Three-dimensional evaluation of mandibular deformation during mouth opening.

AIM: Deformation of the mandible presents a major challenge for many dentists, both in conventional prosthetic supraconstructions and in complex implant restorations. This study aimed to evaluate the three-dimensional (3D) deformation of the mandible in vivo with scannable impression material and an industrial optical scanner. MATERIALS AND METHODS: In the present study, 20 female and 20 male subjects were examined. In each case, two impressions were made with polyvinylsiloxane: one with the mouth slightly open, and a second with the mouth wide open. The impressions were digitized with an industrial optical scanner and transformed into a virtual model. The two corresponding models were digitally superimposed over all the teeth. Then, an individual local coordinate system was assigned to each individual tooth. Subsequently, a best-fit procedure was performed for each individual tooth. Finally, the open- and closed-mouth models were compared by calculating the differences and rotations in the individual axes. This procedure was performed individually for each tooth. RESULTS: The mean deviations in the x-, y-, and z-coordinates ranged from 0.011 mm at the canines to 0.232 mm at the molars. Larger discrepancies were observed in the female subjects than in the male subjects; however, these differences were not statistically significant. CONCLUSION: The results demonstrated that the posterior region of the mandible deformed when the mouth was maintained in a wide-open position. Therefore, this position should be avoided when performing dental impressions. Moreover, potential negative consequences of this mandibular deformation should be taken into consideration when planning wide-span fixed dental restorations.

The design process of a multimodal module that synthesized knowledge across nursing courses.

BACKGROUND: Nursing faculty are being challenged to increase the use of technology in the classroom. Use of technology addresses multiple learning styles, increases student engagement, encourages active learning and improves students' attention. OBJECTIVES: Evaluate student satisfaction to a faculty designed multimedia teaching strategy. DESIGN: Cross sectional design with data collected over six semesters from six cohorts of nursing students. SETTING: An urban university in the Midwest United States. PARTICIPANTS: 154 sophomore generic and accelerated BSN students enrolled in Fundamentals of Nursing; Ninety-nine participants were female (66.9%) and 49 (31.8%) were male. Eighty-three percent were less than 20years to 30years in age. METHODS: A multimedia teaching strategy developed by three faculty integrating narrated case study, questioning and animation of skills and pathophysiology was implemented during the class session on infection control. At the conclusion, questionnaires were distributed to collect evaluation data. RESULTS: 120 students (77.9%) stated that the animated pathophysiology helped them understand the pathophysiological processes better than lecture alone. When combined with lecture, 121 students or 78.6% reported a better understanding of the material than if presented as lecture alone. 123 (79.9%) of the students stated that watching the animated video improved their understanding of the lecture content. As stated by one student, "I liked the visualization because it helped me further understand the material." 104 (67.5%) stated that presenting course content from multiple courses into one format facilitated the importance of these courses; "I liked that different aspect[s] of nursing were brought together." CONCLUSIONS: Use of multimedia in the classroom engages students in the learning process by actively involving students in the learning process as well as facilitating the delivery of difficult course content. Overall, students voiced a preference for all instructional materials to be presented in an animated format.

Can different occlusal positions instantaneously impact spine and body posture? : A pilot study using rasterstereography for a three-dimensional evaluation.

PURPOSE: Orthodontists influence dental occlusion directly. To suggest any link between dental occlusion and body posture is highly contentious, as evidenced by the literature. Rasterstereography, an optical technique that enables three-dimensional (3D) body measurements to be collected, has not yet been used to impartially examine whether different occlusal positions could instantaneously alter spine and body posture. We therefore set out to use this technique to nonsubjectively evaluate this question under static conditions. METHODS: Optical body scans were collected for 44 subjects, using the Diers formetric 4D system, for seven different mandible positions. In total, ten spinal and body posture parameters were assessed (trunk inclination, trunk imbalance, pelvic tilt, pelvic torsion, fleche cervicale, fleche lombaire, kyphotic angle, lordotic angle, surface rotation, and lateral deviation) for each mandible position and compared with scans performed with habitual intercuspation (HIC). RESULTS: Significant body posture deviations were found for the fleche cervicale (position of the mandible: right eccentrically), fleche lombaire (positions of the mandible: physiologic rest position, cotton rolls on both sides, bite elevation 1 mm), and the kyphotic angle (positions of the mandible: cotton rolls on both sides, right eccentrically). No other significant differences were detected. CONCLUSIONS: Data for the parameters that varied with different dental occlusions generated high standard deviations. Therefore, within the limitations of this pilot study, we could not conclusively associate dental occlusion to an instantaneous impact on the tested parameters. The posture changes that we detected could also have arisen from individual neuromuscular compensation; a possibility that must now be ruled-in, or out, by further research studies with a higher number of subjects.

Evaluation of an enzyme immunoassay for antibodies to a recombinant Blastomyces adhesin-1 repeat antigen as an aid in the diagnosis of blastomycosis in dogs.

OBJECTIVE: To evaluate the sensitivity and specificity of an enzyme immunoassay (EIA) for antibodies to a recombinant Blastomyces adhesin-1 repeat antigen (rBAD-1) to aid in the diagnosis of blastomycosis in dogs and compare the findings with results from other tests used for this purpose. DESIGN: Prospective analytic study. SAMPLE: Serum and urine from 70 dogs with and without blastomycosis. PROCEDURES: Serum and urine samples were collected from dogs with blastomycosis (n = 21), histoplasmosis (8), or nonfungal pulmonary disease (21) and from healthy control dogs living in a blastomycosis-endemic area (20). Serum was tested for antibodies against Blastomyces dermatitidis with the rBAD-1 antibody EIA and an A-antigen antibody agar gel immunodiffusion (AGID) assay. Serum and urine were tested for B dermatitidis antigen with a quantitative EIA. RESULTS: Sensitivity of the quantitative antigen EIA was 100% in serum and urine samples from dogs with blastomycosis, with specificity of 95% in urine samples from dogs with nonfungal pulmonary disease and 100% in urine samples from healthy dogs. Sensitivity of the rBAD-1 antibody EIA (95%) was significantly greater than that of the A-antigen antibody AGID assay (65%). Specificity of the antibody EIA was 88% in dogs with histoplasmosis, 95% in healthy dogs, and 100% in dogs with nonfungal pulmonary disease. CONCLUSIONS AND CLINICAL RELEVANCE: The rBAD-1 antibody EIA had greater sensitivity than the A-antigen antibody AGID assay in dogs with blastomycosis. This antibody EIA may assist in distinguishing histoplasmosis from blastomycosis. Further evaluation in a larger prospective study is needed to verify these results.

Predictors of stress and coping strategies of US accelerated vs. generic Baccalaureate Nursing students: an embedded mixed methods study.

BACKGROUND: Stress is an inevitable part of life and is especially pervasive in the lives of nursing students. Identifying the predictors of stress as well as coping strategies used can allow for the implementation of appropriate coping interventions to assist in the management of stress in nursing students. Mixed methods research that has been undertaken to gain an understanding about student stress, especially juxtaposing generic versus accelerated nursing students could not be identified. OBJECTIVES: (1) Identify predictors of stress between accelerated and generic Baccalaureate Nursing (BSN) students; and (2) Describe stressors and coping strategies used by accelerated students in comparison with generic students. DESIGN: Embedded mixed methods study. SETTING: Accelerated and generic BSN third- and fourth-year nursing students at two Midwestern universities. PARTICIPANTS: 210 participants: accelerated (n=75) and generic (n=135). METHODS: A questionnaire packet, including demographics, history of depression, the Perceived Stress Questionnaire, Rosenberg Self-Esteem Scale, Multidimensional Scale of Perceived Social Support, and open-ended questions were administered to students at the end of a class. Simultaneous multiple regression was used to examine predictors of stress. Content analysis was used to analyze qualitative data. RESULTS: Predictors of stress for both the accelerated and generic groups included history of depression, year in the program, emotional support, and self-esteem. Fear of failure and clinical incompetence, problematic relationships, and time management issues were identified as major stressors. Coping strategies used by both groups included positive thinking and social support. CONCLUSIONS: Senior students with a history of depression, low self-esteem, and little social support were more likely to experience high levels of stress. This gives educators the potential to identify at risk students and establish stress reduction programs. Encouraging students to use individualized coping strategies will be beneficial.

Abnormal sterol metabolism in a patient with Antley-Bixler syndrome and ambiguous genitalia.

Antley-Bixler syndrome (ABS) is a rare multiple anomaly syndrome comprising radiohumeral synostosis, bowed femora, fractures of the long bones, premature fusion of the calvarial sutures, severe midface hypoplasia, proptosis, choanal atresia, and, in some, ambiguous genitalia. Of fewer than 40 patients described to date, most have been sporadic, although reports of parental consanguinity and affected sibs of both sexes suggests autosomal recessive inheritance in some families. Known genetic causes among sporadic cases of ABS or ABS-like syndromes are missense mutations in the IgII and IgIII regions of FGFR2, although the assignment of the diagnosis of ABS to such children has been disputed. A third cause of an ABS-like phenotype is early in utero exposure to fluconazole, an inhibitor of lanosterol 14-alpha-demethylase. The fourth proposed cause of ABS is digenic inheritance combining heterozygosity or homozygosity for steroid 21-hydroxylase deficiency with effects from a second gene at an unknown locus. Because fluconazole is a strong inhibitor of lanosterol 14-alpha-demethylase (CYP51), we evaluated sterol metabolism in lymphoblast cell lines from an ABS patient without a known FGFR2 mutation and from a patient with an FGFR2 mutation and ABS-like manifestations. When grown in the absence of cholesterol to stimulate cholesterol biosynthesis, the cells from the ABS patient with ambiguous genitalia but without an FGFR2 mutation accumulated markedly increased levels of lanosterol and dihydrolanosterol. Although the abnormal sterol profile suggested a deficiency of lanosterol 14-alpha-demethylase, mutational analysis of its gene, CYP51, disclosed no obvious pathogenic mutation in any of its 10 exons or exon-intron boundaries. Sterol metabolism in lymphoblasts from the phenotypically unaffected mother was normal. Our results suggest that ABS can occur in a patient with an intrinsic defect of cholesterol biosynthesis at the level of lanosterol 14-alpha-demethylase, although the genetic nature of the deficiency remains to be determined.

New Directions and Developments in Managed Care Financing.

This overview discusses articles published in this issue of the Health Care Financing Review, entitled "Managed Care: Advances in Financing." Articles cover the cutting-edge developments in payment methods for managed care organizations and their providers; new approaches to financing managed health care services for Medicare and Medicaid beneficiaries and special sub-populations; and the financing challenges presented by new managed care delivery models and industry consolidation.