Search

Nurse practitioners (NPs) and physician assistants (PAs) have an important role in delivery of care in a tertiary children's hospital emergency department (ED). Most NPs and PAs have not had any formal training to work in a pediatric ED; although our NPs and PAs had no formal ED training, some were acute care certified. We describe a curriculum designed to improve knowledge and skills of NPs and PAs in the pediatric ED. The curriculum consists of three modules, namely, online lecture series, procedural workshops, and case scenarios in a simulated setting. Module 1 consisted of online lecture on 10 common ED diagnoses. The second module consisted of procedural workshops on lumbar puncture, incision and drainage of abscesses, gastrostomy insertion, and laceration repair. The third module included simulation scenarios on ED-specific cases of seizure in an infant, bronchiolitis and ruptured appendicitis with shock. Each module was evaluated by a survey. Participants rated each item on the survey using a Likert scale response (1 = disagree completely to 5 = agree completely ). Both NPs and PAs demonstrated increase in knowledge scores in posttest 1 vs pretest ( p.001) and did not show a significant decline in posttest 2 ( p = .073). The mean ratings of components of the online lecture series, workshops, and simulation scenarios were 4.5-4.7, 4.4-4.8, and 4.5-4.7, respectively, with positive comments. This novel curriculum meets the educational needs of NPs and PAs at our institution and can be used as a model to train them at other tertiary care pediatric EDs.

Introduction Optimal resuscitation team size for workload distribution among team members is not known. In addition, decision support tools (DSTs) are available to improve team performance, but the effect on workload is not known. Because increased workload can impair performance, we aimed to determine whether team size or use of a DST alters workload in healthcare providers (HCPs) while performing neonatal resuscitation. Methods We report a substudy of a randomized, 2 × 2 factorial design study using 109 Neonatal Resuscitation Program-trained HCPs. Healthcare providers were randomized to 1 of 4 permutations, including team size of 2 versus 3 and using DST versus memory alone while performing 2 simulated neonatal resuscitations. The HCPs' workload was assessed by the National Aeronautics and Space Administration Task Load Index obtained after each scenario. Mixed effects linear models compared the effect of team size and DST use on National Aeronautics and Space Administration Task Load Index scores. Results When all team members were combined, there was an increased workload in teams of 2 HCPs compared with teams of 3 and was primarily due to an increase in workload on the team leaders. Decision support tool use increased workload for the other team members in the first of the 2 scenarios but did not increase workload in the second scenario. Conclusions Teams of 2 HCPs reported a higher workload compared with teams of 3 HCPs. Decision support tool use can increase workload for other team members when first introduced as a new task. This study highlights the need to consider factors that negatively affect mental workload when determining the composition of a resuscitation team.

To study characteristics of oxygenation during the first 2 postnatal months and correlation with the occurrence and severity of retinopathy of prematurity (ROP) among infants of extremely low birth weight.This retrospective study analyzed the incidence and severity of hyperoxemia and hypoxemia while on respiratory support with or without supplemental oxygen among infants of extremely low birth weight (birth weight1000 g) admitted to the neonatal intensive care unit during 2016-2020. The findings were correlated with the occurrence and severity of ROP after adjusting for baseline covariates.After adjusting for differences in baseline demographic and clinical features, the group with severe ROP was exposed to greater fraction of inspired oxygen (FiOSevere ROP is associated with greater FiO

Skin and soft tissue infections (SSTIs) are a common reason for presentation to the emergency department (ED) and account for 3% of ED visits. Patients with a diagnosis of cellulitis requiring intravenous (IV) antibiotics have traditionally been admitted to the hospital. In our institution, these patients are placed in the ED Observation Unit (EDOU) for IV antibiotics.The purpose of this study is to determine if 3 doses of IV antibiotics are adequate to document clinical improvement in children with uncomplicated SSTI.A prospective cohort study of children aged 3 months to 18 years with uncomplicated SSTI admitted (2009-2013) to the EDOU at a children's hospital for IV antibiotics was conducted.One hundred six patients (mean age, 68 months) were enrolled; 57% were boys, 53% of patients had cellulitis only and 47% had cellulitis with drained abscesses. There was a significant decrease in pain scores and size of cellulitis from arrival to discharge (P0.001 and P0.001, respectively). Eighty-three percent of patients were discharged after 3 to 4 doses of antibiotics, and 17% were admitted. The location of the wound, presence of systemic symptoms, and prior use of oral antibiotics did not predict admission in our study.The EDOU is a reasonable alternative to inpatient admission in the management of patients with uncomplicated SSTI requiring IV antibiotics.

Objective We studied rapid response events after acute clinical instability outside ICU settings in pediatric cardiac patients. Our objective was to describe the characteristics and outcomes after rapid response events in this high-risk cohort and elucidate the cardiac conditions and risk factors associated with worse outcomes. Design A retrospective single-center study was carried out over a 3-year period from July 2011 to June 2014. Setting Referral high-volume pediatric cardiac center located within a tertiary academic pediatric hospital. Patients All rapid response events that occurred during the study period were reviewed to identify rapid response events in cardiac patients. Interventions None. Measurements and main results We reviewed 1,906 rapid response events to identify 152 rapid response events that occurred in 127 pediatric cardiac patients. Congenital heart disease was the baseline diagnosis in 74% events (single ventricle, 28%; biventricle physiology, 46%). Seventy-four percent had a cardiac surgery before rapid response, 37% had ICU stay within previous 7 days, and acute kidney injury was noted in 41% post rapid response. Cardiac and/or pulmonary arrest occurred during rapid response in 8.5%. Overall, 81% were transferred to ICU, 22% had critical deterioration (ventilation or vasopressors within 12 hr of transfer), and 56% received such support and/or invasive procedures within 72 hours. Mortality within 30 days post event was 14%. Significant outcome associations included: single ventricle physiology-increased need for invasive procedures and mortality (adjusted odds ratio, 2.58; p = 0.02); multiple rapid response triggers-increased ICU transfer and interventions at 72 hours; critical deterioration-cardiopulmonary arrest and mortality; and acute kidney injury-cardiopulmonary arrest and need for hemodynamic support. Conclusions Congenital heart disease, previous cardiac surgery, and recent discharge from ICU were common among pediatric cardiac rapid responses. Progression to cardiopulmonary arrest during rapid response, need for ICU care, kidney injury after rapid response, and mortality were high. Single ventricle physiology was independently associated with increased mortality.

The neonatal cutaneous mycobiome has not been characterized in preterm infants. Invasive fungal infections in preterm neonates are associated with high mortality. The immaturity of the preterm skin predisposes neonates to invasive infection by skin colonizers. We report the clinical and host determinants that influence the skin mycobiome.Skin swabs from the antecubital fossa, forehead, and gluteal region of 15 preterm and 15 term neonates were obtained during the first 5 weeks of life. The mycobiome was sequenced using the conserved pan-fungal ITS2 region. Blood samples were used to genotype immune modulating genes. Clinical metadata was collected to determine the clinical predictors of the abundance and diversity of the skin mycobiome.The neonatal mycobiome is characterized by few taxa. Alpha diversity of the mycobiome is influenced by antibiotic exposure, the forehead body site, and the neonatal intensive care unit (NICU) environment. Beta diversity varies with mode of delivery, diet, and body site. The host determinants of the cutaneous microbiome include single-nucleotide polymorphisms in TLR4, NLRP3,CARD8, and NOD2.The neonatal cutaneous mycobiome is composed of few genera and is influenced by clinical factors and host genetics, the understanding of which will inform preventive strategies against invasive fungal infections.

Background Substance use disorders during pregnancy are a concern both to the public and medical community, because the negative consequences can be detrimental to both mother and the fetus. The accurate identification of prenatal drug exposure is necessary to determine appropriate medical and psychosocial intervention, and to identify risk factors that may affect outcomes for the mother and her newborn. The prevalence of prenatal drug exposure is very difficult to estimate because of flaws in all methods of identification. Objective The study is designed to identify risk factors and demographic variables that contribute to nondisclosure of illicit and nonillicit substance use. In addition, this study aims to determine if nondisclosure leads to adverse neonatal outcomes. Study design Newborns delivered with a positive meconium or urine toxicology, and/or known maternal exposure to illicit and nonillicit substances, were identified. Maternal records were reviewed for disclosure of substance use during pregnancy at admission for delivery along with other medical and demographic variables. Women with antenatal prescription drug use that may alter toxicology screens were excluded from analysis. Pediatric records were also reviewed to obtain neonatal variables. Results One hundred sixty-eight newborns were identified as having prenatal exposure to an illicit or nonillicit substance over the 4-year period. Eighty-six per cent (145/168) of women tested positive or their newborn tested positive for at least 1 illicit substance, and 49% (82/168) tested positive for multiple illicit substances. Fifty-four per cent (91/168) of women did not disclose using at least one illicit drug for which she or her newborn tested positive.With regards to maternal characteristics, there was no statistically significant difference between age (P = 0.958), parity (P = 0.300), or race (P = 0.531), and disclosure or failure to disclose about illicit drug use. However, patients who did not report prenatal illicit drug use (33/82 = 40%) were less likely (P = 0.049) to receive complete prenatal care (defined as 3 or more visits) compared with those who acknowledged their substance use (40/70 = 57%). Conclusion Substance use disorders during pregnancy are an often underestimated cause of maternal, fetal, and neonatal complications. Limited studies have examined the relationship between maternal characteristics and associated illicit or nonillicit drug use. The absence of correlation between maternal demographics and disclosure of illicit substance use demonstrates the fact that all antepartum patients are at risk for these behaviors. Furthermore, the fact that women who did not disclose their illicit drug use were less likely to seek complete prenatal care reflects the need for physicians to provide a destigmatized healthcare environment, encouraging pregnant women to disclose their substance use so they can be provided with appropriate counseling and treatment.

Objective: To compare the efficacy of monofilament suture, braided polyester thread, and 5 mm tape suture in reducing preterm birth (PTB).Study design: Women who received a cerclage at Touro Infirm...

To evaluate the growth of premature infants fed a postdischarge diet of human milk (HM) complemented with transitional formula (TF) as compared with those fed TF only.In this prospective cohort study, 51 infants' diets and anthropometrics were collected at discharge and at 12-15 months corrected gestational age.Post discharge, infants in both groups exhibited similar growth velocities and changes in z-scores. The duration of infants' HM consumption was not correlated with weight gain (r = -0.25, p = 0.26). The duration of complementary TF feeds also did not correlate with increased growth (r = -0.11, p = 0.44). Both groups achieved catch-up growth and displayed growth velocities that significantly exceeded the upper limit of the World Health Organization (WHO) weight growth standard (p 0.001).Preterm infants receiving HM and complementary TF post discharge had growth velocities at or exceeding weight gain projected by the WHO growth standard for term infants.

Necrotizing enterocolitis (NEC) is a leading cause of newborn gastrointestinal emergencies, affecting 1-3 per 1000 live births. Although NEC has been linked to a microbial etiology, associations with maternal intrapartum and resultant newborn early-onset invasive Group B streptococcus (EO-GBS) have been weakly defined.The study aim was to determine the relationship between EO-GBS and NEC.Data from 2008 to 2015 were collected from pediatric records with ICD diagnosis codes consistent with all stages of NEC, with the exception of neonatal EO-GBS data (only available 2011-2015).For the 131 newborns meeting inclusion criteria, the mean gestational age (GA) and birthweight at delivery was 30.2 weeks and 1449 g. Maternal comorbidities were not associated with a more advanced stage of NEC, however male gender (OR 3.2, p .001), lower mean 1 (OR = 0.89, p = .045) and 5 min Apgar scores (OR = 0.84, p = .009) were significantly associated with higher NEC stage, after controlling for GA. Infectious morbidities including chorioamnionitis (OR = 1.5, p = .553) and intrapartum antibiotic administration (OR = 1.3, p = .524) were not significantly associated with higher NEC stage. Neither neonatal sepsis workup (OR = 0.27, p = .060) nor positive blood culture (OR = 0.97, p = .942) prior to NEC diagnosis were statistically significant. Type of feed prior to diagnosis (p = .530) was not significantly associated with NEC stage, however, expressed breast milk tended to be protective against higher stage of NEC (OR = 0.49, p = .055). Type of feed included total parenteral nutrition, mother's or donor expressed breast milk, trophic, full and high calorie feeds. Of the 579 newborns admitted from 2011 to 2015, 13 (2%) were diagnosed with EO-GBS and 64 met diagnostic criteria for NEC. GBS positive newborns had significantly higher odds of NEC (OR = 5.37, p = .009). NEC stage was not significantly different for patients with GBS positive vs. GBS negative mothers (p = .732), nor was there a significant difference in GA (p = .161).Our study is the first to describe a strong correlation between neonatal EO- GBS disease and NEC, with more than a five-fold increase in the odds of developing NEC in newborns of GBS positive mothers.To investigate a possible relationship between EO-GBS disease and the neonatal diagnosis of NEC. Secondary analysis will determine if maternal antepartum and intrapartum factors along with neonatal variables contribute to a more advanced stage of NEC by retrospective chart review of patient data collected at Children's Hospital: New Orleans.

Uncivil behavior by a faculty member or student can threaten a classroom environment and make it less conducive to learning. The aim of this study was to explore faculty behaviors that dental faculty and students perceive to be uncivil when exhibited in the classroom and clinic. In 2015, all faculty, administrators, and students at a single academic dental institution were invited to participate in an electronic survey that used a five-point Likert scale for respondents to indicate their agreement that 33 faculty behaviors were uncivil. Response rates were 49% for faculty and 59% for students. Significant differences were found between student and faculty responses on 22 of the 33 behavioral items. None of the three category composite scores differed significantly for students compared to faculty respondents. The category composite scores were not significantly associated with gender, ethnicity, or age for faculty or students. Overall, this study found significant differences between students and faculty about perceived uncivil faculty behaviors, though not for categories of behaviors.

Introduction White spot lesions are often seen on the teeth after orthodontic treatment, resulting in unpleasant esthetics. The aim of this in-vitro study was to compare subjectively and objectively the esthetic outcomes of white spot lesions treated with 3 commercially available products that have been reported to have a positive effect on the remineralization of enamel. Methods Forty extracted premolars were randomly allocated into 1 of 4 groups (n = 10). The teeth were exposed to a demineralization solution at 37°C for 14 days to produce white spot lesions that were about 100 μm deep. Each group was then randomly assigned to receive either control treatment with artificial saliva or treatment with 1 of the 3 commercially available products: Restore toothpaste (Dr. Collins Inc, Orange County, Calif), which contains NovaMin (Dr. Collins Inc); Prevident 5000 (Colgate, New York, NY); and MI Paste Plus (GC America, Alsip, Ill). All groups were evaluated 5 times at 6 time points during the study. Results The subjective and objective results were mixed within groups and between groups for the products tested. Conclusions We found no conclusive evidence that any of these 3 materials produced more favorable esthetic white spot lesion remineralization results.

Following the debonding of orthodontic brackets, the removal of residual adhesive from the enamel surface is required. Published adhesive removal protocols present conflicting advice.The present study evaluated the surface roughness of enamel after debonding and instrumentation with non-traditional orthodontic polishing systems.The facial aspects of 35 extracted human incisor teeth were scanned with a surface profilometer for surface roughness prior to the bonding of orthodontic brackets. After debonding, residual adhesive was removed with a 12-fluted titanium carbide bur. The teeth were randomly divided into seven groups (N = 5 per group) and the enamel surface was polished with one of seven products. All samples were re-scanned for surface roughness and subjectively evaluated via SEM.There was no significant difference in enamel surface roughness between the groups when compared using surface profilometry. Visual observations from the SEM evaluations demonstrated differences in the enamel surface at the microscopic level that were not detected by profilometric analysis.The present study found no statistically significant difference in mean enamel smoothness change from pretreatment to post-treatment between the seven polishing methods studied via profilometer surface reading measurements. An SEM analysis showed visual differences in enamel striations viewed at 1000x magnification in a comparison of traditional versus non- traditional polishing methods.

Anemia is common among adult heart failure patients and is associated with adverse outcomes, but data are lacking in children with heart failure. The purpose of this study was to determine the prevalence of anemia in children hospitalized with acute heart failure and to evaluate the association between anemia and adverse outcomes.Review of the medical records of 172 hospitalizations for acute heart failure.Single, tertiary children's hospital.All acute heart failure admissions to our institution from 2007 to 2012.None.Composite endpoint of death, mechanical circulatory support deployment, or cardiac transplantation.Patients ages ranged in age from 4 months to 23 years, with a median of 7.5 years, IQR 1.2, 15.9. Etiologies of heart failure included: dilated cardiomyopathy (n = 125), restrictive cardiomyopathy (n = 16), transplant coronary artery disease (n = 18), ischemic cardiomyopathy (n = 7), and heart failure after history of congenital heart disease (n = 6). Mean hemoglobin concentration at admission was 11.8 g/dL (±2.0 mg/dL). Mean lowest hemoglobin prior to outcome was 10.8 g/dL (±2.2 g/dL). Anemia (hemoglobin10 g/dL) was present in 18% of hospitalizations at admission and in 38% before outcome. Anemia was associated with increased risk of death, transplant, or mechanical circulatory support deployment (adjusted odds ratio 1.79, 95% confidence interval = 1.12-2.88, P = .011). For every 1 g/dL increase in the patients' lowest hemoglobin during admission, the odds of death, transplant, or mechanical circulatory support deployment decreased by 18% (adjusted odds ratio = 0.82, 95% confidence interval = 0.74-0.93, P = 0.002).Anemia occurs commonly in children hospitalized for acute heart failure and is associated with increased risk of transplant, mechanical circulatory support, and inhospital mortality.

To evaluate the percentage force decay of elastomeric chain products utilizing three different design mechanisms simulating canine retraction; and to evaluate the percentage force decay of elastomeric chain products from four different companies.In vitro, laboratory study.LSUHSC Dental School, New Orleans, LA, USA.Closed (non-spaced), grey elastomeric chains from four companies were selected for the study. Three acrylic resin jigs were constructed to provide a framework for three simulated space closure mechanisms. The 6-5-3, the chain loop, and the 6-3 were the configuration mechanisms used in the study.An electronic force gauge was used to measure the percentage force decay associated with each elastomeric chain over 28 days at preselected times.There was a significant difference in the mean percentage force decay for the three different mechanisms (P0·001). For all four companies, the 6-3 mechanical design had the smallest mean percentage force decay. There was a significant difference in the mean percentage force decay for the different companies (P0·001). For all three mechanisms, Ormco had the smallest percentage force decay while Unitek had the highest percentage force decay.The significant difference in the mean percentage force decay for the different mechanisms suggests that the 6-3 design is a more efficient means of closing extraction spaces utilizing elastomeric chains.

Objectives/Hypothesis: To report our experience with management of giant salivary stones via a combined approach technique using salivary endoscopy (CA) and results of a review of current literature related to giant salivary stones. Study Design: Retrospective case series. Methods: An institutional review board-approved chart review was performed on patients managed with a CA to treat giant salivary stones (≥15 mm). In addition, we reviewed the English literature from 1942 to 2009. Results: Table 1 consists of 54 stones; 47 of which were identified during the review of literature and 7 from our case series. Of those 47 stones, 23 were hilar in location, 23 were glandular in location, and 1 stone was missing data. The gland preservation rate in the 47 reported stones was 57% (17/30). Among patients where gland resection was reported, the majority of the patients (12/13) had hilar glandular stones. Only one patient with a ductal stone had a gland resection. In our series, CA enabled a gland preservation rate of 86% (6/7). Among these patients, stone location was hilar glandular in six (86%) and ductal in one (14%). The mean size of stones from the literature review was 35 mm and from our series was 19 mm. Conclusions: Our review reflects current treatment recommendations for giant stones, i.e., transoral sialolithotomy for ductal stones and gland resection for hilar glandular stones. Our preliminary experience with CA for giant stones suggests improved gland preservation rates (86% vs. 57%) independent of stone location and with preservation of salivary function. Laryngoscope, 2010

Objectives To determine the efficacy of common solutions used to dissolve blood clots blocking tympanostomy tubes (TTs) of differing lengths and diameters. Study Design An ex vivo experimental study. Methods Ear models were built by the study investigator. Tympanostomy tubes were inserted into the models and blocked with blood clots. Test solutions were applied to the blood clots, and time for clearance was recorded via microscopic visual confirmation. Results Richards T-tube had higher odds of unclogging than collar button tubes (odds ratio: 2.37, 95% confidence intervals 1.02–5.54, p = 0.042). Vinegar and 3% hydrogen peroxide were most effective for Richards T-tubes and collar button tubes, respectively. Conclusion Common solutions (vinegar and hydrogen peroxide) were more effective than antibiotic drops in clearing blood clot blocking TTs.

The aim of this study was to investigate the existence of correlations between dental admissions criteria, including a chalk carving exercise, and students' subsequent academic performance. The retrospective cohort study examined the records of dental students at Louisiana State University Health Science Center School of Dentistry for the years 1998 to 2008. Only those students who could be categorized into the following four groups were included: 1) those who graduated in the top 10% of their class, 2) those who graduated in the bottom 10% of their class, 3) those who repeated a year of dental school, and 4) those who were dismissed or resigned. The study sample consisted of 176 students: 62 in the first group, 62 in the second group, 25 in the third group, and 27 in the fourth group. Data collected were each student's undergraduate grade point average (GPA); chalk carving score; undergraduate biology, chemistry, physics (BCP) GPA; Dental Admission Test (DAT) Academic Average; Perceptual Ability Test (PAT) score of the DAT; total DAT score; grade in preclinical operative dentistry class; grade in morphology and occlusion class; and dental school GPA at graduation. The results showed that only the undergraduate GPA and BCP GPA were significantly higher for students in the top 10% of their class than for other groups. The only positive correlation involving the chalk carving scores was with the preclinical operative dentistry course grade. This study thus found limited correlations between this institution's admissions criteria and its students' success in dental school.

With the support for curriculum change expressed by the American Dental Education Association's Commission on Change and Innovation in Dental Education (ADEA CCI), the Louisiana State University Health Sciences Center School of Dentistry (LSUSD) initiated a course that vertically integrates the basic sciences and clinical sciences and promotes critical thinking. The resulting Dental Rounds course includes presentations by D3 and D4 students on interesting clinical cases, which the entire student body is required to attend. Following the third year of the program, a formal evaluation was conducted, in which surveys were disseminated to students, recent graduates, and faculty members to collect feedback on the efficacy of the course, its perceived value, and its success as an educational tool. Of the 242 students and graduates who were sent surveys, 181 responded, a 74 percent response rate. Of the eighty full-time faculty members, sixty-one responded, a 76 percent response rate. Most respondents reported that the objectives of the course were being achieved, but they identified case-related discussion as an area for strengthening critical thinking skills. As a result, modifications were planned to include formal participation of D1 and D2 students in the presentations, less frequent sessions to accommodate more complete cases, more emphasis on basic science, more structured mentoring, and a modified question format. Dental Rounds was a necessary integration step in dental education for LSUSD, and it is anticipated that the planned modifications will lead to strengthening of critical thinking skills in both students and faculty.

The purpose of this study was to document current practices among pediatric and general dentists who are members of the American Academy of Pediatric Dentistry (AAPD) regarding the use of local anesthesia (LA) on children undergoing dental rehabilitation under general anesthesia (GA).A survey was administered via e-mail to AAPD members to document the use of LA during dental rehabilitations under GA and the rationales for its use.A total of 952 of 5,599 members responded to this survey; 79 percent of respondents use LA at least part of the time during dental rehabilitations under GA. "Improved patient recovery" was the most commonly cited rationale for administering LA. Extraction of permanent and primary teeth were the two most common procedures cited for the use of LA, respectively.There is no consensus among the respondents on the use of local anesthesia during dental rehabilitation under general anesthesia, but the majority responded that it does play a role in their perioperative patient management.

The purpose of this study was to formulate and characterize experimental antibacterial fluoride-releasing sealants and compare them with commercial sealants for fluoride release, recharge, adhesion, and microleakage.Two experimental sealants (Exp-1, Exp-2) containing a synthesized antibacterial fluoride-releasing monomer and fluoride-releasing filler were formulated. Exp-2 also contained NovaMin nanoparticles. Commercial sealants Clinpro (CL) FluroShield (FS), and SeLECT Defense (E34) were also included. Fluoride release from disk samples in deionized water was measured daily using an ion-selective electrode for 14 days, and after recharging with Neutra-Foam (2.0% sodium fluoride), fluoride was measured for 5 days. Microtensile bonding strengths (MTBS) to enamel were tested after 24-hour storage in water at 37°C or thermocycling 5-55°C for 1,000 cycles. A microleakage test was conducted on extracted teeth using a dye-penetration method. The data were analyzed using analysis of variance with the Tukey's honestly significant difference test and Kruskal-Wallis test.Exp-1 and Exp-2 had significantly higher fluoride release and recharge capabilities than CL and FL (P.05). All tested sealants had similar MTBS before and after thermocycling. Exp-2 and Exp-1 had significantly lower microleakage scores (P.05) than other groups.The experimental sealants had higher fluoride release and recharge capabilities and similar or better retention than commercial sealants.

The purpose of this study was to measure the incidence of pain and analgesic use following restorative and surgical procedures and preventive fissure sealants in children and adolescents.One hundred and thirty 2- to 18-year-olds were selected from the Louisiana State University School of Dentistry pediatric dental clinic and appointed for restorative and surgical procedures and preventive fissure sealants. Each child's discomfort was evaluated immediately after the procedure using a Wong-Baker FACES Pain Rating Scale. Parents were contacted by phone within 48 hours following the procedure for a verbal survey to assess discomfort and analgesic use.Thirty-three percent of the children reported discomfort, and 31% were given over-the-counter analgesics by their parents. Compared to all other subjects, patients who had received a primary stainless steel crown were significantly more likely to report discomfort (P.001). The extraction of primary teeth did not result in a significant increase in reported pain.Postoperative discomfort is significantly associated with stainless steel crown treatment of primary teeth.

The professional dental literature is lacking in information concerning the use of technology in evaluation procedures utilized in postgraduate dental education. The purpose of this study was to identify the methods of evaluation of U.S. postgraduate specialty residents currently in place. The study also sought to determine if there were any patterns among programs more likely to utilize electronic submission in the evaluation process. An electronic survey consisting of eighteen questions was sent to the program directors of all accredited U.S. dental specialty programs (n=416). The survey yielded 150 responses, for a 36 percent response rate. The results showed that the majority of responding program directors (68 percent) evaluate their residents using a hardcopy evaluation instrument, while a minority of directors (32 percent) reported using an electronic evaluation instrument. The majority of respondents (58 percent) said they require faculty members to formally evaluate residents semiannually. Fifty percent of responding program directors reported a need for improvement in their current evaluation system. Those reporting a need for improvement were less likely to be using an electronic format. There was no statistical significance between faculty responsiveness and the mode of evaluation used. With many program directors reporting room for improvement in their current evaluation system, innovation in the evaluation systems of postgraduate dental education is needed.

Introduction The purpose of this study was to determine the shaping ability of 3 nickel-titanium (NiTi) endodontic file systems by measuring canal transportation. Methods Seventy-two S-shaped canals in resin blocks were randomly allocated into 3 groups ( n = 24): the Self-Adjusting File (SAF; ReDent Nova, Ra’anana, Israel) group, the Typhoon group (Typhoon rotary files with Controlled Memory Wire; DS Dental, Johnson City, TN), and the Vortex group (ProFile Vortex rotary files with M-Wire NiTi; Dentsply Tulsa Dental Specialties, Tulsa, OK). Blocks were secured in a jig for imaging standardization and instrumentation stabilization. Gates Glidden and PathFile drills (25 mm/.02 taper) were used to prepare the glide paths. For the Typhoon and Vortex groups (25 mm/.04 taper), canals were flooded with sterile water and instrumented using a crown-down technique from sizes 40 to 20/.04 and then apically enlarged to size 30/.04. The SAF group (25 mm) was instrumented with constant sterile water irrigation in a light-pecking, transline motion. Pre- and postinstrumentation images were taken at 40× magnification and layered, and canal transportation was measured. Results After adjusting for the level and canal wall side, the mean transportation was significantly higher for the Typhoon ( P P = .005) groups compared with the SAF group. Additionally, the mean transportation was significantly higher for the Typhoon group versus the Vortex group ( P Conclusions Under the conditions of this study, SAFs showed less canal transportation than ProFile Vortex and Typhoon files in simulated S-shaped root canals.

Devastated by the aftermath of Hurricane Katrina in August 2005, the New Orleans campus of the Louisiana State University School of Dentistry was closed for two years. With help from the university's Systems Office, the school created a temporary campus in Baton Rouge, seventy-five miles from the New Orleans campus. The eight postdoctoral education programs, however, were forced to find clinic and seminar space in other facilities and cities. Of the seventy-nine students in these programs, only sixteen did not continue after the storm. This article describes how each program maintained its curriculum while the main campus was closed. By comparing numbers of student applications to these programs in each year since Hurricane Katrina with the average baseline for each in the ten years preceding the storm, this article illustrates the current viability of these residency programs. Total applications in 2005-07 were significantly lower than baseline measures, but applications in 2008 and 2009 have returned to pre-storm levels. A comparison of these application numbers with national trends also demonstrates that these programs have rebounded from the effects of Hurricane Katrina.

The various reasons for the current and projected shortages of dental faculty members in the United States have received much attention. Dental school deans have reported that the top three factors impacting their ability to fill faculty positions are meeting the requirements of the position, lack of response to position announcement, and salary/budget limitations. An electronic survey sent to program directors of specialty programs at all accredited U.S. dental schools inquired about the number of vacant positions, advertised vacant positions, reasons for not advertising, selection of advertising medium, results of advertising, and assistance from professional dental organizations. A total of seventy-three permanently funded full-time faculty positions were reported vacant, with 89.0 percent of these positions having been advertised in nationally recognized professional journals and newsletters. Networking or word-of-mouth was reported as the most successful method for advertising. The majority of those responding reported that professional dental organizations did not help with filling vacant faculty positions, but that they would utilize the American Dental Association's website or their specialty organization's website to post faculty positions if they were easy to use and update.

To compare the shear bond strengths and modes of failure of three orthodontic brackets: a polycrystalline ceramic bracket, a collapsible polycrystalline ceramic bracket and a metal bracket.Ninety extracted human premolar teeth were selected and examined at x3 magnification for any enamel defects. Three types of brackets and one orthodontic adhesive were used. One half of the sample was tested in a universal testing machine to determine the shear bond strength. The other half was debonded with the appropriate pliers and the tooth surface examined at x5 magnification. The site of failure was scored with the modified Adhesive Remnant Index (ARI). Teeth with an ARI grade of zero were examined in a SEM to determine any enamel fracture.No statistically significant differences in bond strength among the samples were found (p0.159). The modes of failure after debonding with pliers were predominantly at the bracket-adhesive interface. The mean shear bond strength of the Clarity bracket was 10.78 +/- 2.74 MPa, the InVu bracket was 12.43 +/- 2.40 MPa and the metal bracket was 11.89 +/- 1.83 MPa. There were significant differences in the mean rank of the ARI grade between the three groups (p = 0.006). The Clarity and InVu (p = 0.011) and the Clarity and metal brackets (p = 0.005) were significantly different, but there was no difference between the InVu and metal brackets (p = 0.187).All three samples had similar bond strengths. The risk of ceramic fracture on debonding was greatest for the InVu ceramic bracket.

The formation of organized nanocrystals that resemble enamel is crucial for successful enamel remineralization. Calcium, phosphate and fluoride ions, and amelogenin are important ingredients for the formation of organized hydroxyapatite (HAP) crystals in vitro. However, the effects of these remineralization agents on the enamel crystal morphology have not been thoroughly studied. The objective of this study was to investigate the effects of fluoride ions, supersaturation degree and amelogenin on the crystal morphology and organization of ex vivo remineralized human enamel. Extracted third molars were sliced thin and acid-etched to provide the enamel surface for immersion in different remineralization solutions. The crystal morphology and mineral phase of the remineralized enamel surface were analyzed by field emission-scanning electron microscopy, attenuated total reflection-Fourier transformed infrared and X-ray diffraction. The concentration of fluoride and the supersaturation degree of hydroxyapatite had significant effects on the crystal morphology and crystal organization, which varied from plate-like loose crystals to rod-like densely packed nanocrystal arrays. Densely packed arrays of fluoridated hydroxyapatite nanorods were observed under the following conditions: σ(HAP)=10.2±2.0 with 1.5±0.5 mg l(-1) fluoride and 40±10 μg ml(-1) amelogenin, pH 6.8±0.4. A phase diagram summarizes the conditions that form dense or loose hydroxyapatite nanocrystal structures. This study provides the basis for the development of novel dental materials for caries management.

To study the cytokine profile in a 52 year old woman with psoriasis, PsA, and HCV who developed hepatic sarcoidosis following Etanercept therapy for 7 months. 11 PsA patients on TNF blockers mean disease duration 158.4 (SD 114.5), mean treatment duration 72.1 (SD 42.14) months, 8/11 PsA were on Etanercept and 5 healthy controls were studied. TNF-α, sTNF RI/RII, IFN-α/β/γ, IL-1 α, IL-15, IL-6, VEGF, s IL-1 R, sIL-6 R, IL-12, IL-23, IL-17, Adiponectin, Leptin and EGF were assessed. All PsA and controls tested negative for Quantiferon TB Gold, hepatitis B/C, HIV, ACE level, chest x-ray, liver function test (LFTs). Serologic biomarkers of the subject in comparison to the controls indicate that sTNF RI value was significantly higher; and IL-1 alpha level has a high outlier compared to the 11 PsA patients on TNF blockers. The clinical course, histologic findings, increased levels of s TNF R I and IL-1 α in the subject as compared to the other PsA on TNF blockade and controls, suggest that most likely Etanercept induced inflammatory cytokine imbalance was responsible for inducing hepatic sarcoidosis.

Objective/Hypothesis: Infection with the hepatitis C virus (HCV) is a global problem with over 170 million people infected. Recently, we have noticed that a large number of patients diagnosed with squamous cell carcinoma of the head and neck (SCCHN) have also been diagnosed with HCV. A review of the literature reveals little information concerning this patient population. The objective of this study was to compare the outcome of SCCHN patients who have been exposed to HCV with naive SCCHN patients. Study Design: Retrospective chart review. Methods: A retrospective chart review from June 1991 through December 2002 was performed to identify patients diagnosed with SCCHN who were screened for HCV. Patients were stratified into two groups (HCV positive and HCV negative). Data were recorded on patients for status of disease at last clinic visit, pretreatment serum albumin and hematocrit levels, and RNA quantities of HCV. Statistical analysis was performed using paired t test to compare serum albumin and hematocrit levels. Kaplan-Meier survival curves were used to compare outcomes. The log-rank test was used to determine significance. Cox regression was used to examine the association of prognostic predictor variables with overall survival and disease-free survival. Results: There was no difference noted in 5 year survival between hepatitis C positive and hepatitis C negative groups in overall outcomes (66.7% vs. 67.9%, P = 1.000) or 5 year disease-free survival (90.5% vs. 80.8%, P = .514). The two groups, HCV positive versus HCV negative, also had similar serum albumin levels (3.62 g/dL vs. 3.72 g/dL, P = .37) as well as serum hematocrit levels (42.9% vs. 41.0%, P = .12). Serum levels of hepatitis C RNA were obtained in seven patients, with only one being undetectable. The only prognostic predictor variable that was significantly associated with overall survival was age. None of the predictor variables were significantly associated with disease-free survival. Conclusion: Co-infection with HCV, although prevalent in the Veterans Administration Hospital population, did not affect patient outcome as defined by disease-free survival. Patients who were seropositive for HCV had comparable serum albumin levels as well as serum hematocrit when compared with HCV negative patients.

Background: Substance abuse is associated with injuries, but these associations have not been well characterized by type of substance and injury type. Methods: A cross-sectional study of patients selected for toxicology screening compared those with positive and those with negative test results for drugs and alcohol. Results: Patients with positive alcohol toxicology results were more likely to have violence-related and penetrating injuries than patients with negative results. However, after adjustment for positive cocaine toxicology results, the association between alcohol and penetrating injury was no longer significant. Positive test results for any drug were not associated with any specific injury type, but cocaine was independently associated with violence-related injury. The associations of alcohol and cocaine with violence-related injury appear to be additive. In contrast, opiates were independently associated with nonviolent injuries and burns. Conclusions: Alcohol and cocaine use is independently associated with violence-related injuries, whereas opiate use is independently associated with nonviolent injuries and burns.

Objective To study the retropharyngeal lymph node status (RPLN) by pretreatment PET-CT imaging in patients with squamous cell carcinomas of the oropharynx (OPSCC). Study Design: Retrospective. Methods 101 patients with a biopsy proven OPSCC were identified. 53 patients meeting inclusion criteria were further analyzed. Results The frequency of RPLN was 20.8% (11/53). Advanced T stage cancer (OR = 5.6250, 95% CI: 1.06 - 29.80, p = 0.0410) and advanced clinical N stage cancer (i.e. N2+) had higher odds (OR = 3.9773, 95% CI: 0.9628 - 16.4291) of being RPLN positive as compared to N0-1 patients. Conclusions Pre-treatment PET-CT can be used as a staging tool to aid in treatment planning of OPSCC, as rates of RPLN and nodal metastasis are consistent with those reported in the literature. Advanced T and N stage are associated with a greater odds ratio of being RPLN positive by PET-CT imaging.