Osteoporosis identification among previously undiagnosed individuals with vertebral fractures.

Because osteoporosis is under-recognized in patients with vertebral fractures, we evaluated characteristics associated with osteoporosis identification. Most patients with vertebral fractures did not receive evaluation or treatment for osteoporosis. Black, younger, and male participants were particularly unlikely to have had recognized osteoporosis, which could increase their risk of negative outcomes. INTRODUCTION: Vertebral fractures may be identified on imaging but fail to prompt evaluation for osteoporosis. Our objective was to evaluate characteristics associated with clinical osteoporosis recognition in patients who had vertebral fractures detected on their thoracolumbar spine imaging reports. METHODS: We prospectively identified individuals who received imaging of the lower spine at primary care clinics in 4 large healthcare systems who were eligible for osteoporosis screening and lacked indications of osteoporosis diagnoses or treatments in the prior year. We evaluated characteristics of participants with identified vertebral fractures that were associated with recognition of osteoporosis (diagnosis code in the health record; receipt of bone mineral density scans; and/or prescriptions for anti-osteoporotic medications). We used mixed models to estimate adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS: A total of 114,005 participants (47% female; mean age 65 (interquartile range: 57-72) years) were evaluated. Of the 8579 (7%) participants with vertebral fractures identified, 3784 (44%) had recognition of osteoporosis within the subsequent year. In adjusted regressions, Black participants (OR (95% CI): 0.74 (0.57, 0.97)), younger participants (age 50-60: 0.48 (0.42, 0.54); age 61-64: 0.70 (0.60, 0.81)), and males (0.39 (0.35, 0.43)) were less likely to have recognized osteoporosis compared to white participants, adults aged 65 + years, or females. CONCLUSION: Individuals with identified vertebral fractures commonly did not have recognition of osteoporosis within a year, particularly those who were younger, Black, or male. Providers and healthcare systems should consider efforts to improve evaluation of osteoporosis in patients with vertebral fractures.

A crosssectional analysis of Facebook comments to study public perception of a new diagnostic test called the Cytosponge.

Social media provides a useful platform for informal discussions about healthcare. Acceptability is key to the uptake of diagnostic devices and this can be difficult to gauge from questionnaires and qualitative studies. The aim of this study is to investigate whether Facebook could be used to gauge public perception toward uptake of a new diagnostic test for Barrett's esophagus called the Cytosponge. We retrospectively reviewed Facebook comments relating to a video on the Cytosponge. We categorized comments into: (1) Positive, (2) Negative, (3) Unknown and (4) Questions. Recurring themes that arose were compared to a qualitative study on the Cytosponge. The video received 22.5 million views and 2837 comments within four months. Of these, 525 comments were positive, 215 were unknown, 179 were negative, 71 were questions, and 1847 were 'Tagged' comments. Among positive comments, recurrent themes were that it was innovative, could lead to early cancer-detection, and more favorable than endoscopy. Among negative comments, a recurring theme was concern about the risk of gagging and vomiting. Among 'questions', a recurring theme was related to the risk of Cytosponge detachment. We compared our analysis to a published qualitative study and found similar themes arose across both studies. Facebook provides a rich source of qualitative data, which could be used to augment studies to gauge public perception toward a new diagnostic test.

Hierarchy of modes in an interacting one-dimensional system.

Studying interacting fermions in one dimension at high energy, we find a hierarchy in the spectral weights of the excitations theoretically, and we observe evidence for second-level excitations experimentally. Diagonalizing a model of fermions (without spin), we show that levels of the hierarchy are separated by powers of R^{2}/L^{2}, where R is a length scale related to interactions and L is the system length. The first-level (strongest) excitations form a mode with parabolic dispersion, like that of a renormalized single particle. The second-level excitations produce a singular power-law line shape to the first-level mode and multiple power laws at the spectral edge. We measure momentum-resolved tunneling of electrons (fermions with spin) from or to a wire formed within a GaAs heterostructure, which shows parabolic dispersion of the first-level mode and well-resolved spin-charge separation at low energy with appreciable interaction strength. We find structure resembling the second-level excitations, which dies away quite rapidly at high momentum.

Parental use and acceptance of an accessible, commercially available intraoral camera for teledentistry in their children.

PURPOSE: The potential of combining teledentistry and engaging parents as underutilised resources to monitor paediatric dental health was emphasised during the COVID-19 pandemic and remains underexplored. This study aims to assess parental acceptance and use of a commercially available intraoral camera (IOC) for effective remote monitoring. METHODS: 47 child-parent dyads, where the parent was the main caregiver and the child was treated under general anaesthesia for early childhood caries, were recruited. Caregivers were trained to image their child's teeth on a commercially available IOC. Subsequently, submitted images were reviewed asynchronously by dentists for image quality, presence of dislodged fillings, abscesses, cavitation, and oral hygiene. Post-surgery monitoring was performed using teledentistry at 1 and 2 months and in-person at 4 months. A modified Telehealth Usability Questionnaire (TUQ) was used to record caregiver acceptance for study procedures. RESULTS: A mean TUQ of 6.09 out of 7 was scored by caregivers. Caregiver-reported issues were limited to problems with technique and child uncooperativeness. The number of clear images during the second teledentistry review was improved compared to the first (p = 0.007). 68% of children liked having images of their teeth taken. CONCLUSION: This study supports the feasibility of using an IOC as a clinically appropriate avenue for teledentistry with a high level of caregiver-child acceptance.

Momentum-dependent power law measured in an interacting quantum wire beyond the Luttinger limit.

Power laws in physics have until now always been associated with a scale invariance originating from the absence of a length scale. Recently, an emergent invariance even in the presence of a length scale has been predicted by the newly-developed nonlinear-Luttinger-liquid theory for a one-dimensional (1D) quantum fluid at finite energy and momentum, at which the particle's wavelength provides the length scale. We present experimental evidence for this new type of power law in the spectral function of interacting electrons in a quantum wire using a transport-spectroscopy technique. The observed momentum dependence of the power law in the high-energy region matches the theoretical predictions, supporting not only the 1D theory of interacting particles beyond the linear regime but also the existence of a new type of universality that emerges at finite energy and momentum.

Past, present and future of Barrett's oesophagus.

Barrett's oesophagus is a condition which predisposes towards development of oesophageal adenocarcinoma, a highly lethal tumour which has been increasing in incidence in the Western world over the past three decades. There have been tremendous advances in the field of Barrett's oesophagus, not only in diagnostic modalities, but also in therapeutic strategies available to treat this premalignant disease. In this review, we discuss the past, present and future of Barrett's oesophagus. We describe the historical and new evolving diagnostic criteria of Barrett's oesophagus, while also comparing and contrasting the British Society of Gastroenterology guidelines, American College of Gastroenterology guidelines and International Benign Barrett's and CAncer Taskforce (BOBCAT) for Barrett's oesophagus. Advances in endoscopic modalities such as confocal and volumetric laser endomicroscopy, and a non-endoscopic sampling device, the Cytosponge, are described which could aid in identification of Barrett's oesophagus. With regards to therapy we review the evidence for the utility of endoscopic mucosal resection and radiofrequency ablation when coupled with better characterization of dysplasia. These endoscopic advances have transformed the management of Barrett's oesophagus from a primarily surgical disease into an endoscopically managed condition.

A case of successfully managed pregnancy in a patient with complex cyanotic congenital heart disease.

Medical advances have increased survival of patients with congenital heart disease. However, cardiac disease in pregnancy carries significant maternal and fetal risks, posing enormous challenges to obstetricians. Cyanotic congenital heart disease is associated with maternal complications such as arrhythmias, thromboembolic events and death. Fetal complications include small for gestational age, miscarriage and prematurity. Cyanotic congenital heart disease patients who continue their pregnancies require holistic multidisciplinary team care with early and coordinated planning for delivery. Management of such patients include early counseling regarding pregnancy-associated risks, close monitoring of their cardiac function and regular scanning for fetal assessment. Choice of anesthesia for these patients requires meticulous planning to achieve a favorable balance between systemic and pulmonary vascular resistance, ensuring minimal change in right-to-left shunting. We report a case of a successfully managed pregnancy in a patient with complex congenital heart disease and a single ventricle of left ventricle morphology.

A century of medical students' activities (Medical College Union/Medical Society).

The Medical College Union (MCU) was formed in 1922 to encourage and promote comradeship and public spirit amongst the students of King Edward VII College of Medicine. The Medical College Union Society was founded and held its first meeting on 31 July 1936. However, the Annual Report for 1940-42 made no reference to the Society at all and it was hence considered to cease to exist as an official body. The Medical Society (Medsoc), headed by Mr Goon Sek Mun, was formed in 1949 and it organised various activities and events for the faculty. Some of these are still being held annually today, with the addition of several others and phasing out of some. These were organised by the individual subgroups in the Medical society, like the Social, Welfare, Sports and Publications committees. The Medsoc also acts as the students' voice in conveying their opinions to the administration and the Dean. With the expected advent of a new medical school in Singapore--a postgraduate one in the Outram Campus, the medical student community in Singapore will only get larger. There should be a role for Medsoc to foster closer ties between the student communities.

Dissolution rates of silicate cements.

The literature relating to the dissolution of the silicate cements is reviewed, including the methodology, intrinsic factors relating to composition and method of mixing, curing etc. and extrinsic factors, i.e. the medium, pH, ionic strength etc. to which the sample of cement is exposed. New experimental data is shown relating the dissolution rate to solution composition and ionic strength. It is seen that samples of silicate cement can take up phosphate from solution as well as releasing this species and a dissolution process based on a reversible equilibrium is advanced. Also considered are the effects of sample volume:area ratio and the effect of agitation.

Aetiology and distribution of mandibular fractures in the National University Hospital, Singapore.

Sixty-seven consecutive mandibular fractures treated mainly in 1998 were surveyed retrospectively. Treatment was performed at the National University Hospital, Singapore. Males outnumbered females by 5:1, with Chinese the commonest racial group involved (56.7%). Most patients were between 20 and 29 years of age. Road traffic accidents formed the largest proportion (61.2%) followed by industrial accidents and assaults. The symphyseal and parasymphyseal regions were most commonly fractured (46.5%). Almost a third of the patients sustained other facial fractures. Treatment was commonly administered within one to two days of discovery of the fracture and open reduction was the treatment plan of choice in 79.1% of the time. Discussion on how aetiology affects the fracture pattern in Singapore is carried out.

Case reports: the use of intermaxillary screws to achieve intermaxillary fixation in the treatment of mandibular fractures.

INTRODUCTION: Treatment of mandibular fractures commonly involves the use of arch bars in temporary maxillo-mandibular fixation (also called intermaxillary fixation) to aid bone plating, for the postoperative application of light elastic traction to correct minor occlusal discrepancies and intermaxillary fixation for post reduction immobilisation. The purpose of this paper is to describe a quick and simple alternative for intermaxillary fixation. CLINICAL PICTURE: Three cases of mandibular fractures are presented to demonstrate the use of intermaxillary screws instead of conventional arch-bar wiring. TREATMENT: Two cases were treated with closed reduction methods while the other case was treated with open reduction. OUTCOME: Subsequent fracture healing was not compromised using this technique. CONCLUSIONS: With careful case selection, successful treatment outcome may be achieved using this time-saving and technically simple procedure. Some of the advantages and disadvantages of the intermaxillary screws are discussed.

Oro-facial pain distribution in the Singapore Armed Forces: a pilot study.

The purpose of the study was to obtain information on the pain distribution in 140 consecutive patients referred to a Singapore Armed Forces (SAF) Temporomandibular Disorders (TMD) and Craniofacial pain clinic from January 1992 to April 1994 via questionnaire, oral history and clinical examination. A cross-sectional study of 130 patients in the general military population was also done to serve as a control and to obtain initial data on the prevalence of signs and symptoms of TMD in the SAF. The control was age and sex matched with the TMD patient sample. The data showed that the "TMD patient" infrequently presented with temporomandibular joint pain alone. Neck pain, shoulder pain, ear ache and headaches were found quite frequently in addition to masticatory muscle tenderness and should be checked for in any TMD patient. Initial findings support the recommendation that the routine palpation of the styloid regions be included in any clinical screening protocol for patients presenting with head, neck and oro-facial pains. A history of macrotrauma and parafunctional habits were also important. Interesting observations relating to the TMD patients in the SAF are briefly described and discussed and there is a need to further explore the correlation between certain SAF vocations and TMD.

Postoperative sore throat after routine oral surgery: influence of the presence of a pharyngeal pack.

A randomized clinical trial was conducted to investigate the effect of the presence of a pharyngeal pack during endotracheal anaesthesia on the incidence of postoperative sore throat. The patients were anaesthetized with fentanyl, thiopentone and atracurium. Thirty-six patients were anaesthetized without placement of pharyngeal packs while 26 patients had pharyngeal packs inserted. There were no significant differences in the incidence or severity of sore throat postoperatively in the two groups (P=0.23). These results contradict previous studies, which showed an increase in the incidence of postoperative sore throat after the use of pharyngeal packs.

Comparison of patient-controlled sedation with propofol and alfentanil for third molar surgery--preliminary results of a pilot study.

Propofol and alfentanil are commonly used for sedation and pain control. A preliminary study to compare the usefulness of these drugs was carried out in ten healthy patients requiring bilateral wisdom tooth surgery. The operations were done in two appointments with the patient receiving a different drug on each occasion. Anxiety levels were recorded on visual analogue scales pre and post-operatively. Both agents caused a decrease in anxiety scores, with propofol causing a more significant reduction. Vomiting and nausea with alfentanil was noted in three patients. Propofol also had an amnesic effect which alfentanil did not have. In conclusion, propofol would appear to be the drug of choice within the limitations of this pilot study.

Inter-fraction prostate motion during intensity-modulated radiotherapy for prostate cancer.

INTRODUCTION: This study aimed to analyse the inter-fraction prostate motion and setup error during intensity-modulated radiotherapy for prostate cancer at the National Cancer Centre Singapore. METHODS: Gold seeds were implanted as fiducial markers. Daily portal films were taken and displacements of the gold seeds from the isocentre in each axis were recorded. Random and systematic errors were used to derive a margin recipe for each axis based on the van Herk formula. RESULTS: 1,077 fractions from 36 patients were analysed. 89.8 percent, 85.2 percent and 83.6 percent of the setup errors were within +/- 2 mm for the right-left (RL), superior-inferior (SI) and anterior-posterior (AP) axes, respectively. The population systematic errors were 0.71 mm, 0.84 mm and 0.87 mm; the population random errors were 1.32 mm, 1.59 mm and 1.70 mm; the overall population mean setup errors were -0.14 (range -2.27 to 1.15) mm, 0.11 (range -2.32 to 1.69) mm and 0.08 (range -1.33 to 1.46) mm; and the van Herk margin recipes were 2.69 mm, 3.22 mm and 3.37 mm for the RL, SI and AP axes, respectively. CONCLUSION: The setup errors and inter-fraction prostate movements were small. Gold seed implantation is a feasible and easy method of verifying the prostate position.

Combining ability analyses of stability parameters and forage yield in smooth bromegrass.

Twenty-one progenies of smooth bromegrass (Bromus inermis Leyss.) from a 7 X 7 half diallel cross, with their parents, were evaluated for three years at four locations in Alberta for the genetic variation of stability in expression of their annual yield. The linear response and deviation from linear response for each genotype were the two stability parameters considered, together with mean performance in the evaluation of each genotype. Four high yielding genotypes, namely 12, 13, 16, and 26, had general adaptability, while genotype 23 was especially suited to a poor environment. Combining ability analysis showed that general combining ability (GCA) and specific combining ability (SCA) were both important in the expression of yield. Inheritance of linear regression was controlled predominantly by GCA whereas both GCA and SCA were equally important in the expression of deviation. The presence of a substantial proportion of variability due to the additive genetic component in the linear response suggests that it should be possible to exploit this fraction of variability in developing high yielding stable cultivars.

Additive inheritance of resistance to pod rot caused by Phytophthora palmivora in cocoa.

Quantitative inheritance of resistance to Phytophthora pod rot (Ppr) was studied in cocoa hybrid progeny from 12 Trinitario x Amazonian crosses and their reciprocal crosses. The crossing scheme was similar to a factorial design. Disease was assessed by the number and percentage of infected pods on each tree. Highly significant differences due to general combining abilities (GCA) were obtained for all characters, except for the GCA of Trinitario on total pod production. Differences for specific combining ability (SCA) were not significant for all characters. There were no significant differences between reciprocal crosses. The Trinitario clone K82 provided the only source for the hybrid progenies of strong Ppr resistance to the hybrid progenies, while K20 provided moderate resistance. Other parental clones - KA2-101, KA5-201, KEE 2, KEE 5, and KEE 52 - produced progenies which were susceptible to Ppr. It is evident that resistance to Ppr in cocoa is inherited additively. Maternal and cytoplasmic effects were assumed to have no influence on inheritance of resistance. It is also concluded that resistance to Ppr of the kind shown by K82 is likely to be horizontal resistance. Breeding for high-yielding cultivars combined with Ppr resistance is the most effective way of controlling Ppr of cocoa on the crops of growers with small holdings in Papua New Guinea.

Interaction between alfalfa cultivars and Rhizobium strains for nitrogen Fixation.

Two experiments were conducted in the greenhouse to study the interaction between alfalfa cultivars (Medicago sativa L. and M. falcata L.) and strains of Rhizobium meliloti Dang. for acetylene reduction rate, plant height and dry weights of shoot, root and whole plant. Fifteen alfalfa cultivars were inoculated with 10 strains of Rhizobium in Experiment I. Variance component analysis revealed that more than 30% of the total variance was due to alfalfa cultivars for acetylene reduction rate and 26% was accounted for by Rhizobium strains. More than 36% of the total variation was attributed to the interaction between alfalfa cultivars and Rhizobium strains for this character. Twenty-five host cultivars and 11 Rhizobium strains were included in Experiment II. The results also showed that the interaction of alfalfa cultivars and Rhizobium strains contributed the largest portion of the total variation for dry weights of shoot, root and whole plant and acetylene reduction rate. The results clearly demonstrated that the non-additive effects were the major component of variation for these characters associated with nitrogen fixation in alfalfa. Therefore, an effective way of improving nitrogen fixation in alfalfa is to select for a favourable combination of specific Rhizobium strains and alfalfa cultivars.

A clinical report about an unusual occurrence of post-anesthetic tongue swelling.

Dentures are routinely removed from the oral cavity before general anesthetic procedures. They are only reinserted much later when the patient returns to the room. This clinical report describes an edentulous patient who developed acute tongue swelling from venous congestion as a result of tongue recovery from general anesthesia. Her complete dentures were used to separate the residual ridges during the recovery period and relieved the congestion. Denture insertion increased the height and volume of the oral cavity, which reduced pressure on the tongue, preventing a cycle of tongue compression, congestion, and swelling. This unusual complication suggests that it may be prudent for the edentulous patient to be accompanied by their dentures in the perioperative period.