The impact of rehabilitation using removable partial dentures and functionally orientated treatment on oral health-related quality of life: a randomised controlled clinical trial

OBJECTIVES: This study aimed to compare two different tooth replacement strategies for partially dentate older patients; namely functionally orientated treatment according to the principles of the shortened dental arch (SDA) and conventional treatment using removable partial dentures (RPDs) using a randomised controlled clinical trial. The primary outcome measure for this study was impact on oral health-related quality of life (OHRQoL) measured using the short form of the oral health impact profile (OHIP-14).

METHODS: Patients aged 65 years and older were randomly allocated to two different treatment groups: the RPD group and the SDA group. For the RPD group each patient was restored to complete arches with cobalt-chromium RPDs used to replace missing teeth. For the SDA group, patients were restored to a premolar occlusion of 10 occluding pairs of natural and replacement teeth using resin bonded bridgework (RBB). OHRQoL was measured using the OHIP-14 questionnaire administered at baseline, 1 month, 6 months and 12 months after treatment intervention.

RESULTS: In total, 89 patients completed the RCT: 44 from the RPD group and 45 from the SDA group. Analysis using a mixed model of covariance (ANCOVA) illustrated that treatment according to the SDA concept resulted in significantly better mean OHIP-14 scores compared with RPD treatment (p<0.05). This result was replicated in both treatment centres used in the study.

CONCLUSIONS: In terms of impact on OHRQoL, treatment based on the SDA concept achieved significantly better results than that based on RPDs 12 months after treatment intervention (trial registration no. ISRCTN26302774).

CLINICAL SIGNIFICANCE: Functionally orientated treatment delivery resulted in significantly better outcomes compared to removable dentures in terms of impact on OHRQoL.

Comparison of functionally orientated tooth replacement and removable partial dentures on the nutritional status of partially dentate older patients: a randomised controlled clinical trial

OBJECTIVES: The aims of this study were to conduct a randomised controlled clinical trial (RCT) of partially dentate older adults comparing functionally orientated treatment based on the SDA concept with conventional treatment using RPDs to replace missing natural teeth. The two treatment strategies were evaluated according to their impact on nutritional status measured using haematological biomarkers.

METHODS: A randomised controlled clinical trial (RCT) was conducted of partially dentate patients aged 65 years and older (Trial Registration no. ISRCTN26302774). Each patient provided haematological samples which were screened for biochemical markers of nutritional status. Each sample was tested in Cork University Hospital for serum Albumin, serum Cholesterol, Ferritin, Folate, Vitamin B12 and 25-hydroxycholecalciferol (Vitamin D).

RESULTS: A mixed model analysis of covariance (ANCOVA) indicated that for Vitamin B12 (p=0.9392), serum Folate (p=0.5827), Ferritin (p=0.6964), Albumin (p=0.8179), Serum Total Cholesterol (p=0.3670) and Vitamin D (p=0.7666) there were no statistically significant differences recorded between the two treatment groups. According to the mixed model analysis of covariance (ANCOVA) for Vitamin D there was a significant difference between levels recorded at post-operative time points after treatment intervention (p=0.0470). There was an increase of 7% in 25-hydroxycholecalciferol levels recorded at 6 months compared to baseline (p=0.0172). There was no further change in recorded levels at 12 months (p=0.6482) and these increases were similar within the two treatment groups (p>0.05).

CONCLUSIONS: The only measure which illustrated consistent significant improvements in nutritional status for either group were Vitamin D levels. However no significant difference was recorded between the two treatment groups.

CLINICAL SIGNIFICANCE: Functionally orientated prosthodontic rehabilitation for partially dentate older patients was no worse than conventional removable partial dentures in terms of impact on nutritional status.

State detection of bond wires in IGBT modules using eddy current pulsed thermography

Insulated gate bipolar transistor (IGBT) modules are important safety critical components in electrical power systems. Bond wire lift-off, a plastic deformation between wire bond and adjacent layers of a device caused by repeated power/thermal cycles, is the most common failure mechanism in IGBT modules. For the early detection and characterization of such failures, it is important to constantly detect or monitor the health state of IGBT modules, and the state of bond wires in particular. This paper introduces eddy current pulsed thermography (ECPT), a nondestructive evaluation technique, for the state detection and characterization of bond wire lift-off in IGBT modules. After the introduction of the experimental ECPT system, numerical simulation work is reported. The presented simulations are based on the 3-D electromagnetic-thermal coupling finite-element method and analyze transient temperature distribution within the bond wires. This paper illustrates the thermal patterns of bond wires using inductive heating with different wire statuses (lifted-off or well bonded) under two excitation conditions: nonuniform and uniform magnetic field excitations. Experimental results show that uniform excitation of healthy bonding wires, using a Helmholtz coil, provides the same eddy currents on each, while different eddy currents are seen on faulty wires. Both experimental and numerical results show that ECPT can be used for the detection and characterization of bond wires in power semiconductors through the analysis of the transient heating patterns of the wires. The main impact of this paper is that it is the first time electromagnetic induction thermography, so-called ECPT, has been employed on power/electronic devices. Because of its capability of contactless inspection of multiple wires in a single pass, and as such it opens a wide field of investigation in power/electronic devices for failure detection, performance characterization, and health monitoring. 

Turbulent heat transfer and coherent vortical structures in gas turbine film cooling

Unsteady coherent structures and turbulent heat transfer in a film cooling flow is studied by using detached eddy simulation (DES). Detailed computations for an inclined jet in crossflow by a single row of 35 degree round holes on a flat plate were performed at blowing ratios of 0.5 and 1.0, and a density ratio of 2.0. The correlation between the coherent vortical structures and the unsteady heat transfer is carefully examined. The instantaneous flow fields and heat transfer distributions are found to be characterized by the formation of large coherent vortical structures. These structures enhance the thermal mixing process and turbulent heat transfer to the wall. From the inspection of both unsteady adiabatic film cooling effectiveness and heat transfer coefficient, these two are found to have substantial local fluctuations due to the large unsteadiness of coherent structures. The fluctuation of the adiabatic effectiveness and heat transfer coefficient, for example, can be as high as 15 and 50 percent of the time-mean value, respectively. It could result in the detrimental effect on film cooling performance.

Unsettling modernity: Shifting values and changing housing styles in the Kathmandu Valley

Abstract

Culture has always been important for the character of the cities, as have the civic and public institutions that sustain a lifestyle and provide an identity. Substantial evidence of the unique historical, urban civilisation remains within the traditional settlements in the Kathmandu Valley in Nepal; manifested in houses, palaces, temples, rest houses, open spaces, festivals, rituals, customs and cultural institutions. Indigenous knowledge and practices prescribed the arrangement of houses, roads and urban spaces giving the city a distinctive physical form, character and a unique oriental nativeness. In technical sense, these societies did not have written rules for guiding development. In recent decades, the urban culture of the city has been changing with the forces of urbanisation and globalisation and the demand for new buildings and spaces. New residential design is increasingly dominated by distinctive patterns of Western suburban ideal comprising detached or semi-detached homes and high rise tower blocks. This architectural iconoclasm can be construed as a rather crude response to the indigenous culture and built form. The paper attempts to dismantle the current tension between traditional and contemporary ‘culture’ (and hence society) and housing (or built form) in the Kathmandu Valley by engaging in a discussion that cuts across space, time and meaning of architecture as we know it.

Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries

Importance Limited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS).

Objectives To evaluate intensive care unit (ICU) incidence and outcome of ARDS and to assess clinician recognition, ventilation management, and use of adjuncts—for example prone positioning—in routine clinical practice for patients fulfilling the ARDS Berlin Definition.

Design, Setting, and Participants The Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients undergoing invasive or noninvasive ventilation, conducted during 4 consecutive weeks in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across 5 continents.

Exposures Acute respiratory distress syndrome.

Main Outcomes and Measures The primary outcome was ICU incidence of ARDS. Secondary outcomes included assessment of clinician recognition of ARDS, the application of ventilatory management, the use of adjunctive interventions in routine clinical practice, and clinical outcomes from ARDS.

Results Of 29 144 patients admitted to participating ICUs, 3022 (10.4%) fulfilled ARDS criteria. Of these, 2377 patients developed ARDS in the first 48 hours and whose respiratory failure was managed with invasive mechanical ventilation. The period prevalence of mild ARDS was 30.0% (95% CI, 28.2%-31.9%); of moderate ARDS, 46.6% (95% CI, 44.5%-48.6%); and of severe ARDS, 23.4% (95% CI, 21.7%-25.2%). ARDS represented 0.42 cases per ICU bed over 4 weeks and represented 10.4% (95% CI, 10.0%-10.7%) of ICU admissions and 23.4% of patients requiring mechanical ventilation. Clinical recognition of ARDS ranged from 51.3% (95% CI, 47.5%-55.0%) in mild to 78.5% (95% CI, 74.8%-81.8%) in severe ARDS. Less than two-thirds of patients with ARDS received a tidal volume 8 of mL/kg or less of predicted body weight. Plateau pressure was measured in 40.1% (95% CI, 38.2-42.1), whereas 82.6% (95% CI, 81.0%-84.1%) received a positive end-expository pressure (PEEP) of less than 12 cm H2O. Prone positioning was used in 16.3% (95% CI, 13.7%-19.2%) of patients with severe ARDS. Clinician recognition of ARDS was associated with higher PEEP, greater use of neuromuscular blockade, and prone positioning. Hospital mortality was 34.9% (95% CI, 31.4%-38.5%) for those with mild, 40.3% (95% CI, 37.4%-43.3%) for those with moderate, and 46.1% (95% CI, 41.9%-50.4%) for those with severe ARDS.

Conclusions and Relevance Among ICUs in 50 countries, the period prevalence of ARDS was 10.4% of ICU admissions. This syndrome appeared to be underrecognized and undertreated and associated with a high mortality rate. These findings indicate the potential for improvement in the management of patients with ARDS.

Fluid strategies and outcomes in patients with acute respiratory distress syndrome, systemic inflammatory response syndrome and sepsis: a protocol for a systematic review and meta-analysis

Background
Fluid administration to critically ill patients remains the subject of considerable controversy. While intravenous fluid given for resuscitation may be life-saving, a positive fluid balance over time is associated with worse outcomes in critical illness. The aim of this systematic review is to summarise the existing evidence regarding the relationship between fluid administration or balance and clinically important patient outcomes in critical illness.

Methods
We will search Medline, EMBASE, the Cochrane Central Register of Controlled Trials from 1980 to the present and key conference proceedings from 2009 to the present. We will include studies of critically ill adults and children with acute respiratory distress syndrome (ARDS), sepsis and systemic inflammatory response syndrome (SIRS). We will include randomised controlled trials comparing two or more fluid regimens of different volumes of fluid and observational studies reporting the relationship between volume of fluid administered or fluid balance and outcomes including mortality, lengths of intensive care unit and hospital stay and organ dysfunction. Two independent reviewers will assess articles for eligibility, data extraction and quality appraisal. We will conduct a narrative and/or meta-analysis as appropriate.

Discussion
While fluid management has been extensively studied and discussed in the critical care literature, no systematic review has attempted to summarise the evidence for post-resuscitation fluid strategies in critical illness. Results of the proposed systematic review will inform practice and the design of future clinical trials.

Systematic review registration
PROSPERO CRD42013005608. (http://​www.​crd.​york.​ac.​uk/​PROSPERO/​)

Subspace-based techniques and applications

Este trabalho focou-se no estudo de técnicas de sub-espaço tendo em vista as aplicações seguintes: eliminação de ruído em séries temporais e extracção de características para problemas de classificação supervisionada. Foram estudadas as vertentes lineares e não-lineares das referidas técnicas tendo como ponto de partida os algoritmos SSA e KPCA. No trabalho apresentam-se propostas para optimizar os algoritmos, bem como uma descrição dos mesmos numa abordagem diferente daquela que é feita na literatura. Em qualquer das vertentes, linear ou não-linear, os métodos são apresentados utilizando uma formulação algébrica consistente. O modelo de subespaço é obtido calculando a decomposição em valores e vectores próprios das matrizes de kernel ou de correlação/covariância calculadas com um conjunto de dados multidimensional. A complexidade das técnicas não lineares de subespaço é discutida, nomeadamente, o problema da pre-imagem e a decomposição em valores e vectores próprios de matrizes de dimensão elevada. Diferentes algoritmos de préimagem são apresentados bem como propostas alternativas para a sua optimização. A decomposição em vectores próprios da matriz de kernel baseada em aproximações low-rank da matriz conduz a um algoritmo mais eficiente- o Greedy KPCA. Os algoritmos são aplicados a sinais artificiais de modo a estudar a influência dos vários parâmetros na sua performance. Para além disso, a exploração destas técnicas é extendida à eliminação de artefactos em séries temporais biomédicas univariáveis, nomeadamente, sinais EEG.

A Meteorological and Snow observational data set from Snoqualmie Pass (921 m), Washington Cascades, U.S.

We introduce a quality controlled observational atmospheric, snow, and soil data set from Snoqualmie Pass, Washington, U.S.A., to enable testing of hydrometeorological and snow process representations within a rain-snow transitional climate where existing observations are sparse and limited. Continuous meteorological forcing (including air temperature, total precipitation, wind speed, specific humidity, air pressure, short- and longwave irradiance) are provided at hourly intervals for a 24-year historical period (water years 1989-2012) and at half-hourly intervals for a more-recent period (water years 2013-2015), separated based on the availability of observations. Additional observations include 40-years of snow board new snow accumulation, multiple measurements of total snow depth, and manual snow pits, while more recent years include sub-daily surface temperature, snowpack drainage, soil moisture and temperature profiles, and eddy co-variance derived turbulent heat flux. This data set is ideal for testing hypotheses about energy balance, soil and snow processes in the rain-snow transition zone. Plots of live data can be found here: http://depts.washington.edu/mtnhydr/cgi/plot.cgi

A Concert of 17th and 18th Century Music, November 16, 1953

Concert Program for A Concert of 17th and 18th Century Music, November 16, 1953

Ocean Boundary Layer Dynamics and Air-Sea Interaction

Thesis (Ph.D.)--University of Washington, 2005-12

Protection of interconnected wind turbines against lightning effects: overvoltages and electromagnetic transientes study

This paper is concerned with direct or indirect lightning strokes on wind turbines, studying overvoltages and electromagnetic transients. As wind power generation undergoes rapid growth, lightning damages involving wind turbines have come to be regarded with more attention. With the aim of providing further insights into the lightning protection of wind turbines, describing the transient behavior in an accurate way, the restructured version (RV) of the electromagnetic transients program (EMTP) is used in this paper. A new case study is presented with two interconnected wind turbines, considering a direct lightning stroke to the blade or considering that lightning strikes the soil near a tower. Comprehensive computer simulations with EMTP-RV are presented and conclusions are duly drawn.

Data Processing at the Flaw Detector with Combined Multisector Eddy-Current Transducer

There is described data processing at the flaw detector with combined multisectional eddy-current transducer and heterofrequency magnetic field. The application of this method for detecting flaws in rods and pipes under the conditions of significant transverse displacements is described.

Effects of selection and drift on G matrix evolution in a heterogeneous environment: a multivariate Qst-Fst Test with the freshwater snail Galba truncatula.

Unraveling the effect of selection vs. drift on the evolution of quantitative traits is commonly achieved by one of two methods. Either one contrasts population differentiation estimates for genetic markers and quantitative traits (the Q(st)-F(st) contrast) or multivariate methods are used to study the covariance between sets of traits. In particular, many studies have focused on the genetic variance-covariance matrix (the G matrix). However, both drift and selection can cause changes in G. To understand their joint effects, we recently combined the two methods into a single test (accompanying article by Martin et al.), which we apply here to a network of 16 natural populations of the freshwater snail Galba truncatula. Using this new neutrality test, extended to hierarchical population structures, we studied the multivariate equivalent of the Q(st)-F(st) contrast for several life-history traits of G. truncatula. We found strong evidence of selection acting on multivariate phenotypes. Selection was homogeneous among populations within each habitat and heterogeneous between habitats. We found that the G matrices were relatively stable within each habitat, with proportionality between the among-populations (D) and the within-populations (G) covariance matrices. The effect of habitat heterogeneity is to break this proportionality because of selection for habitat-dependent optima. Individual-based simulations mimicking our empirical system confirmed that these patterns are expected under the selective regime inferred. We show that homogenizing selection can mimic some effect of drift on the G matrix (G and D almost proportional), but that incorporating information from molecular markers (multivariate Q(st)-F(st)) allows disentangling the two effects.

Psychometric properties of the Marlowe-Crowne Social Desirability Scale in eight African countries and Switzerland

The purpose of this study was to assess the cross-cultural validity of the Marlowe-Crowne Social Desirability scale short form C, in a large sample of French-speaking participants from eight African countries and Switzerland. Exploratory and confirmatory analyses suggested retaining a two-factor structure. Item bias detection according to country was conducted for all 13 items and effect was calculated with R2. For the two-factor solution, 9 items were associated with a negligible effect size, 3 items with a moderate one, and 1 item with a large one. A series of analyses of covariance considering the acquiescence variable as a covariate showed that the acquiescence tendency does not contribute to the bias at item level. This research indicates that the psychometric properties of this instrument do not reach a scalar equivalence but that a culturally reliable measurement of social desirability could be developed.