bluuebunny/crossref_metadata_2025 huggingface dataset:
Anaphylaxis due to formaldehyde released from root‐canal disinfectant
Authors: Kunisada Makoto , Adachi Atsuko , Asano Hiroshi , Horikawa Tatsuya
Published: March 2003

A 50‐year‐old woman developed anaphylaxis 8 h after application of a paraformaldehyde‐containing root canal disinfectant. Radioallergosorbent test showed that she had a high level of formaldehyde‐specific IgE in her serum. Prick tests to formaldehyde and paraformaldehyde showed immediate‐type responses to both. We reviewed the literature describing cases with anaphylaxis/angioedma caused by formaldehyde in root canal disinfectants and found that about 1/2 of the reported cases developed symptoms over 2 h after dental treatment. We speculated that the delay in the manifestation of her symptoms was possibly due to gradual formaldehyde release from paraformaldehyde and time lag of penetrating and diffusing of formaldehyde outside the dentin. Patch testing showed that she also had delayed‐type allergy to formaldehyde, paraformaldehyde and eugenol. Physicians should pay attention to root canal disinfectants, even if anaphylaxis occurs several hours after dental treatment.
What do trainee hairdressers know about hand dermatitis?
Authors: Ling T. C. , Coulson I. H.
Published: March 2003

Hand dermatitis is an important cause of morbidity in hairdressers. We conducted a questionnaire survey of 121 trainee hairdressers from 2 hairdressing colleges in Burnley (UK). The questionnaire concerned the number and types of hairdressing procedures performed, previous and current medical history, awareness of risks to the skin from hairdressing, and knowledge of hand dermatitis prevention. 17% of the trainees suffered currently from hand dermatitis. This is likely to be due to the large amount of wet work done by apprentice hairdressers, particularly those who worked in salons. 2/3 of trainees were not aware that atopic eczema predisposed to hand dermatitis. Formal pre‐school and pre‐employment counselling was limited. Knowledge on hand care among trainees was not often translated into practice, with gloves being worn by only 9% when shampooing and 58% when perming. Prevention of hand dermatitis by education and pre‐employment counselling is of fundamental importance.
55 cases of allergic reactions to hair dye: a descriptive, consumer complaint‐based study
Authors: Søsted H. , Agner T. , Andersen K. E. , Menné T.
Published: March 2003

Severe facial and scalp dermatitis following the use of permanent hair dyes has been reported in several cases. Para‐phenylenediamine (PPD) is known as a potent contact allergen, and PPD is allowed in hair dye at a concentration of 6%. Hair dye reactions are usually diagnosed by the patients themselves, and adverse reactions to hair dye may not necessarily be recorded by the health care system, unless the reactions are especially severe. Based on this assumption, we suspected that hair dye dermatitis was occurring more frequently than reported in the literature. Consumer complaint‐based data were obtained by advertising for persons with adverse reactions to hair dye. Among those responding to the advertisement, 55 cases of severe, acute allergic contact dermatitis were identified. The main symptoms were severe oedema of the face, scalp and ears, and clinically this was often mistaken for angio‐oedema. The 55 cases comprised a total of 75 visits to the health service and 5 admissions to hospital. 18 persons had sick leave, which supports the impression of very severe dermatitis reactions. 60% were treated with antihistamine, while 52% were treated with corticosteroids. 29% of the cases were patch tested and all were found positive to PPD. Our data presented here clearly show that PPD and its derivatives in hair dye at the present concentrations presents a significant health risk for the population. Furthermore, the severe acute allergic skin reactions are often misdiagnosed in the health care system. The frequency of allergic contact dermatitis resulting from hair dye is likely to be underestimated. New methods to survey the frequency of adverse reactions should be considered.
Occupational irritant contact dermatitis from synthetic mineral fibres according to Finnish statistics
Authors: Jolanki Riitta , Mäkinen Ilpo , Suuronen Katri , Alanko Kristiina , Estlander Tuula
Published: March 2003

Synthetic mineral fibres (i.e. man‐made vitreous fibres, MMVF) are classified into glass filament, mineral wool (glass wool, rock wool and slag wool), refractory ceramic fibres, and fibres for special purposes. This paper analyses the data on occupational irritant contact dermatitis (ICD) caused by MMVF during 1990–99 in Finland according to the Finnish Register of Occupational Diseases (FROD). A total of 63 cases from MMVF were reported. 56 were diagnosed as ICD, and 2 as allergic contact dermatitis, both from rock wool. 53 out of 63 cases were due to mineral wool or glass filaments; half of the cases, according to a rough estimate, were due to mineral wool and a half due to glass filaments used in lamination work. Carpenters, building workers and insulation workers have the highest risk of ICD from mineral wool. 4 cases in carpenters, 4 in building workers and 2 in insulation workers were reported from MMVF. For every 100 000 employed workers, only 1.6 cases of ICD in carpenters, 2.7 in building workers and 9.1 in insulation workers were annually due to MMVF, respectively. Mineral wool used in construction work, insulation, etc., cannot be considered to be a common cause of occupationally induced ICD. However, information on harmful skin effects of MMVF is useful to exposed persons in the prevention of the effects.
Treatment of the noncompliant Class III growing patient
Authors: Carano Aldo , Balsamo Lorenzo , Siciliani Giuseppe
Published: March 2003

The treatment of skeletal Class III malocclusion is one of the most challenging problems that confronts the practicing orthodontist, particularly in the late deciduous or early mixed dentition periods. In addition to its inherent difficulty, compromised results can also be due to poor patient cooperation; orthopaedic appliances for Class III treatment can be uncomfortable and unaesthetic. There are few acceptable alternatives when a patient refuses to wear an orthopaedic appliance. The aim of this report is to introduce an approach for the treatment of the non compliant dental and skeletal Class III in growing patients. The Smart Wire (SW) is a new orthodontic device simply formed by a 1 mm diameter stainless‐steel arch wire that is inserted into the extraoral tube of the upper molar bands. The SW interferes with lower incisors in the front upon mandibular closure. Thus, a distally directed force is applied on the lower incisors and on the mandible while at the same time a mesial force is transmitted onto the upper molars. This combination of force and reaction guides the orthodontic‐orthopaedic correction of Class III malocclusions in growing patients.
Treatment of a Class II deformity with skeletal open bite and lateroocclusion
Authors: Watted Nezar , Wieber Michael , Reuther Jürgen
Published: March 2003

A fundamentally important treatment outcome in orthognathic surgery is improved dentofacial esthetics in both the sagittal and vertical dimensions. In patients with a skeletal open bite, increased lower face height and a strained lip closure, the vertical dimension relationships can be improved by surgical impaction of the maxilla. The consequence of maxillary impaction is an autorotation of the mandible and the elevation of the tip of the nose as the anterior nasal spine is repositioned. Naturally, the skeletal and soft tissue responses are dependent on the extent of surgical repositioning. We present here a clinical case that demonstrates these changes.
Self‐ligating brackets and treatment efficiency
Authors: Harradine Nigel W.T.
Published: March 2003

A number of laboratory studies have shown very low levels of archwire friction for self‐ligating brackets when compared to conventional ligation methods. However, justifiable reservations have been expressed as to the in vivo relevance of these findings. This study was designed to compare treatment efficiency with conventional fully programmed brackets and Damon SL self‐ligating brackets. Thirty consecutively finished cases treated by the author with Damon SL brackets were compared with 30 matched cases treated by the author with conventional brackets. Parallel studies quantified the incidence of technical problems with Damon SL brackets and with conventional ligatures and also the chairside time required for ligation/slide closure and ligature removal/slide opening with these two bracket types. The Damon SL cases required an average of four fewer months and four fewer visits to be treated to an equivalent level of occlusal regularity as measured by the PAR scores.
Expression of the basal cell adhesion molecule (B‐CAM) in normal and diseased human skin
Authors: Bernemann Thi‐Mai , Podda Maurizio , Wolter Manfred , Boehncke Wolf‐Henning
Published: March 2003

The basal cell adhesion molecule (B‐CAM) is a 90‐kD cell surface glycoprotein with a characteristic immunoglobulin domain structure. The pattern of B‐CAM expression in cultured cells suggests that the molecule is associated with a substrate‐adherent growth pattern in some lineages. We investigated the expression of B‐CAM in normal and diseased human epidermis by means of immunohistochemistry employing a single batch of high‐titer mouse monoclonal antibody G253. Snap‐frozen biopsy material from normal skin (n=8), psoriasis (n=5), contact dermatitis (n=6), basal cell carcinoma (n=5) and fetal skin (n=6) was studied. In normal human skin, B‐CAM was found in varying degrees throughout the epidermis with a preference for suprabasal expression, hair follicles were regularly of a B‐CAM‐positive phenotype. There were no qualitative differences with regard to the B‐CAM expression pattern in normal skin in comparison to psoriasis and contact dermatitis. In contrast, fetal skin (15th to 18th week of gestation) was characterized by B‐CAM‐positive cells in the basal layer of the epidermis as well as in the outer root sheath of hair follicles. Basal cell carcinomas also regularly expressed high levels of B‐CAM. A strong B‐CAM‐positive phenotype can be found in the outer root sheath of hair follicles of adult and fetal human skin as well as in fetal basal keratinocytes.
Hyperthermia to normal human skin in vivo upregulates heat shock proteins 27, 60, 72i and 90
Authors: Wilson Niall , McArdle Anne , Guerin Deirdre , Tasker Helen , Wareing Paul , Foster Christopher S. , Jackson Malcolm J. , Rhodes Lesley E.
Published: March 2003

This study was performed to test the hypothesis that expression of heat shock proteins (HSPs) exhibits a spatially selective response within intact human skin following in vivo exposure to thermal stress. This response is believed to protect cells and tissues from further damage. Using Western blotting and immunohistochemistry, we studied the expression of a range of HSPs in normal human skin of 5 subjects prior to and following heating in vivo. The skin was heated to 41±0.5°C for 1 h and biopsies were taken at 4, 8 and 24 h and from control, untreated skin. HSPs 27, 60, 72i, 90, 110 and heat shock constitutive (HSC)70 were expressed in normal skin, but the extent and distribution of these HSPs showed considerable variation. HSP27, 60 and 72i were found predominantly in the epidermis, whereas HSC70 showed weak epidermal staining but strong dermal expression. Heating the skin in vivo resulted in an increased skin content of HSP27, 60, 72i and 90, with maximal increase at 24 h following hyperthermia, while the skin content of HSC70 and HSP110 were unchanged. Significant increases in the content of HSP72i and HSP90 had occurred by 4 h following hyperthermia, with a mean ±SEM of 206±50% and 197±38% of the control, untreated values, respectively (p<0.05). These findings indicate the complexity of HSP dynamics in human skin, and suggest that heating within the experimental range may protect the skin from further stresses for at least 24 h.
Is there a special relationship between CD30‐positive lymphoproliferative disorders and epidermal proliferation?
Authors: Cespedes Yvana P. , Rockley Paul F. , Flores Frank , Ruiz Phillip , Kaiser Mark R. , Elgart George W.
Published: March 2003

The relationship between CD30+ lymphoma and epithelial proliferations is not well defined. CD30+ lymphoma and lymphomatoid papulos (LyP) share immunohistochemical epitopes and some other features. A single case of LyP associated with multiple keratoacanthomas (KAs) was recently reported. We report two cases of atypical lymphocytic proliferation with features of CD30+ lymphoma and LyP intimately associated to KA and squamous cell carcinoma (SCC), KA type. This similar combination of an epidermal tumor and apparent involvement with atypical lymphocytic infiltrates raises the possibility of an association between the two entities. We speculate that the association may be more than expected to occur by chance and suggest several mechanisms by which the association may evolve.
Immunohistochemical localization of ornithine decarboxylase in skin tumors
Authors: Kagoura Masayori , Toyoda Masahiko , Matsui Chihiro , Morohashi Masaaki
Published: March 2003

Background: Ornithine decarboxylase (ODC) plays an important role in the biosynthesis of polyamines. Induction of ODC and polyamine synthesis has been demonstrated in neoplastic tumors and is thought to be related to the degree of malignancy.

Methods: In this study, we investigated a series of basal cell epitheliomas (BCE), Bowen's disease, squamous cell carcinomas (SCC), and metastatic tumors of the skin using an antibody against ODC for immunohistochemistry.

Results: Eight of 12 cases of BCE failed to show a positive reaction for ODC. In Bowen's disease, 5 of 13 cases diffusely showed positive reaction for ODC. Fourteen of 15 cases of SCC showed ODC expression, the intensity of which was decreased in the peripheral layer. At higher magnification, the distribution of ODC in the positive SCC cases showed granular and heterogenous patterns. Ten of 14 cases of metastatic skin tumors exhibited positive reactions, and well‐differentiated adenocarcinomas tended to show more strongly positive than poorly‐differentiated ones.

Conclusions: These results support the conclusion that the intensity and the incidence of positive immunohistochemical staining for ODC correlate with the degree of cellular differentiation, and furthermore, that heterogenous distribution of ODC staining may be associated with heterogeneity of tumor cells.
CGRP‐immunoreactive nerves in prurigo nodularis – an exploration of neurogenic inflammation
Authors: Liang Yong , Jacobi Henrik H. , Reimert Claus M. , Haak‐Frendscho Mary , Marcusson Jan A. , Johansson Olle
Published: March 2003

Background: The present study has explored the localization and distribution of calcitonin gene‐related peptide (CGRP)‐immunoreactive (IR) nerve fibers in prurigo nodularis, especially emphasizing its relationships to mast cells and eosinophils, which all are important contributors to inflammation.

Methods: The exact localization of CGRP in the nerve fibers of prurigo nodularis lesional skin has been clarified by an ultrastructural immunogold labelling technique; and the relationships of CGRP‐IR nerve fibers to tryptase‐IR mast cells or eosinophil cationic protein (ECP)‐IR eosinophils were also investigated by immunofluorescence double‐labelling.

Results: This ultrastructural study has demonstrated that CGRP immunoreactivity is increased in the dense‐core vesicles in the axons of the prurigo nodularis lesional skin; the axons which contain CGRP are, in addition, enlarged and have more dense‐core vesicles than the axons which do not contain CGRP. The immunofluorescence investigation demonstrated that tryptase‐containing mast cells and ECP‐containing eosinophils also are significantly increased in the lesional skin.

Conclusions: The results indicate that certain neurons increasingly express CGRP, which may dynamically result in a neurogenic inflammation in the lesional skin, through vasodilatation, and recruitment and regulation of inflammatory cells, e.g. eosinophils and mast cells.
Pagetoid dyskeratosis of the prepuce. An incidental histologic finding resembling extramammary Paget's disease
Authors: Val‐Bernal J. Fernando , Garijo M. Francisca
Published: March 2003

Background: Pale cells resembling those of paget's disease have been seen as an incidental finding within the epidermis in a variety of benign papules most commonly located in intertriginous areas. This lesion, called pagetoid dyskeratosis, is considered a reactive process in which a small part of the normal population of keratinocytes is induced to proliferate. Among the inductors friction is suspected. As far as we know, these cells have not been reported in the penis.

Methods: Here we describe the location of the lesion in the foreskin and the incidence of this lesion in a group of 281 unselected patiets surgically treated for phimosis. In selected cases histochemical staining and immunohistochemical studies were performed.

Results: Pagetoid dyskeratosis was found in 105 cases (37.4%) but only in 5 cases (1.8%) the lesion was conspicuous. The cells of pagetoid dyskeratosis show an immunohistochemical profile different from the surrounding keratinocytes characterized by premature keratinization. Pagetoid dyskeratosis cells must be distinguished from the artefactual clear cells of the epidermis, from reactive melanocytes, and from pale‐cell acanthosis. In cases in which pagetoid dyskeratosis shows a florid expression there is a hazard of overdiagnosis to the patient. The main differential diagnosis includes extramammary Paget's disease, pagetoid squamous cell carcinoma in situ, epidermotropic metastasis, superficial spreading malignant melanoma, clear cell papulosis, and penile koilocytoses.

Conclusions: The pathologist should be familiar with the histologic features of pagetoid dyskeratosis in the foreskin in order to avoid misdiagnosis and unnecessary treatment. Routine histologic study is usually sufficient to identify the lesion.
Intra‐epidermal and intra‐dermal sebocrine adenoma with cystic degeneration and hemorrhage
Authors: Mahalingam Meera , Byers H. Randolph
Published: March 2003

Background: The ducts of eccrine glands may give rise to intra‐epidermal, confluent epithelial and intra‐dermal adenomas known as hidroacanthoma simplex, eccrine poroma, and dermal duct tumor, respectively. An apocrine and sebaceous counterpart of the eccrine poroma has been described by several authors as adnexal, poroma‐like adenoma with apocrine and sebaceous differentiation or sebocrine adenoma.

Methods: Using clinical history and routine histologic techniques, we describe a new lesion with features similar to sebocrine adenoma but representing the intra‐epidermal and intra‐dermal counterparts with cystic degeneration and hemorrhage. Briefly, an 84‐year‐old female presented with a 6mm dark tan papule on the neck that clinically appeared as an unusual macular seborrheic keratosis with underlying hemorrhage.

Results: Histopathological examination showed a benign dermal cystic appendage tumor with pale polygonal cells, occasional non‐keratinizing ducts, sebaceous differentiation and central hemorrhage with fibrin deposits. Serial sections did not reveal any epidermal connection. However, epithelioid cells with large nuclei in an intra‐epidermal pagetoid pattern were focally seen.

Conclusion: These findings represent a new cystic, hemorrhagic variant of sebocrine adenoma.
The utility of cytokeratin 5/6 in the recognition of cutaneous spindle cell squamous cell carcinoma
Authors: Sigel Jessica E. , Skacel Marek , Bergfeld Wilma F. , House Nancy S. , Rabkin Michael S. , Goldblum John R.
Published: March 2003

Background: Cutaneous spindle cell squamous cell carcinoma (SSCC) is a challenging diagnosis since it may be difficult to distinguish from spindle cell melanoma, leiomyosarcoma and atypical fibroxanthoma. Furthermore, it may be difficult to demonstrate epithelial differentiation by a traditional immunohistochemical panel. We performed an expanded immunohistochemical evaluation of ultrastructurally documented SSCC to assess its utility in diagnosing this entity.

Methods: We identified 16 cases of SSCC that were composed predominantly of spindle‐shaped cells and with ultrastructural evidence of epithelial differentiation (i.e. at least rudimentary cell junctions). Immunohistochemical analysis using antibodies to a variety of cytokeratins (AE1/3, K903, CK5/6) and S‐100 protein was performed. The extent of immunostaining was graded on a scale of 0 to 4+ (0: no staining; 1+: ≤25%; 2+: 26–50%; 3+: 51–75%; 4+: >75%).

Results: Of the 16 cases, 6 expressed AE1/3 (38%), 8 expressed K903 (50%) and 11 (69%) expressed CK5/6. Six cases were positive for all three CK markers and two cases were positive for both K903 and CK5/6 but negative for AE1/3. Three cases (19%) stained for CK5/6 without any staining for AE1/3 or K903. Five cases (31%) were negative for all epithelial markers. The extent of CK5/6 staining was either similar to or greater than K903 staining in 7 of 8 cases that stained with both markers. All 16 cases were negative for S‐100 protein.

Conclusions: Including CK5/6 in the initial battery of immunostains performed on a cutaneous spindle cell neoplasm can help demonstrate epithelial differentiation in SSCC, even in the absence of AE1/3 or K903 staining. However, some cases of cutaneous SSCC can only be confirmed ultrastructurally, as up to one‐third may not show evidence of epithelial differentiation using an expanded immunohistochemical panel.
Vascular endothelium express CS‐1 fibronectin in allergic contact dermatitis
Authors: Martín A. P. , Ortiz S. , Cabalier M. E. D. , Frede S. , Burgos E. , Hliba E. , Serra H.
Published: March 2003

Background: Allergic contact dermatitis (ACD) is a common human dermatosis in which not all the mechanisms involved in its pathogenesis have been elucidated.

Objective: To study the expression of CS‐1 fibronectin, TARC and Th1‐associated chemokine receptors in biopsies from allergic patch test reactions.

Material and methods: Thirteen patients already diagnosed with ACD were challenged on the back with the antigen responsible of the disease and macroscopic responses and biopsies taken after 48 h. Skin biopsies from negative control challenge sites, AD and ICD were also taken. Samples were fixed, embedded in paraffin wax and processed in order to perform histological and immunohistochemical studies.

Results: All subjects with ACD showed a positive clinical response and a perivascular mononuclear cell infiltration at 48 h, which was not seen in the negative controls. The majority of skin‐infiltrating cells were CD4+ and CD8+ and up to 54% or 40% of them expressed CXCR3 or CCR5, respectively. We also showed expression of CS‐1 fibronectin in inflamed endothelial cells not only in ACD but also in AC and ICD. In contrast TARC was only expressed in ACD and AC.

Conclusion: We showed for the first time that CS‐1 fibronectin is expressed in dermal vessels from allergic patch tests positive reactions, as well as irritant and atopic skin lesions.
Expression of polo‐like kinase (PLK1) in thin melanomas: a novel marker of metastatic disease
Authors: Kneisel Lucas , Strebhardt Klaus , Bernd August , Wolter Manfred , Binder Angelika , Kaufmann Roland
Published: March 2003

Background: The maximum thickness of a primary malignant melanoma as measured by Breslow's method is currently the most important prognostic factor. However, some thin melanomas (≤ 0.75 mm), which should have an excellent prognosis according to Breslow, can be lethal due to their ability to metastasize.

Methods: In our study, thin malignant melanomas (≤ 0.75 mm) from 36 patients were analyzed with immunohistochemical techniques using monoclonal antibodies directed against PLK1 and Ki‐67. The immunoreactivity of 22 melanomas which developed metastases within 5 years of follow‐up was compared with a group of 14 non‐metastasized melanomas. Two independent investigators evaluated stained sections. Differences of PLK1 and Ki‐67 indices between melanomas with and without metastases were tested statistically using the Mann–Whitney U‐test.

Results: Malignant melanomas with metastases expressed PLK1 at markedly elevated levels compared to melanomas without metastases (median, 60.00% vs. 37.98%; p = 0.000053). The difference of the Ki‐67 index between both groups was not significant (median, 6.35% vs. 4.53%; p = 0.150473).

Conclusions: Our results suggest that PLK1 expression in thin melanomas is a reliable marker to identify patients at high risk for metastases.
Strict correlation between uPAR and plakoglobin expression in pemphigus vulgaris
Authors: Lo Muzio Lorenzo , Pannone Giuseppe , Staibano Stefania , Mignogna Michele Davide , Rubini Corrado , Farronato Giampietro , Ferrari Francesca , Nocini Pier Francesco , De Rosa Gaetano
Published: March 2003

Background:  Recent studies have reported nuclear delocalization of plakoglobin in acantholytic pemphigus vulgaris cells. The objective of this study was to evaluate the role of plakoglobin in the pathogenesis of acantholysis in pemphigus vulgaris (PV) and its relation with the urokinase‐type plasminogen activator receptor (uPAR) expression.

Materials and methods:  Plakoglobin and uPAR expressions were evaluated by immunohistochemistry in 22 cases of PV at various stages of the disease, and as controls in 18 specimens of skin/oral mucosa from healthy patients.

Results:  Healthy skin/normal oral mucosa showed strong plakoglobin expression in the basal and spinous layers with prevalent cellular membrane distribution; the intensity of staining progressively decreased toward the superficial layers of the epithelium. In PV patients, a progressive displacement of the plakoglobin signal toward the nucleus was found in 18/22 of the cases. Healthy skin/normal oral mucosa showed low uPAR expression with prevalent cellular membrane distribution. In the PV patients, strong uPAR expression was present in the acantholytic cells in 16/22 of the cases. There was direct correlation (p < 0.05) between the uPAR expression and nuclear plakoglobin.

Conclusions:  The uPAR overexpression in acantholytic PV may be considered a direct consequence of plakoglobin abnormal distribution. Nuclear delocalization of plakoglobin, a direct consequence of plakoglobin‐Dsg‐3 dissociation induced by PV IgG, probably induces uPAR overexpression. This evidence suggests a central role for plakoglobin in PV pathogenesis because of its delocalization toward the nucleus, which is the probable cause of the uPAR gene expression.
The 2030 Problem: Caring for Aging Baby Boomers
Authors: Knickman James R. , Snell Emily K.
Published: March 2003

Objective.To assess the coming challenges of caring for large numbers of frail elderly as the Baby Boom generation ages.

Study Setting.A review of economic and demographic data as well as simulations of projected socioeconomic and demographic patterns in the year 2030 form the basis of a review of the challenges related to caring for seniors that need to be faced by society.

Study Design.A series of analyses are used to consider the challenges related to caring for elders in the year 2030: (1) measures of macroeconomic burden are developed and analyzed, (2) the literatures on trends in disability, payment approaches for long‐term care, healthy aging, and cultural views of aging are analyzed and synthesized, and(3)simulations of future income and assets patterns of the Baby Boom generation are developed.

Principal Findings.The economic burden of aging in 2030 should be no greater than the economic burden associated with raising large numbers of baby boom children in the 1960s. The real challenges of caring for the elderly in 2030 will involve: (1) making sure society develops payment and insurance systems for long‐term care that work better than existing ones, (2) taking advantage of advances in medicine and behavioral health to keep the elderly as healthy and active as possible, (3) changing the way society organizes community services so that care is more accessible, and (4) altering the cultural view of aging to make sure all ages are integrated into the fabric of community life.

Conclusions.To meet the long‐term care needs of Baby Boomers, social and public policy changes must begin soon. Meeting the financial and social service burdens of growing numbers of elders will not be a daunting task if necessary changes are made now rather than when Baby Boomers actually need long‐term care.
Reasons for placement and replacement of restorations in student clinics in Manchester and Athens
Authors: Deligeorgi V. , Wilson N. H. F. , Fouzas D. , Kouklaki E. , Burke F. J. T. , Mjör I. A.
Published: March 2003

Data on reasons for the placement and replacement of restorations provide insight into patterns of clinical practice. This study investigated reasons for the provision of restorations in student clinics at the Universities of Manchester and Athens. Using the methods first described by Mjör, data were collected in relation to all initial and replacement restorations placed in adult patients in the main teaching clinics in the 2 schools over a 3‐month period. The principal reason for intervention was recorded, according to approved treatment plans. Data were collected on 2620 restorations, 1431 (55%) of which were placed in Manchester. Primary caries was the main reason for the placement of initial restorations: 82% in Athens and 48% in Manchester (p<0.001). The principal reason for restoration replacement was secondary caries, accounting for 54% in Manchester and 33% in Athens (p<0.001). Other differences between the schools, included the ratio of initial placement to replacement restorations (Manchester 1:1.1; Athens 1:0.6: p<0.01) and significantly more 2‐surface class II restorations having been placed in Manchester (p<0.001). Class III and IV restorations predominated in Athens. It is concluded, despite the acknowledged limitations of the methods employed, that the patterns of placement and replacement of restorations and the use of materials differ between the dental schools of Manchester and Athens. The differences are considered to relate more to local patterns of dental disease and patient selection for student clinics than to any differences in teaching philosophy. Subsequent studies of the type reported, despite acknowledged limitations would provide insight into the impact on patient care of the teaching of new materials, techniques and treatment philosophies.
Professional competence in final‐year dental undergraduates: assessment of students admitted by individualised selection and through traditional modes
Authors: Röding Karin
Published: March 2003

In 1993, a new admission system was introduced at the Dental School, Karolinska Institutet, Sweden. One‐third, and subsequently 60% of the students were admitted through an individualised selection system, and the remainder through traditional modes, using secondary school matriculation scores, or a university standard aptitude test. In this study, professional competence of final year undergraduates, assessed by faculty members, was related to mode of admission. The participating faculty members had tutored the students in the adult comprehensive care clinic for 1–3 semesters. 13 faculty members assessed students from 3 freshman intakes. A specially designed protocol was used, comprising 7 different criteria to be graded on a scale of 1 to 5, and one overall rating on a scale of 1 to 7. The faculty members were also asked to nominate which of the 7 criteria they considered most important for the overall rating: (A) knowledge, (B) initiative, (C) responsibility and judgement, (D) patient contact, (E) clinical skills, (F) co‐operative approach and (G) commitment and motivation. Responsibility and judgement (n=11) and knowledge (n=6) were rated as the most important criteria. The evaluation of professional competence using the overall rating as a score shows a better median value (M=5.5) for the individualised group than for the traditional group (M=5.0). There was little or no difference between the 2 groups in median values for the most important 2 criteria, (C and A), but for the individualised group, the interval for the inter‐quartile range (IQR) was not only higher, but also more homogeneous. It is concluded that by final year, students originally admitted by individual selection seem to be more professionally competent than classmates admitted on traditional university entrance scores.
An investigation into the use of a structured clinical operative test for the assessment of a clinical skill
Authors: Scott B. J. J. , Evans D. J. P. , Drummond J. R. , Mossey P. A. , Stirrups D. R.
Published: March 2003

Aim: This study was designed to investigate the level of agreement between a group of assessors observing students undertaking a structured clinical operative test.

Method: 3 assessors agreed a series of criteria to assess the performance of undergraduate students in the recording of a dental impression. Guidelines for assessing whether the students adequately performed in relation to each criteria were also agreed. Following preliminary validation between the assessors, 2 assessors independently scored the performance of each student by reference to the agreed criteria, and the levels of agreement between assessors were compared. The 3 assessors worked in pairs with each other on three groups of students who were in the early stages of their clinical course.

Results: A total of 39 clinical dental students were assessed in the recording of a dental impression. The 3 pairs of assessors had satisfactory levels of agreement in the study with similar judgements being made on 90% or more of the 12 criteria assessed. Some differences existed between the pairs of assessors. Certain criteria were more easily judged than others and this was reflected in the level of agreement seen. For over 90% of the criteria, positive assessments were made by each of the 3 assessors, and although there were minor variations between the pairs of assessors, this may have reflected the ability of the groups of students studied.

Conclusion: The study showed that different assessors were generally able to make agreed judgements on performance criteria in a structured clinical operative test. In setting up performance assessment it is necessary to have close collaboration between assessors to make clearly defined criteria so that judgements are not too subjective. Furthermore, for the assessment of more complex clinical skills, great care is needed in assembling criteria that can be used reproducibly, and sufficient preparation time for the assessors is critical.
Basic sciences education in the dental curriculum in Southern Europe
Authors: Martínez‐Álvarez Concha , Sanz Mariano , Berthold Peter
Published: March 2003

A survey was conducted to determine the current status of the basic sciences education in Southern European dental schools. Responses were collected from schools in Malta, Greece, Portugal, Italy, France and Spain. The results show that there is some uniformity across Southern Europe, even if there are some variations among dental schools both within one country and among the different countries. The links with Medicine seem to be strong. Most basic sciences dental educators have a medical degree and usually have their main appointment in a medical school. The only exception to this is found in France, where the faculty, who are mostly dentists, have their main appointment in a dental school. In half of the countries, courses are given jointly to both dental and medical students. There is, in general, poor coordination between the basic science subjects and other subjects in the dental curriculum. All the surveyed schools maintain traditional curricula and teaching methodologies. However, there is an increased movement towards self‐directed learning, computer‐assisted learning and improved coordination with clinical subjects.
The use of group participation and an enquiry‐based study guide with computer assisted learning
Authors: Botelho Michael
Published: March 2003

Introduction: The aim of this investigation was to explore the use of group participation and an enquiry‐based study guide to enhance the learning experience when using a computer assisted learning (CAL) program.

Materials and methods: Forty‐eight students were asked to complete a CAL program on resin bonded bridges in groups of 2–4 with an enquiry‐based study guide. An evaluation questionnaire of the learning experience was included with the study guide with paired positive and negative questions and open‐ended questions for students to complete and return. The responses were collated and the nature of the comments qualitatively analysed.

Results: Thirty‐two questionnaires were returned. There were almost three times the numbers of positive to negative responses relating to the usefulness of the enquiry based study guide, group participation and the CAL program. The majority of these positive responses related to the usefulness of the study guide and group participation in highlighting and guiding learning and creating opportunities for discussion, problem solving and peer teaching. A small number of negative responses cited the target‐orientated nature of the study guide and the longer time needed for group work, due to the varying learning abilities of the participants and the need for discussion.

Conclusion: The use of group participation and an enquiry‐based study guide was reported to enhance the learning experience of CAL.
A comparison of changes in dental students’ and medical students’ approaches to learning during professional training
Authors: Lindemann Robert , Duek JodyLee , Wilkerson LuAnn
Published: March 2003

The purposes of this study were 1) to compare the learning approaches of dental students (DS) and medical students (MS) for the Class of 1998 at a single institution at admission and graduation and 2) to determine if their learning approaches changed over the course of their studies. An Approaches to Studying Inventory (ASI) was administered to DS and MS at two times: their first month in school and their last month in school. Means and standard deviations were calculated for three ASI orientations to studying: ‘Meaning’, ‘Reproducing’, and ‘Achieving’. An additional domain referred to as ‘Styles and Pathologies’ identified learning problems. In comparison, DS and MS demonstrated a different pattern of learning approaches at matriculation; however, at graduation these differences were less apparent. Over time, DS reported a decreased use, and MS reported an increased use of the Reproducing orientation bringing them closer together. MS also demonstrated an increased use of the Achieving orientation. The Meaning orientation, which indicates a deep approach to learning, was equivalently used by both groups at entry and remained unaltered.
Comparison of dental licensure, specialization and continuing education in five countries
Authors: Schleyer Titus , Eaton Kenneth A. , Mock David , Barac'h Victoire
Published: March 2003

Dental practice and education are becoming more globalized. Greater practitioner and patient mobility, the free flow of information, increasingly global standards of care and new legal and economic frameworks (such as European Union [EU] legislation) are forcing a review of dental licensure, specialization and continuing education systems. The objective of this study was to compare these systems in Canada, France, Germany, the UK and the US. Representatives from the five countries completed a 29‐item questionnaire, and the information was collated and summarized qualitatively. Statutory bodies are responsible for licensing and re‐licensing in all countries. In the two North American countries, this responsibility rests with individual states, and in Europe, with the countries themselves, mainly governed by the legal framework of the EU. In some countries, re‐licensure requires completion of continuing education credits. Approaches to dental specialization tend to differ widely with regard to definition of specialities, course and duration of training, training facilities, and accreditation of training programmes. In most countries, continuing education is provided by a number of different entities, such as universities, dental associations, companies, institutes and private individuals. Accreditation and recognition of continuing education is primarily process‐driven, not outcome‐orientated. Working towards a global infrastructure for dental licensing, specialization and continuing education depends on a thorough understanding of the international commonalities and differences identified in this article.
Elevational gradients in ant species richness: area, geometry, and Rapoport's rule
Authors: Sanders Nathan J.
Published: March 2003

Studying the distributions of plants and animals along environmental gradients can illuminate the factors governing and maintaining species diversity. There are two general predictions of how species richness and elevation are related: either species richness decreases monotonically with increasing elevation or richness peaks at mid‐elevations. Several processes might contribute to this pattern. In this paper, I examine patterns in ant species richness along elevational gradients in three states in the western US: Colorado, Nevada, and Utah. I test for the effects of available area and the geometric constraints model on species richness patterns. I also test Rapoport's rescue hypothesis, which relates the extent of species’ elevational ranges to patterns in species richness. In each state, species richness peaked at mid‐elevations. Area explained more variation in species richness than the geometric constraints model in Colorado and Utah, but not in Nevada. Area and geometric constraints together explained 90%, 99%, and 57% of the variation in species richness in Colorado, Nevada, and Utah, respectively. Even though there were peaks at mid‐elevations, I still found a strong Rapoport effect. This work suggests that the influences of area and geometric constraints cannot be overlooked when examining patterns in species richness along environmental gradients.
Winter herbivory by voles during a population peak: the importance of plant quality
Authors: Hambäck Peter A. , Grellmann Doris , Hjältén Joakim
Published: March 2003

Bilberry shoots are one of the main food sources for grey‐sided voles Clethrionomysrufocanus during winter. This study examined the relation between plant quality variables of bilberry Vacciniummyrtillus shoots, overall vegetation height, and the winter consumption of bilberry by grey‐sided voles. Results show that only the phenolic concentration correlated significantly with the amount of bilberry biomass consumed, and bilberry consumption decreased with an increasing phenolic concentration. The best predictor of herbivory on bilberry was not plant quality but rather the overall vegetation height. This may be because the quality of bilberry shoots is high in all habitats and that predation is a greater mortality risk than nutritional deficiencies during winter.
Dynamic populations in a dynamic landscape: the metapopulation structure of the marsh fritillary butterfly
Authors: Wahlberg Niklas , Klemetti Teemu , Hanski Ilkka
Published: March 2003

The marsh fritillary butterflyEuphydryas auriniais an endangered species in most of northern Europe. We describe the metapopulation structure ofE. auriniain Finland, where the species has declined drastically in the past decades. We found two types of habitat patches suitable for the species: semi‐permanent meadows and transient clearcuts in the forest. Patch area was the most significant variable predicting the occurrence ofE. auriniain a habitat patch. The species tended to be found in young rather than old clearcuts, apparently because the vegetation became too high in the latter. We used the incidence function model to simulate the metapopulation dynamics ofE. auriniain its dynamic landscape and discovered that the continued presence of the semi‐permanent meadows is essential for the survival of the species in the study area in southeast Finland.
Growth and morphological response of old‐forest lichens transplanted into a young and an oldPicea abiesforest
Authors: Hilmo Olga
Published: March 2003

This experimental study focuses on why old‐forest lichens such asLobaria scrobiculataandPlatismatia norvegicaare scarce in younger spruce stands. Understanding the factors limiting the distribution of species is important for developing appropriate methods for forest management aiming to maintain biodiversity. A successful growth ofL. scrobiculataandP. norvegicawas found in the young planted stand as the rate of growth did not differ between the young stand and the old spruce forest where they naturally occurred, during 14 months of transplantation. In the young forest environment,L. scrobiculatashowed a significantly higher specific thallus weight, and a slightly higher water‐holding capacity. This morphological response is probably due to a higher light exposure in the young stand and consequently a higher rate of desiccation. The ubiquitous speciesPlatismatia glaucashowed a significantly higher rate of growth in the young forest than in the old forest, and a positive relationship between growth rate and light exposure was found. This transplant study has shown that the environmental conditions in younger planted forests are not necessarily unfavourable for growth of old‐forest lichens. Other factors, such as limited dispersal ability and poor diaspore production, are probably important for explaining the species scarcity in younger stands.
Granivory rates by rodents, insects, and birds at different microsites in the Patagonian steppe
Authors: Folgarait Patricia J. , Sala Osvaldo E.
Published: March 2003

We studied the rates of seed removal by different granivores, in different microsites, at different times, in a Patagonian shrub steppe in South America. Granivory rates of exotic (Phalaris canariensis) and native (Mulinum spinosum) seed species were an order of magnitude lower than those reported for another cool desert from North America with comparable climatic conditions. Insects and rodents removed the greatest amount of seeds in comparison to birds. In general, there were no differences in seed removal across microsites, except at one sampling time (when rodents and insects removed more seeds from bare soil and beside tussocks in comparison to positions beside shrubs, while birds took similar amounts of seeds from all microsites). The length of the experiment differentially affected the granivory rate of different groups. Removal rates (per day) were significantly greater, and exhibited lower variability, when seeds were left for a longer period of time in the field (a month) than for a few days. Insects were more efficient at finding the seeds rapidly and rodents at depleting them; birds could not find or deplete many seeds in short periods of time. Rates of granivory decreased slightly but significantly as the summer progressed mainly due to a reduction of seed removal by birds and rodents but not by insects. Granivores removed an order of magnitude less native seeds than exotic seeds. These differences seemed to be related to palatability as M. spinosum seeds have more phenols, toxic concentrations of iron and copper, and lower dry matter digestibility, phosphorous, and nitrogen content, in comparison to P. canariensis seeds.