Negative online reviews of orthodontists: Content analysis of complaints posted by dissatisfied patients.

INTRODUCTION: Patients may express views about their orthodontic care by posting publicly available reviews on the Internet. This study analyzed online reviews of orthodontists with an emphasis on the types and frequency of complaints expressed in negative reviews. METHODS: A random sample of 10.6% of the American Association of Orthodontists membership was evaluated to identify members practicing in a North American office that is limited to orthodontics and has an online presence. Information regarding those orthodontists and their offices was collected. For offices with Google and/or Yelp reviews, all negative (1- or 2-star) reviews were saved for content analysis. If an office posted a response to a negative review, those responses were also collected for analysis. RESULTS: Of the 807 eligible orthodontists, 92.4% had reviews on Google and/or Yelp. Average ratings of orthodontists were very positive (ie, 4- and 5-star reviews constituted >97% of Google reviews and >88% of Yelp reviews), yielding an average orthodontist rating of 4.72 on Google and 4.42 on Yelp. However, approximately half of those orthodontists (50.9%) also had at least 1 negative review. The 3 most frequently mentioned categories of complaints were regarding quality of care and/or service, interpersonal interactions, and money and/or financial issues. An analysis of the specific kinds of complaints is described. Orthodontists posting responses to negative reviews had significantly better average ratings than those who did not, but this association does not demonstrate a causal relationship. CONCLUSIONS: Understanding the complaints orthodontic patients express in online reviews may suggest strategies to improve patient satisfaction and an orthodontist's online reputation.

Mouthguards during orthodontic treatment: Perspectives of orthodontists and a survey of orthodontic patients playing school-sponsored basketball and football.

INTRODUCTION: The objectives of this research were to identify the beliefs and practices of orthodontists about mouthguard use in orthodontic patients and to survey orthodontic patients currently playing school-sponsored basketball and/or football about mouthguards. METHODS: Fifteen orthodontists were interviewed about mouthguard use in their patients. Patients (aged 11-18 years) playing organized school basketball (n = 53) or football (n = 22) from 13 of those 15 orthodontic practices participated in an online survey about mouthguards. RESULTS: Approximately half of the orthodontists interviewed had initiated discussions about mouthguards with their patients. Although boil-and-bite mouthguards were recommended most often by orthodontists with only a single orthodontist recommending a stock type, stock was the most commonly used type (football [59%], basketball [50%]) followed by boil-and-bite (football [27%], basketball [35%]). Only 2 of the 75 patients surveyed (<3%) reported using a custom mouthguard. All football players reported using a mouthguard, as mandated by this sport. Basketball does not mandate mouthguard use, and only 38% of basketball players reported wearing one. Players who used mouthguards cited forgetting as the most frequent reason for not always using one. A greater percentage of football (91%) than basketball (32%) players reported that their coach recommended a mouthguard (P <0.001). CONCLUSIONS: Orthodontists differ in how they approach mouthguard use by their patients, which likely reflects a lack of evidence-based guidelines. The beliefs, recommendations, and practices of orthodontists concerning mouthguard use and the use of mouthguards by orthodontic patients are discussed. Research directions to improve mouthguard use are suggested.

Plasma corticosterone, epinephrine, and norepinephrine levels increase during administration of nitrous oxide in rats.

Nitrous oxide (N2O) is a gaseous drug with abuse potential. Despite its common clinical use, little is known about whether N2O administration activates the HPA axis and/or the sympathetic adrenomedullary system. The goal of this study was to determine whether 60% N2O alters plasma concentrations of corticosterone (CORT), epinephrine (EPI), and norepinephrine (NE) in male Long-Evans rats. A gas-tight swivel assembly in the lid of a gas administration chamber allowed the remote collection of blood samples from an indwelling jugular vein catheter at four time-points: baseline and at 30, 60, and 120 min during a two-hour administration of 60% N2O. Relative to baseline, plasma CORT (n = 9) was significantly elevated at all three time-points during N2O inhalation (mixed model analysis, p = .001) and plasma EPI and NE levels were each significantly elevated (n = 8, p ≤ .001) at the 30 min assessment. EPI then declined and did not differ from baseline at the 60 and 120 min assessments (p > .05) whereas NE remained elevated (120 min, p = .001). Administration of 60% N2O increases circulating CORT, EPI, and NE, supporting N2O as a physiological stressor. An N2O-induced increase in CORT is consistent with the observation that addictive drugs typically activate the HPA axis causing increased plasma levels of glucocorticoids. Allostatic models of drug addiction typically involve stress systems and the possible role of stress hormones in N2O-induced allostatic dysregulation is discussed.

Brown adipose tissue thermogenesis does not explain the intra-administration hyperthermic sign-reversal induced by serial administrations of 60% nitrous oxide to rats.

Initial administration of ≥60% nitrous oxide (N2O) to rats promotes hypothermia primarily by increasing whole-body heat loss. We hypothesized that the drug promotes heat loss via the tail and might initially inhibit thermogenesis via brown adipose tissue (BAT), major organs of thermoregulation in rodents. Following repeated administrations, N2O inhalation evokes hyperthermia underlain by increased whole-body heat production. We hypothesized that elevated BAT thermogenesis plays a role in this thermoregulatory sign reversal. Using dual probe telemetric temperature implants and infrared (IR) thermography, we assessed the effects of nine repeated 60% N2O administrations compared to control (con) administrations on core temperature, BAT temperature, lumbar back temperature and tail temperature. Telemetric core temperature, telemetric BAT temperature, and IR BAT temperature were reduced significantly during initial 60% N2O inhalation (p≤0.001 compared to con). IR thermography revealed that acute N2O administration unexpectedly reduced tail temperature (p=0.0001) and also inhibited IR lumbar temperature (p<0.0001). In the 9th session, N2O inhalation significantly increased telemetric core temperature (p=0.007) indicative of a hyperthermic sign reversal, yet compared to control administrations, telemetric BAT temperature (p=0.86), IR BAT temperature (p=0.85) and tail temperature (p=0.47) did not differ significantly. Thus, an initial administration of 60% N2O at 21°C may promote hypothermia via reduced BAT thermogenesis accompanied by tail vasoconstriction as a compensatory mechanism to limit body heat loss. Following repeated N2O administrations rats exhibit a hyperthermic core temperature but a normalized BAT temperature, suggesting induction of a hyperthermia-promoting thermogenic adaptation of unknown origin.

Tooth wear and the role of salivary measures in general practice patients.

OBJECTIVES: The goal of this study was to investigate the association between tooth wear and salivary measures in a random sample of patients from practices of dentist members of a practice-based research network. MATERIALS AND METHODS: Patients completed a questionnaire on oral self-care, health, dietary habits, medications, and socio-demographic variables. Six salivary characteristics (consistency, resting salivary flow, resting salivary pH, stimulated salivary flow, stimulated salivary pH, and buffering capacity) were measured, and a dental examination included categorizing patients according to the dentist's judgment of the degree of tooth wear (i.e., none/minimal, some, or severe/extreme). Bivariate and multinomial logistic regression models were used to relate salivary characteristics and other factors to the outcome of tooth wear. RESULTS: Data are reported from 1,323 patients (age range 16-97 years) from 61 practices. Patient age, gender, number of teeth, and perception of dry mouth were associated with tooth wear, but salivary and dietary factors were either weakly or not related. CONCLUSIONS: The findings of this cross-sectional assessment suggest that using these salivary tests and dietary assessments in real-life clinical settings is unlikely to be useful in assessing tooth wear risk. Suggestions are offered about risk assessment for tooth wear. CLINICAL RELEVANCE: Assessing a dental patient's risk of tooth wear using salivary measures and dietary assessments as described is not recommended for general dental practice until stronger evidence exists indicating its utility.

"Why do you want your child to have braces?" Investigating the motivations of Hispanic/Latino and white parents.

INTRODUCTION: Many psychological, social, and cultural factors influence parents' motivation to seek orthodontic care for their children. In this study, we used Q methodology to identify and categorize shared motives and determine whether cultural differences exist between Hispanic/Latino (H/L) and non-Hispanic/Latino, white (W) parents. METHODS: The fundamental question posed to the parents was "Why do you want your child to have braces?" Q methodology involves 3 stages. (1) Interviews of H/L (n = 5) and W (n = 5) parents generated 35 statements that represented different motives to seek orthodontic care. (2) In the Q sort, 70 new parents (22 H/L, 48 W) ranked statements in order of relative importance using a forced distribution grid. (3) Factor analysis was performed separately for the H/L and W groups to uncover cultural differences. RESULTS: Four motivational profiles were described for both the H/L and W parents based on the significant factors identified in each group. More H/L parents (18 of 22 parents) than W parents (22 of 48 parents) were characterized by 1 of their group's 4 profiles. Comparisons of the motivational profiles across the groups showed 4 global themes: well-timed treatment that prevents future dental problems, parental responsibility, perceived benefits, and perceived need instilled by the dentist. CONCLUSIONS: Four global themes captured the motives of most parents seeking orthodontic treatment for their children. Understanding these global themes can help clinicians frame their treatment discussions with parents.

Classification and treatment of Class II subdivision malocclusions.

INTRODUCTION: Patients with Class II subdivision malocclusions are a challenge for clinicians because reestablishing symmetry in 1 arch or both arches is often a treatment goal. In patients with mandibular skeletal asymmetry, surgery is often a treatment option. However, patients may be unwilling to undergo surgery, and other options might have to be considered. The aim of this study was to evaluate the etiologies and outcomes of Class II subdivision patients treated at the University of Washington graduate orthodontic clinic in Seattle from 1995 through 2011. METHODS: A search of patients treated between 1995 and 2011 resulted in the identification of 110 consecutively treated Class II subdivision subjects with complete records. Ninety-eight subjects could be classified into 1 of 3 groups, based on midline position and dental or skeletal etiology. Initial and final models were used to measure the peer assessment rating scores, midlines, overjet, overbite, and molar positions. Initial and final cephalograms were traced and measured. Charts were reviewed for information regarding treatment. RESULTS: Twenty-five percent of the 98 subjects had their maxillary and mandibular midlines coincident with the facial midline; their asymmetries were due to a maxillary posterior dental asymmetry. Another 15% had maxillary midlines deviated from their facial midlines, caused by maxillary anterior and posterior dental asymmetry. About 50% of the subjects had mandibular midlines that were not coincident with their facial midlines, and most of them exhibited some degree of mandibular skeletal asymmetry. Over the past 15 years, treatment strategies used at the University of Washington indicated trends toward less surgery, fewer extractions, less use of headgear, and more reliance on fixed functional appliances. Ideal correction of midlines was not always achieved, especially in patients with mandibular skeletal asymmetry, with undercorrection occurring more commonly than overcorrection. Final peer assessment rating scores were comparable, regardless of the origin of the asymmetry or the extractions status. Mandibular incisor proclination was increased when fixed functional appliances were used, as well as when a Class I molar relationship was the target for the Class II side. CONCLUSIONS: Class II subdivision malocclusions were grouped into 3 main categories; the largest category was mandibular asymmetry. Interesting trends were noted with regard to treatment strategies, midline and molar corrections, and mandibular incisor proclination.

Robust thermoregulatory overcompensation, rather than tolerance, develops with serial administrations of 70% nitrous oxide to rats.

Changes in typical whole-animal dependent variables following drug administration represent an integral of the drug's pharmacological effect, the individual's autonomic and behavioral responses to the resulting disturbance, and many other influences. An archetypical example is core temperature (T(c)), long used for quantifying initial drug sensitivity and tolerance acquisition over repeated drug administrations. Our previous work suggested that rats differing in initial sensitivity to nitrous oxide (N(2)O)-induced hypothermia would exhibit different patterns of tolerance development across N(2)O administrations. Specifically, we hypothesized that rats with an initially insensitive phenotype would subsequently develop regulatory overcompensation that would mediate an allostatic hyperthermic state, whereas rats with an initially sensitive phenotype would subsequently compensate to a homeostatic normothermic state. To preclude confounding due to handling and invasive procedures, a valid test of this prediction required non-invasive thermal measurements via implanted telemetric temperature sensors, combined direct and indirect calorimetry, and automated drug delivery to enable repeatable steady-state dosing. We screened 237 adult rats for initial sensitivity to 70% N(2)O-induced hypothermia. Thirty highly sensitive rats that exhibited marked hypothermia when screened and 30 highly insensitive rats that initially exhibited minimal hypothermia were randomized to three groups (n=10 each/group) that received: 1) twelve 90-min exposures to 70% N(2)O using a classical conditioning procedure, 2) twelve 90-min exposures to 70% N(2)O using a random control procedure for conditioning, or 3) a no-drug control group that received custom-made air. Metabolic heat production (via indirect calorimetry), body heat loss (via direct calorimetry) and T(c) (via telemetry) were simultaneously quantified during N(2)O and control gas administrations. Initially insensitive rats rapidly acquired (3(rd) administration) a significant allostatic hyperthermic phenotype during N(2)O administration whereas initially sensitive rats exhibited classical tolerance (normothermia) during N(2)O inhalation in the 4(th) and 5(th) sessions. However, the sensitive rats subsequently acquired the hyperthermic phenotype and became indistinguishable from initially insensitive rats during the 11(th) and 12th N(2)O administrations. The major mechanism for hyperthermia was a brisk increase in metabolic heat production. However, we obtained no evidence for classical conditioning of thermal responses. We conclude that the degree of initial sensitivity to N(2)O-induced hypothermia predicts the temporal pattern of thermal adaptation over repeated N(2)O administrations, but that initially insensitive and sensitive animals eventually converge to similar (and substantial) magnitudes of within-administration hyperthermia mediated by hyper-compensatory heat production.

Direct animal calorimetry, the underused gold standard for quantifying the fire of life.

Direct animal calorimetry, the gold standard method for quantifying animal heat production (HP), has been largely supplanted by respirometric indirect calorimetry owing to the relative ease and ready commercial availability of the latter technique. Direct calorimetry, however, can accurately quantify HP and thus metabolic rate (MR) in both metabolically normal and abnormal states, whereas respirometric indirect calorimetry relies on important assumptions that apparently have never been tested in animals with genetic or pharmacologically-induced alterations that dysregulate metabolic fuel partitioning and storage so as to promote obesity and/or diabetes. Contemporary obesity and diabetes research relies heavily on metabolically abnormal animals. Recent data implicating individual and group variation in the gut microbiome in obesity and diabetes raise important questions about transforming aerobic gas exchange into HP because 99% of gut bacteria are anaerobic and they outnumber eukaryotic cells in the body by ∼10-fold. Recent credible work in non-standard laboratory animals documents substantial errors in respirometry-based estimates of HP. Accordingly, it seems obvious that new research employing simultaneous direct and indirect calorimetry (total calorimetry) will be essential to validate respirometric MR phenotyping in existing and future pharmacological and genetic models of obesity and diabetes. We also detail the use of total calorimetry with simultaneous core temperature assessment as a model for studying homeostatic control in a variety of experimental situations, including acute and chronic drug administration. Finally, we offer some tips on performing direct calorimetry, both singly and in combination with indirect calorimetry and core temperature assessment.

Individual differences in biological regulation: Predicting vulnerability to drug addiction, obesity, and other dysregulatory disorders.

Physiological regulation is so fundamental to survival that natural selection has greatly favored the evolution of robust regulatory systems that use both reactive and preemptive responses to mitigate the disruptive impact of biological and environmental challenges on physiological function. In good health, robust regulatory systems provide little insight into the typically hidden complex array of sensor-effector interactions that accomplish successful regulation. Numerous health disorders have been traced to defective regulatory mechanisms, and generations of scientists have worked to discover ways to correct these defects and restore normal physiological function. Despite progress, numerous chronic health disorders remain resistant to treatment, and indeed for some disorders the incidence is increasing. We propose that an individual's susceptibility to acquire certain persistent dysregulatory disorders can be traced to interindividual variation in how that individual's regulatory system responds to challenges. Preexisting reliable individual differences among regulatory systems are typically unrecognized until appropriate regulatory challenges (e.g., exposure to a drug of abuse) lead to dysregulation (e.g., drug addiction). Specific characteristics of an individual's regulatory responsiveness may include etiological factors that participate in the acquisition, escalation and maintenance of health disorders characterized by dysregulation. By appropriately challenging a healthy individual's regulatory systems to identify its underlying characteristics, it is possible to ascertain whether an individual has an elevated risk for acquiring a dysregulated health condition and thereby enable strategies designed to prevent, rather than treat, the condition. This model is applied to drug addiction, and in addition we relate this approach to other dysregulated conditions such as obesity. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Reliability of the conditioned pain modulation paradigm across three anatomical sites.

Background and aims Conditioned Pain Modulation (CPM) is a measure of pain inhibition-facilitation in humans that may elucidate pain mechanisms and potentially serve as a diagnostic test. In laboratory settings, the difference between two pain measures [painful test stimulus (TS) without and with the conditioning stimulus (CS) application] reflects the CPM magnitude. Before the CPM test can be used as a diagnostic tool, its reliability on the same day (intra-session) and across multiple days (inter-session) needs to be known. Furthermore, it is important to determine the most reliable anatomical sites for both the TS and the CS. This study aimed to measure the intra-session and inter-session reliability of the CPM test paradigm in healthy subjects with the TS (pressure pain threshold-PPT) applied to three test sites: the face, hand, and dorsum of the foot, and the CS (cold pressor test-CPT) applied to the contralateral hand. Methods Sixty healthy participants aged 18-65 were tested by the same examiner on 3 separate days, with an interval of 2-7 days. On each day, testing was comprised of two identical experimental sessions in which the PPT test was performed on each of the three dominant anatomical sites in randomized order followed by the CPM test (repeating the PPT with CPT on the non-dominant hand). CPM magnitude was calculated as the percent change in PPT. The Intraclass Correlation Coefficient (ICC), Coefficient of Variation (CV), and Bland-Altman analyses were used to assess reliability. Results PPT relative reliability ranged from good to excellent at all three sites; the hand showed an intra-session ICC of 0.90 (0.84, 0.94) before CPT and ICC of 0.89 (0.83, 0.92) during CPT. The PPT absolute reliability was also high, showing a low bias and small variability when performed on all three sites; for example, CV of the hand intra-session was 8.0 before CPT and 8.1 during CPT. The relative reliability of the CPM test, although only fair, was most reliable when performed during the intra-session visits on the hand; ICC of 0.57 (0.37, 0.71) vs. 0.20 (0.03, 0.39) for the face, and 0.22 (0.01, 0.46) for the foot. The inter-session reliability was lower in all three anatomical sites, with the best reliability on the hand with an ICC of 0.40 (0.23, 0.55). The pattern of absolute reliability of CPM was similar to the relative reliability findings, with the reliability best on the hand, showing lower intra-session and inter-session variability (CV% = 43.5 and 51.5, vs. 70.1 and 73.1 for the face, and 75.9 and 78.9 for the foot). The CPM test was more reliable in women than in men, and in older vs. younger participants. Discussion The CPM test was most reliable when the TS was applied to the dominant hand and CS performed on the contralateral hand. These data indicate that using the CS and TS in the same but contralateral dermatome in CPM testing may create the most reliable results.

Activation time and material stiffness of sequential removable orthodontic appliances. Part 3: premolar extraction patients.

INTRODUCTION: The purpose of this study was to describe the movement of teeth adjacent to premolar extraction spaces during space closure with aligner appliances and then fixed appliances. METHODS: The sample included 24 subjects from a larger study investigating an aligner system. All subjects had at least 1 premolar extracted as part of treatment. Dental casts and panoramic radiographs were measured for tooth tipping adjacent to extraction spaces at 3 treatment points: T0, initial; T2, end of aligners; and T3, end of fixed appliances. Chart records were reviewed for information about time in treatment. RESULTS: Treatment with aligners resulted in significant tipping of the teeth adjacent to premolar extraction sites. When followed by fixed appliances, these teeth were significantly uprighted. Aligner treatment followed by treatment with fixed appliances took an average of 40 months. CONCLUSIONS: In premolar extraction patients treated with aligners, dental tipping occurs but can be corrected with fixed appliances. This dual modality treatment might require more time than treatment with fixed appliances alone.

Concentration-related metabolic rate and behavioral thermoregulatory adaptations to serial administrations of nitrous oxide in rats.

BACKGROUND: Initial administration of ≥60% nitrous oxide (N2O) to rats evokes hypothermia, but after repeated administrations the gas instead evokes hyperthermia. This sign reversal is driven mainly by increased heat production. To determine whether rats will behaviorally oppose or assist the development of hyperthermia, we previously performed thermal gradient testing. Inhalation of N2O at ≥60% causes rats to select cooler ambient temperatures both during initial administrations and during subsequent administrations in which the hyperthermic state exists. Thus, an available behavioral response opposes (but does not completely prevent) the acquired hyperthermia that develops over repeated high-concentration N2O administrations. However, recreational and clinical uses of N2O span a wide range of concentrations. Therefore, we sought to determine the thermoregulatory adaptations to chronic N2O administration over a wide range of concentrations. METHODS: This study had two phases. In the first phase we adapted rats to twelve 3-h N2O administrations at either 0%, 15%, 30%, 45%, 60% or 75% N2O (n = 12 per group); outcomes were core temperature (via telemetry) and heat production (via respirometry). In the second phase, we used a thermal gradient (range 8°C-38°C) to assess each adapted group's thermal preference, core temperature and locomotion on a single occasion during N2O inhalation at the assigned concentration. RESULTS: In phase 1, repeated N2O administrations led to dose related hyperthermic and hypermetabolic states during inhalation of ≥45% N2O compared to controls (≥ 30% N2O compared to baseline). In phase 2, rats in these groups selected cooler ambient temperatures during N2O inhalation but still developed some hyperthermia. However, a concentration-related increase of locomotion was evident in the gradient, and theoretical calculations and regression analyses both suggest that locomotion contributed to the residual hyperthermia. CONCLUSIONS: Acquired N2O hyperthermia in rats is remarkably robust, and occurs even despite the availability of ambient temperatures that might fully counter the hyperthermia. Increased locomotion in the gradient may contribute to hyperthermia. Our data are consistent with an allostatic dis-coordination of autonomic and behavioral thermoregulatory mechanisms during drug administration. Our results have implications for research on N2O abuse as well as research on the role of allostasis in drug addiction.

Systems-level adaptations explain chronic tolerance development to nitrous oxide hypothermia in young and mature rats.

RATIONALE: Nitrous oxide (N(2)O) can initially lower core temperature (T (core)), but hypothermic tolerance develops with chronic administration. Therefore, one or both of T (core)'s controlling determinants, heat production (HP) and heat loss (HL), must adapt across repeated N(2)O administrations. Simultaneous measurements of HP, HL, and T (core) during chronic N(2)O administrations will elucidate this adaptive process and constitute a rigorous model for studying the systems-level dynamics of tolerance in both mature and young animals. This approach is justified by the need to better understand the increased vulnerability to addiction associated with adolescent drug use. OBJECTIVES: The objective of the study was to measure HL and HP across repeated steady-state administrations of 60% N(2)O in young and mature rats. MATERIALS AND METHODS: Synchronous measurements of HP (indirect calorimetry), HL (direct calorimetry), and T (core) (telemetry) were obtained during 60% N(2)O administrations in adolescent (28-45 days, n = 11) and mature rats (>90 days, n = 8). Rats received five 90-min drug exposures (every other day). RESULTS: Compared to mature rats, adolescents initially exhibited greater hypothermia, but acquired tolerance more rapidly and actually developed hyperthermia during the fifth administration. In both groups, N(2)O consistently increased HL, but progressive increases of intrasessional HP over repeated administrations prevented hypothermia and subsequently promoted hyperthermia in adolescent rats. CONCLUSIONS: Adolescent rats hyper-adapt to N(2)O hypothermia. Increases of intrasessional HP across N(2)O administrations explained both tolerance to N(2)O hypothermia and the unexpected hyperthermia observed in adolescents. These findings raise the possibility that the increased vulnerability to addiction associated with adolescent drug use involves a hyper-adaptive tolerance mechanism.

Direct evidence for systems-level modulation of initial drug (in)sensitivity in rats.

RATIONALE: Some argue that pharmacological effects trigger corrective regulatory responses of varying strength. If so, some commonly used in vivo measures of initial drug sensitivity are difficult to interpret because the measured effects represent a combination of underlying pharmacological effects and regulatory counter-responses with the relative contribution of each influenced by individual and dose-related factors. OBJECTIVES: The objective of this study was determine if core temperature (T (core)), a common measure in drug research, can mask the variability both in underlying pharmacological effects and physiological counter-responses during an initial administration of the hypothermia-promoting drug, nitrous oxide (N(2)O). METHODS: T (core) was measured synchronously with its determinants, heat production (HP) and heat loss (HL) during steady-state N(2)O administration. Drug-naive rats received a 90-min exposure to 0, 15, 30, 50, 60, or 75% N(2)O plus a paired control gas exposure (n > or = 8 per group). HP was measured via indirect calorimetry, HL via direct calorimetry, and T (core) via telemetry. RESULTS: T (core) was unaltered by concentrations < or =50% N(2)O, but at 30 and 50% N(2)O, this stability masked significant increases of HL that were offset by increases of HP. On average, hypothermia accompanied 60 and 75% N(2)O inhalation owing to uncompensated increases of HL. However, some rats administered with these doses also exhibited T (core) stability via significant opposing changes of HL and HP. CONCLUSIONS: A common in vivo measure of initial drug sensitivity can fail to disclose underlying pharmacological sensitivity owing to regulatory counter-responses. This concept has implications for understanding relationships between phenotypic variation in initial drug sensitivity and subsequent drug-taking phenotypes.

Combining alprazolam with systematic desensitization therapy for dental injection phobia.

To determine whether a benzodiazepine facilitates systematic desensitization, 144 subjects with dental injection phobia received systematic desensitization in combination with placebo or one of two doses of alprazolam (0.5mg or 0.75mg). Systematic desensitization therapy included computer-controlled presentation of digitized video segments followed by in vivo exposure segments, culminating in an actual dental injection. Subjects advanced to the next hierarchy segment when low anxiety was reported during a segment. Alprazolam and placebo groups progressed at the same rate. The 0.75mg group had elevated heart rates while watching video segments compared with placebo. In a subsequent behavioral avoidance test (during which subjects were randomized to a new drug condition), there was no indication that state-dependent learning had occurred. Dental fear was reduced similarly in all groups for 1 year after study completion. No advantage was found to combining alprazolam with systematic desensitization for dental injection phobia.

Felis Punctatis: Cat Claw-induced Punctures.

Animal-induced conditions in humans predominantly present as infectious zoonoses. However, trauma-associated injuries from the teeth or claws can also occur. Several zoonotic infections can be transmitted by cats, a common household pet, to their owners. The clinical features of a woman who developed multiple sites of trauma-induced cutaneous punctures from her cat's paws while it was kneading on her clothes-covered abdomen are described. The repetitive insertion and withdrawal of the sharp tips of the cat's claws created distinctive groups of erythematous punctures on the patient's skin. We suggest that Latin nomenclature be used to designate the name for this claw-induced dermatosis that includes not only the causative animal (felis for cat) but also a descriptive term for the skin lesions (punctatis for punctures): felis punctatis.

Methods to evaluate profile preferences for the anteroposterior position of the mandible.

INTRODUCTION: Facial profile disharmonies in the anteroposterior (AP) position of the mandible are among the most frequent reasons that patients seek orthodontic treatment. Various methods are available for assessing profile preferences, and differences between them could affect treatment decisions. The purposes of this study were to compare and contrast 3 methods of evaluating profile preferences for the AP position of the mandible. METHODS: Facial profile preferences of white orthodontists (n = 28) and white (n = 56) and Japanese-American (n = 55) laypeople were evaluated. The esthetic significance of variations in the AP position of the mandible was investigated by using 3 methods: a traditional semantic differential scale, the Perceptometrics method (Health Programs Intl, Wellesley, Mass), and the implicit association test (IAT). RESULTS: Findings from the semantic differential scale show that, overall, there is a general preference among orthodontists and laypeople for an orthognathic profile (P <.001). Findings from the Perceptometrics method indicate that orthodontists consider the most pleasing profile to be more forward than do lay subjects (P <.001). The IAT results show a positive bias among all 3 groups toward orthognathic profiles and a negative bias toward profiles with mandibular retrognathism or prognathism. The IAT suggested that laypeople were more tolerant of mandibular prognathism in men than in women (P <.01), and more tolerant of mandibular retrognathia in white women than in men (P = .03). CONCLUSIONS: These results support the benefits of using both implicit and explicit methods to assess facial profile preferences.

Physiological Regulation: How It Really Works.

Contrary to dogma, much physiological regulation utilizes learning from past experience to make responses that preemptively and effectively neutralize anticipated regulatory challenges. Understanding physiological regulation therefore requires expanding explanatory models beyond homeostasis and allostasis to emphasize the prominence of conditioning.