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The COVID‐19 pandemic has had an immense and worldwide impact. In light of future pandemics or subsequent waves of COVID‐19 it is crucial to focus on the ethical issues that were and still are raised in this COVID‐19 crisis. In this paper, we look at issues that are raised in the testing and tracing of patients with COVID‐19. We do this by highlighting and expanding on an approach suggested by Fineberg that could serve as a public health approach. In this way, we highlight several ethical issues. As regards testing, questions are raised such as whether it is ethical to use less reliable tests in order to increase testing capacity or minimize harm for patients. Another issue is how wide testing should be and whether selective testing is in accordance with principles of social justice. Patients who have recovered from COVID‐19 might have some degree of immunity but attributing certain 'immunopriviliges' raises ethical questions. The use of various tracing methodologies (mobile apps or databases and trained tracers) raised evident questions of social justice and privacy. We argue why it is key to always uphold a test of proportionality where a fair balance must be sought. [ABSTRACT FROM AUTHOR]

Abstract Background The wide range of fresh gas flow - vaporizer setting (FGF - FD) combinations used by different anesthesiologists during the wash-in period of inhaled anesthetics indicates that the selection of FGF and FD is based on habit and personal experience. An empirical model could rationalize FGF - FD selection during wash-in. Methods During model derivation, 50 ASA PS I-II patients received desflurane in O2 with an ADU® anesthesia machine with a random combination of a fixed FGF - FD setting. The resulting course of the end-expired desflurane concentration (FA) was modeled with Excel Solver, with patient age, height, and weight as covariates; NONMEM was used to check for parsimony. The resulting equation was solved for FD, and prospectively tested by having the formula calculate FD to be used by the anesthesiologist after randomly selecting a FGF, a target FA (FAt), and a specified time interval (1 - 5 min) after turning on the vaporizer after which FAt had to be reached. The following targets were tested: desflurane FAt 3.5% after 3.5 min (n = 40), 5% after 5 min (n = 37), and 6% after 4.5 min (n = 37). Results Solving the equation derived during model development for FD yields FD=-(e(-FGF*-0.23+FGF*0.24)*(e(FGF*-0.23)*FAt*Ht*0.1-e(FGF*-0.23)*FGF*2.55+40.46-e(FGF*-0.23)*40.46+e(FGF*-0.23+Time/-4.08)*40.46-e(Time/-4.08)*40.46))/((-1+e(FGF*0.24))*(-1+e(Time/-4.08))*39.29). Only height (Ht) could be withheld as a significant covariate. Median performance error and median absolute performance error were -2.9 and 7.0% in the 3.5% after 3.5 min group, -3.4 and 11.4% in the 5% after 5 min group, and -16.2 and 16.2% in the 6% after 4.5 min groups, respectively. Conclusions An empirical model can be used to predict the FGF - FD combinations that attain a target end-expired anesthetic agent concentration with clinically acceptable accuracy within the first 5 min of the start of administration. The sequences are easily calculated in an Excel file and simple to use (one fixed FGF - FD setting), and will minimize agent consumption and reduce pollution by allowing to determine the lowest possible FGF that can be used. Different anesthesia machines will likely have different equations for different agents.

Objective: To evaluate the water-sorption characteristics and the solubility behavior of 4 luting cements-2 composite resins (CRs), a polyacid-modified composite resin (PMCR), and a resin-modified glass-ionomer cement (RMGIC)-according to the ISO 4049 specifications. Method and Materials: Five disks (15 x 1 mm) of each material (Variolink II [CR1; Vivadent], Panavia F [CR2; Kuraray], Resinomer [PMCR; Bisco], and Fuji Plus [RMGIC; GC]) were prepared according to the manufacturers' instructions. Specimens were first desiccated until a consistent mass was obtained. Specimens were immersed for 7 days in distilled water and immediately weighed after this period. Then the disks were post-desiccated and weighed every day for 35 days. The water sorption and solubility of each specimen were calculated according to the change in its weight as observed before and after immersion and desiccation periods. Results: Fuji Plus exhibited the overall higher values of water sorption and solubility (P < .001). Of the 3 resin-based luting cements, Resinomer demonstrated significantly higher water sorption and solubility (P < .001), whereas Variolink II and Panavia F showed low values and were not significantly different (P = .2). Conclusions: Behavior of resin-based materials in water varies according to the composition characteristics. In particular, the high portion of hydrophilic chemical species, as well as the filler characteristics, provoke very high water sorption and solubility values. In this way, and within the limitations of this in vitro study, composite resin luting cements appear to be more suitable than compomers and resin-modified glass-ionomer cements to meet longevity requirements. [ABSTRACT FROM AUTHOR]

Much is changing in health care organization today. A perspective or paradigm that is gaining ever increasing momentum is that of translational, extramural and integrated care. Current research suggests many potential benefits for integrated care and health care networks but the ethical issues are less frequently emphasized. Showing that integrated care can be beneficial, does not mean it is automatically ethically justified. We will argue for three ethical requirements such health care networks should meet. Subsequently we will look at the mechanisms driving the formation of networks and examine how these can cause networks to meet or fail to meet these ethical requirements or obligations. The three mechanisms we will examine are government, civil society and market mechanisms, which, we argue, should be balanced properly. Each mechanism is able to provide a relevant ethical perspective to health care networks. However, when the balance is skewed towards a single mechanism, health care networks might fail to promote one or more of the ethical requirements. [ABSTRACT FROM AUTHOR]

Background: Multiple studies have investigated the outcome of integrated care programs for chronically ill patients. However, few studies have addressed the specific role hospitals can play in the downstream collaboration for chronic disease management. Our objective here is to provide a comprehensive overview of the role of the hospitals by synthesizing the advantages and disadvantages of hospital interference in the chronic discourse for chronically ill patients found in published empirical studies.Method: Systematic literature review. Two reviewers independently investigated relevant studies using a standardized search strategy.Results: Thirty-two articles were included in the systematic review. Overall, the quality of the included studies is high. Four important themes were identified: the impact of transitional care interventions initiated from the hospital's side, the role of specialized care settings, the comparison of inpatient and outpatient care, and the effect of chronic care coordination on the experience of patients.Conclusion: Our results show that hospitals can play an important role in transitional care interventions and the coordination of chronic care with better outcomes for the patients by taking a leading role in integrated care programs. Above that, the patient experiences are positively influenced by the coordinating role of a specialist. Specialized care settings, as components of the hospital, facilitate the coordination of the care processes. In the future, specialized care centers and primary care could play a more extensive role in care for chronic patients by collaborating. [ABSTRACT FROM AUTHOR]

Purpose: To assess the influence of applicator tip diameter on the inclusion of porosities in three different flowable resin composites. Methods: The initial porosity of three syringes [Filtek Supreme XTE Flowable (XTE), Grandio Flow (GRF), Gradia Direct Flo (GDF)] was determined by 3D tomography. 25 samples per syringe, i.e. 75 samples in total, were prepared using five applicator tips of different diameters (n= 5). The porosity of the 75 samples was assessed by 3D tomography. Results: For each of the materials, the applicator tips, irrespective of type, all generated an increase in the average porosity percentage compared to the initial porosity of the syringes. For XTE and GRF, the applicator tips, irrespective of type, all generated a decrease in the average porosity volume compared to the initial average porosity volume in their respective syringes. Conversely, for GDF the average porosity volume of the samples was increased. Furthermore, for each of the materials, varying the diameter of the applicator tips had no significant influence on the porosity percentage and volume. Using the present study conditions, the applicator tip generated a variation in the initial porosity of the materials; however, the diameter of the tip had no influence on said variation. [ABSTRACT FROM AUTHOR]

Amelogenesis imperfecta (AI) is a hereditary disorder caused by mutations of genes primarily involved in the enamel formation. Several different types of AI have been identified, based on the phenotype and on the mode of inheritance. Regardless of the type, the dental treatment tends to be the same, favoring the complete removal of the compromised enamel late in the patient's life. With the new dentistry guidelines that orient clinicians towards minimal invasiveness, it should be mandatory to intercept patients affected by AI earlier, not only to protect the dentition from further degradation but also to help patients improve their self-esteem. This article examines the restorative dentistry performed on a 24-year-old Caucasian female suffering from the hypoplastic type of AI, using only adhesive procedures. Due to the complex needs of the patient, an interdisciplinary approach was followed, involving orthodontics, periodontics, and restorative dentistry. A full-mouth adhesive rehabilitation was achieved by means of direct composite restorations, veneer/onlays and facial/palatal veneers. No elective endodontic therapy was necessary for restorative purposes. The esthetics, mechanics, and biological success were achieved and maintained. The bond to the enamel did not show signs of degradation (eg, discoloration or infiltration) even after 5 years of function. This is encouraging as it shows that adhesive techniques may be a reliable approach even in the presence of a compromised enamel layer. [ABSTRACT FROM AUTHOR]

Background: The wide range of fresh gas flow - vaporizer setting (FGF - FD) combinations used by different anesthesiologists during the wash-in period of inhaled anesthetics indicates that the selection of FGF and FD is based on habit and personal experience. An empirical model could rationalize FGF - FD selection during wash-in. Methods: During model derivation, 50 ASA PS I-II patients received desflurane in O2 with an ADU® anesthesia machine with a random combination of a fixed FGF - FD setting. The resulting course of the end-expired desflurane concentration (FA) was modeled with Excel Solver, with patient age, height, and weight as covariates; NONMEM was used to check for parsimony. The resulting equation was solved for FD, and prospectively tested by having the formula calculate FD to be used by the anesthesiologist after randomly selecting a FGF, a target FA (FAt), and a specified time interval (1 - 5 min) after turning on the vaporizer after which FAtt had to be reached. The following targets were tested: desflurane FAt 3.5% after 3.5 min (n = 40), 5% after 5 min (n = 37), and 6% after 4.5 min (n = 37). Results: Solving the equation derived during model development for FD yields FD=-(e(-FGF*-0.23+FGF*0.24)*(e(FGF*-0.23) *FAt*Ht*0.1-e(FGF*-0.23)*FGF*2.55+40.46-e(FGF*-0.23)*40.46+e(FGF*-0.23+Time/-4.08)* 40.46-e(Time/-4.08)*40.46))/((-1+e(FGF*0.24))*(-1 +e(Time/-4.08))*39.29). Only height (Ht) could be withheld as a significant covariate. Median performance error and median absolute performance error were -2.9 and 7.0% in the 3.5% after 3.5 min group, -3.4 and 11.4% in the 5% after 5 min group, and -16.2 and 16.2% in the 6% after 4.5 min groups, respectively. Conclusions: An empirical model can be used to predict the FGF - FD combinations that attain a target endexpired anesthetic agent concentration with clinically acceptable accuracy within the first 5 min of the start of administration. The sequences are easily calculated in an Excel file and simple to use (one fixed FGF - FD setting), and will minimize agent consumption and reduce pollution by allowing to determine the lowest possible FGF that can be used. Different anesthesia machines will likely have different equations for different agents. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the influence of photopolymerization mode with a light emitting diode (LED) lamp on the curing contraction kinetics and degree of conversion of 3 resin-based restorative materials. Methods: The curing contraction kinetics ofAdmira (ADM), Filtek P60 (P60), and Filtek Flow (FLO) were measured by the glass slide method. The materials were exposed to light from a 1,000 mW/cm-2 power LED lamp (Elipar Freelight 2) in 3 modes: 2 continuous modes of 20 and 40 seconds (C20 and C40), and 1 exponential mode (E20; 5 seconds of exponential power increase followed by 15 seconds of maximum intensity). The degree of conversion (DC) was measured for each of the materials, and each of the modes by Fourier transformed infra-red spectrometry. Results: P60 had the significantly lowest final contraction and FLO the highest among all light exposure modes. The C20 and C40 modes did not produce any difference in contraction or degree of conversion. The E20 mode led to a significant slowing of contraction speed combined with greater final contraction. Conclusions: Use of a LED lamp (1,000 mW/cm2) in continuous mode reduces the exposure time by half for identical curing shrinkage and degree of conversion. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this in vitro study was to evaluate the polymerization shrinkage and the microleakage of direct resin-based restorative materials commonly used in pediatric dentistry. Methods: Standardized Class V cavities overlapping the cementoenamel junction were prepared on the buccal and the lingual surfaces of 40 extracted human mandibular third molars (36 specimens, 4 controls). The cavities were restored with 4 different materials: a packable resin composite (Filtek P60), a compomer (Compoglass F), an ormocer (Admira) and their associated bonding agents (Scotchbond 1, Excite, and Admira Bond, respectively), and a resin-modified glass ionomer (Fuji II LC). The teeth were then immersed in methylene blue solution for 48 hours. Dye penetration was evaluated for all materials, which were analyzed using a multivariate model (a=0.05): influence of microleakage score, margin location (enamel/cementum), and preparation location (buccal/lingual). Multivariate analysis was performed using a polychotomous logistic regression. Polymerization shrinkage was evaluated by the disk deflective method. The percentage of polymerization shrinkage (N=3) was evaluated by ANOVA and Tukey test. Results: Regarding polymerization shrinkage, the P60 demonstrated the lowest value, followed by ADM and COF, whereas FLC presented the highest shrinkage-strain (P<.0001). The preparation location had no significant effect on dye penetration (P=.86). Margin location (enamel or cementum) had a significant effect on microleakage (odds ratio [OR]=24.61). Significant differences in the microleakage patterns and scores were also observed between the 4 restorative materials. Admira exhibited the lowest overall microleakage. In comparing Filtek P60, Compoglass F, and Fuji II LC to Admira, P60 showed significantly less microleakage (OR=1.30) than Fuji II LC (OR=1.47), whereas Compoglass F demonstrated the greatest significant overall microleakage (OR=3.15). Conclusion: Within the experimental conditions of this in vitro study, the microleakage was significantly lower at the enamel margins than at the cementum margins for the four restorative materials tested. The ormocer and the packable resin composite exhibited the best sealing ability, as well as the lowest polymerization shrinkage. It could not be demonstrated in this study, however, that the higher the polymerization shrinkage was, the lower the marginal sealing ability was. [ABSTRACT FROM AUTHOR]

Arterial tonometry is a non-invasive technique for continuous registration of arterial pressure waveforms. This study aims to assess tonometric blood pressure recording (TBP) as an alternative for invasive long-term bedside monitoring. A prospective study was set up where patients undergoing neurosurgical intervention were subjected to both invasive (IBP) and non-invasive (TBP) blood pressure monitoring during the entire procedure. A single-element tonometric pressure transducer was used to better investigate different inherent error sources of TBP measurement. A total of 5.7 hours of combined IBP and TBP were recorded from three patients. Although TBP performed fairly well as an alternative for IBP in steady state scenarios and some short-term variations, it could not detect relevant long-term pressure variations at all times. These findings are discussed in comparison to existing work. Physiological alterations at the site of TBP measurement are highlighted as a potentially important source of artifacts. It is concluded that at this point arterial tonometry remains not enough understood for long-term use during a delicate operative procedure. Physiological changes at the TBP measurement site deserve further investigation before tonometry technology is to be considered as an non-invasive alternative for long-term clinical monitoring. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the water sorption characteristics and solubility behavior of two resin-based composites, an ormocer, a compomer and a resin-modified glass-ionomer, according to ISO 4049 specifications and also without the initial desiccation cycle. Methods: After polymerization, five disks (15 x 1 mm) of each material [Filtek P60 (P60), Solitaire 2 (SOL2), Admira (ADM), Compoglass F (COF) and Fuji II LC (FLC)] were desiccated until a constant mass (m1) was obtained. They were immersed in distilled water for 7 days and immediately weighed after that period (mass m2). Then disks were again desiccated and weighed every day for 35 days (mass m3). Sorption and solubility values were deduced from these different measures. Without initial desiccation mass m1 was obtained just after polymerization. Results: Without initial desiccation, all the materials absorbed less water and solubility was 1.5 to 8 times greater than in standard experiment. For the two protocols, water sorption and solubility were significantly greater in FLC, and ADM showed the least weight loss of all the materials tested. [ABSTRACT FROM AUTHOR]

Statement of problem: Microleakage around dental restorations is implicated in the occurrence of secondary carious lesions, adverse pulpal response, and reduced restoration longevity. Purpose: The aim of this in vitro study was to evaluate the microleakage of indirect resin composite inlays cemented with 4 luting agents. Material and methods: Standardized Class V inlay preparations overlapping the cemento-enamel junction were prepared on the buccal and lingual surfaces of 40 extracted human mandibular third molars. Eighty postpolymerized, heat-treated resin composite inlays (Targis, 72 specimens, 8 controls) were processed in stone replicas and cemented into the preparations using 4 luting agents (n=18+2 controls for each cement group): a resin composite used with a bonding agent (Variolink II/Excite), a resin composite used with a self-etching primer, but without bonding agent (Panavia F/ED Primer), a modified resin composite used with a bonding agent (Resinomer/One Step), and a resin-modified glass-ionomer cement (Fuji Plus). Thirty-six inlays (n=9+1 control) were subjected to thermal cycling (2000 cycles, 5°C/55°C), whereas the other 36 were not. All the teeth were then immersed in 1% methylene blue dye solution for 48 hours. Microleakage score, margin location (enamel/cementum), thermal cycling history, and preparation location (buccal/lingual) were analyzed using a multivariate model (α=.05). Multivariate analysis was performed using a polychotomous logistic regression. Results: The preparation location had no significant effect on dye penetration. The margin location (enamel or cementum) and the thermal cycling had a significant effect on microleakage (odds ratios [ORs]=17.6 and 8.04, respectively). In comparing the 3 resin-based luting agents (Variolink II, Panavia F, and Resinomer) to Fuji Plus, Panavia F exhibited the lowest significant overall microleakage (OR=0.09), followed by Variolink II (significant OR equal to 0.43), whereas Resinomer demonstrated the greatest significant overall microleakage (OR=1.35). Conclusion: Within the experimental conditions of this in vitro study, thermal cycling significantly increased microleakage (OR=8.04). The overall microleakage at the enamel margins was significantly lower than the overall microleakage at the cementum margins for the 4 luting agents tested (OR=17.6). [Copyright &y& Elsevier]

The chronic fatigue syndrome affecting a large patient population with different symptoms such as sleeplessness, tiredness and pain is examined in our center. Patients can be selected using different criteria, Fukuda's criteria being the most recommended nowadays and Holmes's criteria the earlier more restricted criteria. We evaluated in 40 patients(32 women, 8 men; mean age 43.0±7.8 years, mean±SD fulfilling Fukuda's criteria for tender points' pain pressure sensitivity and infrared thermography emission. By considering Holmes' (H) criteria for the chronic fatigue syndrome and fibromyalgia (F) criteria, we subdivided the population into 4 subgroups: (F+ H+, F+ H-, F- H+, F- H-). Fibromyalgia patients not fulfilling Holmes' criteria (F+ H-) were statistically different for pain pressure threshold (p = 0.03) from the other patients. Moreover, this first group showed a normal infrared thermographic emission considering pain, where the other patients showed a rather abnormal vasomotor reaction. [ABSTRACT FROM AUTHOR]

Study objective: To evaluate whether the use of remifentanil to supplement propofol during spontaneous respiration confers any benefits in terms of quality of sedation and recovery, or in terms of reduction in propofol requirements.Design: Prospective, randomized, double-blind study.Setting: University hospital.Patients: 50 ambulatory adult ASA physical status I and II patients scheduled for total colonoscopy.Interventions: Patients were randomized to receive either propofol alone or propofol plus remifentanil 0.1 μg/kg/min, while independently maintaining spontaneous respiration.Measurements: Cardiovascular and respiratory variables were measured before induction and at 1-minute intervals thereafter. Recovery from anesthesia was assessed using simple verbal commands and the Steward Post Recovery Score. Patient satisfaction was measured with a visual analog scale. Computer simulation was used to calculate the effect-site concentrations of propofol and remifentanil.Main results: The depressant effects on blood pressure and respiratory function were significantly higher when propofol and remifentanil were combined. Although the addition of remifentanil resulted in a decrease of propofol usage, recovery of anesthesia was faster and patient satisfaction was higher when using propofol alone.Conclusions: The addition of remifentanil to propofol during spontaneous ventilation offered no benefits compared with the use of propofol alone. [Copyright &y& Elsevier]