Comparative Study Between Non-Diffractive Extended Depth of Focus and Monofocal Intraocular Lenses.

Purpose: To evaluate the visual acuity and quality of vision in bilaterally implanted ZCBOO/ZCTx monofocal (Johnson & Johnson Vision) intraocular lens (IOL) and bilaterally implanted DATx15 extended depth of focus (EDOF) IOL (Alcon Vision, LLC). Methods: A single site, non-interventional study comparing ZCBOO/ZCTx monofocal IOL patients implanted with DATx15 IOL toric or non-toric versions in both eyes. A total of 30 patients (60 eyes) completed the study in the monofocal group, 32 (64 eyes) in the EDOF group, and all were targeted for emmetropia. Binocular uncorrected distance, intermediate (66cm), and near (40cm) visual acuities and distance corrected distance, intermediate (66cm) and near (40cm) visual acuities were assessed. Binocular distance corrected defocus curve testing was from -3.5 D to +3 D. Patient reported visual disturbances (QUVID) and IOL satisfaction (IOLSAT) questionnaires were administered. Results: The DATx15 group mean uncorrected visual acuity was 0.15 ± 0.10 logMAR at 66cm and 0.36 ± 0.14 logMAR at 40cm, compared to 0.24 ± 0.15 logMAR and 0.59 ± 0.17 logMAR respectively for the ZCBOO/ZCTx group. The DATx15 group (23 respondents, 74%) also reported significantly more spectacle independence at near with the IOLSAT (p < 0.01), compared to the ZCBOO/ZCTx group (13 respondents, 43%). Glare, halos, starbursts, and blur reported on the QUVID questionnaire were similar in the two groups. Conclusion: The DATx15 group had improved near and intermediate vision and increased spectacle independence compared to the ZCBOO/ZCTx group.

Age estimation of Hispanic children using the London Atlas.

PURPOSE: To test the accuracy of the London Atlas for age estimation of Hispanic children and to determine if there is any difference in age accuracy between Hispanic males and females. METHODS: The London Atlas was used to estimate age from panoramic radiographs of 17 males and 17 females for each year of age from six to 15.99 years, using the electronic patient database of a dental school. Exclusion criteria included gross pathology, hypodontia, hyperdontia, and previous orthodontic treatment. RESULTS: There were 332 panoramic radiographs evaluated. In all age groups, 34 radiographs (from 17 males and 17 females) were reviewed, except for the age bracket 6-6.99 years, for which only 26 radiographs were available. The mean age estimated of the entire sample by the London Atlas (11.44 years) was greater than the mean chronological age (11.09 years), which was statistically significant (P<.001). The mean difference between chronological and estimated ages for males was .30 years and for females was .40 years, but the difference between sexes was not significant (P=.324). One hundred sixty-two radiographs (49%) were estimated to the exact age interval while 45 (14%) were under-estimated and 125 (38%) were over-estimated. Two hundred and forty radiographs (72%) were estimated to a value within one year of the actual age. CONCLUSION: There was no difference in age estimation prediction accuracy between Hispanic males and females but an age overestimation of three percent in the cohort was seen. The London Atlas accuracy is suitable for use in forensic investigation.

The Evolving Role of Dental Responders on Interprofessional Emergency Response Teams.

Disaster and pandemic response events require an interprofessional team of health care responders to organize and work together in high-pressure, time-critical situations. Civilian oral health care professionals have traditionally been limited to forensic identification of human remains. However, after the bombing of the Twin Towers in New York, federal agencies realized that dentists can play significant roles in disaster and immunization response, especially on interprofessional responder teams. Several states have begun to incorporate dentists into the first responder community. This article discusses the roles of dental responders and highlights legislative advancements and advocacy efforts supporting the dental responder.

Safety and effectiveness of a new toric presbyopia-correcting posterior chamber silicone intraocular lens.

PURPOSE: To evaluate the safety and effectiveness of the Trulign toric intraocular lens (IOL) in adults with cataract. SETTING: Eight private practices in the United States and 1 in Canada. DESIGN: Prospective randomized single-masked multicenter study. METHODS: A toric IOL (1.25 D, 2.00 D, or 2.75 D, determined by a toric calculator) was implanted in eligible patients with age-related cataract requiring a 16.00 to 27.00 diopter (D) spherical IOL power and with a predicted postoperative astigmatism of 0.83 to 2.50 D. Eyes within the lowest cylinder range (predicted postoperative astigmatism 0.83 to 1.32 D) were randomized in a 1:1 ratio between the 1.25 D toric IOL group and the nontoric accommodating IOL (Crystalens) control group. RESULTS: The toric 1.25 D group had a statistically significantly greater percentage reduction in absolute cylinder (P < .001) and uncorrected distance visual acuity (P = .002) than the control group at the 120- to 180-day visit. The mean monocular uncorrected vision at distance, intermediate, and near was 20/25, 20/22, and 20/39, respectively, with the 1.25 D, 2.00 D, and 2.75 D toric IOLs in aggregate (toric group). In addition, 96.1% of patients (123/128) had 5.0 degrees or less absolute IOL rotation postoperatively. Regarding safety, the endpoints for preservation of corrected visual acuity and the incidence of complications and adverse events were met. CONCLUSION: The toric IOL was safe and effective in reducing the effects of preoperative corneal astigmatism and provided excellent uncorrected distance and intermediate vision and functional near vision. FINANCIAL DISCLOSURES: Dr. Pepose is a consultant to Bausch & Lomb and was medical monitor of this study. Drs. Buckhurst, Whitman, Feinerman, Hovanesian, Davies, Labor, and Carter are consultants to Bausch & Lomb. At the time of the study, Drs. Hayashida, and Khodai were employees of Bausch & Lomb. Drs. Colvard and Mittleman have financial or proprietary interest in any material or method mentioned.

Just-in-time training of dental responders in a simulated pandemic immunization response exercise.

ABSTRACT OBJECTIVE: The reauthorization of the Pandemic and All-Hazards Preparedness Act in 2013 incorporated the dental profession and dental professionals into the federal legislation governing public health response to pandemics and all-hazard situations. Work is now necessary to expand the processes needed to incorporate and train oral health care professionals into pandemic and all-hazard response events. METHODS: A just-in-time (JIT) training exercise and immunization drill using an ex vivo porcine model system was conducted to demonstrate the rapidity to which dental professionals can respond to a pandemic influenza scenario. Medical history documentation, vaccination procedures, and patient throughput and error rates of 15 dental responders were evaluated by trained nursing staff and emergency response personnel. RESULTS: The average throughput (22.33/hr) and medical error rates (7 of 335; 2.08%) of the dental responders were similar to those found in analogous influenza mass vaccination clinics previously conducted using certified public health nurses. CONCLUSIONS: The dental responder immunization drill validated the capacity and capability of dental professionals to function as a valuable immunization resource. The ex vivo porcine model system used for JIT training can serve as a simple and inexpensive training tool to update pandemic responders' immunization techniques and procedures supporting inoculation protocols.

Photodynamic therapy: occupational hazards and preventative recommendations for clinical administration by healthcare providers.

OBJECTIVE: Photodynamic therapy (PDT) as a medical treatment for cancers is an increasing practice in clinical settings, as new photosensitizing chemicals and light source technologies are developed and applied. PDT involves dosing patients with photosensitizing drugs, and then exposing them to light using a directed energy device in order to manifest a therapeutic effect. Healthcare professionals providing PDT should be aware of potential occupational health and safety hazards posed by these treatment devices and photosensitizing agents administered to patients. MATERIALS AND METHODS: Here we outline and identify pertinent health and safety considerations to be taken by healthcare staff during PDT procedures. RESULTS: Physical hazards (for example, non-ionizing radiation generated by the light-emitting device, with potential for skin and eye exposure) and chemical hazards (including the photosensitizing agents administered to patients that have the potential for exposure via skin, subcutaneous, ingestion, or inhalation routes) must be considered for safe use of PDT by the healthcare professional. CONCLUSIONS: Engineering, administrative, and personal protective equipment controls are recommendations for the safe use and handling of PDT agents and light-emitting technologies.

Application of immunohistochemical staining to detect antigen destruction as a measure of tissue damage.

Electrocautery and directed energy devices (DEDs) such as lasers, which are used in surgery, result in tissue damage that cannot be readily detected by traditional histological methods, such as hematoxylin and eosin staining. Alternative staining methods, including 3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) to stain live tissue, have been reported. Despite providing superior detection of damaged tissue relative to the hematoxylin and eosin (H&E) method, the MTT method possesses a number of drawbacks, most notably that it must be carried out on live tissue samples. Herein, we report the development of a novel staining method, "antigen destruction immunohistochemistry" (ADI), which can be carried out on paraffin-embedded tissue. The ADI method takes advantage of epitope loss to define the area of tissue damage and provides many of the benefits of live tissue MTT staining without the drawbacks inherent to that method. In addition, the authors provide data to support the use of antibodies directed at a number of gene products for use in animal tissue for which there are no species-specific antibodies commercially available, as well as an example of a species-specific direct antibody. Data are provided that support the use of this method in many tissue models, as well as evidence that ADI is comparable to the live tissue MTT method.

Natural products and traditional medicine: turning on a paradigm.

Paradigm shifts in the strategies and the sciences that would enhance the quality, safety, and efficacy of traditional medicines and dietary supplements in global health care are discussed. Some of the challenges facing traditional medicine in health care are described, and the importance of defining clear goals and directions for the information systems, botany, chemistry, and biology related to plants and health care, including for drug discovery and quality control, is indicated.

An assessment of the occupational hazards related to medical lasers.

OBJECTIVE: Occupational hazards associated with medical laser applications remain poorly understood and uncharacterized. METHODS: A literature search was performed using PubMed, and all articles relevant to beam and nonbeam medical laser hazards were reviewed. The Rockwell Laser Industries Laser Accident Database was searched for medical laser injuries and abstracted. RESULTS: Eye injuries, skin burns, injuries related to the onset of fires, and electric shock have been reported in relation to medical laser use. It is probable that both acute and chronic health effects have been experienced by medical personnel as the result of exposure to laser generated air contaminants. CONCLUSIONS: Because of the clinical benefits they provide, the growth of laser technologies and applications are anticipated to result in an increase in the number and type of medical personnel with future exposure to laser hazards.

Handheld directed energy sensor for environmental monitoring and clinician safety.

INTRODUCTION: Directed energy (DE) research and development is generating more powerful portable devices designed to support operational, environmental, clinical, point detection, and remote-sensing applications. These same DE devices present potential for injury, thereby impacting medical operations. The environmental surveillance and clinical communities require handheld sensor platforms that afford preemptive detection and monitoring of potentially hazardous exposures to DE and other electromagnetic (EM) frequencies. METHODS: A personal digital assistant (PDA) was interfaced with a wavelength sensor board via a multifunction data acquisition card to passively detect wavelengths in the 480-950 nm range. A 9V DC battery coupled to a voltage up-converter with a manual ON/OFF switch powered the sensor board. The sensor board was integrated with a standard operating system-based PDA. Graphical programming software integrated the data acquisition card with the PDA. RESULTS: The DE wavelength sensor/PDA platform detected and relayed laser radiation information from 480 to 950 nm ranges, with graphical data output to the PDA screen. DISCUSSION: This project demonstrated the technical ability to detect anthropogenic DE frequency signatures using a handheld, battery-driven DE sensor platform. Laboratory and field assessment studies are underway to validate operational applications. This DE-sensing prototype is designed explicitly for DE medical measurement and signatures intelligence (MED MASINT) to meet the protection needs of environmental and clinical operators.

Disaster medicine training survey results for dental health care providers in Illinois.

BACKGROUND: Ongoing vigilance by governments, public health agencies and health care professionals monitoring potential epidemic and pandemic outbreaks, terrorist threats and ever-present natural disasters requires the continuous evolution of comprehensive disaster response plans and teams, which include the integration of oral health care professionals. METHODS: The authors conducted a study in which oral health care professionals assessed their training in the American Medical Association's (AMA's) National Disaster Life Support (NDLS) courses. At the conclusion of each instructional session, the authors asked participants to complete an anonymous course evaluation form to report their impressions of the training activity. The authors included in the analysis those evaluations associated with sessions attended almost exclusively by dentists and hygienists. RESULTS: The authors derived descriptive statistics from the selected course evaluations. Overall, oral health care professionals believed that the Core Disaster Life Support (CDLS) and Basic Disaster Life Support (BDLS) courses were of great educational value, rating course impact at 9.50 and 9.29, respectively, on a scale from 1 to 10. CONCLUSIONS: Statistical evaluation instruments reveal satisfaction with the all-hazards awareness training received through the AMA's NDLS disaster medicine training curriculum. Licensed oral health care professionals in Illinois accepted the utility and merits of, and benefited from, the four-hour CDLS and eight-hour BDLS certification programs. Practice Implications. Dental professionals in Illinois require minimal additional training for dental emergency responder duties. The AMA's NDLS curriculum provides effective preparation for dental professionals.

Survey of medical ethnobotanicals for dental and oral medicine conditions and pathologies.

Ethnomedical questionnaires were distributed in Chicago, Costa Rica, and Colombia to identify the most common over-the-counter (OTC) plant or plant-based products advocated for treating oral pain, ulcerative conditions, and cancer within these locations. Over 100 plants or plant-based herbal preparations and commercial products, purchased from local botanical markets and pharmacies, were advocated for the treatment of oral medicine conditions. Locally familiar and common language names were attributed to the plant products at the time of purchase. Plant products or plant-based commercial products containing plant-based essential oils, anesthetic constituents, and or chemical compounds recommended as OTC oral medicine preparations were systematized, tabulated, and correlated with the published phytotherapeutic literature. Though pharmacognostic research is available for some of the species collected, further ethnographic research is needed to correlate common names with the accurate taxonomic identification for each plant species. Furthermore, epidemiological research is needed to verify the use and standardized dosage for OTC ethnomedicine preparations for oral medicine conditions. Pharmacognostic research and clinical trails which can verify taxonomy, dose, safety, active principles, and efficacy of these OTC oral medicine products must be enhanced in order to verify the claimed validity in contemporary, global, oral medicine practice.

The dental emergency responder: Expanding the scope of dental practice.

BACKGROUND: Natural disasters, the potential for terrorism and weapons-of-mass-destruction events occurring within the continental United States necessitate that all licensed health care providers understand the National Incident Management System and be able to contribute to inoculation, mass casualty assistance and triage care of the populace. CONCLUSIONS: Health care and political leaders constantly revise "all hazard" response plans, using the available health care assets that local, state and federal agencies bring to emergency events. Illinois Public Act 49-409 modifies the scope of dental practice within Illinois to allow for a dental emergency responder (DER). PRACTICE IMPLICATIONS: The DER is a dentist or dental hygienist "acting within the bounds of his or her license when providing care during a declared local, state or national emergency."

Some thoughts on the future of ethnopharmacology.

A discussion is offered of the future potential role of ethnopharmacology in global health care.