The role of spirituality and identity formation in personal recovery from traumatic brain injury: A qualitative analysis through the personal experiences of survivors.

Traumatic brain injury (TBI) is a type of acquired brain injury (ABI) that happens when a sudden, external, physical assault damages the brain. TBI can cause long-term cognitive impairments and other lifestyle changes that may affect psychological wellbeing. Among the psychological challenges people recovering from TBI often face is the subjective loss of their pre-injury identity. Quantitative and qualitative research suggests that spirituality can play a positive role in recovery from TBI, increasing the quality of life and overall mental health. However, thus far, the research into this topic has not directly addressed the relationship between identity and spirituality after TBI. The present study sought to do this by thematically analyzing 22 public podcasts featuring interviews of people recovering from TBI telling their stories. The authors review the spiritual themes discussed in the podcasts and then propose a hypothesis about how, through a sense of connection to something self-transcendent, spirituality may enable people to test new meanings and identities, relatively free from the consequences of discrepancy in meaning and identity after TBI.

Community seroprevalence of SARS-CoV-2 in children and adolescents in England, 2019-2021.

OBJECTIVE: To understand community seroprevalence of SARS-CoV-2 in children and adolescents. This is vital to understanding the susceptibility of this cohort to COVID-19 and to inform public health policy for disease control such as immunisation. DESIGN: We conducted a community-based cross-sectional seroprevalence study in participants aged 0-18 years old recruiting from seven regions in England between October 2019 and June 2021 and collecting extensive demographic and symptom data. Serum samples were tested for antibodies against SARS-CoV-2 spike and nucleocapsid proteins using Roche assays processed at UK Health Security Agency laboratories. Prevalence estimates were calculated for six time periods and were standardised by age group, ethnicity and National Health Service region. RESULTS: Post-first wave (June-August 2020), the (anti-spike IgG) adjusted seroprevalence was 5.2%, varying from 0.9% (participants 10-14 years old) to 9.5% (participants 5-9 years old). By April-June 2021, this had increased to 19.9%, varying from 13.9% (participants 0-4 years old) to 32.7% (participants 15-18 years old). Minority ethnic groups had higher risk of SARS-CoV-2 seropositivity than white participants (OR 1.4, 95% CI 1.0 to 2.0), after adjusting for sex, age, region, time period, deprivation and urban/rural geography. In children <10 years, there were no symptoms or symptom clusters that reliably predicted seropositivity. Overall, 48% of seropositive participants with complete questionnaire data recalled no symptoms between February 2020 and their study visit. CONCLUSIONS: Approximately one-third of participants aged 15-18 years old had evidence of antibodies against SARS-CoV-2 prior to the introduction of widespread vaccination. These data demonstrate that ethnic background is independently associated with risk of SARS-CoV-2 infection in children. TRIAL REGISTRATION NUMBER: NCT04061382.

The effect of potential investment expansion and hot strength on the fit of full crown castings made with phosphate-bonded investment.

In an earlier investigation, it was shown that when full crowns are cast in gypsum-bonded investments, their relative inaccuracy is affected by both the investment's potential expansion and its hot strength. This study repeated the earlier one, but used a high-melting gold alloy and two phosphate-bonded investments. The investments were used under conditions which gave a range of potential expansions and hot strengths. Casting inaccuracies were determined both diametrally and axially. All castings showed distortion, which varied under the different conditions. All were oversized axially, by amounts varying from + 0.8% to +2.3%. Diametral inaccuracies ranged from -0.2% to +0.7%. Investment expansion had a strong effect on axial inaccuracy, but a negligible effect on diametral inaccuracy. Conversely, hot strength had a strong effect on diametral inaccuracy, but only a very weak effect on axial inaccuracy. With phosphate-bonded investments, both potential expansion and hot strength are important parameters of relative casting inaccuracy. In combination, these properties showed very strong correlations with both diametral and axial inaccuracies. The observed distortions were the result of anisotropic mould expansion and anisotropic alloy shrinkage. The best fit, and least distortion, occurred with an investment setting under dry conditions.

The effect of potential investment expansion and hot strength on the fit of full-crown castings made with a gypsum-bonded investment.

OBJECTIVES: It has been claimed that the strength of the investment mold at the casting temperature affects the dimensional accuracy of castings (e.g., Markley, 1953; Earnshaw, 1957; Asgar, 1972), but the relationship has not been studied quantitatively. In this investigation, the effects of both mold expansion and hot strength on the relative inaccuracy of full-crown castings have been measured and analyzed. The likelihood that a strong investment could cause distortion of the casting by non-uniform restriction of casting shrinkage (Earnshaw, 1969b) was also considered. METHODS: Castings were made with a commercial gypsum-bonded inlay investment, used both as supplied and with modifications that increased its expansion and reduced its hot strength. In both series of tests, the investments were used over a wide range of liquid/powder (L/P) ratios in casting rings fitted with dry ceramic liners, and set under dry conditions. RESULTS: Casting inaccuracy showed a significant linear correlation with total expansion and a highly significant linear correlation with the combination of total expansion and hot strength. The modified investment, with its low hot strength, gave less distortion of casting shape than did the much stronger unmodified material. However, it was found that to ensure sound castings, the hot compressive strength should not be less than 1.8MPa. SIGNIFICANCE: This investigation showed that while investment expansion is the major variable affecting casting inaccuracy, hot strength is an important modifying factor which also has to be considered when predicting casting inaccuracy from measured properties of the investment.

The fit of gold-alloy full-crown castings made with pre-wetted casting ring liners.

Measurements were made of the fit of full-crown gold-alloy castings produced with two types of pre-wetted ring liner (asbestos and cellulose) and a typical gypsum-bonded investment (Cristobalite Inlay, Sybron/Kerr Products, Romulus, MI; W/P = 0.40). Laboratory measurements were made of the effects of the liners on potential investment expansion, and properties of the lining materials considered relevant to casting accuracy were also measured. There was a wide variation in values for mean dimensional inaccuracy. One liner produced a series of castings all of whose inaccuracies lay within the range +/- 0.1%, with a mean value of + 0.01%. With the other five liners, all or most castings were undersize. With three, all or most castings showed inaccuracies worse than -0.2%. The values for casting inaccuracy with the various liners showed a probable correlation with potential investment expansion (p < 0.05); however, no correlation was found between casting inaccuracy and any apparently relevant liner properties, alone or in combination. In casting techniques which use a pre-wetted ring liner, the choice of a specific lining material is an important factor which has a significant effect on casting inaccuracy. With at least three of the six liners tested, a higher investment expansion was needed for accurate full-crown castings to be ensured.

The fit of gold-alloy full-crown castings made with ceramic casting ring liners.

Measurements were made of the fit of gold-alloy full-crown castings produced with dry ceramic ring liners. When used with vacuum investing, these liners absorb relatively large amounts of water from the investment mix (thereby reducing its original W/P ratio) and then function as wet liners, thus increasing the investment's potential expansion and giving castings which are consistently larger than when air investing is used. With four of the five liners tested, investing in air produced many castings which were unacceptably undersized (inaccuracy worse than -0.2%). The fifth liner, an industrial material 2 mm thick, gave only one casting out of 12 which was outside this limit, although all castings were undersized to a lesser extent. Vacuum investing gave improved casting accuracy; with four of the five liners, the improvement was highly significant (p < 0.001), and with the fifth, probably significant (p < 0.05). Even with vacuum investing, however, with only two of the liners did all castings show inaccuracies within +/- 0.2%. With the other three liners, some castings (ranging from 2/10 to 7/9) had inaccuracies worse than -0.2%. With both air and vacuum investing, changing from one liner to another caused changes in relative casting accuracy which were often significant (p < 0.01) or highly significant (p < 0.001). In casting techniques where a ceramic ring liner is used, the choice of specific lining material and the choice between investing in air or under vacuum are important factors which can have a major effect on the fit of castings.

Preosteoblast production in COSMOS 2044 rats: short-term recovery of osteogenic potential.

The influence of a 13.8-day spaceflight and approximately 8.5-11 h of recovery at 1 g on fibroblast-like osteoblast precursor cells was assessed in the periodontal ligament of rat maxillary first molars. Preosteoblasts (C + D cells), less differentiated progenitor cells (A + A' cells), and nonosteogenic fibroblast-like cells (B cells) were identified by nuclear volume analysis (i.e., A + A' = 40-79 microns 3; B = 80-119 microns 3; C + D greater than or equal to 120 microns 3). No differences were observed among flight (F), synchronous (SC), vivarium, and basal control groups in the A + A' (F: 28.0 +/- 3.7 vs. SC: 27.4 +/- 2.2), B (F: 33.1 +/- 1.4 vs. SC: 32.4 +/- 2.4), or C + D (F: 38.4 +/- 4.5 vs. SC: 39.2 +/- 1.6) cell compartments (mean +/- SE, n = 5). Compared with previous spaceflight experiments, the present data are consistent with a postflight response to replenish preosteoblasts and restore periodontal ligament osteogenic potential. These data emphasize the need to 1) unequivocally determine the flight effect by killing the animals in-flight and 2) further assess the postflight recovery phenomenon.

Dimensional accuracy of small gold alloy castings. Part 4. The casting ring and ring liners.

The role of the casting ring and its asbestos liner is discussed. Asbestos as a liner has now largely been replaced by two alternative materials, one based on cellulose and the other on ceramic fibres. The limited literature on the effect of these newer materials on casting accuracy is also reviewed as their introduction may require significant changes in the traditional technology of dental casting.

Dimensional accuracy of small gold alloy castings. Part 3. Gypsum-bonded investment expansion.

The literature on the setting and thermal expansion of investments under both laboratory and practical conditions is reviewed.

Dimensional accuracy of small gold alloy castings. Part 1. A brief history and the behaviour of inlay waxes.

Part 1 reviews published studies which relate to materials and techniques contributing to the dimensional accuracy of small dental castings. A brief history of the cire perdue or lost-wax method of casting alloys and the development of modern dental casting materials and techniques are presented. Data on the behaviour of inlay wax, in particular its contraction and distortion, are reviewed as is the extensive literature about the casting shrinkage of gold alloys (Part 2) and the setting and thermal expansion of investments under both laboratory and practical conditions (Part 3). Part 4 discusses the role of the casting ring and its asbestos liner. Asbestos as a liner has now largely been replaced by two alternative materials, one based on cellulose and the other on ceramic fibres. The limited literature on the effect of these newer materials on casting accuracy is also reviewed, as their introduction may require significant changes in the traditional technology of dental casting.

Preosteoblast production 55 hours after a 12.5-day spaceflight on Cosmos 1887.

The influence of 12.5 days of spaceflight and a 55 h stressful recovery period (at 1 g) on fibroblastlike osteoblast precursor cells was assessed in the periodontal ligament (PDL) of rats that were 91 days old at launch. Nuclear morphometry was used as a marker for precursor cell differentiation in 3 microns sections cut in the midsagittal plane from the maxillary first molar. According to nuclear volume, cells were classified as preosteoblasts (C + D cells, greater than or equal to 120 microns 3) and less differentiated progenitor cells (A + A' cells, 40-79 microns 3). Compared with synchronous controls (simulated flight conditions), the 55 h postflight recovery period at 1 g resulted in a 40% decrease in the A + A' cell population, a 42% increase in the C + D cells, and a 39% increase in the number of PDL fibroblastlike cells near the bone surface. These results are consistent with a postflight osteogenic response in PDL. This recovery response occurred despite physiological stress in the flight animals that resulted in a highly significant (P less than or equal to 0.001) increase in adrenal weight. The data suggest that after spaceflight there is a strong and rapid recovery mechanism for osteoblast differentiation that is not suppressed by physiological stress.

Nuclear morphometric analysis of osteoblast precursor cells in periodontal ligament, SL-3 rats.

Five small (55 days old, 196 +/- 5 g) (mean +/- SE) and five large (83 days old, 382 +/- 4 g) Sprague-Dawley strain, specific pathogen-free rats were exposed to a 7-day spaceflight and 12-h postflight recovery period. As measured in 3-micron sections, periodontal ligament (PDL) fibroblastlike cells were classified according to nuclear size: A + A' (40-79), B (80-119), C (120-169), and D (greater than or equal to 170 microns 3). Since the histogenesis sequence is A----A'----C----D----osteoblast, the relative incidence of A + A' to C + D is an osteogenic index. No difference in A + A' or C + D cells in small rats may reflect partial recovery of preosteoblast formation (A----C) during the 12-h postflight period. Large flight rats demonstrated increased numbers of A + A', indicating an inhibition of preosteoblast formation (A----C). At least in the older group, a 7-day flight is adequate to reduce PDL osteogenic potential (inhibition in PDL osteoblast differentiation and/or specific attrition of C + D cells) that does not recover by 12-h postflight.

Osteoblast histogenesis in periodontal ligament and tibial metaphysis during simulated weightlessness.

According to nuclear size, fibroblast-like cells adjacent to bone surfaces in the periodontal ligament (PDL) and tibial primary spongiosa (PS) were classified as less differentiated progenitors and committed osteoprogenitors (A/A'), nonosteogenic cells (B), or preosteoblasts (C/D). The ratio of A/A' to C/D cells reflects osteogenic status of bone lining tissue. When 83-day-old rats were subjected to simulated weightlessness (S-W) for 17 d and examined for changes in osteoblast histogenesis, PDL and PS cell populations increased in A/A' cells (p less than 0.01; less than 0.05) but decreased in C/D cells (p less than 0.01; less than 0.05) compared to controls. These data indicate that the nuclear volume method, originally developed in PDL, can also be used to assess osteoblast histogenesis in PS of long bones, and that simulated weightlessness in the present experimental context interferes with osteoblast histogenesis. Since the surfaces of both weightbearing (PS) and nonweightbearing (PDL) bones were affected, systemic factors appear important in the gravity-related mechanism of osteoblast histogenesis. Although unloading of the tibia and cephalad fluid shifts occur during S-W, the data attained in this experiment could also be explained by stress and/or cessation of growth in the S-W rats.

Proliferation and differentiation sequence of osteoblast histogenesis under physiological conditions in rat periodontal ligament.

To define the mechanism of osteoblast histogenesis, nuclear morphometry was utilized as a marker for precursor cell differentiation. One hour after 3H-thymidine injection, groups of 7-week-old rats were killed at hourly intervals over one complete 24-hr photoperiod (LD 12:12). S-phase and mitosis were assessed in autoradiographs of 3-micron sections of molar periodontal ligament (PDL) adjacent to a physiological bone-forming surface. Labeled nuclei were divided into four categories according to morphometry of nuclear size: A (40-79 micron3), B (80-119 micron3), C (120-169 micron3), and D (greater than or equal to 170 micron3) cells. C and D cells synthesize DNA during the light and divide in the following dark phase; the rhythm for A cells is the opposite. B cells demonstrated no preference and were subsequently determined to be nonosteogenic. Compared to A cells the S-phase photoperiod of C and D cells (combined) is approximately a one-to-one reciprocal relationship, suggesting two proliferating progenitors in series. Based on arrest points in the histogenesis sequence, five compartments are defined: 1) A cells, less differentiated, self-perpetuating precursors; 2) A' cells, committed osteoprogenitors; 3) C cells, G1 stage preosteoblasts; 4) D cells, G2 stage preosteoblasts; and 5) Ob cells, morphologically distinct osteoblasts. Minimal elapsed time for the A----A'----C----D----Ob sequence is about 60 hr (five alternating dark/light cycles). A stress/strain-mediated increase in nuclear volume (A'----C) is an important, rate-limiting step in osteoblast differentiation.

Depression in general practice.

The nature and course of depressive disorders in a group of general practice patients were assessed by screening 564 subjects who attended representative practices in Sydney by means of a self-report depression inventory. Of these, 25% of women and 17% of men reported significant depressive symptoms. An interview was sought with these "potential depressives" to determine, in particular, the extent to which they might be considered to have a psychiatric disorder, using the PSE case-finding procedure. Of those interviewed, 83% scored as psychiatric "cases", while the mean duration of their depression was nine months. A longitudinal component to the study suggested that the mental condition of the sample had improved minimally at six weeks' and at 20 weeks' follow-up assessments.

Use of impedance plethysmography to continually monitor bone marrow blood flow.

Methods for measuring bone-blood flow are often time-consuming, tedious, single-point measurements which require sacrifice of the animal. An impedance plethysmographic technique is described which can be used to quantify temporal bone marrow blood flow changes. Results obtained with the impedance technique compare favorably with the data from simultaneously administered microspheres. Injection of sympathomimetic drugs produced measurable responses: isoproterenol caused a significant increase in bone marrow blood flow within 1 min and levarterenol decreased bone marrow blood flow. Data obtained with impedance plethysmography suggest that the technique is feasible for multiple measurements on the same animal and that the technique can be used to study acute or chronic changes in bone marrow blood flow following various experimental treatments.

Inhibition of cortical and trabecular bone formation in the long bones of immobilized monkeys.

The acute effects of immobilization on cortical and trabecular bone formation were studied in juvenile male rhesus monkeys (Macaca mulatta). Four animals were immobilized for two weeks by application of total body casts. Two control monkeys were housed in separate metabolic cages under similar environmental and dietary conditions. Tetracycline derivatives were administered on three separate occasions to label sites of bone formation. The tetracycline-labeling frequency and mineral apposition rate of osteons and trabecular bone surfaces in the humerus and femur were determined. The inhibition of bone formation induced by immobilization was more pronounced in trabecular bone. Immobilized monkeys exhibited a moderate, but statistically nonsignificant, reduction in the percentage of osteons forming bone. Conversely, the dramatic decline in the percentage of trabecular surfaces undergoing bone formation in immobilized monkeys was found to be highly significant. The diminished rate of mineral apposition in osteons suggested that osteoblastic activity was impaired in cortical bone during immobilization. The mineral apposition rate in trabecular bone could not be determined reliably due to minimal tetracycline deposition, which indicated that osteoblastic activity and/or recruitment almost ceased in the metaphyseal tissue of immobilized monkeys.

Simulating certain aspects of hypogravity: effects on bone maturation in the non-weight bearing skeleton.

This study reports the effects of simulation of certain aspects of hypogravity (via partial skeletal unloading) on the growth and maturation of the non-weight bearing mandibles of 41-d and 1-yr-old rats. Partial skeletal unloading was effected by elevating the hindquarters (PULEH), and this simulation was controlled with normally loaded animals fed either ad libitum or the average amount of food consumed by the the experimental group (group-mean fed). The chemical status of the mandibles after 10 d or 14 d PULEH closely resembled that of control rats. The younger PULEH rats and their group-mean fed controls demonstrated a trend toward impaired maturation of mineral and matrix moieties; yet the concentrations of calcium (Ca) and phosphorus (P) expressed as a ratio to collagen hydroxyproline content were normally distributed within a density gradient profile which separates the mineral and matrix moieties into various age-dependent fractions. These data demonstrate that 10 d or 14 d PULEH in young or old rats, respectively, is not sufficient to elicit the maturation deficit observed in the mandibles of rats flown for 18.5 d in the Soviet Biosatellite Cosmos-1129. Unless the duration of PULEH is critical, the cephalad fluid shift which is common to PULEH and spaceflight animals cannot be solely responsible for the flight-induced maturation deficit. Because the mandibles of the PULEH rats remain antigravity-postured, the results emphasize the importance of gravity unloading to the impairment of mandibular bone matrix/mineral maturation during spaceflight. Decreased gravity and, hence, gravity unloading cannot be mimicked in ground-based models of hypokinesia.