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A cast-free approach is described to fabricate an implant-supported interim restoration by using the postoperative cone beam computed tomography (CBCT) scan to locate the placed implant. A postoperative intraoral scan was aligned to the postoperative CBCT scan through a dental implant planning software program. An attached interim abutment and implant analog complex was then scanned and superimposed on the placed implant in the postoperative CBCT scan. Once the best alignment was achieved, a virtual cast was generated, and an interim restoration with bilateral positioning wings was fabricated on the interim abutment and inserted during the second-stage surgery. This technique offers a cast-free approach to inserting an implant-supported interim restoration immediately after the second-stage surgery to guide the healing of the soft tissue that can minimize chairside time and optimize the clinical workflow.

Background Reconstruction of continuity defect of mandible is challenging, and there has been a lot of advancement in this field with variety of options for restoration. However, choice often becomes restricted in resource limited settings due to lack of trained manpower, time, infrastructure, supply of graft materials, etc. In this context, we aim to test the reliability of Kirschner wire (K-wire) with adaptation of looped-end for immediate interim reconstruction of continuity defect of mandible. Materials and method Retrospectively, medical records of 10 years data were reviewed to include 22 patients who underwent immediate interim reconstruction of mandible with K-wire with looped-end adaptation for continuity defect of mandible. Data regarding patient demographic, type and length of mandibular defect, diameter of the wire and complications were recorded. Result Among 22 patients within a follow-up period of 1–60 months (median 7.5), complications developed in 7 (31.8%) patients. Three patients (13.6%) had major complications which required interventions, and 5 patients (22.3%) with minor complications were managed conservatively. Total wire removal in our study is only 9%, which is lowest among the reported literature, migration or extrusion through bone was nil, and overall aesthetic and functional result was good in majority except few where either wire had to be removed or got deformed. Conclusion Kirschner wire (K-wire) should be considered in resource limited setting as an immediate interim reconstructive method of mandible for being cheap and widely available. Our technique of looped-end adaptation results in better stabilisation leading to less removal rate, migration or extrusion.

The biologically oriented preparation technique (BOPT) uses a vertical tooth preparation and simultaneously a controlled rotary instrumentation of the gingival sulcus. The resulting blood clot is stabilized with the interim restoration. However, accurate transfer of the emergence profile of the interim crown to the definitive restoration is essential to maintain the gingival architecture. This technique article describes clinical and laboratory procedures to predictably transfer the emergence profile of the interim crown to duplicate the gingival architecture in the definitive restoration.

Interim imaging with computed tomography (iCT) to assess response is common during frontline chemoimmunotherapy for follicular lymphoma (FL), but there is little evidence of its utility. We retrospectively reviewed outcomes of iCT in 190 patients with biopsy-proven FL who received first-line chemoimmunotherapy from 2003-2018. Most iCTs showed partial response (PR, 83%), with a minority showing complete response (CR, 8%) or stable disease (5%). Seven patients (4%) had radiographic disease progression (PD) on iCT; on repeat biopsy, four had another malignancy identified and three had transformation to DLBCL. Only one had asymptomatic PD. The 3-year PFS of all patients was 74% (median follow up 75 months). Patients with PR on iCT had similar 3-year PFS and OS as those with CR. In conclusion, iCT has limited utility in identifying patients with asymptomatic early progression during first-line treatment. Patients with PD mid-treatment warrant biopsy to identify histologic transformation or other malignancies.

A new technique of guided implant surgery is presented. A conventional complete denture is converted into both tomographic and surgical guides and later into an interim implant-supported fixed prosthesis. A plate derived from a computed tomography scan becomes the physical link between the virtual planning and tube positioning device. Furthermore, the interim placement of mini-implants adjacent to the symphysis region stabilizes the guide throughout the guided surgery. This technique reduces treatment time and costs.

Statement of problem Adjusting an interim screw-retained crown made of acrylic resin for maintenance of peri-implant soft tissues after immediate implant insertion requires accuracy and time. Assessments of these factors by using digital techniques are sparse. Purpose The purpose of this clinical study was to describe a technique to fabricate an acrylic resin interim crown by using the data acquired from a cone beam computed tomography (CBCT) scan. The 3D tomography files were converted to a standard tessellation language (STL) file format used to print or to mill the interim crown with a technique called digital immediate tooth restoration (DITR). Additionally, the chair time spent during the prosthetic phase was evaluated in comparison with a protocol in which a standard interim crown (SIC) was fabricated with an indirect-direct technique. Material and methods Patients who needed to replace a single nonrestorable tooth were treated from February to June 2018 with an immediately placed implant and an acrylic resin screw-retained interim prosthesis that was connected to the implant immediately after placement of the implant. The participants were divided into 2 groups according to the acrylic resin interim crown fabrication technique: group DITR and group SIC. The average time to finalize the prostheses was compared between the groups. The total chair time (TCT) taken for the adaptation of the interim crown was noted and distinguished in 3 different times corresponding to each phase of adaptation of the interim restoration of the interproximal contact areas (CT1), adaption of the postextractive alveolar bone walls (CT2), and adaption of the occlusal contacts (CT3). For each time, the number of changes (N-CT1, N-CT2, N-CT3, and TN) needed to complete each prosthetic phase was also marked and observed. Generalized linear mixed models and generalized linear models were used for data analysis. All the sites were definitively restored with a screw-retained crown after 6 months of healing, and the participants were provided with standard hygiene recall appointments for the next year. Results A total of 82 crowns at sites distributed across the mandible and the maxilla were included in the study. Thirty-five were restored with an SIC and 47 with a DITR interim crown. None of the implants were lost during the 18-month follow-up period. The analysis of the chair times registered for the adaptation of the interim crown to the implant healing abutment and to the neighboring teeth between the 2 groups showed a reduction if a DITR interim crown was used (average CT1 of 15 ±14 seconds, CT2 of 2 ±5 seconds, CT3 of 59 ±19 seconds, and TCT of 76 ±28 seconds for group DITR and average CT1 of 135 ±27 seconds, CT2 of 185 ±30 seconds, CT3 of 73 ±16 seconds, and TCT of 394 ±61 seconds for group SIC). The number of corrections to finalize the interim crown adaptations was lower for the group DITR (0.81 ±0.74 for N-CT1, 0.19 ±0.39 for N-CT2, and 2.81 ±0.74 for N-CT3) when compared with the number of corrections needed for the group SIC (4.37 ±0.81 for N-CT1, 5.57 ±0.77 for N-CT2, and 3.86 ±0.64 for N-CT3). Conclusions The data from CBCT scans led to interim acrylic resin crowns that needed fewer adjustments with the immediate implant placement and interim restoration approach, reducing chair time.

This clinical report describes a completely digital workflow for the rehabilitation of the maxillary and mandibular arches with implant-supported fixed interim prostheses. Computer-assisted implant planning was used to fabricate a multifunctional surgical template for the guided placement of transitional and endosteal dental implants. Advantages of this technique include the integration of a completely digital workflow into the production of a virtual diagnostic tooth arrangement for edentulous patients, the planning of implant placement as per a restorative-driven approach, and the delivery of implant-supported fixed interim prostheses.

Maintaining natural-looking soft tissues around dental implants is one of the biggest challenges for the restorative team. To achieve this, the emergence profile of the preexisting teeth in the alveolus can be emulated rather than conditioning the soft tissue architecture arbitrarily. The biotransfer technique uses an interim restoration with a biologically driven emergence profile fabricated before the implant surgery.

The solution concept of a Bayesian equilibrium of a Bayesian game is inherently an interim concept. The corresponding ex ante solution concept has been termed a Harsányi equilibrium; examples have appeared in the literature showing that there are Bayesian games with uncountable state spaces that have no Bayesian approximate equilibria but do admit a Harsányi approximate equilibrium, thus exhibiting divergent behaviour in the ex ante and interim stages. Smoothness, a concept from descriptive set theory, has been shown in previous works to guarantee the existence of Bayesian equilibria. We show here that higher rungs in the countable Borel equivalence relation hierarchy can also shed light on equilibrium existence. In particular, hyperfiniteness, the next step above smoothness, is a sufficient condition for the existence of Harsányi approximate equilibria in purely atomic Bayesian games.

Problem definition: Clinical trials are crucial to new drug development. This study investigates optimal patient enrollment in clinical trials with interim analyses, which are analyses of treatment responses from patients at intermediate points. Our model considers uncertainties in patient enrollment and drug treatment effectiveness. We consider the benefits of completing a trial early and the cost of accelerating a trial by maximizing the net present value of drug cumulative profit. Academic/practical relevance: Clinical trials frequently account for the largest cost in drug development, and patient enrollment is an important problem in trial management. Our study develops a dynamic program, accurately capturing the dynamics of the problem, to optimize patient enrollment while learning the treatment effectiveness of an investigated drug. Methodology: The model explicitly captures both the physical state (enrolled patients) and belief states about the effectiveness of the investigated drug and a standard treatment drug. Using Bayesian updates and dynamic programming, we establish monotonicity of the value function in state variables and characterize an optimal enrollment policy. We also introduce, for the first time, the use of backward approximate dynamic programming (ADP) for this problem class. We illustrate the findings using a clinical trial program from a leading firm. Our study performs sensitivity analyses of the input parameters on the optimal enrollment policy. Results: The value function is monotonic in cumulative patient enrollment and the average responses of treatment for the investigated drug and standard treatment drug. The optimal enrollment policy is nondecreasing in the average response from patients using the investigated drug and is nonincreasing in cumulative patient enrollment in periods between two successive interim analyses. The forward ADP algorithm (or backward ADP algorithm) exploiting the monotonicity of the value function reduced the run time from 1.5 months using the exact method to a day (or 20 minutes) within 4% of the exact method. Through an application to a leading firm’s clinical trial program, the study demonstrates that the firm can have a sizable gain of drug profit following the optimal policy that our model provides. Managerial implications: We developed a new model for improving the management of clinical trials. Our study provides insights of an optimal policy and insights into the sensitivity of value function to the dropout rate and prior probability distribution. A firm can have a sizable gain in the drug’s profit by managing its trials using the optimal policies and the properties of value function. We illustrated that firms can use the ADP algorithms to develop their patient enrollment strategies.

The purpose of this article is to describe how UF Health Jacksonville’s nursing designed and implemented a deliberate and systematic succession planning program to ensure nursing leadership continuity in key positions, retain and develop future leaders, and encourage professional development and advancement. Our formal program known as FOCUSED (Fostering Organizational Change Using Structured Education and Development) is inclusive of all levels of nursing. FOCUSED uses 5 nursing leadership competencies and a 9-box talent matrix tool to select high potential candidates for development and promotion. Since implementing FOCUSED, we have reduced nurse leader turnover, increased hiring internal candidates, and decrease temporary agency spending for interim leadership.

This paper considers social contracts (or mechanisms) in negotiations with incomplete information in which an outside option is a probabilistic conflict and a peaceful agreement is ex ante efficient. Applications include partnership, labor-management bargaining, pretrial negotiations, and international negotiations. I compute the set of interim incentive efficient mechanisms, the ex ante incentive efficient mechanism, as well as the neutral bargaining solution. I numerically illustrate that the focus on the ex ante incentive efficient mechanism as the most reasonable prediction is not robust. This paper justifies the neutral bargaining solution as the unique, robust solution among all interim incentive efficient mechanisms.

This essay seeks to contribute to the literature that asks how interim constitutions can become self-enforcing norms capable of producing a successful constitution-making process. It uses the Chilean constitution-making process as an example to theorize on how the political narratives associated with the November 2019 Agreement, which sets the framework for constitutional change, can influence its self-enforcing capacity. The authors identify and reconstruct the two prevailing normative theories underlying the Chilean constitution-making process: the evolutive and the revolutionary narratives. These present themselves in both radical and moderate versions. While evolutive ideas emphasize institutional continuity, consensus-building, and an incrementalist approach to constitutional change, revolutionary arguments rely on the constituent power theory and push for a profound social transformation that can break with the past. Even though these narratives are in tension with each other in many respects, they have both influenced the design of the rules of the constitution-making process. The authors claim that the self-enforcing capacity of the interim constitution partly depends on whether, and to what extent, the moderate versions of these narratives succeed or prevail in the political discourse.

The Coronavirus disease 2019 (COVID-19) is spreading around the world, representing a global pandemic. In this context, governments from all around the world suspended all education, industry and business activities, alongside restricting the movement of people. Nevertheless, during this period, the activity of the law enforcement and the forensic investigators never stopped. At the present time, clinical and forensic autopsies of SARS-CoV-2 virus-positive cases, as well as handling of potentially infected biological samples in forensic practice have given guidance. However, less attention has been given to the development of specific adjustments to the existing crime scene investigation protocols and procedures for this exceptional time. This manuscript aims to share the methods and strategies adopted for the investigation of high priority criminal cases during the pandemic. Furthermore, other pandemic-related processes are critically explored, in order to propose adjustments for any forensic services to be prepared to face similar challenges in the future. The overall goal of this manuscript is to provide a summary of the main measures and the procedures developed to make the operations possible, while safeguarding the technicians in the field and the activity in the forensic laboratory. In order to minimize the risk of infection for personnel, adjustments to the standard practice have been proposed for each of the different phases of crime scene management, i.e. CSI call policy, equipment preparation, working groups, procedure at the scene, chain of custody and analyses of the evidence at the forensic lab. As this is a current study, based on limited cases and limited sources in the literature, changes and updates to the indications provided in this paper may be needed in the near future, according to new virologic data epidemiological trends.

Objective: To evaluate the speech outcomes after primary cleft palate repair in a single tertiary medical institution of Thailand.Materials and Methods: A prospective cohort study was performed. Patients who had cleft palate with/without cleft lip and underwent primary cleft palate repair were included. Speech assessment was performed using the Pittsburgh weighted speech score (PWSS) by a speech-language pathologist.Results: Forty patients (21 males and 19 females) who underwent primary cleft palate repair at Siriraj Hospital were included. The median age at the time of speech evaluation was 7 years. The median age at primary cleft palate surgery was 12 months. The predominant cleft palate type was Veau 3 (47.5%). Oronasal fistula occurred 40%. Two-flap palatoplasty and intravelar veloplasty were the most common procedures. Median PWSS was 7, in which the competence velopharyngeal mechanism was found 5%, borderline competence 10%, borderline incompetence 32.5%, and incompetence velopharyngeal mechanism 52.5%. Among the velopharyngeal incompetence group, articulation disorder was the most common disorder with median score of 3. Besides, the median scores for hypo/hyper-nasality, nasal emission, phonation, and facial grimace disorder were 1, 2, 0 and 0, respectively. There was no statistically significant association between velopharyngeal incompetence and cleft types, age at primary surgery, type of operation, the width of cleft palate and prevalence of postoperative oronasal fistula or otitis media effusion.Conclusion: Velopharyngeal incompetence has been commonly identified after cleft palate repair in our institute. The articulation disorder is the most common characteristic.

India has been hard-hit by the Covid-19 pandemic. The virus has exacted a heavy toll in terms of lives lost and deteriorating health outcomes. The economic consequences of the pandemic have been similarly grim. In this paper we attempt an initial, interim, assessment of the impacts of the crisis on poverty. We review the growing literature that considers emerging poverty impacts, noting that there remain significant knowledge gaps due to limited evidence on current welfare outcomes. We analyze pre-Covid survey data to examine the incidence of chronic poverty and downward mobility during a period of rapid economic growth and declining poverty. A profile of poverty during such a period might offer a plausible, partial, window on population groups currently at risk. We suggest that, notwithstanding the severe initial impacts of the crisis on poverty, there are grounds for expecting further consequences going forward. As the virus has spread out of the relatively affluent cities, and as economic stagnation persists, rural areas, with historically higher rates of chronic poverty and vulnerability, may see particularly sharp increases in poverty. While recent vaccination developments offer some grounds for optimism, there remains an urgent need to identify, implement and amplify effective policy alleviation measures.

Background Diffuse large B cell lymphoma is the most frequent aggressive non-Hodgkin lymphoma. Predicting response and estimating prognosis earlier makes management of this heterogeneous lymphoma more satisfying. Interim PET response is established in Hodgkin Lymphoma to tailor the therapy but results for non-Hodgkin Lymphoma is unconvincing. In the current study evaluation of interim PET and survival outcomes of 103 DLBCL patients is performed. Patients and Methods About 103 Patients with DLBCL followed up in a single center between 2009 and 2019 were enrolled the study. All patients received R-CHOP chemoimmunotherapy at first line. Interim PET was performed after at least one or more cycles. All PET scans were performed with 18F-FDG isotope as PET/CT. PET scoring results were evaluated according to the 5-Point Deauville Scoring system defined in the National Comprehensive Cancer Network clinical guidelines for iPET and eotPET. 5-P DS of scores of 1 to 3 were defined as negative scans, and scores of 4 to 5 were considered to be positive scans. Results Forty-six (44.7%) Female and 57 (55.3%) male aged between 25 and 83 (median 57) years newly diagnosed DLBCL patients were enrolled in the study. Median PFS was 21 (interquartile range 8.5-53.7) months and median OS was 33.5 (interquartile range 12.5-62.9) months for the total cohort. Positive predictive value of interim PET according to Deauville scoring system was 65.4% and negative predictive value was 77.9%. Conclusion Our study showed that according to Deauville 5 point scale (D 5PS) scoring system, interim PET-positive patients have shorter both PFS and OS than iPET-negative patients.

Objective To investigate the treatment efficacy of low-level light therapy on dentin hypersensitivity. Materials and methods Following the PRISMA guideline, six electronic databases supplemented with bibliographies were searched till December 2020. Two reviewers performed the screenings independently with a reliability assessment. Studies fulfilling the pre-registered eligibility criteria were included for risk-of-bias assessment and data synthesis. Results Thirty-five articles ultimately informed this systematic review based on the eligibility criteria and underwent risk-of-bias assessment (ĸ = 0.86). Quantitative results were deduced by meta-analysis of 20 randomised controlled trials: LLLT showed favourable outcomes compared to placebos for immediate (SMD: 1.09, 95% CI: 0.47 to 1.70), interim (SMD: 1.32, 95% CI: 0.41 to 2.23), and persistent efficacies (SMD: 2.86, 95% CI: 1.98 to 3.74). However, substantial heterogeneity existed among included studies (I2: 64–95%). Regarding comparisons with other desensitising strategies, LLLT showed no significant benefits in DH alleviation over others except fluorides for interim efficacy (SMD: 0.31, 95% CI: 0.10 to 0.52) and persistent efficacy (SMD: 0.45, 95% CI: 0.03 to 0.86). Conclusions This systematic review shows that LLLT has positive immediate, interim, and persistent DH-treatment efficacies compared with placebo. No superior treatment effects of LLLT were observed except fluoride agent use. Further studies are warranted—RCTs with low risk of bias, consistent technical settings, comprehensive assessments, and long follow-up periods. Clinical relevance This systematic review bridges a critical research gap by analysing clinical evidence in the DH-alleviating efficacy of LLLT in comparison with placebo and other in-office desensitising strategies.

This paper looks at scalar politics, power struggles, and institutional emergence in Daw Lar Lake in Karen state, Myanmar. It brings to light tensions between centralized and decentralized approaches in the country's natural resource governance, and how these are manifested in the current legal stalemate with regard to the formal management status of the lake. Building on earlier research on legal pluralism and critical institutionalism, we look at: 1) how the current legal stalemate with regard to the formal management status of the lake is rooted in ongoing bureaucratic struggles between different government agencies; 2) local communities' strategies to develop and implement their own vision of lake governance through the formation of the Daw Lar Lake Interim Committee; and 3) the extent to which the Interim Committee is able to mediate diverse and often competing local uses and claims to natural resources at (inter) village level, which are based on a mix of customary and ‘official’ legal entitlements and normative orderings. From a policy perspective, we highlight the need to identify pathways for collective action among and across different groups of resource users, as the latter will be crucial in addressing ongoing resource competition, managing cross-sectoral livelihood impacts and ensuring sustainable lake management.

Introduction Like many teaching hospitals in Australia, after-hours computed tomography (CT) reporting at our institution is undertaken by the on-call radiology registrar. The accuracy of these reports is important as management is often initiated based on the interim findings, prior to review by the consultant radiologist. A common exception to this approach is cervical CT (CCT), as many hospital protocols recommend patients to remain in spinal precautions until the report is finalised by a consultant, although there are very few studies to support this practice. Methods The interim registrar reports for all CCTs performed after-hours over a 12-month period were retrospectively reviewed. The final consultant report was used as the gold standard to establish accuracy of the registrar report. The primary outcome was discrepancy between the provisional and final reports. Any discrepancy was classified as either an 'overcall' or 'miss'. Discrepancies were graded by the RADPEER scoring system. Results A total of 1084 after-hours CCT studies were reviewed. The number of cases positive for injury was 37 (3.4%). The total number of discrepancies was 14 (discrepancy rate 1.3%), including 4 overcalls (0.3%) and 10 misses (0.9%). The discrepancy rates for junior and senior registrars were 1.7% and 0.7% respectively. Only 5 misses (0.5%) were considered clinically significant. Conclusion Registrars reporting after-hours CCT have low rates of discrepancy with very few clinically significant misses. However, the reduced registrar sensitivity for detection of cervical injury highlights the ongoing importance of consultant review in the process of cervical spine clearance pathways.

This article provides an interim assessment of the macroeconomic consequences of the COVID‐19 pandemic. Estimates suggest a median output loss of approximately 6.5% in 2020, a gap that is expected to narrow to around 4% of the pre‐pandemic trend by the end of 2021. There is, however, a high dispersion of economic losses across economies, reflecting varying exposures to the pandemic and societies' responses. High‐frequency indicators and epidemiological models provide some insight into the interactions between the pandemic evolution and societies' strategies for combating it, including the role of vaccination. The article draws lessons from experiences thus far and discusses challenges ahead.

Objectives In 2018, the World Health Organisation (WHO) reported that almost 10 million people worldwide had tuberculosis (TB). The majority of the TB cases were concentrated in South East Asian Region (SEAR) countries. To curb this burden, the WHO has set interim targets to reduce TB incidence by 50% and mortality by 75% by 2025 (interim targets of the ‘End TB’ strategy). Hence, this study was conducted to determine the progress of SEAR countries towards reaching these interim targets for TB incidence and mortality. Methods Secondary data analysis was performed using information from the WHO Global Health Observatory and Global Health Estimates for all SEAR countries. ARIMA modelling was used to forecast TB incidence and TB mortality from 2000 to 2025. Joinpoint regression was performed to determine the average annual percent change. Results Based on the current trend, we estimated that the incidence and mortality of TB in SEAR countries will decline to 3.7 million (4.37 million in 2018) and 495,280 (650,979 in 2016) by 2025, respectively. Projected age-standardised TB incidence showed a significant decline in only four SEAR countries, with the maximal decline in Myanmar (47.3%) followed by India (23.4%) compared with 2015 estimates. Age-standardised TB mortality showed a declining trend in six SEAR countries, with the maximum decline found in Myanmar (60.3%) followed by Thailand (39.0%). Conclusions Current study findings show that it is highly unlikely for most SEAR countries to achieve the WHO recommended interim End TB targets of 50% reduction in incidence and 75% reduction in mortality by 2025.

The 1969 White Paper In Place of Strife was the Labour government’s response to the 1968 Donovan Report. Its most contested proposals were three penal clauses, where fines could be imposed: against unions for refusing to ballot in certain official strikes or if they struck against a ruling in inter-union recognition disputes; and against workers for refusing to return to work when a ‘conciliation pause’ was ordered in certain unconstitutional strikes (in breach of a disputes procedure). Peter Dorey’s political account Comrades in Conflict (2019) provides an opportunity to explore the industrial relations aspects of the White Paper. First, the proposed sanctions are explored in an analysis of the Donovan Report and government discussions. Second, key industrial disputes, which shaped the White Paper and the decision to present an interim bill, are examined. Third, the impracticability of fines on unconstitutional strikers prompted the exploration of legislative alternatives. The opposition of the Trades Union Congress is assessed

The WTO dispute settlement system is in crisis due to the persistent blockage of the appointment of Appellate Body members by the United States. This paper reviews the US criticisms against the Appellate Body and argues that its allegations are unfounded and its approach is wrong. To deal with the US blockage, various proposals have been made, with the most popular being the Multiparty Interim Appeal Arbitration Arrangement (MPIA) set up by several key Members including the European Union and China. After a thorough analysis of the key features of the MPIA from both theoretical and practical perspectives, this paper argues that the MPIA fails to provide a proper solution to the Appellate Body crisis due to its many defects. Instead, the paper suggests the appointment of Appellate Body members based on majority voting at the General Council. This paper concludes by noting that only such a rule-based solution can not only solve the current Appellate Body crisis but also deter similar attempts to sabotage the WTO dispute settlement system in the future.