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Research has demonstrated that school librarians can make a meaningful contribution to student reading proficiency, learning and academic achievement. This study examines the perspectives of school...

BACKGROUND Proximal sesamoid bone (PSB) fractures are the most common fatal musculoskeletal injury in North American racehorses. Computed tomography has the potential to detect morphological changes in bone structure but can be challenging to analyse reliably and quantitatively. OBJECTIVES To develop a radiomics platform that allows the comparison of features from micro-CTs (µCT) of PSBs in horses that sustained catastrophic fractures with horses that did not. To compare features calculated with a radiomics approach with features calculated from a previously published study that used quantitative µCT in the same specimens. STUDY DESIGN Retrospective study of cadaver specimens of µCT images of PSBs using prospectively applied radiomics. METHODS Radiomics features were computed on standardised CT datasets to benchmark the software. Features from µCT images of PSBs from eight horses that sustained PSB fracture and eight controls were computed using the contralateral, intact forelimb from horses sustaining PSB fracture (cases, n = 19) and all available forelimbs for controls (n = 30). Two-hundred and fifteen radiomic features were calculated, and similar or comparable features were compared with those reported in a previous study that used the same specimens. RESULTS Morphologic features computed with the radiomics approach, such as volume, minor axis dimensions and anisotropy were highly correlated with previously published data. A high number of imperceptible radiomic features, such as entropy, coarseness and histogram features were also found to be significantly different (P

Simple Summary The collaboration between periodontics and orthodontics has the potential to allow safer orthodontic tooth movement and improve vulnerable oral conditions especially for patients with very thin bone and soft tissue. By providing this interdisciplinary surgical approach where thin bone and soft tissue are surgically augmented to convert a fragile-thin to a robust-thick tissue phenotype, this permits orthodontic treatment in these previously thin tissue cases to proceed without iatrogenically induced adverse effects. This is an infrequently performed procedure with few clinical recommendations. This review paper provides the rationale and the currently available evidence on the benefits of this novel surgical approach. Abstract Purpose: This systematic review compares the clinical and radiographic outcomes for patients who received only a corticotomy or periodontal accelerated osteogenic orthodontics (PAOO) with those who received a conventional orthodontic treatment. Methods: An electronic search of four databases and a hand search of peer-reviewed journals for relevant articles published in English between January 1980 and June 2021 were performed. Human clinical trials of ≥10 patients treated with a corticotomy or PAOO with radiographic and/or clinical outcomes were included. Meta-analyses were performed to analyze the weighted mean difference (WMD) and confidence interval (CI) for the recorded variables. Results: Twelve articles were included in the quantitative analysis. The meta-analysis revealed a localized corticotomy distal to the canine can significantly increase canine distalization (WMD = 1.15 mm, 95% CI = 0.18–2.12 mm, p = 0.02) compared to a conventional orthodontic treatment. In addition, PAOO also showed a significant gain of buccal bone thickness (WMD = 0.43 mm, 95% CI = 0.09–0.78 mm, p = 0.01) and an improvement of bone density (WMD = 32.86, 95% CI = 11.83–53.89, p = 0.002) compared to the corticotomy group. Conclusion: Based on the findings of the meta-analyses, the localized use of a corticotomy can significantly increase the amount of canine distalization during orthodontic treatment. Additionally, the use of a corticotomy as a part of a PAOO procedure significantly increases the rate of orthodontic tooth movement and it is accompanied by an increased buccal bone thickness and bone density compared to patients undergoing a conventional orthodontic treatment.

Objectives: To conduct a prospective pilot trial to test the clinical efficacy and accuracy of a newly developed Bluetooth-enabled retainer, which was synchronized with an iOS mobile application, cloud database and provider webpage. Setting and Sample Population: Five orthodontic residents in a university setting. Material and Methods: At the delivery of the retainers (T0), each participant was given an Bluetooth-enabled retainer, logbook and iPod Touch installed with the mobile application. Participants were instructed to wear the retainer for 12 hours per day and record in the logbook each time the retainer was inserted or removed and trained to synchronize the device daily to the mobile application. After the 5-day study period (T1), statistical analysis was performed comparing the device-reported data to the logbook data using two calculation methods. Results: From T0 – T1, the participants wore their retainers for a median of 11.55 hours per day and the median difference between the self-reported (logbook) data and the device data was 35 minutes or 5.1% over the 5-day study period. Using an adjusted method to calculate the device-reported wear time, the median error was 13 minutes or 1.9%. Conclusion: Subjects were able to successfully wear the retainer and upload the data to the mobile application and cloud database. Patient compliance and technical issues could be monitored daily via the provider webpage, and early intervention was possible with reminder messaging. The Bluetooth-enabled retainer showed a clinically acceptable level of accuracy and usability that validates it for future clinical testing.

A grid-isolated Liquefied Natural Gas (LNG) import terminal has been expanded to include liquefaction and export capabilities. The new electrical system contains two 65MW steam turbine generators and 30 load feeders with two intertie breakers connecting the generation systems of the import and export facilities. To prevent loss of power to the plant, during contingency, it is important to perform load-generation balance within 100ms. In addition, the system frequency should be maintained within the 95% of the nominal frequency to prevent system instability. An IEC 61850 based Fast Load Shedding (FLS) scheme is deployed in this new plant to operate for loss-of-power condition, either from the generators or from the existing intertie connections. Protection relays with communication capabilities to exchange IEC 61850 Generic Object-Oriented System Event (GOOSE) were used over redundant communication networks utilizing Parallel Redundancy Protocol (PRP) for high-speed communications within the plant. Two redundant FLS Controllers exchange GOOSE messages with feeder, motor, transformer and generator relays to capture breaker status and power flow information for reliable operation. In addition, compressor-loading interlocks over the same IEC 61850 PRP network are implemented using motor protection relays to ensure the availability of at least one fuel gas compressor at all times. This paper presents lessons learned from the design and deployment of the FLS scheme by utilizing the available protection relays and adding FLS Controllers. The design strategies, such as IEC 61850 GOOSE communications between relays and Controllers, redundant PRP networks, network quality of service, etc. are discussed. The challenges to integrate non-IEC 61850 devices into the scheme are also discussed. The FLS initiation logic (to arm and disarm the scheme), and adaptive load-generation balance design are presented with test results, with the objective of sharing experiences from the design and deployment of a FLS scheme that guarantees plant’s availability and stability.

IntroductionThe aim of this study was to evaluate three dimensionally the effect of the combined maxillary expansion and protraction treatment on oropharyngeal airway in children with non-syndromic cleft palate with or without cleft lip (CP/L).MethodsCBCT data of 18 preadolescent individuals (ages, 8.4 ± 1.7 years) with CP/L, who underwent Phase I orthodontic maxillary expansion with protraction, were compared before and after treatment. The average length of treatment was 24.1± 7.6 months. The airway volume and minimal cross-sectional area (MCA) were determined using 3DMD Vultus imaging software with cross-sectional areas calculated for each 2-mm over the entire length of the airway. A control group of 9 preadolescent individuals (ages, 8.7 ± 2.6 years) with CP/L was used for comparison.ResultsThere was a statistically significant increase in pharyngeal airway volume after phase I orthodontic treatment in both groups, however, there was no statistically significant change in minimal cross-sectional area in neither study nor control group.ConclusionThe findings showed that maxillary expansion and protraction did not have a significant effect on increasing oropharyngeal volume and MCA in patients with CP/L.

Interruptions are thought to be significantly associated with medication administration errors. Researchers have tried to reduce medication errors by decreasing or eliminating interruptions. In this article, we argue that interventions are often (perhaps unreflectively) based on one particular model of risk reduction-that of barriers placed between the source of risk and the object-to-be-protected. Well-intentioned interventions can lead to unanticipated effects because the assumptions created by the risk model are not critically examined. In this article, we review the barrier model and the assumptions it makes about risk and risk reduction/prevention, as well as the model's incompatibility with work in healthcare. We consider how these problems lead to interruptions interventions with unintended negative consequences. Then, we examine possible alternatives, viz organizing work for high reliability, preventing safety drift, and engineering resilience into the work activity. These all approach risks in different ways, and as such, propose interruptions interventions that are vastly different from interventions based on the barrier model. The purpose of this article is to encourage a different approach for designing interruptions interventions. Such reflection may help healthcare communities innovate beyond old, ineffective, and often counterproductive interventions to handle interruptions.

Here we provide an integrative review of basic control circuits, and introduce techniques by which their regulation can be quantitatively measured using human neuroimaging. We illustrate the utility of the control systems approach using four human neuroimaging threat detection studies (N = 226), to which we applied circuit-wide analyses in order to identify the key mechanism underlying individual variation. In so doing, we build upon the canonical prefrontal-limbic control system to integrate circuit-wide influence from the inferior frontal gyrus (IFG). These were incorporated into a computational control systems model constrained by neuroanatomy and designed to replicate our experimental data. In this model, the IFG acts as an informational set point, gating signals between the primary prefrontal-limbic negative feedback loop and its cortical information-gathering loop. Along the cortical route, if the sensory cortex provides sufficient information to make a threat assessment, the signal passes to the ventromedial prefrontal cortex (vmPFC), whose threat-detection threshold subsequently modulates amygdala outputs. However, if signal outputs from the sensory cortex do not provide sufficient information during the first pass, the signal loops back to the sensory cortex, with each cycle providing increasingly fine-grained processing of sensory data. Simulations replicate IFG (chaotic) dynamics experimentally observed at both ends at the threat-detection spectrum. As such, they identify distinct types of IFG disconnection from the circuit, with associated clinical outcomes. If IFG thresholds are too high, the IFG and sensory cortex cycle for too long; in the meantime the coarse-grained (excitatory) pathway will dominate, biasing ambiguous stimuli as false positives. On the other hand, if cortical IFG thresholds are too low, the inhibitory pathway will suppress the amygdala without cycling back to the sensory cortex for much-needed fine-grained sensory cortical data, biasing ambiguous stimuli as false negatives. Thus, the control systems model provides a consistent mechanism for IFG regulation, capable of producing results consistent with our data for the full spectrum of threat-detection: from fearful to optimal to reckless. More generally, it illustrates how quantitative characterization of circuit dynamics can be used to unify a fundamental dimension across psychiatric affective symptoms, with implications for populations that range from anxiety disorders to addiction.

Approaches to safety have often considered the “human” factor in an organisation or operation as a major contributor to unwanted outcomes. The view of “human” as a problem leads to responses that involve trying to exert more control over people. While these may make intuitive sense for some, research suggests that such a view may not be valid as there are an enormous number of other factors (many of which are beyond control of the human at the sharp end) that are behind the creation of success and the occasional failures. This chapter begins with a review of normal accident theory, before using complexity science to fill out the problematic nature of the notion of “human error”. It then discusses one of the prominent problems associated with complexity, safety drift. Lastly, this chapter looks at various proposed solutions (e.g. resilience engineering) by which a healthcare system can manage complexity and perhaps reduce the potential harm to patients.

The history of efforts to reduce ‘human errors’ across workplaces and industries suggests that people (or their weaknesses) are seen as a problem to control [1, 3, 15, 16]. However, some have proposed that humans can be heroes as they can adapt and compensate for weaknesses within a system and direct it away from potential catastrophes [15]. But the existence of heroes would suggest that villains (i.e. humans who cause a disaster) exist as well [16], and that it might well be the outcome that determines which human becomes which. The purpose of this chapter is to examine if complex socio-technical systems would allow for the existence of heroes and villains, as outcomes in such systems are usually thought to be the product of interactions rather than a single factor [17]. The chapter will first examine if the properties of complex systems as suggested by Dekker et al. [18] would allow for heroes and villains to exist. These include: (a) synthesis and holism, (b) emergence, (c) foreseeability of probabilities, not certainties, (d) time-irreversibility and, (e) perpetual incompleteness and uncertainty of knowledge, before concluding with a discussion of the implications of the (non) existence of heroes and villains in complex systems for the way we conduct investigations when something goes wrong inside of those systems.