A Clinical Presentation of the Direct Gold/Composite Sandwich Restoration.

The intent of this paper is to present a new idea for increasing the life expectancy of class II composite restorations where the proximal marginal seal is compromised by the necessity to rely on dentin bonding. As implied by the Clinical Relevance statement, studies show that bonding to dentin in areas with high levels of bacterial action, combined with sustained high plaque formation, tends to be the "Achilles heel" with regard to sustained long-term restorations. Therefore, this paper will present a thought experiment, combined with clinical evidence, for combining gold foil with composite in these areas for the class two composite restoration. The results, if proven viable, will be to develop a procedure utilizing the properties of gold foil that make it one of the longest-lasting restorative materials with the recent development of modern cosmetic materials for a truly long-lasting and healthy class II restoration.

Cohort differences in the progression of developmental pathways: evidence for period effects on secular trends of violence in males.

BACKGROUND: Rates of violence in the USA have fluctuated widely over the past few decades. Theorists have examined period and cohort effects, but there appear to be no studies examining these effects on progression in developmental pathways towards violence. OBJECTIVE: To assess whether differences in progression among individuals in the Pittsburgh Youth Study are consistent with period or cohort effects. DESIGN: Multivariate logistic regression was conducted to examine differences between cohorts in the odds of progressing through the developmental pathway towards violence. Adjusted and unadjusted odds ratios (ORs) and corresponding 95% CI are reported. SETTING: Pittsburgh Pennsylvania, from 1987 to 2000. SUBJECTS: Two cohorts of male adolescents from the Pittsburgh Youth Study. The youngest cohort (n = 503) was followed from median ages 7 to 20, and the oldest cohort (n = 506) was followed up from median ages 13 to 25. MAIN OUTCOME MEASURE: The odds of progression along a developmental pathway towards violence. RESULTS: There was no statistically significant difference between the cohorts in progression from minor aggression to physical fighting (OR = 1.13, 95% CI 0.77 to 1.65). However, after adjustment for major risk factors, the oldest cohort was significantly more likely to progress from physical fighting to violence (OR = 2.34, 95% CI 1.39 to 3.92). CONCLUSIONS: These results provide initial evidence that cohort effects, which would be present early in development, do not contribute significantly to later differences in reported violence and raises the possibility of whether period effects can explain these differences.

Longitudinal family and peer group effects on violence and nonviolent delinquency.

Explored the longitudinal relations between family relationships and parenting characteristics, violence and nonviolent delinquency of peers, and individual delinquency and violence using data from a sample of 246 adolescent male participants in the Chicago Youth Development Study. Family and parenting characteristics were measured when participants averaged 12 years of age, peer group offending when participants averaged 14 years of age, and individual offending when participants averaged 17 years of age. Family characteristics and parenting were represented by an ordinal variable ranging from exceptional families characterized by emotional closeness, strong beliefs about family, and good parenting skills, to struggling families characterized by a lack of emotional cohesion, deviant beliefs, and poor parenting. Peers' violence but not nonviolent delinquency predicted individual violence and nonviolent delinquency, and family types predicted peer deviance as well as individual violence and delinquency. Effects varied somewhat due to gang membership and ethnicity.

Patterns of family functioning and adolescent outcomes among urban African American and Mexican American families.

The relations of patterns of family functioning, prosocial behaviors, and internalizing and externalizing symptoms over time were evaluated among a sample of economically disadvantaged inner-city African American and Mexican American male adolescents. Ethnic group differences for configurations of family functioning over time, levels of prosocial and problem behaviors, and relations of family functioning to risk were found. Among both ethnic groups, exceptionally functioning families provided a protective effect against risk. Overall, African American youth had stronger attitudes toward school and higher educational aspirations than Mexican American youth. Unlike previous investigations, once socioeconomic status was controlled, no differences were found for either internalizing or externalizing problems between the 2 groups. The importance of considering socioeconomic status and community context when evaluating minority parenting and family functioning is discussed.

Burn pain management in children.

Burn injuries present complex management problems that are exacerbated by the pain and suffering associated with burns. This pain commands primary consideration in the treatment plan, and the goal should be to achieve the least pain possible. This article describes strategies for assessing children's pain and for treating pain with a combination of pharmacologic and complementary therapies. An experienced interdisciplinary team is essential to successful pain management.

Relation of family problems to patterns of delinquent involvement among urban youth.

The relation of patterns of family problems and patterns of delinquent behavior over time was evaluated among a sample of inner-city minority adolescent males. Empirically derived groups were identified and included: nonoffenders, chronic minor offenders, escalators, and serious chronic offenders. Patterns of family problems were also identified and differentially related to delinquency groups. Members of the group involved in serious chronic offending were more likely to have families characterized by multiple problems including disruption, conflict, and lack of parental involvement, sometimes so extreme as to meet the legal requirement of neglect. They were also more likely to have families characterized by deviant behavior and attitudes. The finding of specific relations between types of family problems and patterns of delinquent behavior has important implications for intervention and prevention. Rather than assuming a general relation between family functioning and delinquent involvement, specific aspects of family functioning may need to be targeted to affect different patterns of delinquent involvement.

Comparison of the hemodynamic and echocardiographic effects of sufentanil, fentanyl, isoflurane, and halothane for pediatric cardiovascular surgery.

Sufentanil, fentanyl, halothane, and isoflurane were compared as sole anesthetic agents in 48 infants and children aged 6 months to 9 years, undergoing repair of congenital heart defects. Patients were randomly assigned to receive sufentanil, 20 microg/kg, fentanyl, 100 microg/kg, isoflurane, 1.6%, or halothane, 0.9%, along with pancuronium, 0.08 mg/kg, for induction and maintenance of anesthesia. Cardiovascular function was measured by echocardiography prior to induction, postinduction, and postintubation. Systemic arterial pressure and heart rate were also recorded. Left ventricular ejection fraction (LVEF) decreased following induction with each agent: sufentanil 9%, fentanyl 9%, isoflurane 4%, and halothane 8%. Following intubation LVEF increased in the sufentanil, fentanyl, and isoflurane groups, but LVEF remained 13% below baseline values in the halothane group. Five of the 12 patients in the halothane group had a LVEF less than 55%. Arterial pressure immediately prior to bypass was significantly less than baseline in each group; however, arterial pressure was higher in the narcotic groups during isolation and cannulation of the great vessels. It is concluded that halothane, 0.9%, used as an induction agent in infants and children undergoing cardiac surgery causes a clinically significant decrease in LVEF. Based on the echocardiographic data, sufentanil, fentanyl, and isoflurane as used in the present study do not have a clinically significant effect on cardiac function and may offer an advantage to infants and children with marginal cardiovascular reserve.

Cardiovascular changes in preterm neonates receiving isoflurane, halothane, fentanyl, and ketamine.

Hemodynamic changes during four anesthetic techniques were studied in 80 preterm neonates. Atropine, 0.02 mg/kg, and pancuronium, 0.1 mg/kg, were given intravenously to all patients, who were ventilated with oxygen and air. Each group of 20 patients then received 0.75% isoflurane, 0.5% halothane, 20 micrograms/kg fentanyl, or 2 mg/kg ketamine. Heart rate (HR), systolic blood pressure (SAP), and mean blood pressure (MAP) were recorded at 1-min intervals until surgical stimulation. HR remained at or above control level in all groups. Statistically significant decreases (P less than 0.01) in SAP and MAP occurred following administration of each anesthetic. SAP decreased 30% during isoflurane administration, 25% during halothane, 21% following fentanyl, and 16% following ketamine. Clinically important decreases (25% or greater) in SAP were observed in some patients in each group, but the incidence was significantly less in patients receiving ketamine (P less than 0.02). The covariables of conceptual age, postnatal age, weight, urine specific gravity, hematocrit, and presence of patent ductus arteriosus did not have statistically significant effects on SAP and MAP changes. The authors conclude that SAP and MAP decrease significantly during each of the anesthetic techniques studied and that clinically important decreases in SAP occur less frequently during the technique using ketamine.

Factors affecting leak around tracheal tubes in children.

This study determined which variables affected endotracheal tube "leak" pressures in 80 surgical patients, two weeks to 11 years of age, intubated with uncuffed tracheal tubes. We defined "leak" pressure as the inspiratory pressure needed to cause an audible escape of gas around the endotracheal tube. "Leak" pressure was measured after varying either head position, tracheal tube depth within the trachea, fresh gas flow rate, or degree of neuromuscular block. "Leak" pressure increased progressively from 16.9 +/- 1.3 cmH2O with complete patient paralysis to 30.6 +/- 1.4 cmH2O following 100 per cent recovery of neuromuscular function. Turning the head from a neutral position to one side increased "leak" pressure from 14.7 +/- 1.7 cmH2O to 24.4 +/- 2.5 cmH2O. Varying tracheal tube depth or fresh gas flow rate produced no significant change in "leak" pressure. Thus, there may be marked variability in "leak" pressure, depending on head position and degree of neuromuscular blockade. Keeping the patient fully paralyzed with the head in a neutral position provides a reliable and consistent method for measuring "leak" pressures.