Resin composites: Modulus of elasticity and marginal quality

OBJECTIVE To investigate how the modulus of elasticity of resin composites influences marginal quality in restorations submitted to thermocyclic and mechanical loading. METHODS Charisma, Filtek Supreme XTE and Grandio were selected as they were found to possess different moduli of elasticity but quite similar polymerization contraction. MOD cavities (n=30) were prepared in extracted premolars, restored and then subjected to thermocyclic and mechanical loading. Marginal quality of the restorations before and after loading was analyzed on epoxy replicas under a scanning electron microscope. The percentage of gap-free margins and occurrence of paramarginal fractures were registered. Modulus of elasticity and polymerization contraction were analyzed with parametric and margins with nonparametric ANOVA and post hoc Tukey HSD or Wilcoxon rank-sum tests, respectively. The number of paramarginal fractures was analyzed with exact Fisher tests (α=0.05). RESULTS Grandio demonstrated significantly more gap-free enamel margins than Charisma and Filtek Supreme XTE, before and after loading (p<0.01), whereas there was no difference between Charisma and Filtek Supreme XTE (p>0.05). No significant effect of resin composite (p=0.81) on the quality of dentine margins was observed, before or after loading. Deterioration of all margins was evident after loading (p<0.0001). More paramarginal enamel fractures were observed after loading in teeth restored with Grandio when compared to Charisma (p=0.008). CONCLUSIONS The resin composite with the highest modulus of elasticity resulted in the highest number of gap-free enamel margins but with an increased incidence of paramarginal enamel fractures. CLINICAL SIGNIFICANCE The results from this study suggest that the marginal quality of restorations can be improved by the selection of a resin composite with modulus of elasticity close to that of dentine, although an increase in paramarginal enamel fractures can result as a consequence.

A novel animal model for external anal sphincter insufficiency

Abstract PURPOSE: Reliable animal models are essential to evaluate future therapeutic options like cell-based therapies for external anal sphincter insufficiency. The goal of our study was to describe the most reliable model for external sphincter muscle insufficiency by comparing three different methods to create sphincter muscle damage. METHODS: In an experimental animal study, female Lewis rats (200-250 g) were randomly assigned to three treatment groups (n = 5, each group). The external sphincter muscle was weakened in the left dorsal quadrant by microsurgical excision, cryosurgery, or electrocoagulation by diathermy. Functional evaluation included in vivo measurements of resting pressure, spontaneous muscle contraction, and contraction in response to electrical stimulation of the afferent nerve at baseline and at 2, 4, and 6 weeks after sphincter injury. Masson's trichrome staining and immunofluorescence for skeletal muscle markers was performed for morphological analysis. RESULTS: Peak contraction after electrical stimulation was significantly decreased after sphincter injury in all groups. Contraction forces recovered partially after cryosurgery and electrocoagulation but not after microsurgical excision. Morphological analysis revealed an incomplete destruction of the external sphincter muscle in the cryosurgery and electrocoagulation groups compared to the microsurgery group. CONCLUSIONS: For the first time, three different models of external sphincter muscle insufficiency were directly compared. The animal model using microsurgical sphincter destruction offers the highest level of consistency regarding tissue damage and sphincter insufficiency, and therefore represents the most reliable model to evaluate future therapeutic options. In addition, this study represents a novel model to specifically test the external sphincter muscle function.

Marginal lands or marginal people? Analysing key processes determining the outcomes of large-scale land acquisitions in Lao PDR and Cambodia

This chapter aims to overcome the gap existing between case study research, which typically provides qualitative and process-based insights, and national or global inventories that typically offer spatially explicit and quantitative analysis of broader patterns, and thus to present adequate evidence for policymaking regarding large-scale land acquisitions. Therefore, the chapter links spatial patterns of land acquisitions to underlying implementation processes of land allocation. Methodologically linking the described patterns and processes proved difficult, but we have identified indicators that could be added to inventories and monitoring systems to make linkage possible. Combining complementary approaches in this way may help to determine where policy space exists for more sustainable governance of land acquisitions, both geographically and with regard to processes of agrarian transitions. Our spatial analysis revealed two general patterns: (i) relatively large forestry-related acquisitions that target forested landscapes and often interfere with semi-subsistence farming systems; and (ii) smaller agriculture-related acquisitions that often target existing cropland and also interfere with semi-subsistence systems. Furthermore, our meta-analysis of land acquisition implementation processes shows that authoritarian, top-down processes dominate. Initially, the demands of powerful regional and domestic investors tend to override socio-ecological variables, local actors’ interests, and land governance mechanisms. As available land grows scarce, however, and local actors gain experience dealing with land acquisitions, it appears that land investments begin to fail or give way to more inclusive, bottom-up investment models.

Quantifying the improvement in sepsis diagnosis, documentation, and coding: the marginal causal effect of year of hospitalization on sepsis diagnosis.

PURPOSE To quantify the coinciding improvement in the clinical diagnosis of sepsis, its documentation in the electronic health records, and subsequent medical coding of sepsis for billing purposes in recent years. METHODS We examined 98,267 hospitalizations in 66,208 patients who met systemic inflammatory response syndrome criteria at a tertiary care center from 2008 to 2012. We used g-computation to estimate the causal effect of the year of hospitalization on receiving an International Classification of Diseases, Ninth Revision, Clinical Modification discharge diagnosis code for sepsis by estimating changes in the probability of getting diagnosed and coded for sepsis during the study period. RESULTS When adjusted for demographics, Charlson-Deyo comorbidity index, blood culture frequency per hospitalization, and intensive care unit admission, the causal risk difference for receiving a discharge code for sepsis per 100 hospitalizations with systemic inflammatory response syndrome, had the hospitalization occurred in 2012, was estimated to be 3.9% (95% confidence interval [CI], 3.8%-4.0%), 3.4% (95% CI, 3.3%-3.5%), 2.2% (95% CI, 2.1%-2.3%), and 0.9% (95% CI, 0.8%-1.1%) from 2008 to 2011, respectively. CONCLUSIONS Patients with similar characteristics and risk factors had a higher of probability of getting diagnosed, documented, and coded for sepsis in 2012 than in previous years, which contributed to an apparent increase in sepsis incidence.

Standardized pelvic floor exercises improve stress urinary incontinence in women with intrinsic sphincter deficiency.

OBJECTIVES Pelvic floor rehabilitation is the conservative therapy of choice for women with stress urinary incontinence (SUI). The success rate of surgical procedures in SUI patients with intrinsic sphincter deficiency (ISD) is low. The aim of this study was to analyse the effect of a standardized physiotherapy on patients with SUI and normotonic urethra and ISD. METHODS In this study, 64 patients with ISD and 69 patients with normotonic urethra were enrolled. Maximum urethral pressure (MUCP) >20 cm H2 O was considered as normotonic urethral pressure. Before and after physiotherapy MUCP was measured and cough testing was performed. Additionally, patient reported outcome was assessed using the King's Health Questionnaire (KHQ). For statistical analyses Excel 2010 (Microsoft Inc; Redmond, Washington) and SPSS 20 (SPSS Inc; Chicago, Illinois) for Windows were used. Power calculation was based on the primary endpoint incontinence impact and general health. For power calculation, GraphPad Statmate version 2.00 for Windows was used. RESULTS Sixty-four patients with ISD and 69 patients with normotonic urethra were included in the study. In SUI patients with normotonic and hypotonic urethra KHQ-scores regarding the primary endpoins "general health" and "incontinence impact" significantly improved following standardized physiotherapy. In both groups MUCP increased after physiotherapy. In SUI patients with ISD standardized physiotherapy resulted in a decreased incidence of a positive cough test. CONCLUSIONS Standardized physiotherapy should be offered to patients with SUI and ISD. Long-term results are subject to future studies. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

The Marginal Impact of ENGOs in Different Types of Democratic Systems

Conventional wisdom suggests that environmental non-governmental organizations (ENGOs) play a major role in pushing states towards more ambitious environmental policies. However, demonstrating that this presumption is in fact true is rather difficult, because the same system structures of democracies that may create more opportunities for ENGO activities are also, on their own, conducive to better environmental policies. This leaves open the possibility that the additional (marginal) impact of ENGOs on policy making is smaller than presumed. In trying to disentangle these effects, this paper examines the influence of ENGOs contingent on key structural characteristics of democratic systems. We develop the argument that presidential systems with a plurality electoral rule per se tend to provide more environmental public goods, which induces a smaller marginal impact of ENGOs. Conversely, parliamentary systems with a proportional representation electoral rule are likely to provide fewer environmental public goods, which allows for a larger marginal impact of ENGOs. We find robust empirical support for these hypotheses in analyses that focus on the ratification behavior of 75 democracies vis-à-vis 250 international environmental agreements in 1973–2002.

La comunicación gráfica pública marginal

El espacio público, atravesado por lugares de tránsito e interacción comunes de los individuos, constituye un terreno fundamental de la comunicación de todas las épocas. Este espacio mantiene a través de la historia del hombre significante su fuerza instrumental como espacio de difusión de significaciones. Éstas se producen ubicando mensajes, señales, símbolos en un segmento visual apropiado y de acceso público. En la construcción de este espacio visual público de comunicación intervienen sujetos comunicativos - locutores- que interpelan a las sociedades colaborando en la conformación de sus identidades y reproducen o trastocan sus representaciones, sus creencias, sus valores, sus conocimientos. Los mensajes son heterogéneos en sus formas, intenciones y lenguajes. El conjunto de estas marcas en el espacio varía, apareciendo y desapareciendo, reemplazándose, tomando nuevas formas y actualizándose necesariamente con el tiempo. Es un espacio continuamente mutante en sus formas y contenidos. Para el analista cultural representan una valiosa fuente de información para el acercamiento a la comprensión de la(s) identidad(es) de una sociedad. Cada texto existente en un momento y lugar determinado funciona entonces como un mensaje para los intervinientes en el proceso comunicativo del signo y además como una marca cultural de la época en la que se produce.

Ferréz en el círculo de los violentos : Ecos eruditos de la barca de Caronte en la escritura marginal en "O ônibus branco"

Aproximar la narración del cuento "O ônibus branco" a aquellas sobre el mito de la barca del inferno es observar rastros de lo hegemónico en la escritura marginal, dirigirse hacia un tipo de información que se encuentra relacionada con las construcciones simbólicas de una cultura de instrucción y lecturas eruditas. ¿De qué lugares toma referencias la escritura producida más allá de los márgenes de la ciudad formal? Tal cuestionamiento impone una investigación que incide sobre la idea de que ciertas narrativas populares encuentran eco en lecturas más allá de aquellas disponibles en los medios masivos y acogen un repertorio culto

La socialización marginal en el trabajo de servicio en la España del Siglo de Oro : Aproximación a su análisis

Durante la temprana modernidad parte de los pobres fueron marginados y criminalizados debido a que no se insertaban en el mercado laboral, motivo que condujo a que fueran instigados al trabajo compulsivamente. La falta de especialización de estos hombres, así como su carácter urbano, fueron factores que contribuyeron a su inserción en diversas ocupaciones de servicio. Los criados no eran económicamente productivos, sino que su función tenía sentido en el marco socio-cultural, ya que servían a la reproducción de status de sus amos. Este tipo de actividades fueron ampliamente descriptas en el corpus de novelas que compone el género de la picaresca española, en el cual podemos observar un retrato sobre cómo imaginaron los literatos -que refractaron en sus obras una concepción social- las prácticas de los servidores. El Guzmán de Alfarache ilustra, a través de las sucesivas ocupaciones de servicio en que se emplea el protagonista, las formas de socialización que existían entre los mozos en el espacio doméstico, donde reproducían las conductas marginales en el marco de socialización "no marginal" que les era impuesto. El análisis que proponemos pretende indagar acerca de este problema en la crítica ilustración realizada por Mateo Alemán en El Guzmán...

Apuntes iniciales para una polémica marginal : Aldo Pellegrini y Osiris Troiani; de Letra y Línea a Contorno

Entre mediados de 1954 y septiembre de 1955, en las jóvenes revistas Letra y Línea, Capricornio, y Contorno, se mantuvo una polémica dilatada entre Osiris Troiani y Aldo Pellegrini, cuya causa parecía justificarse en una nota de Carlos Latorre acerca de Sur y la literatura italiana. El propósito de este trabajo es, por un lado, dar cuenta de esa temporalidad desfasada y marginal en que se organiza esta disputa contra los preceptos del surrealismo, más precisamente, el surrealismo en Argentina, reparando en cuáles son las nuevas concepciones críticas y literarias que comienzan a ponerse en juego al momento de discutir. Por otro lado, aunque de forma breve, se amplía el contexto de revistas literarias y publicaciones periódicas que han sido introducidas, tanto en referencias como en repercusiones de esta polémica

Literatura marginal e a compreensão das dinâmicas sociais das periferias brasileiras

O presente artigo discute, a partir das noçoesde literatura e sociedade desenvolvidas por Antonio Candido e de campo social de Pierre Bourdieu, a produçao ficcional e a trajetória social e intelectual de determinados escritores no campo literário brasileiro. A manifestaçao cultural desses autores, caracterizada de periféricae denominada "literatura marginal", ganhou a cena pública brasileira no final da década de 1990 com a publicaçao dos romances Cidade de Deus, do carioca Paulo Lins e Capao Pecado, do paulistano Ferréz.O romance de Paulo Lins tornou-se mundialmente conhecido depois que o cineasta Fernando Meirelles filmou "Cidade de Deus" conquistando, inclusive, indicaçoes para a disputa do Oscar. Ferréz publicou outros livros e organizou a revista "Literatura Marginal", coletânea com diferentes moradores de bairros periféricos da cidade de Sao Paulo.A partir da análise das obras desses dois autores sugerimos que os morros, favelas e periferias têm suas próprias características e a literatura marginal pode indicar mais uma oportunidade para desvendar esse mundo que espacialmente está tao próximo, mas socialmente muito distante