bluuebunny/crossref_metadata_2025 huggingface dataset:
Pain Management Interventions in the Nursing Home: A Structured Review of the Literature
Authors: Herman Adam D. , Johnson Theodore M. , Ritchie Christine S. , Parmelee Patricia A.
Published: June 2009

Residents in nursing homes (NHs) experience pain that is underrecognized and undertreated. This pain contributes to a decline in quality of life. Although descriptive studies of pain assessment and management have been conducted, few have been published that critically evaluate interventions to improve pain management. Identification of the strengths and gaps in the current literature is required. A literature search was conducted of clinical trials that evaluated prospective interventions to improve pain management. Information on the intervention type, resident sample and setting, endpoints, and study design were extracted. Studies were classified based on a modification of Donabedian's model of healthcare quality. Four categories of interventions were identified: actor, decision support, treatment, and systems. The search strategy and selection criteria yielded 21 articles. Eleven studies used an actor intervention; of these, eight also employed a systems intervention, and one also used a treatment intervention. Two studies used a decision support intervention, seven used a treatment intervention, and one used a systems intervention. The overall quality of research was uneven in several areas: research design—nine studies were quasi‐experimental in nature, endpoints measures were not consistent—three did not perform statistical analysis, and characteristics of the resident samples varied dramatically. In conclusion, the number of high‐quality studies of pain management in NHs remains limited. Process endpoints are used as surrogate measures for resident endpoints. Systematic approaches are needed to understand how each type of intervention improves the quality of pain management at the resident level.
Serum Insulin‐Like Growth Factor‐1 Binding Proteins 1 and 2 and Mortality in Older Adults: The Health, Aging, and Body Composition Study
Authors: Hu Donglei , Pawlikowska Ludmila , Kanaya Alka , Hsueh Wen‐Chi , Colbert Lisa , Newman Anne B. , Satterfield Suzanne , Rosen Clifford , Cummings Steven R. , Harris Tamara B. , Ziv Elad ,   for the Health, Aging, and Body Composition Study
Published: June 2009

OBJECTIVE: To evaluate the relationship between serum insulin‐like growth factor 1 (IGF‐1), IGF‐1 binding protein 1 (IGFBP‐1), and IGF‐1 binding protein 2 (IGFBP‐2) and fasting insulin, fasting glucose, adiposity, and mortality in older adults.

DESIGN: A prospective cohort study with mean follow‐up of 6.2 years.

SETTING: Participants were recruited and followed at two centers affiliated with academic medical institutions.

PARTICIPANTS: Six hundred twenty‐five men and women aged 70 and older and in good health at the time of enrollment.

MEASUREMENTS: Serum IGF‐1, IGFBP‐1, and IGFBP‐2; fasting serum insulin; fasting serum glucose; visceral fat; and total percent fat.

RESULTS: Higher IGFBP‐1 and higher IGFBP‐2 were significantly associated with lower fasting insulin, lower fasting glucose, and lower adiposity, but higher IGFBP‐1 and IGFBP‐2 were associated with greater mortality. In multivariate adjusted models, the hazard ratio for all‐cause mortality was 1.48 (95% confidence interval (CI)=1.14–1.92) per standard deviation (SD) increase in IGFBP‐2 and 1.34 (95% CI=1.01–1.76) per SD increase in IGFBP‐1. No association was found between IGF‐1 and all‐cause mortality.

CONCLUSIONS: Higher IGFBP‐1 and IGFBP‐2 are associated with lower adiposity and decreased glucose tolearance but also with greater all‐cause mortality. Higher levels of serum IGF‐1 binding protein (IGFBP) may indicate greater IGF‐1 activity and thus represent an association between higher IGF‐1 activity and mortality in humans.
Bruising as a Marker of Physical Elder Abuse
Authors: Wiglesworth Aileen , Austin Raciela , Corona Maria , Schneider Diana , Liao Solomon , Gibbs Lisa , Mosqueda Laura
Published: June 2009

OBJECTIVES: To describe bruising as a marker of physical elder abuse.

DESIGN: Consenting older adults were examined to document location and size of bruises and assess whether they were inflicted during physical abuse. An expert panel confirmed physical abuse. Findings were compared with results of an earlier study of accidental bruising in older adults.

SETTING: Residences of participants.

PARTICIPANTS: Sixty‐seven adults aged 65 and older reported to Adult Protective Services (APS) for suspected physical elder abuse.

MEASUREMENTS: Age, sex, ethnicity, race, functional status, medical conditions, cognitive status, history of falls, bruise size and location, recall of cause, and responses to Revised Conflicts Tactics Scale and Elder Abuse Inventory.

RESULTS: Seventy‐two percent (n=48) of older adults who had been physically abused within 30 days before examination had bruises. The physically abused older adults had significantly larger bruises; more of them knew the cause of their bruises (43 (89.6%) vs 16 (23.5%) of the comparison group); and they were significantly more likely to have bruises on the face, lateral aspect of the right arm and the posterior torso (including back, chest, lumbar, and gluteal regions) than older adults from an earlier study who had not been abused (n=68).

CONCLUSION: Bruises that occur as a result of physical elder mistreatment are often large (>5 cm) and on the face, lateral right arm, or posterior torso. Older adults with bruises should be asked about the cause of the bruises to help ascertain whether physical abuse occurred.
A Laboratory Procedure for Optimal Implant Abutment Preparation
Authors: Özcelik Tuncer Burak , Yilmaz Burak
Published: June 2009

Simplicity and predictability have made cement‐retained implant crowns the recent restoration of choice. The taper of the abutment is of particular importance for cement‐retained implant restorations. The ideal taper of the implant abutment allows the clinician to control the overall retention of restorations. The technique described in this report presents the laboratory preparation of an implant abutment for a cement‐retained crown using a counter gauge to control the preparation taper.
Comparison of a New Braid Fixation System to an Interlocking Intramedullary Nail for Tibial Osteotomy Repair in an Ovine Model
Authors: LU YAN , NEMKE BRETT , LORANG DOUGLAS M. , TRIP ROEL , KOBAYASHI HIROHITO , MARKEL MARK D.
Published: June 2009

Objectives—To compare bone healing of tibial osteotomy repaired with Nitinol wire braid and hardened steel rods (Braid system) and polymethylmethacrylate bone cement with an interlocking intramedullary (IM) nail fixation in an ovine model.

Study Design—In vitro and in vivo experimental study.

Animals—Adult female sheep (n=22).

Methods—Using sheep tibia, a middiaphyseal transverse osteotomy was performed in the right tibia, which were then randomly assigned to the Braid system group or IM nail group (n=5). The left tibia were used as controls. The torsional properties of tibial constructs were compared. The study was repeated in vivo in 12 sheep and mechanical properties and bone healing were evaluated at 12 weeks.

Results—In vitro, there was no significant difference in torsional stiffness between the groups. In vivo, operative time for the Braid system group was significantly shorter than the IM nail group. At 12 weeks, there were no significant differences in maximum torque and torsional stiffness between IM nail and Braid system groups nor were there significant radiographic or histologic differences between the groups.

Conclusions—The Braid system might decrease operative time for repair of transverse middiaphyseal tibial fractures and result in similar bone healing at 12 weeks after surgery compared with an interlocking IM nail repair.

Clinical Relevance—A Nitinol Braid system may be a treatment option for transverse midshaft tibial fractures.
Potemkin Villages: “The” Medium‐Term Expenditure Framework in Developing Countries
Authors: SCHIAVO‐CAMPO SALVATORE
Published: June 2009

By neglecting institutional and capacity considerations, medium‐term expenditure framework (MTEF) introduction has produced in most developing countries elaborate facades of fiscal reform at high transaction costs without improving budgetary outcomes. There have been positive impacts: awareness of the need to look beyond the immediate urgencies; some encouragement of intragovernmental coordination; and initial orientation toward results. Negative impacts have been much heavier: little local ownership; distraction from basic budgeting problems; and severe strain on limited capacity. Unbundling “the” MTEF permits identifying the variant suitable to the specific country and the steps to gradually develop it: unlike a “programmatic MTEF,” a simple “forecasting MTEF” is both feasible and useful.
An Evaluation of Alternative Tax and Expenditure Limitation Policies on Kansas Local Governments
Authors: SPRINGER JOB D. , LUSBY AARON K. , LEATHERMAN JOHN C. , FEATHERSTONE ALLEN M.
Published: June 2009

Cross‐sectional time series data in a partial adjustment model are used to examine county government fiscal behavior under a “hard” tax and expenditure limitation policy, an aggregate property tax levy limit, versus a “soft” limit under Truth in Taxation in Kansas. Results indicate that under the aggregate levy limit, per capita property taxes, own‐source revenues and own‐source expenditures were significantly higher than under the Truth in Taxation policy where local officials face many fewer restrictions on their ability to raise the levy.
Federal Grants, Earmarked Revenues, and Budget Crowd‐Out: State Highway Funding
Authors: NESBIT TODD M. , KREFT STEVEN F.
Published: June 2009

This paper examines the potential for budget crowd‐out in state highway financing. Highway projects are funded primarily through state earmarked tax revenues and federal highway grants. Theoretically, these two sources of revenues could crowd‐out state general funds, freeing up these funds for other uses. Previous studies of highway funding show little evidence of significant crowd‐out, providing support for the “flypaper effect.” The empirical model of this paper better controls for the endogeneity of federal highway grants and state earmarked highway revenues than previous studies and results suggest little to no crowd‐out. Also, our study concludes that state budgeting decisions in the post‐Intermodal Surface and Transporation Efficiency Act era still support the “flypaper effect.”
Latina Spaces: Middle–Class Ethnic Capital and Professional Associations in the Latino Community
Authors: Vallejo Jody Agius
Published: June 2009

This article examines the incorporation of middle–class Latinas in Southern California. Based on three years of participant observation, 30 in–depth interviews, and 50 conversational interviews with the organization's members, I find that the upwardly mobile Latinas mobilize “middle–class ethnic capital” to create professional associations in ethnic communities that provide valuable business skills, networks, and social capital to coethnics. Members of the organization realize that they must approximate the normative business standards of white middle–class business culture to get ahead, yet they feel that it is vital to retain their ethnic identity and provide resources to the ethnic community. While contemporary immigration research maintains the Latino ethnic communities lack the “high–quality resources” that might buffer against downward assimilation and advance upward mobility, these findings suggest that it takes one or two extra generations for Latinos to mobilize class and ethnic resources to promote mobility.
Suburban Neighborhood Poverty in U.S. Metropolitan Areas in 2000
Authors: Holliday Amy L. , Dwyer Rachel E.
Published: June 2009

Suburban areas have become more diverse and stratified in the United States, with a particularly striking increase in poverty, challenging theories that conceptualize poverty predominantly as a central city phenomenon. Little scholarly work has examined suburban poverty, however, and the small existing literature focuses primarily on inner–ring suburbs in the Northeast and Midwest and relies too much on the concentric zone model of metropolitan development. We use Census 2000 summary data to examine the prevalence and form, characteristics, and determinants of suburban poverty at the neighborhood and metropolitan levels across the entire country. We draw on more sophisticated ecological and place stratification perspectives and argue that suburban poverty manifests in more varied forms than the typical model and diverges in crucial respects from central city poverty. Our results identify a particularly distinctive racial profile for suburban poverty, associated especially with Hispanic residential location, with implications for trends in racial segregation as well.
Coalition Formation and Metropolitan Contention: An Analysis of the Politics of Light–Rail Transit in the Twin Cities of Minnesota
Authors: Knudson Paul T.
Published: June 2009

This article, by examining the planning, development, construction, and operation of the Hiawatha light–rail transit line in the Twin Cities of Minnesota, attempts to further the understanding of coalition–building between lawmakers in urban and suburban areas, as well as those at the local, state, and federal levels, and how this cooperation affects metropolitan areas. the analysis relies on primary and secondary data from local newspapers, radio transcripts, and organization websites and materials from 1995 to 2007 to examine the political processes surrounding the project. Previous research on coalition–building strategies and regionalism informs the theoretical approach of the article. Key findings suggest that traffic congestion acts as a powerful motivator for uniting urban and suburban interests. the research also supports previous findings that big–city mayors seldom take the lead in promoting regional cooperation. in addition, findings suggest that governor–brokered coalitions can be relatively unstable, and that the possibility for receiving federal funds promotes regional cooperation along the lines of transportation issues.
Characterization of the Grain‐Boundary Character and Energy Distributions of Yttria Using Automated Serial Sectioning and EBSD in the FIB
Authors: Dillon Shen J. , Rohrer Gregory S.
Published: June 2009

A dual‐beam focused ion beam scanning electron microscope was used to collect a series of parallel electron backscatter diffraction maps of polycrystalline yttria. Using characteristics of the triple junctions, the individual layers were aligned and the geometries of the grain‐boundary planes between the layers were determined. This information was used to calculate the five‐parameter grain‐boundary character distribution (GBCD) and grain‐boundary energy distribution (GBED). The GBCD derived from the three‐dimensional data was qualitatively the same as that derived from a stereological analysis of the same data. The anisotropy in the GBCD of yttria is relatively weak compared with other ceramics and is inversely correlated to the GBED.
Electrical Conductivity of RuO2–Borosilicate Glasses: Effect of the Synthesis Route
Authors: Pflieger Rachel , Malki Mohammed , Guari Yannick , Larionova Joulia , Grandjean Agnès
Published: June 2009

Although glass–RuO2 composites are well known for their particular electrical properties, the reasons for their very low percolation thresholds are still subject to debate. In this paper, a detailed study of the influence of various experimental parameters (temperature, RuO2 content, stirring, etc.) on the electrical conductivity and, in particular, on the percolation threshold in borosilicate glass–RuO2 composites is presented. This percolation threshold is shown to increase by a factor of two (from 0.6 to 1.2 vol%) when stirring is applied during synthesis and by more than a factor of three (>2.1 vol%) when a sol–gel route is used. Besides, the study of various synthesis temperatures reveals that the electronic part of the electrical conductivity is highly correlated to Ru solubility in the glass matrix. It can be concluded from these various experiments that both the presence of dissolved ruthenium in the glass matrix and the possibility of RuO2 particles to rearrange in the melt in order to form kind of a network are necessary for a low percolation threshold.
Epidemiological features of Wegener's granulomatosis and microscopic polyangiitis: two diseases or one ‘anti‐neutrophil cytoplasm antibodies‐associated vasculitis’ entity?
Authors: MAHR ALFRED D.
Published: June 2009

Because of their multiple overlapping clinical characteristics, Wegener's granulomatosis (WG) and microscopic polyangiitis (MPA) have increasingly been conceptualized as different expressions of a unique anti‐neutrophil cytoplasm antibodies (ANCA)‐associated vasculitis (AAV) disease spectrum. However, this continuum theory remains hindered by uncertainty surrounding a potentially common etiology. This review sheds light on our current understanding of the epidemiology of WG and MPA with the aim of weighing the evidence supporting whether or not these two vasculitis forms are distinct diseases. At present, some epidemiological evidence exists that WG and MPA might correspond to mere variants of a single AAV entity.
Fifty years of antineutrophil cytoplasmic antibodies (ANCA) testing: do we need to revise the international consensus statement on testing and reporting on ANCA?
Authors: COHEN TERVAERT JAN WILLEM , DAMOISEAUX JAN
Published: June 2009

During the first international workshop on antineutrophil cytoplasmic antibodies (ANCA), Copenhagen 25 and 26 January 1988, ANCA, as detected by the indirect immunofluorescence (IIF) technique, was extensively discussed. Cytoplasmic fluorescence pattern was found in patients with vasculitis. In contrast, perinuclear fluorescence pattern was found in vasculitis but also in many other inflammatory disorders. At the workshop, it was stated that IIF should be combined with an antigen‐specific technique and capture and direct enzyme‐linked immunosorbent assay techniques were discussed. In 1999/2003, an international consensus statement on testing and reporting on ANCA was published. For vasculitis, IIF was advocated as a screening assay, followed by an antigen‐specific assay. In other non‐vasculitic inflammatory diseases, only IIF on ethanol‐fixed granulocytes was advocated. Recently, it was demonstrated that antigen‐specific tests could be used as screening tests. Furthermore, it became clear that antigen‐specific tests, in which antigens are directly coated to the solid phase, demonstrate highly variable sensitivities and specificities, whereas when capture or anchor technologies are used, more reproducible results are obtained. Based on these studies, we propose that the international consensus statement on ANCA should be revised.
Most proteinase3‐ and myeloperoxidase‐antineutrophil cytoplasmic antibodies enzyme‐linked immunosorbent assays perform less well in treated small‐vessel vasculitis than in active disease
Authors: SAVIGE JUDY , TREVISIN MICHELLE , HAYMAN MATTHEW , POLLOCK WENDY
Published: June 2009

Antineutrophil cytoplasmic antibodies (ANCA) levels have been thought to follow disease activity, with levels being high at presentation, declining with treatment and increasing just before relapse. However, we have shown that ANCA often persist for many years in patients with clinically inactive Wegener's granulomatosis. ANCA assays are less sensitive for treated disease than for active disease, and the levels in treated patients produce different results in different assay systems. ANCA often persist for years without relapse, and the risk of relapse probably depend on levels that are critical for any individual patient. The capture enzyme‐linked immunosorbent assays may be more sensitive in detecting early relapse. Relapse is more common when ANCA levels are high but, although elevated, ANCA levels are lower in relapse than at presentation. Standardized ANCA levels for the definitions of remission and relapse may not be possible, and the optimal ANCA testing protocol for treated disease remains unclear.
p16 Expression differentiates between desmoplastic Spitz nevus and desmoplastic melanoma
Authors: Hilliard Nicholaus J. , Krahl Dieter , Sellheyer Klaus
Published: June 2009

Background:  Loss of p16 in melanomas reflects worse outcomes for patients. It is associated with depth of invasion, ulceration, vascular invasion, lymph node metastases, metastases, recurrence of melanoma and decreased 5‐year survival. Desmoplastic melanoma is an insidious malignant melanoma subtype that commonly occurs on sun‐damaged skin of the head and neck area in elderly patients. The diagnostic conundrum occurs with confusion of desmoplastic melanoma with scars, hyalinizing blue nevi, desmoplastic Spitz nevi and diffuse neurofibromas.

Methods:  The present study uses immunohistochemistry with a p16 antibody to differentiate desmoplastic Spitz nevi (n = 15 cases) from desmoplastic melanomas (n = 11). To date, no other studies have been published defining the expression pattern of p16 in desmoplastic melanoma.

Results:  81.8% of desmoplastic melanomas were negative for p16 and 18.2% were only weakly stained. In contrast, all desmoplastic Spitz nevi were moderately to strongly positive for p16.

Conclusions:  The staining pattern for p16 in desmoplastic melanomas and Spitz nevi in conjunction with the histopathologic features, S100 staining, Ki67 proliferation index and clinical scenario may aid in the difficult differential diagnosis between these two entities. Further confirmatory studies are indicated.
Remifentanil analgosedation in preterm newborns during mechanical ventilation
Authors: Giannantonio Carmen , Sammartino Maria , Valente Elisabetta , Cota Francesco , Fioretti Maria , Papacci Patrizia
Published: June 2009

Aim:  To assess efficacy of remifentanil in preterm newborns during mechanical ventilation.

Methods:  Remifentanil was administered by continuous intravenous infusion to provide analgesia and sedation in 48 preterm infants who developed respiratory distress and required mechanical ventilation. We examined the doses needed to provide adequate analgesia, extubation time after the discontinuation of opioid infusion, the presence of side effects and safety of the use.

Results:  Remifentanil provided adequate analgesia, with a significant reduction of NIPS and COMFORT score since 1 h after starting the infusion of remifentanil. The drug was initially administered at a dose of 0.075 μg/kg/min, but in 73% of newborns the latter had to be increased; at a dose of 0.094 ± 0.03 (mean ± standard deviation) μg/kg/min, 97% of the newborns received adequate analgesia and sedation. The time elapsed between the discontinuation of remifentanil infusion and extubation was 36 ± 12 min. Treatment was started between the 1st and the 17th day of life. The mean duration of therapy was 5.9 ± 5.7 days. No side effects on the respiratory or cardiovascular system were observed.

Conclusion:  Remifentanil is a manageable and effective opioid in the newborn undergoing mechanical ventilation, though randomized controlled trials and information about long‐term outcomes are necessary.
Fish oil supplementation in pregnancy and lactation may decrease the risk of infant allergy
Authors: Furuhjelm Catrin , Warstedt Kristina , Larsson Johanna , Fredriksson Mats , Böttcher Malin Fagerås , Fälth‐Magnusson Karin , Duchén Karel
Published: June 2009

Maternal intake of omega‐3 (ω‐3) polyunsaturated fatty acids (PUFAs) during pregnancy has decreased, possibly contributing to a current increased risk of childhood allergy.

Aim:  To describe the effects of maternal ω‐3 long‐chain PUFA supplementation during pregnancy and lactation on the incidence of allergic disease in infancy.

Methods:  One hundred and forty‐five pregnant women, affected by allergy themselves or having a husband or previous child with allergies, were included in a randomized placebo‐controlled trial. Daily maternal supplementation with either 1.6 g eicosapentaenoic acid and 1.1 g docosahexaenoic acid or placebo was given from the 25th gestational week to average 3–4 months of breastfeeding. Skin prick tests, detection of circulating specific immunoglobulin E (IgE) antibodies and clinical examinations of the infants were performed.

Results:  The period prevalence of food allergy was lower in the ω‐3 group (1/52, 2%) compared to the placebo group (10/65, 15%, p < 0.05) as well as the incidence of IgE‐associated eczema (ω‐3 group: 4/52, 8%; placebo group: 15/63, 24%, p < 0.05).

Conclusion:  Maternal ω‐3 fatty acid supplementation may decrease the risk of food allergy and IgE‐associated eczema during the first year of life in infants with a family history of allergic disease.
How does surrounding vegetation affect the course of succession: A five‐year container experiment
Authors: Lanta Vojtěch , Lepš Jan
Published: June 2009

Question: How does location and time of insertion affect the course of succession in experimental containers?

Location: Benešov nad Lipou, Českomoravská vrchovina (Czech‐Moravian uplands), Czech Republic

Methods: We designed a 5‐year container experiment in which plant succession started from scratch. Soil conditions were constant and all containers were filled with homogeneous substrate containing no propagules. We placed the containers in two contrasting habitats (meadow and floodplain) under identical climatic conditions but differing in surrounding vegetations and hence seed input. New containers were installed (and hence succession started) in two subsequent years, twice in each year (spring and autumn). We assume that the individual dates would lead to differences in propagule input and weather conditions.

Results: Although both year and season of succession initiation considerably affected the initial species composition, we observed a pronounced convergence within the set of containers located in each habitat. However, the similarity of containers initiated at the same time but located in different habitats decreased over the course of succession. Final composition of the meadow and floodplain containers was therefore mostly determined by permanent seed input from their nearby neighborhood.

Conclusions: This study demonstrated that propagule availability is an important determinant of the course of succession, and that differential seed input leads to different pathways of succession, even when all other environmental conditions are equal.
Class II Restorations with Margins below the CEJ
Authors: KANCA III JOHN , GREITZER GERALD
Published: June 2009

Introduction:  Historically, Class II restorations using resin composite with margins below the dentino‐enamel junction (dej) have fared poorly in investigations, exhibiting significant dye penetration along the marginal interfaces. In all reports located by the authors the gingival margins of sub‐CEJ restorations have been finished, even though in actual practice this is not feasible in the vast majority of cases.

Purpose:  The purpose of this study was to examine the effect of finishing on gingival margins located below the cemento‐enamel junction of Class II resin composite restorations.

Materials and Methods:  Class II resin composite restorations with margins below the dej were placed in 40 extracted human molars using a dentin‐enamel adhesive, a flowable resin composite, and a universal microhybrid resin composite restorative material. In all groups the adhesive was light activated for ten seconds and the restorative resin composite was light activated for ten seconds. The flowable increments were 1 mm in thickness and the restorative resin composite increments were 2 mm in thickness. In groups 1, 3, and 4 the flowable was light activated for ten seconds while in group 2 the flowable was light activated for 40 seconds. In groups 1, 2, and 4 the sub‐CEJ margins were finished withfinishing discs while in group 3 the sub‐CEJ margins were unfinished. In group 4 the dentin adhesive was reapplied following finishing procedures. All groups were immersed in dye for 24 hours.

Results:  The two groups in which the margins were finished exhibited varying degrees of dye penetration. There was no dye penetration in the unfinished and the resealed groups.

Conclusions:  It was concluded that the finishing procedure itself causes damage to the resin‐dentin interface, which allows dye penetration to occur. This could potentially explain why resin adhesive materials have fared so poorly in Class II in vitro investigations, which is not the common clinical experience.

CLINICAL SIGNIFICANCE

It is likely that, in clinical situations in which high‐quality materials are used properly, Class II restorations with margins below the CEJ perform better than is indicated by research. In most clinical situations it is not feasible to finish Class II margins below the CEJ. However in those cases in which access is available to finish Class II margins on dentin, resealing with the adhesive is highly recommended.
Effects of Glass Fiber Layering on the Flexural Strength of Microfill and Hybrid Composites
Authors: ERONAT NESRIN , CANDAN ÜMIT , TÜRKÜN MURAT
Published: June 2009

Statement of the Problem:  In stress‐bearing cavities, low fracture resistance adversely affects the longevity of the dental resin composite restorations.

Purpose:  The aim of this in vitro study was to investigate the effect of glass fiber layering on the flexural strength of microfill and hybrid composites.

Materials and Methods:  Flexural test specimens (N = 75) were prepared according to International Organization for Standardization (ISO) 4049 specifications (25 × 2 × 2 mm) by using a standard metallic mold. Materials used and groups were as follows (N = 15): group 1: hybrid composite (Clearfil APX, Kuraray Co.Ltd, Osaka, Japan); group 2: microfill composite (Clearfil ST, Kuraray Co.Ltd.); group 3: hybrid + microfill composite; group 4: woven glass fiber (EverstickNet, StickTech Ltd, Turku, Finland) + hybrid composite; group 5: woven glass fiber + microfill composite. The specimens were stored in distilled water at 37°C for 7 days. Afterward, they were loaded to fracture (1 mm/min) by using a universal testing machine (AG‐50 kNG Shimadzu Co., Kyoto, Japan). Flexural strengths were expressed as maximum flexural load per cross‐sectional area of the specimen. The results were statistically analyzed with Kruskall–Wallis and Mann–Whitney U tests (p < 0.01).

Results:  Significant increases in the flexural strength were found for both hybrid and microfill composites when fiber layering was used (group 1: 78 ± 7 MPa; group 4: 93 ± 4 MPa) (group 2: 42 ± 5 MPa; group 5: 64 ± 4 MPa) (p < 0.01). Flexural strength of fiber‐reinforced hybrid composite was significantly higher than the other groups evaluated (p < 0.01). There were no significant differences in flexural strength between microfill/hybrid combination and fiber‐reinforced microfill composite (p > 0.01).

Conclusions:  Glass fiber layering of microfill and hybrid composites presented higher flexural strength, and veneering of hybrid composite with microfill composite increased the resistance of the restoration.

CLINICAL SIGNIFICANCE

Glass fiber reinforcement of both hybrid and microfill resin composite materials may be a clinical option in otherwise unfavorable clinical conditions, such as large cavities and/or where bruxism is in present restorative dentistry.
VENEZUELA'S SOLIDARITY ECONOMY: COLLECTIVE OWNERSHIP, EXPROPRIATION, AND WORKERS SELF‐MANAGEMENT
Authors: Azzellini Dario
Published: June 2009

The essay appraises and analyzes different organizational efforts of the Bolivarian government in Venezuela to achieve a democratization of property and management of means of production. The different approaches adopted since 2000 (first a strengthening of cooperatives, then the creation of Social production companies [EPS] and finally the Socialist Enterprises as well as the concept of endogenous development, normative orientation of production organization, and state job training) are described and critically analyzed. Regarding the internal organization of production sites models of comanagement, self‐management, and workers control are presented and then critically analyzed concerning successes and failures by resuming fieldwork done about three factories: The Aluminum factory Alcasa, the paper factory Invepal, and the valves factory Inveval.
U.S. AND CHINESE LABOR AT A CHANGING MOMENT IN THE GLOBAL NEOLIBERAL ECONOMY
Authors: Friedman Ellen David
Published: June 2009

For the past sixty years, Cold War ideology kept the U.S. labor movement totally disengaged from the All‐China Federation of Trade Unions. Even as vast and relevant changes took place, which should have altered the stalemate (including the introduction of capitalized markets in China, the relocation of much U.S.‐based production to China, the interpenetration of U.S.‐Chinese economies through trade, financial, diplomatic, commercial, and cultural relations), little thaw has come. This article begins by examining elements of the U.S. and Chinese labor movements during defining periods of the 1950s–1970s, the 1980s–1990s, and the current decade, drawing some frequently unrecognized parallels. The pattern of systematic labor degradation created by the global regime of neoliberalism will be seen to have brought crisis to labor movements in both countries. We end on the question of trade union reform, and the almost unimaginable possibility of transnational labor solidarity emerging.
PIRATES OF THE CARIBBEAN: SEIU'S FAILED BID IN PUERTO RICO
Authors: Rosado Marzán César F.
Published: June 2009

In October of 2008, the Service Employees International Union (SEIU) failed to obtain majority support to represent a 40,000‐member bargaining unit of public school teachers in Puerto Rico even though it had most of the odds stacked in its favor: a huge war chest, a decertified and bankrupt rival, and the Puerto Rican government qua employer's neutrality, if not outright support. The Federación de Maestros de Puerto Rico, the SEIU's rival, campaigned against the SEIU's bid for exclusive representation by focusing on rank‐and‐file mobilization and a message against raiding by a “colonial” union. The event showed that even progressive and successful unions such as the SEIU are not immune to oligarchic tendencies and may raid other unions in pursuit of money and power. Strategies that combine more democratic, bottom‐up mobilization, including, in the case of Puerto Rico, strengthening the long‐established tradition of minority unionism, could dampen future oligarchic tendencies, buttress industrial democracy, and create better coexistence between trade union organizations. To move forward, especially given the global crisis that has befallen us, unions need to start acting in the most principled of ways and expressing solidarity in the deepest manners.
NOT JUST COLLECTIVE BARGAINING: THE ROLE OF TRADE UNIONS IN CREATING AND MAINTAINING A DEMOCRATIC SOCIETY
Authors: Fick Barbara J.
Published: June 2009

This article addresses the historical and contemporary roles which trade unions have played in creating conditions necessary for democracy to flourish. Their effectiveness in fulfilling these roles is due in large measure to the organizational characteristics which make trade unions the archetypal civil society organization: democratic representation, demographic representation, financial independence, breadth of concerns, and placement within society. This article explores these aspects of the trade union movement and suggests that advocates for democracy have cause for concern in the absence of a vibrant, and independent, domestic trade union movement.
CORRELATES OF TEACHERS' PERCEPTIONS ON SUPPORT RECEIVED FROM THEIR BUILDING UNION REPRESENTATIVES
Authors: Friedman Barry A. , Abraham Steven E. , Markow Dana
Published: June 2009

The decline of unions in the U.S. is a salient issue for workers, and a number of studies have demonstrated the relationships between worker attitudes and unionization. The vast majority of this research pertains to workers' attitudes toward the union as an organization, but little has examined workers attitudes to the union officials who are closest to them on a daily basis. As unions strive to maintain membership and support, research that addresses correlates of union members' satisfaction with their work‐site union representatives is needed. This study investigates factors associated with teachers' assessment of the adequacy of the support they receive from their building union representatives. Study results show that teachers' satisfaction with leadership communication, board of education practices, staff support, school pride, parent involvement, and the lack of gossip among employees are all associated with teachers' rating of the support they receive from their building union representatives. Implications for the selection and preparation of work‐site union representatives are discussed.
A NUMERICAL APPROACH TO COMPUTE TEXTURAL ATTRIBUTES OF COOKED RICE BY EXTRUSION TESTING
Authors: PARK AERI , LEE SEUNG JU
Published: June 2009

The cooked rice extrusion testing system consisted of a piston disc and a sample container with a pot base insert of one outlet. Sinit (N/m) and Smax (N/m) are the slopes of the force–deformation curve in the packing and compression stages, respectively, and in the original method they are graphically drawn. Here, however, they were numerically computed as the differential of force to distance. The Sinit and Smax from the numerical and drawing methods were compared in terms of data reproducibility and accuracy as described by coefficient of variation (CV) and correlation coefficient (CC), respectively. The numerically computed Sinit and Smax showed lower CV: the new method, 0.03–0.06 and 0.03–0.06; the original method, 0.18–0.39 and 0.03–0.14, respectively. Sinit by the new method showed higher CC with the adhesiveness of the samples: the new method,−0.99; the original method,−0.4. Therefore, the new method proved to be better in data accuracy and reproducibility.

PRACTICAL APPLICATIONS

The extrusion test is a practical instrumental method for measuring the textural properties of cooked rice. Nevertheless, its force–deformation curves are difficult to analyze quantitatively. This study attempted to improve the existing method for curve data analysis by applying a numerical method to compute the instrumental parameters. Based on the findings, this new method provided better data reproducibility and accuracy, and in terms of the instrumental parameters, can facilitate the implementation of cooked rice quality control in the field.
WHITE GUAVA FRUIT AND PUREES: TEXTURAL AND RHEOLOGICAL PROPERTIES AND EFFECT OF THE TEMPERATURE
Authors: SÁNCHEZ CONSTANZA , BLANCO DOMINGO , ORIA ROSA , SÁNCHEZ‐GIMENO ANA C.
Published: June 2009

This study focuses on the effect of temperature on the rheological properties of white guava puree. The results of the textural analysis on the whole guava as well as the rheological analysis on the puree made from it showed different behaviors depending on whether the fruit was unripened or ripened. A relationship was observed between the textural properties of the whole guava and the rheological parameters of its puree. The behavior of white guava puree was thixotropic and pseudoplastic, and its rheological properties were dependent of the temperature. Its consistency coefficient decreased and its flow behavior index increased with an increase in temperature. Experimental data were fitted by the power law, and the activation energy of the process was calculated from the Arrhenius equation. Oscillation test data showed that the viscoelasticity for the guava puree was also affected by temperature.

PRACTICAL APPLICATIONS

Knowledge of the rheological properties of foods is useful for quality control, and design and evaluation of process equipment. In this study, it has demonstrated the relationship between textural properties of whole white guava fruit and rheological properties of the purees obtained from these fruits.
The U.S. Preventive Services Task Force: An evidence‐based prevention resource for nurse practitioners
Authors: Trinite Tricia , Loveland‐Cherry Carol , Marion Lucy
Published: June 2009

Purpose: To describe the work of the U.S. Preventive Services Task Force and to encourage nurse practitioners (NPs) to use its evidence‐based recommendations for clinical preventive services.

Sources: Evidence reports, recommendation statements, and journal articles published under the auspices of the U.S. Preventive Services Task Force since its establishment in 1984.

Conclusions: A core competency for NPs working in primary care is knowledge about and provision of appropriate preventive services for their patients. The U.S. Preventive Services Task Force, an independent panel of experts in prevention and primary care, is an important resource for NPs.

Implications for Practice: NPs can use Task Force recommendations to guide their screening, counseling, and preventive medication decisions. They can also educate patients about the missed prevention opportunities related to underuse of effective services and the potential harms of overuse of inappropriate preventive services.
Diarrhea A to Z: America to Zimbabwe
Authors: Spies Lori A.
Published: June 2009

Purpose: To review international statistics on the morbidity and mortality of diarrhea, pathophysiology, global incidence, and implications for the clinical practice of nurse practitioners (NPs).

Data sources: Selective review of literature.

Conclusions: Because of ever‐increasing international travel, immigration, and rising awareness of global health issues, NPs must be current on the prevention, diagnosis, and treatment of diarrhea.

Implications for Practice: Increased awareness of diarrhea as a significant international health issue mandates that NPs counsel clients who travel to high‐risk areas about preventive measures to avoid exposure or manage symptoms while traveling. Guidelines for evidence‐based treatments of diarrheal illness are widely available and should be followed.
Teen Perceptions of Facilitator Characteristics in a School‐Based Smoking Cessation Program
Authors: Jarrett Traci , Horn Kimberly , Zhang Jianjun
Published: June 2009

Background:  Facilitators are often responsible for the implementation of public health programs, yet little is known about how they influence outcomes. Not‐On‐Tobacco (N‐O‐T) is a youth smoking‐cessation program implemented by trained facilitators. The purpose of this study was to investigate teens’ perceptions of facilitator characteristics and the relationship between those perceptions and program outcomes.

Methods:  Data were collected from N‐O‐T participants aged 14 to 19 who completed a survey about perceptions of facilitator characteristics that were linked to program outcomes 3 months post‐baseline (n = 769). Eight facilitator characteristics were ordered, based on importance to participants. Chi‐square tests measured differences in perceptions of facilitator characteristics according to race and sex, and an aggregate facilitator favorability score was created and analyzed in relation to program outcomes (smoking reduction or cessation vs increase/no change). Logistic regression was used to analyze facilitator characteristics’ relationship to outcomes, controlling for race and sex.

Results:  Participants rated facilitator characteristics of trustworthy, cares about students, and confidential as most important. Girls consistently ranked facilitator characteristics as more important than did boys. There were few significant differences based on race, except that white students rated nonjudgmental to be more important than did nonwhite students. There were no significant findings from the logistic regression, but there was a significant relationship between the aggregate facilitator favorability score and favorable changes in smoking outcomes (reduction or cessation).

Conclusions:  This study provides insights into the facilitator characteristics that are important to teen participants. It demonstrates that teens’ overall perceptions of facilitators contribute to their perception of how the program contributes to their success and program outcomes.
Commentary: Innovation Policy for a New Era
Authors: Kapczynski Amy
Published: June 2009

Intellectual property policy is a key social and political issue for all countries today. This is particularly evident in the area of pharmaceutical and other medical technologies, especially given the appalling global disparities in health outcomes around the world, the importance of health to development, and the high economic returns of investment in health. Appropriate medicines, diagnostics, vaccines, and monitoring equipment are, of course, a key component of health care systems. And intellectual property policy — and most particularly, patent policy — can have substantial effects on the price and availability of medicines and other medical technologies.
Right to Experimental Treatment: FDA New Drug Approval, Constitutional Rights, and the Public's Health
Authors: Leonard Elizabeth Weeks
Published: June 2009

Do terminally ill patients who have exhausted all other available, government-approved treatment options have a constitutional right to experimental treatment that may prolong their lives? On May 2, 2006, a divided panel of the U.S. Court of Appeals for the District of Columbia, in a startling opinion, Abigail Alliance for Better Access to Developmental Drugs v. Von Eschenbach, held “Yes.” The plaintiffs, Abigail Alliance for Better Access to Developmental Drugs (Abigail Alliance) and Washington Legal Foundation, sought to enjoin the Food and Drug Administration (FDA) from refusing to allow the sale of investigational new drugs that had not yet received FDA approval. The terminally ill plaintiffs contended that they quite literally could not wait that long for the drugs. With no other treatment options available, the plaintiffs urged the court to recognize a fundamental, constitutional right to take potentially life-saving or life-prolonging drugs, even though the treatment had not been fully tested through human trials for safety and effectiveness and could not be legally marketed to the public.
Riegel v. Medtronic, Inc.: Revisiting Pre-Emption for Medical Devices
Authors: Patsner Bruce
Published: June 2009

The pre-emption doctrine as applied to food and drug law argues that manufacturers whose products gain Food and Drug Administration (FDA) marketing approval are immune from tort liability in state court solely on the basis of their FDA approval. This pre-emption protection applies both to claims of direct damages caused by the product and as well as indirect (failure to warn/labeling) damages claims.

The recent 8-1 U.S. Supreme Court decision in Riegel v. Medtronic, Inc. upheld the manufacturer’s contention that the pre-emption provision in the 1976 Medical Device Amendments of 1976 (MDA) to the 1938 Federal Food, Drug and Cosmetic Act (FDCA) completely precluded civil damages suits by injured plaintiffs in state court. Justice Ginsburg was the lone dissenter.
Pushing the Dead into the Next Reproductive Frontier: Post Mortem Gamete Retrieval under the Uniform Anatomical Gift Act
Authors: Spielman Bethany
Published: June 2009

During the last 115 years, the National Conference of Commissioners of Uniform State Laws (NCCUSL) has promulgated more than 300 uniform or model acts. These acts have been drafted to produce uniformity among state laws, and to provide clarity and stability in critical areas of the law. Uniform Anatomical Gift Acts were promulgated in 1968 and again in 1987. The third and most recent revision of the Act was promulgated in 2006 and amended in 2007. This act (UAGA 2006) was placed on NCCUSL’s target list; that is, commissioners were asked to make its enactment a priority in their home states. In 2007, 20 states enacted UAGA 2006; by mid-2008, UAGA 2006 had been introduced or enacted in over a dozen more states and the District of Columbia. NCCUSL’s goal for UAGA 2006 is enactment in all states by 2009.