bluuebunny/crossref_metadata_2025 huggingface dataset:
Appropriateness of Psychostimulant Prescription to Children: Theoretical and Empirical Perspectives
Authors: Miller Anton
Published: January 2017

Objectives:

1) To consider study designs for evaluating how appropriately stimulant medications are prescribed to children. 2) To investigate appropriateness by seeking evidence of consensus around how stimulant management should be undertaken, collecting and reviewing evidence of actual physician practice in relation to use of stimulants, and evaluating the closeness of fit between recommended and actual practice.

Method:

Electronic databases and other published and unpublished material were searched for the decade 1987–1997 to identify 1) authoritative recommendations for medical management of attention-deficit hyperactivity disorder (ADHD) and 2) surveys of physician practice. Available information was analyzed qualitatively for commonalities and trends and for concordance between recommendations and practice.

Results:

Despite differences in emphasis between experts, common themes were identifiable regarding prerequisites and follow-up for use of stimulants. Overall, it was rare to find physician practice in accordance with expert recommendations more than 70% of the time, suggesting that management may be suboptimal in at least 30% of children treated with medication for ADHD. Across surveys, consistent differences appear in physician practice patterns related to practice type. Management by specialist consultants approximates standards recommended by experts, while management by primary care practitioners diverges from these standards.

Conclusions:

There are grounds for concern about the quality and appropriateness of medical management for children with ADHD. The methodology used in this study holds promise for wider application, with planning and refinement. There is a need to find ways to improve care for children with ADHD provided by primary care physicians.
Changes in Newspaper Images of Black Americans
Authors: Martindale Carolyn
Published: January 2017

Coverage of blacks has made up a tiny proportion of total content since the 1950s in four leading U.S. dailies — the New York Times, the Boston Globe, the Atlanta Constitution and the Chicago Tribune — indicates this study of stereotypical images of black Americans.
Skills Testing at American Newspapers
Authors: Hipsman Barbara J. , Wearden Stanley T.
Published: January 2017

Frustrated by experiences of finding out too late about job candidates' deficiencies in basic skills and dissatisfied with standard job interviews as an effective screening device, many editors are turning to skills testing to help them determine who can make the grade.
Agency Law & Works for Hire: Are Freelancers Employees?
Authors: Middleton Kent R.
Published: January 2017

Confusion over copyright ownership of work by freelancers is unclarified by recent Supreme Court decisions. Meanwhile, rights to work done by non-employees seem to rest with the freelancer.
A Study of Time-Dependent Operating Room Fees and How to save $100 000 by Using Time-Saving Products
Authors: Shippert Ronald D.
Published: January 2017

Problem/Issue:

Product costs are a portion of the annually increasing costs of medical care. With diligent analysis of product costs, including the cost of time to use the product, the surgeon can reduce these spiraling costs. The purpose of this study was to provide the surgeon with the necessary information to make informed decisions about time- and cost-efficient products.

Materials and Methods:

This study involved phoning, faxing, or e-mailing hospitals and anesthesia groups across the United States to obtain time-dependent costs in the hospital operating room. Operating room fees charged by the hospital and anesthesiologist professional fees are included. Various products were then relatively compared with the time needed to prepare, use, or apply the product. Time and cost factors were then compared in order to ascertain the most time- and cost-effective products.

Findings:

The findings revealed an average of $62 per minute (rounded to the closest dollar) for the hospital operating room fee (range $21.80–$133.12) and $4 per minute for the anesthesiologist professional fee (range $2.20–$6.10), with a total of $66 per minute. This figure represents a marked increase from the 1991 rate of $20 per minute. Generalizations from this study indicate that time-cost efficiency is seen more so in kits (trays) than in nonkits and more so in disposables than in durables. Products that require fewer people are more time-cost efficient than those that require more people, and products that require fewer steps are more time-cost efficient than those that require more steps. Specific findings included time and cost dominance for the following products: staples over sutures, direct-current cautery over alternating-current cautery, syringes over Dermajet or Madajet, MagneSplint over suturing the nasal septum, aluminum-Velcro or aluminumfoam Denver Splint and Xomed Bridgemaster over any of the polypropylene heat-sensitive splints, Rhino Rocket and Merocel over Vaseline gauze, Brennan RhinoCath over manual blood removal, 1-piece Biplane liposuction cannulas over any 2-piece type, Doyle ear-dressing kit over component parts, Dale nasal dressing over component parts, preformed implants over manual forming, and Denver Splint kits over component parts.

Conclusions:

Each hospital or private suite will have different charges, and the range of product choices for each surgeon will be different. However, the principle is the same: If you save time, you will save money. In addition to the monetary benefit, the patient will be safer and receive less anesthesia, and the surgeon will have more time for his or her own social or professional life. Each surgeon should analyze the product choices and choose those products that will deliver quality care in less time. To save more than $100 000, the surgeon has to save only approximately 7 minutes per case on 250 cases.
Kinematic Comparison of Spontaneously Generated Blinks and Voluntary Blinks in Normal Adult Subjects
Authors: Baker Robert S. , Abou-Jaoude Edward S. , Napier Sharon M.
Published: January 2017

Purpose:

Spontaneous and voluntary blinks share a common final neuromuscular pathway but have totally different purposes and have come under different evolutionary pressures. The purpose of this study is to compare quantitative blink kinematics (down-phase duration, amplitude, peak velocity, and lid-closure duration) of spontaneously generated blinks with voluntary blinks in normal adults.

Methods:

Spontaneous and voluntary (tone generated) blinks of the right eye of 7 subjects were studied by a modified scleral search coil technique. Automated analysis of each blink kinematic was performed and statistical analysis of pooled data was undertaken.

Results:

All kinematics of voluntary blinks were greater than those of spontaneous blinks: duration (77.6 ± 10.0 milliseconds) was 17.6% longer, amplitude (43.1 ± 7.9°) was 40.8% larger, peak velocity (1288.6 ± 358.5°/ms) was 47.3% faster, and mean lid-closure duration (13.4 ± 4.7 milliseconds) was 61.4% longer (P < .001 in all cases).

Conclusion:

Kinematics of voluntary and spontaneous blinks are significantly different, reflecting their different supranuclear control. This quantitative study confirms previous qualitative observations and clearly separates these categories of eyelid movement as distinct, with spontaneous blinks serving a purely physiologic function and voluntary blinks being a part of facial expressivity.
Incidental Finding of Restylane in a Deep Mohs Micrographic Surgical Margin
Authors: Lane Joshua E.
Published: January 2017

Objective:

Soft tissue augmentation is a mainstay of minimally invasive facial rejuvenation. Hyaluronic acid fillers, such as Restylane, have been used extensively for this purpose. Because it is so extensively used, Mohs surgeons should be aware that it may appear when surgical margins are histologically examined during micrographic surgery.

Methods:

Case report.

Case Presentation:

A 54-year-old woman referred for treatment of a squamous cell carcinoma of the left upper cutaneous lip. She was treated successfully with Mohs micrographic surgery. Restylane was identified as acellular blue foreign material in the hematoxylin-eosin stained frozen sections obtained from the biopsy. Subsequent inquiry to the patient revealed that Restylane had been injected 4 months previously.

Discussion:

Restylane is a hyaluronic acid filler that is commonly used to improve facial lines and rhytides. The clinical and histologic duration of Restylane is thought to approximate 6 to 9 months. It is important to recognize that when intraoperative frozen sections are examined, they may contain unexpected histologic features given the expanded use of cosmetic filling agents.

Conclusion:

It would be reasonable for Moh's surgeons to become aware of the different cosmetic filling agents and their histologic appearance and to include on presurgical questionnaires a question about past treatment with cosmetic fillers to avoid unexpected histologic findings.
Reduced Lidocaine Concentration in Tumescent Liposuction: A Report of Efficacy at 400 mg/L
Authors: Zavala-Alarcon Edgardo , May-Villanueva Luis
Published: January 2017

Tumescent liposuction is considered a very safe procedure, but increasing dosages of total lidocaine used in extensive procedures have raised concerns about safety. Multiple cases of fatality probably related to lidocaine toxicity have raised questions about continued performance of liposuction in the office setting; these questions are being evaluated by several state medical boards. We performed a prospective nonblinded evaluation of 100 consecutive tumescent liposuction procedures using the traditional 0.05% lidocaine concentration versus a 0.04% concentration, which theoretically can reduce the total lidocaine dosage by 20% with no evidence of reduced efficacy. We believe that this new dosage could potentially decrease the likelihood of lidocaine-related events, although additional studies are required to confirm our findings.
Laminar Dermal Reticulotomy for Facial Nevus of Ota
Authors: Pierce Harold E.
Published: January 2017

Laminar Dermal Reticulotomy and dermabrasion are procedures often sought by noncaucasian patients for the amelioration of post acne scarring, post traumatic scarring, and the correction of dyschromias. Many surgeons simply deny these patients access to these procedures without the benefit of an in-depth history, physical examination and proper dermatopathological study to determine the depth of the pathology. A case is presented to stress more critical evaluation prior to patient rejection.
The Dental Art Can Remedy the III, Restore Her Hopes, and Make Her Lovely Still
Authors: Barsh Laurence I.
Published: January 2017

Dentistry, once thought of only as an unpleasant necessity, has assumed a major role in improving the appearance of people who were once distressed by their smiles. New bonding techniques and osseointegrated dental implants can restore the health and appearance to a dentition that, just a few years ago, would have been considered unrestorable. The purpose of this paper is to acquaint the facial plastic surgeon with some of the new concepts and procedures in cosmetic dentistry.
Retraction Sectioning of Micrografts and the Micro-Pen (Electric Knife)
Authors: Greco Joseph
Published: January 2017

A hair transplant surgeon can be highly skilled, meticulous, conscientious, but the results will only be directly proportional to the quality of grafts the surgical team is capable of producing.
The Challenge of Columellar Reconstruction: A Report of Eleven Cases Treated by Different Techniques
Authors: Benmeir P. , Lusthaus S. , Ad-El D. , Weinberg A. , Neuman A. , Wexler M. P.
Published: January 2017

Reconstruction of the columella is difficult and there is not a universally accepted technique for performing it. We report a series of eleven cases during the last twelve years for columellar reconstruction. The diverse techniques employed are described and the relevant literature reviewed. A special mention is made about the better way to reconstruct the columella in cases of median cleft of the face.
The Use of Infrared Coagulation in Hair Transplant and Scalp Reduction Surgery
Authors: Hitzig Gary S. , Schwinning John P. , Handler Seymour L.
Published: January 2017

The infrared coagulator, a spin off of laser technology, has been used for more than a decade, first in Europe and then in the United States, for the in-office elimination of first and second degree hemorrhoids. Even more recently, it has been employed in the treatment and removal of unwanted tattoos. This device has been FDA approved for both anorectal and dermatologic applications.

Within the last year, we have conducted a thorough study in our practice of the use and comparison of electrocoagulation, radiosurgical coagulation, and infrared coagulation during both hair transplantation and scalp reduction surgery.

The infrared coagulator with its multiple-sized tips and pinpoint accuracy has proven to be superior (especially in a wet field) in providing excellent hemostasis, allowing minimal blood loss, and in allowing the clearest visual field in performing both hair transplant and scalp reduction surgery. Because no ground or antenna plates are necessary for the use of the device, it is extremely safe and effective and thus minimizes both patient risk and electrical shock. Its excellent effect in a wet field (it's used in bleeding hemorrhoids) as well as its uncumbersome size and versatility, makes it the ideal instrument for use during hair transplant and scalp reduction surgery.

The device has been tested in the treatment of arteriovenous fistulas in the donor area of the scalp as well and has proved to be quite safe and effective.

This paper presents a study encompassing 110 patients undergoing either hair transplant or scalp reduction surgery. Each different modality of coagulation is utilized for the various transplant or scalp reduction sessions on the same patient. Comparisons of effectiveness and postoperative complications are made. Detailed results and photographs are presented.
Fat Transplants in Male and Female Genitals
Authors: Hernandez-Perez Enrique , Machado Aurelina
Published: January 2017

In the past 6 years we have performed fat transplantation in 236 male and female genitals. Fat is extracted from a donor area, usually the abdomen, and then decanted. The shaft of the male penis or, in females, the labia and pubis, are injected with the fat through small cannulas. Results have been quite satisfactory.
Credentialing in Cosmetic Surgery
Authors: Ellis Michael S.
Published: January 2017

In this paper, the author enumerates the policies and recommendations of organized medical organizations, federal and state laws concerning credentialing, and the rights of physicians to provide specific patient care services. He introduces the policy supported by the American Medical Association (AMA), including a description of the practice of clinical proctoring as a tool for peer review. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards are discussed, as are the positions on credentialing advocated by the American Board of Medical Specialists (ABMS), the American College of Surgeons, the American Academy of Otolaryngology—Head and Neck Surgeons (AAO–HNS), and the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), and the American Society of Plastic and Reconstructive Surgeons, Inc.
Standardizing the Nomenclature of Grafts
Authors: Schell Barbara J. , Stough D. Bluford , Nelson Bruce
Published: January 2017

The field of hair restoration surgery has experienced rapid growth and advancement, which has enabled an unparalleled aesthetic result compared to years past. Unfortunately, many of the recent advances and refinements have contributed to a concomitant increase in confusion regarding terminology. We submit that in order to critically perform accurate studies as well as relay pertinent information regarding techniques and outcomes, a standardized nomenclature system must be adopted. Such a system is described herein and terms are defined in a simple and precise manner. A standardized nomenclature system will enable the discipline of hair restoration surgery to move forward more efficiently and effectively by validating the field as a scientific discipline.
A New Alopecia Reduction Design: No Visible Scars, No Slots, No Frechet Flaps
Authors: Marzola Mario
Published: January 2017

There has been much discussion over a number of years about the efficacy of alopecia reductions in the treatment of male pattern baldness. The majority opinion has been negative, citing too much surgery, too many complications, and too much scarring involved in the procedure. As a result, the alopecia reduction procedure has become less popular with both doctors and patients, and is no longer performed at all in many practices. A new design of alopecia reduction is offered in this paper. It fulfills all of the criteria required of a modern procedure. There is no scarring in the temples and in the crown, there is no slot formation, and there is no need for Frechet Flaps. It is easy to design, easy to perform, and can be used with any intra- and interoperative device.
The Hair Transplant Megasession Technique: A Review
Authors: Shiell Richard C.
Published: January 2017

The hair transplant megasession technique was introduced over a decade ago but has become more widely used only in the past 3 years. With more general use, criticism of the technique has arisen, and this article attempts to examine the factors leading to the success or failure of a valuable new surgical concept.
Topiramate in the Catastrophic Epilepsies of Childhood
Authors: Glauser Tracy A.
Published: January 2017

Several epileptic syndromes that occur during childhood are characterized by severe treatment-resistant seizures, progressive loss of higher intellectual functions, and characteristic electroencephalographic abnormalities. These catastrophic epileptic syndromes include epileptic encephalopathy with diffuse slow spike waves (Lennox-Gastaut syndrome), West syndrome, progressive myoclonic epilepsies, and electrical status epilepticus during sleep. This article summarizes each syndrome and reviews the most recent information concerning the effectiveness of topiramate with respect to each condition. Suggestions are offered to help clinicians maximize topiramate's efficacy and tolerability in patients suffering with these syndromes. Overall, topiramate is a valuable antiepileptic medication in the treatment of catastrophic pediatric epileptic syndromes. (J Child Neurol 2000;15:S14-S21).
Safety and Tolerability of Topiramate in Children
Authors: Levisohn Paul M.
Published: January 2017

Three double-blind, randomized, placebo-controlled studies of topiramate that include children have been published and prospective but unblinded and retrospective reviews have been reported providing information regarding topiramate's safety and tolerability. These studies indicate that side effects tend to occur early in treatment with topiramate, especially in children receiving polypharmacy. Two classes of adverse events are commonly reported: central nervous system and anorexia/weight loss. Central nervous system effects include somnolence, difficulties with concentration, and behavior changes. Tolerance to these effects seems to develop in most children. When it occurs, weight loss has been noted in the first 12 to 18 months, after which normal weight gain resumes, without long-term impact on growth. As opposed to the experience in adults, aphasia and word-finding difficulties are not commonly seen, and parasthesiae are not reported by children. Renal calculi are rare. Life-threatening idiosyncratic reactions have not been attributed to topiramate. While metabolic acidosis has been reported, no other clinically significant laboratory abnormalities have been associated with the use of topiramate in children. (J Child Neurol 2000;15:S22-S26).
Pharmacokinetics and Pharmacodynamics of Topiramate
Authors: Bourgeois Blaise F.D.
Published: January 2017

In the treatment of children with epilepsy, the role of topiramate has been expanding gradually. The main factor that has contributed to this trend is the relatively large body of information that has accumulated on the clinical pharmacology of topiramate in children, including its broad-spectrum efficacy, pediatric pharmacokinetics, side-effect profile, and safety. It has also become increasingly apparent with time that topiramate, in contrast to other broad-spectrum antiepileptic drugs used in children, does not seem to be associated with a significant risk of any serious or life-threatening adverse effects. The present review summarizes the available evidence related to the clinical pharmacology of topiramate in children and provides an update on its known mechanisms of action. Finally, available experimental data on the neuroprotective effect of topiramate are reviewed because of their considerable clinical potential in the treatment of children and newborns. (J Child Neurol 2000;15:S27-S30).
Movement Disorders in Children: Definitions, Classifications, and Grading Systems
Authors: Delgado Mauricio R. , Albright A. Leland
Published: January 2017

Disorders that affect movement in children are relatively common. However, they have received little attention, especially when compared with epilepsy and neuromuscular disorders. In this review article, we address the major types of movement disorders that affect children, their clinical characteristics and etiologies, and, when available, the scales used to grade them. A discussion on spasticity, which traditionally is not addressed in reviews of “movement disorders,$quotedblright is also included. (J Child Neurol 2003;18:S1—S8).
Oral Pharmacotherapy of Childhood Movement Disorders
Authors: Edgar Terence S.
Published: January 2017

Movement disorders, a common problem in children with neurologic impairment, are receiving increasing clinical attention. The differences in movement disorders between adults and children are striking; presentation is frequently insidious and may be characterized by mild hypotonia. The clinical manifestations of extrapyramidal disorders are profoundly influenced by the age of onset. The conditions reviewed in this article are expressed clinically by the occurrence of abnormalities of movement and posture, often in association with disturbances of muscle tone. This article reviews empiric drug use and recommendations for childhood movement disorders. (J Child Neurol 2003;18:S40—S49).
Neurosurgical Treatment of Spasticity and Other Pediatric Movement Disorders
Authors: Albright A. Leland
Published: January 2017

For children whose spasticity and movement disorders are inadequately treated by oral medications and botulinum toxins, neurosurgical procedures are now available to effectively treat spasticity, tremor, and many cases of dystonia. Spastic diplegia can be treated with selective lumbar rhizotomies, which significantly decrease spasticity, increase range of motion, and improve Gross Motor Function Measure scores. Children with spastic quadriparesis and those with secondary dystonia can be treated with intrathecal baclofen, which diminishes both spasticity and dystonia and is associated with improved function and quality of life. Children with primary dystonia and those with tremor can be treated with deep brain stimulation of the internal globus pallidus and thalamus, respectively. Some children with chorea respond to deep brain stimulation. There are no effective neurosurgical treatments for athetosis or ataxia. The effectiveness of neurosurgical treatments of pediatric movement disorders has increased significantly in the past 15 years. (J Child Neurol 2003;18:S67—S78).
Biosynthesis and Metabolism of Carnitine
Authors: Lee Carter A. , Abney Tom O. , Lapp David F.
Published: January 2017

This review article presents the biosynthesis, metabolism, sources, levels, and general functions of carnitine. Emphasis is placed on the expression of carnitine deficiency and insufficiency as well as the causes of these conditions. The various functions of carnitine are discussed as they may relate to disease treatment. (J Child Neurol 1995;10(Suppl):2S3-2S7).
Old Swallowing and Dysphagia: Thoughts on Intervention and Prevention
Authors: Robbins JoAnne
Published: January 2017

Aging “baby boomers” are ushering in the new millennium. Indeed, the fastest growing segment of the population in this nation is older adults (Fig. 1). In the year 1900, approximately 1 in every 25 persons in the United States was 65 years old or older. In the year 2000, 1 in 5 Americans will be 65 or older. This demographic transition has enormous consequences for the society at large. It calls for significant research attention to the major biologic, social, and psychological challenges of aging.
Risk Factors for Aspiration Pneumonia
Authors: Langmore Susan E.
Published: January 2017

Pneumonia is a serious and common infection occurring in hospitalized and nursing home patients. Most cases of nosocomial pneumonia are aspiration related, with oropharyngeal secretions, refluxed gastric contents, food, and/or liquid being the possible sources of aspiration. Aspiration pneumonia develops when necessary prerequisite conditions are met. The relationship among dysphagia, malnutrition, dehydration, and aspiration pneumonia is complex and interdependent. Prevention of aspiration pneumonia requires attention to the risk factors.
Nutrition Issues in Dysphagia: Identification, Management, and the Role of the Dietitian
Authors: Brody Rebecca
Published: January 2017

The relationship between dysphagia and malnutrition is strong. If dysphagia is undiagnosed or untreated, it can result in progressive malnutrition and its related sequelae. Registered dietitians can play an essential role in early identification of patients at risk for dysphagia and development of dysphagia‐focused nutrition care plans. Dysphagia screening, inclusive of mealtime observation, and basic physical examinations can assist in identification and referral to the dysphagia team. The nutrition care plan should be individualized and centered around the primary goal of nutrition therapy for the dysphagic patient: adequate and safe intake of nutrients. Creative and nutritious meal planning as well as continuous monitoring with review of risk factors and diet adjustments are critical to the success of the nutrition plan.
Rheology Overview: Control of Liquid Viscosities in Dysphagia Management
Authors: Mills Russell H.
Published: January 2017

In this article, the author presents a model that demonstrates that viscosity is an important variable in all aspects of the dysphagia evaluation and management. Data are presented that show that clinicians do not provide close control of this important variable. As a consequence, clinicians are at risk for producing diagnostic and management errors. The author summarizes the “dilution curve” method for creating viscosity‐accurate test materials and reviews the status of research for developing viscosity standards for thickened liquids.
Self-development
Authors: Gray Harry
Published: January 2017

Knowing yourself is the first stage in reducing stress
Self-development
Authors: Gray Harry
Published: January 2017

Beliefs are more powerful than targets—and more long-lasting
The French Perspective
Authors: Roussau-Rambaud Michelle
Published: January 2017

Management in a French lycée and the quest for European Citizenship for our students, is the focus here.
Evidence or Clinicians or the Person
Authors: Florczak Kristine L.
Published: January 2017

In this column, the issue of who should drive healthcare decision-making will be considered. To that end, evidence-based practice and evidence-informed practice models of care will be discussed. Problems with the use of each of these models will be brought to light followed by a presentation of a proposed model of care that puts the person at the center of healthcare decision- making.
Including the Voice of Older Adults in Research
Authors: Velzke Kari , Baumann Steven L.
Published: January 2017

The authors of this paper discuss the use of participatory and visual research methods with older adults with daily care needs in the United Kingdom. The comments made by older adults and their caregivers in focus groups provided the narrative for this paper. The authors also discuss how to engage older adults in participatory research. Nursing research and practice both involve evaluating processes to gain a holistic understanding of patients through multiple means of data collection. In other words, how do nurses give voice to otherwise silent older adults, even in cases when their strength and recall is failing?
Optical Methods To Measure Shape and Size
Authors: Boone P.M.
Published: January 2017

A number of methods are available to quantify exterior size and shape of living and non-living objects. Relevant items for dentistry are the exterior of face and skull and the surface of dental casts. To the best of our knowledge, dentitions have not yet been measured in situ. The optical methods using incoherent light are mechanical sensing of casts, visual stereometry (on the subject or on stereophotographic pairs), moire techniques, and optical-sensor morphometry. It will be shown that the three latter systems in fact rely on the same physical principles, although they involve quite different technologies. On the other hand, coherent optical techniques, such as holography and contouring holographic interferometry, are presented.

The basic principles of the different techniques are shown, and their main features in relation to applications to the dental object discussed. Main features include: resolving power, range, time needed for a measurement, requirements for the surface of the object, and ease of selection and collection of data. Examples of methods from the literature and from work by the author are given.
Piezoelectric Polymer Transducers
Authors: Davis G.T.
Published: January 2017

Poly(vinylidene fluoride) (CH2-CF2)n is a tough, flexible polymer readily available in the form of thin film which can be made piezoelectric by the temporary application of a high electric field. The areas of the film which become piezoelectric can be controlled to be the areas where metal electrodes are evaporated onto the film. The same electrodes and associated leads are subsequently used to detect the electric charge generated by the application of pressure to the active area. Such films may have applications in the measurement of occlusal forces.

Many of the problems that might be encountered in an occlusal gauge have been addressed separately in other applications. For example, polymer transducers less than 100 μm thick have been developed and tested for measuring the nip pressure on an intaglio printing press. Piezoelectric polymer gauges have been successfully encased in a protective layer of another polymer to prevent the sharp edges of sand particles from breaking through the piezoelectric film. Transducer films with an array of active areas have been produced with electrical leads from each area so that the source of the signal can be traced. Electrode patterns have usually been established by evaporation of metal through a mask, but silk-screening a conductive ink has also been shown to be an effective means of defining which areas of the film are to be made piezoelectric. Finally, poly(vinylidene fluoride) has been shown to retain 80% of its initial activity after 1000 hours at 100°C, and it is unaffected by moisture. Therefore, if necessary, gauges to be used in dentistry could be subjected to steam sterilization for repeated use.

The physical properties of such polymer films and examples of their use in pressure transducers are reviewed with the intent of stimulating interest in development of a system useful for measuring occlusal forces.
Biochemical and Micro-Analytical Methods
Authors: Bowen W.H.
Published: January 2017

Because of the small amounts of material available for study, investigations of plaque, caries lesions in enamel, and antibodies in saliva pose difficult challenges for investigators. Sophisticated biochemical and fluorescence techniques can now be used to investigate the microbial composition of plaque, thereby avoiding the need for tedious culturing techniques from single sites on tooth surfaces. A range of microchemical methodologies is available which greatly facilitates the analysis of plaque fluid, thereby enhancing our understanding of tooth-plaque interactions. The application of a range of novel physiochemical techniques should help to clarify our knowledge of the interactions involved in pellicle formation and elucidate the phenomena involved in the formation of the early caries lesion. A range of techniques is now available for the study of antibodies in saliva. These include ELISA, RIA, and solid-phase immunoassay. The application of these methodologies to the investigation of oral diseases should facilitate our understanding of the pathogenesis of dental maladies at the molecular level.
A 3-D Model of Enamel Development At the Scale of One Inch to the Micron
Authors: Boyde A.
Published: January 2017

A greatly enlarged physical model of the interface between ameloblasts and enamel facilitates the discussion of factors which might be involved in the control of the development of crystal orientation patterns and the prisms (or rods) in dental enamel. The model specifically relates to the most common circumstances in human enamel development. The 3-D concepts grasped from the developmental model help to explain the fracture mechanics of the adult tissue.
Calcium Binding in Enamel Fluid and Driving Force for Enamel Mineralization in the Secretory Stage of Amelogenesis
Authors: Moreno E.C. , Aoba T.
Published: January 2017

A large portion (about 85%) of the calcium present in the fluid of porcine enamel in the secretory stage of amelogenesis appears to be in a non-ionic form. Calcium is probably bound in the fluid by peptides derived from the enzymatic degradation of the amelogenins present in the matrix or by other ligands of an as-yet-undetermined nature. The apparent dissociation constant of the hypothesized complex was determined by titration of a small aliquot of fluid (50 μL) with 10 mmol/L CaCl2 solution, adding 2 μL at a time. The initial composition of the fluid was determined analytically. The ionic calcium activity, (Ca 2+), and the pH value along the titration were determined by a specific ion and a glass electrode, respectively, with the same reference micro-electrode. The concentration of bound Ca, [B], was related to the (Ca2+) by the equation [B] = N(Ca2+)/ {K + (Ca2+)}, in which K is the dissociation constant of the Ca-ligand complex and N is the number of binding sites per liter of fluid. The values of K and N were obtained by a non-linear least-squares procedure. The value of K, 7.47 × 10-5 mol/L, indicates that the binding bond is rather weak, a feature that seems advantageous if complexed calcium acts as a reservoir and/or fine control of calcium levels in the fluid during enamel formation. The effects that the total concentration of calcium, [Ca]T, the total concentration of P, the concentration of ligand, and the pH value have on the degree of saturation (DS) were investigated by simulation models. It is concluded that the factor that most affects the DS is [Ca]T. Some physicochemical aspects of amelogenesis are discussed on the basis of present knowledge and the reported results.
Production of Monoclonal Antibodies Against Enamelin and Against Amelogenin Proteins of Developing Enamel Matrix
Authors: Deutsch D. , Palmon A. , Catalano-Sherman J. , Laskov R.
Published: January 2017

The extracellular matrix of developing enamel contains two major classes of proteins, the hydrophobic proline-rich amelogenins and the acidic serine-, glycine-, and aspartic-rich enamelins. These proteins have been postulated as playing a major role in the mineralization and structural organization of developing enamel. To identify and further characterize these different proteins and their possible role in this complex process of biological mineralization, we have in recent years been concerned with the production of specific probes for these proteins. Previously, we have reported on the successful production of specific polyclonal antibodies against enamelin proteins, which did not cross-react with amelogenins, and against amelogenin proteins, which did not cross-react with enamelins (Deutsch et al., 1986, 1987). We now report the production of monoclonal antibodies against a major bovine amelogenin protein (28 kDa) and against a major bovine enamelin protein (66 kDa). One monoclonal antibody against amelogenin and one against enamelin are described. The results showed that the monoclonal antibody against the amelogenin protein reacted strongly with the 28-kDa amelogenin protein band but did not cross-react with enamelins, and the one against the enamelin protein reacted with the 66-kDa enamelin protein but did not cross-react with amelogenins. These monoclonal antibodies provide a specific and powerful tool to distinguish between and further characterize these different classes of proteins, and to improve our understanding of the process of enamel formation.
A Characterization of Amelogenin Messenger RNA in the Bovine Tooth Germ
Authors: Young M.F. , Shimokawa H.S. , Sobel M.E. , Termine J.D.
Published: January 2017

In order to study the nature of amelogenin mRNA, we isolated ameloblast-rich tissue from the unerupted permanent incisor tooth germs of 18-month-old steers and subjected it to guanidine HC1 solubilization for extraction of mRNA. When poly A+ ameloblast RNA was incubated with radioactive deoxynucleotides and reverse transcriptase, four major transcripts were detected with sizes of 1.9, 1.4, 0.7, and 0.4 kb in length. One of the transcripts (0.7 kb) corresponded precisely in length to that predicted from the size of the major in vitro translated amelogenin proteins (27,000 daltons). To determine whether the transcripts did indeed encode amelogenin mRNA, we constructed a λgt11 cDNA library and isolated several amelogenin cDNA's by screening with amelogenin antibody. Four clones were amplified and insert sizes determined by acrylamide gel electrophoresis. Two of the clones had insert sizes of ~ 0.7 kb (λAm 16, XAm 7), and two had insert sizes of ~ 0.4 kb (λAm 11, λAm 4). When the amelogenin cDNA was radiolabeled and used for northern analysis, two species of amelogenin message (0.75 and 0.45 kb) were evident, both of which showed extensive hybridization to λAm 16 (large) and λAm 11 (small) cDNA. These data indicate that: (1) Amelogenin mRNA is heterogeneous in the bovine tooth germ, having two major species 800 and 400 bases long; and (2) the major species of amelogenin share extensive sequence homology. Based on these data, we suggest that at least part of the heterogeneity of amelogenin matrix protein may arise from the production of heterogeneous amelogenin mRNA's that share some common nucleotide sequences.
Hydroxyapatite and Carbonated Apatite as Models for the Dissolution Behavior of Human Dental Enamel
Authors: Budz J.A. , Lore M. , Nancollas G.H.
Published: January 2017

It is now well-established that kinetic aspects as well as considerations based solely on solubilities and thermodynamic driving forces should be taken into account while one is attempting to understand the mechanism of dental caries. In the present study, kinetic comparisons of the dissolution of hydroxyapatite, carbonated apatite, and ground human dental enamel have been made in order that the appropriateness of these synthetic phases as enamel dissolution models can be assessed. Specific additives used to form intact surface layers in vitro have also been investigated. An interesting phenomenon related to surface-controlled dissolution has been revealed. During Constant Composition experiments, the dissolution rates for all the systems decrease markedly as the reaction proceeds. Further tests with fresh crystals suggest that micro-impurities, in addition to microstructural changes of the dissolving surfaces, may play a role in the case of hydroxyapatite but do not influence the dissolution of carbonated apatite. Kinetic results for ground human enamel indicate the release of dissolution poisons. Nevertheless, the results confirm expectations that carbonated apatite may be a better model for enamel than near-stoichiometric synthetic hydroxyapatite.
A Comparative Study of Disturbed Mineralization of Rat Incisor Enamel Induced By Strontium and Fluoride Administration
Authors: Suga S. , Aoki H. , Yamashita Y. , Tsuno M. , Ogawa M.
Published: January 2017

The disturbed pattern of mineralization of developing enamel of the rat incisor after the oral administration of SrCl2 and NaF was investigated in an attempt to disclose possible mechanisms which might not be readily detectable under normal conditions, but which may control the progressive mineralization of developing enamel, especially during the maturation stage. Undemineralized ground sections of upper incisors were examined by contact microradiography, tetracycline labeling, and electron microprobe analysis. It was clear that Sr and F disturb the pattern of mineralization during the maturation stage in a characteristic fashion. Sr inhibits the early stage of maturation in which mineralization progresses from the surface toward the middle layer, whereas F accelerates the same stage prominently. At the late stage of maturation, the pattern of hypomineralization is different in the enamel of Sr- and F-treated rats. Mineralization in the inner and innermost layers of the Sr-treated rats and that in the outer layer of the F-treated rats ceases earlier than that in the controls, although the enamel is still hypomineralized.

At the latest stage of maturation, Fe penetrates more deeply into the hypomineralized enamel of the Sr- and F-treated rats, because of the higher porosity of the matrix.

These results suggest that the maturation stage is not a simple, continuous process, but rather is composed of substages (phases) which have different control mechanisms and in which mineralization progresses in different modes and rates.
Composites - Characterization of Composite Filling Materials: Reactor Response
Authors: Ruyter I.E.
Published: January 2017

Dental composite restorative materials consist of an organic matrix, ceramic fillers, and the interface between the inorganic fillers and the matrix. Marked variations in the composition of the composite materials, as well as different degrees of conversion after polymerization, have been observed. These circumstances lead to substantial differences in the properties of polymerized composite materials. The variations in clinical behavior of the different composite materials, e.g., discoloration or lack of wear resistance, may be explained on the basis of differences in composition. This review paper describes the composition, conversion, and properties of presently available composite materials.
Future of Materials and Materials Research
Authors: Stanford J.W.
Published: January 2017

The purpose of this paper was to summarize the presentations on porcelain materials, endodontic materials, casting metals, impression materials, armamentarium, amalgam, resins, composites, cements, bonding agents, adhesives, and calcium phosphate materials. Eight series of recommendations for future research are presented and include areas of basic research, animal models, biocompatibility, correlated laboratory and clinical testing procedures, epidemiological studies, workshops and conferences, materials research criteria, and a Dental Research Information Center. These recommendations were subsequently presented to the Programs Advisory Committee for Extramural Research of the National Institute of Dental Research.
Amalgam: Reactor Response
Authors: Greener E.H.
Published: January 2017

Although the number of research reports on dental composites far outnumbers those on amalgams in recent years, amalgam remains the popular clinical choice for posterior restorations. Recent research on corrosion phenomena, mechanical properties, and new compositions indicates that the useful properties of amalgam may still be improved. Given the current position of amalgam within the dental armamentarium, focused research on the physical chemistry and metallurgy of current and new amalgams may continue to pay dividends.
Dental Amalgam: Reactor Response
Authors: Marek M.I.
Published: January 2017

Dental amalgam continues to be an important restorative material; both fundamental and applied research should be encouraged. The criteria for replacement of amalgam restorations should be re-examined to determine if the integrity of the margins should continue to receive the dominant research interest.

In the studies of mechanical properties, first attempts have been made to apply fracture mechanics analysis to dental amalgam. The heterogeneous structure and time-dependent strain of dental amalgam will have to be considered in future studies. More attention should be given to the effects of zinc, which has been shown to improve resistance to marginal fracture.

The corrosion properties have been studied in depth, but there are some important unanswered questions. The pathways of corrosion attack in high-copper amalgams and the kinetics of attack in amalgams of different composition should be examined. Biocompatibility of dental amalgam has recently received renewed interest and will have to be examined in more detail. The clinical significance of the release of metallic elements from restorations is generally unknown.

Dental amalgam faces strong competition from non-metallic restorative materials. Future research should be more strongly focused on the critical issues. The involvement of scientists from related disciplines should be encouraged, and no effort should be made to restrict the talent pool by a centralization of resources.
The Role of Toothbrushing in the Prevention and Treatment of Periodontal Disease: Personal Experience of Both Clinical and Experimental Observation for More than Thirty Years
Authors: Ishikawa J.
Published: January 2017

There have been dramatic developments in the theory and therapy of periodontal disease in the last few decades. This paper focuses on the role of toothbrushing in the treatment and prevention of periodontal disease, based on the author's personal experience gained from both clinical and experimental observations for more than 30 years.

Even in the recent past, periodontal disease was considered to be untreatable because of various misconceptions regarding its etiology. Attention was concentrated mainly on systemic factors. As a result, periodontallyinvolved teeth were extracted mostly due to lack of technical know-how. The author devoted his primary investigative efforts to systemic factors and found that those were only minimally significant. Later, after using wild and captive monkeys to make extensive experimental studies on local factors, he was convinced that food habit (hard, fibrous, or soft) contributes directly to the etiology of periodontal disease which is restricted in the oral environment itself.

Today it is well-established that accumulation of bacterial plaque on the tooth surface is the most important single factor responsible for periodontal disease, and systemic influence can merely modify the condition. Therefore, the accumulated plaque should be mechanically removed by toothbrushing. The essence of mechanical toothbrushing is not only to remove the plaque but also to compensate for the mechanical stimulation of the gingiva (gingival massage), which is lacking with modern soft food. This lecture reviews the effect of methodical toothbrushing obtained from both clinical and experimental studies in animals.