Accounting for effects of system dynamics to improve accuracy of emissions reported in e-cig vaping machines.

Laboratory emissions testing of electronic cigarettes continues to be a focus in the tobacco research community. In particular, to inform policy regarding appropriate test protocols to regulate the manufacture, marketing and sale of tobacco products. This study aims to enhance current understanding of the way laboratory systems used to generate topography profiles and capture resultant emissions from inhaled tobacco products may interact with the device under test. A programmable emission system (vaping machine) is introduced and characterized. The operating envelope of this system is presented. This study demonstrates that the performance of an emissions system may be influenced by various factors, resulting in discrepancies between command puff parameter inputs and the observed puffs generated. The study findings conclude that any emissions system should be characterized with the desired test device to determine the effective operating range of the system under "Load" conditions. Furthermore, reporting emissions from electronic cigarettes as a function of "command" puff flow rate and cumulative volume result in under-estimation bias and may give rise to incorrect conclusions regarding the impact of product characteristics on emissions. Conversely, reporting emissions in terms of "observed" puff flow rate and cumulative volume reduces bias errors and limits opportunity for intentional misrepresentation of results.

Parenchymal trafficking of pleural mesothelial cells in idiopathic pulmonary fibrosis.

Idiopathic pulmonary fibrosis (IPF) is characterised by myofibroblast proliferation leading to architectural destruction. Neither the origin nor the continued proliferation of myofibroblasts is well understood. Explanted human IPF lungs were stained by immunohistochemistry for calretinin, a marker of pleural mesothelial cells (PMCs). Chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF) lungs acted as controls. The number of PMCs per 100 nucleated cells and per photomicrograph was estimated along with the Ashcroft score of fibrosis. Mouse PMCs expressing green fluorescent protein (GFP) or labelled with nanoparticles were injected into the pleural space of mice given intranasal transforming growth factor (TGF)-ß1. Mouse lungs were lavaged and examined for the presence of GFP, smooth muscle α-actin (α-SMA) and calretinin. Calretinin-positive PMCs were found throughout IPF lungs, but not in COPD or CF lungs. The number of PMCs correlated with the Ashcroft score. In mice, nanoparticle-laden PMCs were recoverable by bronchoalveolar lavage, depending on the TGF-ß1 dose. Fluorescent staining showed α-SMA expression in GFP-expressing PMCs, with co-localisation of GFP and α-SMA. PMCs can traffic through the lung and show myofibroblast phenotypic markers. PMCs are present in IPF lungs, and their number correlates with IPF severity. Since IPF presumably begins subpleurally, PMCs could play a pathogenetic role via mesothelial-mesenchymal transition.

Effect of e-liquid flavor on electronic cigarette topography and consumption behavior in a 2-week natural environment switching study.

Electronic Nicotine Delivery Systems (ENDS) offer an alternate means to consume nicotine in a variety of flavored aerosols. Data are needed to better understand the impact of flavors on use behavior. A natural environment observational study was conducted on experienced ENDS users to measure the effect of e-liquid flavor on topography and consumption behavior. The RIT wPUMTM monitor was used to record to record the date and time and puff topography (flow rate, volume, duration) for every puff taken by N = 34 participants over the course of two weeks. All participants used tobacco flavor for one week, and either berry or menthol flavor for one week. Results provide strong evidence that flavor affects the topography behaviors of mean puff flow rate and mean puff volume, and there is insufficient evidence to support an influence of flavor on mean puff duration and mean puff interval. There was insufficient evidence, due to the low power associated with the limited number of observation days, to establish a relationship between flavor and cumulative consumption behavior. While the results indicate that an effect may be evident, additional observation days are required to establish significance.

[Characteristics of risk groups with an insufficient demand for dental services - results of the study of health in Pomerania (SHIP)]. / Merkmale von Risikogruppen einer unzureichenden Inanspruchnahme zahnmedizinischer Leistungen - Ergebnisse der Study of Health in Pomerania (SHIP).

AIM: The purpose of this study was to identify risk groups for low dental care utilisation and to highlight adequate determinants for necessary action. METHODS: The database was the "Study of Health in Pomerania" (SHIP), a cross-sectional sample drawn from the adult population (20 - 79 years) in a northeast region of Germany. 4310 of 7008 randomly selected inhabitants participated in the examinations (response rate 68.8 %). The use of dental care in the last year was analysed using logistic regression according to the conceptual model by Andersen and Newman. RESULTS: Multivariate analysis revealed that participation in the bonus scheme system of the statutory sickness funds (OR = 8.2) and participation in the bonus system of the private health insurance companies (OR = 2.6) as "enabling resources" predicted dental care use in the last year. "Objektive need" (OR = 1.02) is weaker associated with dental care utilisation than "subjective need", for instance the attitude towards need of regular dental checkups. Presence of own teeth is a significant predictor for dental care utilization (OR = 3.3), whereas edentulous persons, those with complete denture prosthesis, don't think about possible oral problems and don't visit the dentist at least once a year. Among "predisposing factors" only gender and education were significant determinats for dental care utilization. CONCLUSIONS: The conclusions concerning the significant influence of subjective need and promotional impact of the bonus scheme are important for health care. Financial incentives and motivation for regular prevention should be continued and upgraded. Measures to improve preventive dental care utilization should focus on persons with low educational levels and on men with inadequate dental care utilisation. The mental anchorage of the term "oral health" rather than the conventional term "dental health" is important, so that edentulous persons become conscious of regular prevention pointers to maintain a high quality of life.

Week Long Topography Study of Young Adults Using Electronic Cigarettes in Their Natural Environment.

Results of an observational, descriptive study quantifying topography characteristics of twenty first generation electronic nicotine delivery system users in their natural environment for a one week observation period are presented. The study quantifies inter-participant variation in puffing topography between users and the intra-participant variation for each user observed during one week of use in their natural environment. Puff topography characteristics presented for each user include mean puff duration, flow rate and volume for each participant, along with descriptive statistics of each quantity. Exposure characteristics including the number of vaping sessions, total number of puffs and cumulative volume of aerosol generated from ENDS use (e-liquid aerosol) are reported for each participant for a one week exposure period and an effective daily average exposure. Significant inter-participant and intra-participant variation in puff topography was observed. The observed range of natural use environment characteristics is used to propose a set of topography protocols for use as command inputs to drive machine-puffed electronic nicotine delivery systems in a controlled laboratory environment.

Electronic Cigarette Topography in the Natural Environment.

This paper presents the results of a clinical, observational, descriptive study to quantify the use patterns of electronic cigarette users in their natural environment. Previously published work regarding puff topography has been widely indirect in nature, and qualitative rather than quantitative, with the exception of three studies conducted in a laboratory environment for limited amounts of time. The current study quantifies the variation in puffing behaviors among users as well as the variation for a given user throughout the course of a day. Puff topography characteristics computed for each puffing session by each subject include the number of subject puffs per puffing session, the mean puff duration per session, the mean puff flow rate per session, the mean puff volume per session, and the cumulative puff volume per session. The same puff topography characteristics are computed across all puffing sessions by each single subject and across all subjects in the study cohort. Results indicate significant inter-subject variability with regard to puffing topography, suggesting that a range of representative puffing topography patterns should be used to drive machine-puffed electronic cigarette aerosol evaluation systems.

Study of Health In Pomerania (SHIP): a health examination survey in an east German region: objectives and design.

OBJECTIVES: The reason for the Study of Health in Pomerania (SHIP) is the lack of epidemiological studies with a broad range of health indicators. Furthermore, in Germany there is a need for studies that take into account the particular situation of life after the reunification. One objective of SHIP is to provide prevalence estimates on a broad range of diseases, risk and health factors for a defined region in the former GDR. METHODS: A sample of 7008 women and men aged 20 to 79 years in a north-east region of Germany, 4900 expected participants. The sample was drawn in two steps: First, 32 communities in the region were selected. Second, within the communities a simple random sample was drawn from residence registries, stratified by gender and age. The data collection and instruments include four parts: oral health examination, medical examination, health-related interview, and a health- and risk-factor-related questionnaire. The oral health examination includes the teeth, periodontium, oral mucosa, craniomandibular system, and prosthodontics. The medical examination includes blood pressure measurements, electrocardiography, echocardiography, carotid, thyroid and liver ultrasounds, neurological screening, blood and urine sampling. The computer-aided health-related interview includes cardiovascular symptoms, utilisation of medical services, health-related behaviours, and socioeconomic variables. The self-administered questionnaire comprises housing conditions, social network, work conditions, subjective well-being and individual consequences from the German reunification.

Caries prevalence in an adult population: results of the Study of Health in Pomerania, Germany (SHIP).

PURPOSE: The aim of this study was to assess the caries prevalence in the adult population of Pomerania, Germany in comparison to national and international data. MATERIALS AND METHODS: The study sample comprised 4,022 randomly selected subjects who were examined from October 1997 to May 2001 within the "Study of Health in Pomerania" (medical and dental, population-based cross-sectional study in Pomerania, Northeast Germany. Response rate: 69%. Age range of subjects: 25-79 yrs). Carious defects, fillings and missing teeth were diagnosed and the DMFT/S scores were calculated according to WHO guidelines (1997). These figures were compared to other German, Swedish and US data. RESULTS: Women exhibited higher mean DMFT and DMFS values in all age groups than men. The mean DMFT/S scores were slightly higher than the values for the only two available nationally representative age groups in Germany. The prevalence of primary carious lesions or secondary caries was very low, resulting in minor treatment needs (decayed surfaces: mean 0.95 +/- 3.3) and high care indices (FS/DFS) for all age groups (90-95%). In contrast to this, the mean numbers of fillings in adults and especially of missing teeth in seniors were much higher in Pomerania for all age groups than in the Swedish and US adult population, where a caries decline was demonstrated. CONCLUSION: In spite of a very low prevalence of primary carious lesions and secondary caries, the mean number DMFT/S and especially MT/S scores in the Pomeranian adult population are high in comparison with Swedish and US data, but differed only slightly from the limited available national data for Germany.

[The development of dysgnathia from the primary dentition to the mixed dentition]. / Untersuchungen zur Dysgnathieentwicklung von der ersten Dentition zum Wechselgebiss.

We investigated the fully developed deciduous dentition in 408 children, and re-examined the situation four years later. The nature of the milk teeth (spaced, unspaced, crowded) has a considerable influence on subsequent development. Orthodontic treatment of the mixed dentition is most likely (76,7%) if there has been crowding of the milk teeth. Frontal crowding, distal occlusion, increased overjet, lateral cross-bite and prognathism of the lower jaw are most frequently retained in the mixed dentition. However, individual development follows this trend to a varying degree. On the basis of the situation in the primary dentition it is not possible to make a definitive prediction of the vertical relationships of the upper and lower front teeth in the permanent dentition.

[Assessment of the success of orthodontic treatment from the viewpoint of general dentistry]. / Erfolgsbewertung einer kieferorthopädischen Behandlung aus allgemeinstomatologischer Sicht.

Using internationally accepted indices, the authors studied the caries and gingivities frequency as well as the oral hygiene in 112 successfully treated orthodontic patients 35 months or thereabout after termination of the treatment and retention. The results obtaines are compared with those from an adequate control group and statistically evaluated. The general dental condition and the degree of oral rehabilitation of the orthodontic patients was better than those of the subjects in the control group.

[The maxillonasal syndrome (Binder)]. / Beitrag zum Maxillonasalen Syndrome (Binder)

In the light of three case reports, the authors explain the symptoms of the maxillonasal syndrome and draw conclusions as to orthodontic therapy.

[Frequency and localization of facets in adults with correct dental arches and malocclusion in anterior teeth region regarding periodontal reaction and occlusal guidance]. / Facettenhäufigkeit und -verteilung bei Erwachsenen mit regelrechten Gebissen und bei Zahnstellungs- und Okklusionsanomalien im Frontzahnbereich in bezug zur periodontalen Reaktion und zur Okklusionführung.

We investigated 322 patients, 20 and 40 old to find connections between the occurrence and localisation of facets, malocclusion and dynamic occlusion and estimated special aspects of periodontal reactions. The symptoms "anterior crowding", "increased overbite and overjet" didn't effect an increasing of frequency of facets in comparison with eugnathic denture. We found, that the facets decreased in lateral segments if the overbite became deeper and on the other hand number of facets increased with advancing years. The localisation of facets and occlusal guidance of dynamic occlusion coincided only in one third of investigated cases. Balancing and hyperbalancing teeth showed frequent facets. There was a direct relationship between increasing frequency and intensity of gingival retraction and the level of the abrasion of the hard tooth substance.

Subjective judgements of quality of life: a comparison study between people with intellectual disability and those without disability.

The present study investigated the relationship between objective and subjective measures of quality of life (QoL), and in particular, health status and primary care services. Thirty-one people with intellectual disability (ID) were interviewed using a QoL questionnaire. Thirty-one matched controls from the general population filled in a parallel questionnaire. The results in both groups support the findings of many researchers which indicate that satisfaction with aspects of life is generally high (i.e. approximate 75% of maximum possible satisfaction). The present study also confirms previous findings which indicate that satisfaction with aspects of life does not generally correlate with objective circumstances in either group. The importance that people attach to aspects of their lives did not generally correlate with their objective circumstances or their satisfaction with life. However, people with ID attached greater importance to all aspects of their lives than those without disability. This may be linked to their aspirations, preferences and opportunities for choice, and therefore, these factors may be a more meaningful way of considering their QoL. The present findings call into question the use of satisfaction as a general measure of QoL, and also indicate that the use of importance as a mediating variable in understanding satisfaction may not be a solution. The participants with ID had poorer health than the controls, and were significantly less satisfied with their health. Contrary to other findings, the present participants with ID reported that they had received more health checks than the controls over the previous year. Half of these checks had been carried out by 'special' services rather than primary care services.

Signs of temporomandibular disorders in tinnitus patients and in a population-based group of volunteers: results of the Study of Health in Pomerania.

The literature has documented a controversial discussion on the possible relationship of otogenous symptoms and craniomandibular dysfunction since the 1920s. Therefore, an investigation was conducted which consisted of two parts: a case study with population-based controls and a cross-sectional study. The aim of the first study was to screen a group of patients suffering from acute or chronic tinnitus for temporomandibular disorders (TMD) in comparison with a population-based group of volunteers without tinnitus. To this end, 30 patients (13 females and 17 males, age 18-71 years) suffering from acute hearing loss associated with tinnitus, isolated acute tinnitus, and chronically transient tinnitus were examined for symptoms of craniomandibular dysfunction. The results were compared with those of clinical functional analysis from 1907 subjects selected representatively and according to age distribution from the epidemiological 'Study of Health in Pomerania' (SHIP); the occurrence of tinnitus was ruled out in these control subjects. Statistical analysis was performed with Chi-square and Mann-Whitney U-tests. Sixty per cent of the tinnitus patients and 36.5% of the control subjects exhibited more than two symptoms of TMD (P = 0.004). Tinnitus patients had significantly more muscle palpation pain (P < 0.001), temporomandibular joint (TMJ) palpation pain (P < 0.001), and pain upon mouth opening (P < 0.001) than the general population group. No statistical differences were found in TMJ sounds, limitation of mandibular movement, or hypermobility of the TMJ. Furthermore, 4228 subjects of the population group examined in the epidemiological study were screened for co-factors of tinnitus with the help of a multivariate logistic regression model which was adjusted for gender, age, and a variety of anamnestic and examined data. Increased odds ratios (OR) were found for tenderness of the masticatory muscles (OR = 1.6 for one to three painful muscles and OR = 2.53 for four or more painful muscles), TMJ tenderness to dorsal cranial compression (OR = 2.99), listlessness (OR = 2.0) and frequent headache (OR = 1.84) A relationship between tinnitus and TMD was established in both examinations. Tinnitus patients seem to suffer especially from myofascial and TMJ pain. A screening for TMD should be included in the diagnostic survey for tinnitus patients.