A survey of investigations used for the management of glaucoma in hospital service in the United Kingdom.

AIMS: This study surveys the current use of investigations for the management of glaucoma in hospital practice by UK ophthalmologists. METHODS: A total of 1007 questionnaires were posted to all active NHS consultant ophthalmologists. They were asked to indicate the type of hospital (whether university (UTH) or general (DGH) hospital), glaucoma specialist status, and availability and use of automated perimetry, disc photography, HRT, GDx, OCT, and pachymetry. RESULTS: A total of 493 completed questionnaires were received and 469 were analysed: 284 (60.6%) DGH, 185 (39.4%) UTH, 144 (30.7%) glaucoma specialists. There was good availability of automated perimetry (467, 99.6%), disc photography (420, 89.6%), pachymetry (374, 79.7%), OCT (212, 45.2%), HRT (206, 43.9%), and GDx (59, 12.6%). A total of 308 (65.7%) consultants had at least one digital imaging instrument available. The majority of consultants used SAP (347, 74.0%) and SITA-fast (282, 60.1%) for glaucoma suspects, and for monitoring glaucoma (283, 60.3% and 197, 42.0%, respectively). Some used Esterman (155, 33.0%) and Goldmann fields (90, 19.2%) in addition to SAP and SITA-fast for glaucoma suspects. Few consultants used short-wavelength automated perimetry and frequency-doubled perimetry. Of the three imaging tests, HRT was the most commonly used investigation for disc asymmetry, early glaucoma, glaucomatous progression, ocular hypertension, normal tension glaucoma, and unreliable visual fields (P<0.0001). Where pachymeters were available, 333 (89.0%) consultants and 117 (98.3%) glaucoma specialists used pachymetry in glaucoma management. CONCLUSIONS: There was some variation in the use of investigations for the diagnosis and management of glaucoma, reflecting the range of techniques available. SAP, SITA-fast, and pachymetry were the most commonly utilised investigations followed by HRT. Glaucoma specialist status, type of hospital, and presence of research influenced the availability and use of all investigations, except visual fields.

Interaction between hypertension and diabetes mellitus in the pathogenesis of sensorineural hearing loss.

The purpose of this study is to support the hypothesis that diabetic end-organ damage of the cochlea is augmented in the setting of hypertension. A historical perspective reviewing the effects of diabetes and hypertension as causative factors in the development of sensorineural hearing loss, as well as the basic epidemiology and pathophysiology of the renal and vascular effects of diabetes and hypertension, is presented. The results of audiologic findings in insulin-dependent diabetic patients, both normotensive and hypertensive, were analyzed and correlated with the results of animal studies to support the hypothesis that sensorineural hearing loss in patients and cochlear hair cell loss in animal studies result from the effects of hypertension in conjunction with insulin-dependent diabetes mellitus.

Photoactivated dentin bonding with N-phenyliminodiacetic acid.

OBJECTIVES: The overall objective of this study was to correlate adhesive resin and polymerization initiator chemistry with bonding to dentin that had been treated with N-phenyliminodiacetic acid (PIDAA), a self-etching primer with initiator and co-initiator potential. The hypotheses to be tested were that: (1) the nature of the adhesive resin and (2) the type of polymerization initiator system are critical factors that can influence the bonding of composite restoratives to dentin. METHODS: Three types of bonding resins: (A) a non-carboxylic acid bonding resin (BisGMA/HEMA); (B) a carboxylic acid monomer (PMDM, the control); and (C) a combination system (BisGMA/HEMA/PMDM), along with two types of initiator systems: (1) a self-curing chemical initiator system based on PIDAA and (2) a dual-cure system involving camphorquinone, PIDAA, and visible light irradiation, were tested with a randomized 3 x 2 full factorial design. Solutions of each resin in acetone were tested with and without camphorquinone. Solution (A) was a 50% solution of 1:1 BisGMA/HEMA; Solution (B), a 10% solution of PMDM; and Solution (C), a 50% solution of 2:2:1 BisGMA/HEMA/PMDM in the ratio of 2:2:1. All percents were on a mass basis. (The photoactivated solutions of A, B, and C also contained 0.5% camphorquinone based on the mass of the resin.) Ninety composite-to-dentin specimens were prepared by a 2-step protocol: 1) 60 s application of 20 microL of 0.3 mol/L PIDAA in 1:1 v/v acetone/H2O; 2) 60 s application of 20 microL of one of the six resin solutions, followed by 60 s visible light irradiation. A visible light-activated composite (Silux, 3M) was then applied to each treated surface and irradiated for 60 s. Specimens were stored in distilled H2O (22 degrees C, 24 h) before shear bond testing. The summary statistics were calculated and a two-way ANOVA and Duncan's Multiple Range test were used to discern if the two factors significantly affected the mean shear bond strength. RESULTS: Mean shear bond strengths and standard deviations were obtained (with and without camphorquinone, respectively): (A), 11.0 MPa +/- 3.9 and 4.1 MPa +/- 4.9; (B), 27.0 MPa +/- 5.3 and 13.7 MPa +/- 5.6; (C), 18.3 MPa +/- 5.3 and 7.0 MPa +/- 5.2. The use of camphorquinone significantly enhanced the mean shear bond strengths obtained with the carboxylic, non-carboxylic and combination monomer based adhesive systems (p < 0.0001). For PIDAA-treated dentin, moderate shear bond strengths were obtained with a non-carboxylic acid resin solution containing camphorquinone. The addition of both PMDM and camphorquinone to this resin further improved the shear bond strengths. The highest mean shear bond strength was obtained with the combination of PMDM and camphorquinone (p < 0.05). SIGNIFICANCE: These results suggest that formulations based on PIDAA, PMDM and camphorquinone are more effective as bonding systems than those formulations without PMDM and camphorquinone. PIDAA, a self-etching primer with initiator and co-initiator abilities, appears to interact positively with both carboxylic acid monomers such as PMDM and the photooxidant camphorquinone.

N-phenyliminodiacetic acid as an etchant/primer for dentin bonding.

Effective composite-to-dentin bonding has been achieved by the sequential use of dilute aqueous nitric acid (HNO3) and acetone solutions of N-phenylglycine and a carboxylic acid monomer, e.g., p-PMDM. Both the HNO3 pre-treatment and the surface-initiated polymerization that results from reaction of infused N-phenylglycine and PMDM have been identified as key elements of this bonding system. In this study, N-phenyliminodiacetic acid, a unique imino acid derivative with acidic and chelating potential, was evaluated as a dual etchant/primer for dentin bonding. A randomized, 2(3) factorial design was used to study the effects of 3 factors on tensile bond strength (TBS): conditioner (HNO3 vs. no HNO3), primer (N-phenylglycine vs. N-phenyliminodiacetic acid), and primer solvent (acetone vs. acetone:H2O). The three-step protocol consisting of HNO3, N-phenylglycine in acetone, and PMDM in acetone served as the control. The hypothesis tested was that N-phenyliminodiacetic acid could act as both an effective conditioner (i.e., etchant) and as a primer. Two-step protocols that included only N-phenyliminodiacetic acid and PMDM were compared with the control. TBS (n = 10 per group) were determined after 24-hour storage in H2O and analyzed by ANOVA and Duncan's Multiple Range test. Primer solvent was critical for obtaining significant bonding to dentin when HNO3 was omitted. N-phenyliminodiacetic acid in acetone without prior HNO3 etching gave the lowest ranking mean TBS (95% CI, 3.8 +/- 1.9 MPa). In contrast, the mean TBS obtained from samples treated with N-phenyliminodiacetic acid in acetone:H2O without prior HNO3 etching was not statistically different (p > 0.05) from the mean TBS for the control (95% CI, 9.3 +/- 1.8 and 9.8 +/- 1.9 MPa, respectively). Due to its dual function as etchant and primer, N-phenyliminodiacetic acid in acetone:H2O provides for a simplified bonding technique that yields strong, PMDM-mediated adhesion to dentin.

New surface-active comonomer for adhesive bonding.

Previous studies have indicated that chemical and physical characteristics of aromatic amines can be influenced by the nature of their substituents. The experimental question examined in the present study relates to the effects of replacing specific hydrogen atoms with methyl groups in a surface-active comonomer utilized in adhesive bonding protocols. N-2-propionic acid-N-3-(2-hydroxy-1-methacryloxy)propyl-3,5-dimethylaniline sodium salt (N35A) was synthesized by an addition reaction of glycidyl methacrylate with the sodium salt of N-reaction of glycidyl methacrylate with the sodium salt of N-(3,5-dimethylphenyl)alanine, which was formed by alkaline hydrolysis of ethyl-N-(3,5-dimethylphenyl)alanate that was prepared by condensation of ethyl-2-bromopropionate with 3,5-dimethylaniline. 1H and 13C NMR spectra and analysis by mass spectroscopy were consistent with N35A after it had been recrystallized from acetone. Color stability and adhesion-promoting capability of N35A were compared with those of N-2-acetic acid-N-3-(2-hydroxy-1-methacryloxy)propyl-4-methylanaline sodium salt (Na-NTG-GMA), the latter being widely used in commercial bonding formulations. Both N35A and Na-NTG-GMA polymerized within a few minutes at 23 degrees C when dissolved in aliquots from a stock solution containing benzene 85 wt%, ethanol 14 wt%, and benzoyl peroxide 1.0 wt%; but with each at 0.018 molal concentration, the N35A suspension was more color-stable than that of the Na-NTG-GMA. In the protocol used, shear bond strengths of a hybrid composite to human dentin with N35A were 30.2 MPa, SD = 7.5 MPa, and with Na-NTG-GMA, 29.7 MPa, SD = 11.8 MPa(n = 7 each; t test, p = 0.93).

Molar efficiency study of chlorinated NPG substitutes in dentin bonding.

This study evaluated and compared the contributions to dentin adhesive bonding of three N-phenylglycine analogues with electron-withdrawing substituents on the aromatic ring. These electron-deficient "N-compounds" included: N-(4-chlorophenyl)-glycine (NCPG), N-methyl-N-(4-chlorophenyl)-glycine (NMNCPG), and N-(3,4-dichlorophenyl)-glycine (NDCPG). An experimental three-step dentin-bonding protocol that consisted of sequential application of acidic ferric oxalate solution, an N-compound in acetone, and a surface-active comonomer in acetone was used. The first and third steps were held constant throughout the study. Each N-compound (NCPG, NMNCPG, NDCPG) was used in step two at ten concentrations ranging from 0.0 mol/L (pure acetone) to 5 x 10(-1) mol/L, depending on solubility. After overnight storage in distilled water, the dentin-to-composite bonds were broken in tension. The data were analyzed with ANOVA, and multiple comparisons were performed with Duncan's Multiple Range test. All statistical tests were controlled at alpha = 0.05. At 5 x 10(-3) mol/L, the relative effectiveness of the three N-compounds (as measured by tensile bond strengths) was NMNCPG > NCPG > NDCPG. Of all concentrations studied, the mean bond strengths produced with NMNCPG were statistically as good as or better than those produced by the other two compounds, and NCPG was always as good as or better than NDCPG. Increased electron-withdrawing from the nitrogen of the amine group by the substituents narrowed the effective concentration range for dentin bonding and, in general, produced lower mean bond strengths between dentin and composite.

The effects of freeze-drying on the potency and stability of live varicella virus vaccine.

Investigations into methods for improving the potency and stability of live varicella-zoster virus (Oka strain) vaccines have included the use of different lyophilization procedures which yielded products with different moisture levels. Three procedures were used: an 8-hour controlled-vacuum (0.47 mBars) procedure, a 14-hour controlled-vacuum (0.14 mBars) procedure, and a 48-hour high-vacuum (less than 0.07 mBars) procedure. Samples were stored for 24 months at -24 degrees C, -15 degrees C (in a frost-free freezer), and 4 degrees C. Potency was determined by a plaque assay in MRC-5 cells; moisture content was measured by the Karl Fisher method. Moisture content was 6 to 8 percent for the product made using the 8-hour procedure, 2 to 7 percent for the 14-hour procedure, and 0.5 to 1.5 percent for the 48-hour procedure. In addition to higher moisture, the 8-hour procedure resulted in a higher initial potency, indicating a lower loss during lyophilization, and better stability than did the 14- and 48-hour procedures. Although the initial potency from the 14-hour procedure was not statistically different from that for the 48-hour procedure, the product made with the 14-hour procedure did have better stability characteristics than that made with the 48-hour procedure.

The effects of stopper drying on moisture levels of Haemophilus influenzae conjugate vaccine.

The discovery and development of increasingly potent biological and pharmaceutical products have resulted in very small amounts of the active ingredient in final product formulations. Pediatric vaccines with sub-milliliter dose sizes pose unique problems for final formulation and lyophilization, especially when stabilizers used are present in small amounts or are hygroscopic. Lyophilized Haemophilus b Conjugate Vaccine (Meningococcal Protein Conjugate) (PedvaxHIB) has a plug weight of about 3 mg in its final formulation. Microgram amounts of water absorbed by the lyophilized plug can cause drastic changes in the moisture content of the product. In a small percentage of the final containers absorption of moisture by the vaccine may cause aesthetic defects (plug collapse) over time, or at elevated temperatures. This paper describes drying methods developed to control residual moisture levels in stoppers used as final container closures. Results on the moisture stability of the product capped with dried and non-dried stoppers are presented.

Modification of interactive behaviors in chronic mental patients.

Four chronic mental patients, residents of a token economy treatment unit, were randomly assigned to an experimental or control condition and attended 10 thirty-minute treatment sessions. For the two experimental subjects, contingent reinforcement was received for interacting with each other according to instructions in four distinct phases of interpersonal behavior: talking to another person, attending and talking to another person, asking and answering questions in a dyad, and working cooperatively in the dyad to solve problems. The two control subjects were instructed to perform the same behaviors but received non-contingent reinforcement. The results indicated a strong contingent reinforcement effect on the performance of the treatment sessions' target behaviors. Several baseline, treatment, and post-treatment response measures indicated that the treatment effects had generalized to other areas of social behavior away from the treatment setting.