Biological manganese-dependent sulfide oxidation impacts elemental gradients in redox-stratified systems: indications from the Black Sea water column.

The reduction of manganese oxide with sulfide in aquatic redox-stratified systems was previously considered to be mainly chemical, but recent isolation of the Black Sea isolate Candidatus Sulfurimonas marisnigri strain SoZ1 suggests an important role for biological catalyzation. Here we provide evidence from laboratory experiments, field data, and modeling that the latter process has a strong impact on redox zonation in the Black Sea. High relative abundances of Sulfurimonas spp. across the redoxcline in the central western gyre of the Black Sea coincided with the high-level expression of both the sulfide:quinone oxidoreductase gene (sqr, up to 93% expressed by Sulfurimonas spp.) and other sulfur oxidation genes. The cell-specific rate of manganese-coupled sulfide oxidation by Ca. S. marisnigri SoZ1 determined experimentally was combined with the in situ abundance of Sulfurimonas spp. in a one-dimensional numerical model to calculate the vertical sulfide distribution. Abiotic sulfide oxidation was too slow to counterbalance the sulfide flux from euxinic water. We conclude that microbially catalyzed Mn-dependent sulfide oxidation influences the element cycles of Mn, S, C, and N and therefore the prevalence of other functional groups of prokaryotes (e.g., anammox bacteria) in a sulfide-free, anoxic redox zone.

Case Reports of Enamel Microabrasion Associated with At-home Dental Bleaching After Orthodontic Bracket Removal.

Adequate removal of residual bonded materials from the enamel surface after orthodontic bracket debonding is critical, since any remaining composite may compromise enamel surface morphology and esthetics. The following clinical case reports present the association of at-home dental bleaching using 10% carbamide peroxide and the removal of residual bonded material using a super fine, tapered diamond bur followed by the use of an enamel microabrasion product after orthodontic bracket debonding. The proposed treatment considerably improved the esthetics and successfully removed the grooves created during the removal of the bonding composite, resulting in a smooth enamel surface.

Enamel Microabrasion and Dental Bleaching on Teeth Presenting Severe-pitted Enamel Fluorosis: A Case Report.

The present clinical case report describes the clinical steps of enamel microabrasion associated with dental bleaching to restore severely-pitted fluorosed teeth. The process of removing the fluorotic superficial stains started by using macroabrasion with a water-cooled fine tapered 3195 FF diamond bur. Rubber dam isolation of the operative field was used to remove the remaining enamel stains and superficial irregularities with the Opalustre microabrasive compound (6.6% hydrochloric acid associated with silicon carbide particles) followed by polishing using fluoridated paste and subsequent 2% neutral fluoride gel topical application. After one month, dental bleaching was performed using 10% carbamide peroxide in custom-formed acetate trays for two hours/day for 42 days. The association of enamel microabrasion with dental bleaching was effective for reestablishing the dental esthetics of a patient with severe dental fluorosis.

The impact of a cervical dysplasia diagnosis on individual cancer prevention habits over time: a bicentric case-control study.

PURPOSE: Annual cervical cancer screening is recommended in Germany as a part of the statutory preventive care. Abnormal results can provoke psychological distress and anxiety, compromising women's adherence. Little is known about how a cervical dysplasia impacts adherence follow-up visits and prevention habits over time. To optimize care strategies, this study aims to identify women at risk for nonadherence to follow-up visits after a screening event. METHODS: Between November 2015 and May 2017, participants with an abnormal Pap smear at the Heidelberg and Leipzig University Hospitals received a four-part questionnaire (sociodemographic data, PHQ-D, self-designed fear and prevention habit questions) at the first consultation (T1) and subsequently after 3 (T2) and 6 (T3) months; healthy controls completed the questionnaire at T1. RESULTS: 132 women with an abnormal Pap smear [with conization: S1 (n = 68, 51.5%), without intervention: S2 (n = 64, 48.5%)] and healthy controls (K, n = 101) generally adhered to gynecological checkups, except S1 6 months after the first diagnosis (S1/T3 - 0.47, signed rank p < 0.0005). Knowledge of primary prevention information, i.e., HPV vaccination, was significantly higher among K (K 58%, S1 29%, S2 44%, Chi-squared p = 0.01) as was vaccine uptake (K 39% versus S1/S2 7% and 17%, respectively, Chi-squared p = 0.0004). Fear of upcoming Pap smears rose significantly over time (S1/T1-S1/T2-S1/T3, Wilcoxon signed-rank test p < 0.001) and was higher among those with conization at T2 (Chi-square test, p = 0.01) and partially accompanied by panic disorders at T1 (Chi-square test p = 0.035). Realization of general preventive habits rose significantly among women without an operative procedure (S2) over the study. CONCLUSION: This study advances the understanding of non-participation in follow-up visits after a dysplasia diagnosis, identifying post-conization women as a special risk group for decreased adherence.

Home Dental Bleaching Monitored With Microelectronic Sensors to Record the Wearing Times of an Acetate Tray/Bleaching Product.

The present case study quantifies the clinical wearing time of an acetate tray/bleaching product during home dental bleaching. The patient was instructed to use a 10% carbamide peroxide gel for 6-8 hours each day for 20 days. The wearing time of the tray was measured by a microsensor from TheraMon microelectronic system (Sales Agency Gschladt, Hargelsberg, Austria) completely embedded in the tray so that the clinician would be informed as to the precise time the tray was placed in the mouth. Evaluation of the daily printout during dental bleaching demonstrated that the patient did not correctly follow the clinician's instructions as to the wearing time of the tray. Recording the wearing time of dental bleaching agents can be beneficial for both dental professional and patient to obtain a more effective treatment according to the patient's needs and expectations.

Assessment of two e-learning methods teaching undergraduate students cephalometry in orthodontics.

AIM: Cephalometry is important for orthodontic diagnosis and treatment planning and is part of the core curriculum for training dentists. Training involves identifying anatomical landmarks. The aim of this investigation was to assess whether e-learning improves learning efficiency; a programme specifically designed for this purpose was compared to commercially available software. METHODS: Thirty undergraduate students underwent traditional training of cephalometry consisting of lectures and tutorials. Tracing skills were tested immediately afterwards (T0). The students were then randomly allocated to three groups: 10 students served as control (CF); they were asked to improve their skills using the material provided so far. Ten students were given a program specifically designed for this study that was based on a power point presentation (PPT). The last group was given a commercially available program that included teaching elements (SW). The groups were tested at the end the six week training (T1). The test consisted of tracing 30 points on two radiographs and a point score improvement was calculated. The students were interviewed after the second test. RESULTS: Both e-learning groups improved more than the traditional group. Improvement scores were four for CF; 8.6 for PPT and 2.8 for SW. For PPT all participants improved and the student feedback was the best compared to the other groups. For the other groups some candidates worsened. CONCLUSIONS: Blended learning produced better learning outcomes compared to using a traditional teaching method alone. The easy to use Power Point based custom software produced better results than the commercially available software.

Maxillary expansion therapy with plates featuring a transverse screw: implications of patient compliance with wear-time and screw activation requirements.

OBJECTIVE: The goal of the present work was to determine the influence of screw activation rates and electronically tracked wear times on transverse maxillary expansion with removable orthodontic appliances. METHODS: In all, 28 patients were included in an open prospective observational study covering approximately 6 months of maxillary transverse expansion. In each of these patients, the maxillary plate appliance used for treatment was fitted with a wear-time sensor to document wear time for the duration of the study. Patients were instructed to activate the transverse expansion screw in their plate appliance by 0.2 mm/week. The resultant gap-width increases were monitored with a caliper over three follow-up appointments scheduled at 2-month intervals. RESULTS: Largely linear increases in gap width due to screw activation were only noted within the first 4 months of treatment. The mean increases in gap width fell short of the values that were anticipated after calculations. Longer daily wear times were, on average, associated with larger gap widths. CONCLUSION: Treatment can be objectively monitored by referring to wear-time tracking and by measuring increases in gap width, thus, ensuring that the appliance fits well. In this way, the process can be customized to serve individual needs and to better utilize the full potential of therapy.

Methods to evaluate compliance of patients with removable appliances-survey results.

OBJECTIVES: Are removable appliances still being routinely used in orthodontic offices? Which methods do clinicians use to assess compliance with wear requirements, and how effective are these methods considered to be? SUBJECTS AND METHODS: A questionnaire inquiring about types of treatment, methods of assessing patient compliance with removable appliances, and the perceived effectiveness of these methods was mailed to a sample of 375 members of the German Orthodontic Society ("Deutschen Gesellschaft für Kieferorthopädie", DGKFO). RESULTS: The rate of returned questionnaires was 29%. Almost all respondents (99%) indicated that they used removable appliances and reported having a "relatively high" proportion of patients currently undergoing such treatment. The most widely used methods of compliance assessment were questioning patients and parents (96%) and examining clinical parameters associated with the dentition and the appliance's fit (95-100%). While these parameters were considered "highly effective", questioning the patients and parents was regarded as "less effective" despite its frequent application. CONCLUSION: Removable appliances continue to be a standard method of orthodontic treatment. While patient compliance with wear requirements is mainly assessed via indirect clinical methods, the effectiveness of these parameters remains unclear.

Questionnaire study of electronic wear-time tracking as experienced by patients and parents during treatment with removable orthodontic appliances.

OBJECTIVE: To survey how patients and parents rate microelectronic wear-time tracking (TheraMon(®)) during treatment with removable orthodontic appliances. PATIENTS AND METHODS: A total of 125 patients with a mean age of 11.99 years whose treatment involved removable appliances with a built-in microsensor for wear-time documentation were enrolled in a questionnaire study addressing electronic wear-time tracking. Respondents included the patients and their parents. RESULTS: A total of 86% of the patients reported that the orthodontic appliance's comfort was unaffected by the installed sensor. A majority of respondents had a favorable impression of wear-time tracking. Printed wear-time documents from the clinician's computer were considered a "nice certificate of compliance" by 46% of patients, and 38% of them stated that they intended to improve their compliance when faced with a poor record. Indeed, 48% of parents believe that wear-time tracking can improve the therapeutic success, while 32% believe that it can reduce the duration of treatment. Around 10% of respondents felt that the sensors were unnecessary and not recommendable. CONCLUSION: These favorable ratings by patients and their parents may help future patients and users to decide for or against microelectronic wear-time tracking. Randomized studies are needed to demonstrate whether the sheer presence of a wear-time sensor stimulates compliance on its own.

[Rehabilitation results of Turkish immigrants - an analysis of routine data from the Rhineland and Westfalia Pension Insurance]. / Rehabilitationserfolg bei Menschen mit türkischem Migrationshintergrund - Eine Auswertung von Routinedaten der Deutschen Rentenversicherungen Rheinland und Westfalen.

AIMS OF THE STUDY: Approximately 3 million Turkish immigrants are living in Germany, in North Rhine-Westfalia their share amounts to 4.7%. They use the same rehabilitation services as Germans, but their treatment usually shows less positive results - as other studies have shown. The aims of the research project "Immigration and Health Inequalities in Rehabilitation" were (a) to quantify the use of medical rehabilitation by Turkish immigrants in different diagnosis groups, (b) to compare outcomes in different diagnosis groups and (c) to find out whether the results will be explained by immigrant status, or by socio-economic factors accompanying immigrant status. METHODS AND RESULTS: An analysis of routine data from Deutsche Rentenversicherung Rheinland and Deutsche Rentenversicherung Westfalen (Rhineland and Westfalia Pension Insurances) was carried out, pertaining to 363 855 persons who had participated in at least one rehabilitation procedure between 2000 and 2006. 4.8% of all rehabilitees were identified as being of Turkish origin. A modified name-based algorithm was used to help to identify Turkish rehabilitees. The outcome of rehabilitation was measured by comparing the medical discharge assessments. Turkish people were in need of rehabilitation more often because of mental disorders/behavioural disturbances (Turkish men=22.0% vs. non-Turkish men=18.4% [p<0.001]; Turkish women=30.8% vs. non-Turkish women=21.6% [p<0.001]) and less often because of neoplasms (Turkish men=4.7% vs. non-Turkish men =7.8% [p<0.001]; Turkish women=6.4% vs. non-Turkish women=13.9% [p<0.001]). Concerning treatment results in several diagnosis groups Turkish rehabilitees benefitted less from treatment than non-Turkish rehabilitees did (musculoskeletal disorders: OR=2.08 [95%-CI=1.97-2.20]; mental disorders/behavioural disturbances: OR=1.70 [95%-CI=1.57-1.84]; respiratory diseases: OR=1.41 [95%-CI=1.14-1.75]; digestive disorders/metabolic diseases: OR=1.36 [95%-CI=1.11-1.66]). Non-Turkish rehabilitees had higher chances of success, even adjusted by social and performance-related factors. The differences were non-significant only in cardio-vascular disease and neoplasm treatment. CONCLUSIONS: Rehabilitation outcomes are significantly less favourable for Turkish people. The differences found can partially be traced to factors related to their migration background and not only to other social differences or performance-related factors of the health services. Immigrant status, hence, affects rehabilitation outcome and must receive attention in both rehabilitation plans and rehabilitation facilities.

Phenological diversity in the interactions between winter moth (Operophtera brumata) larvae and parasitoid wasps in sub-arctic mountain birch forest.

Population cycles of the winter moth (Operophtera brumata) in sub-arctic coastal birch forests show high spatiotemporal variation in amplitude. Peak larval densities range from levels causing little foliage damage to outbreaks causing spatially extensive defoliation. Moreover, outbreaks typically occur at or near the altitudinal treeline. It has been hypothesized that spatiotemporal variation in O. brumata cycle amplitude results from climate-induced variation in the degree of phenological matching between trophic levels, possibly between moth larvae and parasitoids. The likelihood of mismatching phenologies between larvae and parasitoids is expected to depend on how specialized parasitoids are, both as individual species and as a guild, to attacking specific larval developmental stages (i.e. instars). To investigate the larval instar-specificity of parasitoids, we studied the timing of parasitoid attacks relative to larval phenology. We employed an observational study design, with sequential sampling over the larval period, along an altitudinal gradient harbouring a pronounced treeline outbreak of O. brumata. Within the larval parasitoid guild, containing seven species groups, the timing of attack by different groups followed a successional sequence throughout the moth's larval period and each group attacked 1-2 instars. Such phenological diversity within parasitoid guilds may lower the likelihood of climate-induced trophic mismatches between victim populations and many/all of their enemies. Parasitism rates declined with increasing altitude for most parasitoid groups and for the parasitoid guild as a whole. However, the observed spatiotemporal parasitism patterns provided no clear evidence for or against altitudinal mismatch between larval and parasitoid phenology.

[Shaping the future of vocational rehabilitation of adults: eight fields of action as starting points for a cross-actor innovation process]. / Die Zukunft der beruflichen Rehabilitation Erwachsener gestalten: Acht Handlungsfelder als Ausgangspunkt für einen akteursübergreifenden Innovationsprozess.

Established by the Federal Ministry of Labour and Social Affairs (BMAS) in October 2007, the Scientific Expert Group RehaFutur had been commissioned to elaborate cornerstones for the medium- and long-term development of vocational rehabilitation of adults with disabilities (re-integration). Initial questions inter alia were as follows: Which function should vocational rehabilitation have in a service- and knowledge-oriented working world that will increasingly be affected by demographic change? How can disabled persons' right to occupational participation by way of vocational rehabilitation, a right stipulated both under the German constitution and in German law, be realized as needed also in the future? Various fields of action have been derived on the basis, for one, of an investigation of the factors, social law, social and education policy as well as European, influencing vocational rehabilitation and, for the other, of an evaluation of current labour market and demographic developments. Dealt with in the fields of action outlined are the aspects: equitable opportunities of access, developmental and needs orientation, closeness to the real occupational and working world, as well as the role of self-determination and self-responsibility. The fields of action are to be understood as framework concept for shaping a cross-actor innovation process. Sustainable vocational rehabilitation is characterized in particular by the fact that it is specifically targeted at promoting disabled persons' self-determination and self-responsibility actively using these in the process and that it strengthens an independent lifestyle, ensures social participation by inclusive structures; also, it facilitates continued participation in working life by ongoing education involving holistic development of professional and personal competencies oriented towards the individual's resources and potentials, safeguarding it by systematic networking with companies. The concept presented for vocational rehabilitation of adults with disabilities encompasses a change of paradigms which service carriers and providers will have to face jointly and including the service users, the rehabilitants.

[Evaluation of outpatient rehabilitation: goals, conceptual framework and study design of a health and pension insurance joint research project]. / Die wissenschaftliche Begleitung im Rahmen der Empfehlungsvereinbarung von Kranken- und Rentenversicherung zur ambulanten Rehabilitation: Zielsetzungen, Rahmenbedingungen und Untersuchungsansatz.

In Germany the statutory health and pension insurance schemes are the main providers of medical rehabilitation, the majority of rehabilitation measures being given in an inpatient setting. Over the last few years, the health and pension insurance schemes have strengthened the extension of outpatient rehabilitation, and have funded a comprehensive evaluation study in this context. In this evaluation study outpatient rehabilitation in centres with different conceptual backgrounds is compared with inpatient rehabilitation in rehab clinics, indications considered being cardiology and orthopaedics. Overall, 14 rehab centres and more than 2000 patients were included in the project. The patients were interviewed and medically examined before and after the measure. A follow-up was done after six and twelve months. In addition to the rehabilitants themselves, the rehab centre physicians as well as the office-practice physicians were interviewed about the outcome of the rehab measure. One year after rehabilitation, data were collected from the relevant health and pension insurance funds concerning the benefits the patients had received. Due to the study's non-experimental design, validity of the results is confined to rehabilitants participating on an outpatient basis and who had been found medically suited for this type of rehabilitation, were capable of travelling to the rehab centre on their own within less than 45 minutes and had voluntarily opted for the outpatient setting. The findings of the study show that outpatient rehabilitants' motivation and expectations differ from those found in inpatient rehabilitation. The health economics analysis performed is restricted to the costs involved in the rehabilitation measure as such as well as the health-related benefits provided to the rehabilitants in the twelve-month study period. The issue of whether increasing outpatient rehab measures will lead to decreasing costs in the rehab system as a whole had not been considered in the framework of this project.

[Outcomes of cardiac rehabilitation treatment and cost-effectiveness relations--A comparison between inpatient and outpatient rehabilitation programmes]. / Behandlungsergebnisse der kardiologischen Rehabilitation und Kosten-Wirksamkeits-Relationen - Ein Vergleich stationärer und ambulanter Versorgungsformen.

Regarding the dominance of inpatient medical rehabilitation programmes efforts have emerged over the last few years to strengthen outpatient medical rehabilitation programmes in Germany. The goal of cardiac rehabilitation is the recovery of physical, psychic and social wellbeing in people with a severe heart condition. For this contribution the central outcomes of cardiac rehabilitation were compared between different rehabilitation programmes (inpatient and outpatient) and cost-effectiveness analyses were made. These results were obtained within the scope of an evaluation study commissioned by the statutory health and pension insurance agency. In summary, the different rehabilitation programmes can be regarded as comparable concerning effectiveness and costs following rehabilitation.

[The quality of organization in cardiac rehabilitation--a comparison of inpatient and outpatient forms of service delivery]. / Die Qualität der Organisation kardiologischer Rehabilitation - Ein Vergleich stationärer und ambulanter Versorgungsformen.

Regarding the ongoing dispute on strengthening outpatient medical rehabilitation programmes, questions arise about the quality of different (organizational) forms of rehabilitation (inpatient and outpatient). The aim of this contribution is to draw a comparison between the structures and processes of inpatient and outpatient facilities for cardiac rehabilitation. Additional questions will be posed regarding the prerequisite factors for improving structures and processes in the quality assurance and management framework.

[Continuity and the quality of medical care for the cardiac patient: cardiac rehabilitation and its interfaces to acute care (phase I) and the process of coming back (phase III)]. / Kontinuität und Prozessqualität in der Behandlung der chronischen Herzerkrankung: Der Zugang zur Rehabilitation und die Schnittstelle zum Alltag.

Cardiac rehabilitation plays a pivotal role in the care for cardiac patients. Yet without sufficient continuity in the care process, the good results achieved in the different stages of therapy and recovery may not last. The aim of this contribution is to highlight the interfaces of cardiac rehabilitation in regard of process continuity as an aspect of the quality of health care. The results show that continuity between the acute care unit and inpatient rehabilitation programmes (phase I - phase II) seems to be sufficient whereas integrating phases II and III may be open for optimizing.

Recurrent pleomorphic adenomas of the parotid gland: clinical evaluation and long-term follow-up.

We report 94 patients with recurrent pleomorphic adenomas of the parotid gland who were referred to our clinics after operations elsewhere. In 78 patients (83%) enucleation was the surgical technique used to remove the tumour. Patients with more than one recurrence were significantly younger than patients who had only one. Many recurrent adenomas (44%) were multifocal. In 20 (21%) further recurrences became obvious after we had operated on them. The mean time interval before recurrence ranged from 7.3 to 10.1 years. Twenty patients (14%) had persistent motor disorders of the facial nerve after operation for recurrence (n = 143). Twenty eight of the 84 patients from whom follow-up data could be obtained developed Frey's syndrome (33%). Our data support the importance of an adequate initial operation to avoid recurrences of pleomorphic adenomas in the parotid gland.

Organizational characteristics associated with agency position in community care networks.

This study examines how organizational characteristics affect agency participation and centrality in community service networks. We find that the network structure of agency relations varies for administrative and client-related activities among the 69 agencies studied, which include all but the most isolated agencies serving people with physical disabilities in a single community. In identifying structurally equivalent groups using network analysis, we find that all types of agencies except HMOs are found throughout community service networks. Analyses show that among the five types of relations, minimal intergroup activity occurs within funding and planning networks and that organizational size and ownership are the best organizational predictors of network location and centrality. Non-profits are the most central for planning and client referrals, and large agencies are the most central for funding. We explore the implications of these findings, particularly for sustaining cooperation within the service networks and for the role of non-profits and medical providers in the community.

Surgical management of pleomorphic adenomas of the parotid gland: a follow-up study of three methods.

PURPOSE: This retrospective study evaluated data pertaining to history, symptoms, diagnosis, and mode of therapy of patients treated for pleomorphic adenoma of the parotid gland. PATIENTS AND METHODS: The records of 475 patients were reviewed. Follow-up was done by questionnaires sent to the referring doctor. RESULTS: The total rate of recurrence was 0.9% after 475 operations for pleomorphic adenoma of the parotid gland. One recurrence (0.7%) was reported for the group with superficial parotidectomy and none for the group with total parotidectomy. The rate of postoperative side effects was also low. The facial nerve was affected in 1.4% after superficial parotidectomy, and in 3.3% after total parotidectomy. CONCLUSION: The results of this follow-up study show that superficial parotidectomy for pleomorphic adenoma located in the superficial lobe of the parotid gland provides adequate therapy and generally avoids recurrence and side effects.

Healing rate of transverse osteotomies of the olecranon used in reconstruction of distal humerus fractures.

To determine the rate of healing of the osteotomy, we studied the cases of 10 patients who had transverse osteotomy of the olecranon for surgical exposure of a complex distal humerus fracture. The average age of the patients was 48 years, and the average follow-up was 24 months. Nine of the fractures were complex supracondylar/intercondylar fractures. All of the humerus fractures were treated with bone plates and screws, and nine of the osteotomies of the ulna were reconstructed with a large lag screw and tension band wire. Smooth pins and a tension band wire were used in 1 patient with osteoporotic bone. Union of the ulnar osteotomy occurred in 7 patients, and 3 of the patients had a nonunion. The average time of healing of the distal humerus fractures was 3.5 months, and the average time of healing of the ulnar osteotomies was 5.2 months. Six of the patients developed a gap at the osteotomy site by displacement or resorption of it, and two of these progressed to a nonunion. The patients whose ulnar osteotomy healed had an average extension lag of 33 degrees, and the average flexion at their elbows was 122 degrees. The patients who had a fibrous nonunion of the ulnar osteotomy had an average extension lag of 27 degrees at the elbow, and all 3 patients had full flexion of the elbow joint. Because of the nonunion rate of 30% in our patients, we no longer use a transverse osteotomy of the olecranon to expose distal humerus fractures at surgery.