Interrater reliability of a customized submaximal cycle ergometer test.

PURPOSE: Graded exercise testing (GXTs) is used to determine maximum oxygen uptake ([Formula: see text]). Recently, customized submaximal exercise testing (CSET) completed on both treadmill and cycle ergometry were validated. METHODS: Interrater reliability of the CSET for cycle ergometry was examined. Thirteen participants (age 31 ± 10.2 y, weight 77.9 ± 10.5 kg, height 176.2 ± 9.9 cm, body mass index 25.1 ± 2.9) completed the 2-stage × 3-min CSET protocol performed by two separate testers. True [Formula: see text] was determined using the highest value derived by a GXT and verification bout. Skeletal muscle oxygen saturation ([Formula: see text]), measured using near-infrared spectrometry on the medial gastrocnemius muscle, and [Formula: see text] were monitored during each CSET; whereby, [Formula: see text] kinetics were modeled breath-by-breath data for each 3-min stage. Measurement agreement was quantified using intraclass coefficient (ICC), typical error (TE), and coefficient of variation (CV). RESULTS: "True" [Formula: see text] (ml·kg-1·min-1) between the GXT (41.3 ± 10.5) and verification (42.5 ± 11.5) was established (ICC = 0.98, TE: 0.98, CV 2.1%). Estimated [Formula: see text] by tester 1 (42.5 ± 9.8) and tester 2 (42.7 ± 8.9) did not differ from "true" [Formula: see text] (F2,36 = 0.02, p = 0.98, ηp2 = 0.00). The second stage evoked a [Formula: see text] slow component of 194 ± 124 ml·min-1 that corresponded with a time-dependent decline of [Formula: see text]. The mean [Formula: see text] from the two CSET testers were highly correlated (ICC = 0.91, TE: 4.1%, CV = 8.9%). CONCLUSIONS: The CSET is a reliable and valid procedure and [Formula: see text] is a useful tool for corroborating the second stage is in the heavy-intensity domain.

American dental hygienists' attitudes towards chairside medical screening in a dental setting.

OBJECTIVES: Targeted screening for medical conditions in a dental setting can be an effective strategy for early identification of individuals at increased disease risk. Dentists, patients and physicians have a favourable attitude towards this strategy. Given that dental hygienists (DHs) are involved in preventive and educational activities, this seems like a natural extension to their roles. We report on the attitudes of American DHs towards chairside medical screening. METHODS: A 5-point Likert scale (1 = very important/willing, 5 = very unimportant/unwilling) survey was mailed to a nationwide random sample of US practicing DHs. Descriptive statistics were used for all questions, and the Friedman nonparametric analysis of variance was used for multi-element questions. RESULTS: A total of 3133 respondents returned the completed questionnaires for an effective response rate of 49.2% and a margin of error 1.8%. The majority of respondents felt it was important to perform/conduct chairside screening for hypertension (94%), diabetes mellitus (89%), cardiovascular disease (85%), HIV (79%) and hepatitis infection (78%); were willing to refer a patient for medical consult (94%), conduct screening that yields immediate results (85%); and were willing to collect the data/samples needed (57-95%). The most important considerations were dentist/owner support (98%), training (97%), patient willingness (98%) and time (98%). CONCLUSION: Similar to dentists, physicians and patients, the majority of the DHs had a favourable attitude towards chairside medical screening. Integrating the DH into screening activities is likely to require additional training and education regarding the diseases of interest, something that could be accomplished through continuing education courses and eventually incorporation into the educational curriculum.

Multiscale investigations of drift-wave turbulence and plasma flows: measurements and total-distribution-function gyrokinetic simulations.

Direct measurements of micro-, meso-, and macroscale transport phenomena in the FT-2 tokamak are shown to be quantitatively reproduced by global full f nonlinear gyrokinetic simulation predictions. A detailed agreement with mean equilibrium E×B flows, oscillating fine-scale zonal flows, and turbulence spectra observed by a set of sophisticated microwave backscattering techniques as well as a good fit of the thermal diffusivity data are demonstrated. A clear influence of the impurity ions on the fluctuating radial electric field is observed.

Measurements of intrinsic ion Bernstein waves in a tokamak by collective Thomson scattering.

In this Letter we report measurements of collective Thomson scattering (CTS) spectra with clear signatures of ion Bernstein waves and ion cyclotron motion in tokamak plasmas. The measured spectra are in accordance with theoretical predictions and show clear sensitivity to variation in the density ratio of the main ion species in the plasma. Measurements with this novel diagnostic demonstrate that CTS can be used as a fuel ion ratio diagnostic in burning fusion plasma devices.

Pancreatic and gastric heterotopic tissue presenting as a symptomatic gallbladder mass: A case report and literature review.

Pancreatic and gastric heterotopia is an uncommon congenital anomaly in which gastric and/or pancreatic tissue is found outside of its anatomic location. In the majority of patients, lesions are found incidentally because they tend to be asymptomatic. However, lesions may become symptomatic when inflammation, obstruction, and bleeding occurs. Depending on tissue size and location they can harvest a landscape of nonspecific symptoms, causing a delay in diagnosis. Heterotopic tissue of either gastric or pancreatic origin have been reported in literature, however the presence of combined gastric and pancreatic heterotopic tissue is exceedingly rare. We report a case of an 18-year-old female with polypoid gastric and pancreatic heterotopia and focal intestinal metaplasia of the gallbladder with clinical findings of acute cholecystitis. In this literature review, we synthesize the clinical significance, histopathological features, diagnosis and management of pancreatic and gastric heterotopic tissue.

Treatment data and technical process challenges for practical big data efforts in radiation oncology.

The term Big Data has come to encompass a number of concepts and uses within medicine. This paper lays out the relevance and application of large collections of data in the radiation oncology community. We describe the potential importance and uses in clinical practice. The important concepts are then described and how they have been or could be implemented are discussed. Impediments to progress in the collection and use of sufficient quantities of data are also described. Finally, recommendations for how the community can move forward to achieve the potential of big data in radiation oncology are provided.

Training, diet and physical characteristics of distance runners with low or high concentrations of high density lipoprotein cholesterol.

We examined possible determinants of serum high density lipoprotein cholesterol (HDL-C) concentrations in 56 male distance runners (aged 20-56 years) by comparing runners whose HDL-C were either above or below the group median of 63 +/- 13 (+/- SD) mg/dl. HDL-C averaged 53 +/- 7 mg/dl for runners below and 73 +/- 11 mg/dl for runners above the median. Neither exercise training (miles run per week, years of running), physical characteristics (height, weight, adiposity), or dietary factors (total daily caloric intake and daily caloric intake from protein, fat, saturated fat, polyunsaturated fat, carbohydrate, and alcohol) differed between the two groups (P greater than 0.05, MANOVA). Apo A-I (P less than 0.01) was higher and triglyceride concentrations lower (P = 0.07) in the high HDL-C group. The data were also analyzed by comparing runners in the lowest and highest tertiles for HDL-C values and essentially the same results were obtained. When all runners were combined, neither training, physical characteristics nor dietary intake was significantly related to HDL-C (P greater than 0.05). Total cholesterol and apo A-I were directly related (r = 0.35 and r = 0.66, respectively, P less than 0.01) and triglycerides inversely related (r = -0.31, P less than 0.05) to HDL-C. Plasma post-heparin lipoprotein lipase activity (LPLA), hepatic triglyceride lipase activity (HTGLA), and HDL-C subfractions were measured in 22 runners.(ABSTRACT TRUNCATED AT 250 WORDS)

Exercise acutely increases high density lipoprotein-cholesterol and lipoprotein lipase activity in trained and untrained men.

We studied the effects of a single exercise session on lipid and lipoprotein concentrations and on postheparin plasma lipoprotein lipase (LPLA) and hepatic triglyceride hydrolase activities (HTGLA) in 11 trained (T) and ten untrained (UT) men. Subjects exercised on a bicycle ergometer at 80% of their maximal heart rate for one (UT) or two hours (T). Blood samples were drawn 24 hours before and at ten minutes and 24, 48, and 72 hours after exercise. Values were analyzed before and after adjustment for estimated changes in plasma volume (PV). High density lipoprotein cholesterol (HDL-C) increased 2 +/- 4 mg/dL in T (P less than 0.05) and 1 +/- 2 mg/dL in UT subjects beginning 48 hours after exercise. This increase was magnified by adjusting for the 5% to 8% postexercise expansion of PV. The increase in HDL in the T subjects was produced by increases in the HDL2-C subfraction (+3 +/- 4 mg/dL, P less than 0.05) whereas HDL3 increased in the UT men (+2 +/- 3 mg/dL, P less than 0.05). LPLA did not change in either subject group when estimated PV changes were ignored but increased 11% (P less than 0.05) at 24 hours after exercise when PV was considered. HTGLA was 11% below baseline in the UT men 24 to 72 hours after exercise (P less than 0.05) but showed no change in either subject group after adjustment for PV. These results demonstrate that exercise acutely increases HDL levels by raising the HDL2 subfraction in T and the HDL3 subfraction in UT men.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute increase in lipoprotein lipase following prolonged exercise.

We investigated the acute effects of prolonged exercise on lipoprotein metabolism. Serum lipid and lipoprotein concentrations and plasma postheparin lipolytic activity were measured in ten well-trained men (ages 21 to 39) the day before and after a 42 km foot race. LDL cholesterol decreased by 10% (113 +/- 31 to 103 +/- 32 mg/dL, P less than 0.01) and total HDL-cholesterol levels increased by 9% (65 +/- 18 to 71 +/- 19 mg/dL, P less than 0.01) the day after the race. No changes in the concentration of apolipoprotein A-I or A-II occurred. Triglyceride levels decreased by 39% (95 +/- 38 to 58 +/- 23 mg/dL, P less than 0.001). Two days after the race, total HDL cholesterol (74 +/- 21 mg/dL, P less than 0.05) and the HDL2 subfraction (37 +/- 19 mg/dL, P less than 0.05) remained significantly elevated compared to pre-race values. Most dramatically, the level of lipoprotein lipase activity measured in postheparin plasma nearly doubled after the race, demonstrating that vigorous exercise acutely increases this enzyme activity. The increase in lipoprotein lipase activity probably mediated the fall in serum triglycerides after exercise and may also account for the increase in HDL cholesterol.

The effects of high-carbohydrate and high-fat diets on the serum lipid and lipoprotein concentrations of endurance athletes.

We examined the effects of high-carbohydrate and high-fat diets on the serum lipid levels of distance runners. For seven days before each study, subjects consumed a diet containing 15% protein, 32% fat, and 53% carbohydrate. During 14-day experimental periods, a control group (n = 10) continued the same diet while two other groups consumed 69% of their calories as either carbohydrate (n = 13) or fat (n = 14). High-density lipoprotein (HDL)-cholesterol decreased 9% during the high-carbohydrate diet because of a 26% fall in the HDL2 fraction (1.063 to 1.125 g/mL). These changes were not accompanied by changes in the levels of apolipoproteins (apo) A-I or A-II. Total and low-density lipoprotein (LDL)-cholesterol initially decreased but subsequently exceeded pre-diet values while triglyceride concentrations increased 30% to 50%. Postheparin lipoprotein lipase activity (LPLA) fell 20%. Despite these dietary effects, HDL and HDL2 cholesterol concentrations in the athletes remained above values typical of sedentary men. The high-fat diet produced different effects on the serum lipids and lipoprotein levels of the athletes. HDL levels changed little during the study although HDL-cholesterol and apo A-I on the last diet day were both slightly above initial values. The high-fat diet provided 111 g of saturated fat per day but had surprisingly little effect on total and LDL-cholesterol whereas serum triglycerides fell by 10% to 20%. Postheparin LPLA increased 30% with fat feeding and the changes in LPLA correlated with alterations in triglyceride levels (r = -0.53, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Postheparin plasma lipolytic activities in physically active and sedentary men after varying and repeated doses of intravenous heparin.

We sought to determine the optimal dose of heparin for evaluating the activities of lipoprotein lipase (LPLA) and hepatic triglyceride hydrolase (HTGLA) in postheparin plasma. Nine physically active and ten sedentary men (age 30 +/- 5 yr, mean +/- SD) received 30, 50, 75, and 100 IU/kg of heparin in random order during a 2-week period. Based on all the samples, the average LPLA in the athletes was 43% higher (P less than 0.001) and HTGLA was 19% lower than in the untrained subjects (NS). The greatest LPLA was obtained after a heparin dose of 75 IU/kg, but LPLA after the three highest doses were not significantly different. There was also a dose effect on HTGLA (P less than 0.001) with greatest activities following doses of 75 and 100 IU/kg. Despite these dose effects, subjects maintained their rank order for both postheparin lipase activities regardless of the heparin dose. The only exception was for LPLA in the sedentary men probably because of lower LPLA and a smaller range of values. We also examined the effect of repeated daily injections of 75 IU/kg heparin on LPLA, HTGLA, and serum lipids. Repeated heparin administration on three consecutive days produced no significant effects on the apparent lipase activities. When all subjects were combined, HDL-cholesterol was increased over time (P less than 0.05) due to increases in both the HDL2 (P less than 0.05) and HDL3-cholesterol (NS) subfractions. Infusion of heparin or saline on three consecutive days into 18 additional men, however, had no effect on any lipid parameter.(ABSTRACT TRUNCATED AT 250 WORDS)

Use of radiology practice guidelines and compliance with accreditation standards in US and Canadian dental schools.

In 1992 and 1997, all US and Canadian dental schools were surveyed by mail regarding the preferred initial radiographic examination prescribed for non-emergency, comprehensive-care patients (dentulous adults, edentulous adults, and children). In both survey years, a minority of US and Canadian dental schools reported using selection criteria for dentulous adults and children, while nearly all schools reported doing so for edentulous adults. The purpose of this secondary analysis was to investigate the relationship between the use of radiology selection criteria (vs. predetermined routine examinations) in US and Canadian dental school clinics and three factors: (1) the credentials of the chief-of-service, (2) institutional funding, and (3) geographic region. "Credentials of the chief-of-service" is the single factor significantly related to the distributions of radiographic examinations prescribed for dentulous adults in both years (Fisher exact test, p < or = 0.02). There are no statistically significant relationships for edentulous adults or children in either year. Multivariate analyses (logistic regression) of the 1997 data reveal that institutions with a credentialed chief-of-service are 2.39 times more likely to report using selection criteria than institutions with a noncredentialed chief-of-service; private institutions are 1.13 times more likely than public institutions, and Canadian schools are 3.65 times more likely than US schools. A similar trend was identified for children. Analysis of the 1992 data revealed similar trends for the credentials of the chief-of-service and the geographic region, but showed no association between institutional funding source and the use of selection criteria. Contrary to accreditation standards, most US and Canadian dental schools obtained pre-determined routine radiographic examinations on most new patients. However, the presence of a credentialed chief-of-service had a positive effect on the use of selection criteria for dentulous adults and children.

Efficacy of panoramic radiography in dental diagnosis and treatment planning.

We compared treatment decisions based on a clinical examination alone with decisions based on an examination plus a panoramic radiograph to determine whether the panoramic radiograph increased the diagnostic yield and consequently affected treatment. Provisional treatment plans, based on a screening clinical examination alone (n = 33), or on a screening clinical examination plus panoramic radiograph (n = 43), were compared with final treatment plans based on a complete diagnostic assessment (including all necessary radiographs). For this analysis, the final treatment plan was considered correct and used as the gold standard. The two groups used in the comparison were equivalent in age, gender, and final treatment plan needs. The availability of a panoramic radiograph did not improve the accuracy with which provisional treatment plans predicted the number of teeth requiring composites, amalgams, crowns, or extraction, nor did it improve the accuracy of the assessment of the periodontal status (Wilcoxon rank sum, alpha = 0.05). The proportion of patients who had an intra-oral full-mouth series as part of the complete diagnostic work-up was essentially the same for both groups (58% and 60%, respectively); the availability of the panoramic film did not reduce the need for full-mouth series radiographs for the development of the final treatment plans.

Modeling multivariate binary responses with multiple levels of nesting based on alternating logistic regressions: an application to caries aggregation.

Clustered binary responses are commonly encountered in dental research. Data analysis may include modeling both the marginal response probabilities (i.e., risk) and the dependence structure between pairs of responses (i.e., aggregation). While second-order generalized estimating equations (GEE2) is a well-known approach for such data, alternating logistic regressions (ALR) is a computationally efficient alternative method, especially for large clusters. We illustrate ALR with an application to caries aggregation using a dataset with 3 levels of nesting: tooth surfaces within an interproximal (IP) region, IP regions within a jaw, and jaws within a subject. Caries lesions appear to aggregate strongly within subjects with a spatially distributed risk. The minimum within-IP-region odds ratio (OR) was 2.25 (95% confidence interval 1.15, 4.41), and the within-IP-region ORs were always greater than the between-IP-region ORs. ALR is a convenient and useful regression technique for explicit modeling of the dependence structure, and may be applicable to other dental research problems involving clustered or nested responses.

Androgens reduce HDL2-cholesterol and increase hepatic triglyceride lipase activity.

We quantified serum lipids and postheparin plasma lipolytic activities in 5 weightlifters presently self-administering androgenic steroids (users) and an equal number not currently using these drugs (non-users). Mean (+/- SD) age (23 +/- 2 vs 25 +/- 4 yr), body weight (102.7 +/- 11.4 vs 86.8 +/- 13.6 kg), and percent body fat (8.6 +/- 2.5 vs 7.8 +/- 6.0%) were not different in users and non-users, respectively. Similarly, there were no differences in total cholesterol (183 +/- 27 vs 176 +/- 32 mg.dl-1) low-density lipoprotein-cholesterol (138 +/- 25 vs 108 +/- 32 mg.dl-1), or triglyceride (93 +/- 26 vs 93 +/- 41 mg.dl-1) levels in the two groups. High-density lipoprotein (HDL)-cholesterol concentrations, however, were significantly lower in the users (26 +/- 10 vs 50 +/- 13 mg.dl-1; P less than 0.05), and most of the difference was due to lower HDL2-cholesterol concentrations (6 +/- 4 vs 22 +/- 9 mg.dl-1; P less than 0.05). Postheparin plasma lipoprotein lipase activity was only slightly lower in the users (3.49 +/- 2.23 vs 5.36 +/- 1.73 mumol FFA.ml-hr-1; P= NS). but hepatic triglyceride lipase activity was significantly higher in this group (27.99 +/- 6.89 vs 11.15 +/- 2.76, mumol FFA.ml-hr-1: P less than 0.001) and correlated inversely with HDL2-cholesterol concentrations (r = -0.81; P less than 0.01). We conclude that androgenic hormones reduce HDL-cholesterol concentrations and the HDL2-cholesterol subfraction, possibly by enhancing hepatic triglyceride lipase activity.

The behavior of angular bony defects following reduction of inflammation.

This study was designed to quantitate the changes in experimental angular bony defects and the surrounding tissues following the removal of irritants associated with marginal periodontitis. Plaque retentive ligatures were placed around the mandibular second bicuspids in each of four squirrel monkeys. Ten weeks later the ligatures were removed and mechanical cleaning was implemented. At the same time, ligatures were placed on the contralateral (control) bicuspids. After 10 weeks the monkeys were sacrificed and the tissues prepared for analysis. The control tissues represented the state of the periodontium immediately prior to ligature removal and the implementation of 10 weeks of mechanical cleaning. Histometric analyses revealed a reduction from 68 to 14% in the inflammatory cell infiltrate present in the supracrestal connective tissue following ligature removal and plaque control. Concomitant with this decrease was a 50% increase (P < 0.01) in the amount of bone present in the coronal periodontium. There was bone repair at the crest and along the angular defect but there was not a total regeneration of the lesion. These tissue changes were accompanied by a reduction in tooth mobility and a reformation of the gingival architecture although there was no new attachment. It appears that there is a potential for bone repair in these angular defects without an alteration in the connective tissue attachment level.

Alveolar bone regeneration after removal of inflammatory and traumatic factors.

In this investigation periodontal destruction was produced by a combination of inflammatory and traumatic factors. After the inflammation was resolved and the trama stopped, a significant amount of alveolar bone regeneration took place. The implications of these findings for the management of advanced periodontal disease are discussed.

Attributes and practices of oral and maxillofacial radiology departments in US and Canadian dental schools.

OBJECTIVE: To assess the actual state of oral and maxillofacial radiology departments in US and Canadian dental schools against the ideal characteristics defined by the American Academy of Oral and Maxillofacial Radiology (AAOMR) 1997 position paper. STUDY DESIGN: Cross-sectional survey of all 65 US and Canadian dental schools. RESULTS: Sixty-four surveys were returned (98%). At most schools, oral and maxillofacial radiology (OMR) was an identifiable division of a department, established policies, and had operational authority for radiographic practices in the primary radiology clinic. The majority of full-time faculty (72%) had formal training in OMR; the majority of part-time faculty (86%) did not. Full-time faculty spent approximately 60% of their time teaching, with the remainder of their time divided among research and scholarship, faculty practice, and service. Routine x-ray equipment was universally available; advanced imaging technologies were not. OMR faculty involvement in the interpretation of radiographs varied across diseases and conditions. Most published scholarship (85%+) was produced by full-time faculty. Average output was 1 paper per person per year, but a relatively small cadre of OMR faculty generated most papers. CONCLUSIONS: In some attributes, the status of OMR closely approximated the ideal characteristics established in the AAOMR report. Among the remaining attributes, bridging the difference between the actual and the ideal will be the challenge for the next 5 years.

Dosimetry and cost of imaging osseointegrated implants with film-based and computed tomography.

Thermoluminescent dosimeters were used to measure radiation doses at craniofacial sites in a tissue-equivalent phantom during film-based multidirectional tomography with the Tomax Ultrascan (Incubation Industries, Ivyland, Pa.) and during computed tomography with the Elscint Excel 2400 (Elscint Corp., Tel Aviv, Israel). Mean absorbed doses for presurgical mandibular and maxillary canine and molar implant assessments were converted to equivalent doses, which were then multiplied by published weighting factors and summed to give effective doses. The computed tomography device consistently delivered higher doses than the Tomax Ultrascan to all anatomic locations; the differences were most pronounced when only one or two implant sites were evaluated. The reasons for the dose disparities are considered both anatomically and procedurally. A survey of examination cost revealed film-based multidirectional tomography to be less expensive than computed tomography.