Minimally invasive management of vital teeth requiring root canal therapy.

The present study aimed to investigate the possible use of a non-instrumentation technique including blue light irradiation for root canal cleaning. Extracted human single rooted teeth were selected. Nine different groups included distilled water, NaOCl, intra-canal heated NaOCl, and NaOCl + EDTA irrigation after either instrumentation or non-instrumentation, and a laser application group following non-instrumentation technique. The chemical assessment of the root canal dentine was evaluated using energy dispersive spectroscopy (EDS) and Fourier transform infrared (FT-IR) spectroscopy. Surface microstructural analyses were performed by using scanning electron microscopy (SEM). The antimicrobial efficacy of different preparation techniques was evaluated using microbial tests. Light application didn't change the calcium/phosphorus, carbonate/phosphate and amide I/phosphate ratios of the root canal dentin. The root canal dentin preserved its original chemistry and microstructure after light application. The instrumentation decreased the carbonate/phosphate and amide I/phosphate ratios of the root canal dentin regardless of the irrigation solution or technique (p < 0.05). The application of light could not provide antibacterial efficacy to match the NaOCl irrigation. The NaOCl irrigation both in the non-instrumentation and instrumentation groups significantly reduced the number of bacteria (p < 0.05). The use of minimally invasive root canal preparation techniques where the root canal is not instrumented and is disinfected by light followed by obturation with a hydraulic cement sealer reduced the microbial load and preserved the dentin thus may be an attractive treatment option for management of vital teeth needing root canal therapy.

Alternative co-initiators for photocurable dental resins: Polymerisation, quantum yield of conversion and cytotoxicity.

OBJECTIVE: Cyclic acetals such as are naturally occurring compounds capable of acting as co-initiators during free-radical polymerisation, and potentially serve to offer non-allergic and biologically less toxic alternatives to conventional (tertiary) amines. The current study aimed to evaluate the polymerisation efficiency and potential toxicity of cyclic acetals compared with conventional photoinitiator systems in photocurable dental resins. METHODS: Both, 1,3 benzodioxole (BZD) and piperonyl alcohol (PA) were used in 0.5, 1.0, 1.5, 2.0, 3.0, 4.0 and 6.0 mol% concentrations. Whereas, N-phenyl glycine (NPG) was utilised in 0.5, 1.0, 1.5, 2.0, 3.0, 4.0 mol% concentrations for photopolymerisation of an unfilled model resin system, BisGMA and TEGDMA (1:1 mass %), involving three separate camphorquinone (CQ) concentrations of 0.5 (Low), 1.0 (Intermediate) and 1.5 (High) mol%. Conventional tertiary amines; ethyl-4-dimethyamino benzoate (EDMAB) and dimethylaminoethyl methacrylate (DMAEMA) were utilised for comparison. Real-time degree of conversion (DC, %) was evaluated using Fourier transform near-infra-red spectroscopy and quantum yield of conversion of CQ was calculated using UV-Vis spectroscopy. Cytotoxicity of NPG and cyclic acetals were assessed using MTT to determine metabolic activity of human dental pulp cells (HDPCs). RESULTS: The cyclic acetals were capable of facilitating free radical polymerisation as co-initiators at all three CQ concentrations. Furthermore, the use of NPG as a co-initiator resulted in post-irradiation DC (%) that were comparable to both EDMAB and DMAEMA for all CQ concentrations. Alternative compounds facilitated the hydrogen abstraction process, which provided high conversion of CQ molecules. Quantum yield increased from 0.009 ± 0.0001 (0.5 mol%) to 0.03 ± 0.006 (6.0 mol%), and 0.01 ± 0.0003 (0.5 mol%) to 0.04 ± 0.001 (6.0 mol%), for respective BZD and PA formulations involving 1.0 mol% CQ. The use of NPG led to relatively higher quantum yield values (Up to 0.09 ± 0.007 at 4.0 mol%), though it exhibited competitive effects in absorbing blue light, which might be attributed to the photolytic degradation of NPG and the formation of N-methylaniline. MTT assay indicated alternative co-initiators to be comparatively less cytotoxic than EDMAB and CQ. Relative metablic activity of HDPCs treated with BZD, PA, and NPG eluates were 58.3 ± 15.7, 57.5 ± 17.4 and 64.6 ± 12.2 %, when compared with untreated HDPCs group (Control), respectively. Exposure to DMAEMA-based eluate led to relative metabolic activity (60.0 ± 0.5 %) that was comparable to that of cyclic acetals. Treatment with neat model resin eluate displayed the highest relative reduction in metabolic activity (28.9 ± 22.4) (P < 0.05), suggesting bisGMA and TEGDMA monomers played significant role in the overall cytotoxicity of photocurable systems involving HDPCs. SIGNIFICANCE: Cyclic acetals were capable of facilitating photo-induced free radical polymerisation reactions with relatively less cytotoxicity compared with their amine counterparts, which might realise reduced cytotoxicity of photocurable materials used for dentistry and biomaterial applications.

Reflections on beam configuration optimization for intensity-modulated proton therapy.

Presumably, intensity-modulated proton radiotherapy (IMPT) is the most powerful form of proton radiotherapy. In the current state of the art, IMPT beam configurations (i.e. the number of beams and their directions) are, in general, chosen subjectively based on prior experience and practicality. Beam configuration optimization (BCO) for IMPT could, in theory, significantly enhance IMPT's therapeutic potential. However, BCO is complex and highly computer resource-intensive. Some algorithms for BCO have been developed for intensity-modulated photon therapy (IMRT). They are rarely used clinically mainly because the large number of beams typically employed in IMRT renders BCO essentially unnecessary. Moreover, in the newer form of IMRT, volumetric modulated arc therapy, there are no individual static beams. BCO is of greater importance for IMPT because it typically employs a very small number of beams (2-4) and, when the number of beams is small, BCO is critical for improving plan quality. However, the unique properties and requirements of protons, particularly in IMPT, make BCO challenging. Protons are more sensitive than photons to anatomic changes, exhibit variable relative biological effectiveness along their paths, and, as recently discovered, may spare the immune system. Such factors must be considered in IMPT BCO, though doing so would make BCO more resource intensive and make it more challenging to extend BCO algorithms developed for IMRT to IMPT. A limited amount of research in IMPT BCO has been conducted; however, considerable additional work is needed for its further development to make it truly effective and computationally practical. This article aims to provide a review of existing BCO algorithms, most of which were developed for IMRT, and addresses important requirements specific to BCO for IMPT optimization that necessitate the modification of existing approaches or the development of new effective and efficient ones.

An Evaluation of the Efficacy of LED Light Curing Units in Primary and Secondary Dental Settings in the United Kingdom.

OBJECTIVE: This study aimed to evaluate the irradiance and the quality of LED light curing units (LCUs) in primary and secondary clinics in the UK and to assess the effect of damage, contamination, use of protective sleeves, and distance of light tips to target on the irradiance and performance of LCUs. METHODS: The irradiance levels (mW/cm2) of 26 LED LCUs from general dental practices and 207 LED LCUs from two dental hospitals were measured using a digital radiometer (Blue Phase II, Ivoclar, Vivadent, Amherst, NY). Ten LED light guide tips (Satelec Mini, Acteon, Merignac, France) were selected to evaluate the effect of chipping, contamination (tip debris), and use of protective sleeves and tips to sensor distance on irradiance (mW/cm2) using a MARC Resin Calibrator (Blue Light Analytics, Halifax, Canada). Homogeneity of the light output was evaluated using a laser beam profiler (SP620; Ophir-Spiricon, North Longan, UT, USA). Statistical analysis was conducted using a one-way analysis of variance (ANOVA) with post hoc Tukey test (α=0.05) and linear regression with stepwise correlation tests. RESULTS: Thirty-three percent of the LCUs delivered irradiance output less than 500 mW/cm2. The condition of the light curing tips was poor, with 16% contaminated with resin debris, 26% damaged, and 10% both contaminated and damaged. The irradiance output was significantly reduced in contaminated (62%) and chipped (50%) light curing tips and when using protective sleeves (24%) (p<0.05). Irradiance was also reduced when increasing the distance with 25% and 34% reduction at 7 mm and 10 mm, respectively (p<0.05). CONCLUSION: There remains a lack of awareness of the need for regular monitoring and maintenance of dental LCUs. Damaged and contaminated light curing tips, use of protective sleeves, and increasing the distance from the restoration significantly reduced the irradiance output and the performance of the LCUs.

Photobiomodulation of oral fibroblasts stimulated with periodontal pathogens.

Photobiomodulation (PBM) utilises light energy to treat oral disease, periodontitis. However, there remains inconsistency in the reporting of treatment parameters and a lack of knowledge as to how PBM elicits its molecular effects in vitro. Therefore, this study aimed to establish the potential immunomodulatory effects of blue and near infra-red light irradiation on gingival fibroblasts (GFs), a key cell involved in the pathogenesis of periodontitis. GFs were seeded in 96-well plates in media + / - Escherichia coli lipopolysaccharide (LPS 1 µg/ml), or heat-killed Fusobacterium nucleatum (F. nucleatum, 100:1MOI) or Porphyromonas gingivalis (P. gingivalis, 500:1MOI). Cultures were incubated overnight and subsequently irradiated using a bespoke radiometrically calibrated LED array (400-830 nm, irradiance: 24 mW/cm2 dose: 5.76 J/cm2). Effects of PBM on mitochondrial activity (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and adenosine triphosphate (ATP) assays, total reactive oxygen species production (ROS assay) and pro-inflammatory/cytokine response (interleukin-8 (IL-8) and tumour growth factor-ß1 (TGFß1)) were assessed 24 h post-irradiation. Data were analysed using one-way ANOVA followed by the Tukey test. Irradiation of untreated (no inflammatory stimulus) cultures at 400 nm induced 15%, 27% and 13% increases in MTT, ROS and IL-8 levels, respectively (p < 0.05). Exposure with 450 nm light following application of P. gingivalis, F. nucleatum or LPS induced significant decreases in TGFß1 secretion relative to their bacterially stimulated controls (p < 0.001). Following stimulation with P. gingivalis, 400 nm irradiation induced 14% increases in MTT, respectively, relative to bacteria-stimulated controls (p < 0.05). These findings could identify important irradiation parameters to enable management of the hyper-inflammatory response characteristic of periodontitis.

Exploring opportunities to enhance effectiveness of mobile health and nutrition strategy for providing health and nutrition services amongst pastoralists in Somali region, Ethiopia.

BACKGROUND: The health system in Ethiopia's Somali Region is weak with limited number of health facilities with more than 60% of the population living more than 5 km to the nearest health facilities. The deployment of mobile health and nutrition teams has played critical role in providing essential health and nutrition services. AIM: This study aimed to assess the effectiveness of the mobile health and nutrition strategy in providing health and nutrition services in the targeted woredas (districts). SETTING: Somali Region of Ethiopia. METHODS: The study was a retrospective chart review of the monthly mobile health and nutrition team and the static health facilities in the 29 woredas between April 2019 and March 2020 and the AccessMod analyses for geographical accessibility to health facilities in the region. RESULTS: 40 (40.4%) out of the 99 woredas in Somali regions have at least 80% of the population living more than 5 km from the nearest health facility out of which 18 (45%) woredas are currently being supported by the mobile health team. The mobile team contributed to increasing access to health services in the targeted woredas with 30.8% of the total children vaccinated for measles and 39% of the total children treated for severe acute malnutrition in the targeted 29 woredas. CONCLUSION: With mobile health and nutrition strategy being recognised as a useful strategy to deliver health and nutrition services in the region, there is a need to explore opportunities and innovation to enhance the effectiveness of the implementation.

Real-time chemical analysis of root filling materials with heating: guidelines for safe temperature levels.

AIM: To investigate the chemical changes affecting different types of gutta-percha and endodontic sealers during heating, and correlate changes with the heating capacity of different heat carriers. METHODOLOGY: The heating capacity of three endodontic heat carriers was evaluated using thermocouples to produce heat profiles. The devices were activated at different temperature set-ups, in continuous or cut-out modes. Chemical changes of six brands of gutta-percha and four types of sealers were assessed in real time during heating using micro-Raman spectroscopy equipped with a heating stage. Raman spectra of each tested material were averaged and compared at different temperature levels. The sealers were further assessed by Fourier transform infrared (FT-IR) spectroscopy. RESULTS: None of the tested heat carriers achieved the temperature levels that were set by the devices and recommended by the manufacturer. The use of continuous heating mode resulted in higher rises in temperature than the 4 s cut-out mode that reached 110 °C. The various brands of gutta-percha exhibited different chemical changes in response to heat. Some changes even occurred below temperature levels generated by the heating devices. All sealers revealed changes in their chemical composition upon heating. Changes in epoxy resin- and zinc oxide-eugenol-based sealers were detectable at 100 °C, with structural alterations beyond that temperature and irreversible changes after cooling. Water loss was irreversible in BioRoot, but its chemical structure was stable as well as for the TotalFill. CONCLUSIONS: The heating capacity of endodontic heat carriers needs to be standardized, so that the temperatures delivered by the tips are the same as that set on the dial. Practitioners should be aware of the actual temperatures generated by these devices, and the suitability of sealers to be used at the temperature levels achieved.

Violet-Blue Light Arrays at 405 Nanometers Exert Enhanced Antimicrobial Activity for Photodisinfection of Monomicrobial Nosocomial Biofilms.

Light-emitting diodes (LEDs) demonstrate therapeutic effects for a range of biomedical applications, including photodisinfection. Bands of specific wavelengths (centered at 405 nm) are reported to be the most antimicrobial; however, there remains no consensus on the most effective irradiation parameters for optimal photodisinfection. The aim of this study was to assess decontamination efficiency by direct photodisinfection of monomicrobial biofilms using a violet-blue light (VBL) single-wavelength array (SWA) and multiwavelength array (MWA). Mature biofilms of nosocomial bacteria (Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli, and Staphylococcus aureus) were grown on 96-well polypropylene PCR plates. The biofilms were then exposed to VBL for 2,700 s (SWA) and 1,170 s (MWA) to deliver 0 to 670 J/cm2, and the antibacterial activity of VBL was assessed by comparing the seeding of the irradiated and the nonirradiated biofilms. Nonirradiated groups were used as controls. The VBL arrays were characterized optically (spectral irradiance and beam profile) and thermally. The SWA delivered 401-nm VBL and the MWA delivered between 379-nm and 452-nm VBL, albeit at different irradiances and with different beam profiles. In both arrays, the irradiated groups were exposed to increased temperatures compared to the nonirradiated controls. All bacterial isolates were susceptible to VBL and demonstrated reductions in the seeding of exposed biofilms compared with the nonirradiated controls. VBL at 405 nm exerted the most antimicrobial activity, exhibiting reductions in seeding of up to 94%. Decontamination efficiency is dependent on the irradiation parameters, bacterial species and strain, and experimental conditions. Controlled experiments that ameliorate the heating effects and improve the optical properties are required to optimize the dosing parameters to advance the successful clinical translation of this technology.IMPORTANCE This study reports the efficacy of VBL and blue light (BL) and their antimicrobial activity against mature biofilms of a range of important nosocomial pathogens. While this study investigated the antibacterial activity of a range of wavelengths of between 375 and 450 nm and identified a specific wavelength region (∼405 nm) with increased antibacterial activity, decontamination was dependent on the bacterial species, strain, irradiation parameters, and experimental conditions. Further research with controlled experiments that ameliorate the heating effects and improve the optical properties are required to optimize the dosing parameters to advance the successful clinical translation of this technology.

Investigating the limits of resin-based luting composite photopolymerization through various thicknesses of indirect restorative materials.

OBJECTIVE: To determine the limitations of using light-curable resin-based luting composites (RBLCs) to bond indirect ceramic/resin-composite restorations by measuring light transmittance through indirect restorative materials and the resulting degree of conversion (DC) of the luting-composites placed underneath. METHODS: Various thicknesses (0-4mm) and shades of LAVA Zirconia and LAVA Ultimate were prepared and used as light curing filters. A commercial, light curable RBLC, RelyX Veneer (control) was compared with four experimental RBLCs of the following composition: TEGDMA/BisGMA (50/50 or 30/70wt%, respectively); camphorquinone/amine (0.2/0.8wt%) or Lucirin-TPO (0.42wt%); microfillers (55wt%) and nanofillers (10wt%). RBLCs covered with the LAVA filter were light-cured for 40s, either with the dual-peak BluephaseG2 or an experimental device emitting either in the blue or violet visible band. The samples were analyzed by Raman spectroscopy to determine DC. Light transmittance through the filters was measured using a common spectroscopy technique. RESULTS: All the factors studied significantly influenced DC (p<0.05). RBLCs with increased TEGDMA content exhibited higher DC. Only small differences were observed comparing DC without filters and filters ≤1mm (p>0.05). For thicknesses ≥2mm, significant reductions in DC were observed (p<0.05). Transmittance values revealed higher filter absorption at 400nm than 470nm. A minimal threshold of irradiance measured through the filters that maintained optimal DC following 40s irradiation was identified for each RBLC formulation, and ranged between 250-500mW/cm2. SIGNIFICANCE: This work confirmed that optimal photopolymerization of RBLCs through indirect restorative materials (≤4mm) and irradiation time of 40s is possible, but only in some specific conditions. The determination of such conditions is likely to be key to clinical success, and all the factors need to be optimized accordingly.

Reduced polymerization stress of MAPO-containing resin composites with increased curing speed, degree of conversion and mechanical properties.

OBJECTIVES: The degree and rate of photopolymerization in resin-based dental composites will significantly affect polymer network formation and resultant material properties that may determine their clinical success. This study investigates the mechanical properties, the generation of stress from polymerization, tooth cusp deflection and marginal integrity of experimental resin composites that contain different photoinitiators. METHODS: Experimental light-activated resin composites (60vol% particulate filled in 50/50mass% bis-GMA/TEGDMA) were formulated using a monoacylphosphine oxide (MAPO) photoinitiator and compared with a conventional camphoroquinone (CQ)-based system. Similar radiant exposure was used (18Jcm(-2)) for polymerization of each material although the curing protocol was varied (400mWcm(-2) for 45s, 1500mWcm(-2) for 12s and 3000mWcm(-2) for 6s). Degree and rate of polymerization was calculated in real-time by near infrared spectroscopy and the generation of stress throughout polymerization measured using a cantilever beam method. Flexural strength and modulus were acquired by three-point bend tests. Standardized cavities in extract pre-molar teeth were restored with each material, the total cuspal deflection measured and post-placement marginal integrity between the tooth and restoration recorded. RESULTS: Generally, MAPO- exhibited a significantly higher degree of conversion (72±0.8 to 82±0.5%) compared with CQ-based materials (39±0.7 to 65±1.6%) regardless of curing protocol (p<0.05) and MAPO-based materials exhibited less difference in conversion between curing protocols. CQ-based materials exhibited between ∼85 and 95% of the maximum rate of polymerization at <15% conversion, whereas MAPO-based RBCs did not approach the maximum rate until >50% conversion. Higher irradiance polymerization had a significant deleterious effect on the mechanical properties of CQ-based materials (p<0.05) whereas MAPO-based materials exhibited increased strength and modulus and were less affected by the curing method. Total cuspal deflection in restored extracted teeth was higher for CQ- compared with MAPO-based materials cured at the lowest irradiance curing protocol (12.9±4.0 and 8.3±1.5µm) and similar at 3000mWcm(-1) for 6s (10.1±3.5 and 9.0±1.5µm). A significant decrease in marginal integrity was observed for CQ-based RBCs cured at high irradiance for short exposure time compared with that of the MAPO-based RBC cured using a similar protocol (p=0.037). SIGNIFICANCE: Polymer network formation dictates the final properties of the set composite and the use MAPO photoinitiators may provide an effective restorative material that exhibits higher curing speeds, increased degree of conversion, strength and modulus without compromise in terms of polymerization stress and marginal integrity between tooth and restoration.

Improving health care financing in Ethiopia

The purpose of this report is to inform deliberations among policymakers and stakeholders. It summarises the best available evidence regarding the design and implementation of policies for improving health care financing. The report was prepared as a background document to be discussed at meetings attended by those engaged in developing policies on health care financing and people with an interest in such policies (stakeholders). It is not intended to prescribe or proscribe specific options or implementation strategies. Rather, its purpose is to allow policy makers and stakeholders to systematically and transparently consider the available evidence about the likely impacts of different options improving health care financing in Ethiopia.

Improving skilled birth attendance in Ethiopia

The purpose of this report is to inform deliberations among policymakers and stakeholders. It summarises the best available evidence regarding the design and implementation of policies for improving skilled birth attendance. The report was prepared as a background document to be discussed at meetings attended by those engaged in developing policies on skilled birth attendance and people with an interest in such policies (stakeholders). It is not intended to prescribe or proscribe specific options or implementation strategies. Rather, its purpose is to allow policy makers and stakeholders to systematically and transparently consider the available evidence about the likely impacts of different options improving skilled birth in Ethiopia.

Effects of red light-emitting diode irradiation on dental pulp cells.

Light irradiation activates a range of cellular processes in a variety of cell types, including stem cells, and can promote tissue repair. This study investigated the effects of light-emitting diode (LED) exposure on dental pulp cells (DPCs). Dose response analysis at 20-second intervals up to 120 seconds demonstrated that a LED array emitting 653-nm red light stimulated significantly increased cell growth at 3 and 7 days post-irradiation with 40 (149 mJ/cm(2)) and 60 (224 mJ/cm(2)) seconds of radiant exposure. Double-dosing cells at days 1 and 4 of a 7-day culture period with 60-second (224 mJ/cm(2)) LED exposure significantly increased cell growth compared with a single dosing regime. BrdU analysis demonstrated significantly increased proliferation rates associated with significantly increased ATP, nitric oxide (NO), and mitochondrial metabolic activity. LED-stimulated NO levels were not reduced by inhibition of NO-synthase activity. Light exposure also rescued the inhibition of mitochondrial dysfunction and increased levels of in vitro mineralization compared with control. Media exchange experiments indicated that autocrine signaling was not likely responsible for red-light-induced DPC activity. In conclusion, data analysis indicated that 653-nm LED irradiation promoted DPC responses relevant to tissue repair, and this is likely mediated by increased mitochondrial activity.

High irradiance curing and anomalies of exposure reciprocity law in resin-based materials.

OBJECTIVES: The aim of this work was to investigate the effect of high irradiance curing on resultant degree of conversion of 'flowable' resin composites and their counterpart higher viscosity paste materials. METHODS: Five commercial flowable materials (Venus; Heraeus Kulzer, Synergy D6; Coltene, Premise; Kerr, Grandio; Voco and Gradia; GC Corp) and their counterpart higher viscosity restorative versions were tested. Specimens were cured with a halogen Swiss Master Light (EMS, Switzerland) using five different curing protocols with similar radiant exposure (18J/cm(2)): 400mW/cm(2) for 45s, 900mW/cm(2) for 20s, 1500mW/cm(2) for 12s, 2000mW/cm(2) for 9s and 3000mW/cm(2) for 6s. Degree of conversion (DC) was measured in real time by Fourier transform near infrared spectroscopy (FT-NIRS). RESULTS: Three- and subsequent two way ANOVA testing revealed significant differences (p≤0.02) with respect to "composite type" and "cure protocol" for DC for all 5 product comparisons. Supplementary one-way ANOVA also revealed significant differences between curing protocols (p<0.05). The majority of higher viscosity resin composite paste materials exhibited similar DC regardless of curing protocol. However, a significant decrease in DC for specimens cured at 3000mW/cm(2) for 6s compared with 400mW/cm(2) for 45s was observed for the flowable materials, Grandio (41±0.36 and 62±1.15%, respectively) and Venus (44±0.44 and 67±0.44%, respectively). Conversely, other flowable materials exhibited little or no significant differences between curing modes. Generally, a higher degree of conversion was observed for flowables compared with their more viscous counterpart, except at high irradiance for those materials where a reciprocal relationship with exposure time was not observed. CONCLUSIONS: The validity of exposure reciprocity law and final degree of conversion depends on several factors, amongst which resin viscosity and filler content were important. Practitioners should be aware of the importance of resin composite constituents and irradiation protocols. Information on material composition and appropriate radiation sources by manufacturers may assist practitioners with the selection of appropriate curing protocols for specific material/light curing unit combinations with the aim of reducing the incidence of under-cured restorations and the clinical impact thereof.

Photoinitiator type and applicability of exposure reciprocity law in filled and unfilled photoactive resins.

OBJECTIVES: To test the influence of photoinitiator type and filler particle inclusion on the validity of exposure reciprocity law. MATERIALS AND METHODS: 50/50 wt% Bis-GMA/TEGDMA resins were prepared with equimolar concentrations of camphorquinone/DMAEMA (0.20/0.80 mass%) (CQ) or Lucirin-TPO (0.42 mass%), and were used either unfilled or filled to 75 mass%. Specimens were cured with a halogen Swiss Master Light (EMS, Switzerland) using four different curing protocols: 400 mW/cm² for 45 s as reference protocol (18 J/cm²), 1500 mW/cm² for 12 s (18 J/cm²), 3000 mW/cm² for 6 s (18 J/cm²) and 3 s (9 J/cm²). Degree of conversion (DC) was measured in real time for 70 s by FT-NIRS and temperature rise using a thermocouple. Depth of cure was determined with a penetrometer technique. RESULTS: With respect to DC and depth of cure, exposure reciprocity law did not hold for any tested material, except for the depth of cure of filled CQ-based materials. At similar radiant exposure, DC was significantly higher (p<0.05) for all unfilled and filled TPO-based materials compared with CQ-based materials. As exposure time was reduced and irradiance increased, TPO-based materials exhibited higher DC whilst an opposite trend was observed for CQ-based materials (p<0.05). For similar curing regimes, depth of cure of CQ-based materials remained significantly greater than that of TPO-based materials. Adding fillers generally reduced DC, except at higher irradiance for CQ-based materials where a positive effect was observed (p<0.05). SIGNIFICANCE: The validity of exposure reciprocity law was dependent on several factors, among which photoinitiator type and filler content were important. Lucirin-TPO is a highly reactive and efficient photoinitiator, which may allow the potential for a reduction in curing time of TPO-based photoactive materials in thin sections.

Dynamic monitoring of refractive index change through photoactive resins.

OBJECTIVES: The change in optical characteristics through the bulk of curing photopolymers is not fully understood. Photopolymerization processes are accompanied by photoinitiator absorption, density changes and volumetric shrinkage, which alter optical properties and affects curing efficiency through depth. METHODS: This investigation demonstrates the use of a novel low coherence interferometry technique for simultaneous measurement of optical (refractive index) and physical (shrinkage) properties throughout curing of photoactive monomers containing various concentrations of bisphenol-A-diglycidyl ether dimethacrylate and triethylene glycol dimethacrylate. RESULTS: Reliability of the interferometry technique was compared with an Abbé refractometer and showed a significant linear regression relationship (p<0.001; adjusted R(2)>0.99) for both uncured and cured resins. The extent and rate of refractive index change and magnitude of shrinkage strain was dependent upon monomer formulation. SIGNIFICANCE: The development of this interferometry technique provides a powerful non-invasive tool that will be useful for improving light transmission through photoactive resins and filled resin composites by precise control of optical properties through material bulk.

Human resource capacity to effectively implement malaria elimination in Ethiopia

The purpose of this report is to inform deliberations among policymakers and stakeholders. It summarises the best available evidence regarding human resource capacity building as well as staff motivation as policy options for developing the capacity to effectively implement the proposed malaria elimination strategy in Ethiopia. The report was prepared as a background document to be discussed at meetings of those engaged in developing policies for malaria elimination and people with an interest in those policies (stakeholders). In addition, it is intended to inform other stakeholders and to engage them in deliberations about those policies. It is not intended to prescribe or proscribe specific options or implementation strategies. Rather, its purpose is to allow stakeholders to systematically and transparently consider the available evidence about the likely impacts of different options for building the human resource capacity for malaria elimination.

Cytotaxonomic description of Simulium kaffaense, a new member of the S. damnosum complex (Diptera: Simuliidae) from south-western Ethiopia.

Although Ethiopia is one of the countries worst affected by human onchocerciasis, the exact taxonomic identity of the blackflies acting as the main vectors in the endemic areas has never been determined. A cytotaxonomic analysis of Simulium damnosum s.l. collected from three endemic sites in south-western Ethiopia has now revealed the existence of the 'Kisiwani' form (a non-anthropophilic cytoform that is common in East Africa) and a newly recognized species, Simulium kaffaense. Simulium kaffaense sp. nov. is differentiated from other members of the S. damnosum complex by six fixed inversions and dozens of 'new' floating inversions. The rearing of egg batches from some of the biting adult females, to larvae or adults, indicated that the human-biting blackflies were all S. kaffaense. As S. kaffaense is not only highly anthropophilic but also, apparently, the only anthropophilic member of the S. damnosum complex present, it is likely to be the main (if not the only) vector of Onchocerca volvulus in the study area. The presence of inversion 1S-1 and a complex inversion possibly involving 1L-3 indicates that S. kaffaense either belongs or is close to the 'Nile' phylogenetic group of S. damnosum s. l. The karyotype frequencies of the inversions in the collections from the three study sites indicate that at least two forms of S. kaffaense, here designated 'Bebeka' and 'Jimma', were caught. The taxonomy and medical importance of S. kaffaense are discussed.

Host choice by indoor-resting Anopheles arabiensis in Ethiopia.

The host preference of indoor resting Anopheles arabiensis has been determined using a direct enzyme-linked immunosorbent assay. A total of 611 specimens, 258 from human dwellings, 179 from mixed dwellings, and 174 from cattle sheds, was examined. The proportion of human blood meals identified was highest from mosquitoes caught in human dwellings (91.5%), followed by those from mixed dwellings (20.2%) and cattle sheds (3.5%) (P < 0.0001). The smaller proportion of human blood meals from mixed dwellings suggests that cattle may protect humans from A. arabiensis.

Decline of Glossina morsitans ugadensis in Gambella, Ethiopia.

Gambella is the only area where sleeping sickness is endemic in Ethiopia. Four species of Glossina had been reported from Gambella out of the five species found in the country in surveys made before 1985. These are Glossina morsitans ugadensis, G. pallidipes, G. fuscipes and G. tachinoides. A tsetse fly survey was carried out in parts of Gambella owing to the fact that the area is undergoing ecological changes due to massive deforestation (because of resettlement and development programmes), poaching, and introduction of domestic animals into tsetse infested parts of Gambella after 1985. Tsetse populations were sampled for one year, March 1993-April 1994, using biconical traps and hand catches. The survey has reported all Glossina spp which were previously reported except G. morsitans ugadensis. It seems that a combination of factors, such as, lack of host and increase in human population have forced G. morsitans ugadensis to decline. This study has consolidated the fact that tsetse flies of the morsitans group specially G. morsitans, are easily affected by human interference while the palpalis group is resistant to this factor. In addition, this study has also indicated, villagization and rural development could be practised where G. morsitans is the only species in a certain area to alleviate pressure on already impoverished land in parts of Africa.