Levetiracetam-associated behavioral adverse events in neurocritical care patients.

STUDY OBJECTIVES: The objective of this study was to identify the incidence of levetiracetam-associated BAEs in NCC patients. DESIGN: Single-center retrospective cohort analysis. DATA SOURCE: Patient charts. PATIENTS: 965 adult ICU patients with a neurological injury receiving levetiracetam that were admitted to an intensive care unit. MEASUREMENTS AND MAIN RESULTS: There were 965 patients included; 52% males with a median GCS of 13. Injury types included TBI (43.1%), ICH (21.8%), SAH (20.5%), and CI (14.6%). BAEs were identified in 46% of patients. Of these, 60% had documentation of agitation/restlessness, delirium, or anxiety while receiving levetiracetam, only 25% had a positive CAM-ICU, 13% had restraints ordered, and 42% received antipsychotics. Patients with TBI had the highest incidence of BAEs (52.4%). The median time to initiation of levetiracetam after hospital admission was 6.4 hours and BAEs occurred after 1.3 days of levetiracetam initiation. CONCLUSIONS: In this study, we found that almost half of our NCC population experienced levetiracetam associated BAEs which were mostly hyperactive in nature. We believe that the incidence of BAEs in our specific patient population cannot solely be attributed to ICU delirium given the lower risk of developing hyperactive delirium in ICU patients as compared to other subtypes. Therefore, monitoring and determination of the benefit versus risk in those experiencing BAEs is highly encouraged.

Professionalism and professional identity formation in dental students: Revisiting the professional role orientation inventory (PROI).

OBJECTIVE: Professionalism is a hallmark of health professions education. Professional identity formation is a growing field of exploration in medical education, and the dental literature is sparse on just how professional identity formation is developed and assessed within dental education. METHODS: The validated professional role orientation inventory (PROI) was administered to 2nd year dental students during a spring semester ethics course. The PROI includes four 10-item scales representing four attitudinal factors: Authority, Responsibility, Agency, and Autonomy. RESULTS: When compared to a historical sample of dental students in the early 1990s, dental students today scored significantly higher on Responsibility (p = 0.0309) and lower on the Agency factor (p = 0.0001). Authority scores in the current sample of dental students were significantly associated with age and race, with an increase in age associated with a decrease in Authority (p = 0.0504) and Caucasian respondents demonstrating significantly higher scores than Asian or Other races. Debt was associated with differences in Autonomy (p = 0.0683) and Agency (p = 0.0106), with those in the 100k-300k anticipated debt range demonstrating lower levels of both Autonomy and Agency. Race was marginally associated with Responsibility with those in the Other race category (Hispanic, Black/African American, Other/Multiracial) demonstrating higher levels than Caucasian (p = 0.0513). CONCLUSION: Dental students' scores denote a continued commitment to others yet a feeling of less sense of control as a practicing professional. A redefining of professionalism to include social activism and advancing health equity is required given their altruism and commitment to others, which remains high.

Is Dose Volume a Better Predictor of Osteoradionecrosis Risk Than Total Dose for Patients Who Have Received Head and Neck Radiation?

PURPOSE: Oral and maxillofacial surgeons frequently encounter patients who require extractions following exposure to head and neck radiation, and they must assess the risk of extraction and consider alternatives such as deliberate root retention. The purpose of this study was to determine whether dose volume would be a better predictor for osteoradionecrosis (ORN) than total dose. METHODS: This is a retrospective cohort study of patients diagnosed with ORN following head and neck radiation (administered between January 2006 and December 2018) and a comparison group selected based on site and dosage who did not develop ORN. The predictor variables were total radiation dose and mandibular dose volume, and the outcome variable was ORN occurrence. Covariates included age, sex, cancer stage and site, radiation therapy type, smoking status, alcohol use, adjuvant chemotherapy use, medical comorbidities, and concomitant tumor surgery. Logistic regression models were employed and area under receiver operating characteristic curve (AUROC) and model accuracy (Acc) were used to determine the better predictor. RESULTS: A total of 56 patients were included in the study: 27 ORN positive (ORN+) and 29 matched controls who did not develop ORN (ORN-). Most patients were male (76.8%), considered smokers (78.6%), used alcohol (80.4%), were in stage IV (66.1%), received chemotherapy (75.0%), and received intensity modulated radiation therapy radiation (55.4%). The statistical models with V50 Gy (cc) and V65 Gy (cc) dosage variables exhibited greater predictability of ORN occurrence than total dose (AUROC: 0.90 vs 0.76 and model accuracy: 0.82 vs 0.75, respectively). CONCLUSIONS: The results suggest that following head and neck radiation, dose volume may be a better predictor of ORN risk than total dose. This finding is significant, both for the oral and maxillofacial surgeon who is preoperatively assessing ORN risk following radiation exposure, and for the radiation oncologist striving to minimize the risk associated with their treatment.

Comparison of 3-dimensional printing technologies on the precision, trueness, and accuracy of printed retainers.

INTRODUCTION: This study aimed to evaluate the differences in the precision, trueness, and accuracy of 3-dimensional (3D) printed clear orthodontic retainers fabricated using printer systems with different printing technologies. METHODS: Retainers (n = 15) were 3D printed using 4 different printers: stereolithography (SLA), digital light processing (DLP), continuous DLP, and polyjet photopolymer (PPP) printers. Printed retainers were transformed into a digital image through a cone-beam computed tomography scan and compared with the original image using 3D superimposition analysis software. At previously chosen landmarks (R6, L6, R3, L3, R1, and L1), intaglio surfaces of the retainers were compared to that of the reference model. The intercanine and the intermolar width measurements were also assessed. A discrepancy of up to 0.25 mm between the printed retainer and the reference retainer intaglio surfaces indicated accuracy and clinical acceptability. Precision and trueness were also determined. Root mean square and percent of points within the tolerance level were calculated for precision and trueness for each retainer. Statistical significance was set at P <0.05. RESULTS: Interrater correlation coefficient indicated good agreement. Statistically significant differences were found between printer types among the 6 landmarks and the arch width measurements. When evaluating tolerance level and root mean square, statistically significant differences in median precision and trueness among each printer type were found. CONCLUSION: Retainers fabricated by SLA, DLP, continuous DLP, and PPP technologies were shown to be clinically acceptable and accurate compared to the standard reference file. Based on both high precision and trueness, SLA and PPP printers yielded the most accurate retainers.

Outcomes following radical prostatectomy or external beam radiation for veterans with Gleason 9 and 10 prostate cancer.

BACKGROUND: The optimal upfront treatment modality for patients with nonmetastatic Gleason Score 9 and 10 prostate cancer (GS 9-10 PCa) is unknown. METHODS: We conducted a retrospective cohort study of patients in the Veterans Health Administration (VHA) with GS 9-10 PCa treated with radical prostatectomy (RP) or external beam radiation therapy with androgen deprivation therapy (EBRT+ADT) from 1/2000 to 12/2010. Outcomes included overall survival (OS), distant metastasis-free survival (DMFS), and salvage/adjuvant therapy-free survival (SAFS), as assessed by Kaplan-Meier analysis. RESULTS: We identified 1220 veterans with GS 9-10 PCa; 335 were treated with RP, and 885 were treated with EBRT+ADT. With a median follow-up of 9.9 years, propensity score-matched analyses demonstrated that RP had superior 10-year OS (70.8% [RP] vs. 61.2% [EBRT+ADT], p < 0.001), 10-year DMFS rates were similar between RP (76.7%) and EBRT+ADT (81.0%), and 10-year SAFS rates were lower for RP vs EBRT + ADT (35.2% [RP] vs. 75.2% [EBRT+ADT], p < 0.001). The receipt of salvage ADT was higher with upfront RP (51.9% vs. 26.1%, p < 0.001), despite receipt of adjuvant/salvage EBRT in 41.8% of RP patients. Among patients treated with RP, there were no differences in outcomes by race. However, higher survival rates were noted among Black patients treated with EBRT+ADT compared with White patients. CONCLUSIONS: This analysis demonstrated higher 10-year OS rates among men treated with upfront RP versus EBRT+ADT, though missing confounders and similar DMFS rates suggest the long-term cause-specific OS rates may be similar. We also highlight real-world outcomes of a diverse patient population in the VHA and improved outcomes for Black patients receiving EBRT+ADT.

Effect of print angulation on the accuracy and precision of 3D-printed orthodontic retainers.

INTRODUCTION: The study aimed to (1) compare the accuracy and precision of 3-dimensional (3D) printed retainers at various angulations and (2) evaluate the effect of angulation on printing time and the amount of resin consumed. METHODS: Using a stereolithography 3D printer, 60 clear retainers were printed at 5 angulations (n = 12, each): 15°, 30°, 45°, 60°, and 90°. Samples for each group were randomly printed in a batch of 6 retainers at all print angulations as print 1 and print 2 cycles. Digital images of the original and printed samples were superimposed. Discrepancies on 8 landmarks were measured by 2 independent examiners, and 0.25 mm was set as the clinically acceptable threshold to determine the accuracy of the retainers. RESULTS: Deviations ranged from 0.074 mm to 0.225 mm from the reference retainer at the cusp tips and incisal edges at all angulations, falling within the threshold of clinical acceptance. However, smooth surface measurements with deviations up to 0.480 mm were deemed clinically not acceptable. Three-dimensional printing at 15° was estimated to be the most time-efficient, whereas 3D printing at 45° was shown to be the most cost-effective setting. CONCLUSIONS: Three-dimensional printed retainers, using a stereolithography printer, were found to be accurate within 0.25 mm at all print angulations at the cusp tips and incisal edges compared with the digital reference file. Smooth facial surfaces did not meet clinical acceptability. Print angulations were shown to affect the cost and amount of resin used.

Wax carving exercises predict performance on practical examinations for first-year dental students.

Perceptual ability test (PAT) is a valid determinant for spatial perceptions. However, a validated psychomotor skill test for dentistry does not currently exist. PURPOSE/OBJECTIVES: This study aimed to determine whether the results of two wax carving exercises (E1 and E2), PAT, quantitative reasoning (QR), and academic average (AA) tests predict students' performance on dental anatomy practical examinations. METHODS: First-year dental students (n = 69) participated in the study. Results of the PAT, QR, and AA were obtained from the Admissions Office. Participants completed wax carving exercises during the first (E1) and last weeks (E2) of the dental anatomy course. Carving instruments, instruction, and rubrics, were provided to participants who were instructed to carve a cube and a semicircle shape into a wax block using the wax subtraction technique. Two calibrated and blinded faculty graded the exercise as ideal, satisfactory, or unsatisfactory in four categories: finish, sharpness, symmetry, and accuracy. During the dental anatomy course, participants completed wax carving practical examinations for a maxillary central incisor and a mandibular first molar. Examinations were graded by calibrated faculty as ideal, satisfactory, or unsatisfactory. The linear mixed effects model assessed influences of independent variables on the practical examinations. RESULTS: estimates of the independent variables on the practical examinations were PAT (0.027), AA (0.088), QR (-0.014), E1 (0.235), and E2 (0.175). CONCLUSIONS: wax carving exercises were stronger predictors of performance on the practical examinations than the PAT, AA, and QR. This simple exercise may help identify students early in their preclinical education requiring additional assistance.

preciseTAD: a transfer learning framework for 3D domain boundary prediction at base-pair resolution.

MOTIVATION: Chromosome conformation capture technologies (Hi-C) revealed extensive DNA folding into discrete 3D domains, such as Topologically Associating Domains and chromatin loops. The correct binding of CTCF and cohesin at domain boundaries is integral in maintaining the proper structure and function of these 3D domains. 3D domains have been mapped at the resolutions of 1 kilobase and above. However, it has not been possible to define their boundaries at the resolution of boundary-forming proteins. RESULTS: To predict domain boundaries at base-pair resolution, we developed preciseTAD, an optimized transfer learning framework trained on high-resolution genome annotation data. In contrast to current TAD/loop callers, preciseTAD-predicted boundaries are strongly supported by experimental evidence. Importantly, this approach can accurately delineate boundaries in cells without Hi-C data. preciseTAD provides a powerful framework to improve our understanding of how genomic regulators are shaping the 3D structure of the genome at base-pair resolution. AVAILABILITY AND IMPLEMENTATION: preciseTAD is an R/Bioconductor package available at https://bioconductor.org/packages/preciseTAD/. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

A pilot survey of personality traits of dental students in the United States.

Introduction The training of dental students and eventual practice of dentistry involves multiple components of the 'person'; therefore, understanding the personality of dental students is critical for creating a supportive student culture.Aims Our objective was to examine the personality traits of students attending Virginia Commonwealth University School of Dentistry.Methods We collected qualitative descriptive research through an anonymous survey sent to all pre-doctoral students, which included the 50-item International Personality Item Pool of the Big Five Markers (IPIP-BFM). Fifty-three dental students completed the survey.Results Analysis indicated that two of the personality traits were significantly different for both gender and academic year. The most significant deviation in scores between genders occurred for 'agreeableness and emotional stability'.Discussion The results demonstrate there may be a degree of commonality of traits shared between dental students and other professionally trained students. Nevertheless, gender-related deviations were the most remarkable findings.Conclusion Studies of personality traits have been used to consider and implement needs-based student services in other professions. The results of surveys of this kind could be considered instrumental in structuring evidence-based student services throughout the dental training curriculum, as they have been helpful for training of other professions.

The effect of orthognathic surgery on facial recognition algorithm analysis.

INTRODUCTION: The purpose of this study was to evaluate the ability of a publicly available facial recognition application program interface to calculate similarity scores for presurgical and postsurgical photographs of patients who underwent orthognathic surgeries. Our primary objective was to identify which surgical procedure(s) had the greatest effect(s) on the similarity score. METHODS: Existing photographs for 25 orthodontic-orthognathic patients were analyzed using the application program interface to calculate similarity scores between the presurgical and postsurgical photographs. Photographs from 2 presurgical timepoints were compared as controls. Both relaxed and smiling photographs were included to assess the added impact of a facial pose. Patient characteristics and surgery types were recorded for statistical analysis. Nonparametric Kruskal-Wallis rank-sum tests were performed to analyze the relationship between patient characteristics and similarity scores. Multiple comparisons Wilcoxon rank-sum tests were performed on the statistically significant characteristics. RESULTS: Recognition scores were significantly lower after orthognathic surgery at rest (P = 0.009) and smiling (P <0.001). Patients receiving both LeFort I and bilateral sagittal split osteotomy (BSSO) surgeries had a lower median similarity score compared with those that received only BSSO (P = 0.009) when comparing relaxed photographs before and after surgery. Similarly, for the score comparing presurgical relaxed photographs to postsurgical smiling photographs, patients that received both surgeries were found to have lower similarity scores compared with those receiving only BSSO (P = 0.036). CONCLUSIONS: Two-jaw surgeries were associated with a statistically significant decrease in similarity score when compared with 1-jaw procedure. Pose was also found to be a factor influencing similarity scores, especially when comparing presurgical relaxed photographs to postsurgical smiling photographs.

Is there an association between Perceptual Ability Test scores and color vision acuity?

OBJECTIVE: The purpose of this study was to determine if there is an association between Perceptual Ability Test (PAT) results and color vision deficiency (CVD). METHODS: Three consecutive classes of first-year dental students (n = 291) voluntarily participated in the study. The Farnsworth-Munsell 100 Hue Color Vision test (FM-100) was administered to students beneath a Macbeth Judge II viewing booth that provided ideal lighting conditions to ascertain CVD. Results of FM-100 test were recorded as total error scores (TES). Color acuity was scored as superior (TES 0-16), average (TES 20-100), or poor (TES > 100). Additional information of age, sex, ethnicity, and time to complete the FM-100 was obtained. Multiple linear regression was used to determine the association between PAT and CVD while adjusting for age, sex, ethnicity, and time to complete the FM-100 test. RESULTS: TES ranged from 0-244. There were 132 students with superior color acuity, 161 with average, and eight with poor acuity. Females performed better than males on the FM-100 test. Time to complete the FM-100 test ranged from 3:40 minutes to 25:12 minutes. There was a strong relationship between PAT scores and CVD (P = 0.0003). A 1-unit increase in PAT scores was found to result in a 9% decrease in TES; indicating that students with higher PAT scores are less likely to have CVD. CONCLUSION: The PAT may be a preliminary screening instrument to identify students who may have CVD. The FM-100 test can then confirm the presence of CVD. Students with CVD may desire to improve dental shade matching skills through targeted training and education.

Recognition of the Asymmetrical Smile: A Comparison of Orthodontists, Oral and Maxillofacial Surgeons, and Laypersons.

PURPOSE: Studies have shown that an asymmetrical smile is a relatively common problem. Yet, many patients are unaware of having this condition. Because having an asymmetrical smile can affect the final esthetic result of orthodontic therapy or orthognathic surgery, such patients need to be aware of the problem. The purpose of this study was to determine what amount of smile asymmetry is clinically evident to orthodontists, oral and maxillofacial surgeons (OMSs), and the lay public. MATERIALS AND METHODS: A total of 56 OMSs, 117 orthodontists, and 123 laypersons participated in the study. They were asked to view a randomly arranged series of computer-generated male and female facial photographs with the smile symmetrical or altered in 0.5-mm increments from 1 to 4 mm and to indicate whether the person had an asymmetrical smile. RESULTS: The OMSs and orthodontists were able to recognize relatively smaller amounts of asymmetry than the laypersons (2 mm vs 3 to 3.5 mm). CONCLUSIONS: Although the clinicians performed better than the laypersons, both groups were able to recognize relatively small amounts of asymmetry. Because such a condition is generally not correctable and can affect the esthetic result, patients undergoing orthodontic therapy or orthognathic surgery need to be made aware of the situation before treatment.