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Background: Acceptance and Commitment Therapy (ACT) is a type of Cognitive Behavioural Therapy, which has demonstrated positive outcomes in individuals with chronic pain. The purpose of this study was to compare the effect of an 8‐week programme combining Exercise with Acceptance and Commitment Therapy (ExACT) with a standalone supervised exercise programme at 1‐year follow‐up. Methods: One hundred and seventy‐five people with chronic pain were randomly assigned to ExACT or supervised exercise only. The primary outcome was pain interference measured with the Brief Pain Inventory‐Interference Scale. Secondary and treatment process outcomes included pain severity, depression, anxiety, pain catastrophizing, pain self‐efficacy, fear avoidance, pain acceptance, committed action, healthcare utilization, patient satisfaction, and global impression of change. Estimates of treatment effects at 1‐year follow‐up were based on intention‐to‐treat analyses, implemented using a linear mixed‐effects model. Results: Eighty‐three participants (47.4%) returned the outcome measures at 1‐year follow‐up. No significant difference was observed between the groups for the primary outcome, pain interference. There was a statistically significant difference between the groups, in favour of ExACT for pain catastrophizing. Within group improvements that were observed within both groups at earlier timepoints were maintained at 1‐year follow‐up for many of the secondary and treatment process outcomes. ExACT group participants reported higher levels of satisfaction with treatment and global perceived change. Conclusions: The study results showed no significant difference between the two groups for the primary outcome pain interference at 1‐year follow‐up. Future research could investigate factors that may predict and optimize outcomes from these types of intervention for people living with chronic pain. Significance: Few previous randomized controlled trials investigating ACT for chronic pain have included long‐term follow‐up. This study found that Exercise combined with ACT was not superior to supervised exercise alone for reducing pain interference at 1‐year follow‐up. Further research is necessary to identify key processes of therapeutic change and to explore how interventions may be modified to enhance clinical outcomes for people with chronic pain. [ABSTRACT FROM AUTHOR]

María Peñarrocha-Diago,1 José Carlos Balaguer-Martí,1 David Peñarrocha-Oltra,1 José Bagán,1 Miguel Peñarrocha-Diago,1 Dennis Flanagan2,31Department of Stomatology, University of Valencia, Valencia, Spain; 2Department of Dental Medicine, Lugano University of Switzerland, Lugano, Switzerland; 3Private Practice, Willimantic, CT, USAAbstract: Complications in dental implant surgery are possible. Bleeding complications have been described that may be serious, particularly in the floor of the mouth. We present two cases of sublingual hematomas during dental implant osteotomies that impeded but did not close the airway. The clinical courses of these patient’s complications are reviewed. One patient had immediate hematoma formation while the other developed a hematoma overnight, presenting the next day. The treatment rendered was a precautionary in-hospital tracheotomy for the first patient and only compression control for the second. Bleeding complications during dental implant placement in the anterior mandible can be serious issues. There is a potential for sublingual hematoma that could compromise the airway by pressing the tongue against the soft palate into the pharynx. In-hospital treatment may be necessary to prevent an adverse outcome. It must be noted that a hematoma in the submandibular space is life threatening by direct airway compression.Keywords: bleeding, cortical perforation, anastomose, hematoma, complications, osteotomy

Andrea Mascolo,1 Elio Boschetti,1 Dennis Flanagan2 1European Institute for Medical Studies, H.E.I. Graduate School, Malta; 2Private Practice, Willimantic, CT, USA Abstract: Ectodermal dysplasia (EDD) is a developmental disorder that affects the skin, hair, and teeth among other organs generated in the ectoderm. Dental implants have been used to successfully treat partial edentulism in EDD patients, but the success rate is much lower for these patients. The report herein is a successful case of a single mini, small diameter, implant used to support a single crown of a mandibular right second premolar. A review of implant treatment in EDD patients is included. Keywords: dental implant, mini implant, occlusal, load, osseointegration

Dennis Flanagan Private Practice, Willimantic, CT, USA Abstract: Implant-supported dental prostheses can be retained by a screw or cement. Implant-supported fixed partial dentures have a passive fit. A passive fit means there is an internal gap between the abutment surface and the intaglio of the retainer to insure that there is no lateral pressure on the supporting implants or friction upon seating of the prosthesis. This gap is filled with cement for retention of the prosthesis. Any lateral pressure may cause marginal bone loss or periimplantitis. Also, there is usually a microscopic gap at the margin of a crown retainer that exposes the cement to oral fluids. The solubility of zinc phosphate (ZOP) cement is a definite liability due to the risk for cement dissolution. In fixed prostheses, the dissolution of the cement of one or more retainers would cause a transfer of the occlusal load to the retained unit(s). The resulting rotation and lifting of the cement-retained implants from occlusal and parafunctional loads could cause loss of osseointegration of the abutment-retained implant(s). ZOP cement may not be indicated for implant-supported fixed partial dentures or splints. Cement dissolution in single unit probably only involves re-cementation, if the patient does not swallow or aspirate the crown. Keywords: passive fit, retention, film thickness, fixed, marginal gap

Dennis Flanagan1,2 1Department of Dental Medicine, Implantology LUdeS Foundation, Ricasoli, Malta; 2Private Practice, Willimantic, CT, USA Abstract: Dental implants are placed endosseously, and the bone is the ultimate bearer of the occlusal load. Patients are not uniform in the maximum bite force they can generate. The occlusal biting load in the posterior jaw is usually about three times of that found in the anterior. It is possible for supporting implants to be overloaded by the patients’ biting force, resulting in bone loss and failure of the fixture. Bite force measurement may be an important parameter when planning dental implant treatment. Some patients can generate extreme biting loads that may cause a luxation of the fixture and subsequent loss of osseointegration. A patient with low biting force may be able to have a successful long-term outcome even with poor anatomical bone qualities. Patients with a high bite force capability may have an increased risk for late component fracture or implant failure. There is no correlation of any bite force value that would indicate any overload of a given implant in a given osseous site. Nonetheless, after bite force measurement, a qualitative judgement may be made by the clinician for the selection of an implant diameter and length and prosthetic design. Keywords: occlusal load, newtons, oral function, force, sensor, software

Introduction: Increasing numbers of people admitted to hospital have diabetes and need specialist support. To date, there is no mechanism which can help teams estimate the number of health care professionals they need to provide optimal care for people with diabetes in hospitals. Methods: The Joint British Diabetes Societies (JBDS) for Inpatient Care Group organised a survey of specialist inpatient diabetes teams in the UK for current staffing and the perception of optimal staffing using mailing lists available through their representative organisations. The results were verified and confirmed by one‐to‐one conversations with individual respondents and discussed in multiple expert‐group meetings to agree on the results. Results: Responses were received from 17 Trusts covering 30 hospital sites. Current diabetes specialist staffing level per 100 people with diabetes in hospital (Median, IQR) for consultants was 0.24 (0.22–0.37), diabetes inpatient specialist nurses was 1.94 (1.22–2.6), dieticians was 0.00 (0.00–0.00), podiatrists was 0.19 (0.00–0.62), pharmacists was 0.00 (0.00–0.37), psychologists was 0.00 (0.00–0.00). The teams also reported that for optimal care the total staff needed for each group (Median, IQR) was much higher; consultants 0.65 (0.50–0.88), specialist nurses 3.38 (2.78–4.59), dieticians 0.48 (0.33–0.72), podiatrists, 0.93 (0.65–1.24), pharmacists, 0.65 (0.40–0.79) and psychologists 0.33 (0.27–0.58). Based on the results of the survey, the JBDS expert group produced an Excel calculator to estimate staffing needs of any hospital site in question just by populating a few of the cells. Conclusion: Current inpatient diabetes staffing is much lower than needed in most Trusts who responded to the survey. The JBDS calculator can provide an estimate of the staffing needs of any hospital. [ABSTRACT FROM AUTHOR]

Sediment from eroded cropland is one of this country's biggest water quality problems. Soil erosion affects everyone. Erosion reduces soil productivity (Craft et al., 1992; Pierce et al., 1984) and [...]