Impact of a Multidisciplinary Round Visit for the Management of Dysphagia Utilizing a Wi-Fi-Based Wireless Flexible Endoscopic Evaluation of Swallowing.

OBJECTIVES: The management of dysphagia requires a multidisciplinary approach, especially in large-scale hospitals. We introduce a novel protocol using a Wi-Fi-based flexible endoscopic evaluation of swallowing (FEES) system and aim to verify its effectiveness in evaluation and rehabilitation of inpatients with dysphagia. METHOD: We conducted novel Wi-Fi-based FEES at the bedside using 3 iPads as monitors and recorders. Functional outcomes of swallowing in 2 different hospitals for acute care with conventional wired or wireless FEES were compared retrospectively. RESULTS: Using the wireless system, we could visit more patients in a short period of time. Furthermore, a large multidisciplinary team was able to be present at the bedside, which made it easy to hold discussions and rapidly devise appropriate rehabilitation strategies. Aspiration pneumonia recurred in a few cases following our intervention with wireless FEES. Functional oral intake score was significantly increased following the intervention. Moreover, the number of deaths during hospitalization using wireless FEES evaluation was lower than those observed using the conventional system. CONCLUSION: Wi-Fi-based wireless FEES system, the first of its kind, allowed our multidisciplinary team to easily and effectively assess inpatients with dysphagia by facilitating simple examinations and intensive transprofessional discussions for patient rehabilitation.

Space closure in the maxillary posterior area through the maxillary sinus.

A common dilemma in adult orthodontic treatment is deciding how best to treat missing posterior teeth. One treatment option is to orthodontically close the space. But closure can be difficult, especially if the open space is in the maxillary posterior area, because tooth movement through the maxillary sinus is limited. The increased difficulty of moving teeth in the maxillary sinus is similar to moving a tooth in the atrophic posterior mandibular ridge. If space closure is selected as a treatment method, proper mechanics and light forces should be applied. In this article, we report movement of teeth through the maxillary sinus and discuss various implications related to orthodontic treatment in the maxillary sinus.

Esthetic orthodontic treatment with a double J retractor and temporary anchorage devices.

This clinical article reports an esthetic treatment option for managing a Class II malocclusion in an adult. The patient, a woman aged 24 years 2 months, had crowding and a convex profile. She was treated with maxillary first premolar extractions, a double J retractor, and temporary skeletal anchorage devices in the maxillary arch. Posttreatment records after 2 years showed excellent results with good occlusion and long-term stability.

Reliability and sensitivity of jerk-cost measurement for evaluating irregularity of chewing jaw movements.

Rate of change in movement acceleration (jerk) is a universally accepted quantity to evaluate irregularities of human limb and eye movements. This study was aimed to attest reliability of the jerk measurement of masticatory jaw movements and to identify its sensitivity to discriminate between movements performed with the presence of varied occlusal interference. Jaw movements during gum chewing were recorded with a 3D tracking device. Twelve adult subjects participated in the experiments. For five subjects, normalized jerk-costs (NJC) during jaw closing were compared between those measured on two separate occasions. For seven subjects, the NJCs during closing were compared with those measured with/without introduction of four different types of occlusal interference. The NJCs did not differ significantly between the two recording occasions. The interference at the canine tooth induced greater increase in the NJCs than that at the molar tooth. The comparison between repeated measures revealed reproducibility of the NJCs. In addition, the NJC was shown to be capable of discriminating between irregularities of the movements induced by occlusal interference at the canine and molar tooth sites. These findings suggest that the NJC is a valid indicator of masticatory jaw movement irregularity induced by disturbances of full intercuspation between upper and lower teeth.

Microfouling studies on experimental test blocks of steel-making slag and concrete exposed to seawater off Chiba, Japan.

Microfouling studies with the emphasis on microalgae (Bacillariophyceae) were carried out on test blocks of steel-making slag in comparison with concrete. Two types of slag test blocks, with and without fly-ash as an additional source of silica, and concrete test blocks of size 75 x 26 x 26 mm were used to study microfouling build-up for a period of 30 d, with intermittent samplings after 1, 2, 3, 7, 14 and 21 d. The species composition, cell density, biomass and surface pH of the test pieces were determined, in addition to the hydrographic parameters of the water column. Microfouling studies showed higher numbers of algal species as well as a greater cell density on the slag than on the concrete blocks. This was true with respect to biomass measured as dry weight also. Colonization was significantly delayed in the case of concrete. Navicula spp. and Nitzschia spp. were the initial colonizers on all three types of substrata and were the dominant genera throughout the study period. While the number of species increased, several disappeared after colonization, as a part of community build-up. The surface pH of the slag blocks was near neutral, whilst that of the concrete was highly alkaline during the initial period of exposure. This alkaline surface reduced the rate of species colonization on the concrete blocks initially. The study showed severe biofouling on the slag blocks compared to concrete and thus they were considered an environmentally benign construction material for land protection. The use of slag as the construction material for land protection would greatly reduce the expense compared to concrete.

Quantum control of molecular chirality: optical isomerization of difluorobenzo[c]phenanthrene.

The results of a theoretical study are presented on quantum control of a chiral exchange reaction of a polyatomic molecule by using infrared laser pulses. Difluorobenzo[c]phenanthrene was chosen to be the simplest model for its helical chirality exchange reaction. This molecule has two stable configurations: M and P forms. From the viewpoint of chemical reaction dynamics, isomerization is regarded as the movement of one of the two representative points that initially correspond to the two forms to the position of the other representative point, while the other representative point remains in its initial position. The ground-state potential energy surface and dipole moment functions required to control this reaction were evaluated at the MP2/6-31+G(d,p) and MP2/TZV+(d,p) levels of molecular orbital (MO) theory. An effective potential energy surface (PES) that is a function of twisting motion of the benzene rings and wagging motion of the CF(2) group was constructed on the basis of the MO results. An analytical expression for the effective PES and that for the dipole moment functions were prepared to make the isomerization control tractable. A quantum control method in a classical way was applied to the isomerization of preoriented difluorobenzo[c]phenanthrene in low temperature limits. The time evolution of the representative point of the M form and that of the P form are separately evaluated to determine the optimal laser fields. This means that the laser control produces pure helical enantiomers from a racemic mixture. Representative points are replaced by the corresponding nuclear wave packets in this treatment. The derived control laser field consists of two linearly polarized E(x)() and E(z)() components that are perpendicular to each other. These components are pi-phase-shifted when the representative point is in the transition-state regions. Under the irradiation of this laser pulse, one of the two representative points of the isomerization is transferred to the target position along the intrinsic reaction path between the enantiomers, while the other representative point remains in its initial potential well. This results in one-way isomerization control, that is, the M(P) to P(M) form. The isomerization is completed with yields of ca. 70% within a few picoseconds. Temporal behaviors of the nuclear wave packet whose center corresponds to the representative point are drawn to see how the desired chiral exchange reaction proceeds in the presence of the control field, while its reverse process is suppressed.