Clinician perspectives on rapid transition to telehealth during COVID-19 in Australia - a qualitative study.

Objective The coronavirus disease 2019 (COVID-19) pandemic precipitated a major shift in the use of telehealth in Australia. The changes highlighted gaps in our knowledge regarding the efficacy of, and clinician attitudes to, the use of telehealth. The current study expands and deepens the available evidence as a result of being collected in unique circumstances that removed one of the major barriers (lack of Medicare rebates) and also one major enablers (willingness) of telehealth uptake. Methods Using a semi-structured interview, we invited clinicians (N = 39) to share their perspectives, attitudes and experiences of using telehealth. Topics covered included perceptions of the strengths and challenges of telehealth, and how experience of using telehealth during the COVID-19 pandemic had influenced clinicians' views and intentions regarding their future practice. Participants included clinicians from five disciplines across public and private practice: paediatrics, neurology, immunology, rural general practice, and orthopaedics. Results We found three key dimensions for consideration when assessing the suitability of telehealth for ongoing practice: the attributes of the patient population, the attributes of the clinical context and environment, and the risks and benefits of a telehealth approach. These findings map to the existing literature and allow us to infer that the experiences of clinicians who previously would have chosen telehealth did not differ significantly from those of our 'pandemic-conscripted' clinicians. Conclusions Our findings map clearly to the existing literature and allow us to infer that the experiences of the clinicians who have chosen telehealth (and are already represented in the literature) did not differ significantly from those trying out telehealth under the unique circumstances of the removal of the Medicare Benefits Scheme barrier and external pressure that over-rides the 'willingness' enabling factor in uptake decisions.

Dental amalgam: the history and legacy you perhaps never knew?

Much has been written about dental amalgam. Over many years, it has served the profession well, yet on environmental grounds its use is being phased down. This article seeks to explore key milestones in the history and development of this versatile material, as well as highlighting how international standards have assisted in reducing environmental mercury contamination.

A kindergarten-based child health promotion program: the Adapted National Aeronautics and Space Administration (NASA) Mission X for improving physical fitness in South Korea.

BACKGROUND: Effective and sustainable intervention programs are needed to promote physical activity (PA) in children. OBJECTIVES: To adapt the NASA Mission X: Train Like an Astronaut program for use with South Korean children, and to evaluate its feasibility and effectiveness for promoting children's physical fitness. METHODS: Children 5 years old (n = 212) and their parents were recruited from three kindergartens in three cities to participate in a 6-week intervention program in fall 2014. We assessed the children's PA and related changes, and parental changes in attitude and beliefs, after participation in the intervention. RESULTS: Girls reported less PA than boys (40.7 vs. 59.0, p < 0.01). Children with a normal body mass index (BMI) were more likely to be active than underweight children (< 10 percentile) or overweight children (⩾ 85 percentile). After the intervention, about one-half of the children had increased their level of PA (49.4%), increased interest in PA (59.1%) and found psychological need satisfaction in exercise (52.6%). The majority of parents became aware of the necessity of childhood PA (94.2%), their child's PA capability (64.3%), and the relationship of PA with their children's self-esteem (79.9%). CONCLUSIONS: The adapted NASA Mission X program was feasible and effective in promoting PA in kindergarteners, and also improved their parents' attitude and beliefs about children's PA in South Korea. This study provided a model for promoting childhood health through child care and educational settings.

Erratum: Child health promotion program in South Korea in collaboration with US National Aeronautics and Space Administration: Improvement in dietary and nutrition knowledge of young children.

[This corrects the article on p. 555 in vol. 10, PMID: 27698964.].

Child health promotion program in South Korea in collaboration with US National Aeronautics and Space Administration: Improvement in dietary and nutrition knowledge of young children.

BACKGROUND/OBJECTIVES: Childhood obesity has become a global epidemic. Development of effective and sustainable programs to promote healthy behaviors from a young age is important. This study developed and tested an intervention program designed to promote healthy eating and physical activity among young children in South Korea by adaptation of the US National Aeronautics and Space Administration (NASA) Mission X (MX) Program. SUBJECTS/METHODS: The intervention program consisted of 4 weeks of fitness and 2 weeks of nutrition education. A sample of 104 subjects completed pre- and post-surveys on the Children's Nutrition Acknowledgement Test (NAT). Parents were asked for their children's characteristics and two 24-hour dietary records, the Nutrition Quotient (NQ) at baseline and a 6-week follow-up. Child weight status was assessed using Korean body mass index (BMI) percentiles. RESULTS: At baseline, 16.4% (boy: 15.4%; girl: 19.2%) of subjects were overweight or obese (based on BMI≥85%tile). Fat consumption significantly decreased in normal BMI children (48.6 ± 16.8 g at baseline to 41.9 ± 18.1 g after intervention, P < 0.05); total NQ score significantly increased from 66.4 to 67.9 (P < 0.05); total NAT score significantly improved in normal BMI children (74.3 at baseline to 81.9 after the program), children being underweight (from 71.0 to 77.0), and overweight children (77.1 at baseline vs. 88.2 after intervention, P < 0.001). CONCLUSIONS: The 6-week South Korean NASA MX project is feasible and shows favorable changes in eating behaviors and nutritional knowledge among young children.

Fracture toughness testing: A discriminatory mechanical testing performance indicator for glass-ionomer restoratives?

OBJECTIVES: To investigate the single-edge notched (SEN) bend fracture toughness (KIC) testing methodology as a reproducible and discriminatory mechanical testing protocol for encapsulated and hand-mixed glass-ionomers (GI). METHODS: SEN bend test-pieces (35.0±0.1mm length, 6.0±0.1mm width, 3.0±0.1mm thickness with a sharp notch formed at mid-length by embedding a scalpel blade) were prepared for KIC testing using three encapsulated GI products (Chemfil Rock, Fuji IXGP Fast Capsule and Ionofil Molar AC). In addition, test-pieces were prepared from a hand-mixed GI product (Ionofil Molar) which contained between 100% and 20% of the manufacturer's recommended powder content (in 10% decrements) for a constant weight of liquid. Groups of 20 test-pieces were prepared for each encapsulated GI product (n=3) and hand-mixed GI powder:liquid mixing ratio (n=9). Data were statistically analyzed and the coefficients of variation (CoV) determined for each encapsulated GI product and hand-mixed GI powder:liquid mixing ratio. RESULTS: The KIC testing methodology failed to discriminate between the encapsulated GI products that were investigated (p=0.225). For the hand-mixed GI, the KIC testing methodology also failed to discriminate between the powder:liquid mixing ratios investigated (R(2)=0.576). The pooled CoV (10%) for the encapsulated GI products and for the powder:liquid mixing ratio groups (12%) identified the reproducibility of the test for this experiment. For the hand-mixed GI mixing ratio groups with between 100% to 50% of the recommended powder content, no trend could be discerned. SIGNIFICANCE: The KIC testing methodology failed to discriminate between different encapsulated GI products and hand-mixed GI powder:liquid mixing ratio groups investigated, despite KIC being an intrinsic material property and the coefficient of variation being acceptable.

The determination of phosphorus containing compounds in dental casting investment products by 31P solid-state MAS-NMR spectroscopy.

OBJECTIVES: To use (31)P solid-state MAS-NMR to determine the phosphorus compounds that occur in dental casting investment material: (a) as-received, (b) after setting and (c) after burn-out and discover whether such compounds are the same in each material across a product range. METHODS: [(1)H] High powered decoupling (HPDC) and [(1)H] cross-polarization (CP) (31)P solid-state MAS-NMR spectroscopy at a resonance frequency of 121.4 MHz were used. Six commercial products were examined. Manufacturer's instructions were followed and a special liquid was used without dilution. RESULTS: All products contain ammonium dihydrogen phosphate as the acid phosphate required for the setting reaction. All set by the formation of struvite and significant amounts of amorphous magnesium orthophosphate. In three products, lesser amounts of newberyite were present and in another the equivalent amorphous compound was formed. When burnt-out, magnesium metaphosphate or pyrophosphate was the dominant matrix compound. A higher burn-out temperature favoured pyrophosphate formation. Farringtonite was present to a lesser extent with the metaphosphate. SIGNIFICANCE: Compounds that were not detected in earlier X-ray powder diffraction spectroscopy studies were detected by NMR, notably amorphous and glassy compounds (magnesium orthophosphate in set investment and magnesium metaphosphate in burnt-out material). The variation between products was significant and far greater than expected from the published scientific literature. Since the formation of compounds is affected by technical procedure and ambient conditions, these findings could offer some insight into the cause of the unpredictability of expansion measurements between laboratories. Further research is being undertaken.

(31)P solid-state MAS-NMR spectroscopy of the compounds that form in phosphate-bonded dental casting investment materials during setting.

OBJECTIVES: To use (31)P solid-state MAS-NMR to determine which compounds form in phosphate-bonded dental casting investment material during setting, when the ambient temperature is altered. To determine whether they differ in material originating at the center of the mix from material that adheres to the mixing bowl wall. METHODS: (1)H high powered decoupled (HPDC) and (1)H cross polarized (CP) (31)P solid-state MAS-NMR spectroscopy were used at a resonance frequency of 121.4MHz to determine molecular structure. Four commercial products were examined. Manufacturer's instructions were followed and special liquid used without dilution. Ambient temperature was between 18 and 37 degrees C. RESULTS: Molecular structures change with ambient temperature and product. Amorphous Mg(3)(PO(4))(2) or struvite dominate with newberyite, cattiite, amorphous Mg(2)P(2)O(7) and amorphous MgHPO(4) present as minor phases. Exceptionally, amorphous MgHPO(4) dominates. Differences in structure were found in material taken from the center of the mix compared with that scraped from the bowl wall, but the incidence may be specific to the product/mixer combination and not a general effect. SIGNIFICANCE: The formation of compounds in phosphate-bonded investment can be affected by ambient temperature. This effect and the use of material adhering to the bowl wall (instead of that from the center of the mix) are possible causes for the unpredictability of setting expansion measurements between laboratories. There is variation between products. When phosphate-bonded investment is required for casting, a consistent ambient temperature must be used and it would be wise to mix sufficient material to avoid scraping the bowl.

A comparison of tungsten-quartz-halogen, plasma arc and light-emitting diode light sources for the polymerization of an orthodontic adhesive.

This study investigated whether there were differences between the debond stress and adhesive remnant index (ARI) of an adhesive cured with three different orthodontic light sources. Sixty sound premolar teeth were divided into three groups of 20. A standard pre-adjusted edgewise premolar bracket (Victory Series) was bonded to each tooth using a light-cured orthodontic adhesive, Transbond X. Group 1 (control) specimens were cured with an Ortholux XT (tungsten-quartz-halogen bulb) light for 20 seconds, group 2 with an Ortho lite (plasma arc) for 6 seconds and group 3 with an Ortholux LED light-emitting diode for 10 seconds. The specimens were debonded 24 hours later using a universal mechanical testing machine, operating at a crosshead speed of 0.5 mm minute(-1). The Weibull modulus and a Logrank test showed no statistically significant differences between the three groups for debond stress. The ARI was assessed at x10 magnification. The ARI scores for group 2 were significantly different (P < 0.01) from those of groups 1 and 3 (between which there was no significant difference). For group 2 there was a greater tendency for failure to occur at the adhesive/tooth interface than for the other two groups. There appears to be no reason why any of the three types of light source cannot be used in orthodontics. Polymerization, as effective as that produced by conventional bulb light sources, was obtained with the short exposure times recommended for the plasma arc or light-emitting diode sources.

Retention of quartz-fibre endodontic posts with a self-adhesive dual cure resin cement.

This study examines retention of a quartz-fibre endodontic post cemented in extracted human teeth using two cement types. Fifty-four extracted buman central incisor teeth were prepared for a tapered quartz-fibre post. Posts were cemented in 28 teeth using conventional resin cement (RelyX ARC), and 26 teeth using self-adhesive resin cement (RelyX Unicem). Posts were cyclically-loaded. Bond strengths were tested and dependability assessment was carried out. Although there was no significant difference in Weibull modulus between groups (p < 0.05), greater dependability was displayed by RelyX Unicem group. Easy application and greater dependability of self-adhesive cement may improve bonding of fibre-based posts in root canals.

Measurement of the diffusion of liquids into dental restorative resins by stray-field nuclear magnetic resonance imaging (STRAFI).

OBJECTIVES: The purpose of this investigation was to determine the diffusion mechanism for water/ethanol mixtures in a diacrylate dental resin by direct observation of the absorbed liquid profiles using NMR microimaging. METHODS: Frequency-swept stray-field magnetic resonance imaging (STRAFI) was used. Solutions containing 25-65% by volume ethanol remained in contact with visible light cured 54% TEGDMA: 46% modified TUDMA sheets while measurements were made. The diffusion profiles were recorded periodically for diffusion times up to 10 h, to a depth of 360 microm and with readings taken at 24 microm intervals. RESULTS: For all liquid mixtures, diffusion was found to be Fickian with coefficients that increased progressively and smoothly with alcohol content in the diffusing mixture, from 2.4 x 10(-13) to 150 x 10(-13) m2 s(-1). A rule of mixtures approach, as suggested by Kwei and Zupko, gave a satisfactory description of the ethanol fraction dependence of the diffusivity. SIGNIFICANCE: Frequency-swept STRAFI offers a new and unique opportunity to produce spatially resolved measurements of the liquids in dental resins to high resolution. In this study, absorption was investigated since an understanding of its mechanism is fundamental to limiting consequent environmental degradation. STRAFI has great potential for other applications, for example drying, liquid exchange, etc. Since STRAFI can discriminate 1H in the liquid from those in softened polymer additional applications are envisaged.