Proactive palliative care for patients with COPD (PROLONG): a pragmatic cluster controlled trial.

BACKGROUND AND AIM: Patients with advanced chronic obstructive pulmonary disease (COPD) have poor quality of life. The aim of this study was to assess the effects of proactive palliative care on the well-being of these patients. TRIAL REGISTRATION: This trial is registered with the Netherlands Trial Register, NTR4037. PATIENTS AND METHODS: A pragmatic cluster controlled trial (quasi-experimental design) was performed with hospitals as cluster (three intervention and three control) and a pretrial assessment was performed. Hospitals were selected for the intervention group based on the presence of a specialized palliative care team (SPCT). To control for confounders, a pretrial assessment was performed in which hospitals were compared on baseline characteristics. Patients with COPD with poor prognosis were recruited during hospitalization for acute exacerbation. All patients received usual care while patients in the intervention group received additional proactive palliative care in monthly meetings with an SPCT. Our primary outcome was change in quality of life score after 3 months, which was measured using the St George Respiratory Questionnaire (SGRQ). Secondary outcomes were, among others, quality of life at 6, 9 and 12 months; readmissions: survival; and having made advance care planning (ACP) choices. All analyses were performed following the principle of intention to treat. RESULTS: During the year 2014, 228 patients (90 intervention and 138 control) were recruited and at 3 months, 163 patients (67 intervention and 96 control) completed the SGRQ. There was no significant difference in change scores of the SGRQ total at 3 months between groups (-0.79 [95% CI, -4.61 to 3.34], p=0.70). However, patients who received proactive palliative care experienced less impact of their COPD (SGRQ impact subscale) at 6 months (-6.22 [-11.73 to -0.71], p=0.04) and had more often made ACP choices (adjusted odds ratio 3.26 [1.49-7.14], p=0.003). Other secondary outcomes were not significantly different. CONCLUSION: Proactive palliative care did not improve the overall quality of life of patients with COPD. However, patients more often made ACP choices which may lead to better quality of care toward the end of life.

Persistent Inflammation in Pulmonary Granuloma 48 Years after Talcage Pleurodesis, Detected by FDG-PET/CT.

In patients with suspicion of lung malignancy, FDG PET/CT is frequently used as a diagnostic and staging imaging modality. However, false positive findings are not uncommon. We demonstrate a case with FDG-avid pulmonary nodules, mimicking lung cancer. After histopathological examination they appeared to be the result of persistent inflamed tissue, due to talcage pleurodesis, which occurred 48 years ago. We concluded that, nearly five decades after talcage pleurodesis, there can still be an ongoing inflammation reaction in the pleurae, which can be detected by FDG PET/CT.

Mental health and debt: challenges for knowledge, practice and identity.

People with mental health problems (MHPs) in Britain are nearly three times more likely to report debt compared with individuals without similar conditions. With one-in-four respondents with MHPs reporting personal debt, this may be equivalent to eight or nine clients in the recommended national community mental health nurses' (CMHNs) caseload of 35. Although client debt is not a new problem for CMHNs, it can pose significant difficulties for client well-being and nursing practice. This paper reviews the published literature on debt and mental health, then considers three of the challenges that client debt can present to: (1) nursing knowledge--moving away from understandings of client debt based on crisis, and towards those focused on process and prevention; (2) nursing practice--reworking the collaborative relationship between CMHNs and external debt advice agencies; and (3) nursing identity--managing the role conflicts that engaging with client debt can bring. The paper concludes by contending that nurses should raise and monitor debt issues among clients, but cannot be expected to become proxy 'debt advisors', with CMHNs being encouraged to increasingly collaborate with debt advisors (rather than simply referring on clients).

Myocastor coypus as a reservoir host of Fasciola hepatica in France.

To clarify the role of the nutria Myocastor coypus in the epidemiology of domestic fasciolosis in Loire-Atlantique (department of western France), 438 nutrias were trapped in 9 humid areas of the department and 304 nutrias were trapped in 3 farms where Fasciola hepatica was present; all animals were necropsied. Liver flukes were found in 160 nutrias: 38 nutrias randomly taken in the department (8.7%) and 122 trapped in fasciolosis areas (40.1%). The average parasitic burden was 5.7 flukes per nutria. Sixty-five percent of the liver flukes measured more than 18 mm (size of sexual maturity). The coproscopic examinations carried out on 144 infected nutrias showed that 90% of the infected nutrias shed fluke eggs. The hatching rate was 39.6%. Two groups of 100 Lymnaea truncatula snails, originating from 2 different populations, were exposed to F. hepatica miracidiae hatched from eggs collected from infected nutrias. The prevalence of the infection was 74% and 58.6% in the 2 groups of snails. The average redial burden was 6.2 rediae per snail. The total number of metacercariae was 72.4 metacercariae per snail producing cercariae. Two groups of 5 sheep were orally infected by 150 metacercariae of nutria or sheep origin, respectively. The installation rates of F. hepatica in sheep were respectively 31.6% and 29.6% for the two groups. Specific antibody kinetics of sheep were similar whether the metacercariae were of nutria or sheep origin. M. coypus allows the complete development of F. hepatica and releases parasitic elements that are infective for domestic ruminants. Because of its eco-ethologic characteristics, the nutria could be a potential wild reservoir of F. hepatica in France.

Palladium catalysed 3-component cascade synthesis of bis(2-arylallyl) tertiary amines from aryl iodides, allene and primary amines.

A 3-component cascade synthesis of bis(2-arylallyl) tertiary amines from aryl iodide, allene and primary aliphatic amines is described; chiral amines give analogous products with no detectable racemisation; mixtures of two different aryl iodides can be utilised to give the mixed tertiary amines as the sole, or major, product; the reaction is sensitive to stereoelectronic effects which lead to mono(2-arylallyl) secondary amines.

Attention deficits: is there a right hemisphere specialization for simple reaction time, sustained attention, and phasic alertness?

Impairments of attentional focus often are claimed to be associated with lesions of the right hemisphere. Although some studies comparing right- and left-brain-damaged patients have supported this idea, others have not found differences between these patients in various attention tasks. The present study was carried out in order to further investigate the putative role of the right hemisphere in a simple reaction time task, a sustained attention task, and a phasic alertness task. Subjects were 46 patients with right-hemisphere lesions and 37 patients with left-hemisphere lesions. Results showed no difference between right- and left-brain-damaged patients in simple reaction time, in speed of response over time (sustained attention), and in the capacity to prepare to an uncoming stimulus (phasic alertness). Future studies will have to use a more precise categorization of lesions than only right-versus left-brain damage.

Shear bond strength of chemical and light-cured glass ionomer cements bonded to resin composites.

A bond between glass ionomer cements (GIC) and resin composites is desirable for the success of the 'sandwich' restoration. Chemically cured glass ionomer cements have been the traditional materials used in this technique since its development, but etching the GIC was necessary to obtain a bond to the composite facing. Producing a very smooth GIC surface has aided in better determining the magnitude of the chemical bond between glass ionomers and resin composites. Shear testing of bonded specimens has revealed that chemical bonding is minimal (0.21 MPa) in conventional glass ionomers, but does exist (4.92 MPa) between GIC and resin composite regardless of the filler content (microfilled vs hybrid) of the composite. Thermal stressing affects the bond to resin-modified glass ionomers, but has no significant effect on self-cured cements. Of all combinations tested. Vitremer/Scotchbond/Silux Plus showed the highest mean shear bond strength. Based on the clinical need for an adhesive bond between GIC liner/base and resin composite, the resin-modified glass ionomer would appear to be the material of choice.

Further characterization of tunicate and tunichrome electrochemiluminescence.

Electrophoresis, size exclusion chromatography, fluorescence, and electrochemiluminescence (ECL) data obtained from the cell-rich perivisceral fluid ('blood') of the tunicate, Molgula occidentalis, suggests that a yellowish protein or protein subunit of < 6.5 kDa is probably responsible for the low level intrinsic ECL reported previously. Variable potential ECL scans and spectrofluorometric analyses directly indicated that chlorophylls from ingested phytoplankton were not significant contaminants of M. occidentalis blood samples. Chlorophylls were also examined indirectly from monocultures of dinoflagellate and diatom species to determine their ECL levels. While ECL was observed in these cultures, high concentrations (10(6) organisms/mL) of dinoflagellates or diatoms were needed to produce ECL levels comparable to those observed for M. occidentalis blood. Additional work with two synthetic tunichrome isomers indicated 10-fold increases in ECL when the '2,3,4-tunichrome' was reacted with Tl+ in 1:1 and 1:2 metal ion to ligand molar ratios. The '3,4,5-tunichrome' isomer exhibited a titration curve with Hg2+ suggestive of the existence of at least two Hg2+ binding sites and a 9- to 10-fold increase in ECL output.

Electrochemiluminescence from tunicate, tunichrome-metal complexes and other biological samples.

Low level intrinsic electrochemiluminescence (ECL) was induced from body fluids and homogenized tissues of oysters and several species of tunicates. No significant ECL was detected in human blood cell lysates, or bovine haematin, but minor ECL was observed in avian blood cell lysates. Both terrestrial grass and seagrass exhibited ECL, which is probably attributable to chlorophyll, since dead (brown) grass did not demonstrate ECL. It was postulated that organic-metal complexes in marine invertebrates were, at least in part, responsible for the intrinsic ECL, since such animals are known to be rich in organically bound metals. However, alternative biochemical mechanisms for the observed ECL, which do not involve metal chelates, are possible. Various metal ions were added to the invertebrate preparations to determine whether exogenous metals could enhance or inhibit the ECL reactions. Strongly oxidizing metal ions such as Ag+, Au+, Cu2+, Hg2+ and Sb2+ at > or = 100 ppm severely inhibited the intrinsic ECL response. No statistically significant ECL enhancement due to addition of metal ions was noted. ECL "profiles' were generated which demonstrated differences in the ECL responses of individual tunicate preparations to the presence of various exogenous metal ions. Differences in ECL profiles may represent differences in types or levels of endogenous metal chelates or other biochemical constituents. In addition, synthetic tunichromes (tunicate pigments) were analysed for ECL in the presence and absence of various added metal ions. One synthetic tunichrome isomer demonstrated a specific ECL interaction with Hg2+, while the other demonstrated broader ECL activity with several metal ions.

Adhesion of silicone to polyurethane in maxillofacial prostheses.

Primers have been reported to increase adhesion between silicone elastomers and polyurethane liners used for maxillofacial prostheses. This study evaluated two primers, three polymerization methods, and seven primer reaction times to determine the conditions for optimum adhesive bond strength. The T-peel strength of specimens was determined as described in ASTM Standard D 1876-72. Failure modes were evaluated, and two-sample t tests and one-way ANOVA were used to compare means for significant (P < .05) differences. Bond strengths were significantly greater for polyurethane treated with primer 1205 rather than S-2260 regardless of the polymerization method or primer reaction time. Neither any single polymerization method nor single primer reaction time consistently yielded greater bond strengths.

Handling characteristics of gallium alloy for dental restoration.

The handling characteristics of a gallium alloy (Gallium Alloy GF) were compared to those of a spherical high-copper amalgam (Tytin). Ten dentists each restored four identical MO preparations in acrylic typodont teeth (no. 30), two with amalgam and two with gallium alloy. Each restoration was evaluated immediately following completion by the operator for six clinically relevant criteria. Each criterion was scored between 1 and 5, where 1 = very poor, 2 = poor, 3 = fair, 4 = good, and 5 = very good. Three two-sided Mann-Whitney tests were used to compare the median scores for significant differences (P < 0.05). The first test indicated no significant difference between scores for the first- and second-placed restorations, within criteria and within alloy type (n = 10). The second test indicated a significant difference between amalgam and gallium alloy, within criteria and within restoration sequence (n = 10), for each criterion except resistance to fracture during removal of the matrix band. The third test indicated a significant difference between amalgam and gallium alloy, within each criteria, combining scores for first- and second-placed restorations (n = 20). During simulated clinical placement, amalgam was rated significantly higher than gallium alloy in each handling characteristic evaluated.

Polymerization shrinkage, impact strength and roughness of montmorillonite-modified denture base resins.

Montmorillonite (MMT) was added to two commercial denture base resins, Lucitone (LU) and Accelar (AC) in amounts varying from 0-8 weight percent (wt%). The linear polymerization shrinkage, impact strength and average roughness or polishability were measured after specimens were processed using standard methods. The linear polymerization shrinkage was 1.37 and 1.02% for the unmodified denture base resins and the impact strength was 37.36 and 20.02 J/m; while the average roughness after polishing was 0.026 and 0.047 microns for LU and AC, respectively. The addition of MMT significantly (P less than 0.05) reduced the linear polymerization shrinkage and impact strength, while increasing the roughness of LU and AC.

The effects of sodium fluoride and stannous fluoride on the surface roughness of intraoral magnet systems.

Four types of intraoral magnets used for retention of overdentures and maxillofacial prostheses were exposed in vitro to SnF2 and NaF to determine the effects of fluoride rinses on surface roughness. The surface roughness (Ra) was measured, after simulated 1, 2, and 5 years' clinical exposure to fluoride (31, 62, and 155 hours). The mean change in Ra was calculated for each period of simulated exposure to fluoride for each magnet type. Two-way ANOVA was used to compare mean change in Ra between magnets within fluorides, and between fluorides within magnets. Paired t tests were used to compare mean change in Ra within fluorides within magnets. The mean change in Ra increased for all magnets after simulated 1, 2, and 5 years of exposure to SnF2 and NaF (p less than 0.03). Using the change in Ra as an indicator for corrosion, PdCo encapsulated SmCo5 magnets and their keepers demonstrated the least corrosion with either fluoride.

The effect of steam autoclave sterilization on methyl methacrylate cranial implant materials.

The use of methyl methacrylates for cranial repairs has been well established. Procedures for sterilization of these materials include soaking in benzalkonium chloride, use of ethylene oxide gas, or cobalt 60 irradiation. Although ethylene oxide sterilization is the most common method, gas sterilization and degassing of these prefabricated implants may require almost as much time as fabrication. This study evaluated impact strength and linear dimensional change following steam autoclave sterilization of heat-processed methyl methacrylate. It was compared to an autopolymerizing methyl methacrylate for impact strength. No statistical difference was found in impact strength between nonsterile heat-processed methyl methacrylate and autoclaved heat-processed methyl methacrylate; however, both were significantly stronger than the autopolymerizing material. A statistically significant linear dimensional change of 1.211% between the autoclaved and nonsterile heat-processed methyl methacrylate was found, but was not considered clinically significant.

Respirability, microstructure and filler content of composite dusts.

Dusts were generated from five composites, with two different shades each. Between 54 and 70 mass percent of the dust (60 to 92% of the particles) collected was respirable. The average particle size collected was 3.97 microns by mass (0.9 microns by number of particles). Between 14 and 22% of the dust generated was respirable. Filler content of the respirable dust particles was within 3 mass percent of the amount of filler in each cured composite. Powder x-ray diffraction revealed that respirable dust particles collected from composites reported to contain crystalline silica fillers contain the same crystalline silica. The results indicate that improperly protected dental personnel who are regularly exposed to composite dusts generated during high-speed finishing of composites containing quartz filler may be at risk for developing silicosis. Dental personnel should wear masks specifically designed to filter respirable silica when finishing composite restorations with high-speed instrumentation.

Spreading of oligomers on polymers.

The successful repair of a composite restoration may depend on the ability of a repair composite to spread on the restoration to be repaired. The purpose of this study was to measure the spreading of four oligomers on their polymers. The oligomers were: ethoxylated bisphenol A dimethacrylate (EB), BisGMA/3EDMA:70/30 (ED), BisGMA-Nupol (NU), and urethane dimethacrylate (UD). Polymer strips were made from these oligomers by light-curing. Spreading was calculated from measurements of the contact angle of the oligomers on the polymers, the surface tension of the oligomers, and the viscosity of the oligomers. In this model system, values of spreading of EB, ED, UD, and NU on oligomer ED were: 2.8, 1.4, 0.24, and 0.0009 cm/s, respectively. The spreading by oligomers EB, ED, and UD on polymer ED was slightly higher than that on polymer UD.

The effects of hollow microsphere fillers on density and impact strength of denture base resins.

The addition of 20 vol% and 40 vol% filler significantly (p less than 0.05) reduced the density and impact strength of the denture base resin when compared with resin without filler. There was no significant difference in the density or impact strength between 20 vol% and 40 vol% filled specimens. Desiccation significantly (p less than 0.05) decreased the density and impact strength of denture base resin regardless of the presence or amount of filler added. The addition of microsphere filler decreased the denture base resin density by 8% to 9%, which may not reduce the weight of prostheses enough to be clinically significant. The impact strength was reduced by approximately 30%.

Constant-volume polymerization of composites by addition of ammonia-modified montmorillonite.

Polymerization shrinkage is a major limitation of dental composites. It generates internal stresses within bonded restorations and leads to marginal leakage, sensitivity and recurrent decay in the absence of adequate bonding. A method is presented for formulating composites that cure at constant volume by adding to the resin system small amounts of the hydrated mineral montmorillonite (MMT), which has been modified by replacing part of its hydration water with ammonia (NH3). The polymerization exotherm of composites containing ammonia-modified montmorillonite (NH3/MMT), cured at ambient temperatures, raises their temperature to between 60 and 80 degrees C, which causes the NH3/MMT particles to swell and counteract polymerization shrinkage. The polymerization shrinkage was measured for the BIS-GMA resin system, without filler, to which had been added NH3/MMT. The addition of 4 to 5 weight percent NH3/MMT resulted in zero polymerization shrinkage. An experimental composite was formulated using the BIS-GMA resin system, hydroxyapatite filler and 4 weight percent NH3/MMT. Cured samples developed compressive strength and hardness comparable to reported values for dental composite resins. Porosity was not detected by scanning electron microscopy. The use of NH3/MMT for formulating polymeric systems that cure at constant volume should be explored for application in direct dental composites.

Particle size and composition of composite dusts.

Inhalation of respirable crystalline silica dusts (sized between 0.5 and 5.0 micrograms) causes silicosis. Crystalline silica fillers are used in some composites and fine dusts/aerosols generated during high-speed finishing of these materials may be regularly inhaled by clinical dental personnel. Due to the widespread use of composites, the potential of these dusts/aerosols for causing silicosis warrants concern. Six composites were polymerized, then abraded with diamond and carbide finishing burs to produce dusts in a manner simulating the clinical finishing of esthetic veneers. Dusts were collected on 0.8 micron filters using an air sampling pump. Six hundred particles of each dust sample were counted and measured using a light microscope. The respirable fraction of dust particles ranged between 57.2 and 85.7%. The diamond bur created more respirable particles than the carbide bur for each composite tested. The elemental composition of particles of each composite was determined by energy dispersive x-ray analysis. Silicon was detected in amounts ranging from 71-100%. Based on the composition and particle size distribution only, dusts generated during simulated finishing of composite resins containing quartz filler have the potential for causing silicosis in dental personnel.

Adhesion characteristics of visible light-cured denture base material bonded to resilient lining materials.

This investigation compared the adhesion of resilient lining materials to Triad visible light-cured denture base material. The liners used were Tru-Soft, Molloplast-B, and Esscheem. Cylindrical samples were made from Triad VLC material and were sectioned to produce a flat bonding surface, which was roughened and treated with Triad bonding agent. Resilient liners 3 mm thick were processed according to the manufacturer's recommendations and samples were stored at 37 degrees +/- 1 degree C in distilled water for 48 hours and 30 days. Tensile bond strength was determined by using an Instron Universal testing machine for the three resilient liners.