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Introduction: A point-of-care testing (POCT) certificate was implemented in a required pharmacy skills-based course. The purpose of this study was to evaluate the impact of manikins on student confidence in performing POCT for infectious diseases. Innovation: Manikins were used to train second-year pharmacy students on nasal swabs, throat swabs, and oral fluid swabs. Student skills were assessed on manikins first, then on a peer. Proficiency was defined as a score of 90% or higher. Students completed a pre- and post-training survey regarding their confidence performing swabs. Student confidence was based on Likert style responses (i.e., ‘Strongly Disagree’ [score: 1], to ‘Strongly Agree’ [score: 5]) performing the swabs. Median change in confidence was calculated using quantile regression. Findings: All students (n=63) demonstrated proficiency in performing swabs. Median confidence for nasal, throat, and oral fluid swabs changed by 2.0 (95% CI: 1.5, 2.5), 2.0 (95% CI: 1.5, 2.5), and 2.0 (95%CI: 1.3, 2.7), respectively. The majority of students reported time spent practicing was adequate for the nasal (n=51, 81%), throat (n=51, 81%), and oral fluid swab (n=59, 94%). All participating students reported manikins to be moderately (n=17, 27%) or extremely (n=46, 73%) valuable, and all students rated their overall experience with manikins as positive (n=63, 100%). Student comments revealed manikins helped to visualize anatomy, practice skills without peer discomfort, and minimize risk during the COVID-19 pandemic. Conclusion: This study demonstrated that inclusion of practice on manikins increased student confidence in performing POCT for infectious diseases. In addition, the majority of students indicated that the use of manikins was valuable to their learning and reported feeling prepared to perform POCT in practice after using the manikins.

Objectives: Interproximal enamel reduction (IER), commonly known as stripping, is a frequently used technique in orthodontic treatment to address issues related to arch length discrepancies and tooth size discrepancies (TSD). The use of digital set-up allows for precise prediction of the amount of IER required. TSD occurs when the sizes of maxillary and mandibular teeth are not in proportion to each other. This study aims to evaluate and compare the suggested IER values generated by the digital set-up of a customized lingual orthodontic appliance in both upper and lower arches, across sextants, and among different teeth concerning TSD. Materials and methods: We analyzed suggested IER values from 809 cases. The statistical analysis was divided into two parts: part 1 focused on the number of stripped surfaces, and part 2 assessed the quantity of enamel removed. Comparisons were made between upper and lower arches, sextants, and teeth using the Friedman test, followed by pairwise Wilcoxon tests with Bonferroni correction. Results: The study found that mandibular and frontal stripping were more frequently suggested than maxillary and posterior stripping. Lower canines were the teeth most commonly recommended for stripping, followed by upper incisors. Conclusion: Within the scope and limits of this cohort study, we conclude that, in general, more IER is required in the mandible as compared to the maxilla. Particularly in the anterior sextants, IER might be necessary to achieve optimal alignment and occlusion.

Geologic, geomorphic, and climatic factors have been hypothesized to influence where streams dry, but hydrologists struggle to explain the temporal drivers of drying. Few hydrologists have isolated the role that vegetation plays in controlling the timing and location of stream drying in headwater streams. We present a distributed, fine-scale water balance through the seasonal recession and onset of stream drying by combining spatiotemporal observations and modeling of flow presence/absence, evapotranspiration, and groundwater inputs. Surface flow presence/absence was collected at fine spatial (~80 m) and temporal (15-min) scales at 25 locations in a headwater stream in southwestern Idaho, USA. Evapotranspiration losses were modeled at the same locations using the Simultaneous Heat and Water (SHAW) model. Groundwater inputs were estimated at four of the locations using a mixing model approach. In addition, we compared high-frequency, fine-resolution riparian normalized vegetation difference index (NDVI) with stream flow status. We found that the stream wetted and dried on a daily basis before seasonally drying, and daily drying occurred when evapotranspiration outputs exceeded groundwater inputs, typically during the hours of peak evapotranspiration. Riparian NDVI decreased when the stream dried, with a ~2-week lag between stream drying and response. Stream diel drying cycles reflect the groundwater and evapotranspiration balance, and riparian NDVI may improve stream drying predictions for groundwater-supported headwater streams.

Abstract Enamel demineralisation can develop on smooth surfaces as an undesirable side effect during orthodontic treatment with fixed appliances. This study aimed to evaluate the ability of 38% silver diamine fluoride in remineralisation (as estimated by fluorescence gain) of artificial initial lesions in smooth surfaces of human enamel. The smooth surfaces of 50 human tooth samples were artificially demineralised and 45 samples were allocated randomly into three groups receiving a single treatment with a varnish: group I: Riva Star (silver diamine fluoride, SDF), group II: Bifluorid 12 (NaF, CaF2), and group III: Cervitec F (CHX, CPC, NH4F). Five samples were assigned as a negative control group without treatment. All samples were exposed to pH-cycling for 28 days. Fluorescence behavior was measured using Quantitative light-induced fluorescence before and after demineralisation and up to four weeks on a weekly basis. Analysis of variance (ANOVA) with Tukey–Kramer post-hoc tests and repeated measures ANOVA were used for statistical evaluation (α = 0.05). After demineralisation, all samples showed mean ΔF of − 16.22% ± 4.35, without significance differences between the fluorescence behaviour of the samples (p = 0.251). After 28 days group comparison showed a statistically significant difference (p = 0.034) for ΔF values: the lowest fluorescence values were found in group I (SDF, mean ΔF − 16.47 ± 6.08) with a significant difference compared to group III (Cervitec F, mean ΔF − 11.71 ± 4.83). In group II (Bifluorid 12) mean ΔF value was − 15.55 ± 2.15) without statistically significant differences to groups I and III. The fluorescence behaviour of SDF varnish on smooth surfaces with artificial initial enamel lesions was significantly lower compared to Cervitec F varnish after short time use.

Background: Consumption of acidic beverages favours development of erosions. Modern diagnostic methods are required to detect erosions at an early stage. This study aimed to evaluate the suitability of an intraoral scanner (IOS) for detection of erosive changes on smooth surfaces adjacent to orthodontic brackets. Methods: Orthodontic metal brackets were attached to the buccal surfaces of 58 extracted permanent human teeth. Teeth were randomly divided into groups: A = 6% citric acid, B = Coca-Cola, C = Redbull, D = Powerade, E = Control, no acid exposure. Teeth were exposed to acid in three erosion cycles, followed by rinsing and brushing. Scans of teeth were performed at baseline and after each erosion cycle and enamel loss was measured. Quantitative light-induced fluorescence (QLF) measurements were performed as reference standard. Results: Significant substance loss was measured in all acid groups after the second and third erosion cycle (p < 0.0001). Correlation between scans and QLF were significant (p = 0.001). Conclusions: With IOS, it was possible to detect and quantify enamel erosion at smooth surfaces with and without orthodontic brackets after a short exposure time. Considering the limitations of in vitro results, the use of IOS can be a promising digital tool to detect and monitor erosive enamel changes during fixed orthodontic treatment.

Abstract Olfactory cues play an important role in mammalian biology, but have been challenging to assess in the field. Current methods pose problematic issues with sample storage and transportation, limiting our ability to connect chemical variation in scents with relevant ecological and behavioral contexts. Real‐time, in‐field analysis via portable gas chromatography–mass spectrometry (GC‐MS) has the potential to overcome these issues, but with trade‐offs of reduced sensitivity and compound mass range. We field‐tested the ability of portable GC‐MS to support two representative applications of chemical ecology research with a wild arboreal primate, common marmoset monkeys (Callithrix jacchus). We developed methods to (a) evaluate the chemical composition of marmoset scent marks deposited at feeding sites and (b) characterize the scent profiles of exudates eaten by marmosets. We successfully collected marmoset scent marks across several canopy heights, with the portable GC‐MS detecting known components of marmoset glandular secretions and differentiating these from in‐field controls. Likewise, variation in the chemical profile of scent marks demonstrated a significant correlation with marmoset feeding behavior, indicating these scents’ biological relevance. The portable GC‐MS also delineated species‐specific olfactory signatures of exudates fed on by marmosets. Despite the trade‐offs, portable GC‐MS represents a viable option for characterizing olfactory compounds used by wild mammals, yielding biologically relevant data. While the decision to adopt portable GC‐MS will likely depend on site‐ and project‐specific needs, our ability to conduct two example applications under relatively challenging field conditions bodes well for the versatility of in‐field GC‐MS.

Children’s treatment means a triangular relationship between the child, practitioner, and parent, with specific interactions influencing the procedure. The objective was to create and validate a hetero-rating scale of parental behavior and verify the correlation between child and parental behavior during pediatric dentistry sessions. Treatment sessions were recorded and evaluated, including 60 children representing three age groups. Two raters interpreted the resulting video clips using the modified Venham scale for children and the new hetero-rating scale for parents. They analyzed the videos twice and attributed scores at different time points of the appointment. The correlation between parental behavior upon entrance and the children’s behavioral at the dental office in the treatment stage was significantly positive in both raters (Kendall Tau: 0.20–0.30). Furthermore, a panel of 20 dental practitioners scored a randomized selection of five recordings per age group. The level of agreement between the two experts was higher than that between the 20 clinicians. Venham types of scale involving multiple aspects can be used in research, but their application in dental practice requires further development. The link between parental anxiety and child anxiety is confirmed, but further research is required to incorporate specific aspects of treatment and parental behavior.

Background Pseudomyxoma peritonei (PMP) is a rare disease, most commonly of appendiceal origin. Treatment consists of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS–HIPEC). The aim of this study was to identify prognostic factors for recurrence and survival. Methods This was an observational study using a prospectively designed database containing consecutive patients with PMP originating from the appendix, undergoing CRS–HIPEC at a tertiary referral centre between 1996 and 2015. Histopathological slides were reassessed. Cox regression was used for multivariable analyses. Results Of 225 patients identified, 36 (16·0 per cent) were diagnosed with acellular mucin, 149 (66·2 per cent) had disseminated peritoneal adenomucinosis (DPAM) and 40 (17·8 per cent) had peritoneal mucinous carcinomatosis (PMCA). The 5‐year overall survival (OS) rates were 93, 69·8 and 55 per cent respectively. Recurrence was observed in 120 patients (53·3 per cent), 39 of whom (17·3 per cent) were treated with a second CRS–HIPEC procedure. Factors independently associated with poor disease‐free survival were six or seven affected regions (hazard ratio (HR) 6·01, 95 per cent c.i. 2·04 to 17·73), incomplete cytoreduction (R2a resection: HR 1·67, 1·05 to 2·65; R2b resection: HR 2·00, 1·07 to 3·73), and more than threefold raised carcinoembryonic antigen (CEA) and/or carbohydrate antigen (CA) 19‐9 level (HR 2·31, 1·30 to 4·11). Factors independently associated with poorer OS were male sex (HR 1·74, 1·09 to 2·77), incomplete cytoreduction (R2a resection: HR 1·87, 1·14 to 3·08; R2b resection: HR 2·28, 1·19 to 4·34), and more than threefold raised CEA and/or CA19‐9 level (HR 2·89, 1·36 to 6·16). Conclusion CEA and CA19‐9 levels raised more than threefold above the upper limit identify patients with PMP of appendiceal origin and poorer survival.

There is a growing international interest in developing soft wearable robotic devices to improve mobility and daily life autonomy as well as for rehabilitation purposes. Usability, comfort and acceptance of such devices will affect their uptakes in mainstream daily life. The XoSoft EU project developed a modular soft lower-limb exoskeleton to assist people with low mobility impairments. This paper presents the bio-inspired design of a soft, modular exoskeleton for lower limb assistance based on pneumatic quasi-passive actuation. The design of a modular reconfigurable prototype and its performance are presented. This actuation centers on an active mechanical element to modulate the assistance generated by a traditional passive component, in this case an elastic belt. This study assesses the feasibility of this type of assistive device by evaluating the energetic outcomes on a healthy subject during a walking task. Human-exoskeleton interaction in relation to task-based biological power assistance and kinematics variations of the gait are evaluated. The resultant assistance, in terms of overall power ratio (Λ) between the exoskeleton and the assisted joint, was 26.6% for hip actuation, 9.3% for the knee and 12.6% for the ankle. The released maximum power supplied on each articulation, was 113.6% for the hip, 93.2% for the knee, and 150.8% for the ankle.

Background: Postoperative Delirium (POD) is the most common complication of elderly patients after surgery associated with increased postoperative morbidity, persistent care dependency and even mortality. Prevention of POD requires detection of patients at high risk prior to surgery. PROPDESC intends to provide an instrument for preoperative routine screening of patients' risk for POD. Methods: PROPDESC is a monocentric prospective observatory trial including 1000 patients older than 60 years from various disciplines of a university hospital planned for surgery of at least 60 min. To develop a score predicting the risk for POD, anesthesiological stratifications, laboratory values, medication and known risk factors as well as quality of life and cognitive performance are taken into account. POD assessment is performed daily on the first five days after the operation respectively the end of sedation in the intensive care units and normal wards. The score is evaluated from 600 data sets and subsequently validated internally. The most appropriate predictors are determined by a component-wise gradient boosting approach. Discussion: Based on retrospective investigations, etiology of POD is considered multifactorial. By a prospective analysis of various factors, PROPDESC intends to provide an applicable tool to predict the risk for POD from preoperative routine data and assessment of cognitive function. Objective is to establish an automatically generating score in preoperative routine to screen patients for increased risk of POD as starting point for POD reduction and management. Model compilation requires a high significance and enhancement within compound as well as regular availability of the selected predictors. Trial registration: DRKS, DRKS00015715. Registered 13 December 2018 - Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015715. Keywords: Postoperative delirium, Risk prediction, Risk score

Background: The establishment of the dental dam improves dentist working conditions and patient protection. The purpose of this study was to analyze the behavior of the child during dental care with or without a dam. Methods: In this interventional randomized study, 51 patients are divided into two groups, one with a rubber dam and the other with cotton roll isolation. Their behavior was observed during the treatment of temporary molars. The duration of the treatment, the patient’s feeling with a visual analogue scale (VAS), the behavior (B) of the child measured with a hetero-evaluation scale (modified Venham scale) and the cardiac frequency (CF) were measured. Results: The group treated with a rubber dam has a significant decrease in the various stress parameters that have been identified (B, p value = 0.034; CF, p value = 0.015). Subgroups of patients with and without nitrous oxide sedation were compared and similar results were obtained. Conclusions: Isolation with a rubber dam reduces child’s stress during dental care. Although it is slightly more time-consuming and training is necessary for a quick and effective placement, it allows dentists to perform dental care in the best possible conditions, while reducing dental anxiety in young patients.

Abstract Histological sectioning is a generally accepted in vitro validation method for caries detection techniques. However, it requires cumbersome sample preparation and induces irreversible sample destruction. Micro-Computer Tomography (micro-CT) allows non-destructive imaging of tooth structure. The aim of this study was to compare the performance of histological sectioning and micro-CT imaging in detecting approximal carious lesions. Unlike previous studies, evaluation is objectified by comparing visual appearance of exactly corresponding anatomical regions. Sixty extracted human teeth were scanned with a desktop micro CT system. Axial histological slices were prepared and photographed. Sample preparation, combined with dedicated image processing, ensured selection of identical anatomical regions on radiographic and histological images. Evaluation of the presence and extent of carious lesions was performed by four dentists using custom-designed software. Each section was scored independently (histo or micro CT). Scores of approximal surfaces were retained for further analysis. Spearman’s correlation coefficients (0.738 to 0.829, p

Actions expressing strong emotions such as anger can be appropriate responses when an agent judges a serious injustice to have been committed. Certainly, a woman can experience these conditions and express herself through actions such as gesturing aggressively, gritting her teeth, or lashing out verbally. If she is consequently labeled “crazy,” “hysterical,” or “a bitch,” what has gone awry? This paper offers an analysis of the common charge of inappropriateness in the case of women’s actions expressing emotion. To begin, I will present core normative distinctions that define appropriate emotional expression. Following this, the “double-bind” of women’s actions expressing emotion will be explored with reference to the conflicting normative practices outlined in the first section of the paper. Put briefly, when a female agent surpasses gendered behavioral expectations, she is seen as having failed what can be called the first test of social coping. The perception of this failure shuts down further avenues for interpreting her behavior. Instead, the social inappropriateness of her emotion is used as further proof of irrationality. The arguments of the second section leave no doubt that gendered norms in the case of actions expressing emotions must be rejected both on epistemological and moral grounds. The final section of the paper explores epistemically and ethically viable alternatives for deciding the rational appropriateness of actions expressing emotion.