Reversible, non-plaque-induced marginal bone loss around an osseointegrated implant: A case report.

This case report documents a non-plaque-induced marginal bone loss around an osseointegrated implant. The loss of osseointegration, most likely caused by overload and/or suboptimal distribution of occlusal loading, may be reversed when the loading is reduced by optimally transmitting stress forces to the implant-to-bone interface and surrounding bone.

The effect of different cleansing methods for removing temporary cement on the tensile bond force of permanently cemented implant-supported metal copings: An in vitro study.

OBJECTIVES: Complete cleaning of temporary cement before permanent cementation of cement-retained implant-supported prosthesis (CISP) when recementing the crown is critical. This study evaluated the effect of different cleaning methods for removing traces of temporary cement on the final tensile bond force (TBF) of CISP recemented with resin cement. MATERIALS AND METHODS: Seventy computer-aided design/computer-aided manufacturing metal implant-supported copings were prepared and distributed into seven groups (N = 10). Copings of six groups (60 samples) were cemented with temporary cement with eugenol and subjected to 5000 thermocycling. After debonding by a universal testing machine, the internal surfaces of the copings were cleaned using one of the six following methods: 1-an ultrasonic water bath (UW), 2-sandblasting, then washing with water (SW), 3-sandblasting and an ultrasonic water bath (SUW), 4-an ultrasonic isopropyl alcohol bath (UA), 5-sandblasting, then washing with isopropyl alcohol (SA) or 6-sandblasting and an ultrasonic isopropyl alcohol bath (SUA). Then the subjects were subsequently cemented by dual-cure self-adhesive resin cement. In the seventh group (control, N = 10), the copings were cemented by dual-cure self-adhesive resin cement without the temporization phase. The TBF was tested using a universal testing machine with a cross-head speed of 1 mm/min. Two-way analysis of variance (ANOVA) and post-hoc Tamhane tests were used for statistical analysis at a significance level of α = .05. RESULTS: The maximum mean of TBF value was observed in SUA group (845 ± 203 N), and the minimum was observed in the temporary cement group (49 ± 20 N). All groups which were cleaned with isopropyl alcohol showed significantly higher TBF values compared with those cleaned with water. CONCLUSIONS: Cleaning of the inner surface of metal copings after debonding with sandblasting and isopropyl alcohol results in the highest value of TBF by eliminating the effect of remaining eugenol and removing traces of temporary cements.

Dry mouth in the seriously ill and dying. / Munntørrhet hos alvorlig syke og døende.

Dry mouth constitutes a significant problem for most patients with grave illnesses and a need for palliative treatment. The main causes are pharmaceuticals, diseases and cancer treatment, which are often associated with increasing age. The condition may give rise to discomfort, pain, dysphagia, speech problems, increased caries activity, dehydration, malnutrition and loss of appetite. There are few evidence-based remedies against this condition. An apparently trivial problem like dry mouth may therefore cause deterioration of the clinical picture and a reduced quality of life.

Household Transmission of SARS-CoV-2: A Prospective Longitudinal Study Showing Higher Viral Load and Increased Transmissibility of the Alpha Variant Compared to Previous Strains.

We studied the secondary attack rate (SAR), risk factors, and precautionary practices of household transmission in a prospective, longitudinal study. We further compared transmission between the Alpha (B.1.1.7) variant and non-Variant of Concern (non-VOC) viruses. From May 2020 throughout April 2021, we recruited 70 confirmed COVID-19 cases with 146 household contacts. Participants donated biological samples eight times over 6 weeks and answered questionnaires. SARS-CoV-2 infection was detected by real-time RT-PCR. Whole genome sequencing and droplet digital PCR were used to establish virus variant and viral load. SARS-CoV-2 transmission occurred in 60% of the households, and the overall SAR for household contacts was 50%. The SAR was significantly higher for the Alpha variant (78%) compared with non-VOC viruses (43%) and was associated with a higher viral load. SAR was higher in household contacts aged ≥40 years (69%) than in younger contacts (40-47%), and for contacts of primary cases with loss of taste/smell. Children had lower viral loads and were more often asymptomatic than adults. Sleeping separately from the primary case reduced the risk of transmission. In conclusion, we found substantial household transmission, particularly for the Alpha variant. Precautionary practices seem to reduce SAR, but preventing household transmission may become difficult with more contagious variants, depending on vaccine use and effectiveness.

Complication following frenectomy: A case report.

When performing a frenectomy in patients with an increased risk of exposing bone dehiscence, it is essential that the distance between the incisions is not too wide and that they are mainly made in the movable mucosa to secure optimal wound closure.

An 8-10 Year Follow-up of Denture Satisfaction and Oral Health-Related Quality of Life with Implant-Retained Mandibular Overdentures.

PURPOSE: To report changes in denture satisfaction and oral health-related quality of life (OHRQoL) in edentulous patients treated with two-implant mandibular overdentures (IODs) over a follow-up of 8 to 10 years. MATERIALS AND METHODS: This is a follow-up of a previous study carried out between 1997 and 2005. The patients were originally randomly divided into one group receiving IODs and another group who had their conventional mandibular dentures relined (RCD group). The RCD group was offered and received IODs at the 2-year follow-up. The participants completed a self-administered questionnaire containing demographics, 15 variables related to denture satisfaction, and 20 questions from the Oral Health Impact Profile (OHIP-20). Changes over time were analyzed using multilevel linear models for denture satisfaction and multilevel ordinal regression analyses for OHIP-20 variables. Comparisons between groups were analyzed using Mann-Whitney U test for ordinal and t test for metric data. RESULTS: Disregarding patients who passed away during follow-up, the 29 responders represented a response rate of 76%. The degree of denture satisfaction and the OHIP-20 scores remained high and stable in the IOD group over the 10-year observation period for all but one variable. The same factors showed only a modest improvement in the RCD group for the first 2 years; however, during the subsequent 8 years of the observation period (after receiving IODs), denture satisfaction and OHIP-20 scores improved to the same level as the original IOD group. CONCLUSION: The positive effect on denture satisfaction and OHRQoL of edentulous patients treated with two-implant mandibular overdentures remained unchanged 8 to 10 years after treatment.

Ionizing radiation, genotoxic stress, and mitochondrial DNA copy-number variation in Caenorhabditis elegans: droplet digital PCR analysis.

Mitochondria are vulnerable to the effects of ionizing radiation; damage to mitochondrial DNA (mtDNA) may be more extensive and persistent than damage to nuclear DNA (nDNA). Variation in mtDNA copy number has been proposed as a marker for mitochondrial dysfunction in response to ionizing radiation. We have developed a precise and sensitive duplex droplet digital PCR (ddPCR) method for quantitation of the mtDNA/nDNA ratio in the model organism Caenorhabditis elegans. The effect on this ratio was investigated over a wide range of doses (0.03-72 Gy) of chronic gamma irradiation. Five mitochondrial targets and two nuclear reference genes were amplified pairwise in duplex PCR format (one mitochondrial and one nuclear target per PCR) by both ddPCR and quantitative PCR (qPCR). The results showed that ddPCR but not qPCR enabled detection of a significant increase in mtDNA copy number (1.6 ± 0.1-fold) for nematodes exposed to high doses (≥24 Gy). Thus, ddPCR provided higher precision and greater sensitivity than qPCR for detection of mtDNA copy number variation. The variation followed a Hill-type dose response with threshold 10.3 ± 1 Gy. This strongly suggests that chronic genotoxic stress affects mtDNA replication. The duplex ddPCR method is a novel, high-precision, sensitive tool for determination of mitochondrial DNA copy number variation and function in C. elegans.

Randomized controlled trial of the effectiveness of three different oral moisturizers in palliative care patients.

Most patients in palliative care have problems with dry mouth caused by medication or as a direct result of their condition. Dry mouth may cause problems that affect the primary disease negatively and contribute to poorer quality of life in palliative patients. This randomized controlled trial compared the efficacy of three different oral moisturizers: 17% watery solution of glycerol; oxygenated glycerol triester (marketed as Aequasyal in Europe and as Aquoral in the USA); and a newly developed product, Salient. Of the three products, glycerol provided the best relief from xerostomia directly after application, but had no effect after 2 h. By contrast, the effects of Aequasyal and Salient were largely maintained over the same period. The findings for oral discomfort and pain and speech problems showed a similar pattern. Despite its poor effect after 2 h, patients preferred glycerol over Salient and Aequasyal, probably because of the unpleasant taste of Aequasyal and the consistency and mode of application of Salient. Within the limitations of this study, none of the three products tested was found to be clinically completely adequate. However, the glycerol solution was preferred by this group of patients, and its short-lived effect can be compensated for by frequent applications.

Rate of avoidable deaths in a Norwegian hospital trust as judged by retrospective chart review.

BACKGROUND: The proportion of avoidable hospital deaths is challenging to estimate, but has great implications for quality improvement and health policy. Many studies and monitoring tools are based on selected high-risk populations, which may overestimate the proportion. Mandatory reporting systems, however, under-report. We hypothesise that a review of an unselected sample of hospital deaths will provide an estimate of avoidability in-between the estimates from these methods. METHODS: A retrospective case record review of an unselected population of 1000 consecutive non-psychiatric hospital deaths in a Norwegian hospital trust was conducted. Reviewers evaluated to what degree each death could have been avoided, and identified problems in care. RESULTS: We found 42 (4.2%) of deaths to be at least probably avoidable (more than 50% chance of avoidability). Life expectancy was shortened by at least 1 year among 34 of the 42 patients with an avoidable death. Patients whose death was found to be avoidable were less functionally dependent compared with patients in the non-avoidable death group. The surgical department had the greatest proportion of such deaths. Very few of the avoidable deaths were reported to the hospital's report system. CONCLUSIONS: Avoidable hospital deaths occur less frequently than estimated by the national monitoring tool, but much more frequently than reported through mandatory reporting systems. Regular reviews of an unselected sample of hospital deaths are likely to provide a better estimate of the proportion of avoidable deaths than the current methods.

Plasmid and Host Strain Characteristics of Escherichia coli Resistant to Extended-Spectrum Cephalosporins in the Norwegian Broiler Production.

Escherichia coli resistant to extended-spectrum cephalosporins have been detected in the Norwegian broiler production, despite the fact that antimicrobial agents are rarely used. The genetic mechanism responsible for cephalosporin resistance is mainly attributed to the presence of the blaCMY-2 gene encoding a plasmid-mediated AmpC-beta-lactamase (pAmpC). The aim of this study was to characterize and compare blaCMY-2 containing Escherichia coli isolated from the intestinal flora of broilers and retail chicken meat (fillets) to identify possible successful clones and/or resistance plasmids widespread in the Norwegian broiler production. Methods used included PCR based phylotyping, conjugation experiments, plasmid replicon typing, pulsed-field gel electrophoresis, multiple locus variable-number tandem-repeats analysis and whole genome sequencing. The nucleotide sequence of an IncK plasmid carrying blaCMY-2 was determined. Intestinal isolates displayed a higher degree of genetic diversity than meat isolates. A cluster of genetically related isolates belonging to ST38, phylogroup D, carrying blaCMY-2 containing IncK plasmids was identified. Furthermore, genes encoding plasmid stability systems (relBE/stbDE and pndAC) were identified on the IncK plasmid. Single nucleotide polymorphism (SNP) analysis of a subset of isolates confirmed a close genetic relationship within the two most prevalent STs. The IncK plasmids within these two STs also shared a high degree of similarity. Cephalosporin-resistant E. coli with the same genetic characteristics have been identified in the broiler production in other European countries, and the IncK plasmid characterized in this study showed close homology to a plasmid isolated from retail chicken meat in the Netherlands. The results indicate that both clonal expansion and horizontal transfer of blaCMY-2 containing plasmids contribute to dissemination of cephalosporin resistant E. coli in the broiler production. The presence of plasmid stability systems may explain why the IncK plasmid containing blaCMY-2 is maintained and disseminated in the Norwegian broiler production in absence of selection pressure from the use of antimicrobial agents.

Patient knowledge and expectations prior to receiving implant-supported restorations.

PURPOSE: Implant dentistry has revolutionized the treatment of partially and completely edentulous patients. The aims of this study were to explore what made patients choose implant treatment and their prior knowledge and expectations of this treatment option. MATERIALS AND METHODS: A study population of 117 subjects was selected from 248 referred possible candidates for implant therapy. The subjects answered a questionnaire regarding implant dentistry prior to professional consultation at two hospital/university-based centers and one private implant center. RESULTS: In most cases, the choice of treatment was motivated by expectations of improved chewing/function (46.0%), appearance (19.5%), or both (18.6%). Improved chewing/function and improved appearance were rated "very important" by 96.5% and 86.1% of patients, respectively. Surprisingly, 57.4% reported that the cost of treatment did not play a role in their decision. Only 6.0% claimed to have much prior knowledge about the treatment and 33.6% had a realistic perception about the length of anticipated service. Patients first received implant-related information primarily (62.9%) from dentists, and 75.2% thought their dentist gave the most useful information. Significant positive associations were found between knowledge about the treatment, the need for periodic professional oral health maintenance, and expected treatment time. CONCLUSION: Patients seek implant therapy primarily to improve chewing function and esthetics, whereas cost seems to be less important. Prior to treatment, many patients lack precise information on the importance of necessary implant-related hygiene measures and implant longevity. The general dentist is the primary source of information.

Evaluation of the ability of four ESBL-screening media to detect ESBL-producing Salmonella and Shigella.

BACKGROUND: The aim of this study was to compare the ability of four commercially available media for screening extended-spectrum beta-lactamase (ESBL) to detect and identify ESBL-producing Salmonella and Shigella in fecal samples. A total of 71 Salmonella- and 21 Shigella-isolates producing ESBL(A) and/or AmpC, were received at Norwegian Institute of Public Health between 2005 and 2012. The 92 isolates were mixed with fecal specimens and tested on four ESBL screening media; ChromID ESBL (BioMèrieux), Brilliance ESBL (Oxoid), BLSE agar (AES Chemunex) and CHROMagar ESBL (CHROMagar). The BLSE agar is a biplate consisting of two different agars. Brilliance and CHROMagar are supposed to suppress growth of AmpC-producing bacteria while ChromID and BLSE agar are intended to detect both ESBL(A) and AmpC. RESULTS: The total sensitivity (ESBL(A)+AmpC) with 95% confidence intervals after 24 hours of incubation were as follows: ChromID: 95% (90.4-99.6), Brilliance: 93% (87.6-98.4), BLSE agar (Drigalski): 99% (96.9-100), BLSE agar (MacConkey): 99% (96.9-100) and CHROMagar: 85% (77.5-92.5). The BLSE agar identified Salmonella and Shigella isolates as lactose-negative. The other agars based on chromogenic technology displayed Salmonella and Shigella flexneri isolates with colorless colonies (as expected). Shigella sonnei produced pink colonies, similar to the morphology described for E. coli. CONCLUSION: All four agar media were reliable in screening fecal samples for ESBL(A)-producing Salmonella and Shigella. However, only ChromID and BLSE agar gave reliable detection of AmpC-producing isolates. Identification of different bacterial species based on colony colour alone was not accurate for any of the four agars.

Increased severity and mortality in adults co-infected with malaria and HIV in Maputo, Mozambique: a prospective cross-sectional study.

BACKGROUND: Co-infection with falciparum malaria and HIV-1 increases the severity and mortality of both infections in unstable malaria-transmission areas. In contrast, in stable transmission areas, HIV co-infection increases the severity of both infections but has not been found to influence malaria mortality. METHODS: In a prospective cross-sectional study, clinical and laboratory data were consecutively collected for all adults admitted with fever and/or suspected malaria to the medical department of the Central Hospital of Maputo, Mozambique, during two malaria seasons from January 2011. Malaria and HIV PCRs were performed, and risk factors for fatal outcomes were analysed. The impact of HIV on the clinical presentation and mortality of malaria was assessed. FINDINGS: A total of 212 non-pregnant adults with fever and/or suspected malaria and 56 healthy controls were included in the study. Of the 131 patients with confirmed falciparum malaria, 70 were co-infected with HIV-1. The in-hospital mortality of the co-infected patients was 13.0% (9/69) compared with 1.7% (1/59) in the patients without HIV (p = 0.018). Malaria severity (p = 0.016) and co-infection with HIV (p = 0.064) were independent risk factors for death although the association with HIV did not reach statistical significance. The co-infected patients had significantly more frequent respiratory distress, bleeding disturbances, hypoglycaemia, liver and renal failure and high malaria parasitemia compared with the patients with malaria alone. INTERPRETATIONS: HIV co-infection is associated with increased disease severity in and mortality from malaria in an area of stable malaria transmission. This finding was not observed earlier and should motivate doctors working in malaria-endemic areas to consider early HIV testing and a closer follow-up of patients with malaria and HIV co-infection.

Increased Severity and Mortality in Adults Co-Infected with Malaria and HIV in Maputo, Mozambique: A Prospective Cross-Sectional Study

Background: Co-infection with falciparum malaria and HIV-1 increases the severity and mortality of both infections in unstable malaria-transmission areas. In contrast, in stable transmission areas, HIV co-infection increases the severity of both infections but has not been found to influence malaria mortality. Methods: In a prospective cross-sectional study, clinical and laboratory data were consecutively collected for all adults admitted with fever and/or suspected malaria to the medical department of the Central Hospital of Maputo, Mozambique, during two malaria seasons from January 2011. Malaria and HIV PCRs were performed, and risk factors for fatal outcomes were analysed. The impact of HIV on the clinical presentation and mortality of malaria was assessed. Findings: A total of 212 non-pregnant adults with fever and/or suspected malaria and 56 healthy controls were included in the study. Of the 131 patients with confirmed falciparum malaria, 70 were co-infected with HIV-1. The in-hospital mortality of the co-infected patients was 13.0% (9/69) compared with 1.7% (1/59) in the patients without HIV (p = 0.018). Malaria severity (p = 0.016) and co-infection with HIV (p = 0.064) were independent risk factors for death although the association with HIV did not reach statistical significance. The co-infected patients had significantly more frequent respiratory distress, bleeding disturbances, hypoglycaemia, liver and renal failure and high malaria parasitemia compared with the patients with malaria alone. Interpretations: HIV co-infection is associated with increased disease severity in and mortality from malaria in an area of stable malaria transmission. This finding was not observed earlier and should motivate doctors working in malaria-endemic areas to consider early HIV testing and a closer follow-up of patients with malaria and HIV co-infection.

A critical appraisal of holistic teaching and its effects on dental student learning at University of Bergen, Norway.

The curriculum of the dental faculty at the University of Bergen, Norway, was revised and a new curriculum implemented in 1998 based on the principles of holistic teaching and patient-centered treatment. The first candidates graduated in 2003. The change of curricula, experience gained, and lack of an evidence base for holistic teaching justify a general discussion of all relevant aspects associated with this approach. The purpose of this article was to make a contribution towards such a discussion. A PubMed search regarding holistic teaching in dentistry was performed. Of the 211 entries on holistic teaching, few discussed holism in depth; none reported outcome measures comparing old and new curricula. Data collected from students graduating in 2003 (new curriculum) and 2000 (old curriculum) on their satisfaction with the teaching comprise a possible outcome measure. In most respects, using prosthodontics as an example, no differences between the two groups of students were found. Students studying under the new holistic curriculum were less satisfied than those studying under the old one regarding the number of available teachers and teachers' feedback on student performance. Both holistic teaching/patient-centered treatment and a more traditional subject-specific approach have advantages and disadvantages, and neither can be practiced in its pure form for ethical and practical reasons. The quantitative results of this study did not support the hypothesis that holism improved students' satisfaction with the teaching. A wide discussion of holism in dental education is needed, along with outcome measures when curricula are changed.

The influence of relining or implant retaining existing mandibular dentures on health-related quality of life: a 2-year randomized study of dissatisfied edentulous patients.

PURPOSE: The purpose was to assess and compare self-reported oral health and oral and general health related quality of life (OHRQoL and HRQoL) in two groups of edentulous adults who reported dissatisfaction with their mandibular dentures, and who were treated with a conventional relining of this denture or by having it converted into an implant-retained one. MATERIALS AND METHODS: Sixty subjects were randomly allocated into two equal groups, a relined conventional denture (RCD) group and an implant-retained overdenture (IOD) group. Data on demographics, oral health, OHRQoL, and HRQoL were recorded by means of a self-administered questionnaire at baseline, 3 months, and 2 years. RESULTS: Fifty-four subjects completed the protocol, 28 in the IOD-group and 26 in the RCD-group. The IOD group reported significant improvement in oral health and Oral Health Impact Profile (OHIP-20) sum score and all its domains after 3 months. The improvements remained stable at the 2-year control. The RCD group reported almost no significant improvements. Neither group reported improved HRQoL. CONCLUSION: The results of this study support the findings from other RCT studies that to implant-retain the mandibular denture significantly improves self-reported oral health and OHRQoL. This treatment modality should be a minimum standard of care in complete denture wearers dissatisfied with their mandibular denture.

Denture wearer's perception of ambient care. Part 2. Analyses of data.

OBJECTIVE: The aim was to investigate to what extent denture wearers were satisfied with the ambient care (care) received. MATERIALS AND METHODS: A study sample of 117 completely edentulous and 56 partially edentulous patients, who had received their dentures in the period 1997-2005 at Bergen School of Dentistry, completed a questionnaire containing eight specific items regarding different aspects of care, each with two positive (a and b) and two negative (c and d) categories, and four global items. The care items, including confidence in the dental team, information, waiting time and cost, constitute the Ambient Care Scale; the global items were concerned with overall care, satisfaction with dentures, self-reported oral and general health. RESULTS: Between 91-100% of Ambient Care Scale responses were in the two positive categories. The completely edentulous group was significantly more satisfied than the partially edentulous group regarding several Ambient Care Scale items and oral health. Also, ratios between categories b and a showed systematic higher degrees of satisfaction for the completely edentulous group than the partially edentulous group. Fifty-six per cent in the completely edentulous group and 36% in the partially edentulous group were very satisfied, i.e. with ≥ 6 of 8 possible responses in category a. Analysis of the very satisfied showed that the highest degrees of satisfaction for both groups were found regarding students and staff, the lowest regarding cost and waiting times. CONCLUSIONS: Patient satisfaction with care was very high. Completely edentulous patients were systematically more satisfied than partially edentulous ones.

Randomized clinical trial comparing dietary intake in patients with implant-retained overdentures and conventionally relined denture.

PURPOSE: This study compared the dietary intake of edentulous subjects dissatisfied with their existing mandibular complete dentures following two different prosthodontic management interventions. MATERIALS AND METHODS: A convenience sample of 60 subjects was randomly allocated into two equal treatment modalities: relined conventional denture (RCD) or converted implant-retained overdenture (IOD). Two-year data incorporating demographics and food avoidance were recorded using a self-administered questionnaire at baseline and regular follow-up intervals. Twenty-four-hour dietary intake assessments were obtained by telephone interviews at three spaced intervals. Dietary analyses were based on nutrient values from the Norwegian Food Composition Table. RESULTS: Twenty-seven patients in the IOD group and 26 in the RCD group completed the protocol. There were no statistical differences regarding dietary intake and energy distribution. Intake of protein and fat, especially saturated fat, were above Nordic recommendations, and carbohydrate intake was below. Vitamin D intake was at the recommended level, but that of vitamin C, folate, and fiber were lower than recommended. The IOD group reported significantly less avoidance of certain food items at 3 and 24 months (P < .001), better chewing ability (P < .001), and greater willingness to eat more of some food items (P < .001). CONCLUSION: There were no significant differences regarding food choices and nutrient intake between the IOD and RCD groups. However, the IOD group reported significantly better chewing ability, less food avoidance, and greater willingness to eat more of certain food items.

Denture wearer's perception of ambient care, part 1: validation of a preliminary scale.

OBJECTIVE: The aim of the present study was to investigate if a preliminary Ambient Care Scale (ACS), intended to measure ambient care in complete denture wearers, had acceptable reliability and validity. MATERIALS AND METHODS: A sample of 117 patients who had received complete dentures in both jaws in the period 1997-2005 at Bergen School of Dentistry completed a questionnaire containing eight items regarding the patients' relationship with the student and clinical personnel, to what extent they were informed and consulted during treatment, waiting times and cost. In addition, information was gathered regarding demographics, The Psychological General Well-Being index (WHO-5), global ambient care, satisfaction with dentures and how patients viewed their oral health. RESULTS: Cronbach's alpha coefficient was 0.76 for the ACS, indicating acceptable internal consistency. From principle component analysis, three factors were extracted, correlating with ACS with coefficients of 0.72, 0.58 and 0.59, respectively. Acceptable construct validity was indicated by the fact that items were formulated by common agreement among three experienced prosthodontists, the extremely low frequency of missing data (<2%) and that ACS, as expected, was able to discriminate between patients satisfied and dissatisfied with their dentures (p = 0.005) and oral health (p = 0.042), but not between those who had high or low WHO-5 scores (p = 0.77). CONCLUSIONS: The ACS appears to have acceptable psychometric properties.