Periodontal systemic associations: review of the evidence

Aim: To critically appraise recent research into associations between periodontal disease and systemic diseases and conditions specifically respiratory disease, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome and cancer.

Methods: A MEDLINE literature search of papers published between 2002 and April 2012 was conducted. Studies that included periodontitis as an exposure were identified. Cross-sectional epidemiological investigations on large samples, prospective studies and systematic reviews formed the basis of the narrative review. A threshold set for the identification of periodontitis was used to identify those studies that contributed to the conclusions of the review.

Results: Many of the investigations were cross-sectional secondary analyses of existing data sets in particular the NHANES studies. There were a small number of systematic reviews and prospective studies. There was substantial variability in the definitions of exposure to periodontitis. A small number of studies met the threshold set for periodontitis and supported associations; however, in some of the chronic diseases there were no such studies. There was strong evidence from randomized controlled trials that interventions, which improve oral hygiene have positive effects on the prevention of nosocomial pneumonias.

Conclusions: There was substantial heterogeneity in the definitions used to identify periodontitis and very few studies met a stringent threshold for periodontitis. Published evidence supports modest associations between periodontitis and some, although not all, of the diseases and conditions reviewed. There is a need to reach a consensus on what constitutes periodontitis for future studies of putative associations with systemic diseases.

The lifetime direct cost of periodontal treatment:A case study from a norwegian specialist practice

Background: Successful periodontal treatment requires a commitment to regular lifelong maintenance and may be perceived by patients to be costly. This study calculates the total lifetime cost of periodontal treatment in the setting of a specialist periodontal practice and investigates the cost implications of choosing not to proceed with such treatment. Methods: Data from patients treated in a specialist practice in Norway were used to calculate the total lifetime cost of periodontal treatment that included baseline periodontal treatment, regular maintenance, retreatment, and replacing teeth lost during maintenance. Incremental costs for alternative strategies based on opting to forego periodontal treatment or maintenance and to replace any teeth lost with either bridgework or implants were calculated. Results: Patients who completed baseline periodontal treatment but did not have any additional maintenance or retreatment could replace only three teeth with bridgework or two teeth with implants before the cost of replacing additional teeth would exceed the cost of lifetime periodontal treatment. Patients who did not have any periodontal treatment could replace ≤4 teeth with bridgework or implants before a replacement strategy became more expensive. Conclusions: Within the limits of the assumptions made, periodontal treatment in a Norwegian specialist periodontal practice is cost-effective when compared to an approach that relies on opting to replace teeth lost as a result of progressive periodontitis with fixed restorations. In particular, patients who have initial comprehensive periodontal treatment but do not subsequently comply with maintenance could, on average, replace ≤3 teeth with bridgework or two teeth with implants before this approach would exceed the direct cost of lifetime periodontal treatment in the setting of the specialist practice studied. © 2012 American Academy of Periodontology.

Incorporating Severity and Risk as Factors to the Fardal Cost-Effectiveness Model to Create a Cost-Benefit Model for Periodontal Treatment

Background: A previously described economic model was based on average values for patients diagnosed with chronic periodontitis (CP). However, tooth loss varies among treated patients and factors for tooth loss include CP severity and risk. The model was refined to incorporate CP severity and risk to determine the cost of treating a specific level of CP severity and risk that is associated with the benefit of tooth preservation.

Methods: A population that received and another that did not receive periodontal treatment were used to determine treatment costs and tooth loss. The number of teeth preserved was the difference of the number of teeth lost between the two populations. The cost of periodontal treatment was divided by the number of teeth preserved for combinations of CP severity and risk.

Results: The cost of periodontal treatment divided by the number of teeth preserved ranged from (US) $ 1,405 to $ 4,895 for high or moderate risk combined with any severity of CP and was more than $ 8,639 for low risk combined with mild CP. The cost of a three-unit bridge was $ 3,416, and the cost of a single-tooth replacement was $ 4,787.

Conclusion: Periodontal treatment could be justified on the sole basis of tooth preservation when CP risk is moderate or high regardless of disease severity.

Design methodology for low power and arametric robustness through output-quality modulation:Application to color-interpolation filtering

Power dissipation and robustness to process variation have conflicting design requirements. Scaling of voltage is associated with larger variations, while Vdd upscaling or transistor upsizing for parametric-delay variation tolerance can be detrimental for power dissipation. However, for a class of signal-processing systems, effective tradeoff can be achieved between Vdd scaling, variation tolerance, and output quality. In this paper, we develop a novel low-power variation-tolerant algorithm/architecture for color interpolation that allows a graceful degradation in the peak-signal-to-noise ratio (PSNR) under aggressive voltage scaling as well as extreme process variations. This feature is achieved by exploiting the fact that all computations used in interpolating the pixel values do not equally contribute to PSNR improvement. In the presence of Vdd scaling and process variations, the architecture ensures that only the less important computations are affected by delay failures. We also propose a different sliding-window size than the conventional one to improve interpolation performance by a factor of two with negligible overhead. Simulation results show that, even at a scaled voltage of 77% of nominal value, our design provides reasonable image PSNR with 40% power savings. © 2006 IEEE.

Process-variation resilient and voltage-scalable dct architecture for robust low-power computing

In this paper, we present a novel discrete cosine transform (DCT) architecture that allows aggressive voltage scaling for low-power dissipation, even under process parameter variations with minimal overhead as opposed to existing techniques. Under a scaled supply voltage and/or variations in process parameters, any possible delay errors appear only from the long paths that are designed to be less contributive to output quality. The proposed architecture allows a graceful degradation in the peak SNR (PSNR) under aggressive voltage scaling as well as extreme process variations. Results show that even under large process variations (±3σ around mean threshold voltage) and aggressive supply voltage scaling (at 0.88 V, while the nominal voltage is 1.2 V for a 90-nm technology), there is a gradual degradation of image quality with considerable power savings (71% at PSNR of 23.4 dB) for the proposed architecture, when compared to existing implementations in a 90-nm process technology. © 2006 IEEE.

VEDA:Variation-aware energy-efficient discrete Wavelet Transform architecture

In this paper, we present a unified approach to an energy-efficient variation-tolerant design of Discrete Wavelet Transform (DWT) in the context of image processing applications. It is to be noted that it is not necessary to produce exactly correct numerical outputs in most image processing applications. We exploit this important feature and propose a design methodology for DWT which shows energy quality tradeoffs at each level of design hierarchy starting from the algorithm level down to the architecture and circuit levels by taking advantage of the limited perceptual ability of the Human Visual System. A unique feature of this design methodology is that it guarantees robustness under process variability and facilitates aggressive voltage over-scaling. Simulation results show significant energy savings (74% - 83%) with minor degradations in output image quality and avert catastrophic failures under process variations compared to a conventional design. © 2010 IEEE.

Process variation tolerant low power DCT architecture

2-D Discrete Cosine Transform (DCT) is widely used as the core of digital image and video compression. In this paper, we present a novel DCT architecture that allows aggressive voltage scaling by exploiting the fact that not all intermediate computations are equally important in a DCT system to obtain "good" image quality with Peak Signal to Noise Ratio(PSNR) > 30 dB. This observation has led us to propose a DCT architecture where the signal paths that are less contributive to PSNR improvement are designed to be longer than the paths that are more contributive to PSNR improvement. It should also be noted that robustness with respect to parameter variations and low power operation typically impose contradictory requirements in terms of architecture design. However, the proposed architecture lends itself to aggressive voltage scaling for low-power dissipation even under process parameter variations. Under a scaled supply voltage and/or variations in process parameters, any possible delay errors would only appear from the long paths that are less contributive towards PSNR improvement, providing large improvement in power dissipation with small PSNR degradation. Results show that even under large process variation and supply voltage scaling (0.8V), there is a gradual degradation of image quality with considerable power savings (62.8%) for the proposed architecture when compared to existing implementations in 70 nm process technology.

Design methodology to trade off power, output quality and error resiliency: Application to color interpolation filtering

Power dissipation and tolerance to process variations pose conflicting design requirements. Scaling of voltage is associated with larger variations, while Vdd upscaling or transistor up-sizing for process tolerance can be detrimental for power dissipation. However, for certain signal processing systems such as those used in color image processing, we noted that effective trade-offs can be achieved between Vdd scaling, process tolerance and "output quality". In this paper we demonstrate how these tradeoffs can be effectively utilized in the development of novel low-power variation tolerant architectures for color interpolation. The proposed architecture supports a graceful degradation in the PSNR (Peak Signal to Noise Ratio) under aggressive voltage scaling as well as extreme process variations in. sub-70nm technologies. This is achieved by exploiting the fact that some computations are more important and contribute more to the PSNR improvement compared to the others. The computations are mapped to the hardware in such a way that only the less important computations are affected by Vdd-scaling and process variations. Simulation results show that even at a scaled voltage of 60% of nominal Vdd value, our design provides reasonable image PSNR with 69% power savings.

Assessing the effectiveness of a DRA versus DRA with an activity schedule procedure on the reduction of problem behaviour

Differential Reinforcement of Alternative behaviour (DRA) (Athens & Vollmer, 2010; Cooper, Heron, & Heward, 2007) is a procedure that consists in withholding reinforcement for the targeted inappropriate behaviour while reinforcing behaviours, i.e., that have the same function, but socially more acceptable topographies. DRA has repeatedly proven to be effective in reducing problem behaviours in individuals with autism (Campbell, 2003). On the other hand, a number of single-subject research studies have provided evidence for the use of activity schedules as a means to decrease aggressive behaviour (Dooley et al., 2001; Flannery & Hemer, 1994; Lalli, Casey, Goh, & Merlinoet al., 1994). The purpose of the present study was to evaluate the effectiveness of DRA in combination with the use of an activity schedule. We compared the impact of the visual activities schedule used in combination with a DRA procedure versus the impact of the DRA procedure used alone on problem behaviour of a boy diagnosed with an Autism Spectrum Disorder. An alternating treatments design was used to compare the rate of behaviour problems in each of the two treatment conditions. DRA was delivered as treatment A, while the combination of the activities schedule and DRA was treatment B.

A function-based treatment package aiming at decreasing self-injurious behaviour and tantrums.

Self-injurious and aggressive behaviours have often been identified as the cause for students’ lack of academic progress, parental distress, health risks and teachers´ low satisfaction levels. Functional analysis has been identified in the research literature as the benchmark of effective treatments for disruptive and/or inappropriate behaviours. The present study was completed with a girl diagnosed with ASD. An experimental functional analysis was conducted identifying the function of self-injurious behaviours and tantrums to be escaping from tasks. A treatment package was consequently put in place integrating several components that aimed at reducing overall levels of inappropriate behaviours. Results showed a clear and meaningful improvement in the student´s overall health and academic progress, as well as in parental involvement, teachers’ satisfaction and school inclusion. These outcomes are discussed in the light of evidence-based experimental procedures based on applied behaviour analysis and more specifically on the functional-analytic literature, which, if put in place consistently, can bring valuable positive changes in the quality of life of individuals with ASD.

The character of behavioural symptoms on admission to three Canadian long-term care homes

Objectives: We determined the prevalence and nature of behavioural symptoms at the time of admission to a long-term care home (LTCH) and occurrence of resident-to-resident aggressive behaviour associated with behavioural symptoms within three months following admission. Method: The Cohen-Mansfield Agitation Inventory and Aggressive Behaviour Scale were completed at the time residents were admitted into the LTCH. A chart review, conducted three months after admission into the LTCH, abstracted documented resident-to-resident aggression. Three LTCHs located in Ontario, Canada participated in the study. Results: During a 16-month period, 339 individuals admitted to the LTCHs comprised the study sample. A comparison was made between residents with and without dementia. At admission, residents with dementia had a greater number of behavioural symptoms than those without dementia (mean = 3.79, SD = 3.32 versus mean = 2.56, SD = 2.24, respectively; t(200) = 1.91; p = 0.059). Residents with and without dementia exhibited similar behaviours but differed on the prevalence of these behaviours. The most frequently reported behavioural symptoms for residents in both groups were verbal agitation and non-aggressive physical behaviours. The most frequently recorded aggressive behaviour for all residents was resisting care. In the three months post admission, 79 (23%) residents were involved in a documented incident that involved aggressive behaviour to another resident. Conclusion: A standardized comprehensive assessment for admission to a LTCH is an important strategy that can be used to identify behavioural symptoms and plan appropriate care management. 

A new performance based method for design and maintenance of reinforced concrete structures

Best concrete research paper by a student - Research has shown that the cost of managing structures puts high strain on the infrastructure budget, with
estimates of over 50% of the European construction budget being dedicated to repair and maintenance. If reinforced concrete
structures are not suitably designed and adequately maintained, their service life is compromised, resulting in the full economic
value of the investment not realised. The issue is more prevalent in coastal structures as a result of combinations of aggressive
actions, such as those caused by chlorides, sulphates and cyclic freezing and thawing.
It is a common practice nowadays to ensure durability of reinforced concrete structures by specifying a concrete mix and a
nominal cover at the design stage to cater for the exposure environment. This in theory should produce the performance required
to achieve a specified service life. Although the European Standard EN 206-1 specifies variations in the exposure environment,
it does not take into account the macro and micro climates surrounding structures, which have a significant influence on their
performance and service life. Therefore, in order to construct structures which will perform satisfactorily in different exposure
environments, the following two aspects need to be developed: a performance based specification to supplement EN 206-1
which will outline the expected performance of the structure in a given environment; and a simple yet transferrable procedure
for assessing the performance of structures in service termed KPI Theory. This will allow the asset managers not only to design
structures for the intended service life, but also to take informed maintenance decisions should the performance in service fall
short of what was specified. This paper aims to discuss this further.

Optical coherence tomography (OCT) for detection of macular oedema in patients with diabetic retinopathy

Background

Diabetic macular oedema (DMO) is a thickening of the central retina, or the macula, and is associated with long-term visual loss in people with diabetic retinopathy (DR). Clinically significant macular oedema (CSMO) is the most severe form of DMO. Almost 30 years ago, the Early Treatment Diabetic Retinopathy Study (ETDRS) found that CSMO, diagnosed by means of stereoscopic fundus photography, leads to moderate visual loss in one of four people within three years. It also showed that grid or focal laser photocoagulation to the macula halves this risk. Recently, intravitreal injection of antiangiogenic drugs has also been used to try to improve vision in people with macular oedema due to DR.Optical coherence tomography (OCT) is based on optical reflectivity and is able to image retinal thickness and structure producing cross-sectional and three-dimensional images of the central retina. It is widely used because it provides objective and quantitative assessment of macular oedema, unlike the subjectivity of fundus biomicroscopic assessment which is routinely used by ophthalmologists instead of photography. Optical coherence tomography is also used for quantitative follow-up of the effects of treatment of CSMO.

Objectives

To determine the diagnostic accuracy of OCT for detecting DMO and CSMO, defined according to ETDRS in 1985, in patients referred to ophthalmologists after DR is detected. In the update of this review we also aimed to assess whether OCT might be considered the new reference standard for detecting DMO.

Search methods

We searched the Cochrane Database of Systematic Reviews (CDSR), the Database of Abstracts of Reviews of Effects (DARE), the Health Technology Assessment Database (HTA) and the NHS Economic Evaluation Database (NHSEED) (The Cochrane Library 2013, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2013), EMBASE (January 1950 to June 2013), Web of Science Conference Proceedings Citation Index - Science (CPCI-S) (January 1990 to June 2013), BIOSIS Previews (January 1969 to June 2013), MEDION and the Aggressive Research Intelligence Facility database (ARIF). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 25 June 2013. We checked bibliographies of relevant studies for additional references.

Selection Criteria

We selected studies that assessed the diagnostic accuracy of any OCT model for detecting DMO or CSMO in patients with DR who were referred to eye clinics. Diabetic macular oedema and CSMO were diagnosed by means of fundus biomicroscopy by ophthalmologists or stereophotography by ophthalmologists or other trained personnel.

Data collection and analysis

Three authors independently extracted data on study characteristics and measures of accuracy. We assessed data using random-effects hierarchical sROC meta-analysis models.

Main results

We included 10 studies (830 participants, 1387 eyes), published between 1998 and 2012. Prevalence of CSMO was 19% to 65% (median 50%) in nine studies with CSMO as the target condition. Study quality was often unclear or at high risk of bias for QUADAS 2 items, specifically regarding study population selection and the exclusion of participants with poor quality images. Applicablity was unclear in all studies since professionals referring patients and results of prior testing were not reported. There was a specific 'unit of analysis' issue because both eyes of the majority of participants were included in the analyses as if they were independent.In nine studies providing data on CSMO (759 participants, 1303 eyes), pooled sensitivity was 0.78 (95% confidence interval (CI) 0.72 to 0.83) and specificity was 0.86 (95% CI 0.76 to 0.93). The median central retinal thickness cut-off we selected for data extraction was 250 µm (range 230 µm to 300 µm). Central CSMO was the target condition in all but two studies and thus our results cannot be applied to non-central CSMO.Data from three studies reporting accuracy for detection of DMO (180 participants, 343 eyes) were not pooled. Sensitivities and specificities were about 0.80 in two studies and were both 1.00 in the third study.Since this review was conceived, the role of OCT has changed and has become a key ingredient of decision-making at all levels of ophthalmic care in this field. Moreover, disagreements between OCT and fundus examination are informative, especially false positives which are referred to as subclinical DMO and are at higher risk of developing clinical CSMO.

Authors' conclusions

Using retinal thickness thresholds lower than 300 µm and ophthalmologist's fundus assessment as reference standard, central retinal thickness measured with OCT was not sufficiently accurate to diagnose the central type of CSMO in patients with DR referred to retina clinics. However, at least OCT false positives are generally cases of subclinical DMO that cannot be detected clinically but still suffer from increased risk of disease progression. Therefore, the increasing availability of OCT devices, together with their precision and the ability to inform on retinal layer structure, now make OCT widely recognised as the new reference standard for assessment of DMO, even in some screening settings. Thus, this review will not be updated further.

The BTA stat test:A tumor marker for the detection of upper tract transitional cell carcinoma

Objectives. To conduct a prospective evaluation to determine the utility of the BTA stat test in the detection of upper tract transitional cell carcinoma (UTTCC). Monitoring for UTTCC currently relies on invasive procedures such as upper tract imaging, ureteral washing cytology (UWC) and/or ureteroscopy, or voided urine cytology (VUC). The BTA stat test is a sensitive qualitative immunoassay that detects human complement factor H-related protein in voided urine.

Methods. A total of 81 patients participated, 27 with histopathologically confirmed UTTCC, 26 with upper tract calculi, and 28 with microscopic hematuria but no evidence of urologic disease. Voided specimens collected before surgery or treatment were tested with the BTA stat test and VUC. UWC was performed in specimens collected by a ureteral catheter.

Results. The BTA stat test was significantly more sensitive and specific than VUC or UWC. The overall sensitivity for each was 82%, 11%, and 48%; the specificity was 89%, 54%, and 33%. The positive predictive value for the BTA stat test was 79% and the negative predictive value was 91%, both the highest of the three tests.

Conclusions. The BTA stat test was superior to VUC and UWC in the detection of UTTCC. These results may support the adoption of a less aggressive follow-up policy when monitoring for UTTCC when the BTA stat result is negative. If cystoscopy is negative and the BTA stat test is positive, upper tract investigations should be expedited and, if the bladder is in place, bladder biopsies performed. (C) 2001, Elsevier Science Inc.

Limitations of Dental Panoramic Tomography in the anterior mandible

Dental Panoramic Tomography (DPT) is a widely used and valuable examination in dentistry. One area prone to artefacts and therefore misinterpretation is the anterior region of the mandible. This case study discusses a periapical radiolucency related to lower anterior teeth that is discovered to be a radiographic artefact. Possible causes of the artefact include a pronounced depression in the mental region of the mandible or superimposition of intervertebral spaces. Additional limitations of the DPT image include superimposition of radio-opaque structures, reduced image detail compared to intra-oral views and uneven magnification. These problems often make the DPT inappropriate for imaging the anterior mandible.

CLINICAL RELEVANCE: Panoramic radiography is often unsuitable for radiographic examination of the anterior mandible.