Preliminary investigation into the validity of dentists' decisions to restore occlusal surfaces of permanent teeth

Abstract – This study investigates the validity of the treatment decisions made by 10 hospital dentists, who examined the fissures of extracted teeth using a visual-only technique. The study shows that 8 of the 10 dentists were more likely to leave carious teeth unrestored than unnecessarily treat sound teeth. The authors suggest that this system of diagnosing occlusal caries is a satisfactory one in terms of its sensitivity and specificity.     

TEMPOROMANDIBULAR JOINT PAIN-DYSFUNCTION SYNDROME: A RARE CAUSE OF HEADACHES IN ADOLESCENTS

The temporomandibular joint pain-dysfunction syndrome has received little attention in the literature on pediatric neurology. Five adolescents with this syndrome are reported, all of whom complained initially of headaches. In all cases the headaches were either continuous or daily and all patients had tenderness of the muscles of mastication and restricted or deviant jaw-opening. The literature is reviewed, and etiology, diagnosis and treatment are discussed. It is concluded that this is a rare but distinct syndrome which can cause headaches in adolescents, appears to have multiple etiologies and should be treated conservatively.     

How ratings vary by staff group in multi-source feedback assessment of junior doctors

Context  UK doctors-in-training undergo assessments of their professional behaviours. From an analysis of multi-source feedback (MSF) data, we report how ratings of junior doctors (Foundation Programme [FP] doctors and senior house officers [SHOs]) differed by staff group.
Methods  The MSF data were collected in 2003 and 2005 in hospitals in the West Midlands. Using a single-sided Team Assessment of Behaviour form, 1928 assessors evaluated 226 FP doctors and SHOs in four domains: professional relationship with patients; communication; team-working, and accessibility. The distribution of 'concerns' across the professional groups was explored using a random effects logistic regression model.
Results  On average, each trainee received nine assessment forms from a range of staff, most commonly nurses. Although concerns were identified for the minority, ratings varied by staff group. Peers (other FP doctors or SHOs) and administrators or managers were four and three times, respectively, less likely to indicate concern. By contrast, consultants and sisters (senior nurses) were more likely to give concern ratings.
Conclusions  Guidance on the selection of assessors in any MSF process should take into account findings that rating behaviour varies by staff group.     

Routine Activities and Alcohol Use: Constraints on Outlet Utilization

Studies of consumers' use of alcohol beverage outlets have provided a basis for understanding drinking behaviors in different drinking environments. These studies have shown that drinking environments are related to both demographic and drinking pattern measures. Absent from these studies has been a theoretical basis on which to make predictions regarding drinking patterns and choices of drinking environments under the various social, economic, and environmental constraints typically confronting alcohol consumers. This study presents one such theoretical approach.
The approach assumes that, in the context of individual preferences for alcohol, drinking choices are constrained by consumers' economic and time-energy budgets for consumption. All other things being equal, it is suggested that greater budgets for consumption will be related to greater alcohol use, quality of beverages purchased, amenity values of purchase locations, or all three. Because on-premise drinking entails greater economic costs, greater drinking levels will be related to lower utilization of on-premise establishments.
The predictions of this approach were tested using data obtained from telephone surveys of consumers conducted in 1990 and 1991. The results showed that controlling for income, variables related to greater time-energy budgets for consumption (i.e., marital status and household composition) were related to greater consumption levels and greater utilization of on-premise establishments. Controlling for demographic measures, greater income was related to greater utilization of restaurants and increased beverage quality. Controlling for all other measures, frequencies of consumption were inversely related to consumption at on-premise establishments, reflecting the expected moderation in costs for heavier consumers on a limited alcohol budget.     

Ethanol and Cocaine Cause Additive Inhibitory Effects on the Calcium Transients and Contraction in Single Cardiomyocytes

The heart is a major locus for the toxic actions of cocaine and ethanol, each of which has been shown to interfere with excitation-contraction coupling in cardiac muscle cells. Because these drugs are frequently used in combination, the present study was designed to investigate how they interact to modify the Ca²⁺ transient and associated contraction in fura2-loaded cardiomyocytes. A high-speed imaging technique using a charge-coupled device as detector and short-term image store was used to measure cytosolic Ca²⁺ and contraction simultaneously from fluorescence images obtained during the contractile cycle. Ethanol (100 mM) and cocaine (50 μM) caused reversible reductions in Ca²⁺ transient amplitude of 24.3 ± 3.0% and 25.1 ± 3.6%, respectively. Neither agent modified basal Ca²⁺. Ethanol treatment decreased peak shortening by 44.3 ± 3.5%, whereas the contractile depression by cocaine was 31.4 ± 5.3%. The relatively greater effect of ethanol on contraction resulted from a Ca²⁺-independent component of ethanol action on contractility. When cardiomyocytes were exposed simultaneously to ethanol and cocaine, Ca²⁺ transient amplitude was reduced by 38.7 ± 3.0%, and peak contraction was decreased by 55.1 ± 3.5%. These values represent a significantly greater inhibition than observed with either drug alone (p < 0.02) and are compatible with additive effects of the two drugs acting at distinct loci within the excitation-contraction coupling pathway. Thus, simultaneous use of cocaine and ethanol leads to an enhanced depression of myocardial contractility, which is likely to contribute to the cardiotoxic actions of the combination of these two drugs.     

IN VIVO ESTIMATION OF CHANGES IN DISTAL TUBULE FLOW AND THEIR ROLE IN DEXAMETHASONE-INDUCED KALIURESIS IN CONTROL AND POTASSIUM-ADAPTED RATS

The aim of this study was to determine whether the kaliuresis associated with glucocorticoids is due to a direct tubular action or is secondary to effects of glucocorticoids on distal tubule flow. A whole kidney technique was used to avoid the problem, inherent in microperfusion and micropuncture studies, of deciding whether (all) the appropriate nephron segment(s) are being studied. The method used was to determine the best whole kidney measure of distal tubule flow (the independent variable) by correlating this with the dependent variable (potassium excretion, corrected for differences in plasma potassium, UkV/PIK+) in conscious intact and adrenalectomized control and potassium-adapted rats. After an intragastric potassium chloride load, the correlation of UkV/PIK+ with UkV + UNaV was better than with either UNaV or UV, as measures of distal tubule flow. From the relationship a measure of potassium excretion independent of distal tubule flow can thus be calculated as UkV/PIK+ divided by (UkV + UNaV), defined as UK#. Measurement of UK# clearly demonstrates decreases in potassium excretion with adrenalectomy and increases in potassium excretion with aldosterone and in the potassium-adapted rat, consistent with described changes in potassium secretion. In contrast, with dexamethasone treatment, whilst there was an increase in UkV and UkV/PIK+, there was no change in UK# either in the control of potassium-adapted rats. These results suggest that the kaliuretic effect of dexamethasone cannot be attributed to direct tubular effects of glucocorticoids but rather can be explained by its effect on distal tubule flow.