Why do we still not know whether refractive error causes headaches? Towards a framework for evidence based practice.

In this paper, we systematically review the available experimental and clinical evidence concerning the causation of headache by refractive error. Despite the apparent belief of both medical and optometric professionals that provision of an appropriate correction may alleviate various types of headache, there is little if any robust evidence in support of this position. We identify four serious methodological and theoretical difficulties with studies to date, which currently render it impossible to assess the relationship between refractive error and headache. The provision by the International Headache Society of the diagnostic category "headache associated with refractive error" is called into question. Five research questions are posited in the form of a framework for the development of evidence-based practice in optometry and the treatment of headache.

Effects of chemical disinfectants on surface characteristics and color of three fixed prosthodontic crown materials.

STATEMENT OF PROBLEM: Dental restorations should reproduce similar optical effects as natural tooth structure to achieve a good color match. Mismatch can result in unsatisfactory shade matching. PURPOSE: This study determined whether chemical disinfectants affected the surface texture and color of 3 fixed prosthodontic materials. MATERIAL AND METHODS: Five chemical disinfectants (Clorox, Banicide, Cidex-7, Biocide, and Multicide) in combination with 3 restorative materials (Dicor, Vita VMK ceramometal porcelain, Midas ADA type III noble casting alloy) were evaluated at 4 different times of immersion (10 minutes, 30 minutes, 24 hours, and 7 days). Changes from baseline for surface roughness and color were evaluated. Surface roughness data were recorded with a surface analyzer and color data in CIE L*a*b* color space were measured with a colorimeter. Data were analyzed with repeated measures analysis of variance and single factor analysis of variance. RESULTS: There were no statistical differences in surface roughness among disinfectants and restorative materials. However, there were statistical differences of changes in color, increase in deltaE and decrease in deltaL, among disinfectants and the noble casting alloy. CONCLUSION: Only 2 of the 3 materials evaluated, Dicor and Vita VMK ceramometal porcelain, can be used with all 5 disinfectants up to 7 days of immersion. Three chemical disinfectants (Biocide, Clorox, and Multicide) caused clinically significant color changes with the noble casting alloy after 7 days of immersion.

A VEP investigation of parallel visual pathway development in primary school age children.

Different features of visual function mature along unique timescales through infancy and early childhood. It is not clear which functions continue to mature in school age children. Functions believed to be mediated by the Magnocellular (M) and Parvocellular (P) pathways were compared in five- (n=25), eight- (n=21) and eleven-year-old children (n=21) and young adult controls (n=20). Steady-state visual evoked potentials were recorded from occipital electrodes in response to very low spatial frequency gratings, at a series of contrasts (M), and to high contrast gratings at a series of spatial frequencies (P). No evidence was found to indicate M pathway development across these age groups. However, the youngest children demonstrated elevated VEP thresholds to the high contrast gratings compared with either the adults or eleven-year-olds. This difference in threshold implies an immaturity of the high contrast, high spatial frequency stream, i.e. the putative P pathway.

Dimensional stability and detail reproduction of irreversible hydrocolloid and elastomeric impressions disinfected by immersion.

STATEMENT OF PROBLEM: Because irreversible hydrocolloid impressions imbibe blood and saliva, immersion rather than spray disinfection may be more effective. Polyether has been shown to be dimensionally sensitive to immersion disinfection. PURPOSE: The aim of this study was to determine whether irreversible hydrocolloid and polyether impressions could be disinfected by immersion without sacrificing accuracy and surface quality. MATERIAL AND METHODS: Impressions were made of a master mandibular arch containing a crown preparation. Changes between the master and working casts were assessed. Irreversible hydrocolloids (Jeltrate; Palgaflex), a polyether (Impregum F), and an addition silicone (President) were used. Disinfectants were an iodophor (Biocide), a glyoxal glutaraldehyde (Impresept de), and a phenol glutaraldehyde (Sporicidin). The control was without disinfection. Casts were formed in Type IV gypsum. The roughness of working dies was also recorded and an analysis of variance was used for statistical evaluation. Results. Casts from disinfected irreversible hydrocolloid and elastomeric impressions maintained accuracy for anteroposterior and cross arch dimensions where differences from the master was less than 0.1%. Buccolingual and mesiodistal dimensions of working dies (disinfected and control) were 6 to 8 microm larger than the master for addition silicones and 11 to 16 pm for polyethers. The occlusogingival dimension of dies for control and disinfected polyether was 9 pm longer than the master compared with -3 microm for addition silicone. The range of mean surface roughness of working dies made from irreversible hydrocolloids was 1.4 to 1.7 microm and ranged from 0.5 to 0.7 microm for elastomeric impressions. Conclusion. Immersion disinfection of Jeltrate material with iodophor and Palgaflex material with glyoxal glutaraldehyde produced casts and dies as accurate as the control. Control and disinfected elastomeric impression produced dies as clinically accurate and smooth as the master. Disinfection of irreversible hydrocolloid impressions with the glyoxal and phenol glutaraldehyde produced a surface smoother than controls.

A 'passive' event-related potential?

Event potentials (ERPs) were recorded in response to visual patterns in two conditions: (1) where no instructions were given to subjects; and (2) where subjects pressed a button whenever a rare stimulus was detected. P3 amplitudes for the No Instructions condition were smaller than for the Active condition, but the latency of the P3s did not differ across conditions. In both conditions, the P3 was either absent or significantly smaller for frequent stimuli than for rare stimuli. It appears a 'passive' visual P3 is measurable, and it occurs at the same latency as a P3 recorded in association with an active response. Thus, it may be possible to record P3s in response to visual stimulation in subjects who cannot follow instructions to respond to rare events.

Effects of chemical disinfectants on the surface characteristics and color of denture resins.

PURPOSE: Because dentures are disinfected repeatedly and for various amounts of time, it was of clinical interest to determine whether chemical disinfectants altered the surface texture or inherent color. MATERIAL AND METHODS: Five chemical disinfectants (Clorox, Banicide, Cidex-7, Biocide, and Multicide) in combination with five denture resins (Dentsply reline material, Hygenic HyFlo, Hygenic Perm, Lucitone 199, and Triad VLC reline resin) were evaluated at four different times of immersion (10 minutes, 30 minutes, 24 hours, and 7 days). Changes from baseline for surface roughness and color were recorded. Surface roughness data were recorded with a surface analyzer. Color data in CIE L*a*b* color space were measured with a colorimeter. Data were analyzed with repeated-measures analysis of variance and single-factor analysis of variance. RESULTS: Although statistical differences were demonstrated among disinfectants and resins for both measured parameters, the magnitudes of change in color and roughness was most often clinically insignificant. CONCLUSIONS: One disinfectant (Multicide) cannot be used on all five resins, and the remaining four disinfectants can be used on any of the five resins for up to a period of 30 minutes. All resins tested can be immersed in the four remaining disinfectants for up to 30 minutes without appreciable alteration to surface texture or color. Lucitone 199 resin can be immersed in any of the four disinfectants for up to 7 days without perceivable color change.

Psychiatric training in medicine residencies: current needs, practices, and satisfaction.

The purpose of this study was to determine the current level of psychiatric training in internal medicine residencies, satisfaction with this training, and perceived need, if any, for more training. Surveys were mailed to all training directors of accredited primary care (N = 178) and categorical (N = 410) internal medicine residencies in the United States; 110 primary care (62%) and 238 categorical (58%) training directors returned the surveys. Seventy-five percent of categorical and 66% of primary care training directors thought their program should spend more time on psychiatric disorders. For all categories of psychiatric disorder, training intensity was greater and satisfaction with training higher in the primary care programs, but less than half of the directors were satisfied with their current level of training, e.g., 33% of categorical and 47% of primary care directors were satisfied with their residents training concerning depression. Training in somatoform disorders, psychotropic drugs, and office psychotherapy were most frequently identified as deficient. The most favored additions to the curriculum were psychiatric consultants in medical clinics and on medical wards. Although most outpatient care for psychiatric disorders is given by primary care physicians, internal medicine training directors perceive current levels of training in their residencies as inadequate. Innovative collaborations between medicine and psychiatry departments will be necessary if treatment of psychiatric disorders in primary care is to be improved.

Factors associated with clinical success of cervical abrasion/erosion restorations.

The purpose of this study was to evaluate the clinical performance of class 5 restorations according to USPHS criteria. Twenty-five patients and 116 abrasion/erosion lesions were restored with either a glass-ionomer cement restoration (Ketac-Fil), a composite resin restoration with a dentin bonding agent (Silux Plus, Scotchbond 2), or a composite resin restoration with a dentin bonding agent and a glass-ionomer liner (Silux Plus, Scotchbond 2, Vitrebond). At 3 years, 24 patients and 110 teeth were evaluated. All restorations were rated clinically acceptable for color match, cavosurface discoloration, surface texture, and caries development. Glass-ionomer cement restorations demonstrated a slightly rougher surface texture than the composite restorations (Friedman Two-way ANOVA, P=0.000). Significant differences were found with retention (Cochran Q test, P=0.012). Percentages retained were: glass ionomer, 97.3% (36/37); composite/dentin bonding agent, 75.7% (28/37); composite/dentin bonding agent/glass-ionomer liner, 100% (36/36). At 3 years class 5 restorations of glass-ionomer cement or composite with a dentin bonding and a glass-ionomer liner demonstrated significantly better retention than restorations of composite with a dentin bonding agent. Increased occlusal function, mobility, and mandibular arch were associated with a decrease in retention rate.

Use of spherical targets to minimize effects of neutron scattering by hydrogen in neutron capture prompt gamma-ray activation analysis.

For hydrogenous targets that are thinner than they are wide, element sensitivities (counts.s-1.mg-1) for determining concentrations of elements by neutron capture prompt gamma-ray activation analysis (PGAA) are enhanced relative to sensitivities obtained from measurements on nonhydrogenous materials. These enhancements are caused mainly by elastic neutron scattering by H, which changes the average neutron fluence rate within the matrix. The magnitude of the effect depends on the macroscopic scattering and absorption cross sections and on the size, shape, and orientation of the target with respect to the neutron beam. Sensitivities increase linearly with H density for thin targets of constant size and shape and also vary with target shape. Theoretical work was shown that element sensitivities for hydrogenous targets in the form of spheres are least affected by neutron scattering. Methods were devised for creating solid spheres and for containing liquids in spherical shapes. Element sensitivities were determined for spheres and disks of several hydrogenous materials. For H, B, Cl, K, Br, and Cd, sensitivities for spheres were found to be less affected by neutron scattering. Exceptions were Sm and Gd sensitivities measured in liquids contained in quartz globes.

Clinical performance of posterior composite resin restorations.

Two formulations of posterior composite resin (P-30 and Bisfil-P) were evaluated and compared to a high-copper, dispersed-phase amalgam (Dispersalloy). One hundred twenty-eight restorations were placed in 27 patients so that each patient received at least one of each material. After 3 years of clinical service, all three restorative materials produced clinically acceptable restorations, according to US Public Health Service and Leinfelder criteria. The amalgam restorations, however, underwent less wear (44 microns) than did the posterior composite resin restorations (60 to 74 microns). Stratification of data by type of tooth, class of restoration, and size of restoration produced the same ranking of wear from lowest to highest: Dispersalloy, Bisfil-P, and P-30. Resin restorations showed 45% more wear in molars than in premolars, and more wear was associated with moderately sized restorations than with conservative restorations. The surface texture of restorations of composite resin with porous strontium glass filler was nearly as smooth as that of enamel and was significantly smoother than that of the restorations of composite resin with zinc glass filler or of unpolished amalgam.

Clinical comparison of Class V resin composite and glass ionomer restorations.

Three techniques for restoring abrasion/erosion lesions were evaluated over a 2-year period: 1) glass ionomer restoration (Ketac-Fil); 2) composite restoration with a dentin bonding agent (Silux Plus, Scotchbond 2); 3) composite restoration with glass ionomer liner and a dentin bonding agent (Silux Plus, Vitrebond, Scotchbond 2). There were 116 lesions restored and 115 evaluated for color match, cavosurface discoloration, surface texture, caries development, and retention. Most restorations were rated clinically acceptable for color match, cavosurface discoloration, surface texture, and caries development when measured at 2 years. Glass ionomer restorations and composite restorations with a glass ionomer liner and a dentin bonding agent demonstrated better retention rates, 97.4% and 100% respectively, than the composite restorations with a dentin bonding agent only (86.8%) (Cochrane Q test, P = 0.07).

Clinical evaluation of direct esthetic restorations in cervical abrasion/erosion lesions: one-year results.

One hundred sixteen cervical abrasion/erosion lesions were restored with one of the following techniques: (1) glass-ionomer cement, (2) composite resin with a dentinal bonding agent, or (3) composite resin with a glass-ionomer cement liner and a dentinal bonding agent. The restorations were assessed at baseline and at 6 months and 1 year postrestoration for retention, caries, color match, marginal staining, and surface texture. No statistically significant differences were found in retention, caries, color match, or marginal staining. A statistically significant difference was found with regard to surface texture: glass-ionomer cement restorations demonstrated a rougher surface than did the composite resin restorations. A substantial number of restorations composed of composite resin with a dentinal bonding agent demonstrated a color shift towards mismatch when evaluated at 6 months. This difference was not significant at the 1-year followup.

Dentin bonding systems: a review of current products and techniques.

Many dentists are facing decisions regarding selection and use of dentin bonding systems. This article presents information on existing products and provides guidance on their use based on laboratory and clinical evidence.

Effects of target shape and neutron scattering on element sensitivities for neutron-capture prompt gamma-ray activation analysis.

Results are presented for a study of the effects of neutron scattering by hydrogen on element sensitivities for in-beam neutron capture prompt gamma-ray activation analysis. In a scattering matrix, sensitivities vary as a function of both the scattering density, i.e., the number of scatters per unit volume and the magnitude of scattering cross sections, and the target geometry, i.e., the target shape and orientation with respect to the neutron beam. Element sensitivities (counts.s-1.mg-1) increased linearly with H density (g.mL-1) for H, B, Na, Cl, K, Mn, Br, Ag, Cd, I, Sm, and Gd, measured for liquids packaged in Teflon bags. Nine of the 12 elements studied had 1.69 +/- 0.18% sensitivity enhancement per percent increase in H density. Samarium sensitivity was enhanced by only 0.54 +/- 0.07%/% H, which may indicate that neutron scattering by H causes a shift in the energy distribution of the neutrons. Manganese sensitivity was enhanced by 2.44 +/- 0.26%/% H. The enhancement of the sensitivity for H itself varied with matrix composition. For several series of disk-shaped, solid, hydrogenous targets, element sensitivities increased with decreasing target thickness until, at some limiting thickness, this trend was reversed. Consistent with theory, sensitivities measured for spherical hydrogenous targets showed no enhancement.

Kinetic analysis of zinc metabolism in humans after simultaneous administration of 65Zn and 70Zn.

Zinc kinetics were studied and compared after oral simultaneous administration of two tracers, radioactive (65Zn) and stable (70Zn) isotope, to four normal human volunteers. Both tracers and zinc concentration were measured in plasma, red blood cells (RBC), urine, and feces for up to 78 days. Radioactive zinc was also measured by external counting over whole body, liver, and thigh. Data from each individual were analyzed using a compartmental model for zinc metabolism. Values calculated for absorption, fractional zinc excretion in urine, exchange with RBC, and secretion into gut using 70Zn data did not differ from values calculated using 65Zn data. Results show that human zinc metabolism can be investigated using stable isotopes as tracers to determine parameters of whole body zinc metabolism, including zinc absorption, excretion, and secretion.

Sensitivity restored of Class V abrasion/erosion lesions.

The effectiveness of restorative treatment in reducing sensitivity associated with the Class V erosion/abrasion lesion was evaluated and the efficacy of three tooth-colored restorative materials in reducing sensitivity was compared. The 108 lesions were restored with either glass ionomer restorative material, composite resin with a dentin bonding agent, or composite resin with a dentin bonding agent and a glass ionomer liner. Composite resin with glass-ionomer liner restorations significantly reduced sensitivity to air and hot and cold water. Glass ionomer restorations and restorations with composite resin and a dentin bonding agent significantly reduced sensitivity but were also associated with increased sensitivity to air and cold respectively in 20% to 30% of the lesions restored when evaluated at 6 months.

Application of polyacrylamide gel electrophoresis/neutron activation analysis for protein quantification.

A combination of two methods, polyacrylamide gel electrophoresis (PAGE) and neutron activation analysis (NAA), has been applied to solutions containing phosphoproteins for the purpose of protein quantification. The proteins were separated by molecular weight using PAGE, and then the whole gel was activated by neutron bombardment. Densitometric measurements of the developed bands from 32P, taken from autoradiographs of the activated gels, resulted in quantification of the phosphorus, and then the related protein. This PAGE/NAA method was applied to several phosphoprotein-containing materials, including commercial milk products and reference materials, i.e., IAEA A-11, milk powder, and SRM 1845, Cholesterol in Egg Powder.

The effect of tray selection on the accuracy of elastomeric impression materials.

This study evaluated the accuracy of reproduction of stone casts made from impressions using different tray and impression materials. The tray materials used were an acrylic resin, a thermoplastic, and a plastic. The impression materials used were an additional silicone, a polyether, and a polysulfide. Impressions were made of a stainless steel master die that simulated crown preparations for a fixed partial denture and an acrylic resin model with cross-arch and anteroposterior landmarks in stainless steel that typify clinical intra-arch distances. Impressions of the fixed partial denture simulation were made with all three impression materials and all three tray types. Impressions of the cross-arch and anteroposterior landmarks were made by using all three tray types with only the addition reaction silicone impression material. Impressions were poured at 1 hour with a type IV dental stone. Data were analyzed by using ANOVA with a sample size of five. Results indicated that custom-made trays of acrylic resin and the thermoplastic material performed similarly regarding die accuracy and produced clinically acceptable casts. The stock plastic tray consistently produced casts with greater dimensional change than the two custom trays.

Radiochemical neutron activation analysis of zinc isotopes in human blood, urine, and feces for in vivo tracer experiments.

Enriched stable isotopes are being increasingly used for study of trace element nutrition in humans who cannot be studied by use of in vivo radioactive tracers (e.g., subjects under age 18 and pregnant women). Zinc metabolism in these subjects can be evaluated by administration of Zn enriched to 65% in the minor isotope, 70Zn (0.6% natural abundance). The enhanced 70Zn is detected later in red blood cells, plasma, urine, and feces by measuring 70Zn/64Zn or 70Zn/68Zn ratios. Stable isotope concentrations are measured by neutron activation of the samples and observation of their products: 244-day 65Zn, 14-h 69mZn, and 4-h 71mZn. Zinc-65 can be observed in these samples without chemical separations 3 weeks after irradiations, but large amounts of 24Na and other short-lived species preclude direct observation of the short-lived Zn activities. Preirradiation chemistry was developed to remove most interferences, the major steps being to place the sample on Chelex resin, elute alkali metals and alkaline earths from it, and irradiate the resin containing the Zn. gamma-Rays of 69mZn can be observed on the irradiated resin, but additional precipitation and solvent extraction steps are needed to remove 56Mn and 64Cu for clear observation of 71mZn and 65Zn within hours after irradiation. Yields for pre- and postirradiation separations are typically 85% and 70%, respectively. The stable isotope tracer method was validated by simultaneous in vivo tracing with radioactive 65Zn in four subjects.