEL OF EVIDENCE IV.

Using plant functional traits and phylogenies to understand patterns of plant community assembly in a seasonal tropical forest in Lao PDR

Plant functional traits reflect different evolutionary responses to environmental variation, and among extant species determine the outcomes of interactions between plants and their environment, including other plant species. Thus, combining phylogenetic and trait-based information can be a powerful approach for understanding community assembly processes across a range of spatial scales. We used this approach to investigate tree community composition at Phou Khao Khouay National Park (18°14’-18°32’N; 102°38’- 102°59’E), Laos, where several distinct forest types occur in close proximity. The aim of our study was to examine patterns of plant community assembly across the strong environmental gradients evident at our site. We hypothesized that differences in tree community composition were being driven by an underlying gradient in soil conditions. Thus, we predicted that environmental filtering would predominate at the site and that the filtering would be strongest on sandier soil with low pH, as these are the conditions least favorable to plant growth. We surveyed eleven 0.25 ha (50x50 m) plots for all trees above 10 cm dbh (1221 individual trees, including 47 families, 70 genera and 123 species) and sampled soils in each plot. For each species in the community, we measured 11 commonly studied plant functional traits covering both the leaf and wood economic spectrum traits and we reconstructed a phylogenetic tree for 115 of the species in the community using rbcL and matK sequences downloaded from Genebank (other species were not available). Finally we compared the distribution of trait values and species at two scales (among plots and 10x10m subplots) to examine trait and phylogenetic community structures. Although there was strong evidence that an underlying soil gradient was determining patterns of species composition at the site, our results did not support the hypothesis that the environmental filtering dominated community assembly processes. For the measured plant functional traits there was no consistent pattern of trait dispersion across the site, either when traits were considered individually or when combined in a multivariate analysis. However, there was a significant correlation between the degree of phylogenetic dispersion and the first principle component axis (PCA1) for the soil parameters.Moreover, the more phylogenetically clustered plots were on sandier soils with lower pH. Hence, we suggest that the community assembly processes across our sitemay reflect the influence ofmore conserved traits that we did not measure. Nevertheless, our results are equivocal and other interpretations are possible. Our study illustrates some difficulties in combining trait and phylogenetic approaches that may result from the complexities of integrating spatial and evolutionary processes that vary at different scales.

A woman's right to know: A policy review of abortion legislation in Texas

Introduction: Despite its legalization, abortion remains a controversial issue, one that has many divided on either side of the political spectrum. While there have been several changes made to abortion policy over the past few decades, one that continues to have many asking questions is the Woman’s Right to Know Act, a piece of state imposed abortion legislation that has implemented strict restrictions and requirements of women seeking abortion, including pre-abortion mandatory counseling and a 24 hour waiting period. This project analyzed four controversial components of the mandatory counseling materials in Texas in an attempt to examine the scientific validity behind this legislation. Methods: In order to understand the scientific validity behind the content of the preabortion mandatory counseling, I conducted a systematic literature review to analyze: the purported link between abortion and breast cancer, the existence of fetal pain, the risk of abortion to future fertility, and the negative psychological effects of abortion. An electronic search in EBSCO and PubMed of review articles published between 1995 and 2010 resulted in fourteen reviews. Results: Results of the systematic review found (1) inconclusive evidence suggesting a link between abortion and breast cancer, (2) that fetal pain likely does not occur until the third trimester of pregnancy, (3) that associations exist between induced abortion and subsequent preterm birth and placenta previa, and (4) that there is mixed evidence relating to the negative psychological effects that exist among women having had an abortion and those who have not had abortion. Conclusion: Based on these conclusions, a recommendation was made to revise the current state mandated counseling materials to reflect more accurate and scientifically-based information about abortion and its potential risks.^