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Recorded incidences of work-related illness and injury within the manufacturing sector remain significantly high, therefore, an awareness of the aetiology of accidents remains integral to any realistic prospect of safety improvement interventions within this complex industry. The epistemological stance adopted in safety behaviour development in research design and execution has largely focused on empirical outcome-based studies. Using personalised individual diaries to record real time data of safety-related events, including social cognitive contextual details, this study, for the first time qualitatively explores employee recorded incidents, permitting the identification of perceived latent conditions belying cognitive errors. The study revealed the most frequently occurring incident types were unsafe acts (38%) followed by unsafe conditions (28%), with a greater proportion of near misses (N = 46) in comparison to actual accidents (N = 13). Also apparent were inconsistencies in formal and informal reporting processes. Skill based errors were the most prevalent recorded human error type associated with distraction, alongside incompatible work environments. Violations were evident, to a lesser degree of recordable incidents. Across all human error types, qualitative accounts of safety climate concepts including leader violations and quality of leadership were described. The study thus made possible the capture of day-to-day safety behaviours and conditions, illuminating new perspectives on meaningful issues at both individual and systems levels. Adopting a systematically tailored approach to the exploration of suboptimal safety behaviour aetiology, there is a greater likelihood of knowledge acquisition of incidents or symptoms at an organisational level, which are then equipped to reflexively respond with a tailored address of these issues ‘in situ’.

Background Childhood obesity is an urgent global concern with a complex multifactorial aetiology. Infant feeding behaviours are a potential target for childhood obesity prevention. However, evidence for the effectiveness of interventions to improve infant feeding behaviours is inconsistent, and knowledge of how interventions have been implemented, what aspects work, and why, is lacking. This review aimed to synthesise qualitative evidence about parents' and health-care professionals' views and experiences of infant feeding interventions, and identify factors influencing intervention implementation. Methods A systematic review and synthesis of qualitative evidence was conducted. CINAHL, Medline, PsycINFO, Embase, and SCOPUS were searched from database inception to Sept 25, 2017, for English-language qualitative studies reporting the implementation of infant feeding interventions from the perspectives of health-care workers, parents, or both. 4794 studies were screened using a-priori inclusion and exclusion criteria. Two reviewers independently extracted data and judged quality. A framework synthesis was conducted and GRADE-CERQual was used to assess confidence in findings. This review is registered with PROSPERO, number CRD42016039652. Findings Of 4794 screened studies, 13 UK, US, and Australian-based studies were included. Supportive relationships and environments were integral to the successful implementation of infant feeding interventions for both health-care professionals and parents. Issues with capacity (ie, time and resources) negatively influenced implementation by health-care professionals; for parents, a focus on practical elements and sustainability beyond the intervention was crucial to ensure success. Interpretation This review provides valuable information to enable informed and robust decisions about future infant feeding interventions and policy development, ensuring that these decisions are guided by stakeholder experiences and are cognisant of previous implementation challenges or successes. Methodologically, this study provides an innovative example of using qualitative evidence synthesis to explore factors influencing intervention implementation and engagement from both provider and participant perspectives. This review provides deeper insight into potential interactions between provider and participant experiences, and a comprehensive holistic overview of factors that are important to consider for future infant feeding interventions. Funding Health Research Board Interdisciplinary Capacity Enhancement Award 2015-1026.

Background Modifiable parental feeding behaviours are implicated in the development of childhood obesity. A lack of outcome standardisation across trials of infant feeding interventions limits examination of intervention effects and mechanisms of change. Core outcome sets (COS) are an agreed-upon minimum set of outcomes that should be measured in trials of a specific health condition. The aim of this research was to develop an infant feeding core outcome set to be evaluated in trials of infant feeding interventions to prevent childhood obesity. Methods Development of the infant feeding COS was conducted in four stages. First, a systematic review identifying all infant feeding outcomes in the extant literature was done. The databases Embase, Medline, CINAHL, CENTRAL, and PsycINFO, were searched for English-language papers, from database inception to Feb 1, 2017, using search terms related to infants (eg, infant), early feeding (eg, complementary feeding), and study design (eg, randomised controlled trial, cohort). Second, a small-group expert stakeholder meeting was held to clarify and discuss identified outcomes. Third was an international e-Delphi outcome prioritisation survey. Fourth, a consensus meeting of expert stakeholders was held. Expert stakeholders included researchers, health-care professionals, parents, and child-care professionals. Findings The systematic review identified 82 infant feeding outcomes. Outcomes were discussed and clarified with 13 stakeholders at the small-group meeting. The e-Delphi study was completed by 79 international stakeholders who rated outcomes for importance of inclusion in the COS. Seven expert stakeholders participated in the consensus meeting. 26 of the identified outcomes from the following nine domains were identified as crucial for inclusion in the COS: breast and formula feeding, introduction of solids, parent feeding practices and styles, parent knowledge and beliefs, practical feeding, food environment, dietary intake, perceptions of infant behaviour and preferences, and child weight outcomes. Interpretation The developed COS is the minimum that should be measured and reported in trials of infant feeding interventions to prevent childhood obesity. Use of this COS will facilitate better synthesis and understanding of intervention effects and is essential to inform development and evaluation of future infant feeding interventions to prevent childhood obesity. Funding Health Research Board Interdisciplinary Capacity Enhancement Award 2015-1026, Irish Research Council New Foundations Award, Health Research Board Trials Methodology Research Network Summer Student Scholarship.

Background The authors conducted a systematic review on this research question: "In populations where nondentists conduct diagnostic, treatment planning, and/or irreversible/surgical dental procedures, is there a change in disease increment, untreated dental disease, and/or cost-effectiveness of dental care?" Methods The authors searched 12 electronic databases for articles published through February 2012 and hand searched relevant articles. They assessed the risk of bias of included studies and extracted data. Results The authors screened 7,701 citations, resulting in 18 observational studies that met the inclusion criteria. They judged 13 of the studies to be at high risk of bias, five at moderate risk and one at low risk. The authors found no data regarding cost effectiveness, irreversible diagnostic procedures or diseases other than caries. Conclusions The authors concluded that the quality of the evidence was poor. They found that in select groups in which participants received irreversible dental treatment from teams that included midlevel providers, caries increment, caries severity or both decreased across time; however, there was no difference in caries increment, caries severity or both compared with those in populations in which dentists provided all irreversible treatment. In select groups in which participants had received irreversible dental treatment from teams that included midlevel providers, there was a decrease in untreated caries across time and a decrease in untreated caries compared with that in populations in which dentists provided all treatment. Clinical Implications Generalizability of results to populations other than those studied is limited owing to the age of some of the studies, as well as to clinical and methodological heterogeneity; consequently, the conclusions should be viewed with caution.

Background The authors conducted a study to assess dentists' and primary care physicians' oral cancer knowledge, attitudes and practices in the Commonwealth of Massachusetts. Methods The authors mailed a 38-item, pretested questionnaire to a stratified sample of dentists and primary care physicians in Massachusetts. The sample population included all general medicine, internal medicine and family practice physicians listed with the Massachusetts Board of Registration in Medicine and all Massachusetts Dental Society members. The authors invited a random sample of more than 1,000 clinicians to participate in the survey. They assessed knowledge, attitudes and practices of respondents and performed a bivariate analysis of responses to questions by using statistical software. Results Forty-nine percent of physicians reported performing an oral cancer examination in patients aged 40 to 55 years, compared with 92 percent of dentists ( P P P Conclusion This survey identified an existing gap in knowledge and practices among physicians and dentists and underscores the need to enhance oral cancer education among both professional groups.

Background Limited information is available from randomized clinical trials comparing the longevity of amalgam and resin-based compomer/composite restorations. The authors compared replacement rates of these types of restorations in posterior teeth during the five-year follow-up of the New England Children's Amalgam Trial. Methods The authors randomized children aged 6 to 10 years who had two or more posterior occlusal carious lesions into groups that received amalgam (n = 267) or compomer (primary teeth)/composite (permanent teeth) (n = 267) restorations and followed them up semiannually. They compared the longevity of restorations placed on all posterior surfaces using random effects survival analysis. Results The average ± standard deviation follow-up was 2.8 ± 1.4 years for primary tooth restorations and 3.4 ± 1.9 years for permanent tooth restorations. In primary teeth, the replacement rate was 5.8 percent of compomers versus 4.0 percent of amalgams ( P = .10), with 3.0 percent versus 0.5 percent ( P = .002), respectively, due to recurrent caries. In permanent teeth, the replacement rate was 14.9 percent of composites versus 10.8 percent of amalgams ( P = .45), and the repair rate was 2.8 percent of composites versus 0.4 percent of amalgams ( P = .02). Conclusion Although the overall difference in longevity was not statistically significant, compomer was replaced significantly more frequently owing to recurrent caries, and composite restorations required seven times as many repairs as did amalgam restorations. Clinical Implications Compomer/composite restorations on posterior tooth surfaces in children may require replacement or repair at higher rates than amalgam restorations, even within five years of placement.

Purpose The purpose of this study was to identify significant predictors of 4 outcomes in patients with severe odontogenic infections: abscess formation, penicillin therapeutic failure (PTF), length of hospital stay (LOS), and need for reoperation. Patients and Methods We used a prospective case series study design and enrolled 37 consecutive patients admitted for severe odontogenic infection between March 1996 and June 1999. Treatment consisted of intravenous penicillin (PCN) or clindamycin in PCN-allergic patients, surgical incision and drainage, and extraction(s) as soon as possible. Study variables were categorized as demographic, preadmission, time-related, preoperative, anatomic, treatment, microbiologic, and complications. The primary outcome variables were abscess formation, PTF, LOS, and reoperation. Multivariate linear and logistic regression techniques were used to measure associations between study variables and the outcome variables. Results The sample consisted of 37 subjects (23 male, 14 female) with a mean age of 34.9 ± 15.8 years. Multivariate analyses, controlling for confounding variables, indicated that culture of Peptostreptococci was a negative predictor of abscess formation. LOS was predicted by the number of infected spaces and duration of operation. There was no significant predictor of PTF or reoperation on multivariate analysis, although PCN-resistant organisms were isolated in all cases of PTF. Conclusion Increased LOS in severe odontogenic infections is predicted by the anatomic extent and severity of the infection and the occurrence of complications such as PTF and the need for reoperation. PTF is significantly associated with later identification of PCN-resistant organisms. The role of Peptostreptococci in abscess formation warrants further investigation.

Purpose Gradual midfacial advancement, applying the principle of distraction osteogenesis, reduces the restriction of the soft tissues and results in bony consolidation without need for grafting. The midface can be distracted by either pushing it forward, using semiburied devices, or pulling it forward by a rigid external device. For each method there are inherent technical problems, such as controlling the vector of movement, symmetry of advancement, and differential movement of the upper/lower face. We have used a combination of the 2 methods, called “push-pull,” in an effort to control the distraction process. The purpose of this paper is to describe our push-pull distraction technique and summarize our early experience. Materials and Methods Ten patients (5 males and 5 females) with a mean age of 11 years 2 months underwent midfacial advancement using push-pull distraction. Two orthodontists, blinded for landmark identification, traced preoperative and postoperative cephalograms and determined linear and angular measurements of midfacial position. A Student t test was used to assess differences between the cephalometric measures on the 2 radiographs. Interexaminer reliability was calculated by an intraclass correlation coefficient. Results Postdistraction cephalograms were taken a mean of 10 months (range, 3 to 20 months) after removal of the devices. Patients exhibited improvement at all levels of the midface after distraction. There was a statistically significant sagittal advancement from the infraorbital rim to dentoalveolus. The central midface was sufficiently advanced as shown by an improved convexity, nasolabial angle, and upper labial protrusion. There were no significant differences between examiners for any of the measurements in this study. Conclusions Push-pull distraction permits 1) equal movement at both the upper and lower facial levels, 2) advancement of the central midface, and 3) symmetric movement of the zygomaticomaxillary complexes. This method also provides a backup, in case one device malfunctions. In combination, the advantages of each device are additive; whereas the weaknesses are not. The push-pull technique is a practical method for midfacial distraction until a better single device is fabricated.

It is important for clinicians to understand the type of clinical studies that appear in the literature and the inherent strengths and limitations of each study. The three possible alternative explanations, chance, bias, and confounding, must be considered for any research study. Thus, it is important to evaluate research studies critically in light of this discussion and not simply to summarize the findings. Finally, conclusions about causality can only be made on the body of evidence, not on any single study.

The objective of this survey was to obtain an indication of the size of the methicillin-resistant Staphylococcus aureus (MRSA) problem in Ireland prior to introducing national MRSA control guidelines. A survey of all microbiology laboratories in Ireland was carried out over two weeks in Spring 1995. For patients from whom MRSA was isolated during the study period standard demographic and clinical data were requested and period prevalence/1000 discharges was calculated. All 45 microbiology laboratories surveyed responded. MRSA was isolated from 448 patients during the two-week period. The period prevalence of MRSA was 16.5/1000 discharges. Males aged > or = 65 had the highest rate (50/1000 discharges). Half of all isolates were from patients in surgical or medical wards, but 4% were from community-based sources such as GPs, nursing homes and hospices. Thirty-two percent of MRSA patients were infected rather than colonized. MRSA is clearly a significant problem in Ireland. While it is largely a hospital problem at present, the increasing trend towards day procedures and shorter hospital stay means that infection will increase in the community.

Summary Subjects The study population was 17,844 adults who had oral0689 exams as part of NHANES III, 1306 of whom wore removable partial dentures. Dental exam data were available for 1303 individuals with removable partial dentures. The study included 1603 removable partial dentures (811 maxillary and 792 mandibular). The age range of the subjects was 17 to 70+. Exposure The presence of a removable partial denture. 0689 Main outcome measure Information regarding defects in removable partial 0689 dentures was obtained from the NHANES III databases. Defects in several categories were noted. Extraoral defect categories included integrity, excessive wear of posterior teeth, and presence of reline/tissue conditioner. Intraoral defect categories included stability and retention. Main results At least 250,000 adults under the age of 40 have removable 0689 partial dentures. In this study, the number of removable partial dentures increased as the age of the patients increased. The number of maxillary removable partial dentures peaked in the 51-to-60 age group, and the number of mandibular removable partial dentures peaked in the 61-to-70 age group. In patients older than 70 years of age, the number of removable partial dentures then decreased with an increase in the number of complete dentures. Only a third of removable partial dentures werefound to be completely satisfactory, with approximately 65% of the dentures having at least 1 defect. Lack of stability was the most common defect noted for both maxillary and mandibular removable partial dentures, followed by tooth wear and lack of integrity. Retention and stability problems were more commonwith maxillary than with mandibular removable partial dentures. However, when patient age was adjusted for, the mandibular removable partial dentures were found to have more problems associated with retention, stability, and relining. Information regarding the age of the removable partial denture was not available.

OBJECTIVE: This study was designed to develop food and liquid cariogenicity indices and to preliminarily test their utility using dietary data from a study of children with and without severe early childhood caries (S-ECC), defined as 3+ smooth surface carious lesions, including at least one pulpally involved tooth. METHODS: Data were collected in a diverse cohort of low-income pre-school aged children made up of 454 children with S-ECC and 429 caries-free children who presented for care at pediatric dental clinics in Washington, DC, Columbus, OH and Cincinnati, OH. The cariogenicity indices were used to score dietary data from a Food Frequency Questionnaire (FFQ) and a 24-hour recall (24HR). RESULTS: There were no statistically significant differences in mean food cariogenicity scores between groups. The liquid cariogenicity score was higher in the S-ECC group as compared to caries-free children (24HR: 5.28 versus 4.66, respectively, p

Historically, radiographic evaluation of the temporomandibular joint has been of limited value. A step-by-step technique which is more correct anatomically is suggested. This technique involves polycycloidal corrected tomography of the temporomandibular joint. Radiographic samples are presented, as well as the results of a random sampling of 300 cases. Fifty-seven percent of the cases showed radiographic changes, and the reasons and limitations of these results are interpreted.