Comparative analysis of optical and numerical models for reflectance and color prediction of monolithic dental resin composites with varying thicknesses.

OBJECTIVE: To assess the prediction accuracy of recent optical and numerical models for the spectral reflectance and color of monolithic samples of dental materials with different thicknesses. METHODS: Samples of dental resin composites of Aura Easy Flow (Ae1, Ae3 and Ae4 shades) and Estelite Universal Flow Super Low (A1, A2, A3, A3.5, A4 and A5 shades) with thicknesses between 0.3 and 1.8 mm, as well as Estelite Universal Flow Medium (A2, A3, OA2 and OA3 shades) with thicknesses between 0.4 and 2.0 mm, were used. Spectral reflectance and transmittance factors of all samples were measured using a X-Rite Color i7 spectrophotometer. Four analytical optical models (2 two-flux models and 2 four-flux models) and two numerical models (PCA-based and L*a*b*-based) were implemented to predict spectral reflectance of all samples and then convert them into CIE-L*a*b* color coordinates (D65 illuminant, 2°Observer). The CIEDE2000 total color difference formula (ΔE00) between predicted and measured colors, and the corresponding 50:50% acceptability and perceptibility thresholds (AT00 and PT00) were used for performance assessment. RESULTS: The best performing optical model was the four-flux model RTE-4F-RT, with an average ΔE00 = 0.72 over all samples, 94.87% of the differences below AT00 and 65.38% below PT00. The best performing numerical model was L*a*b*-PCHIP (interpolation mode), with an average ΔE00 = 0.48, and 100% and 79.69% of the differences below AT00 and PT00, respectively. SIGNIFICANCE: Both optical and numerical models offer comparable color prediction accuracy, offering flexibility in model choice. These results help guide decision-making on prediction methods by clarifying their strengths and limitations.

Promoting sleep and rest in hospitalized children: a best practice implementation project.

OBJECTIVE: The objective of this project was to implement scientific evidence to promote sleep and rest in pediatric patients during hospitalization. INTRODUCTION: Hospitals are not conducive to quality sleep, as external factors such as light, noise, and interruptions from health care staff can disturb patients. Being hospitalized has a detrimental impact on children's sleep because it reduces how much sleep they get and the quality of that sleep. It has been reported that up to 20% to 30% of hospitalized children experience sleep problems. METHODS: This project was conducted at the Marqués de Valdecilla University Hospital in Cantabria, northern Spain. The project used the JBI Evidence Implementation Framework, which is grounded in an audit, feedback, and re-audit process, together with a structured approach to identifying and managing barriers to change. The study subjects were 100 children aged 2 to 16 years, who were admitted to the hospital's pediatric unit from November to December 2021, and 27 multi-disciplinary health care staff. RESULTS: Implementing the evidence-based strategies improved our care practices, with the follow-up audit results showing a marked improvement in compliance. Thus, training health care staff on pediatric sleep increased from 4% to 80%; using a multi-faceted approach to sleep promotion increased from 21% to 87%; and promoting relaxation techniques to promote sleep increased from 0% to 80%. CONCLUSIONS: The project met its objectives. Areas for improving children's sleep and rest during hospitalization were identified. To avoid resistance to change, it was necessary to involve the entire team and maintain training. We recommend follow-up audits once a year, to ensure the sustainability of the project. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A252.

Musicianship and prominence of inter-hemispheric connectivity determine two different pathways to atypical language dominance.

During infancy and adolescence, language develops from a predominantly inter-hemispheric control - through the corpus callosum - to a predominantly intra-hemispheric control - mainly subserved by the left arcuate fasciculus. Using multimodal neuroimaging, we demonstrate that human left-handers (both male and female) with an atypical language lateralization show a rightward participation of language areas from auditory cortex to inferior frontal cortex when contrasting speech to tones perception, and an enhanced inter-hemispheric anatomical and functional connectivity. Crucially, musicianship determines two different structural pathways to this outcome. Non-musicians present a relation between atypical lateralization and intra-hemispheric underdevelopment across the anterior arcuate fasciculi, hinting at a dysregulation of the ontogenetic shift from an inter-hemispheric to an intra-hemispheric brain. Musicians reveal an alternative pathway related to inter-hemispheric overdevelopment across the posterior corpus callosum and the auditory cortex. We discuss the heterogeneity in reaching atypical language lateralization and the relevance of early musical training in altering the normal development of language cognitive functions.Significance statement Since the discovery in the 19th century that left-handedness predisposes to an atypical lateralization of language, progress in understanding how this condition appears in healthy individuals has been scarce. Here, we introduce a new relevant factor: musical training. We demonstrate how this early and intensive audiomotor learning can potentially modify the hemispheric specialization of language by prompting a differential development of the callosal fibers. Importantly, this perspective also reveals an alternative route to atypical lateralization - unrelated to musicianship - through an underdevelopment of the arcuate fasciculi. In both scenarios, interhemispheric connectivity through the callosum remains prominent, directly or indirectly. Therefore, the historical lack of definitive answers to this phenomenon might be attributed to the existence of multiple potential pathways.

Temporal assessment of Gross alpha emissions from the petroleum industry in Tenerife, Canary Islands (2001-2022).

A ca. 76% decrease in gross alpha activity levels, measured in surface aerosols collected in the city of Santa Cruz de Tenerife (Spain), has been explained in the present study in connection with the reduction of activities, and eventual closure, of an oil refinery in the city. Gross Alpha in surface aerosols, collected at weekly intervals over a period of 22 years (2001-2022), was used for the analysis. The dynamic behaviour of the gross alpha time series was studied using statistical wavelet, multifractal analysis, empirical decomposition method, multivariate analysis, principal component, and cluster analyses approaches. This was performed to separate the impact of other sources of alpha emitting radionuclides influencing the gross alpha levels at this site. These in-depth analyses revealed a noteworthy shift in the dynamic behaviour of the gross alpha levels following the refinery's closure in 2013. This analysis also attributed fluctuations and trends in the gross alpha levels to factors such as the 2008 global economic crisis and the refinery's gradual reduction of activity leading up to its closure. The mixed-model approach, incorporating multivariate regression and autoregressive integrated moving average methods, explained approximately 84% of the variance of the gross alpha levels. Finally, this work underscored the marked reduction in alpha activity levels following the refinery's closure, alongside the decline of other pollutants (CO, SO2, NO, NO2, Benzene, Toluene and Xylene) linked to the primary industrial activity in the municipality of Santa Cruz de Tenerife.

The impact of the COVID-19 pandemic on childhood vaccination rates and the role of sociodemographic factors: A cohort study.

OBJECTIVE: This study examines the impact of the COVID-19 pandemic on both routine and non-routine vaccinations in infants during their initial 18 months of life, concurrently exploring the complex influence of sociodemographic factors. METHODS: A cohort study was conducted, involving 2007 children in two distinct periods: pre-pandemic (January-June 2018) and pandemic (March 2020-May 2021). Participants were classified into two cohorts: 962 children in the 2018 group and 1045 children in the 2020-21 group. Utilizing unconditional logistic regression, the association between vaccination (complete or non-routine) and socioeconomic factors was examined, with adjustments for potential confounding variables such as age, breastfeeding, gestational age, and twins. RESULTS: The study's analysis reveals that in the post-pandemic period, mothers were three times more likely to opt for non-routine vaccines (95% CI 2.25-4.23). However, no significant alterations were observed in routine vaccination rates. Protective factors for complete vaccination included having an employed mother, higher education, and a medium-to-high income. Conversely, a higher income was associated with a reduced likelihood of complete vaccination (OR 0.34, 95% CI 0.20-0.59). CONCLUSION: Contrary to initial expectations, this study concludes that the COVID-19 pandemic did not have a substantial impact on childhood complete vaccination rates. Nevertheless, a noticeable increase in the choice of non-routine vaccination was observed. Sociodemographic factors, such as maternal education, income, and employment status, emerged as key influencers, particularly in the context of deciding on non-routine vaccinations.

Rhabdomyolysis in Acute HIV Infection.

Rhabdomyolysis is a rare but potentially life-threatening complication of acute HIV infection. We present a case report of a young adult male who presented with fever, myalgia, and elevated creatine phosphokinase levels, ultimately diagnosed with acute HIV infection-associated rhabdomyolysis. This case highlights the importance of considering HIV infection in the differential diagnosis of rhabdomyolysis, particularly in at-risk populations, even in the absence of typical HIV-related symptoms.

Yoga in Pediatric Gastroenterology.

PURPOSE OF REVIEW: Pediatric use of yoga as an integrative medicine modality has increased in prevalence over the last several decades. In this article, we review the available evidence for yoga in pediatric gastrointestinal disorders. RECENT FINDINGS: Evidence supports that in many pediatric disorders of gut brain interaction (DGBI), including irritable bowel syndrome, functional abdominal pain and functional dyspepsia, yoga decreases pain intensity and frequency and increases school attendance. Yoga has been shown to improve health-related quality of life and improve stress management as an effective adjunct to standard medical therapy in pediatric inflammatory bowel disease (IBD). Further studies are needed regarding optimal frequency, duration of practice and evaluation of the impact on IBD disease activity measures. Yoga may benefit pediatric gastroenterology patients with DGBIs and IBD through improving quality of life and reducing pain. Future yoga studies could investigate biomarkers and continued research will help integrate this modality into routine pediatric gastroenterology care.

Long-term Health Outcomes After Hospital Discharge Among Children Hospitalized for MIS-C or COVID-19, September 29, 2021, to June 21, 2022.

BACKGROUND: The long-term effects of children hospitalized with multisystem inflammatory syndrome in children (MIS-C) or acute COVID-19 are not well known. Our objective was to determine long-term outcomes. METHODS: Children hospitalized with MIS-C or COVID-19 at 3 US hospitals from March 2020, through February 2021 were followed to assess health through 2 years post-hospitalization using medical records and patient surveys. RESULTS: Medical record abstraction was performed for 183 patients hospitalized with MIS-C, 53 of whom participated in surveys, and 97 patients hospitalized with COVID-19, 35 of whom participated in surveys. Patients with MIS-C were younger (median, 9 vs. 14 years of age for COVID-19 patients; P = 0.004), more frequently male (62% vs. 39%; P < 0.001) and had more cardiac (14% vs. 2%; P = 0.001) and neurologic sequelae (8% vs. 1%; P = 0.023). Children with COVID-19 more often had other comorbidities (59% vs. 19%; P < 0.001). Full mental recovery at the time of survey 2 (median, 16 months post-hospitalization for patients with MIS-C and 20 months for patients with COVID-19) was 85% and 88%, respectively; full physical recovery was 87% and 81%, respectively; and nearly all had resumption of normal activities. Patients with MIS-C reported more frequent headache at 1 month (45% vs. 20%; P = 0.037). Patients with COVID-19 were more likely to report cough at 1 month (37% vs. 17%; P = 0.045). Fatigue persisted >1 year in 15%-20% of patients in both groups. CONCLUSIONS: Approximately 20% of children with MIS-C and COVID-19 continued to have symptoms including fatigue and headache >1 year after hospital discharge. The duration of these findings emphasizes the importance of providers following patients until sequelae have resolved.

Measurement invariance of the Intuitive Eating Scale-2 across country, ethnicity, sex, and sexual orientation: A cross-cultural study between Brazil and the U.S.

Intuitive eating is defined as being connected to internal hunger, satiety, and appetitive cues and flexibly using these cues to determine when, what, and how much to eat. The Intuitive Eating Scale-2 (IES-2) is a widely used measure of facets of intuitive eating. However, the scale has shown unstable factor structure in several validation studies and there is a lack of studies investigating the measurement invariance of the IES-2 beyond sex. We aimed to evaluate the psychometric properties of the IES-2, testing several factor structures among Brazilian and U.S. samples of men and women; to test measurement invariance across country of origin, ethnicity, sex, and sexual orientation; and to evaluate its internal consistency. Three models of the latent structure of the IES-2 were tested using confirmatory factor analyses (CFA) in a total of 1072 young adults (452 Brazilians and 620 Americans), aged 18-35 years. Results demonstrated that only a 3-factor solution with 11 items of the IES-2 showed adequate fit to the data for both countries. This model demonstrated scalar invariance across sex and sexual orientation, but only configural invariance was found across country of origin and ethnicity. Good internal consistencies were found for both the Brazilian and American samples. The present study provides support for a 3-factor solution with 11 items of the IES-2, to Brazilian and American samples. The study also offers evidence of internal consistency, and invariance between sex (i.e., male and female) and sexual orientation (i.e., heterosexual participants and sexual minority participants).

SEOM-GEICO clinical guideline on epithelial ovarian cancer (2023).

In recent years, the incorporation of new strategies to the therapeutic armamentarium has completely changed the outcomes of epithelial ovarian cancer (EOC). The identification of new predictive and prognostic biomarkers has also enabled the selection of those patients more likely to respond to targeted agents. Nevertheless, EOC is still a highly lethal disease and resistance to many of these new agents is common. The objective of this guideline is to summarize the most relevant strategies to manage EOC, to help the clinician throughout the challenging diagnostic and therapeutic processes and to provide evidence-based recommendations.

Hematology of Liolaemus pacha (Iguania: Liolaemidae) and its relationship with mite infestation, reproductive period and body condition.

Variations in hematological profile in reptiles can be caused by multiple factors, including parasites presence. Our goals were to identify and morphologically describe blood cells of Liolaemus pacha and analyze their relationship with sex, body condition, individual reproductive/post-reproductive period and mite infestation. Blood smear analyses do not indicate the presence of hemoparasites, suggesting that the mites Neopterygosoma do not serve as vectors for these organisms, as has been proposed for other genera of ectoparasitic mites. In post-reproductive period, there was a reduction in specimens' body condition and a higher leukocyte count in uninfected lizards. This could be a consequence of the testosterone effects, in higher concentration during the reproductive season, which can increase the metabolic rate, decreasing feeding rate. Infested and non-infested lizards showed no differences in body condition, as well as in leukocyte count, hence the host's immune system could be developing infestation tolerance. Infested specimens had a higher count of monocytes, thrombocytes, heterophils and lymphocytes. Based on cells function, mites' effect could be associated with inflammatory processes, allergic reactions or infectious diseases. These results suggested a complex interaction between lizards' hematological parameters and factors associated to ectoparasites or body conditions. We consider this work as a diagnostic tool for genus Liolaemus, to evaluate health quality, with relevance to the conservation or management of this lizard's genus.

Effect of polishing and bleaching on color, whiteness, and translucency of CAD/CAM monolithic materials.

OBJECTIVE: To evaluate the effect of polishing and bleaching on the recovery of lightness, color, whiteness, and relative translucency parameter (RTP) in CAD/CAM materials and changes in these properties when another staining in coffee was conducted after the treatments. MATERIALS AND METHODS: Disks of Lava Ultimate (LU), Vita Enamic (VE), IPS Empress CAD (EMP), IPS e.max CAD (EMAX), and Vita Suprinity (VS) were (1) not treated (control), (2) polished with Proxyt or (3) Ceramisté, (4) bleached with Opalescence PF or (5) Whiteness HP Blue, and (6) air polished with Clinpro Prophy Powder. CIE L*a*b* color coordinates were registered at baseline (R0), after staining with coffee for 30 min daily for 36.5 days and treatment (R1), and after another staining (R2). Differences (R1-R0 and R2-R0) in lightness (ΔL00), color (ΔE00), RTP (ΔRTP00), and whiteness (ΔWID) were evaluated by mixed repeated measures ANOVA and 95% confidence intervals (α = 0.05) and interpreted in function of their respective 50:50% PT and AT thresholds. Topography was evaluated by scanning electron microscopy (SEM). RESULTS: In LU, Opalescence PF and Proxyt decreased Δ L 00 R 1 - R 0 $$ {\Delta L}_{00\left({R}_1\hbox{--} {R}_0\right)} $$ , Δ E 00 R 1 - R 0 $$ {\Delta E}_{00\left({R}_1\hbox{--} {\mathrm{R}}_0\right)} $$ , and ΔWI D R 1 - R 0 $$ {\Delta \mathrm{WI}}_{\mathrm{D}\left({R}_1\hbox{--} {R}_0\right)} $$ and showed lower Δ L 00 R 2 - R 0 $$ {\Delta L}_{00\left({R}_2\hbox{--} {R}_0\right)} $$ , Δ E 00 R 2 - R 0 $$ {\Delta E}_{00\left({R}_2\hbox{--} {R}_0\right)} $$ , and ΔWI D R 2 - R 0 $$ {\Delta \mathrm{WI}}_{\mathrm{D}\left({R}_2\hbox{--} {R}_0\right)} $$ . In VE, all treatments decreased Δ L 00 R 1 - R 0 $$ {\Delta L}_{00\left({R}_1\hbox{--} {R}_0\right)} $$ , Δ E 00 R 1 - R 0 $$ {\Delta E}_{00\left({R}_1\hbox{--} {R}_0\right)} $$ , and ΔWI D R 1 - R 0 $$ {\Delta \mathrm{WI}}_{\mathrm{D}\left({R}_1\hbox{--} {R}_0\right)} $$ , whereas Δ L 00 R 2 - R 0 $$ {\Delta L}_{00\left({R}_2\hbox{--} {R}_0\right)} $$ , Δ E 00 R 2 - R 0 $$ {\Delta E}_{00\left({R}_2\hbox{--} {R}_0\right)} $$ , and ΔWI D R 2 - R 0 $$ {\Delta \mathrm{WI}}_{\mathrm{D}\left({R}_2\hbox{--} {R}_0\right)} $$ were lower in Opalescence PF than in the control group. In both moments, ΔE00 and ΔWID in EMP (also ΔL00) and EMAX were higher in Opalescence PF than in the control group, from which the other treatments did not differ in R1-R0. In EMP, Δ E 00 R 2 - R 0 $$ {\Delta E}_{00\left({R}_2\hbox{--} {R}_0\right)} $$ in Whiteness HP Blue (also Δ L 00 R 2 - R 0 $$ {\Delta L}_{00\left({R}_2\hbox{--} {R}_0\right)} $$ ) and Proxyt were also higher in comparison to the control group and in VS, Ceramisté decreased Δ L 00 R 1 - R 0 $$ {\Delta L}_{00\left({R}_1\hbox{--} {R}_0\right)} $$ , Δ E 00 R 1 - R 0 $$ {\Delta E}_{00\left({R}_1\hbox{--} {R}_0\right)} $$ , and Δ R T P 00 R 1 - R 0 $$ \varDelta RT{P}_{00\left({R}_1\hbox{--} {R}_0\right)} $$ , whereas Opalescence PF increased ΔRTP 00 R 1 - R 0 $$ {\Delta \mathrm{RTP}}_{00\left({R}_1\hbox{--} {R}_0\right)} $$ . Δ E 00 R 2 - R 0 $$ {\Delta E}_{00\left({R}_2\hbox{--} {R}_0\right)} $$ of Ceramisté and ΔWI D R 2 - R 0 $$ {\Delta \mathrm{WI}}_{\mathrm{D}\left({R}_2\hbox{--} {R}_0\right)} $$ and Δ R T P 00 R 2 - R 0 $$ \varDelta RT{P}_{00\left({R}_2\hbox{--} {R}_0\right)} $$ of Proxyt were lower than those of the control group. CONCLUSIONS: The most suitable treatment to recover the lightness, color, whiteness, and RTP without changing these properties after another coffee exposure is material-dependent. CLINICAL SIGNIFICANCE: Although the effectiveness of the treatment was material-dependent, Proxyt was the only treatment that promoted clinically acceptable changes for both LU and VE, while for purely ceramic materials, this condition was observed with Ceramisté and Clinpro Prophy Powder.

Influence of educational level on the prevalence of risk behaviors during the perinatal period. / Influencia del nivel de estudios en la prevalencia de conductas de riesgo durante el periodo perinatal.

The objective of this work was to assess changes during pregnancy and after childbirth in diet, consumption of tobacco, electronic cigarettes, cannabis, alcohol use and exposure to environmental tobacco smoke depending on the mother's educational level.A cross-sectional study was carried out whose target population was 18,822 Galician women aged 18-49 who gave birth between September 2015 and August 2016, and their 19,204 live-born children. A descriptive analysis was performed, and the prevalence of different behaviors was estimated at three time points - pre-pregnancy, pregnancy and after childbirth - depending on the mother's educational level. Percentages of change were calculated.Information was obtained from 6,436 women. Regardless of the educational level, during pregnancy there was an improvement in the different lifestyles. In the first months after childbirth, lifestyles worsened, except for exposure to environmental tobacco smoke and the use of electronic cigarettes. Most of the risk behaviors showed a gradient depending on the educational level; thus, the lower the educational level, the higher the prevalence of risk behaviors.In general, during pregnancy all women adopted healthier lifestyles that they abandoned in the months following childbirth. Women with a lower level of education showed a higher prevalence of risk behaviors, both in the period prior to pregnancy, as well as during pregnancy and after childbirth.

El objetivo de este trabajo fue valorar cambios durante el embarazo y tras el parto en la dieta, consumo de tabaco, cigarrillos electrónicos, alcohol, cannabis y exposición al humo ambiental de tabaco en función del nivel de estudios de la madre. Para ello, se llevó a cabo un estudio transversal cuya población objetivo fueron 18.822 mujeres gallegas de 18-49 años que dieron a luz entre septiembre 2015 y agosto 2016, y sus 19.204 hijos/as nacidos vivos. Se realizó un análisis descriptivo y se estimó la prevalencia de diferentes conductas en tres momentos temporales ­pre-embarazo, embarazo y tras el parto­ en función del nivel de estudios de la madre. Se calcularon los porcentajes de cambio. Se obtuvo información de 6.436 mujeres. Con independencia del nivel de estudios, durante el embarazo se produce una mejora en los diferentes estilos de vida. En los primeros meses tras el parto los estilos de vida empeoran, con excepción de la exposición al humo ambiental de tabaco y el consumo de cigarrillos electrónicos. La mayoría de las conductas de riesgo muestran un gradiente dependiente del nivel educativo; así, a menor nivel educativo, mayor es la prevalencia de conductas de riesgo. En general, durante el embarazo todas las mujeres adoptan estilos de vida más saludables que abandonan en los meses siguientes al parto. Las mujeres con menor nivel de estudios muestran una mayor prevalencia de conductas de riesgo, tanto en el periodo previo al embarazo, como en el embarazo y tras el parto.

Prognostic Implications of Blood Immune-Cell Composition in Metastatic Castration-Resistant Prostate Cancer.

The prognosis for patients with metastatic castration-resistant prostate cancer (mCRPC) varies, being influenced by blood-related factors such as transcriptional profiling and immune cell ratios. We aimed to address the contribution of distinct whole blood immune cell components to the prognosis of these patients. This study analyzed pre-treatment blood samples from 152 chemotherapy-naive mCRPC patients participating in a phase 2 clinical trial (NCT02288936) and a validation cohort. We used CIBERSORT-X to quantify 22 immune cell types and assessed their prognostic significance using Kaplan-Meier and Cox regression analyses. Reduced CD8 T-cell proportions and elevated monocyte levels were substantially connected with a worse survival. High monocyte counts correlated with a median survival of 32.2 months versus 40.3 months for lower counts (HR: 1.96, 95% CI 1.11-3.45). Low CD8 T-cell levels were associated with a median survival of 31.8 months compared to 40.3 months for higher levels (HR: 1.97, 95% CI 1.11-3.5). These findings were consistent in both the trial and validation cohorts. Multivariate analysis further confirmed the independent prognostic value of CD8 T-cell counts. This study highlights the prognostic implications of specific blood immune cells, suggesting they could serve as biomarkers in mCRPC patient management and should be further explored in clinical trials.

Impact of an Intervention Aimed at Improving Sleep Quality in Hospitalized Children.

BACKGROUND: Hospitalized children need adequate sleep to favor early recovery. METHODS: To study the sleep pattern of children admitted to a pediatric inpatient unit, a cross-sectional study was carried out at a reference hospital in northern Spain. The main study variables were medical specialty of admission, sleep-inducing treatment, hours of sleep at home and during admission, number of nocturnal awakenings, and reasons for awakening. Differences in the hours of sleep and nighttime awakenings between the initial period and at six months were calculated using the Student's t-test. RESULTS: We included 100 baseline patients and 100 post-intervention patients. Up to 4% of the baseline sample and 3% of the six-month sample had been prescribed a sleep-promoting drug. Regarding awakenings, 79% of the children in the baseline sample suffered awakenings, with a mean of 1.98 awakenings (range 1-13). At six months, the percentage of children who experienced awakenings decreased by 17%, with a mean of 1.34 (range 1-5). In the baseline sample, 48% were caused by nursing care, decreasing to 34% after the intervention. CONCLUSIONS: An educational intervention with the implementation of targeted evidence-based practices is a useful measure for improving the sleep pattern by decreasing the number of awakenings.

Visual evaluation of the color adjustment of single-shade and group shade resin composites in restorations with different cavity configurations.

OBJECTIVE: To evaluate the influence of the tooth shade, type of resin composite and cavity configuration on the color adjustment of single-shade and group shade resin composites. METHODS: Class I and V cavities were prepared in artificial acrylic mandibular right molars with different shades - A1, A2, A3, A3.5 and A4. Three single-shade (OMN, UNI, CHA) and two group shade (FIL, HAR) resin composites were evaluated. Seventy-five observers, including dentists, dental students and laypersons (n = 25), participated in the study. A psychophysical experiment based on visual assessments of the color matching between each tooth and each restoration was ranked from 0 (excellent match) to 4 (huge mismatch), and mean frequencies (%) were calculated. Visual color differences among composite materials and tooth shades were statistically tested (P < 0.05). RESULTS: The results showed highest percentages of unacceptable color mismatches for class V compared to class I restorations, especially for more chromatic tooth shades (A3.5 and A4). The percentage of ratings of acceptability was higher for laypersons group. For class V, OMN presented significant difference only from UNI in tooth shades A1, A2, A3 and A4. However, for class I, OMN presented significant differences with CHA for A1, A2 and A4, and with HAR and FIL for A1. CONCLUSIONS: Class I resin composite restorations exhibit superior color matching than Class V, with lighter and low chroma tooth shades demonstrating better color adjustment. The color matching of both cavity configurations is comparable for single and group shade resin composites. CLINICAL SIGNIFICANCE: Cavity configuration and tooth shade may impact color matching of single and group shade resin composites. This study demonstrates superior color matching in class I configurations over class V for both single and group shade resin composites. Additionally, restorations placed in teeth with lighter shades exhibit more favorable color adjustment.

Virtual reality-based therapy for chronic low back and neck pain: a systematic review with meta-analysis.

Purpose: To compile all the scientific evidence available to date to evaluate the effect of virtual reality based therapy (VRBT) on reducing pain intensity, kinesiophobia, and associated disability, and on increasing the hr-QoL in patients with chronic neck pain (CNP) or chronic low back pain (CLBP). Methods: Studies published in PubMed Medline, SCOPUS, Web of Science, CINAHL Complete, and Physiotherapy Evidence Database (PEDro) up to June 2023 were searched. All searches followed the PICOS Framework. Two authors independently screened the studies found in the searches. Any differences of opinion regarding the selection of studies were settled by a third author. Results: Twenty-five RCTs, published between 2013 and 2022, providing data from 1261 patients (20 RCTs) with CLBP and 261 patients (five RCTs) with CNP, were included. In reducing pain intensity for patients with CLBP, meta-analyses showed that VRBT is effective in reducing pain just to the end of the intervention, and this effect could be maintained 1 and 6 months after the therapy. Conclusion: VRBT was found to be better than therapeutic exercise (TE), sham, and no intervention (NI), showing a major effect when VRBT was used as a complementary therapy to conventional physiotherapy (CPT). Further, VRBT showed an immediate effect and immersive VRBT was the most adequate VRBT modality in reducing pain in CNP patients. No differences were found between non-immersive VRBT and immersive VRBT in reducing pain, kinesiophobia, disability, and hr-QoL in patients with CLBP.

Neurological outcomes and mortality of hyperoxaemia in patients with acute brain injury: protocol for a systematic review and meta-analysis.

INTRODUCTION: Oxygen is frequently prescribed in neurocritical care units. Avoiding hypoxaemia is a key objective in patients with acute brain injury (ABI). However, several studies suggest that hyperoxaemia may also be related to higher mortality and poor neurological outcomes in these patients. The evidence in this direction is still controversial due to the limited number of prospective studies, the lack of a common definition for hyperoxaemia, the heterogeneity in experimental designs and the different causes of ABI. To explore the correlation between hyperoxaemia and poor neurological outcomes and mortality in hospitalised adult patients with ABI, we will conduct a systematic review and meta-analysis of observational studies and RCTs. METHODS AND ANALYSIS: The systematic review methods have been defined according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and follow the PRISMA-Protocols structure. Studies published until June 2024 will be identified in the electronic databases MEDLINE, Embase, Scopus, Web of Science, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature and ClinicalTrials.gov. Retrieved records will be independently screened by four authors working in pairs, and the selected variables will be extracted from studies reporting data on the effect of 'hyperoxaemia' versus 'no hyperoxaemia on neurological outcomes and mortality in hospitalised patients with ABI. We will use covariate-adjusted ORs as outcome measures when reported since they account for potential cofounders and provide a more accurate estimate of the association between hyperoxaemia and outcomes; when not available, we will use univariate ORs. If the study presents the results as relative risks, it will be considered equivalent to the OR as long as the prevalence of the condition is close to 10%. Pooled estimates of both outcomes will be calculated applying random-effects meta-analysis. Interstudy heterogeneity will be assessed using the I2 statistic; risk of bias will be assessed through Risk Of Bias In Non-Randomised Studies of Interventions, Newcastle-Ottawa or RoB2 tools. Depending on data availability, we plan to conduct subgroup analyses by ABI type (traumatic brain injury, postcardiac arrest, subarachnoid haemorrhage, intracerebral haemorrhage and ischaemic stroke), arterial partial pressure of oxygen values, study quality, study time, neurological scores and other selected clinical variables of interest. ETHICS AND DISSEMINATION: Specific ethics approval consent is not required as this is a review of previously published anonymised data. Results of the study will be shared with the scientific community via publication in a peer-reviewed journal and presentation at relevant conferences and workshops. It will also be shared key stakeholders, such as national or international health authorities, healthcare professionals and the general population, via scientific outreach journals and research institutes' newsletters.

[Improving the nutritional care of oncology patients - Validation of a multidisciplinary protocol in the Spanish clinical setting]. / Mejorando la atención nutricional del paciente oncológico: validación de un protocolo multidisciplinar en el entorno clínico español.

INTRODUCTION: malnutrition is a very frequent problem in oncology patients and can have serious repercussions. Adequate nutritional management is cost-effective in terms of health and survival in this population, but it requires multidisciplinary coordination, specific training, and continuous follow-up. OBJECTIVE: to validate the applicability and efficacy of a multidisciplinary nutritional support protocol in oncology patients. METHODS: a multidisciplinary nutritional protocol was developed for oncology patients, with guidelines for screening and assessment of malnutrition, treatment, re-evaluation, and management of side effects, as well as guidance on supplementation and eating patterns. The protocol would be implemented in various clinical centers, collecting data through a structured questionnaire, registering variables before and after implementation. RESULTS: the protocol and its impact were implemented and evaluated in 39 centers. An improvement in nutritional care was observed, evidenced by an earlier initiation of nutritional assessment and an increase in the number of patients receiving adequate care following the protocol implementation. Problems related to inadequate malnutrition coding in the centers, limited resources, and the need for greater interdepartmental collaboration were identified. CONCLUSIONS: the conduct of this study provides insights into how the implementation of a multidisciplinary nutritional support protocol can improve the nutritional care received by patients and informs about the main obstacles to adequate implementation.