Telephone cognitive screening with older Aboriginal Australians: A preliminary study.

OBJECTIVES: Cognitive screening via telehealth is increasingly employed, particularly during the COVID-19 pandemic. Telephone adaptations of existing cognitive screening tests must be validated across diverse populations. The present study sought to evaluate an existing 26-point telephone adaptation of the Mini-Mental State Examination (tMMSE) in a sample of older Aboriginal Australians. Additionally, we aimed to evaluate a telephone adaptation of the urban version of the Kimberley Indigenous Cognitive Assessment short-form (tKICA screen). METHODS: A sub-sample (n = 20) of participants (aged 55-69 years; 11 women) who had completed an in-person cognitive assessment (MMSE and KICA screen) within the past 6 months as part of the Koori Growing Old Well Study completed telephone-based cognitive testing without an assistant. RESULTS: There was moderate correlation and reasonable agreement between MMSE versions (rs  = 0.33; p = 0.2), although the limits of agreement were unacceptably wide (-4.1 and 4.8 points difference). Poorer performance was seen on the tMMSE for Season (p = 0.02) and Phrase (p = 0.02) items, and better performance for three-word Recall (p = 0.03). KICA-screen versions were poorly correlated (rs  = 0.20; p = 0.4) with telephone scoring a mean of 2.17 points below the face-to-face score, greater bias observed at the lower end of the performance and worse scores for Season (p = 0.02) and Recall (p = 0.001) items. Age and education were not associated with telephone screening performance. Hearing impairment was associated with poorer performance on the tKICA screen (p = 0.04) but not the tMMSE (p = 0.6). CONCLUSIONS: Results indicate that telephone administration of the MMSE and/or KICA screen is not equivalent to in-person testing for older Aboriginal people, and further revision and evaluation are required.

Reflections on working and walking gently together in collaboration and partnership in Aboriginal ageing research.

PROBLEM: An important aspect of the work that takes place in and across our Aboriginal Health and Ageing research group is about building partnerships between Aboriginal and Torres Strait Islander peoples and non-Indigenous people. Partnerships are created between colleagues and co-researchers as well as with community Elders, Aboriginal community-controlled organisations, community groups and associations and individuals. SETTING: To fully realise this has required an introspective look at the way we function as a team of Aboriginal researchers and non-Indigenous researchers working together. It has challenged us to explore and determine our shared visions and shared outcomes and to develop strong, enduring and authentic partnerships by putting culture at the centre of everything we do. KEY MEASURES FOR IMPROVEMENT: This wisdom-led approach has fostered the development of a shared narrative about research WITH Aboriginal and Torres Strait Islander communities and a shared language of research collaboration. STRATEGIES AND EFFECTS OF CHANGE: This paper aims to provide an opportunity to reflect on the key elements of co-design which have underpinned our work together across cultures both within team and within community. LESSONS LEARNT: This paper will provide lived examples of the co-design and co-creation process utilised by our team in working with community. It will further share a model which underpins these experiences. It provides a framework to refer to and reflect upon, which commits to working with shared respect, shared meaning, shared knowledge and an enriched experience of collaboratively working and walking and learning together.

Effects of the harvesting technique and external stenting on progression of vein graft disease 2 years after coronary artery bypass.

OBJECTIVES: In a post hoc analysis of the VEST III trial, we investigated the effect of the harvesting technique on saphenous vein graft (SVG) patency and disease progression after coronary artery bypass grafting. METHODS: Angiographic outcomes were assessed in 183 patients undergoing open (126 patients, 252 SVG) or endoscopic harvesting (57 patients, 114 SVG). Overall SVG patency was assessed by computed tomography angiography at 6 months and by coronary angiography at 2 years. Fitzgibbon patency (FP I, II and III) and intimal hyperplasia (IH) in a patient subset were assessed by coronary angiography and intravascular ultrasound, respectively, at 2 years. RESULTS: Baseline characteristics were similar between patients who underwent open and those who underwent endoscopic harvesting. Open compared with endoscopic harvesting was associated with higher overall SVG patency rates at 6 months (92.9% vs 80.4%, P = 0.04) and 2 years (90.8% vs 73.9%, P = 0.01), improved FP I, II and III rates (65.2% vs 49.2%; 25.3% vs 45.9%, and 9.5% vs 4.9%, respectively; odds ratio 2.81, P = 0.09) and reduced IH area (-31.8%; P = 0.04) and thickness (-28.9%; P = 0.04). External stenting was associated with improved FP I, II and III rates (odds ratio 2.84, P = 0.01), reduced IH area (-19.5%; P < 0.001) and thickness (-25.0%; P < 0.001) in the open-harvest group and reduced IH area (-12.7%; P = 0.01) and thickness (-9.5%; P = 0.21) in the endoscopic-harvest group. CONCLUSIONS: A post-hoc analysis of the VEST III trial showed that open harvesting is associated with improved overall SVG patency and reduced IH. External stenting reduces SVG disease progression, particularly with open harvesting.

Tooth-cusp preservation with lithium disilicate onlay restorations: A fatigue resistance study.

OBJECTIVES: This study examined the in vitro fatigue resistance of maxillary premolars with 2 mm or 3 mm preserved cusp thicknesses restored with lithium disilicate onlays. MATERIALS AND METHODS: Premolars(N = 48) were divided into six groups. Onlays for groups 1 to 4 preserved a 3 mm functional (G1), 2 mm functional (G2), 3 mm nonfunctional (G3), or 2 mm nonfunctional (G4) buccal-lingual cusp width. Onlays for group 5 (G5, control) replaced both cusps. Group 6 (G6) samples were identical to G1 with added retentive boxes. Lithium disilicate onlays were exposed to thermocycling (10 000 cycles, 5°C-55°C, 30s/cycle) and mechanical loading (1.2 million cycles at 1.4 Hz and 70 N). All samples were examined for onlay debonding or cusp or onlay fracture. RESULTS: Failure rates were 75%(G1), 0.0%(G2), 12.5%(G3), 0.0%(G4), 0.0%(G5), and 0.0%(G6). The difference in percent failure between the groups preserving the functional cusps (37.5%) and the groups preserving the nonfunctional cusps (6.3%) was statistically significant (P = .04; 95%CI:2.11-55.66). No cusp or restoration fractures were observed; all failures were due to debonding of the restoration. CONCLUSION: Teeth with thin remaining cusps that were restored with bonded lithium disilicate onlay restorations were not prone to fracture. Retentive preparation features that physically eliminated lateral displacement prevented onlay debonding even though the ceramic-enamel margin was directly at the occlusal contact. CLINICAL SIGNIFICANCE: The use of adhesively retained lithium disilicate ceramic onlays may be a viable alternative to full coverage restorations and may challenge traditionally accepted principals related to preparation resistance and retention form of ceramic partial coverage restorations.

External stenting and disease progression in saphenous vein grafts two years after coronary artery bypass grafting: A multicenter randomized trial.

OBJECTIVES: Little data exist regarding the potential of external stents to mitigate long-term disease progression in saphenous vein grafts. We investigated the effect of external stents on the progression of saphenous vein graft disease. METHODS: A total of 184 patients undergoing isolated coronary artery bypass grafting, using an internal thoracic artery graft and at least 2 additional saphenous vein grafts, were enrolled in 14 European centers. One saphenous vein graft was randomized to an external stent, and 1 nonstented saphenous vein graft served as the control. The primary end point was the saphenous vein graft Fitzgibbon patency scale assessed by angiography, and the secondary end point was saphenous vein graft intimal hyperplasia assessed by intravascular ultrasound in a prespecified subgroup at 2 years. RESULTS: Angiography was completed in 128 patients and intravascular ultrasound in the entire prespecified cohort (n = 51) at 2 years. Overall patency rates were similar between stented and nonstented saphenous vein grafts (78.3% vs 82.2%, P = .43). However, the Fitzgibbon patency scale was significantly improved in stented versus nonstented saphenous vein grafts, with Fitzgibbon patency scale I, II, and III rates of 66.7% versus 54.9%, 27.8% versus 34.3%, and 5.5% versus 10.8%, respectively (odds ratio, 2.02; P = .03). Fitzgibbon patency scale was inversely related to saphenous vein graft minimal lumen diameter, with Fitzgibbon patency scale I, II, and III saphenous vein grafts having an average minimal lumen diameter of 2.62 mm, 1.98 mm, and 1.32 mm, respectively (P < .05). Externally stented saphenous vein grafts also showed significant reductions in mean intimal hyperplasia area (22.5%; P < .001) and thickness (23.5%; P < .001). CONCLUSIONS: Two years after coronary artery bypass grafting, external stenting improves Fitzgibbon patency scales of saphenous vein grafts and significantly reduces intimal hyperplasia area and thickness. Whether this will eventually lead to improved long-term patency is still unknown.

Topical Vancomycin Reduces the Incidence of Deep Sternal Wound Complications After Sternotomy.

BACKGROUND: Deep sternal wound infection remains a significant hazard for cardiosurgical patients undergoing median sternotomy. Although the prophylactic use of topical vancomycin to reduce the incidence of deep sternal wound complications (DSWC) has been repeatedly examined, the method remains controversial. METHODS: We report here on a continuous experience that encompassed a total of 1251 cardiosurgical patients who underwent various procedures via median sternotomy. Beginning in October 2015 and in response to a surge of DSWC (4.4%), 3 surgeons on our team began to apply 2.5 g vancomycin paste to the sternal edges just prior to closure, while the remaining 2 surgeons did not. An interim analysis comparing the 2 groups suggested that vancomycin was indeed effective, and from February 2016 on, all surgeons adopted the routine use of vancomycin in all patients. RESULTS: Retrospective analysis of 496 surgical patients from January to September 2015 had revealed a baseline incidence of DSWC of 4.4%. In the divided-use period between October 2015 and February 2016, DSWC was seen in 8.6% (8 of 93) of the no-vancomycin group. In the vancomycin group, the incidence fell to 0.8% (1 of 129). In March 2016, all surgeons began using vancomycin and the overall rate of DSWC for all surgeons and all patients subsequently declined to 1.1%. No adverse effects were observed. CONCLUSIONS: Topical vancomycin application is highly effective in the prevention of DSWC after median sternotomy.

Ngarraanga Giinganay ('thinking peacefully'): Co-design and pilot study of a culturally-grounded mindfulness-based stress reduction program with older First Nations Australians.

First Nations 'survivors' are ageing in increasing numbers. Life-course stress and depression are of concern for older First Nations Australians, yet there are limited psychosocial interventions. This study aimed to co-design a culturally-grounded mindfulness-based program ('Ngarraanga Giinganay') and evaluate acceptability/feasibility with an Aboriginal community on Gumbaynggirr Country. An expert Working Group guided program development, with Aboriginal and non-Aboriginal clinicians/consultants. A workshop, collaborative yarning group with older Aboriginal people (n = 9), and further consultation contributed to the design/refinement of the 8-session group-based program, ensuring content aligned with therapeutic principles of mindfulness and cultural understandings of the Gumbaynggirr community. A single-group pilot study was conducted (n = 7, 62-81 years), co-facilitated by an Aboriginal clinician and Elder. Outcomes were qualitative (understandings of mindfulness, program acceptability, benefits to health/wellbeing). Pilot results demonstrated feasibility, acceptability and preliminary effectiveness. The program enhanced understandings of mindfulness and participants highlighted benefits such as helping anxiety, relaxation, focusing on the moment and connection to Country/land. Trends were seen for reducing depression, anxiety and stress symptoms, and blood pressure. This study provides insight into partnering with underrepresented populations through ageing research, highlighting the effectiveness of this co-design approach. Ngarraanga Giinganay has considerable potential for supporting health and wellbeing of First Nations peoples.

Patterns and preferences for accessing health and aged care services in older Aboriginal and Torres Strait Islander Australians.

OBJECTIVES: To determine preferences for health and aged care services in Aboriginal and Torres Strait Islander Australians and explore related factors. METHODS: Mixed-method, cross-sectional study including 336 Aboriginal and Torres Strait Islander people aged 60 years and older from regional and urban areas. RESULTS: Exclusive preference for Aboriginal Community Controlled services was most common. This preference significantly increased when preferences for, and use of, aged care and disability services were considered. The likelihood of holding an exclusive preference for Aboriginal Community Controlled services was higher in regional settings compared to urban and in those reporting lower engagement in traditional activities during childhood. CONCLUSIONS: These findings suggest that the majority of older Australian Aboriginal and Torres Strait Islander people prefer aged and disability care provided by Aboriginal services. Given the anticipated increase in service demand in this population, there is a growing need for culturally safe services, particularly in regional settings.

Older Aboriginal Australians' Health Concerns and Preferences for Healthy Ageing Programs.

While there is strong evidence of the need for healthy ageing programs for older Aboriginal Australians, few are available. It is important to understand older Aboriginal Australians' perspectives on healthy ageing in order to co-design culturally-appropriate programs, including views on technology use in this context. Semi-structured interviews were conducted with 34 Aboriginal Australians aged 50 years and older from regional and urban communities to explore participants' health concerns, preferences for healthy ageing programs, and receptiveness to technology. Qualitative data were analyzed using a grounded theory approach. This study found that older Aboriginal Australians are concerned about chronic health conditions, social and emotional well-being, and difficulties accessing health services. A range of barriers and enablers to participation in current health programs were identified. From the perspective of older Aboriginal people, a successful healthy ageing program model includes physical and cognitive activities, social interaction, and health education. The program model also provides culturally safe care and transport for access as well as family, community, cultural identity, and empowerment regarding ageing well as central tenets. Technology could also be a viable approach for program delivery. These findings can be applied in the implementation and evaluation of culturally-appropriate, healthy ageing programs with older Aboriginal people.

Survival of Cast Gold and Ceramic Onlays Placed in a School of Dentistry: A Retrospective Study.

PURPOSE: This study was done to compare the survival rates of cast gold and ceramic onlays placed in a dental school setting. MATERIAL AND METHODS: An electronic search was conducted in the patient records at Adams School of Dentistry, University of North Carolina at Chapel Hill for onlay codes that were in the database (From 1998 until 2018). Progress notes and radiographs were scrutinized to establish the survival time of the restorations. Any complications that occurred during the life time of the restorations were noted. The survival was summarized by categorization based on ranges of survival time in years; group 1: 1 to 5 years, group 2: 6 to 22 years. The mean survival time and standard deviation were calculated. One-way ANOVA was used to determine whether there was a statistically significant difference in the survival times between gold and ceramic onlays. RESULTS: The mean survival rate of cast gold onlays (86.6%) was comparable to that of ceramic onlays (81.1%). The gold onlays in Group 1 had a higher mean survival time (2.43 years) than the ceramic onlays (2.03 years). This difference was statistically significant (p = 0.002). The ceramic onlays in Group 2 had a mean survival time of 19.75 years while gold onlays had a mean survival time of 17.63 years. This difference was not statistically significant (p = 0.91). CONCLUSION: It was concluded that while the survival rate of ceramic onlays (81.1%) was inferior to that of cast gold onlays (86.6%), it was comparable.

The effect of staining and vacuum sintering on optical and mechanical properties of partially and fully stabilized monolithic zirconia.

The effect of staining and vacuum sintering on optical properties and the bi-axial flexural strength of partially and fully stabilized monolithic zirconia (PSZ, FSZ) were evaluated. Disc-shaped specimens divided into three subgroups (n=15): non-stained, stained and non-stained with vacuum sintering. After staining and sintering, optical properties were evaluated using a reflection spectrophotometer and bi-axial flexural strength was tested using the piston-on-three balls technique. Statistical analysis was performed using multivariate analysis of variance (MANOVA) followed by post-hoc Tukey's tests (p<0.05). Staining decreased translucency parameter (TP) values of FSZ (p<0.05). Sintering under vacuum enhanced TP values for PSZ (p<0.05). Staining enhanced surface gloss for both types of zirconia (p<0.05). Staining increased bi-axial flexural strength of FSZ (p<0.05), while it decreased the strength of PSZ (p<0.05). Sintering under vacuum provided minimal benefits with either type of zirconia.

Impact of gastric acidic challenge on surface topography and optical properties of monolithic zirconia.

OBJECTIVE: To evaluate the surface topography and optical properties of monolithic zirconia after immersion in simulated gastric acid. MATERIALS AND METHODS: Four partially stabilized (PSZ) and one fully stabilized (FSZ) zirconia materials were selected for the study: Prettau (PRT, Zirkonzahn), Zenostar (ZEN, Ivoclar), Bruxzir (BRX, Glidewell), Katana (KAT, Noritake) and FSZ Prettau Anterior (PRTA, Zirkonzahn). IPS e.max (Ivoclar) was used as a control. The specimens (10×10×1.2mm, n=5 per material) were cut, sintered, polished and cleaned before immersed in 5ml of simulated gastric acid solution (Hydrochloric acid (HCl) 0.06M, 0.113% solution in deionized distal water, pH 1.2) for 96h in a 37°C incubator. Specimens were weighed and examined for morphological changes under scanning electron microscope (SEM) coupled with energy dispersive X-ray spectroscopy (EDX). Surface roughness was evaluated by a confocal microscope. Surface gloss and translucency parameter (TP) values were determined by a reflection spectrophotometer before and after acid immersion. The data was analyzed by one-way ANOVA followed by Tukey's HSD post hoc test (p<0.05). RESULTS: PRTA displayed the most weight loss (1.40%) among the zirconia specimens. IPS e.max showed about three times more weight loss (3.05%) than zirconia specimens as an average. SEM examination indicated areas of degradation, bead-like shapes and smoothening of the polishing scratches after acid immersion. EDX displayed ion interactions and possible ion leaching from all specimens. Sa and Sq values for PRTA, ZEN and IPS e.max were significantly lower (p<0.05) after acid immersion. TP values increased significantly for PRT, ZEN and IPS e.max (p<0.05), while the surface gloss of ZEN, PRTA and IPS e.max increased (p<0.05). SIGNIFICANCE: Monolithic zirconia materials show some surface alterations in an acidic environment with minimum effect on their optical properties. Whether a smoother surface is in fact a sign of true corrosion resistance or is purely the result of an evenly progressive corrosive process is yet to be confirmed by further research.

Optical properties and light irradiance of monolithic zirconia at variable thicknesses.

OBJECTIVES: The aims of this study were to: (1) estimate the effect of polishing on the surface gloss of monolithic zirconia, (2) measure and compare the translucency of monolithic zirconia at variable thicknesses, and (3) determine the effect of zirconia thickness on irradiance and total irradiant energy. METHODS: Four monolithic partially stabilized zirconia (PSZ) brands; Prettau® (PRT, Zirkonzahn), Bruxzir® (BRX, Glidewell), Zenostar® (ZEN, Wieland), Katana® (KAT, Noritake), and one fully stabilized zirconia (FSZ); Prettau Anterior® (PRTA, Zirkonzahn) were used to fabricate specimens (n=5/subgroup) with different thicknesses (0.5, 0.7, 1.0, 1.2, 1.5, and 2.0mm). Zirconia core material ICE® Zircon (ICE, Zirkonzahn) was used as a control. Surface gloss and translucency were evaluated using a reflection spectrophotometer. Irradiance and total irradiant energy transmitted through each specimen was quantified using MARC® Resin Calibrator. All specimens were then subjected to a standardized polishing method and the surface gloss, translucency, irradiance, and total irradiant energy measurements were repeated. Statistical analysis was performed using two-way ANOVA and post-hoc Tukey's tests (p<0.05). RESULTS: Surface gloss was significantly affected by polishing (p<0.05), regardless of brand and thickness. Translucency values ranged from 5.65 to 20.40 before polishing and 5.10 to 19.95 after polishing. The ranking from least to highest translucent (after polish) was: BRX=ICE=PRT

Degree of conversion of dual-polymerizing cements light polymerized through monolithic zirconia of different thicknesses and types.

STATEMENT OF PROBLEM: Monolithic zirconia restorations are increasingly common. Dual-polymerizing cements have been advocated for cementation. The opacious nature of zirconia restoration can attenuate light, compromising optimal resin polymerization and eventually restoration debonding. PURPOSE: The purpose of this in vitro study was to evaluate the influence of material thickness on light irradiance, radiant exposure, and the degree of monomer conversion (DC) of 2 dual-polymerizing resin cements light-polymerized through different brands of monolithic zirconia. MATERIAL AND METHODS: Dual-polymerizing resin cements (RelyX Ultimate; 3M-ESPE, and Variolink II; Ivoclar, Vivadent) were mixed according to the manufacturers' instructions with a film thickness of 40 µm, placed under a 10 × 10 mm specimen of monolithic zirconia (Prettau Anterior by Zirkonzahn, Katana by Noritake, BruxZir by Glidewell, and Zenostar by Wieland) and a zirconia core control (ICE zirkon by Zirkonzahn) at various thicknesses (0.50, 1.00, 1.50, and 2.00 mm, n = 5 of each thickness). Each specimen was irradiated for 20 seconds (RelyX Ultimate) and 40 seconds (Variolink II) with Elipar S10 (3M-ESPE, 1200 mW/cm(2)). The amount of irradiance and radiant exposure was quantified for each specimen. Fourier transform infrared spectroscopy was used to measure the DC from the bottom surface of the resin. Statistical analysis was performed with 2-way ANOVA and post hoc Tukey honest significant difference (HSD) tests (α = .05). RESULTS: Light irradiance and radiant exposure decreased as the thickness of the specimen increased (P < .05) regardless of the brand. The ranking from least to highest was BruxZir < ICE zircon = Wieland < Katana = Prettau Anterior. The zirconia brand, thickness, and cement type had a significant effect on the DC (P < .001). The DC decreased significantly as the thickness of the zirconia increased (P < .001). Katana and Prettau Anterior showed the highest DC and BruxZir showed the lowest. CONCLUSION: The thickness of zirconia affects the DC of resin-based cements. The DC of the resin cements differed significantly between cements and among zirconia brands. More polymerizing time may be needed to deliver sufficient energy through some brands of zirconia.

Dynamic Abutment: A method of redirecting screw access for implant-supported restorations: Technical details and a clinical report.

The esthetic outcome of implant-supported restorations is affected by the implant position. A well-placed implant will allow appropriate contours of the restoration and together with an adequate volume of soft tissue will result in a functional and esthetic restoration. When a screw-retained restoration is anticipated, an implant that is angled too far facially would be esthetically unacceptable. In 2004, an abutment called the Dynamic Abutment (Talladium International Implantology) became commercially available. This abutment can allow a deviation of the restoration screw access angle to the implant angle of up to 28 degrees while allowing a screw-retained restoration to be connected directly to the platform of the implant. The purpose of this article was to describe the components, technique, and clinical use of this abutment.

A retrospective multicenter study of the Artelon® carpometacarpal joint implant.

BACKGROUND: This study aims to evaluate patient outcomes associated with use of the Artelon® Spacer for the treatment of arthritis of the carpometacarpal joint (CMCJ) of the thumb. METHODS: Patients with Eaton stage I, II, or III carpometacarpal (CMC) joint arthritis and disabling pain that had failed conservative treatment were evaluated at 12, 36, and 48 months postsurgery for changes in pinch, patient satisfaction, pain, range of motion, grip strength, grind test, operative time, and X-ray evidence of subsidence. RESULTS: Complete data was available for 46 subjects and 49 thumbs. A statistically significant improvement in pain when subjected to a first CMC joint grind test, CMCJ stability and patient perception of hand and wrist function following implant insertion was seen. Patient-oriented outcomes showed statistically significant improvement in the Disabilities of the Arm, Shoulder, and Hand; pain; pinch and grip strength; and range of motion. X-ray analysis revealed that none of the distributions of measures of osteophytes, subluxation, and joint space narrowing showed statistically significant change. Bone erosion/remodeling changes of the first metacarpal were statistically significant. CONCLUSIONS: At a follow-up period of 4 years, patients had measured improvement as well as positive self-reported functional improvements following Artelon® implant insertion for the treatment of arthritis of the thumb CMCJ.