Impact of an automated large vessel occlusion detection tool on clinical workflow and patient outcomes.

Purpose: Automated large vessel occlusion (LVO) tools allow for prompt identification of positive LVO cases, but little is known about their role in acute stroke triage when implemented in a real-world setting. The purpose of this study was to evaluate the automated LVO detection tool's impact on acute stroke workflow and clinical outcomes. Materials and methods: Consecutive patients with a computed tomography angiography (CTA) presenting with suspected acute ischemic stroke were compared before and after the implementation of an AI tool, RAPID LVO (RAPID 4.9, iSchemaView, Menlo Park, CA). Radiology CTA report turnaround times (TAT), door-to-treatment times, and the NIH stroke scale (NIHSS) after treatment were evaluated. Results: A total of 439 cases in the pre-AI group and 321 cases in the post-AI group were included, with 62 (14.12%) and 43 (13.40%) cases, respectively, receiving acute therapies. The AI tool demonstrated a sensitivity of 0.96, a specificity of 0.85, a negative predictive value of 0.99, and a positive predictive value of 0.53. Radiology CTA report TAT significantly improved post-AI (mean 30.58 min for pre-AI vs. 22 min for post-AI, p < 0.0005), notably at the resident level (p < 0.0003) but not at higher levels of expertise. There were no differences in door-to-treatment times, but the NIHSS at discharge was improved for the pre-AI group adjusted for confounders (parameter estimate = 3.97, p < 0.01). Conclusion: Implementation of an automated LVO detection tool improved radiology TAT but did not translate to improved stroke metrics and outcomes in a real-world setting.

Methodology for measuring the in vitro seating and unseating forces of prefabricated attachment systems used to retain implant overdentures.

PURPOSE: The purpose of this in vitro investigation was to measure the forces generated during the continuous seating and unseating of prefabricated attachment systems used to retain implant overdentures. MATERIALS AND METHODS: An experimental design consisting of interchangeable fixture mounts, a radially indexable fixture holder, and a materials testing systems (MTS) machine was used to measure forces generated during the insertion and removal of spherical stud attachments (Straumann, Inc, Waltham, WA). Three separate experiments were conducted measuring the seating and unseating forces of a vertically aligned patrix/matrix assembly, a 20 degrees angled patrix opposing a vertically positioned matrix, and a vertically positioned patrix opposing a 20 degrees angled matrix. For each patrix/matrix combination, three specimens were tested. Measurements were continuously recorded under reproducible conditions in the presence of artificial saliva. All specimens were subjected to 10,000 seating/unseating cycles. Statistical analysis was performed with rank analysis of variance (ANOVA) for a group comparison (alpha= 0.05). RESULTS: Results showed variability in the initial insertion and removal forces among experimental groups and among specimens within each experiment. A marked increase in the seating and unseating forces was recorded for all specimens during the first 300 cycles, followed by a gradual decrease in these forces. The exact p-values for the Kruskal-Wallis test showed no significant difference between the initial and final seating/unseating forces (p > 0.1) nor in the maximum seating/unseating forces (p > 0.6) among the three experimental groups. CONCLUSIONS: Spherical stud attachments exhibited consistent seating and unseating forces over 10,000 cycles. A 20 degrees angle between the patrix and matrix had no effect on the overall seating and unseating force values.

Targeted antimicrobial activity of a specific IgG-SMAP28 conjugate against Porphyromonas gingivalis in a mixed culture.

Antimicrobial peptides coupled to a ligand, receptor or antibody for a specific pathogenic bacteria could be used to develop narrow-spectrum pharmaceuticals with 'targeted' antimicrobial activity void of adverse reactions often associated with the use of broad-spectrum antibiotics. To assess the feasibility of this approach, in this study sheep myeloid antimicrobial peptide (SMAP) 28 was linked to affinity- and protein G-purified rabbit immunoglobulin G (IgG) antibodies specific to the outer surface of Porphyromonas gingivalis strain 381. The selective activity of the P. gingivalis IgG-SMAP28 conjugate was then assessed by adding it to an artificially generated microbial community containing P. gingivalis, Aggregatibacter actinomycetemcomitans and Peptostreptococcus micros. The specificity of the P. gingivalis IgG-SMAP28 conjugate in this mixed culture was concentration-dependent. The conjugate at 50 microg protein/mL lacked specificity and killed P. gingivalis, A. actinomycetemcomitans and P. micros. The conjugate at 20 microg protein/mL was more specific and killed P. gingivalis. This is an initial step to develop a selective antimicrobial agent that can eliminate a specific periodontal pathogen, such as P. gingivalis, from patients with periodontal disease without harming the normal commensal flora.

Video-Assisted Clinical Instruction in Dentistry (VACID) enhances real-time visualisation of clinical procedures.

AIM: The use of Video-Assisted Clinical Instruction in Dentistry (VACID) in the training of dental students represents an innovative teaching medium. Despite the many advantages that this teaching medium promises to offer, little objective research has been published to substantiate its purported benefits. This article examines the students' response to the application of VACID to enhance real-time visualisation of clinical procedures while observing live clinical procedures in periodontics. METHOD: Forty third-year dental students, observing surgical procedures during their rotation in the Department of Periodontics, were invited to participate in a survey designed to examine perceptions relating to their learning experience to using conventional and video-assisted real-time visualisation of clinical procedures. Students' responses were obtained using a questionnaire administered immediately after the completion of the observational period. The survey employed attitude questions addressing both enabling and outcome criteria. Wilcoxon signed-rank test was used to compare the student's responses. An open-ended question was also included in the survey to give students the opportunity to provide additional feedback regarding their experience and suggestions to improve on it. RESULTS: Results suggest that the implementation of VACID in the clinical setting improves the student's learning experience, interest and satisfaction. Ninety per cent of students strongly agreed to have VACID implemented for their next clinical observation. Responses to the open-ended question indicated that improved visualisation was extremely helpful in understanding the progress of clinical procedures. CONCLUSION: The implementation of VACID in the clinical setting enhances real-time visualisation of surgical procedures beyond what is offered by the conventional observational format.