Effect of obturators on facial form following surgery for head and neck cancer and impact on the perception of appearance.

OBJECTIVES: To describe the correlation between changes in the surface area and depth of the face in individuals wearing an obturator compared with it not being in place, and self-reported Quality of Life in relation to appearance. METHODS: Difference images were created from stereophotogrammetry images recorded from research participants with and without their obturators in place. On the difference images of the face, surface areas and mean depths were calculated. Oral health impact profile questionnaires (OHIP-49) were completed. RESULTS: Data from 19 research participants were recorded. The mean size of the outlined area of the face when the obturators were present compared to when they were not was 1411 mm2 (SD ± 848). Similarly the mean depth differences ranged up to 6.14 mm. Although a proportion of the individuals reported effects in relation to their quality of life, there were no statistically significant relations between the surface areas and mean depths with the participants' responses to the quality of life questions. CONCLUSIONS: There are clear changes in facial tissues, both in relation to surface area and depths when obturators are worn compared to when they are not. There is no simple relationship between the extent of facial change with and without an obturator and quality of life around appearance. The determinants of changed quality of life in this group of patients require greater exploration.

DEVELOPMENT OF CLINICAL DEMENTIA RATING SCALE CUTOFF SCORES FOR PATIENTS WITH PARKINSON'S DISEASE.

BACKGROUND: The purpose of this study was to explore validity of the Clinical Dementia Rating Scale in measuring cognitive impairment among individuals with Parkinson's disease. The scale was created for use in patients with Alzheimer's disease and, to date, there have been no published studies examining if this tool is appropriate for patients with Parkinson's disease. METHODS: The data were obtained from the National Alzheimer's Coordinating Center database and included 490 subjects diagnosed with Parkinson's disease, further categorized as having Parkinson's disease dementia (n= 151), mild cognitive impairment (n= 186), or normal cognition (n = 153) by a treating physician. Sensitivity, specificity, positive predictive value and negative predictive values were calculated for the Clinical Dementia Rating Scale Global Score as well as the Sum of Boxes Score using existing cutoff scores. Finally, new cutoff scores were calculated using sensitivity and specificity values derived using Receiver Operating Characteristic curves. RESULTS: Sensitivity and specificity of the published Global Score cutoff scores for patients with dementia were .34 and .10, respectively. The newly calculated cutoff scores for patients with dementia yielded a sensitivity of .79 and a specificity of .96. The area under the curve was 0.92 (95% CI = 0.90-0.95). CONCLUSION: The CDR is a useful tool in identifying dementia in patients with Parkinson's disease when the cutoff scores are adjusted.

Recurrent syncope due to refractory cerebral venous sinus thrombosis and transient elevations of intracranial pressure.

Chronic paroxysmal intracranial hypertension leading to syncope is a phenomenon not reported previously in patients with refractory cerebral venous sinus thrombosis. We report a case of paroxysmal intracranial hypertension leading to syncopal episodes in a patient with idiopathic autoimmune hemolytic anemia and venous sinus thrombosis. This case demonstrates that intermittent elevations in intracranial pressure can lead to syncope in patients with venous sinus thrombosis and emphasizes the importance of considering this potentially treatable etiology of syncopal episodes.

Effects of cognitive remediation on neurocognitive functions and psychiatric symptoms in schizophrenia inpatients.

OBJECTIVE: Many individuals diagnosed with schizophrenia have significant neurocognitive deficits, especially in the areas of attention, memory, and executive function. These deficits may exacerbate patients' psychiatric symptoms. Cognitive remediation has shown efficacy in improving neurocognitive functioning and may lead to amelioration of psychiatric symptoms in persons with schizophrenia. METHOD: Forty-two schizophrenic inpatients were randomly assigned to either a cognitive remediation group (n=21) or a control group (n=21) and were assessed using a neuropsychological battery and symptom scales for depression, anxiety, and positive and negative symptoms of schizophrenia at baseline and after two months of participation in a cognitive remediation program. RESULTS: The intervention group showed significant improvements in neuropsychological functioning, depression and negative symptoms of schizophrenia after the intervention compared to the control group. CONCLUSION: Results of the study provide support for cognitive remediation as an efficacious intervention to improve neurocognitive functioning and decrease psychiatric symptoms of schizophrenia.

Sexual selection maintains whole-body chiral dimorphism in snails.

Although the vast majority of higher animals are fixed for one chiral morph or another, the cause for this directionality is known in only a few cases. In snails, for example, rare individuals of the opposite coil are unable to mate with individuals of normal coil, so directionality is maintained by frequency-dependent selection. The snail subgenus Amphidromus presents an unexplained exception, because dextral (D) and sinistral (S) individuals occur sympatrically in roughly equal proportions (so-called 'antisymmetry') in most species. Here we show that in Amphidromus there is sexual selection for dimorphism, rather than selection for monomorphism. We found that matings between D and S individuals occur more frequently than expected by chance. Anatomical investigations showed that the chirality of the spermatophore and the female reproductive tract probably allow a greater fecundity in such inter-chiral matings. Computer simulation confirms that under these circumstances, sustained dimorphism is the expected outcome.

A study to compare the oral health impact profile and satisfaction before and after having replacement complete dentures constructed by either the copy or the conventional technique.

AIMS: To assess the oral health impact profile (OHIP) on edentulous subjects who needed to have their dentures replaced either by a copy technique or a conventional technique, and to determine whether any change in the subjects' assessment of their original and replacement dentures impacted on oral health related quality of life parameters. BACKGROUND: The OHIP is an instrument used to measure subjects' perceptions of the social impact of oral disorders on their well being. Changes in the OHIP may occur when subjects need to have their complete dentures replaced. Furthermore, it is possible that the method by which the dentures are constructed may impact on this. METHODS: A total of 65 edentulous subjects were studied. Thirty-three subjects had their dentures constructed by a copy technique and 32 by a conventional technique. Subjects completed the OHIP-14 questionnaires before and after being provided with a set of replacement complete dentures. They also assessed specific features of the upper and lower dentures. Responses were recorded on a Likert scale. RESULTS: For many subjects, the responses in the before treatment questionnaires were at the lower end of the Likert scale, indicating that there were no major impacts on oral health related quality of life parameters. There were no major differences between the copy denture subjects and the conventional denture subjects in relation to the change in OHIP scores before and after treatment. Generally subjects expressed improved satisfaction with the new lower denture. However, for the copy denture group there were significant improvements for all seven assessments compared with only five out of seven assessments for subjects in the conventional group. CONCLUSION: For these groups of edentulous subjects, although they may need dentures to be replaced after a period of wear, this does not necessarily have significant impacts on oral health related quality of life parameters. It seems likely that this is the main reason why the provision of new dentures by either a copying or conventional technique did not result in major changes to the OHIP.

Population structure and coil dimorphism in a tropical land snail.

Tree snails of the subgenus Amphidromus s. str. are unusual because of the chiral dimorphism that exists in many species, with clockwise (dextrally) and counter-clockwise (sinistrally) coiled individuals co-occurring in the same population. Given that mating in snails is normally impeded when the two partners have opposite coil, positive frequency-dependent selection should prevent such dimorphism from persisting. We test the hypothesis that a strong population structure with little movement between tree-based demes may result in the fixation of coiling morphs at a very small spatial scale, but apparent dimorphism at all larger scales. To do so, we describe the spatial structure in a Malaysian population of A. inversus (Müller, 1774) with 36% dextrals. We marked almost 700 juvenile and adult snails in a piece of forest consisting of 92 separate trees, and recorded dispersal and the proportions of dextrals and sinistrals in all trees over a 7-day period. We observed frequent movement between trees (155 events), and found that no trees had snail populations with proportions of dextrals and sinistrals that were significantly different from random. Upon recapture 1 year later, almost two-thirds of the snails had moved away from their original tree. We conclude that population structure alone cannot stabilise the coil dimorphism in Amphidromus.

Peer review amongst restorative specialists on the quality of their communication with referring dental practitioners.

OBJECTIVE: A peer review study was carried out to assess the written communication between consultants and specialist registrars in restorative dentistry with the referring general dental practitioners. METHODS: Seven people took part in the study and each presented referral and reply letters for five patients whom they had seen for consultation. The referral letters were used for information only and were not used in the peer review process. Each participant inspected the referral and reply letters from the other six participants. The reply letters were anonymously peer reviewed by using a proforma containing agreed criteria in relation to appropriate factors to include in the reply letter. The reviewer also ranked the letter in relation to overall quality on a 1-10 point scale. RESULTS: It was found that the participants' letters generally conformed positively with the agreed criteria although there were some differences between individuals. There were particular problems identified in relation to tooth notation. Reply letters commonly used different forms of tooth notation to the referring practitioners. CONCLUSIONS: The ranking of the letters generally indicated that the participants' replies were judged to be favourable by their peers. There may be scope for continuing this study in relation to peer review by other groups of professionals, in particular practitioners in primary dental care.

Identifying the position of an ear from a laser scan: the significance for planning rehabilitation.

Laser scanning techniques are used to plan the construction of prosthetic ears as dimensional measurements between anthropometric points can be accurately measured on a screen image. The aim of this study was to determine if these techniques could be used to assess the position of ears on the face. Computer-generated images were created from laser scans of 20 subjects. Frames of reference were constructed by locating a series of anthropometric points on the face from which three orthogonal planes were constructed. A central reference point was identified at the intersection of the three orthogonal planes. Dimensional measurements were made between anthropometric points on the ear and the reference planes. The differences between anthropometric points and the reference planes on the left and right sides of the face were small. It was possible to describe the location of points three-dimensionally with respect to a central reference point. The development of frames of reference and a central reference point would appear to offer many advantages in the assessment and description of ear position for patients requiring reconstruction with prostheses.

Voluntary and reflex control of the human temporalis muscle.

Electromyographic recordings (EMGs) were made in 10 human subjects from the anterior and posterior parts of the temporalis muscle using skin surface electrodes. The activities produced by voluntary maximal clenching tasks and the reflex responses to electrical stimulation of the muco-gingival junction were studied. In most subjects, maximum activity in both parts of the muscle occurred when clenching in the intercuspal position (anterior temporalis: 7 of 10 subjects; posterior temporalis: 9 of 10 subjects). Clenching maximally in the retruded position usually resulted in less activity; when this activity was expressed as a percentage of the maximum achieved by each subject for that part of the muscle, the median values were: anterior temporalis, 68% and posterior temporalis, 79%. Clenching in the protruded position produced little or no activity (median values: anterior temporalis, 3%; posterior temporalis, 5%). There were no significant differences between the EMG activities of the anterior and posterior parts of the muscle during these tasks when the activities were normalized to the maximum achieved in each part of the muscle. Application of electrical stimuli at the muco-gingival junction (upper incisor region) produced reflex inhibitions and excitations in both parts of the muscle. There were no significant differences in the thresholds of these reflexes between the anterior and posterior parts of the muscle. Furthermore, there was little difference between the two parts of the muscle in terms of the latencies, durations and magnitudes of the responses. Thus the results of the study suggest that there are similar neural control mechanisms for the anterior and posterior parts of the temporalis muscle despite the common view that these parts of the muscle have different functions.

Evaluation of the impact and acceptance of a nutrition program in an HIV community clinic.

The present paper describes the evaluation of a nutrition service and research model for human immunodeficiency virus (HIV)-positive clients within a community based HIV acquired immune deficiency syndrome (AIDS) medical clinic. This program was designed to develop an effective, practical, replicable model for the delivery of nutrition services in the ambulatory HIV care setting. The objectives of evaluating the model were to define the ways that nutrition services in HIV/AIDS impacted clients, the clinic, and referral sources, and to continually refine the model by determining what services provide greatest benefit to clients, especially in view of the changing landscape of HIV therapy. Four evaluation activities completed during the study period of 5 years are described. These included a focus group and semistructured interview with clients, a semistructured interview with workers from the local network of service referral agencies and a client satisfaction survey at study "close-out." These evaluation processes confirmed or prompted programmatic modifications that improved access, confidentiality, and the relevance of specific components for clients. Providers/stakeholder's concerns were addressed through more frequent communication about clients' specific nutrition issues, clearer and easier referral and cooperation in recruiting patients. Also, the evaluation activities provided a platform for the communication of general and specific information about the program and for outreach. Although clients' and workers' priorities differed in some details of program implementation, there was strong agreement on the value of addressing nutrition concerns in HIV. Favorable feedback about the program gave impetus to continue nutrition services in the clinic after the project period ended and supports its application in other sites and settings.

Mesostructured materials for optical applications: from low-k dielectrics to sensors and lasers.

Recent advances on the use of mesoporous and mesostructured materials for electronic and optical applications are reported. The focus is on materials which are processed by block-copolymer templating of silica under weakly acidic conditions and by employing dip- and spin-coating as well as soft lithographic methods to bring them into a well-defined macroscopic shape. Several chemical strategies allow the mesostructure architecture to be used for electronic/optical applications: Removal of the block-copolymers results in highly porous, mechanically and thermally robust materials which are promising candidates for low dielectric constant materials. Since the pores are easily accessible, these structures are also ideal hosts for optical sensors, when suitable are incorporated during synthesis. For example, a fast response optical pH sensor was implemented on this principle. As-synthesized mesostructured silica/block-copolymer composites, on the other hand, are excellently suited as host systems for laser dyes and photochromic molecules. Laser dyes like rhodamine 6G can be incorporated during synthesis in high concentrations with reduced dimerization. This leads to very-low-threshold laser materials which also show a good photostability of the occluded dye. In the case of photochromic molecules, the inorganic-organic nanoseparation enables a fast switching between the colorless and colored form of a spirooxazine molecule, attributed to a partitioning of the dye between the block-copolymer chains. The spectroscopic properties of these dye-doped nanocomposite materials suggest a silica/block-copolymer/dye co-assembly process, whereby the block-copolymers help to highly disperse the organic dye molecules.

An investigation into the use of a structured clinical operative test for the assessment of a clinical skill.

AIM: This study was designed to investigate the level of agreement between a group of assessors observing students undertaking a structured clinical operative test. METHOD: 3 assessors agreed a series of criteria to assess the performance of undergraduate students in the recording of a dental impression. Guidelines for assessing whether the students adequately performed in relation to each criteria were also agreed. Following preliminary validation between the assessors, 2 assessors independently scored the performance of each student by reference to the agreed criteria, and the levels of agreement between assessors were compared. The 3 assessors worked in pairs with each other on three groups of students who were in the early stages of their clinical course. RESULTS: A total of 39 clinical dental students were assessed in the recording of a dental impression. The 3 pairs of assessors had satisfactory levels of agreement in the study with similar judgements being made on 90% or more of the 12 criteria assessed. Some differences existed between the pairs of assessors. Certain criteria were more easily judged than others and this was reflected in the level of agreement seen. For over 90% of the criteria, positive assessments were made by each of the 3 assessors, and although there were minor variations between the pairs of assessors, this may have reflected the ability of the groups of students studied. CONCLUSION: The study showed that different assessors were generally able to make agreed judgements on performance criteria in a structured clinical operative test. In setting up performance assessment it is necessary to have close collaboration between assessors to make clearly defined criteria so that judgements are not too subjective. Furthermore, for the assessment of more complex clinical skills, great care is needed in assembling criteria that can be used reproducibly, and sufficient preparation time for the assessors is critical.

A transcultural perspective on the emotional effect of tooth loss in complete denture wearers.

PURPOSE: The purpose of this study was to compare the emotional effects of tooth loss in three edentulous populations. MATERIALS AND METHODS: A questionnaire study involved 142 edentulous subjects undergoing routine prosthodontic care at Guy's, King's and St Thomas's Dental Institute, London; the Dental School, Dundee, Scotland; and the Faculty of Dentistry, University of Hong Kong. Data were analyzed using the chi-squared test. RESULTS: Difficulty in accepting tooth loss was a relatively common experience (44%) in all groups, with almost half feeling that their confidence had been affected. The majority (66%) felt that their choice of food was restricted and that the overall eating experience was less enjoyable, particularly the Hong Kong group. A significant proportion of the participants were concerned about their appearance without dentures, although the trend was less marked in Hong Kong. Forty-three percent felt that they were not adequately prepared for tooth loss, although the Hong Kong group was least concerned. CONCLUSION: In general, the emotional effect of tooth loss was significant in all groups. The restrictions on daily activities were generally greater in the Hong Kong group. However, this group was much less inhibited by denture wearing. The differences observed in the Hong Kong Chinese are most likely due to different cultural values and expectations associated with these aspects of daily living.

The emotional effects of tooth loss in partially dentate people attending prosthodontic clinics in dental schools in England, Scotland and Hong Kong: a preliminary investigation.

AIM: To compare the emotional effects of tooth loss in three partially dentate populations. DESIGN: A questionnaire survey. MATERIALS AND METHODS: A questionnaire was completed by 150 partially dentate subjects undergoing routine prosthodontic care at Guy's, King's and St Thomas's Dental Institute, London; the Dental School, Dundee, Scotland; and the Faculty of Dentistry, University of Hong Kong. Data were analysed using the Chi-square test. RESULTS: Forty nine per cent of all participants reported difficulties in accepting the loss of some of their teeth. People from Dundee were less likely to have difficulties accepting tooth loss (P = 0.001). People from London took longer to come to terms with their tooth loss and were more likely to feel less confident (P < 0.001). Fifty five per cent of all participants restricted their choice of foods and 54 per cent had not enjoyed their food as much as before. Fewer people in Dundee restricted their choice of food (P < 0.001) and were more likely to enjoy their food (P = 0.009). People in Hong Kong were most likely to restrict their choice of food (P = 0.006). Thirty five percent of all subjects felt unprepared for the effects that tooth loss had upon them. People in Hong Kong were more prepared for tooth loss than those in Dundee and London (P = 0.003). In addition, they were less concerned about leaving their dentures out overnight (P = 0.024). CONCLUSIONS: The emotional effects of tooth loss were significant in all groups. People from London took longer to come to terms with their tooth loss.

Nutrition and cancer education: ten years of progress.

The Nutrition Education and Research Program at the University of Nevada School of Medicine was awarded two separate NIH/NCI R25 cancer education grants over a ten-year period. With this support, a four-year longitudinal nutrition curriculum was implemented, including the required 20-hour freshman Medical Nutrition Course, junior and senior nutrition electives, and a senior assignment in nutrition and cancer during the rural rotation with faculty preceptors. Funding has also supported nutrition integration into the basic science courses, patient care courses, and specialty clerkships. A unique nutrition fellowship for medical students who specialize in nutrition during their four years of training and graduate with special Qualifications in Nutrition (SQIN) has also been instituted. The curriculum reflects a longitudinal, interdisciplinary, but flexible, integration of nutrition into an already crowded medical school education.

Laser scanning of the ear identifying the shape and position in subjects with normal facial symmetry.

The objective of the present study was to discover if dimensional measurements of the ear could be determined with a laser scanning technique and whether or not the location of landmarks of the ear could be reliably measured with respect to those on the midline of the face. Computer-generated images were created from laser scans of 20 subjects. Dimensional measurements were made between landmarks on the ear and face. Differences between repeated dimensional measurements of the ear were very small, as were those measurements made between landmarks on the ear to the midline of the face. Differences between dimensions of the left and right ears were observed, but were of a small magnitude. The results suggest that the dimensions of the ear and its position with respect to landmarks in the midline of the face can be reliably measured on normal subjects and that laser scanning is a useful technique for planning and monitoring facial reconstruction of the ear.

The contribution of mechanoreceptive neurones in the gingival tissues to the masticatory-parotid salivary reflex in man.

The masticatory-parotid salivary reflex has been studied in fully dentate subjects. Salivary flow was recorded by siting a modified Lashley cup over the orifice of the parotid duct on one side of the mouth. Subjects chewed on small pieces of silicone rubber for 1-min periods which resulted in a reflex secretion of parotid saliva. The secretion was greatest when the subject chewed on the same side of the mouth (ipsilateral) as the salivary flow was recorded. Less salivary flow resulted when the subjects chewed on the opposite side of the mouth (contralateral). Selected areas of the buccal or lingual gingival tissues were then anaesthetized on the side ipsilateral to the Lashley cup. Anaesthesia of the lingual and buccal gingival tissues together resulted in a reduction of salivary flow in response to similar chewing cycles. Anaesthesia of the lingual gingival tissues alone also resulted in a reduction of salivary flow, but anaesthesia of the buccal gingival tissues alone did not. During mastication it is likely that mechanoreceptors in the gingival tissues will be stimulated which may result in salivary flow. This requires further study as other mechanoreceptive neurones are also known to be involved in the masticatory-parotid salivary reflex.