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Partial or complete failure of tooth eruption may be due to several causes, including primary failure of eruption (PFE), and an accurate diagnosis is essential for appropriate management. This article reviews PFE and the possible treatment options. Case reports of two patients diagnosed with PFE are presented and their management discussed. CPD/Clinical Relevance: Primary failure of eruption can be difficult to diagnose and differentiate from other causes of failure of eruption. This paper highlights the clinical presentation of PFE through a review of the literature and by illustration with two clinical cases.

Objective: To identify and profile the available orthodontic smartphone apps published on the UK Apple App Store and Google Play Store. Design: A review of available smartphone apps. Setting: London, UK Methods: The Apple App Store and Google Play Store were accessed in October 2018; all orthodontic apps with a title and description available in English were included. Each app was classified according to the following criteria: name; target audience (patient or clinician); focus; platform (Apple App Store and/or Google Play Store); cost; rating and number of ratings; size; creation date; country of development and developer. Results: A total of 305 orthodontic related apps were identified for inclusion. The majority of apps were aimed at patients (n = 241) and the most of these were focussed on gaming (n = 136), many apps were also found to be developed by specialist practices (n = 63) and to provide knowledge for patients (n = 56). Two hundred and ninety-five apps were free, with some of these including the option of paying for in-app purchases. Most apps were developed in the USA (n = 84). Conclusions: There has been an increase in the availability of orthodontic apps in recent years. The majority of available apps are patient-focused, most commonly games. A number of apps aim to elicit a behaviour change in our patients; therefore, there is a need to assess the quality and educational content of these.

Introduction: Mobile phone applications (apps) can be engaging, accessible, versatile and have the potential to improve patient care. In 2017, 354 orthodontic apps were reported to be available, many of them targeted at patients; however, the awareness and usage of apps among orthodontic patients was unreported. Aim: The primary aim of this study was to assess patients’ current awareness of orthodontic apps. Methods: One hundred orthodontic patients (50 new and 50 in treatment) completed a questionnaire designed to explore their awareness, access to and utilisation of orthodontic apps and social media to support orthodontic treatment. Furthermore, their willingness to engage with and use an app to aid with orthodontic treatment was explored. There were no age restrictions or exclusion criteria. Results: Ninety percent of patients had access to a smartphone, of which 73% belonged to them (rather than a parent/relative). Apple was the most popular platform (56%) followed by Android (26%). Only 7% of patients were aware that apps were available to help with orthodontic treatment and no patients had previously used an app related to orthodontics. However, 87% of patients stated that they would be willing to use an app to support treatment. Twenty-one percent of patients had previously looked up information on social media, with YouTube being the most popular platform. Conclusion: Current awareness of the availability of apps is poor, despite the finding that 87% of patients reported they would be willing to use an app to aid with orthodontic treatment. Given the availability of apps targeted at orthodontic patients, there is a need to assess the quality of these apps and, if appropriate, navigate patients towards high-quality, effective apps.

This study examined the effect of mild hypothermia (a 0.5 °C decrease in rectal temperature) on heart rate variability (HRV), with the identical hypothermia protocol performed twice and compared using intraclass correlation coefficient (r) analysis to study the repeatability. Twelve healthy males each completed 1 neutral (23 °C) and 2 cold (0 °C) trials. In the neutral trial, participants sat quietly for 30 min. In the cold trials, baseline data were obtained from a 5-min sample following 30 min of quiet sitting at 23 °C, followed by passive exposure to 0 °C; hypothermic measures were taken from a 5-min period immediately prior to rectal temperature decreasing by 0.5 °C. HRV was obtained from a 3-lead electrocardiogram. There were no differences (all p > 0.05) in baseline measures between the neutral and the 2 cold trials, suggesting no precooling anxiety related to the cold trials. Heart rate, together with HRV measures (i.e., root mean square difference of successive normal RR intervals, triangular interpolation of NN interval histogram, low-frequency oscillations (LF), and high-frequency oscillations (HF)), increased (all p < 0.05) with mild hypothermia and showed excellent reliability between the 2 cold trials (all r ≥ 0.81). In contrast, the LF/HF ratio decreased (p < 0.05) and had only fair reliability between the 2 cold trials (r = 0.551). In general, hypothermia led to increases in heart rate, together with most measures of HRV. Although it was counterintuitive that both sympathetic and vagal influences would increase simultaneously, these changes likely reflected increased stress from whole-body cooling, together with marked cardiovascular strain and sympathetic nervous system activity from shivering to defend core body temperature. An important methodological consideration for future studies is the consistent and repeatable HRV responses to hypothermia.

This study examined cutaneous vasoconstriction to whole-body hypothermia, specifically contributions of neural and endothelial vasomotor responses in glabrous and non-glabrous skin. Eleven participants were semi-recumbent at an ambient temperature of 22 °C for 30 min, after which ambient temperature was decreased to 0 °C until rectal temperature (Tre) had decreased by 0.5 °C. Laser-Doppler fluxmetry was measured at the forehead and thigh for measures of glabrous and non-glabrous skin, respectively; wavelet analysis was performed on the laser-Doppler signal to determine endothelial and neural activities. Hypothermia took on average 97 ± 7 min and caused marked decreases at glabrous (42 ± 5%baseline, p

Persistent genital arousal disorder [PGAD] is a distressing physiologic arousal condition with no psychologic etiology. We highlight identification and treatment of PGAD and associated mental comorbidities in a 15-year-old male who presented to Pediatric Urology with PGAD with pain, and resultant depression and suicidal ideation. After failure of conservative pharmacologic management, MRI of the lumbosacral spine demonstrated an L5-S1 annular tear and herniation of the nucleus pulposus. The patient underwent transforaminal steroid injection with reduction in symptoms, and eventually lumbar discectomy with near complete resolution of symptoms. Management of this condition should include a focus on the mental health component.

1. Margaret A. Singer, MD* 2. Ashton Chen, DO† 3. Avinash Shetty, MD† 4. Steve Hodges, MD‡ 1. *University of Minnesota 2. †Department of Pediatrics, 3. ‡Department of Urology, Wake Forest University Medical Center, Winston-Salem, NC 1. Address correspondence to Ashton Chen, DO, Department of Pediatrics, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: achen{at}wakehealth.edu This is a fascinating case report that demonstrates findings and treatment of urinary schistosomiasis while also revealing variations in patient care across varying settings. In the United States, this child received what the authors describe as “gold standard” care—involving a diagnostic surgical procedure and multiple visits with multiple subspecialists. If this child had stayed in Mali, he most certainly would have had received a clinical diagnosis of schistosomiasis and effective treatment with oral praziquantel—without any diagnostic testing. Outside of the endemic area, some reasonable clinicians would still have treated presumptively, and others would have opted for treatment based on symptoms and serologic confirmation of schistomal infection, realizing, as the authors point out, that positive serology alone does not prove an active infection. Still, other clinicians might have opted to test multiple concentrated urine samples (especially the urine produced at the end of voiding) without a surgical search for the definitive diagnosis. All readers of Index of Suspicion can learn from this case and then decide how best to implement diagnostic and therapeutic interventions in their own settings based on careful analysis of the various risks and benefits. Phil Fischer, Former Section Editor, Index of Suspicion A 13-year-old boy presents with a 7-year history of recurrent, gross hematuria. Referred by his pediatrician, he is being evaluated by a pediatric nephrologist. Each episode of hematuria, which he experiences about every 2 months, occurs mid-urine stream and without associated dysuria, fever, or abdominal pain. He is under guardianship of …

The current athletic apparel industry is worth approximately $135 billion (Jensen et al., 2016), and sports sponsorship global expenditure has reached $62.8 billion (Kelly, 2018). Collegiate apparel brand contracts have significantly contributed with single contracts worth up to $16 million (Jensen et al., 2017). The contracts provide institutions with apparel and accessories, as well as monetary and product bonuses. Despite their prevalence, apparel sponsorship agreements remain largely under-researched. Thus, the two-fold purpose of this study was to (1) explore the role of branded athletic apparel in collegiate athletic program sponsorship agreements, and (2) how these agreements are managed within collegiate athletic programs. A triangulation of methods was used in the data collection process, including document analysis, website content review, and in-depth interviews. Two key themes emerged from the data: Gender Matters and Sport Significance. Findings revealed disparities in product and financial provisions based upon gender and sport.

The purpose of the study was to explore the ways apparel and textile firms might think innovatively to address the cost and scarcity of a skilled, domestic workforce in order to facilitate the reshoring of their operations in the United States. In depth interviews were conducted with 24 individuals with knowledge of or experience in reshoring from a production or policy perspective. Three themes were identified: Direct Investments, Indirect Solutions, and Differentiating to Meet Demand. Data were interpreted through the lens of innovation theory. Results extend previous literature on the topic by highlighting the ways that industry stakeholders think firms can overcome the barriers to reshoring and make a successful return to domestic production.

To examine the relationship between demographics, other tobacco use, and JUUL dependency on combustible cigarette use among college JUUL users. Participants: Undergraduates (n = 595) at a large sou...

Adverse childhood experiences (ACEs), such as maltreatment and severe household dysfunction, represent a significant threat to public health as ACEs are associated with increased prevalence of several chronic diseases. Biological embedding, believed to be rooted in dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis, is the prevailing theory by which chronic diseases become imprinted in individuals following childhood adversity. A shift towards HPA axis hypoactivity occurs in response to ACEs exposure and is proposed to contribute towards altered cortisol secretion, chronic low-grade inflammation, and dysregulated hemodynamic and autonomic function. This shift in HPA axis activity may be a long-term effect of glucocorticoid receptor methylation with downstream effects on hemodynamic and autonomic function. Emerging evidence suggests syncopal tendencies are increased among those with ACEs and coincides with altered neuroimmune function. Similarly, chronic low-grade inflammation may contribute towards arterial baroreceptor desensitization through increased arterial stiffness, negatively impacting autonomic regulation following posture change and increasing rates of syncope in later life, as has been previously highlighted in the literature. Although speculative, baroreceptor desensitization may be secondary to increased arterial stiffness and changes in expression of glucocorticoid receptors and arginine vasopressin, which are chronically altered by ACEs. Several research gaps and opportunities exist in this field and represent prospective areas for future investigation. Here, we synthesize current findings in the areas of acute psychosocial stress reactivity pertaining to HPA axis function, inflammation, and hemodynamic function while suggesting ideas for future research emphasizing systemic interactions and postural stress assessments among those with ACEs. This review aims to identify specific pathways which may contribute towards orthostatic intolerance in populations with history of childhood adversity.

Nephrogenic adenoma is a rare, benign lesion that can be encountered anywhere along the urinary tract. It is associated with genitourinary trauma, chronic inflammation, genitourinary surgery, renal transplant, urolithiasis, and radiation. In children, these lesions are almost exclusively found in the bladder. However, we report an unusual case of a 15-year-old boy with no prior urologic history who presented with an obstructing right ureteral nephrogenic adenoma that required an ileal ureter interposition and right ureterectomy.

One of the co-authors, Raffy Dotan, wishes to remove his name from the original version of this article. The corrected author group should be.

In this paper, links between creativity, design, and innovation are explored through the literature specific to the textile and apparel industries. We discuss the ways that the apparel industry embodies entrepreneurial innovation through creativity and design that makes it an exemplar of the idea of “Main Street” entrepreneurship, albeit one that relies in part on “Silicon Valley” innovation via its relationship with the textile industry. We conclude with a discussion of the need for more research on the topic and offer recommendations for future empirical investigations. Further research specific to the apparel industry would augment the thin foundation of existing literature and shed light on how innovation occurs through creativity and design within a key global industry and “Main Street” endeavor.

To investigate cutaneous sensory nerve contribution to hyperaemia following chronic shear stress training.Eleven males underwent a shear stress intervention (forearm occlusion 5 s, rest 10 s) for 30 min, 5 times·weekIn response to local heating, EMLA treatment significantly delayed the onset of vasodilatation (p 0.001), time-to-peak (p 0.001), time to 39 °C (p 0.02), time to 42 °C (p 0.006), but not time to 44 °C (p 0.2). EMLA treatment also increased time-to-peak for PORH (p ≤ 0.01). In the experimental limb after 6 weeks, both onset time and time to peak were shorter in response to local heating at the untreated and EMLA-treated sites (all p 0.001). There were no changes in time-to-peak for PORH at the untreated and EMLA-treated sites (p ≥ 0.4); however, the peak PORH response was reduced with EMLA treatment (p ≤ 0.03). The 6-week intervention increased the peak PORH at the untreated sites (p 0.001) but not at EMLA-treated (p 0.05) sites. Comparing the control limb before and after 6 weeks, no differences in responses occurred at either the untreated skin sites (p ≥ 0.9) or the EMLA-treated sites (p ≥ 0.9).Sensory nerve blockade attenuated the improvements in cutaneous vascular responses to thermal hyperaemia and PORH following chronic exposure to shear stress. These data demonstrate an important role for sensory nerve function in the initiation of vasodilatation to both PORH and thermal hyperaemia, in both the time to onset and the magnitude of vasodilatation.

Individuals with Alzheimer’s disease may not be able to dress themselves due to memory limitations. Thus, the role of caregivers is important, as they are the individuals who assist those with Alzheimer’s in completing not just medical tasks, but fundamental activities of daily living, such as selecting garments to wear and getting dressed. The purpose of this study was to understand how caregivers make such choices. This study employed qualitative interviews with twelve caregivers. Four themes emerged to structure the interpretation, The Role of Proxy, Routine Selections, Gift-Giving for Loved Ones, and Triangular Relationships. In general, the higher self-complexity of individuals with Alzheimer’s stems from the confusion and frustration. Based on the framework of choosing-for-others, the clothing choices of individuals with Alzheimer’s by family member caregivers illustrate options based on the relationship and highlight the recipient’s preferences.

Nursing students bring an array of morals, values, and ethics that may be inconsistent with ethical integrity. This study explored nurse educator perceptions of student ethical integrity and how educators can foster an ethical foundation in students and novice educators. Four major themes influencing ethical integrity emerged: the learning environment, behaviors, ethical principles, and a toolbox of strategies. Strategies for fostering ethical integrity included: modeling ethical integrity, effective communication, grading accuracy, faculty perceptions, and faculty peer mentoring.

We sought to highlight the current advances in the oral treatments for overactive bladder in the pediatric population. We discuss gold standard therapies as well as describe more recent advances. Several therapies that have previously been approved in the adult populations are explored here, including combination therapies and mirabegron. Children with overactive bladder are now provided with more therapeutic options than previously available. Anticholinergics alone or in combination with medications such as mirabegron or alpha-blockers (in the setting of bladder outlet obstruction) improve bladder capacity and rates of dryness in these children. Further research is underway to further improve the drugs at hand while reducing their side effect profiles.

In this review, we will describe the techniques which we have developed to properly diagnose the constipation component of pediatric bowel and bladder disorders (BBD) in children and the treatment techniques that most rapidly and effectively resolve these issues. Constipation is commonly understood to be a major component of dysfunctional elimination syndrome in children. All methodologies described for the treatment of overactive bladder dysfunction in the pediatric population include the treatment of constipation as a critical component. Diagnostic techniques that remain inconclusive are best used to diagnose constipation and the treatment modalities most ideally suited to address bowel dysfunction in these patients.

The expert performance approach is reviewed as a systematic framework for the study of expertise. Its potential as a framework for the study of how experts learn is presented. The need to develop representative tasks to capture learning is discussed, as is the need to employ process-tracing measures during acquisition to examine what actually changes during learning and to use realistic retention and transfer tests. A focus on individual differences in learning within groups of expert performers is recommended in order to identify characteristics of more efficient and effective learning. The identification and study of how experts learn will enhance our understanding of skill acquisition and how this may be promoted using instructional interventions and practice opportunities. The challenge for scientists is to generate knowledge that helps those involved in facilitating skill acquisition continue to help experts acquire and refine skills across professional domains.

This study examined the effect of ageing on the low-frequency oscillations (vasomotion) of skin blood flow in response to local heating (LH). Skin blood flow was assessed by laser-Doppler flowmetry on the forearm at rest (33 °C) and in response to LH of the skin to both 42 °C and 44 °C in 14 young (24 ± 1 years) and 14 older (64 ± 1 years) participants. Vasomotion was analyzed using a wavelet transform to investigate power of the frequency intervals associated with endothelial, neural, myogenic, respiratory, and cardiac activities of the laser-Doppler signal. Laser-Doppler flux increased in both groups with LH (both d > 1.8, p < 0.001). Endothelial activity increased in both groups following LH to 42 °C (young d = 1.4, p < 0.001; older d = 1.2, p = 0.005) and 44 °C (young d = 1.4, p = 0.001; older d = 1.5, p = 0.005). Endothelial activity was higher in the young compared to older group during LH to 42 °C (d = 1.4, p = 0.017) and 44 °C (d = 1.5, p = 0.004). In response to LH to 42 °C and 44 °C, neural activity in both groups was decreased (both groups and conditions: d > 1.2, p < 0.001). Myogenic activity increased in the younger group following LH to 44 °C (d = 1, p = 0.042), while in the older group, myogenic activity increased following LH to 42 °C (d = 1.2, p = 0.041) and 44 °C (d = 1.1, p = 0.041). Respiratory and cardiac activities increased in both groups during LH to 42 °C and 44 °C (All: d > 0.9, p < 0.017). There were no differences in wavelet amplitude between younger and older in the neural (d = 0.1, p > 0.7), myogenic (d = 0.3, p > 0.7), respiratory (d = 0.4, p > 0.6), and cardiac (d = 0.1, p > 0.7) frequency intervals. These data indicate that LH increases cutaneous endothelial and myogenic activity, while decreasing neural activity. Furthermore, ageing reduces the increase in cutaneous endothelial activity in response to LH. © 2017

Children thermoregulate effectively during exercise despite sweating rate being consistently lower when compared with adults. The skin blood flow (SkBF) response of children to exercise is inconsistent, when compared with adults. We examined the SkBF response to exercise in children and adults, along with the potential contribution of nitric oxide to the SkBF response. Forearm SkBF during cycling (30 min at 60% $$\dot{V}$$O2max) was investigated in 12 boys (10 ± 1 years) and 12 men (22 ± 2 years) using laser-Doppler flowmetry and Nω-nitro-l-arginine methyl ester (L-NAME) iontophoresis to inhibit nitric oxide synthase. The exercise-induced SkBF increase was similar in boys and men (mean ± SD, 540 ± 127 vs. 536 ± 103% baseline, respectively, p = 0.43, d = 0.01 [− 0.8 to 0.8]). However, the total hyperaemic response to exercise (area-under-the-curve, AUC) indicated that boys had a greater vasodilatory response (cutaneous vascular resistance, CVC) (p

Objective Spectral analyses of laser-Doppler flowmetry measures enable a simple and non-invasive method to investigate mechanisms regulating skin blood flow. We assessed within-day and day-to-day variability of cutaneous spectral analyses. Methods Eleven young, healthy males were tested twice in three identical sessions, with 19 to 24 days between visits, for a total of six tests. Wavelet data were analyzed at rest, in response to local skin heating to 42 and 44°C, and during 5-minutes PORH. We did this for six frequency bands commonly associated with physiological functions. To assess reliability, we calculated CV and ICC scores. Results At rest, mean CV for the wavelet data ranged from 21% to 24% and ICC scores ranged from 0.67 to 0.91. During local heating, mean CV scores ranged from 17% to 22% and mean ICC scores ranged from 0.71 to 0.95. For peak PORH, CV ranged from 14% to 23% and the ICC range was 0.88 to 0.97. For the area under the curve of the PORH, CV range was 12% to 21% and ICC range was 0.81 to 0.92. Conclusions These analyses indicate good-to-excellent reliability of the wavelet data in healthy young males.

We compare microvascular reactivity assessed by laser-Doppler fluxmetry (LDF) and laser speckle contrast imaging (LSCI) of boys and men during rest, post-occlusive reactive hyperaemia (PORH), and cycling exercise.19 boys (9 ± 1 y) and 18 men (22 ± 2 y) participated. LDF and LSCI measures were taken of the forearm during rest, PORH, and exercise.For all 3 assessments, the LSCI presented with higher flux values than the LDF for both boys and men (p 0.001). Bland-Altman analyses indicated that there was a positive linear bias between LSCI and LDF measurements in both boys and men. Regression analyses showed that the responses for the two methods were variable, depending on the particular assessment. For instance, at rest in boys there was no relationship between LDF and LSCI (rLSCI presented with higher values than LDF during rest, PORH, and exercise; the disparity between the two measures was larger as blood flow increased. The assessments were generally consistent, both methods appear to provide usable data for the assessment of microvascular reactivity in both boys and men. There are biases to each method and the data are not interchangeable between LDF and LSCI.

According to the European Skills Council, the apparel industry is experiencing a renaissance in countries throughout the European Union, and this renaissance is marked by innovation and technical development among small firms. In this paper, the AEGIS database is used to estimate a growth model for the apparel industry. The annual rate of growth of European apparel firms is modeled and measured in terms of growth in number of employees since the firm was founded. The model is presented through descriptive statistical analyses on the relevant variables that were used to estimate this dimension of firm performance—founder characteristics including gender and education, as well as whether the firm is family owned. The model has implications for identifying factors important to apparel firm growth that could help in policy development designed to foster increased industry growth.

To investigate the treatment outcome in terms of the malocclusion features and the changes in the occlusion of patients undergoing orthodontic/orthognathic treatment using the Peer Assessment Rating (PAR) and the Index of Complexity, Outcome and Need (ICON) and to test the application of the Index of Orthognathic Functional Treatment Need (IOFTN) on this sample as a measure of orthognathic pre-treatment need.Retrospective longitudinal cohort study.The orthodontic department at the Eastman Dental Hospital.The study models of a sample of 100 orthodontic/orthognathic patients who were treated at the Eastman Dental Hospital were measured using the PAR index and ICON at three stages: pre-treatment, pre-surgery and at debond. Treatment need was assessed by measuring IOTN and IOFTN using start study models.99% of the sample showed an improvement in PAR score, with 82% of the sample being greatly improved. ICON showed that 95% of the sample had an improvement of different degrees with 5% being not improved or worse. The IOFTN qualified 97% of the patients for orthognathic treatment when used retrospectively on the sample while the DHC of IOTN qualified the whole sample for orthodontic treatment.Orthodontic/orthognathic treatment showed improved and acceptable overall results. The PAR index and ICON were valid measures to investigate the outcome of orthognathic treatment. IOFTN proved to be a useful tool in determining and prioritizing orthognathic treatment based purely on functional need.

We have demonstrated in previous publications the consistent association of the dilated rectum and overactive bladder in children. The pioneering work on this topic, first published by Sean O’Regan, described an enema regimen ideally suited to resolve megaretcum and voiding compliants in these children. As our experience has grown with this population, we have gained more insight into the function of the dilated rectum, its role in dysfunctional elimination syndrome, and the methods required for its most effective resolution. In this review, we will describe the Modified O’Regan protocol, which we have developed to treat patients resistant to Dr. O’Regan’s originally described regimen, and we will introduce the concept of “rectal failure,” which we feel fully describes the onset and progression of dysfunctional elimination syndrome.

Sydney Domville Rowland was a bacteriologist and staff member at the Lister Institute of Preventive Medicine when the First World War broke out in 1914. Following a request to the Director of the Lister Institute to staff and equip a mobile field laboratory as quickly as possible, Rowland was appointed to take charge of No. 1 Mobile Laboratory and took up a temporary commission at the rank of Lieutenant in the Royal Army Medical Corps. On 9 October 1914, Rowland set out for the European mainland and was subsequently attached to General Headquarters in Saint-Omer, France (October 1914-June 1915), No. 10 Casualty Clearing Station in Lijssenthoek, Belgium (June 1915-February 1916, during which period he was promoted Major), and No. 26 General Hospital in Etaples, France (February 1916-March 1917). His research focused on gas gangrene, typhoid fever, trench fever, wound infection and cerebrospinal fever. In February of 1917, while engaged in identifying meningococcal carriers, Rowland contracted cerebrospinal meningitis to which he succumbed at age 44 on 6 March 1917. His untimely death might have been caused by laboratory-acquired meningococcal disease, especially since Rowland9s work with Neisseria meningitidis isolates had extended beyond routine laboratory techniques and included risk procedures like immunisation of rabbits with pathogenic strains isolated from cerebrospinal fluid. Currently, microbiology laboratory workers who are routinely exposed to N. meningitidis isolates are recognised as a population at increased risk for meningococcal disease, for which reason recommended preventive measures include vaccination and handling of isolates within a class II biosafety cabinet.

Foreign body insertion into the ears and nose is common in children and is often witnessed by the carer or reported by the child and therefore appropriate management can be sought promptly. However, these incidents can go unreported and may be accompanied by non-specific symptoms making diagnosis difficult. Button batteries are common in everyday life and their small size and shiny appearance make them appealing to children and their ingestion or insertion is not uncommon. Due to their size, shape and electrochemical composition button batteries pose serious complications if ingested, inhaled or inserted. In the nose they usually cause intense local tissue reactions resulting in severe tissue destruction, septal necrosis or stenosis of the nasal cavity as well as posing the risk of subsequently being ingested or aspirated. This case report details an incidental finding of a button battery in the floor of the nose discovered on routine orthodontic radiographs. An upper standard occlusal and dental panoramic tomography showed a radiopaque, cylindrical, object in the floor of the nose which a subsequent CBCT localized to the floor of the right nasal fossa. The patient required orthodontic extractions and the exposure and bonding of teeth under general anaesthetic. Therefore the battery was removed by the maxillofacial surgery team at the same general anaesthetic. This is a rare case of an incidental finding of a long-standing button battery impaction which was asymptomatic and did not have any detrimental effects. This case highlights the dangers of button battery impaction and the need for prompt referral for removal.

Objectives: To seek the views of adolescents with malocclusion about how the appearance and arrangement of their teeth affects their everyday life and to incorporate these views into a new Malocclusion Impact Questionnaire (MIQ). Methods: Semi-structured interviews were undertaken with a purposive sample of 30 young people (10–16 years) referred for orthodontic treatment to two dental teaching hospitals. The interviews were recorded, transcribed and analysed using framework analysis. Several themes and sub themes were identified and these were used to identify items to include in the new measure. Results: Three themes emerged which were: concerns about the appearance of their teeth, effect on social interactions and oral health/function. Participants expressed the view that their teeth did not look normal, causing them embarrassment and a lack of confidence, particularly when they were with their peers or having their photograph taken. Concerns regarding the potential effect of a malocclusion on oral health, in terms of food becoming stuck between crooked teeth, interferences when chewing and increased risk of damaging the teeth were also identified. The themes were used to generate individual items for inclusion in the questionnaire. Conclusions: Common themes relating to the impact of malocclusion on the lives of young people were identified and generated items for the new MIQ to measure the oral health-related quality of life of young people with malocclusion. Part 2 outlines the further development and testing of the MIQ.

Objective: To test the items, identified through qualitative inquiry that might form the basis of a new Malocclusion Impact Questionnaire (MIQ) to measure the oral health-related quality of life (OHQoL) of young people with malocclusion. Methods: Piloting with 13 young people reduced the number of items from 37 to 28. Cross-sectional testing involved a convenience sample aged 10–16 years, attending the Orthodontic Department of the Charles Clifford Dental Hospital, Sheffield. The fit and function of the initial MIQ questions were examined using item response theory. Results: 184 participants (113 females; 71 males) completed a questionnaire (response 85%), seven participants were excluded due to missing responses. The mean age of participants was 12·9 years (SD 1·4) and they had a wide range of malocclusions. The majority were White British (67·4%). Data from 47 participants were used to analyse test–retest reliability. Rasch analysis was undertaken, which further reduced the number of items in the questionnaire from 28 to 17. Unidimensionality of the scale was confirmed. The analysis also identified that the original 5-point response scale could be reduced to three points. The new measure demonstrated good criterion validity (r = 0·751; P

Objective Spectral analyses of laser-Doppler signal can delineate underlying mechanisms in response to pharmacological agents and in cross-sectional studies of healthy and clinical populations. We tested whether spectral analyses can detect acute changes in endothelial function in response to a 6-week intervention of repeated bouts of hyperaemia. Methods Eleven males performed forearm occlusion (5 s with 10 s rest) for 30 min, 5 times/week for 6 weeks on one arm; the other was an untreated control. Skin blood flow was measured using laser-Doppler fluxmetry (LDF), and endothelial function was assessed with and without nitric oxide (NO) synthase-inhibition with L-NAME in response to local heating (42 °C and 44 °C) and acetylcholine. A wavelet transform was used for spectral analysis of frequency intervals associated with physiological functions. Results Basal measures were all unaffected by the hyperaemia intervention (all P > 0.05). In response to local skin heating to 42 °C, the 6 weeks hyperaemia intervention increased LDF, endothelial NO-independent and NO-dependent activity (all P ≤ 0.038). In response to peak local heating (44 °C) endothelial NO-independent and NO-dependent activity increased (both P ≤ 0.01); however, LDF did not (P > 0.2). In response to acetylcholine, LDF, endothelial NO-independent and NO-dependent activity all increased (all P ≤ 0.003) post-intervention. Conclusions Spectral analysis appears sufficiently sensitive to measure changes over time in cutaneous endothelial activity that are consistent with standard physiological (local heating) and pharmacological (acetylcholine) interventions of assessing cutaneous endothelial function, and may be useful not only in research but also clinical diagnosis and treatment.

We examined the effects of 4 different wheelchair seatings on physiological and perceptual measures in 21 healthy, pre-pubertal children (9 ± 2 years). Participants were able-bodied and did not regularly use a wheelchair. Participants sat for 2 h in Neutral (∼22.5 °C, ∼40%RH) and Hot (∼35 °C, ∼37%RH) conditions. Four seating technologies were: standard incontinent cover and cushion (SEAT1); standard incontinent cover with new cushion (SEAT2) were tested in Neutral and Hot; new non-incontinent cover with new cushion (SEAT3); new incontinent cover and new cushion (SEAT4) were tested in Neutral only. Measurements included skin blood flow (SkBF), sweating rate (SR) and leg skin temperature (TlegB) on the bottom of the leg (i.e. skin-seat interface), heart rate (HR), mean skin temperature, tympanic temperature, thermal comfort, and thermal sensation. During Neutral, SkBF and TlegB were lower (∼50% and ∼1 °C, respectively) and SR higher (∼0.5 mg cm−2·min−1) (p 0.05). During Hot, HR and temperatures were higher than in Neutral but there were no differences (p > 0.05) between SEATs. New cover and cushion improved thermoregulatory responses during Neutral but not Hot. An impermeable incontinent cover negated improvements from cushion design. Seat cover appears more important than seat cushion during typical room conditions.

Using the 2004 and 2008 panels of the Survey for Income and Program Participation (SIPP), we examine whether the heavily feminized health care industry produces “good jobs” for workers without a college degree as compared to other major industries. For women, we find that jobs in the health care industry are significantly more likely than the food service and retail industries to provide wages above $15 per hour, health benefits, fulltime hours, and job security. Jobs in the health care industry are not “good jobs” for low- and middle-skill men in terms of wages, relative to the industries of construction and manufacturing, but health care jobs can provide men with greater job security, and in comparison to construction, a higher probability of employer-based health insurance. That said, the findings emphasize that because men and women are differentially distributed across industries, access to different forms of job quality is also gendered across industries, with important implications for gender dynamics and economic strain within working class families.

Few studies have investigated skin blood flow in children and age-related differences in the underlying mechanisms. We examined mechanisms of skin blood flow responses to local heating, postocclusive reactive hyperaemia (PORH), and isometric handgrip exercise in adult and prepubescent males, hypothesizing that skin blood flow responses would be greater in children compared with adults. We measured skin blood flow in 12 boys (age, 9 ± 1 years) and 12 men (age, 21 ± 1 years) using laser-Doppler flowmetry at rest, in response to 3-min PORH, 2-min isometric handgrip exercise, and local skin heating to 39 °C (submaximal) and 44 °C (maximal). Using wavelet analysis we assessed endothelial, neural, and myogenic activities. At rest and in response to local heating to 39 °C, children had higher skin blood flow and endothelial activity compared with men (d ≥ 1.1, p < 0.001) and similar neurogenic and myogenic activities (d < 0.2, p > 0.05). Maximal responses to 44 °C local skin heating, PORH, and isometric handgrip exercise did not differ between boys and men (all d ≤ 0.2, p > 0.05). During PORH children demonstrated greater endothelial activity compared with men (d ≥ 0.6, p < 0.05); in contrast, men had higher neurogenic activity (d = 1.0, p < 0.01). During isometric handgrip exercise there were no differences in endothelial, neurogenic, and myogenic activities (d < 0.2, p > 0.3), with boys and men demonstrating similar increases in endothelial activity and decreases in myogenic activity (d ≥ 0.8, p < 0.05). These data suggest that boys experience greater levels of skin blood flow at rest and in response to submaximal local heating compared with men, while maximal responses appear to be similar. Additionally, endothelial mediators seem to contribute more to vasodilatation in boys than in men.

This study examined self-paced, high-intensity exercise during mild hypothermia and whether hyperoxia might offset any potential impairment. Twelve trained males each completed 15-km time trials in three environmental conditions: Neutral (23°C, [Formula: see text] 0.21), Cold (0°C, [Formula: see text] 0.21), and Cold+Hyper (0°C, [Formula: see text] 0.40). Cold and Cold+Hyper trials occurred after a 0.5°C drop in rectal temperature. Rectal temperature was higher ( P ≤ 0.016) throughout Neutral compared with Cold and Cold+Hyper; Cold had a higher ( P ≤ 0.035) rectal temperature than Cold+Hyper from 2.5 to 7.5 km, and hyperoxia did not alter thermal sensation or comfort. Oxyhemoglobin saturation decreased from ~98% to ~94% with Neutral and Cold, but was maintained at ~99% in Cold+Hyper ( P < 0.01). Cerebral tissue oxygenation index (TOI) was higher in Neutral than in Cold throughout the time trial (TT) ( P ≤ 0.001), whereas Cold+Hyper were unchanged ( P ≥ 0.567) from Neutral by 2.5 km. Muscle TOI was maintained in Cold+Hyper compared with Neutral and was higher ( P ≤ 0.046) than Cold throughout the entire TT. Power output during Cold (246 ± 41 W) was lower than Neutral (260 ± 38 W) at all 2.5-km intervals ( P ≤ 0.012) except at 12.5 km. Power output during Cold+Hyper (256 ± 42 W) was unchanged ( P ≥ 0.161) from Neutral throughout the TT, and was higher than Cold from 7.5 km onward. Average cadence was higher in Neutral (93 ± 8 rpm) than in either Cold or Cold+Hyper (Cold: 89 ± 7 and Cold+Hyper: 90 ± 8 rpm, P = 0.031). In conclusion, mild hypothermia reduced self-paced exercise performance; hyperoxia during mild hypothermia restored performance to thermoneutral levels, likely due to maintenance of oxygen availability rather than any thermogenic benefit. NEW & NOTEWORTHY We examined self-paced, high-intensity exercise with 0.5°C rectal temperature decreases in a 0°C ambient environment, along with whether hyperoxia could offset any potential impairment. During a 15-km time trial, power output was lower with hypothermia than with thermoneutral. However, with hypothermia, hyperoxia of [Formula: see text] = 0.40 restored power output despite there being no thermophysiological improvement. Hypothermia impairs exercise performance, whereas hyperoxia likely restored performance due to maintenance of oxygen availability rather than any thermogenic benefit.

Research has shown the effectiveness of observational practice for motor learning, but there continues to be debate about the mechanisms underlying effectiveness. Although cortical processes can be moderated during observation, after both physical and observational practice, how these processes change with respect to behavioural measures of learning has not been studied. Here we compared short-term physical and observational practice during the acquisition and retention of a novel motor task to evaluate how each type of practice modulates EEG mu rhythm (8–13 Hz). Thirty healthy individuals were randomly assigned to one of three groups: (1) physical practice (PP), (2) observational practice (OP), and (3) no practice (NP) control. There were four testing stages: baseline EEG, practice, postpractice observation, and delayed retention. There was significant bilateral suppression of mu rhythm during PP but only left lateralized mu suppression during OP. In the postpractice observation phase, mu suppression was bilateral and larger after PP compared to that after OP. NP control showed no evidence of suppression and was significantly different to both the OP and PP groups. When comparing the three groups in retention, the groups did not differ with respect to tracing times, but the PP group showed fewer errors, especially in comparison to the NP group. Therefore, although the neurophysiological measures index changes in the OP group, which are similar but moderated in comparison to PP, changes in these processes are not manifest in observational practice outcomes when assessed in a delayed retention test.

The development of “replacement parts” for humans has been the dream of clinicians ever since solitary organ dysfunction has been identified as the cause of morbidity and mortality in otherwise healthy humans. Organ transplantation has been used successfully to prolong and improve life for countless patients but has also introduced new disease processes and morbidities that force us to look for better solutions. Autologous tissue and organ transplantation is seen as the ultimate goal, as the ability to grow replacement organs and tissues would revolutionize the care of patients with organ failure and does not come burdened with the risk of immunologic rejection. In this summary, we will describe the history and techniques of tissue and organ engineering and its promise to provide autologous bladder tissue for use in children with bladder disease.

Non-neurogenic bladder dysfunction, or bladder dysfunction in children with an intact nervous system, falls under the generic term of dysfunctional elimination. This bladder dysfunction encompasses a variety of different symptom presentations whose unifying characteristic usually involves an overactive bladder or involuntary and uninhibited bladder contractions. This syndrome of dysfunctional elimination is linked to pelvic floor dysfunction which does not allow for adequate voluntary pelvic floor relaxation which then prevents complete emptying during micturition or defecation, resulting in extreme cases in urinary and fecal incontinence. The origins and most appropriate therapies for this disorder remain a matter of debate. We will present what we believe the preponderance of the evidence points to as the causes of non-neurogenic bladder dysfunction in children and methods for its most efficacious prevention and treatment.

The aim of this study is to determine the effect of repeated bouts of local skin heating on the roles of nitric oxide synthase (NOS) and sympathetic nerves in cutaneous vasodilatation. In 3 repeated-heating protocols skin blood flux of the forearm and leg was measured using laser-Doppler flowmetry and data are presented as cutaneous vascular conductance (CVC; flux/blood pressure). Local heating was performed from 33°C (thermoneutral) to 42°C at 0.5°C·10s(-1), allowed to cool passively for ~60-min, then reheated at the same rate. In protocol 1, CVC was measured in response to repeated heating. In protocol 2, NOS was inhibited with N(G)-nitro-l-arginine methyl ester (L-NAME) and in protocol 3, sympathetic nerve blockade was achieved with bretylium tosylate (BT), both infused via intradermal microdialysis. In protocol 1, there were no differences (P0.05) in CVC at either the forearm (88±4 vs. 86±4%max) or the leg (97±4 vs. 96±6%max) between heating bouts. In protocol 2, no differences (P0.05) in CVC were observed between heating bouts at L-NAME treated sites at either the forearm (55±3 vs. 51±4%max) or the leg (71±3 vs. 70±4%max) . In protocol 3, there were differences (P0.001) between BT treated sites when comparing the first and second bouts of heating for both the forearm (75±3 vs. 88±4%max) and the leg (79±3 vs. 97±4%max). The effect of sympathetic blockade on CVC responses to local heating was abolished following repeated bouts of heating. Consequently, it is our suggestion that when examining mechanisms of skin blood flow control, investigators use single bouts of local heating.

This chapter uses the AEGIS data to construct measures of entrepreneurial performance so that the second part of the Sources of Knowledge→Strategic Behavior→Entrepreneurial Performance relationship can be examined empirically. The performance measures are related to commercialization, sales growth, and employment growth.

Regarding the relationship Sources of Knowledge→Strategic Behavior→Entrepreneurial Performance, the empirical evidence suggests that for textile firms, technical sources of knowledge affect the strategic behavior of firms, and that behavior in turn affects entrepreneurial behavior as measured by sales growth. However, for apparel firms, technical sources of knowledge have a direct rather than an indirect effect on sales growth.

This chapter explores the sources of knowledge identified in Chap. 6, and investigates if there is a direct relationship between the importance of the factors and sources of knowledge and entrepreneurial performance. The ultimate goal of this chapter is to consider the strength of the first part of the relationship: Sources of Knowledge→Strategic Behavior→Entrepreneurial Performance. The empirical evidence supports that sources of knowledge are related to strategic behaviors.