Evaluation of Clinical Periodontal Parameters of Abutment Teeth Supporting Distal-Extension Base Removable Partial Dentures: A Cross-sectional Study.

To assess the clinical periodontal status of abutment teeth in regards of different design components of distal-extension removable partial dentures. Subjects (N=100) with acrylic or cobalt-chromium distal-extension removable partial dentures were enrolled and their periodontal parameters plaque and gingival indices [PI, GI], probing depths [PD], clinical attachment loss [CAL] and a mobility index [MI] evaluated. Denture base type, major connector, occlusal rests position, design of direct retainers, retention, stability and denture wearing habits were further evaluated. Acrylic RPDs were associated with higher mean±SE PI [1.70±0.74], GI [1.76±0.55], PD scores [2.47±1.02 mm] and CAL values [4.46±2.11 mm] compared to CO-CR RPDs [p⟨0.05]. For abutments, the PI [1.6±0.83], GI [1.72±0.57], PD [2.32±1.03] and CAL [4.26±2.08] were higher than their non-abutments counterparts [p⟨0.05]. CAL scores were found to be significantly higher for mandibular abutments compared to maxillary ones [P=0.002]. The highest PI [1.83±1.10] and GI [2.00±0.00] scores were associated with lingual bars and horse-shoe connectors, respectively. Full palatal coverage and lingual plates were associated with the highest PD [2.80±0.48] and CAL [4.70±0.37] scores. Acrylic RPDs, type of major connector, wrought wire clasps and distal occlusal rests may be considered as risk factors for periodontal disease progression in distal-extension removable partial denture wearers.

Nutrient digestibility, rumen parameters, and (cannabinoid) residues in sheep fed a pelleted diet containing green hemp (Cannabis sativa L.) biomass.

The feeding value for ruminants of green hemp biomass, from the low Δ9-tetrahydrocannabinol (Δ9-THC) variety of Cannabis sativa L., is unknown. Twelve Merino ewes were individually penned and randomly allocated on a stratified liveweight basis to one of two pelleted dietary treatments, control (0% hemp, n = 6) or hemp (42% green hemp biomass, n = 6) that delivered a diet meeting the nutrient requirements of the animals. The experimental period consisted of 17 d dietary and housing adaptation, followed by 7 d total urine and feces collection for determination of apparent nutrient digestibility. A ruminal fluid sample was collected on day 27 and assessed for pH, ammonia, volatile fatty acid (VFA), and cannabinoid concentrations. A blood sample from the jugular vein and incisional subcutaneous fat biopsy from an area around the base of the tail were collected on day 28 with additional fat biopsies taken 35 d and 140 d post-feeding to measure cannabinoids. The dry matter (DM), organic matter (OM), and crude protein (CP) digestibilities, along with total VFA concentration did not differ (P = 0.713) between the two diets; however, acid detergent fiber (ADF) and neutral detergent fiber (NDF) digestibilities (P < 0.001), water intake (P = 0.023), and fecal water output (P < 0.001) were significantly lower for the sheep-fed Hemp. Rumen pH did not vary (P = 0.256) between diets, but ruminal ammonia concentration was significantly lower (P = 0.024) for sheep consuming Hemp. Sheep-fed Hemp had significantly greater molar proportions of butyric (P = 0.039) and hexanoic (P = 0.012) acids and lower molar proportions of propionic acid (P = 0.003). There were no differences between diets for N intake (P = 0.175), fecal N output (P = 0.253), and N balance (P = 0.695), with all sheep in positive N balance; however, there was significantly lower (P = 0.001) urinary N output for sheep-fed Hemp. Cannabidiolic acid (CBDA) and tetrahydrocannabinolic acid (THCA) were detected in plasma of all sheep-fed Hemp. ∆9-tetrahydrocannabinol was present in the subcutaneous fat of four of the six sheep on the final day of being fed Hemp, and in all (six) sheep 35 d post-feeding and one sheep 140 d post-feeding Hemp. No cannabinoids were detected in the corresponding samples taken from the sheep-fed Control. Thus, despite green hemp biomass being nutritionally a suitable feed for ruminants, under current Food Standards in Australia, the presence of these cannabinoid residues restricts its use in ruminant diets.

Data Resource Profile: the Scottish Social Care Survey (SCS) and the Scottish Care Home Census (SCHC).

INTRODUCTION: Linked health care datasets have been used effectively in Scotland for some time. Use of social care data has been much more limited, partly because responsibility for these services is distributed across multiple local authorities. However, there are substantial interactions between health and social care (also known internationally as long-term care) services, and keen policy interest in better understanding these. We introduce two social care resources that can now be linked to health datasets at a population level across Scotland to study these interdependencies. These data emerge from the Scottish Government's centralised collation of data from mandatory returns provided by local authorities and care homes. METHODS: Deterministic and Probabilistic methods were used to match the Social Care Survey (SCS) and Scottish Care Home Census (SCHC) to the Community Health Index (CHI) number via the National Records of Scotland (NRS) Research Indexing Spine. RESULTS: For the years 2010/11 to 2015/16, an overall match rate of 91.2% was achieved for the SCS to CHI from 31 of Scotland's 32 local authority areas. This rate varied from 76.7% to 98.5% for local authority areas. A match rate of 89.8% to CHI was achieved for the SCHC in years 2012/13 to 2015/16 but only 52.5% for the years 2010/11 to 2011/12. CONCLUSION: Indexing of the SCS and SCHC to CHI offers a new and rich resource of data for health and social care research.

Highly acidic pH values of carbonated sweet drinks, fruit juices, mineral waters and unregulated fluoride levels in oral care products and drinks in India: a public health concern.

PURPOSE: The objective of this study was to quantify and assess the concentrations of fluoride in commonly used oral care products, fruit juices, bottled waters, soft drinks, favoured bottled milk and milkshakes and to determine the pH of carbonated sweet drinks and drinks marketed in India. MATERIALS AND METHODS: Various commercial brands of dentifrices, toothpowders, mouthwashes, bottled waters, sweet carbonated drinks and fruit juices were collected randomly from different outlets in Mangalore city, Karnataka, India. A fluoride ion-selective electrode was employed to estimate the fluoride concentrations. A standardised pH meter was used to detect pH in the drinks. RESULTS: The fluoride level in toothpastes ranged between 96 and 1397 mg/l, whereas in toothpowder the fluoride content ranged from 35 to 1380 mg/l and mouthwash fluoride concentrations varied from 6 to 228 mg/l. The fluoride level in bottled waters ranged between 0.10 and 0.12 mg/l, and that in fruit juices between 0.09 and 0.21 mg/l. Most of the carbonated sweet drinks and fruit juices had highly acidic pH values which ranged between 2.62 and 4.26. CONCLUSION: Of the wide variety of dentifrices and toothpowders available in India, most brands do not indicate the fluoride levels on their packaging or inserts. Similarly, the unregulated acidic pH values of carbonated sweet drinks are not only potentially contributing to non-carious tooth loss (enamel erosion and dentine erosion), but are also a contributing factor to the weight gain observed in Indian adolescents.

Effect of housing environment on laying hen meat quality: Assessing Pectoralis major pH, colour and tenderness in three strains of 80-81 week-old layers housed in conventional and furnished cages.

1. Meat quality is affected by factors such as stress, genetic strain and activity and is determined in part by measures of pH, colour and tenderness. In conventional laying hen cages (CC), lack of physical space and inability to perform highly motivated behaviours leads to stress and inactivity. Furnished cages (FCs) permit expression of highly motivated behaviours, but typically house larger group sizes than CC, thereby contributing to social stress. The objective of this study was to evaluate the effects of CC and FC laying hen housing environments and strain differences on meat quality of 80-81-week-old birds. 2. Pectoralis major meat quality was assessed for two flocks of Shaver White (SH), Lohmann Lite (LL) and Lohmann Brown (LB) hens housed in either 5-hen CC or 40-hen FC. Between 80 and 81 weeks, muscle samples were collected from randomly selected hens and analysed for muscle pH, colour and shear force (SF) using established methods. 3. In both flocks, the combined treatment body weights (BWs) were higher for CC than FC hens and the combined strain BWs were higher for LB than LL and SH hens. Flock 1 LB had lower initial and ultimate pH than SH and LL, and greater pH decline than SH. Muscle redness (a*) was higher for CC SH than FC SH in both flocks. Muscle a* was higher for LL than SH and LB in Flock 1, and higher than SH in Flock 2. Housing differences in muscle SF were absent. In CC, SF was higher for SH than LL and LB in Flock 1, and higher than LB in Flock 2. 4. Lack of housing differences suggests that environmental stressors present in both housing systems similarly affected meat quality. Strain differences for muscle pH, a* and SF indicate increased stress experienced by SH and LL hens. The absence of Flock 2 strain differences is consistent with the cannibalism outbreak that occurred in this flock and most severely impacted LB hens.

A Primitive Growth Factor, NME7AB , Is Sufficient to Induce Stable Naïve State Human Pluripotency; Reprogramming in This Novel Growth Factor Confers Superior Differentiation.

Scientists have generated human stem cells that in some respects mimic mouse naïve cells, but their dependence on the addition of several extrinsic agents, and their propensity to develop abnormal karyotype calls into question their resemblance to a naturally occurring "naïve" state in humans. Here, we report that a recombinant, truncated human NME7, referred to as NME7AB here, induces a stable naïve-like state in human embryonic stem cells and induced pluripotent stem cells without the use of inhibitors, transgenes, leukemia inhibitory factor (LIF), fibroblast growth factor 2 (FGF2), feeder cells, or their conditioned media. Evidence of a naïve state includes reactivation of the second X chromosome in female source cells, increased expression of naïve markers and decreased expression of primed state markers, ability to be clonally expanded and increased differentiation potential. RNA-seq analysis shows vast differences between the parent FGF2 grown, primed state cells, and NME7AB converted cells, but similarities to altered gene expression patterns reported by others generating naïve-like stem cells via the use of biochemical inhibitors. Experiments presented here, in combination with our previous work, suggest a mechanistic model of how human stem cells regulate self-replication: an early naïve state driven by NME7, which cannot itself limit self-replication and a later naïve state regulated by NME1, which limits self-replication when its multimerization state shifts from the active dimer to the inactive hexamer.

T lymphocytes are not required for the development of fatty degeneration after rotator cuff tear.

OBJECTIVES: Rotator cuff tears are among the most common and debilitating upper extremity injuries. Chronic cuff tears result in atrophy and an infiltration of fat into the muscle, a condition commonly referred to as 'fatty degeneration'. While stem cell therapies hold promise for the treatment of cuff tears, a suitable immunodeficient animal model that could be used to study human or other xenograft-based therapies for the treatment of rotator cuff injuries had not previously been identified. METHODS: A full-thickness, massive supraspinatus and infraspinatus tear was induced in adult T-cell deficient rats. We hypothesised that, compared with controls, 28 days after inducing a tear we would observe a decrease in muscle force production, an accumulation of type IIB fibres, and an upregulation in the expression of genes involved with muscle atrophy, fibrosis and inflammation. RESULTS: Chronic cuff tears in nude rats resulted in a 30% to 40% decrease in muscle mass, a 23% reduction in production of muscle force, and an induction of genes that regulate atrophy, fibrosis, lipid accumulation, inflammation and macrophage recruitment. Marked large lipid droplet accumulation was also present. CONCLUSIONS: The extent of degenerative changes in nude rats was similar to what was observed in T-cell competent rats. T cells may not play an important role in regulating muscle degeneration following chronic muscle unloading. The general similarities between nude and T-cell competent rats suggest the nude rat is likely an appropriate preclinical model for the study of xenografts that have the potential to enhance the treatment of chronically torn rotator cuff muscles. Cite this article: Bone Joint Res 2014;3:262-72.

One-year clinical evaluation of a Glass Carbomer fissure sealant, a preliminary study.

Glass Carbomer is a new generation of restorative material developed from glass-ionomer cements with possibility of gradual mineralization into fluorapatite. The aim of this clinical trial was to investigate the retention of Glass Carbomer fissure sealant after 12 months, in comparison to a commonly used conventional resin-based sealant. Forty-eight teeth in 24 patients [mean (SD) = 8 (2.3) years] with well-delineated fissure morphology were randomly divided into two equal groups and sealed with Bis-GMA resin-based Helioseal F (group A, Ivoclar Vivadent, Liechtenstein) and Glass Carbomer (group B, Glass Carbomer Sealant, Glass Carbomer Products, Leiden, Netherlands) using the split mouth design. Materials were placed and set according to the manufacturer's instructions using a polymerization unit Bluephase 16i (Vivadent, Liechtenstein). Complete sealant retentions in both groups were 100% and 75% after 6 and 12 months of clinical service, respectively. There were there were no secondary caries lesions in both groups after 6 months; two new carious lesions were detected in both groups after 12 months. The Mann-Whitney U test revealed no significant difference between the two groups at both evaluations points (P > 0.05). Glass Carbomer material showed a similar retention rate when compared with a resin-based sealant. Future studies are required to examine the long-term performance of Glass Carbomer sealants.

Maximum bite force following unilateral implant-supported prosthetic treatment: within-subject comparison to opposite dentate side.

Bite force is a significant component of chewing and masticatory function. The literature lacks studies that compare bite force values of implant-supported fixed bridges to natural dentition within same subjects. The objective of the study was to assess maximum occlusal bite force (MBF) among patients with an implant-supported fixed prosthesis and compare it to their opposite dentate side and also to determine the effect of gender, age and Body Mass Index (BMI) on maximum occlusal bite force. Forty patients (20 males and 20 females, mean age = 42.7 ± 9.6 years) with an implant-supported fixed prosthetic rehabilitation on one side and dentate on the other side were recruited into this study. Participants' MBF were measured bilaterally at the first molar region using a digital hydraulic occlusal force gauge (GM10). The measurements were repeated three times (with 45 s intervals between times) for each side, and the highest value of the bite force (MBF) was recorded for each side. The mean MBF was 577.9 N at the implant-supported prosthesis side and 595.1 N at the dentate side. The average MBF was higher at the dentulous side (P < 0.05). Maximum occlusal bite force was higher in males and participants with higher weight and height. However, BMI was not significantly related to MBF values. Maximum occlusal bite force values at the dentate side were slightly (3%) but significantly higher than MBF at implant-supported prosthesis side. Males, taller patients and patients with higher weights had higher MBF values. Body mass index was not significantly related to MBF values.

Influence of dentine thickness and repeated firing on the colour of IPS e.max press.

The purpose of this study was to determine the possible effects of the veneering porcelain thickness, and of repeated firing on the final shade of IPS e.max Press. Sixty disc-shaped IPS e.max Press specimens were fabricated and divided into 6groups according to shade (A2, C2) and porcelain thickness (0.5, 1.0 and 1.5 mm). Repeated firing (3, 5 and 7firings) was performed and the colour differences (AE) were determined. With increased thickness, A2 specimens showed a significant reduction in L* values and increase in a* and b* values while C2 specimens showed reductions in L*a*b values (P < 0.01). We would conclude that clinically, the preparation should provide at least 1 mm of thickness for the aesthetic potential of this dentine porcelain to be realized.

In vitro evaluation of the effect of different endodontic sealers on retentive strength of fiber posts.

PURPOSE: There is limited information in the literature regarding the effect of different endodontic sealers on the bond strength of fiber posts luted with core buildup materials. The purpose of this study was to evaluate the effect of three different root canal sealers on the retentive strength of prefabricated fiber posts luted with a composite resin cement. MATERIALS AND METHODS: Fifty-four extracted single-rooted mandibular premolar teeth were prepared and randomly divided into three groups. The first two groups were obturated with gutta-percha and one of two eugenol-based root canal sealers (Endofil, Tubli-Seal). The third group (control) was obturated with gutta-percha and a resin-based root canal sealer (AH26). Prefabricated fiber posts were luted into the prepared post spaces with a composite resin cement (Multicore Flow). The pullout forces required for dislodgment of posts from their prepared post spaces were recorded. Data were collected and statistically analyzed. RESULTS: The AH26 group had significantly greater retentive strengths for the posts when compared with the Endofil and Tubli-Seal (eugenol-based sealers) groups (p<0.0001). There was no significant difference between the means of the retentive strengths for the Endofil and Tubli-Seal groups (p=0.745). CONCLUSION: The chemical formulation of root canal sealers significantly affected the retentive strength for prefabricated fiber posts luted with a resin cement. Eugenol-based sealers significantly reduced the bond strength of prefabricated fiber posts luted with resin cement.

Concepts of diabetes self-management in Mexican American and African American low-income patients with diabetes.

The goal of the study was to explore low-income minority patients' concepts of diabetes self-management and assess the extent to which patient beliefs correspond to evidence-based recommendations. African American and Mexican American patients with type 2 diabetes were recruited from safety net clinics that serve the uninsured and under-insured in Chicago and San Francisco to participate in focus group discussions. Grounded theory was used to identify themes related to diabetes self-management. Strategies participants mentioned for diabetes self-care were medication use, diet, weight loss and exercise. Eating more fruit and vegetables and consuming smaller portions were the most commonly mentioned dietary behaviors to control diabetes. African Americans expressed skepticism about taking medications. Mexican Americans discussed barriers to acquiring medications and use of herbal remedies. Mexican Americans frequently mentioned intentional exercise of long duration as a management strategy, whereas African Americans more frequently described exercise as regular activities of daily living. Blood glucose self-monitoring and reducing risks of diabetes complications were rarely mentioned as diabetes self-management behaviors. African American and Mexican American patients have different concepts of diabetes self-management, especially with regard to medication use and physical activity. Consideration of these differences may facilitate design of effective self-management interventions for these high-risk populations.

Tooth-whitening activity of a novel home-bleaching system utilising thermal diffusion: a multifactorial simultaneous evaluation of efficacy at cervical, body and incisal tooth sites.

INTRODUCTION: The ability of a thermal diffusion system (TDS) to promote the tooth-whitening actions of a bleaching gel/bleaching activator combination product (containing a final hydrogen peroxide (H(2)O(2)) content of 10.0% (w/v)) towards discoloured 'smile-zone' teeth was examined. METHODS: Fifty teeth in 15 participants aged 18-62 years were investigated. The CIE tooth shade parameters L(*), a(*) and b(*), together with Vitapan shade scores (VSSs), were simultaneously recorded at three separate tooth areas (cervical, body and incisal sites) with a novel spectrophotometric monitoring system before treatment, and also at 14 days after completion of a 10-day treatment period in which the product was applied 'at-home' (twice daily).Results The tooth-whitening treatment administered gave rise to extremely significant increases in L(*), and decreases in the a(*) and b(*) shade parameters for each of the tooth areas investigated (p <10(-10)). Post-treatment mean decreases in the VSS values were 8.26, 9.70 and 9.14 for the cervical, body and incisal areas respectively (p <10(-8) in each case). Mean ΔE values determined post-treatment were also very highly significant for each tooth region examined (p <10(-10) in each case). CONCLUSIONS: The tooth-whitening system tested exerted extremely powerful bleaching actions in all tooth areas investigated. The order of tooth-whitening effectiveness was body > incisal > cervical for Δb(*) and ΔE, and incisal > body > cervical for Δa(*) and ΔL(*), and this may reflect the TDS's ability to promote the penetration of H(2)O(2) to intrinsic stain sites.

Psychological profiles in patients with recurrent aphthous ulcers.

The aim of this study was to investigate the psychological profiles of patients with recurrent aphthous ulcers (RAUs). 50 patients (27 men and 23 women, mean age 31.44±9.95 years) with diagnosed RAUs participated in this study. 50 controls who matched the patients in age and gender were also recruited. The participants' personality and psychological profiles were assessed using the Hospital Anxiety and Depression Scale (HAD) and the Neuroticism-Extraversion-Openness Five Factor Inventory (NEO-FFI). Data analysis showed that females had higher HAD anxiety scores than males in both patients and controls. Patients' age, intensity of pain and number, position, duration, and frequency of ulcers had no relation to HAD and NEO-FFI scores. Patients reported higher levels of anxiety in comparison to controls, but both reported comparable depression scores. Patients' NEO-FFI scores were not different from those reported by controls and the psychological profiles of patients and controls were similar. In conclusion; stressful situations and conditions (i.e. anxiety) rather than personality profiles and stable psychological traits were related to the occurrence of recurrent aphthous ulcers.

Effect of abrupt weaning at housing on leukocyte distribution, functional activity of neutrophils, and acute phase protein response of beef calves.

BACKGROUND: Sixteen, spring-born, single suckled, castrated male calves of Limousin x Holstein-Friesian and Simmental x Holstein-Friesian dams respectively, were used to investigate the effect of weaning on total leukocyte and differential counts, neutrophil functional activity, lymphocyte immunophenotypes, and acute phase protein response. Calves grazed with their dams until the end of the grazing season when they were housed in a slatted floor shed. On the day of housing, calves were assigned to a treatment, (i) abruptly weaned (W: n = 8) or (ii) non-weaned (controls) (C: n = 8). Weaned calves were housed in pens without their dams, whereas non-weaned (control) calves were housed with their dams. Blood was collected on day -7, 0 (housing), 2, 7, and 14 to determine total leukocyte and differential counts and concentration of fibrinogen and haptoglobin. Lymphocyte immunophenotypes were characterised using selected surface antigens (CD4+, CD8+, WC1+ (gammadelta T cells), MHC Class II+ lymphocytes), and the functional activities of neutrophils (surface expression of L-selectin (CD62L), phagocytic and oxidative burst activity) were investigated using flow cytometry. RESULTS: Treatment x sampling time interactions (P < 0.05) were detected for total leukocyte and neutrophil counts, all lymphocyte subsets, mean fluorescence intensity of CD62L+ neutrophils, and percentage neutrophils performing phagocytosis. On d 2, total leukocyte and neutrophil count increased (P < 0.001), and percentage CD4+ and CD8+ lymphocytes, percentage phagocytic neutrophils, mean fluorescence intensity of CD62L+ neutrophils decreased (P < 0.05) in W compared with baseline (d 0), whereas they were unchanged (P > 0.05) in C. On d 2, percentage WC1+ lymphocytes decreased (P < 0.05), whereas percentage MHC class II+ lymphocytes increased (P < 0.05) in W and C, however the magnitude of change was greater in W than C. There were no treatment x sampling time interactions (P > 0.05) for monocyte, eosinophil, and basophil counts, percentage G1+ neutrophils, or percentage oxidative burst positive neutrophils. CONCLUSIONS: Abrupt weaning resulted in increased neutrophil counts and impaired trafficking and phagocytic function. Together with the changes in lymphocyte subsets, the results suggest that there was a greater transitory reduction in immune function at housing in abruptly weaned than non-weaned beef calves.

Can state or response entropy be used as a measure of sleep depth?

SUMMARY: In this prospective observational study we examined the potential of the spectral entropy measures 'state' and 'response' entropy (Entropy monitor), as measures of sleep depth in 12 healthy adult subjects. Both median state and response entropy values varied significantly with sleep stage (p = 0.017 and p = 0.014 respectively; ANOVA). Median state or response entropy did not decrease significantly during the transition from awake to stage I sleep (p > 0.017). State entropy values decreased significantly between sleep stages I and II (p < 0.001). Both state and response entropy values were significantly less (40 and 45 arbitrary units respectively) in stage III (slow wave sleep) vs stage II sleep (p = 0.008). We conclude that state and response entropy values, when expressed as a function of time, may be a useful means of quantifying aspects of sleep.

Value of database linkage: are patients at risk of familial colorectal cancer being referred for genetic counselling and testing?

BACKGROUND: Unique research opportunities are being created in an era of increasingly sophisticated data collection and data linkage. There are Familial Cancer Clinics (FCC) to counsel patients and families about risk reduction strategies and to carry out genetic testing where appropriate. There is currently no objective evidence as to whether appropriate patients are being referred to the FCC. METHODS: Using a unique resource, the BIO21:MMIM informatics platform, we were able to link data from a prospective colorectal cancer (CRC) database at four Melbourne hospitals with the FCC database for the 4-year period from 2002 to 2005. We determined the number of patients that, on the basis of at least one risk factor suggestive of hereditary CRC, could have been considered for FCC referral, the number that was referred and the number that attended. RESULTS: Of the 829 new diagnoses of CRC 228 (27.5%) would potentially have benefited from FCC referral. Of these, 50 persons (21.9%) were referred and 32 (14.0%) attended. The highest referral rates were in young, early-stage CRC patients with a family history and the lowest in late-stage and multiple-polyp patients. Patient sex, language and insurance status did not influence referral or attendance. CONCLUSION: The database linkage capability provided by MMIM has enabled us to carry out a unique study. The results suggest that the rate of appropriate FCC referral is low, that certain subgroups are at particular risk of non-referral and that many referred patients do not ultimately attend. Interventions that increase referral rates and encourage attendance need to be considered.

Shear bond strength and residual adhesive after orthodontic bracket debonding.

OBJECTIVE: To compare the shear bond strength and determine the area of residual adhesive on teeth after the debonding of brackets bonded with two types of orthodontic adhesives. These were a resin-modified glass ionomer cement (RMGIC; Fuji ORTHO LC, GC Corporation, Tokyo, Japan) and a resin applied as a precoated bracket (APC bracket, 3M Unitek GmbH, Seefeld, Germany). MATERIALS AND METHODS: A total of 60 premolar teeth were randomly divided into two groups, and brackets were bonded according to the manufacturers' instructions. In group 1, the teeth were conditioned using 10% polyacrylic acid, and the brackets were bonded using Fuji Ortho LC in wet condition. In group 2, the teeth were etched using 37% phosphoric acid, and the APC brackets were bonded. Bond strength was measured using a testing instrument (2000S, Lloyds Instruments, Fareham, England) at a crosshead speed of 1 mm/min, and the residual adhesive was quantified using a three-dimensional laser scanning instrument. RESULTS: The Mann-Whitney test showed that the median bond strength of group 1 was significantly lower than that of group 2 (P < .001). A Pearson chi-square test of the Adhesive Remnant Index (ARI) revealed a significant difference among the groups tested. All the adhesives in group 1 failed at the enamel/adhesive interface (100%), whereas group 2 exhibited cohesive failure of the adhesive (90%). CONCLUSIONS: The bond strength values obtained with the RMGIC were above the minimum values suggested in the literature to achieve a clinically effective adhesion in orthodontics.

The issue of anti-D: an integrated seamless approach from recognition of need to bedside administration.

BACKGROUND: The appropriate and timely administration of Anti-D immunoglobulin to Rhesus (D) negative women who have delivered Rhesus (D) positive babies is a vital part of obstetric care. Anti-D has an especially high profile in Ireland because of the tragic inadvertent transmission of Hepatitis C to Irish women in past decades. AUDIT: We have reviewed our policy and procedures pertaining to the administration of Anti-D for sensitising events during pregnancy and postnatally, in the Mid-Western Health Board in 1999/2000. As a result, major changes were made in the storage, issue, recording and administration of Anti-D. New procedures in the transfusion laboratory and in the maternity hospital have been accepted by scientists and midwives and supported by haematology and obstetric medical staff. The pharmacy and haematology laboratory no longer have a role in this programme. IMPLEMENTATION OF MULTI-DISCIPLINARY CHANGE MANAGEMENT: As a result of these changes, the storage, issuing and tracking of Anti-D has become the responsibility of the hospital blood bank. Measurement offoeto-maternal haemorrhage (FMH) is now the responsibility of bio medical scientists in blood bank, utilising both flow cytometry (increasingly recognised as the gold standard method) and the Kleihauer method (Kleihauer-Betke). The programme has moved from a doctor-administered IV Anti-D Ig, to a midwife-administered IM preparation. Prescription remains the responsibility of the doctor. These changes are facilitated by the protocol guided issue of the appropriate dose of Anti-D Ig by bio medical scientists to midwives. The issue of the Anti-D Ig occurs simultaneously with issue of results of mother and baby's serology testing and estimation of volume of FMH. These major changes have been guided by audit and needs assessment and require close liaison between medical, nursing and laboratory scientific staff in haematology, transfusion and obstetrics. CRITICAL INCIDENT AUDIT-CASE REPORT: Before new procedures became official policy, a critical incident audit allowed us to pilot our protocol and to revise it using draft new procedures. In this critical incident we describe successful management of a patient with a large foeto-maternal haemorrhage. This incident supported the need for the procedural enhancements already underway. This critical incident re-emphasised the need for the planned systems improvements to be introduced quickly.