Interrater reliability of a customized submaximal cycle ergometer test.

PURPOSE: Graded exercise testing (GXTs) is used to determine maximum oxygen uptake ([Formula: see text]). Recently, customized submaximal exercise testing (CSET) completed on both treadmill and cycle ergometry were validated. METHODS: Interrater reliability of the CSET for cycle ergometry was examined. Thirteen participants (age 31 ± 10.2 y, weight 77.9 ± 10.5 kg, height 176.2 ± 9.9 cm, body mass index 25.1 ± 2.9) completed the 2-stage × 3-min CSET protocol performed by two separate testers. True [Formula: see text] was determined using the highest value derived by a GXT and verification bout. Skeletal muscle oxygen saturation ([Formula: see text]), measured using near-infrared spectrometry on the medial gastrocnemius muscle, and [Formula: see text] were monitored during each CSET; whereby, [Formula: see text] kinetics were modeled breath-by-breath data for each 3-min stage. Measurement agreement was quantified using intraclass coefficient (ICC), typical error (TE), and coefficient of variation (CV). RESULTS: "True" [Formula: see text] (ml·kg-1·min-1) between the GXT (41.3 ± 10.5) and verification (42.5 ± 11.5) was established (ICC = 0.98, TE: 0.98, CV 2.1%). Estimated [Formula: see text] by tester 1 (42.5 ± 9.8) and tester 2 (42.7 ± 8.9) did not differ from "true" [Formula: see text] (F2,36 = 0.02, p = 0.98, ηp2 = 0.00). The second stage evoked a [Formula: see text] slow component of 194 ± 124 ml·min-1 that corresponded with a time-dependent decline of [Formula: see text]. The mean [Formula: see text] from the two CSET testers were highly correlated (ICC = 0.91, TE: 4.1%, CV = 8.9%). CONCLUSIONS: The CSET is a reliable and valid procedure and [Formula: see text] is a useful tool for corroborating the second stage is in the heavy-intensity domain.

Treatment data and technical process challenges for practical big data efforts in radiation oncology.

The term Big Data has come to encompass a number of concepts and uses within medicine. This paper lays out the relevance and application of large collections of data in the radiation oncology community. We describe the potential importance and uses in clinical practice. The important concepts are then described and how they have been or could be implemented are discussed. Impediments to progress in the collection and use of sufficient quantities of data are also described. Finally, recommendations for how the community can move forward to achieve the potential of big data in radiation oncology are provided.

Pancreatic and gastric heterotopic tissue presenting as a symptomatic gallbladder mass: A case report and literature review.

Pancreatic and gastric heterotopia is an uncommon congenital anomaly in which gastric and/or pancreatic tissue is found outside of its anatomic location. In the majority of patients, lesions are found incidentally because they tend to be asymptomatic. However, lesions may become symptomatic when inflammation, obstruction, and bleeding occurs. Depending on tissue size and location they can harvest a landscape of nonspecific symptoms, causing a delay in diagnosis. Heterotopic tissue of either gastric or pancreatic origin have been reported in literature, however the presence of combined gastric and pancreatic heterotopic tissue is exceedingly rare. We report a case of an 18-year-old female with polypoid gastric and pancreatic heterotopia and focal intestinal metaplasia of the gallbladder with clinical findings of acute cholecystitis. In this literature review, we synthesize the clinical significance, histopathological features, diagnosis and management of pancreatic and gastric heterotopic tissue.

American dental hygienists' attitudes towards chairside medical screening in a dental setting.

OBJECTIVES: Targeted screening for medical conditions in a dental setting can be an effective strategy for early identification of individuals at increased disease risk. Dentists, patients and physicians have a favourable attitude towards this strategy. Given that dental hygienists (DHs) are involved in preventive and educational activities, this seems like a natural extension to their roles. We report on the attitudes of American DHs towards chairside medical screening. METHODS: A 5-point Likert scale (1 = very important/willing, 5 = very unimportant/unwilling) survey was mailed to a nationwide random sample of US practicing DHs. Descriptive statistics were used for all questions, and the Friedman nonparametric analysis of variance was used for multi-element questions. RESULTS: A total of 3133 respondents returned the completed questionnaires for an effective response rate of 49.2% and a margin of error 1.8%. The majority of respondents felt it was important to perform/conduct chairside screening for hypertension (94%), diabetes mellitus (89%), cardiovascular disease (85%), HIV (79%) and hepatitis infection (78%); were willing to refer a patient for medical consult (94%), conduct screening that yields immediate results (85%); and were willing to collect the data/samples needed (57-95%). The most important considerations were dentist/owner support (98%), training (97%), patient willingness (98%) and time (98%). CONCLUSION: Similar to dentists, physicians and patients, the majority of the DHs had a favourable attitude towards chairside medical screening. Integrating the DH into screening activities is likely to require additional training and education regarding the diseases of interest, something that could be accomplished through continuing education courses and eventually incorporation into the educational curriculum.

Multiscale investigations of drift-wave turbulence and plasma flows: measurements and total-distribution-function gyrokinetic simulations.

Direct measurements of micro-, meso-, and macroscale transport phenomena in the FT-2 tokamak are shown to be quantitatively reproduced by global full f nonlinear gyrokinetic simulation predictions. A detailed agreement with mean equilibrium E×B flows, oscillating fine-scale zonal flows, and turbulence spectra observed by a set of sophisticated microwave backscattering techniques as well as a good fit of the thermal diffusivity data are demonstrated. A clear influence of the impurity ions on the fluctuating radial electric field is observed.

Temporally resolved plasma composition measurements by collective Thomson scattering in TEXTOR (invited).

Fusion plasma composition measurements by collective Thomson scattering (CTS) were demonstrated in recent proof-of-principle measurements in TEXTOR [S. B. Korsholm et al., Phys. Rev. Lett. 106, 165004 (2011)]. Such measurements rely on the ability to resolve and interpret ion cyclotron structure in CTS spectra. Here, we extend these techniques to enable temporally resolved plasma composition measurements by CTS in TEXTOR, and we discuss the prospect for such measurements with newly installed hardware upgrades for the CTS system on ASDEX Upgrade.

Elevation angle alignment of quasi optical receiver mirrors of collective Thomson scattering diagnostic by sawtooth measurements.

Localized measurements of the fast ion velocity distribution function and the plasma composition measurements are of significant interest for the fusion community. Collective Thomson scattering (CTS) diagnostics allow such measurements with spatial and temporal resolution. Localized measurements require a good alignment of the optical path in the transmission line. Monitoring the alignment during the experiment greatly benefits the confidence in the CTS measurements. An in situ technique for the assessment of the elevation angle alignment of the receiver is developed. Using the CTS diagnostic on TEXTOR without a source of probing radiation in discharges with sawtooth oscillations, an elevation angle misalignment of 0.9° was found with an accuracy of 0.25°.

Intermediate frequency band digitized high dynamic range radiometer system for plasma diagnostics and real-time Tokamak control.

An intermediate frequency (IF) band digitizing radiometer system in the 100-200 GHz frequency range has been developed for Tokamak diagnostics and control, and other fields of research which require a high flexibility in frequency resolution combined with a large bandwidth and the retrieval of the full wave information of the mm-wave signals under investigation. The system is based on directly digitizing the IF band after down conversion. The enabling technology consists of a fast multi-giga sample analog to digital converter that has recently become available. Field programmable gate arrays (FPGA) are implemented to accomplish versatile real-time data analysis. A prototype system has been developed and tested and its performance has been compared with conventional electron cyclotron emission (ECE) spectrometer systems. On the TEXTOR Tokamak a proof of principle shows that ECE, together with high power injected and scattered radiation, becomes amenable to measurement by this device. In particular, its capability to measure the phase of coherent signals in the spectrum offers important advantages in diagnostics and control. One case developed in detail employs the FPGA in real-time fast Fourier transform (FFT) and additional signal processing. The major benefit of such a FFT-based system is the real-time trade-off that can be made between frequency and time resolution. For ECE diagnostics this corresponds to a flexible spatial resolution in the plasma, with potential application in smart sensing of plasma instabilities such as the neoclassical tearing mode (NTM) and sawtooth instabilities. The flexible resolution would allow for the measurement of the full mode content of plasma instabilities contained within the system bandwidth.

Clinical research and diagnostic efficacy studies in the oral and maxillofacial radiology literature: 1996-2005.

OBJECTIVES: The aim of this study was to determine the level of evidence that is published in the oral and maxillofacial radiology (OMR) literature. METHODS: OMR papers published in Dentomaxillofacial Radiology and Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology between 1996 and 2005 were classified using epidemiological study design and diagnostic efficacy hierarchies. The country of origin and number of authors were noted. RESULTS: Of the 725 articles, 384 could be classified with the epidemiological study design hierarchy: 155 (40%) case reports/series and 207 (54%) cross-sectional studies. The distribution of study designs was not statistically significant across time (Fisher's exact test, P = 0.06) or regions (P = 0.89). The diagnostic efficacy hierarchy was applicable to 246 articles: 71 (29%) technical efficacy and 166 (67%) diagnostic accuracy studies. The distribution of efficacy levels was not statistically significant across time (P = 0.22) but was significant across regions (P < 0.01). Authors from Japan produced 26% of the papers with a mean ± standard deviation of 5.78 ± 1.98 authors per paper (APP); American authors, 23% (3.78 ± 1.72 APP); and all others, 51% (3.76 ± 1.51 APP). CONCLUSION: The OMR literature consisted mostly of case reports/series, cross-sectional, technical efficacy and diagnostic accuracy studies. Such studies do not provide strong evidence for clinical decision making nor do they address the impact of diagnostic imaging on patient care. More studies at the higher end of the study design and efficacy hierarchies are needed in order to make wise choices regarding clinical decisions and resource allocations.

Measurements of intrinsic ion Bernstein waves in a tokamak by collective Thomson scattering.

In this Letter we report measurements of collective Thomson scattering (CTS) spectra with clear signatures of ion Bernstein waves and ion cyclotron motion in tokamak plasmas. The measured spectra are in accordance with theoretical predictions and show clear sensitivity to variation in the density ratio of the main ion species in the plasma. Measurements with this novel diagnostic demonstrate that CTS can be used as a fuel ion ratio diagnostic in burning fusion plasma devices.

Comparison of Computer-based Clinical Decision Support Systems and Content for Diabetes Mellitus.

BACKGROUND: Computer-based clinical decision support (CDS) systems have been shown to improve quality of care and workflow efficiency, and health care reform legislation relies on electronic health records and CDS systems to improve the cost and quality of health care in the United States; however, the heterogeneity of CDS content and infrastructure of CDS systems across sites is not well known. OBJECTIVE: We aimed to determine the scope of CDS content in diabetes care at six sites, assess the capabilities of CDS in use at these sites, characterize the scope of CDS infrastructure at these sites, and determine how the sites use CDS beyond individual patient care in order to identify characteristics of CDS systems and content that have been successfully implemented in diabetes care. METHODS: We compared CDS systems in six collaborating sites of the Clinical Decision Support Consortium. We gathered CDS content on care for patients with diabetes mellitus and surveyed institutions on characteristics of their site, the infrastructure of CDS at these sites, and the capabilities of CDS at these sites. RESULTS: The approach to CDS and the characteristics of CDS content varied among sites. Some commonalities included providing customizability by role or user, applying sophisticated exclusion criteria, and using CDS automatically at the time of decision-making. Many messages were actionable recommendations. Most sites had monitoring rules (e.g. assessing hemoglobin A1c), but few had rules to diagnose diabetes or suggest specific treatments. All sites had numerous prevention rules including reminders for providing eye examinations, influenza vaccines, lipid screenings, nephropathy screenings, and pneumococcal vaccines. CONCLUSION: Computer-based CDS systems vary widely across sites in content and scope, but both institution-created and purchased systems had many similar features and functionality, such as integration of alerts and reminders into the decision-making workflow of the provider and providing messages that are actionable recommendations.

Collective Thomson scattering measurements with high frequency resolution at TEXTOR.

We discuss the development and first results of a receiver system for the collective Thomson scattering (CTS) diagnostic at TEXTOR with frequency resolution in the megahertz range or better. The improved frequency resolution expands the diagnostic range and utility of CTS measurements in general and is a prerequisite for measurements of ion Bernstein wave signatures in CTS spectra. The first results from the new acquisition system are shown to be consistent with theory and with simultaneous measurements by the standard receiver system.

Root canal system in the mesiobuccal root of the maxillary first molar: an in vitro comparison study of computed tomography and histology.

OBJECTIVES: The purpose of this study was to investigate a new diagnostic approach to the examination of the canal configuration of the mesiobuccal root of the maxillary first molar. MATERIALS AND METHODS: High-resolution computed tomography (CT) was compared with histology in vitro. There were 152 teeth investigated and classified according to Weine and Vertucci. RESULTS: CT describes the exact canal configuration, verifying information identical to histology, and thus serving as the "gold standard" in vitro. With regard to canal position, 9 (5.92%) of the teeth examined were Vertucci type 1, 48 (31.58%) were Vertucci type 2, 91 (59.87%) were Vertucci type 4, 1 (0.66%) was Vertucci type 5, 1 (0.66%) was Vertucci type 6. Of the 152 teeth examined, 3 (1.97%) could not be classified using Weine, 2 (1.31%) could not be classified according to either Weine or Vertucci, and no Vertucci types 3, 7 or 8 were identified. CONCLUSIONS: CT offers complete information on the number and configuration of root canals. As the root canal configuration of the adult does not change rapidly, CT investigations can be used for multiple subsequent treatments.

Modeling multivariate binary responses with multiple levels of nesting based on alternating logistic regressions: an application to caries aggregation.

Clustered binary responses are commonly encountered in dental research. Data analysis may include modeling both the marginal response probabilities (i.e., risk) and the dependence structure between pairs of responses (i.e., aggregation). While second-order generalized estimating equations (GEE2) is a well-known approach for such data, alternating logistic regressions (ALR) is a computationally efficient alternative method, especially for large clusters. We illustrate ALR with an application to caries aggregation using a dataset with 3 levels of nesting: tooth surfaces within an interproximal (IP) region, IP regions within a jaw, and jaws within a subject. Caries lesions appear to aggregate strongly within subjects with a spatially distributed risk. The minimum within-IP-region odds ratio (OR) was 2.25 (95% confidence interval 1.15, 4.41), and the within-IP-region ORs were always greater than the between-IP-region ORs. ALR is a convenient and useful regression technique for explicit modeling of the dependence structure, and may be applicable to other dental research problems involving clustered or nested responses.

New insights into the mechanisms of the thermal Fenton reactions occurring using different iron(II)-complexes.

Although the Fenton reagent (a mixture of hydrogen peroxide and an iron(II) salt) has been known for more than a century, the manifold mechanisms occurring during the thermal Fenton reaction are still under discussion. Indeed, this discussion served as a powerful driving force for the steadily increasing insight into the field of inorganic radical and electron transfer chemistry. In this work, an experimental approach towards the elucidation of the first steps taking place in the reaction between several iron(II)-complexes and hydrogen peroxide (H2O2) in water at pH = 3.0 is presented. 2,4-xylidine (2,4-dimethylaniline) reacts differently with reactive intermediates via the addition or hydrogen abstraction by the hydroxyl radical (HO*) or electron transfer reactions to higher valent iron-species, such as a hydrated ferryl-complex (Fe(IV)). The chemical reactivity of the employed iron(II)-complexes with H2O2 differed strongly depending on their ground-state one-electron oxidation potentials. The results are interpreted in accordance with the paradigm originally developed by Goldstein et al. which is based on the evidence obtained from the Marcus theory that outer-sphere electron transfer reactions between metal complexes are not likely to occur because they are too slow. Therefore, most of the "Fenton-reagents" form transient metal complexes, which can be described as [LnFe-H2O2]m+. They form, depending on the reaction conditions, either the hydroxyl radical or higher-valent iron complex species.

Degradation of polyvinyl alcohol (PVA) by homogeneous and heterogeneous photocatalysis applied to the photochemically enhanced Fenton reaction.

The reaction mechanism of the oxidative degradation of polyvinyl alcohol (PVA) by the photochemically enhanced Fenton reaction was studied using a homogeneous (Fe2+(aq) + H2O2) and a heterogeneous reaction system (iron(III)-exchanged zeolite Y+ H2O2). In the homogeneous Fenton system, efficient degradation was observed in a batch reactor, equipped with a medium pressure mercury arc in a Pyrex envelope and employing 80% of the stoichiometric amount of H2O2 required for the total oxidation of PVA and a concentration ratio as low as I mole of iron(II) sulfate per 20 moles of PVA sub-units (C2H40). Model PVA polymers of three different molecular weights (15,000, 49,000 and 100,000 g mol(-1)) were found to follow identical degradation patterns. Strong experimental evidence supports the formation of supermacromolecules (MW: 1-5 x 10(6) g/mol) consisting of oxidized PVA and trapped iron(III) at an early reaction stage. Low molecular weight intermediates, such as oxalic acid, formic acid or formaldehyde were not found during PVA degradation in the homogeneous Fenton system, and we may deduce that the manifold of degradation reactions is mainly taking place within the super-macromolecules from which CO2 is directly released. However, in the heterogeneous Fenton system, the reaction behavior was found to be distinctly different: a decrease of the molecular weights of all three tested monodisperse PVA samples was observed by the broadening of the GPC-traces during irradiation, and oxalic acid was formed. The results lead to the mechanistic hypothesis that during the heterogeneous Fenton process, the cleavage of the PVA-chains may occur at random positions, the reactive centres being located inside the iron(III)-doped zeolite Y photocatalysts.

Attributes and practices of oral and maxillofacial radiology departments in US and Canadian dental schools.

OBJECTIVE: To assess the actual state of oral and maxillofacial radiology departments in US and Canadian dental schools against the ideal characteristics defined by the American Academy of Oral and Maxillofacial Radiology (AAOMR) 1997 position paper. STUDY DESIGN: Cross-sectional survey of all 65 US and Canadian dental schools. RESULTS: Sixty-four surveys were returned (98%). At most schools, oral and maxillofacial radiology (OMR) was an identifiable division of a department, established policies, and had operational authority for radiographic practices in the primary radiology clinic. The majority of full-time faculty (72%) had formal training in OMR; the majority of part-time faculty (86%) did not. Full-time faculty spent approximately 60% of their time teaching, with the remainder of their time divided among research and scholarship, faculty practice, and service. Routine x-ray equipment was universally available; advanced imaging technologies were not. OMR faculty involvement in the interpretation of radiographs varied across diseases and conditions. Most published scholarship (85%+) was produced by full-time faculty. Average output was 1 paper per person per year, but a relatively small cadre of OMR faculty generated most papers. CONCLUSIONS: In some attributes, the status of OMR closely approximated the ideal characteristics established in the AAOMR report. Among the remaining attributes, bridging the difference between the actual and the ideal will be the challenge for the next 5 years.

Use of radiology practice guidelines and compliance with accreditation standards in US and Canadian dental schools.

In 1992 and 1997, all US and Canadian dental schools were surveyed by mail regarding the preferred initial radiographic examination prescribed for non-emergency, comprehensive-care patients (dentulous adults, edentulous adults, and children). In both survey years, a minority of US and Canadian dental schools reported using selection criteria for dentulous adults and children, while nearly all schools reported doing so for edentulous adults. The purpose of this secondary analysis was to investigate the relationship between the use of radiology selection criteria (vs. predetermined routine examinations) in US and Canadian dental school clinics and three factors: (1) the credentials of the chief-of-service, (2) institutional funding, and (3) geographic region. "Credentials of the chief-of-service" is the single factor significantly related to the distributions of radiographic examinations prescribed for dentulous adults in both years (Fisher exact test, p < or = 0.02). There are no statistically significant relationships for edentulous adults or children in either year. Multivariate analyses (logistic regression) of the 1997 data reveal that institutions with a credentialed chief-of-service are 2.39 times more likely to report using selection criteria than institutions with a noncredentialed chief-of-service; private institutions are 1.13 times more likely than public institutions, and Canadian schools are 3.65 times more likely than US schools. A similar trend was identified for children. Analysis of the 1992 data revealed similar trends for the credentials of the chief-of-service and the geographic region, but showed no association between institutional funding source and the use of selection criteria. Contrary to accreditation standards, most US and Canadian dental schools obtained pre-determined routine radiographic examinations on most new patients. However, the presence of a credentialed chief-of-service had a positive effect on the use of selection criteria for dentulous adults and children.

[Influence of risk factor "hot foods over 37 degrees Celsius" on oral flora and the pathogenesis of gingivitis and periodontitis]. / Der Einfluss des Risikofaktors "Nahrung mit mehr als 37 degrees C" auf die Keimzahl der Mundhöhle und die Entstehung von entzündlichen Parodontopathien.

Austrian law prescribes that hot food and beverages must be served at a minimum temperature of 75 degrees C. Within a group of 50 volunteers, we studied hot food at a temperature higher than 37 degrees C as a risk factor for the pathogenesis of gingivitis and periodontitis. In the first part of the investigation the effects of heat on bacterial growth in the mouth were evaluated. Bacterial growth was significantly reduced after drinking hot tea (70 degrees C) (p < 0.001). The ability of the volunteers to estimate the temperature of a direct heat stimulus in the mouth was tested in the second part of the study. 82% of the volunteers underestimated the temperature of tea (70 degrees C) by about 15 degrees C. In the third part of the study the periodontal state of the volunteers was determined by index measurements. Moreover, eating behaviour was assessed by a questionnaire. No statistically significant correlation between eating behaviour (hot/cold) and periodontal inflammation was found.