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To determine the adherence of dental providers to the 2007 American Heart Association (AHA) infective endocarditis prevention guidelines regarding antibiotic drug administration before invasive dental procedures. The study included all adults (≥18 years old) with a moderate-risk (MR) or high-risk (HR) cardiac condition who received dental care at participating dental offices from January 1, 2005, through June 1, 2015, in Olmsted County, Minnesota. Data collected included the date and type of dental procedure performed and receipt of antibiotic prophylaxis (AP). A total of 1351 patients underwent 8854 dental visits at participating dental offices during the study period; 1236 patients had an MR cardiac condition and 115 had an HR condition. The percentage of visits in which antibiotic drugs were used for indicated dental procedures in the MR group declined from 64.6% before to 8.6% after publication of the 2007 AHA guidelines (P<.001); for the HR group, AP declined from 96.9% before to 81.3% after publication of the guidelines (P=.02). In this historical cohort in Olmsted County there was a statistically significant reduction in AP in the MR group before invasive dental procedures. In addition, there was an unanticipated significant reduction in AP in the HR group after publication of the 2007 AHA guidelines. These findings can be used to provide feedback and education to medical and dental professionals who are involved in decision making regarding the use of dental prophylaxis for their patients.

Imagery-focused therapies within cognitive behavioural therapy are growing in interest and use for people with delusions. This review aimed to examine the outcomes of imagery-focused interventions in people with delusions. PsycINFO, PubMed, MEDLINE, Web of Science, EMBASE and CINAHL were systematically searched for studies that included a clinical population with psychosis and delusions who experienced mental imagery. The review was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and quality appraisal of all included papers was completed using the Crowe Critical Appraisal Tool. Information from included texts was extracted and collated in Excel, which informed the narrative synthesis of results. Of 2,736 studies identified, eight were eligible for inclusion and rated for quality with an average score of 70.63%. These studies largely supported their aims in reducing levels of distress and intrusiveness of imagery. Four of the eight studies used case series designs, two were randomised controlled trials, and two reported single case studies. It appears that interventions targeting mental imagery were acceptable and well tolerated within a population of people experiencing psychosis and delusions. Some therapeutic improvement was reported, although the studies consisted of mainly small sample sizes. Clinical implications include that people with a diagnosis of psychosis can engage with imagery-focused therapeutic interventions with limited adverse events. Future research is needed to tackle existing weaknesses of design and explore the outcomes of imagery interventions within this population in larger samples, under more rigorous methodologies.

Abstract Background and Hypothesis Intrusive mental images and negative schematic beliefs have been identified as maintenance and possible causal factors for some psychotic experiences, with limited focus in existing therapies in psychosis. Our primary aim was to assess the feasibility and acceptability of undertaking a randomized controlled trial (RCT) of a novel, imagery focused psychological therapy for psychosis (iMAPS). Study Design An assessor-blind RCT (iMAPS-2). Participants who were help seeking; with hallucinations or delusions, who reported distressing intrusive mental imagery were eligible to take part. Participants were randomly assigned (2:1) to receive 12 sessions of iMAPS therapy plus standard care or treatment as usual (TAU). Assessments were undertaken at 0, 16 and 28 weeks. The primary feasibility outcomes were recruitment target, retention at 16 week follow up and number of therapy sessions attended. Study Results The trial recruitment was 100% of target (45 participants). The study had a high rate of retention of 80% (36 participants) at 16-week primary endpoint, a high rate of adherence to the imagery focused therapy (77%) and positive qualitative feedback. There were two serious adverse events in the iMAPS therapy arm deemed unrelated to treatment and zero in the TAU group. Conclusions This is the largest trial to date of imagery focused therapy for psychosis, demonstrating it is safe. An adequately powered clinical and cost effectiveness trial is warranted to provide an estimate of the effects of the iMAPS therapy. Trial Registration ISRCTN 81150786.

Purpose The parameters of the power-duration relationship (i.e., the critical power, CP, and the curvature constant, W′) may theoretically predict maximal performance capability for exercise above the CP. The CP and Wʹ are associated with the parameters of oxygen uptake ( V ˙ O 2 ) kinetics, which can be altered by manipulation of the work-rate forcing function. We tested the hypothesis that the CP and Wʹ derived from constant work-rate (CWR) prediction trials would overestimate ramp incremental exercise performance. Methods Thirty subjects (males, n  = 28; females, n  = 2) performed a ramp incremental test, and 3–5 CWR prediction trials for the determination of the CP and Wʹ. Multiple ramp incremental tests and corresponding CP and Wʹ estimates were available for some subjects such that in total 51 ramp test performances were predicted. Results The ramp incremental test performance (729 ± 113 s) was overestimated by the CP and Wʹ estimates derived from the best (751 ± 114 s, P  < 0.05) and worst (749 ± 111 s, P  < 0.05) individual fits of CWR prediction trial data. The error in the prediction was inversely correlated with the magnitude of the Wʹ for the best ( r  = −0.56, P  < 0.05) and worst individual fits ( r  = −0.36, P  < 0.05). Conclusions The overestimation of ramp incremental performance suggests that the CP and Wʹ derived from different work-rate forcing functions, thus resulting in different V ˙ O 2 kinetics, cannot be used interchangeably. The present findings highlight a potential source of error in performance prediction that is of importance to both researchers and applied practitioners.

Background To assess the impact of metal artifact reduction techniques in 3D printing by evaluating image quality and segmentation time in both phantom and patient studies with dental restorations and/or other metal implants. An acrylic denture apparatus (Kilgore Typodent, Kilgore International, Coldwater, MI) was set in a 20 cm water phantom and scanned on a single-source CT scanner with gantry tilting capacity (SOMATOM Edge, Siemens Healthcare, Forchheim, Germany) under 5 scenerios: (1) Baseline acquisition at 120 kV with no gantry tilt, no jaw spacer, (2) acquisition at 140 kV, (3) acquisition with a gantry tilt at 15°, (4) acquisition with a non-radiopaque jaw spacer and (5) acquisition with a jaw spacer and a gantry tilt at 15°. All acquisitions were reconstructed both with and without a dedicated iterative metal artifact reduction algorithm (MAR). Patients referred for a head-and-neck exam were included into the study. Acquisitions were performed on the same scanner with 120 kV and the images were reconstructed with and without iterative MAR. Segmentation was performed on a dedicated workstation (Materialise Interactive Medical Image Control Systems; Materialise NV, Leuven, Belgium) to quantify volume of metal artifact and segmentation time. Results In the phantom study, the use of gantry tilt, jaw spacer and increased tube voltage showed no benefit in time or artifact volume reduction. However the jaw spacer allowed easier separation of the upper and lower jaw and a better display of the teeth. The use of dedicated iterative MAR significantly reduced the metal artifact volume and processing time. Same observations were made for the four patients included into the study. Conclusion The use of dedicated iterative MAR and jaw spacer substantially reduced metal artifacts in the head-and-neck CT acquisitions, hence allowing a faster 3D segmentation workflow.

In this article, the author claims that lack of attention to international issues in our schools stems in part from a lack of preparation among teachers. But that situation is ripe for change, and both teachers and professors are ready and willing to make it happen.

1. Mental health and substance abuse problems are rapidly growing components of health care premiums and associated costs. 2. Managed care has become as integral factor in the delivery of these services. This trend has elicited concerns about the negative impact of managed care on service access and clinical outcomes. 3. Some managed care designs may actually discourage participation in treatment programs as well as reduce options available to clients. The treatment arena is also shifting from inpatient to outpatient care for most cases. 4. Studies demonstrate the financial efficacy of managed care. However, insufficient data exist about effects on clinical outcomes. 5. The addition of an employee assistance program to the managed care process improves access and may positively affect clinical and financial outcomes.

Now a major force Board for Professional Teaching Standards was established in 1987 to set high, rigorous standards for what accomplished teachers should know and practice and to certify teachers via performance-based assessments. National Board Certification, which complements state licensing, helps empower teachers through mentoring and school restructuring projects (MLH)