Few prospective trials of implant-retained mandibular dentures have evaluated the increase and duration of patient satisfaction, costs of denture maintenance in relation to different methods of ...attaching overdentures to implants, or the use of a reinforced framework.
This report evaluates subjects' satisfaction and prosthodontic maintenance during a 3-year randomized clinical trial of implant-retained mandibular complete dentures, whether reinforced or not with a cast framework, and attached by bar-clip or 2.25-mm ball-spring matrices to endosteal dental implants.
One hundred edentulous subjects, each having at least 1 year's experience with conventional complete dentures, were selected from respondents to a university dental clinic's request for volunteers. Candidates were examined to verify adequate mandibular bone and medical suitability for implants. Subjects then received 2 implants in the anterior mandible before being stratified by mandibular bone height and gender and assigned randomly to 1 of 4 treatment groups. Every subject received a new maxillary complete denture in addition to an implant-supported mandibular complete denture, with or without a reinforcing framework, connected to implants by either a bar-clip or a ball-spring patrix and matrix. The dentures were adjusted and repaired as needed. Subjects indicated on a visual analogue scale (VAS) satisfaction with conventional dentures prior to the study and then with new dentures at 1 month, 1 year, and 2 years. The results reported here are from the first 68 subjects observed for 3 years after receiving new dentures (19 subjects received new dentures less than 3 years before this analysis, and another 13 subjects were lost to follow-up). VAS scores are presented in simple tables and graphs, and results for different groups were compared using 2-sided nonparametric rank tests and repeated measures ANOVA. With respect to costs and maintenance,
t tests were used to compare group means. Sample size and other design considerations used a .05 significance level.
After receiving new dentures with mandibular implant supports, improved satisfaction “within subject” was prompt, durable, substantial, and statistically significant, regardless of the attachment mechanism, and with or without a reinforcing framework. In contrast, there were no notable satisfaction differences between the 2 attachment mechanisms, or with the presence or absence of a reinforcing framework, either at specific intervals after receiving the new dentures, or in repeated measures ANOVA. For both attachment groups, most denture adjustments occurred during the first year. This accounted for 81% of total adjustments during 3 years, when the 34 subjects in the ball-spring group and the 34 in the bar-clip group were combined. The mean numbers of adjustments per subject and associated clinical times did not differ significantly between the 2 groups. Conversely, denture repairs declined more slowly than adjustments. Almost all repairs (90%) occurred in the ball-spring group to correct problems with the attachments, 39% in the first year, and tapering off only slightly in the following 2 years. Over 3 years of follow-up, mean numbers of repairs per subject differed significantly between groups: 6.7 repairs per person in the ball-spring group, compared to 0.8 in the bar-clip group (
P<.001), and mean time per appointment was greater for repairs in the ball-spring group: 18.9 minutes compared to 16.9 (
P<.01). The cast framework had no influence on the satisfaction expressed or on adjustments and repairs.
Subjects were very satisfied with the new dentures, although the ball-spring attachment tested in this trial required substantially more repairs.
Vanillin (4-hydroxy-3-methoxybenzaldehyde) is an important flavour and aroma molecule, but is also of interest because of its biogenetic relationship to the phenylpropanoid pathway and to other ...molecules of physiological significance, notably salicylate. Recent progress towards characterisation of the biosynthesis of vanillin is reviewed. In
Vanilla, there is some evidence that the route to vanillin-β-
d-glucoside may proceed from 4-coumaric acid via 4-hydroxybenzaldehyde, with glucoside formation occurring not necessarily as the final step, and possibly with the involvement of 4-hydroxybenzyl alcohol β-
d-glucoside tartrate bis-esters as “shunt” metabolites. This appears to be given tentative support by the recent partial characterisation of a 4-hydroxybenzaldehyde synthase from
Vanilla. On the other hand, a well-characterised, CoA-dependent, non-oxidative chain-shortening mechanism to produce vanillin from ferulic acid, occurring as part of a pathway of hydroxycinnamate degradation in
Pseudomonas, may not be representative of hydroxycinnamate chain-shortening mechanism(s) occurring in
Vanilla and other plants. Nevertheless, by expression of the
Pseudomonas enzyme 4-hydroxycinnamoyl-CoA hydratase/lyase (HCHL), attempts have been made to introduce a direct capacity for vanillin formation into model plants by diversion of the phenylpropanoid pathway. The results obtained have emphasised the obstacles to achieving the desired oxidation level (aldehyde) and ring substitution (4-hydroxy-3-methoxyphenyl), even when a substantial metabolic diversion is successfully achieved. Finally, the significance of the latest biosynthetic and biotechnological developments is reviewed briefly in relation to authentication of vanillin.
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Firearms are a leading cause of injury mortality across the lifespan, with elevated risks for older adult populations. To inform prevention efforts, we conducted a probability-based web survey ...(12/1/2019–12/23/2019) of 2048 older adults (age 50–80) to characterize national estimates of firearm ownership, safety practices, and attitudes about health screening, counseling, and policy initiatives. Among older U.S. adults, 26.7% 95%CI = 24.8%–28.8% report owning one or more firearms. The primary motivation for ownership was protection (69.5%), with 90.4% highlighting a fear of criminal assault. 39.4% of firearm owners reported regularly storing firearm(s) unloaded and locked, with 24.2% regularly storing at least one loaded and unlocked. While most firearm owners found healthcare screening (69.2% 95%CI: 64.9–73.1) and safety counseling (63.2% 95%CI = 58.8–67.3) acceptable, only 3.7% of older adults reported being asked about firearm safety by a healthcare provider in the past year. Among firearm owners, there was support for state-level policy interventions, including allowing family/police to petition courts to restrict access when someone is a danger to self/others (78.9% 95%CI = 75.1–82.3), comprehensive background checks (85.0% 95%CI = 81.5–87.9), restricting access/ownership under domestic violence restraining orders (88.1%; 95%CI = 84.9–90.7, and removing firearms from older adults with dementia/confusion (80.6%; 95%CI = 76.8–84.0. Healthcare and policy-level interventions maintained higher support among non-owners than owners (p's < 0.001). Overall, data highlights opportunities exist for more robust firearm safety prevention efforts among older adults, particularly healthcare-based counseling and state/federal policies that focus on addressing lethal means access among at-risk individuals.
•Little is known about older adult (OA) firearm ownership and views on safety topics.•26.7% of older U.S. adults (age 50-80) own 1 firearm(s), primarily for protection.•24.2% of OA firearm owners regularly store their firearms unlocked and loaded.•Most OAs support healthcare firearm safety counseling, but few receive it regularly.•Most OAs support policies meant to reduce firearm access for high-risk individuals.
With recent advances in the treatment of non-small-cell lung cancer (nsclc) and current fiscal constraints within publicly funded health care systems, understanding the real-world economic effect of ...lung cancer management has become important. The objective of the present study was to determine the costs and resources used in the management of nsclc cohorts in Ontario.
Patients diagnosed between 1 April 2010 and 31 March 2015 were identified in the Ontario Cancer Registry and linked to provincial administrative databases, capturing resources such as hospitalizations, cancer clinic visits, physician services, and systemic therapies or radiotherapy. A cost-of-illness analysis using a bottom-up approach and the GETCOST macro available at ices determined the overall total and mean costs in 2017 Canadian dollars. Resource utilization results were analyzed according to the total number of encounters per resource, the number of patients using each resource, and the number of encounters per patient. A separate cost-and-resource analysis was conducted for radiotherapy.
The 24,729 nsclc patients identified included 4542 with stage iii unresectable disease and 10,103 with stage iv nonsquamous disease. The overall total cost for all nsclc patients was $1.9 billion, with inpatient hospitalizations ($635.2 million), cancer clinic visits ($323.7 million), and physician services ($301.4 million) being the top cost contributors. The mean cost per patient was $76,816. The total cost of radiotherapy was $38.5 million.
Real-world costs for the management of nsclc during the 5-year period examined were substantial, despite the fact that median survival was poor and treatment information was limited.
In this paper, we report the results of an X-ray monitoring campaign on the heavily obscured Seyfert galaxy, Markarian 3, carried out between the fall of 2014 and the spring of 2015 with NuSTAR, ...Suzaku and XMMNewton. The hard X-ray spectrum of Markarian 3 is variable on all the time-scales probed by our campaign, down to a few days. The observed continuum variability is due to an intrinsically variable primary continuum seen in transmission through a large, but still Compton-thin column density (N(sub H) approx. 0.8-1.1 x 10(exp 24)/sq cm). If arranged in a spherical-toroidal geometry, the Compton scattering matter has an opening angle approx. 66deg, and is seen at a grazing angle through its upper rim (inclination angle approx. 70deg). We report a possible occultation event during the 2014 campaign. If the torus is constituted by a system of clouds sharing the same column density, this event allows us to constrain their number (17 +/- 5) and individual column density, approx. (4.9 +/- 1.5) x 10(exp 22)/ sq cm. The comparison of IR and X-ray spectroscopic results with state-of-the art torus models suggests that at least two-thirds of the X-ray obscuring gas volume might be located within the dust sublimation radius. We report also the discovery of an ionized absorber, characterized by variable resonant absorption lines due to He- and H-like iron. This discovery lends support to the idea that moderate column density absorbers could be due to clouds evaporated at the outer surface of the torus, possibly accelerated by the radiation pressure due to the central AGN emission leaking through the patchy absorber.
Objectives
To determine the diagnostic yield of analysing biparametric (T2‐ and diffusion‐weighted) magnetic resonance imaging (B‐MRI) for prostate cancer detection compared with standard digital ...rectal examination (DRE) and prostate‐specific antigen (PSA)‐based screening.
Patients and Methods
Review of patients who were enrolled in a trial to undergo multiparametric‐prostate (MP)‐MRI and MR/ultrasound fusion‐guided prostate biopsy at our institution identified 143 men who underwent MP‐MRI in addition to standard DRE and PSA‐based prostate cancer screening before any prostate biopsy. Patient demographics, DRE staging, PSA level, PSA density (PSAD), and B‐MRI findings were assessed for association with prostate cancer detection on biopsy.
Results
Men with detected prostate cancer tended to be older, with a higher PSA level, higher PSAD, and more screen‐positive lesions (SPL) on B‐MRI. B‐MRI performed well for the detection of prostate cancer with an area under the curve (AUC) of 0.80 (compared with 0.66 and 0.74 for PSA level and PSAD, respectively). We derived combined PSA and MRI‐based formulas for detection of prostate cancer with optimised thresholds. (i) for PSA and B‐MRI: PSA level + 6 x (the number of SPL) > 14 and (ii) for PSAD and B‐MRI: 14 × (PSAD) + (the number of SPL) >4.25. AUC for equations 1 and 2 were 0.83 and 0.87 and overall accuracy of prostate cancer detection was 79% in both models.
Conclusions
The number of lesions positive on B‐MRI outperforms PSA alone in detection of prostate cancer. Furthermore, this imaging criteria coupled as an adjunct with PSA level and PSAD, provides even more accuracy in detecting clinically significant prostate cancer.
Values‐affirmation interventions have the potential to improve students’ experience and achievement in school. Researchers have proposed that these benefits are greatest when affirmation exercises ...are delivered by teachers (versus researchers). The current research provides an experimental test of whether describing affirmation activities as provided by teachers increases students’ engagement with the activities and students’ positive perceptions of their teachers. In a 2×2 field experiment, delivered to students during their first year of high school, students completed either an affirmation or matched control activity purportedly provided by either teachers or researchers. We found that describing affirmation activities as provided by teachers led students to perceive that teachers at their school were more interested in students’ broader lives outside of school and provided marginally more care and support to students, as compared to the same affirmation exercise described as provided by researchers and control activities attributed to either source. In addition, teacher‐provided affirmation activities prompted students to write more during the activities. The present study provides initial evidence that affirmation interventions can improve students’ perceptions of their relationship with their teachers—a potent driver of student success—but only when affirmation activities are seen as coming from and of interest to teachers.
We present NuSTAR observations of the bright Seyfert 2 galaxy NGC 2110 obtained in 2012, when the source was at the highest flux level ever observed, and in 2013, when the source was at a more ...typical flux level. We include archival observations from other X-ray satellites, namely XMM–Newton, Suzaku, BeppoSAX, Chandra and Swift. Simultaneous NuSTAR and Swift broad-band spectra (in the 3–80 keV range) indicate a cutoff energy E
c > 210 keV, with no detectable contribution from Compton reflection. NGC 2110 is one of the very few sources where no evidence for distant Compton-thick scattering is found and, by using temporal information collected over more than a decade, we investigate variations of the iron Kα line on time-scales of years. The Fe Kα line is likely the sum of two components: one constant (originating from distant Compton-thick material) and the other one variable and linearly correlated with the source flux (possibly arising from Compton-thin material much closer to the black hole).
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