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Background The prevalence of burnout and depressive symptoms is high among physician trainees. Research Question What is the burden of burnout and depressive symptoms among fellows training in pulmonary and critical care medicine (PCCM) and what are associated individual fellow, program, and institutional characteristics? Study Design and Methods We conducted a cross-sectional electronic survey of fellows enrolled in pulmonary, PCCM, and critical care medicine training programs in the United States to assess burnout and depressive symptoms. Burnout symptoms were measured using the Maslach Burnout Index two-item measure. The two-item Primary Care Evaluation of Mental Disorders Procedure was used to screen for depressive symptoms. For each of the two outcomes (burnout and depressive symptoms), we constructed three multivariate logistic regression models to assess individual fellow characteristics, program structure, and institutional polices associated with either burnout or depressive symptoms. Results Five hundred two of the 976 fellows who received the survey completed it—including both outcome measures—giving a response rate of 51%. Fifty percent of fellows showed positive results for either burnout or depressive symptoms, with 41% showing positive results for depressive symptoms, 32% showing positive results for burnout, and 23% showing positive results for both. Reporting a coverage system in the case of personal illness or emergency (adjusted OR [aOR], 0.44; 95% CI, 0.26-0.73) and access to mental health services (aOR, 0.14; 95% CI, 0.04-0.47) were associated with lower odds of burnout. Financial concern was associated with higher odds of depressive symptoms (aOR, 1.13; 95% CI, 1.05-1.22). Working more than 70 hours in an average clinical week and the burdens of electronic health record (EHR) documentation were associated with a higher odds of both burnout and depressive symptoms. Interpretation Given the high prevalence of burnout and depressive symptoms among fellows training in PCCM, an urgent need exists to identify solutions that address this public health crisis. Strategies such as providing an easily accessible coverage system, access to mental health resources, reducing EHR burden, addressing work hours, and addressing financial concerns among trainees may help to reduce burnout or depressive symptoms and should be studied further by the graduate medical education community.

This study aims to evaluate differences in implant stability between post-extractive implantsPatients were grouped into two different categories. In Group A 10 patients had an immediate post-extractive implant, then a provisional, acrylic resin crown was placed (immediate loading). In Group B (control group) 10 patients only had an immediate post-extractive implant. Both upper and lower premolars were chosen as post-extractive sites. Implant Stability Quotient (ISQ) was measured thanks to RFA measurements (Osstell®). Five intervals were considered: immediately after surgery (T0) and every four weeks, until five months after implant placement (T1, T2, T3, T4,T5). A statistical analysis by means of Student's T-test (significance set at p0.05) for independent sample was carried out in order to compare Groups A and B.The ISQ value between the two groups showed a statistically significant difference (p0.02) at T1. No statistically significant difference in ISQ was assessed at T0, T2, T3, T4 and T5.After clinical assessment it is possible to confirm that provisional and immediate prosthetic surgery in post-extraction sites with cone-shaped implants, platform-switching abutment and bioactive surface can facilitate osseointegration, reducing healing time.

The aim of this retrospective case-control study was to identify, in a group of growing children and adolescents affected by malocclusion, specific dento-skeletal characteristics which could be correlated to the onset, in the above-mentioned subjects, of craniomandibular disorders (CMD).Among the patients treated at the Paedodontics and Orthodontics department of Bari Dental School, we recruited a group of patients with malocclusion and symptoms of temporomandibular disorders, as an experimental group. We considered as controls those patients who, match-paired to their skeletal class depending on the ANB angle, did not show any CMD sign or symptom.Of the 128 examined patients, 15 showed signs and/or symptoms of CMD (11.7%). When compared to 15 patients non-affected by CMD, we could not detect statistically significant differences in both skeletal and occlusal characteristics. It is still interesting to notice how in CMD patients, characteristics of skeletal hyperdivergence are often to be found.The present study seems to confirm that in growing children and adolescents, the presence of signs and/or symptoms of CMD is not associable to a specific vertical skeletal growth pattern or to other specific occlusal characteristics.

To identify potential antigenic targets for Porphyromonas gingivalis vaccine development.In the present study, we analyzed the Porphyromonas gingivalis, fimA type II primary amino acid sequence and characterized the similarity to the human proteome at the pentapeptide level.We found that exact peptide-peptide profiling of the fimbrial antigenThe concept that protein immunogenicity is allocated in rare peptide sequences and the search the Porphyromonas gingivalis fimA type II sequence for peptides unique to the bacterial protein and absent in the human host, might be used in new therapeutical approaches as a significant adjunct to current periodontal therapies.

Green and Sustainable Remediation (GSR) principles and practices were incorporated into various phases of the remediation life cycle during a Resource Conservation and Recovery Act (RCRA) Corrective Action cleanup. GSR best management practices (BMPs) were identified and employed to the extent possible during the investigation, remedy evaluation, and remedy implementation phases of the cleanup. As part of the remedy evaluation phase, potential remedial alternatives were evaluated against GSR principles and practices to support the selection of a preferred remedial alternative. This included the identification of inherent GSR similarities within the five existing RCRA balancing criteria and the development of a sixth new balancing criterion. The sixth criterion consisted of five relevant GSR categories, including consumption of resources and materials, CO2 emissions, waste minimization and reuse, community benefit, and corporate image and corporate sustainability. Because of the lack of consensus, the constantly evolving nature, and limited guidance associated with GSR, various GSR-related uncertainties and barriers were encountered. These uncertainties and barriers primarily related to the development of a GSR evaluation approach; contractual mechanisms; worker routines; regulatory agency support; and facility benefits, incentives, and recognition. In an effort to overcome some of these uncertainties and barriers, professional judgment was used to support various decision-making processes. The GSR evaluation and implementation approaches considered are discussed in this case study as well as the various uncertainties and barriers encountered. In general, this case study provides a successful demonstration of GSR, given guidance limitations, facility permit constraints, complexities associated with site-specific conditions, and a situation where the most feasible options were not considered the most green and sustainable (primarily because of their energy-intensive nature, resource consumption, or waste generation).

Background Dental disease is more extensive in adults with chronic kidney disease, but whether dental health and behaviors are associated with survival in the setting of hemodialysis is unknown. Study Design Prospective multinational cohort. Setting & Participants 4,205 adults treated with long-term hemodialysis, 2010 to 2012 (Oral Diseases in Hemodialysis [ORAL-D] Study). Predictors Dental health as assessed by a standardized dental examination using World Health Organization guidelines and personal oral care, including edentulousness; decayed, missing, and filled teeth index; teeth brushing and flossing; and dental health consultation. Outcomes All-cause and cardiovascular mortality at 12 months after dental assessment. Measurements Multivariable-adjusted Cox proportional hazards regression models fitted with shared frailty to account for clustering of mortality risk within countries. Results During a mean follow-up of 22.1 months, 942 deaths occurred, including 477 cardiovascular deaths. Edentulousness (adjusted HR, 1.29; 95% CI, 1.10-1.51) and decayed, missing, or filled teeth score ≥ 14 (adjusted HR, 1.70; 95% CI, 1.33-2.17) were associated with early all-cause mortality, while dental flossing, using mouthwash, brushing teeth daily, spending at least 2 minutes on oral hygiene daily, changing a toothbrush at least every 3 months, and visiting a dentist within the past 6 months (adjusted HRs of 0.52 [95% CI, 0.32-0.85], 0.79 [95% CI, 0.64-0.97], 0.76 [95% CI, 0.58-0.99], 0.84 [95% CI, 0.71-0.99], 0.79 [95% CI, 0.65-0.95], and 0.79 [95% CI, 0.65-0.96], respectively) were associated with better survival. Results for cardiovascular mortality were similar. Limitations Convenience sample of clinics. Conclusions In adults treated with hemodialysis, poorer dental health was associated with early death, whereas preventive dental health practices were associated with longer survival.

A passive sampler was tested for the purpose of collecting ground water bacteria under natural gradient conditions. Samples were collected within a series of dual-port dialysis cells (originally containing sterile water) mounted within a length of polyvinyl chloride pipe that was suspended within the center of the screened interval of a monitoring well. Previous passive sampling devices, the design of which the present study was based on, have been employed in evaluating in situ bacterial activity (primarily contaminant degradation ability) and the collection of colloids; however, the characterization of the collected bacterial fraction has yet to be demonstrated. Concern for the performance of this collection device, particularly with respect to sampling of the biological population, is addressed through laboratory and field experiments. These experiments demonstrated (1) the ability to maintain a dynamic equilibrium with respect to bacterial concentrations within and outside of the dialysis cells; (2) unbiased sampling related to bacterial communities as determined by denaturing gradient gel electrophoresis; (3) uniform collection by dialysis cells throughout the length of the sampler; and (4) acquisition of a representative sample, although a minimum suspension time could not be determined with available data. These results have provided a level of confidence in the ability of the passive sampler to collect ground water samples for the purpose of bacterial characterization.

Sjögren's syndrome (SS) is a chronic autoimmune rheumatic disorder in which lymphocytes invade the exocrine glands, leading to destruction of the glandular tissue. Systemic inflammation also may occur and involve multiple organs. Ninety percent of patients with SS are female, Caucasian, and middle-aged. The characteristic symptoms of xerostomia and xerophthalmia often are trivialized, and the disorder is significantly underdiagnosed. Early diagnosis and management can prevent devastating oral and ocular complications and internal organ damage. Treatment modalities are aimed at providing comfort and preventing complications and progression of the disease. In the perioperative practice setting, nurses play an important role in the health care team involved in providing surgical care to patients with SS.

To compare the effectiveness of two different routes of antibiotic administration in preventing septic complications in patients undergoing third molar extraction.Twenty-four healthy patients requiring bilateral surgical removal of impacted mandibular third molars were successfully enrolled for this study. Depth of impaction, angulation, and relationship of the lower third molars with the mandibular branch had to be overlapping on both sides. A split-mouth design was chosen, so each patient underwent both the first and second surgeries, having for each extraction a different antibiotic route of administration. The second extraction was carried out 1 month later. To compare the effects of the two routes of antibiotic administration, inflammatory parameters, such as edema, trismus, pain, fever, dysphagia and lymphadenopathy were evaluated 2 and 7 days after surgery. Side effects of each therapy were evaluated 48 h after surgery.Oral and intramuscular antibiotic therapies overlap in preventing post-operative complications in dental surgery (p0.05), even if the oral intake, seems to promote the onset of significant gastrointestinal disorders (p=0.003).This study could help dentists in their ordinary practice to choose the right route of antibiotic administration in the third molar surgery. At the same effectiveness, the higher cost and the minor compliance of the patient seem not to justify a routine antibiotic intramuscular therapy, reserving it for patients with gastrointestinal disorders.

Anatomical, morphological and physiological leaf traits of Quercus ilex in response to different traffic levels (high traffic level, type A sites; average traffic level, type B sites; control sites, type C sites) were analysed in Rome. Superficial leaf deposits were analysed comparing unwashed and washed leaf samples. Washing lowered Pb 61% in A, 54% in B and 27% in C. Sr, Fe, Cu, Zn and Al showed the same trend as Pb. The higher photosynthetic activity of 1-year-old leaves (Pn=7.0+/-2.9 micromol m(-2 )s(-1), average value) in A sites with respect to B sites (6.7+/-2.4 micromol m(-2 )s(-1)) and C sites (6.7+/-1.8 micromol m(-2 )s(-1)) seems to be related to higher stomatal conductance (g(s)=0.13+/-0.06 mol m(-2 )s(-1)), higher total chlorophyll content (Chl=1.57 mg g(-1)) and higher leaf thickness (L(T)=218.9 microm), particularly palisade parenchyma thickness (109.4 microm). Q. ilex showed, on average, 95% of 1-year-old leaves and rarely 2-year-old leaves in A and B sites; 77% 1-year leaves, 20% previous-year leaves and sporadic 3-year leaves in C sites. The enhanced leaf senescence in A sites is compensated by a stimulated shoot production (18% higher with respect to C sites); 25% increased specific leaf area seems to be compensatory growth occurring in order to increase the size of the assimilatory area. The inverse trend of leaf life-span and Pn seems to be Q. ilex' adaptive strategy in polluted areas.

The presence of atrophic-erosive lesions among gingival tissues makes oral hygiene procedures difficult for several reasons. Plaque control and rigorous oral hygiene are a fundamental requisite for the treatment of any oromucosal disease.A patient suffering from a mixed atrophic-erosive form of oral lichen planus (OLP), with serious gingival involvement, was also treated with the topical application of clobetasol propionate 0.05% using gingival trays. The highest hygiene standards of both patient and trays were of fundamental importance.The management of the patient suffering from gingival atrophic-erosive OLP requires the synergic treatment of both dentist and dental hygienist, whose contribution supports the corticosteroid and/or immunosuppressive treatment.

The dynamic stabilization of lumbar spine is a non-fusion stabilization system that unloads the disc without the complete loss of motion at the treated motion segment. Clinical outcomes are promising but still not definitive, and the long-term effect on instrumented and adjacent levels is still a matter of discussion. Several experiments have been devised in order to gain a better understanding of the effect of the device on the intervertebral disc. One of the hypotheses was that while instrumented levels are partially relieved from loading, adjacent levels suffer from the increased stress. But this has not been proved yet. The aim of this study was to investigate the long-term effect of dynamic stabilization in vivo, through the quantification of glycosaminoglycans (GAG) concentration within instrumented and adjacent levels by means of the delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage (dGEMRIC) protocol. Ten patients with low back pain, unresponsive to conservative treatment and scheduled for Dynesys implantation at one to three lumbar spine levels, underwent the dGEMRIC protocol to quantify GAG concentration before and 6 months after surgery. Each patient was also evaluated with visual analog scale (VAS), Oswestry, Prolo, Modic and Pfirrmann scales, both at pre-surgery and at follow-up. Six months after implantation, VAS, Prolo and Oswestry scales had improved in all patients. Pfirrmann scale could not detect any change, while dGEMRIC data already showed a general improvement in the instrumented levels: GAG was increased in 61% of the instrumented levels, while 68% of the non-instrumented levels showed a decrease in GAG, mainly in the posterior disc portion. In particular, seriously GAG-depleted discs seemed to have the greatest benefit from the Dynesys implantation, whereas less degenerated discs underwent a GAG depletion. dGEMRIC was able to visualize changes in both instrumented and non-instrumented levels. Our results suggest that the dynamic stabilization of lumbar spine is able to stop and partially reverse the disc degeneration, especially in seriously degenerated discs, while incrementing the stress on the adjacent levels, where it induces a matrix suffering and an early degeneration.

The aim of this study was to evaluate the clinical and microbiologic results of local delivery of adjunctive antimicrobials in the treatment and management of patients with periodontitis.The study population included 33 patients (age range, 37-49 years), with chronic adult periodontitis. Eleven of 33 received local treatment with 10% doxycycline injected directly into the periodontal pocket; 11 received local treatment with a chlorhexidine-based gel (1.5%) in situ; 11 received mechanical treatment with scaling and root planing. The crevicular fluid of the doxycycline-treated group was analyzed using high performance liquid chromatography over a period of 1 month.In the 11 patients treated with an antibiotic we observed a reduction in attachment loss and a reduction in probing depth of 1.4 mm; in the 11 chlorhexidine-treated patients we observed a reduction in attachment loss and a reduction in probing depth of 0.9 mm; in the remaining 11 patients the reduction in attachment loss and probing depth was less than those measured in the other two treatment groups.Our results suggest that direct delivery of antimicrobial agents to the infection site may be a useful adjunctive to conventional periodontal treatment.

The possibility of the non-parenteral Hepatitis C Virus (HCV) transmission is supported by the demonstration that the actual virus is present in several body fluids, including saliva. From a review of the literature many investigators have found the presence of HCV-RNA in saliva, however, widely contrasting results emerge, with detection rates ranging from 0-100%. To further examine HCV salivary shedding, saliva samples were collected from 46 chronically HCV-infected patients and tested for HCV-RNA and occult blood. Quantification and genotyping of serum HCV-RNA were also carried out for each patient. HCV-RNA was detected in 39.13% of the saliva samples. The viral salivary shedding was significantly related to viraemia levels, serum viral genotype and the presence of salivary occult blood. Our findings indicate that the HCV salivary shedding occurs in about one third of HCV infected patients, but seem to suggest that it is unlikely when the serum viral genotype is 3a. Moreover, blood leakage into the oral cavity is possibly the main source of the salivary HCV-RNA. Although the occurrence of the viral salivary shedding does not necessarily mean that HCV transmission occurs by saliva, our results suggest the need for further investigations into the biological factors possibly involved in HCV mucosal transmission related to both the source and the exposed subjects.

Patients who undergo a renal transplant also require a pharmacological immunosuppressor therapy with cyclosporine (CsA) as well as anti-hypertensive calcium channel-blockers (CCBs); the former suppresses interferon and interleukin-2 production thus interfering with T cell cell-mediated activity, while the latter are used in order to counteract the nephrotoxicity of CsA which causes the local release, of thromboxane A2 with vascular vasoconstriction in the kidney. The use of both these drugs, particularly if used in association, leads to the onset of a clinical picture of variable entity, characterized mainly by a hypertrophy originating usually at the level of interdental papillae, and more pronounced in the anterior maxillary areas and the vestibular surfaces of the teeth, in a more or less symptomatic manner. The therapy is above all preventive, with an appropriate oral hygiene program, both professionally as well as at home, and with the use of substitutive drugs that do not present such side effects.

Tha aim of this paper is to assess the effects in vivo of the Nd: Yag laser on gingival microflora in patients periodontally at risk.An investigation has been carried out on 5 patients suffering from serious periodontal disease, with a sub-gingival check-up a week after the treatment. The selected patients presented either a relapse after the raising of a traditional flap, or showed acute phenomena and were, therefore, treated with a laser with the propedeutic intention of surgery; or they refused traditional surgical therapy or presented systematic pathologies that could not be included in the appropriate protocol. Pockets were chosen that had a probe depth of between 5-8 mm, an optic fibre probe was pushed as far as possible into the probe depth, for about 1 minute per site, 5 times, at 30 second intervals. The samples, taken in order to calculate bacteria colonies, were carried out before using the laser, immediately after and, again, 1 week later.All the sites showed a slight reduction in the quantity of colonies forming immediately after the Nd:Yag laser application, while a week later, only if clinical inflammation appeared to be resolved, the bacteria forming colonies seemed to be reduced.From this study it can be concluded that the use of the Nd:Yad laser represents, in mild and average periodontitis, a therapeutic aid to scaling and root planing and, in the same way, in serious periodontitis for traditional surgical therapy.

Human viruses play a fundamental role in the pathogenesis of periodontal disease due to their intrinsec capacity to interfere with immune system of the host. Herpesvirus maybe involved in the onset or progress of a number of periodontal diseases while HIV seems to be related to the linear gingival erythema (LGE) and necrotizing ulcerative periodontitis (NUP).

The rationale for using tazarotene in oral lichen planus (OLP) is its regulatory action on the growth and differentiation of keratinocytes and on inflammation. This randomized, placebo-controlled study addresses evaluation of the effects of topic tazarotene in the treatment of OLP.The degree of lesions before and after treatment scored by a 6-score scale in six cases treated with tazarotene was statistically compared with those of six controls treated with placebo.Twelve patients with hyperkeratosic OLP were randomly allocated to treatment with tazarotene gel 0.1% b.i.d. or with placebo for eight consecutive weeks.The statistical comparison was executed by means of Wilcoxon analysis for paired data.Patients treated with tazarotene presented a significant reduction of their lesions as compared with the control group. Among transitory side-effects, burning sensation and taste abnormalities were observed.Topical tazarotene may be a valuable therapeutic tool in the treatment of hyperkeratotic OLP.

A classification should be simple, repeatable and standardized to allow a choice of treatment, but an ideal thoracolumbar spine classification remains difficult. Different types of traumatic events can create different types of fractures. In the AO classification the fractures are classified by increasing severity in type A, type B, type C. This classification is based on anterior and posterior elements; a fracture is defined as unstable if the posterior elements are damaged. The Thoracolumbar Injury Classification and Severity Score (TLICS) defines when surgery is indicated. McCormack’s classification suggests when anterior column reconstruction is necessary.

A good analytical chemistry research paper may be defined as one that passes the critical review of one’s peers for publication in a recognized reviewed jour-nal. Factors to consider in publishing an analytical paper include careful selection of the right journal, clear concise presentation that emphasizes the re-search contribution and its significance to the field, and careful revision if called for to account for the reviewers’ and editors’ criticisms. Rather special requirements apply to methods papers as opposed to other types of analytical papers. Data should be included to establish the accuracy and precision of the method by the use of standard reference mate-rials, standard addition studies, interference studies, and comparisons with established methods. Day-to-day and run precision studies of the proposed method in a real setting help validate the method. Common problems with analytical papers are discussed. Specific suggestions are given for improving the likeli-hood of publication. Data are given on the ultimate disposition of manuscripts submitted toAnalytical Chemistry. Reasons for rejection of papers submitted to the journal are summarized.