Reduction In Discomfort Research Articles

Effectiveness of Dry Needling in Bothersome Chronic Tinnitus in Patients with Myofascial Trigger Points.

Introduction Therapeutic dry needling (DN) is effective in reducing the discomfort of chronic somatosensory tinnitus in patients with myofascial trigger points (MTP)s. Objective To evaluate the efficacy of DN in chronic somatosensory tinnitus discomfort in patients with MTP. Methods Placebo-controlled paired trial that included 16 patients with a diagnosis of somatosensory chronic tinnitus and with the presence of at least one active or latent MTP. Treatment was performed in two phases: (1) four sessions (one session per week for four consecutive weeks) of placebo DN and (2) four sessions of therapeutic DN with a gap (washout) of 15 days between these phases. Results The Tinnitus Handicap Inventory (THI) variable and its emotional domain had a statistically significant reduction in therapeutic DN when compared with placebo DN ( p = 0.024 and p = 0.011, respectively). The tinnitus visual analogic scale (VAS) signaled a reduction in tinnitus discomfort when compared with moments before and after therapeutic DN ( p < 0.05). Conclusion The therapeutic DN technique for MTP in patients with chronic tinnitus of somatosensory origin proved effective in reducing symptom discomfort, as measured by the THI (total score) and its emotional domain when compared with placebo DN.

P–670 Urine estrone–3-glucuronide (E3G) assay: is there any place during ovarian stimulation for IVF cycles?

Study questionCould the urine estrone–3-glucuronide (E3G) assay be used efficiently to monitor a controlled ovarian hyperstimulation (COH) cycle, in comparison to a serum estradiol (E2) assay?Summary answerE3G testing provides an alternative to serum E2 assessment and a new “patient friendly” approach for COH monitoring.What is known alreadyIn many IVF clinics basic monitoring tools for controlled ovarian stimulation during IVF procedure are ultrasound measurements of follicle growth and hormone assessment of serum E2 levels. The monitoring can occur 4–6 times during stimulation, but repeated blood sampling causes patient stress. In contrast, E3G sampling, one of principal metabolites of estradiol in urine, is non-invasive and can be performed by the patients themselves and measured by fluorescent immunoassay. A correlation has been shown between concentrations of E2 present in plasma and concentrations of E3G in different phases of menstruation cycle.Study design, size, durationThis is a pilot, prospective study, in a single IVF clinic. Twenty female participants were recruited November 2020 -January 2021, aged 25–43 years and BMI: 18–28kg/m2. Dynamic change of serum E2 and urine E3G at ovarian stimulation monitoring are being analyzed.Participants/materials, setting, methodsConcurrent urine E3G and serum E2 values were collected from patients who provided between 2 and 4 samples on different days of their COH IVF cycle. Serum E2 values were assessed routinely, while E3G values were measured and validated using a fluorescent immunoassay Mira Fertility Plus® analyzer.Main results and the role of chance: The urine E3G of assay was validated for intra- and inter-assay variability with a coefficient of variation of < 20%. It was also validated for analytical and functional sensitivity and sample stability. Linear regression of serum E2 and E3G values of 56 early morning urine samples who had evaluated between Days 4 and 13 of menstruation cycle provided an R = 0,81. Urine E3G values also correlated to follicle growth. Patient survey results showed that urine sampling was the preferred method of analysis.Limitations, reasons for cautionWe have provided proof of principle that urine E3G measurement can be accurately carried out using fluorescent immunoassay technology during routine COH for IVF cycles. The patients’ study group has to be expanded in order to enable us to find the appropriate place of urine E3G assay in COH protocol.Wider implications of the findings: Urine E3G testing correlates well to serum E2 assessment in COH. Urine E3G assay provides an alternative to serum-based assessment. The ease of urine sampling allows a reduction in patient discomfort during venopuncture, costs, time, and infection risks in epidemics/pandemics, like COViD–19, and offers a patient-friendly approach to ovarian stimulation.Trial registration numberNA

Assessment of Benefits and Risks of Probiotics in Processed Cerealbased Baby Foods Bifidobacterium Lactis Bb12

The Norwegian Scientific Committee for Food Safety (VKM) has appointed an ad hoc-group of experts to answer a request from the Norwegian Food Safety Authority regarding benefit and risk assessment of B. lactis Bb12 in baby foods focusing on the age groups 4-6 months, 612 months and 1-3 years. This assessment is based on the literature provided by the notifier as well as that found by a MEDLINE search. &#x0D; &#x0D; An notification for use of processed cereal-based baby foods (from now on called cereals) intended for infants and small children supplemented with the microorganism Bifidobacterium lactis (B. lactis) Bb12 in Norway initiated this work. &#x0D; &#x0D; Studies of potential hazards and positive health effects from cereals containing B. lactis Bb12 intended for infants and young children have not been reported in the available literature. However, reports on safety of and positive health effects from infant and follow on formula supplemented with B. lactis Bb12 are available and have been assessed by VKM. In most of these clinical studies B. lactis Bb12 was administered in combination with other probiotic strains.&#x0D; &#x0D; Clinical studies report no serious adverse events of infant formula supplemented with B. lactis Bb12. The effect of long term daily consumption of such supplemented formula by the actual age groups is not known.&#x0D; &#x0D; A few studies have demonstrated some effect of supplementing baby food with probiotics, including B. lactis Bb12, on diarrhoea and atopic eczema while other studies do not show such effects. Thus, the scientific evidence for a favourable effect of supplementing formula or solid food with B. lactis Bb12, is weak and in some cases lacking. &#x0D; &#x0D; There are no studies demonstrating a positive effect of cereals supplemented with B. lactis Bb12 intended for infants and small children.&#x0D; &#x0D; Several health claims related to probiotics have been assessed by EFSA, including claims on reduction of gastro-intestinal discomfort, normal functioning of the alimentary tract, building of the natural intestinal barrier, improvement of the general immunity, mental and cognitive developments of children and immune system of children during growth. In the opinions so far, EFSA has concluded that a cause and effect relationship has not been established between the consumption of the probiotic containing products and the claimed effect. None of the products assessed so far contained B. lactis Bb12 (1 November 2009).&#x0D; &#x0D; Commercially produced cereals are frequent given to infants and small children in Norway from an early age and this is particularly important for the establishment of the intestinal bacterial flora and the development of the intestinal mucosal immune system. According to the notifier, one portion (25gram) of the cereal powder contains 1 x 109 B. lactis Bb12 in monoculture. Taking into consideration that the daily intake is often greater than one portion of cereals, even in infants below 6 months of age, this would represent a daily intake of 1-2 x 109 cfu B. lactis Bb12 for an infant 4-6 months and even more in infants above 6 months. If a considerable amount of the B. lactis Bb12 survives the transport to the small intestine, it would represent a dominating and monocultural supply, often several times a day, to the small intestine. The immaturity and vulnerability of the intestinal microbiota and the immune system makes the two lowest age groups, 4 – 6 and 6 – 12 months, at the highest risk of unwanted health effects due to the daily intake of probiotics.

Effects of Virtual Reality-Based Cognitive Training in the Elderly with and without Mild Cognitive Impairment.

ObjectiveThis study aimed to introduce a 4-week long fully immersive virtual reality-based cognitive training (VRCT) program that could be applied for both a cognitively normal elderly population and patients with mild cognitive impairment (MCI). In addition, we attempted to investigate the neuropsychological effects of the VRCT program in each group. MethodsA total of 56 participants, 31 in the MCI group and 25 in the cognitively normal elderly group, underwent eight sessions of VRCT for 4 weeks. In order to evaluate the effects of the VRCT, the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet was administered before and after the program. The program’ s safety was assessed using a simulator sickness questionnaire (SSQ), and availability was assessed using the presence questionnaire. ResultsAfter the eighth session of the VRCT program, cognitive improvement was observed in the ability to learn new information, visuospatial constructional ability, and frontal lobe function in both groups. At the baseline evaluation, based on the SSQ, the MCI group complained of disorientation and nausea significantly more than the cognitively normal elderly group did. However, both groups showed a reduction in discomfort as the VRCT program progressed. ConclusionWe conclude that our VRCT program helps improve cognition in both the MCI group and cognitively normal elderly group. Therefore, the VRCT is expected to help improve cognitive function in elderly populations with and without MCI.

Extended-Reality Technologies: An Overview of Emerging Applications in Medical Education and Clinical Care.

Extended-Reality Technologies: An Overview of Emerging Applications in Medical Education and Clinical Care.

Validation of thermal simulations of a non-air-conditioned office building in different seasonal, occupancy and ventilation conditions

In this work, a methodology for the validation of non-air-conditioned building thermal simulations is proposed. Having certainty in these simulations can give confidence to building designers on the possibility to avoid the use of mechanical air-conditioned systems or to reduce the period of their use, thus increasing the building's energy efficiency. The main features of the proposed methodology that differentiate it from the previous ones are: i) the separation of data inputs which values are known with uncertainty into those that have more influence on indoor air temperature and those with more impact on surface temperatures; ii) to carry out the calibration process in two stages having as comparison variables indoor air temperature in the first stage and adding surface temperatures in the second stage; and iii) to carry out the validation process in different seasonal, occupancy and ventilation conditions. The case study is an office building, simulations are performed in EnergyPlus employing the Airflow Network model for infiltration and ventilation. Quantitative comparisons are made using eight metrics. The results show the advantages of carrying out the second stage of validation proposed in this work. The validation results show that the building model obtained from the calibration process is suitable to simulate the building in different seasonal, occupancy and ventilation conditions, and can be used with certainty to test strategies to improve thermal comfort in the building. For the case study, two strategies are tested showing important reductions in thermal discomfort on occupancy hours during the critical hot season.

A Tri-Layer Optimization Framework for Day-Ahead Energy Scheduling Based on Cost and Discomfort Minimization

Over the past few decades, industry and academia have made great strides to improve aspects related with optimal energy management. These include better ways for efficient energy asset management, generating great opportunities for optimization of energy distribution, discomfort minimization, energy production, cost reduction and more. This paper proposes a framework for a multi-objective analysis, acting as a novel tool that offers responses for optimal energy management through a decision support system. The novelty is in the structure of the methodology, since it considers two distinct optimization problems for two actors, consumers and aggregators, with solution being able to completely or partly interact with the other one is in the form of a demand response signal exchange. The overall optimization is formulated by a bi-objective optimization problem for the consumer side, aiming at cost minimization and discomfort reduction, and a single objective optimization problem for the aggregator side aiming at cost minimization. The framework consists of three architectural layers, namely, the consumer, aggregator and decision support system (DSS), forming a tri-layer optimization framework with multiple interacting objects, such as objective functions, variables, constants and constraints. The DSS layer is responsible for decision support by forecasting the day-ahead energy management requirements. The main purpose of this study is to achieve optimal management of energy resources, considering both aggregator and consumer preferences and goals, whilst abiding with real-world system constraints. This is conducted through detailed simulations using real data from a pilot, that is part of Terni Distribution System portfolio.

Biomaterials for Periodontal and Peri-Implant Regeneration.

Periodontal and peri-implant regeneration is the technique that aims to restore the damaged tissue around teeth and implants. They are surrounded by a different apparatus, and according to it, the regenerative procedure can differ for both sites. During the last century, several biomaterials and biological mediators were proposed to achieve a complete restoration of the damaged tissues with less invasiveness and a tailored approach. Based on relevant systematic reviews and articles searched on PubMed, Scopus, and Cochrane databases, data regarding different biomaterials were extracted and summarized. Bone grafts of different origin, membranes for guided tissue regeneration, growth factors, and stem cells are currently the foundation of the routinary clinical practice. Moreover, a tailored approach, according to the patient and specific to the involved tooth or implant, is mandatory to achieve a better result and a reduction in patient morbidity and discomfort. The aim of this review is to summarize clinical findings and future developments regarding grafts, membranes, molecules, and emerging therapies. In conclusion, tissue engineering is constantly evolving; moreover, a tailor-made approach for each patient is essential to obtain a reliable result and the combination of several biomaterials is the elective choice in several conditions.

Impact of Vibration on the Levels of Biomarkers: A Systematic Review

Introduction: The objective of this systematic review is to assess the effect of vibrational force on biomarkers for orthodontic tooth movement. Methods: An electronic search was conducted for relevant studies (up to December 31, 2020) on the following databases: Pubmed, Google scholar, Web of Science, Cochrane Library, Wiley Library, and ProQuest Dissertation Abstracts and Thesis database. Hand searching of selected orthodontic journals was also undertaken. The selected studies were assessed for the risk of bias in Cochrane collaboration risk of bias tool. The “traffic plot” and “weighted plot” risk of bias distribution are designed in the RoB 2 tool. The 2 authors extracted the data and analyzed it. Results: Six studies fulfilled the inclusion criteria. The risks of biases were high for 4, low and some concern for other 2 studies. The biomarkers, medium, device, frequency and duration of device, as well as other data were extracted. The outcomes of the studies were found to be heterogenous. Conclusion: One study showed highly statistically significant levels of IL-1 beta with &lt;.001. Rate of tooth movement was correlated with levels of released biomarkers under the influence of vibrational force in 3 studies, but it was found to be significant only in 1 study. It was further observed that vibration does not have any significant reduction in pain and discomfort.

Long-term stability of adjunctive use of enamel matrix protein derivative on porcine-derived xenograft for the treatment of one-wall intrabony defects: A 4-year extended follow-up of a randomized controlled trial.

BackgroundThe long‐term outcomes of demineralized porcine bone matrix (DPBM) in combination with enamel matrix protein derivative (EMD) for the treatment of one‐wall intrabony defects have not yet been evaluated. Therefore, this study aimed to assess the clinical, radiographic, and patient‐reported outcomes of regenerative therapy using DPBM with EMD (test group) in comparison with DPBM alone (control group) for the treatment of one‐wall intrabony defects in the molar regions.MethodsThirty‐four patients (control group, n = 18, and test group, n = 16) were available at the 4‐year follow‐up assessment. Clinical (probing pocket depth and clinical attachment level [CAL]), radiographic (defect depth and width), and patient‐reported (Oral Health Impact Profile [OHIP]‐14) parameters were evaluated at baseline, 2 years, and 4 years after regenerative treatment.ResultsBoth treatment modalities, with and without adjunctive use of EMD, resulted in significant improvement of clinical (mean gain in CAL of 1.58 ± 1.34 mm), radiographic (mean defect width fill of 2.41 ± 0.90 mm), and oral health‐related quality of life outcomes at 2 years after regenerative treatment of one‐wall intrabony defects (P < 0.001), which has been sustained over a 4‐year follow‐up period. Particularly, OHIP‐14 scores revealed a statistically significant reduction in physical pain, psychological discomfort, and physical disability (P < 0.05).ConclusionsThe clinical, radiographic, and patient‐reported outcomes were significantly improved when DPBM was used in the regenerative treatment, but no additional benefits were observed with the adjunctive use of EMD.

The effects of chair intervention on lower back pain, discomfort and trunk muscle activation in office workers: a systematic review

Objectives. The chair is a standard piece of workstation equipment in an office. Previous studies showed that a suitable chair may reduce musculoskeletal symptoms. This review investigated the effect of chair intervention on lower back pain (LBP), discomfort and trunk muscle activation among office workers. Methods. Five electronic databases from 1980 to May 2020 were searched for relevant randomized and non-randomized controlled trials. The methodological quality of the included studies was assessed using the 13-item Cochrane risk of bias tool. Quality of evidence was assessed and rated according to Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines. Results. Two randomized controlled trials, 10 repeated-measures studies and two prospective cohort studies were included in this review. Nine studies were rated as high quality. The results indicated very low-quality to low-quality evidence for the conflicting effect of chair intervention on pain and discomfort reduction as well as trunk muscle activation among office workers. When stratified by chair type, the level of evidence for health benefits derived from any type of chair was still of very low to low quality. Conclusion. Unless supplementary high-quality studies provide different evidence, chair interventions are not recommended to reduce LBP or discomfort and activate trunk muscles.

808-Nm Near-Infrared Laser Photobiomodulation versus Switched-Off Laser Placebo in Major Aphthae Management: A Randomized Double-Blind Controlled Trial

Background: the aphtha is one of the most common oral mucosal ulcerations and presents as a painful punched-out sore. Systemic and topical medications are used to reduce inflammation and pain and to support the natural period of remission. Alternative treatment modalities have been requested to relieve pain and improve its healing. In this regard, photobiomodulation, which is a manipulation of cells’ metabolism through an energy transfer by light sources of non-ablative or thermal intensity, could support aphtha management. The predictor variable of our research was the photobiomodulation through higher energy and power irradiated through a handpiece with a flat-top beam profile. The primary end point was the complete healing of the aphtha, defined as the time from the irradiation to the complete recovery. The secondary end point was pain relief, evaluated daily through the visual analogue scale (VAS), from the irradiation to 24 and 48 h after. Methods: a randomized, double-blind, controlled trial was conducted according to the CONSORT guideline. Irradiation was performed through an 808-nm diode laser with flat-top handpiece, and 1 W, 1 W/cm2, 60 J, 60 J/cm2 for 60 s on a spot-size area of 1 cm2. Time of complete healing and pain evaluation by VAS scale were evaluated. Results: between 1 January, 2020 and 1 March, 2021, 126 patients were screened for the study at the Department of Surgical and Diagnostic Sciences, University of Genoa, Italy. Sixty patients were randomly assigned (30 in the photobiomodulation group and 30 in the placebo group). Patients of the photobiomodulation group experienced complete healing in an average time of 8.13 days ± 1.69 (min 5–max 10 days), while for the placebo group the average time extended to 30.76 ± 4.63 days (min 25–max 42 days). Patients of the photobiomodulation therapy group experienced a statistically significant reduction in pain and discomfort 24 and 48 h after treatment (p &lt; 0.05); the reduction was statistically higher (p &lt; 0.05) 48 h after treatment compared to 24 h after. Conclusions: photobiomodulation at the parameters and modality of irradiation proposed accelerates the healing recovery and reduces pain compared to the patients treated with the placebo.

Effectiveness of a 6-Month 22.5-mg Leuprolide Acetate Depot Formulation With Tamoxifen for Postoperative Premenopausal Estrogen Suppression in Hormone Receptor-Positive Breast Cancer.

BackgroundIn patients with hormone receptor-positive (HR+)/premenopausal breast cancer, luteinizing hormone-releasing hormone analogs (LHRHas) are used as standard endocrine treatment. Based on previous clinical studies, 1-month formulations are recommended in most breast cancer treatment guidelines, but long-acting formulations facilitate reductions in side effects and patient discomfort caused by frequent administration. However, few efficacy studies have been conducted on 6-month formulations. Therefore, this study aimed to evaluate the efficacy of 6-month formulations of LHRHas.MethodsThis retrospective study was conducted from January 2018 to December 2019 and involved premenopausal patients with HR+ breast cancer administered 6-month LHRHas as adjuvant treatment after surgery, and those previously administered chemotherapy or other LHRHa types were excluded. Patients’ estradiol (E2) and follicle-stimulating hormone (FSH) levels were measured before surgery, and their E2 levels were also measured at 3, 6, 12, 18, and 24 months at periodic postsurgical examinations.ResultsA total of 228 patients were included, and the median patient age was 44 (range, 25–54) years. The mean serum E2 and FSH levels before surgery were 69.7 (range, 4–683) pg/mL and 7.3 (range, 0.4–88.9) mIU/mL, respectively, whereas the mean serum E2 level monitored at intervals during the 6-month LHRHa administration was 5.5 (range, 4.0–52) pg/mL. No women menstruated during the follow-up period after the LHRHas administration, and the E2 levels were less than 30 pg/mL in all patients except one.ConclusionsThe 6-month LHRHa formulation adequately suppressed ovarian function in premenopausal patients with HR+ breast cancer. This indicates that long-acting LHRHas can be effectively used for patient convenience and that there is high compliance with long-term use.

COVID-19 Management in the Pediatric Age: Consensus Document of the COVID-19 Working Group in Paediatrics of the Emilia-Romagna Region (RE-CO-Ped), Italy.

Since December 2019, coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread, becoming the first pandemic of the 21st century by number of deaths (over 2,000,000 worldwide). Many aspects of SARS-CoV-2 infection in children and adolescents remain unclear, and optimal treatment has not yet been defined. Therefore, our goal was to develop a consensus document, practically synthesizing the accumulated data and clinical experience of our expert group. Literature research was carried out using the keywords “COVID-19” or “SARS-CoV-2” and “children” or “pediatrics” and “prevention” or “diagnosis” or “MIS-C” or “treatment” in electronic databases (MEDLINE, PUBMED), existing guidelines and gray literature. The fact that the majority of the problems posed by SARS-CoV-2 infection in pediatric age do not need hospital care and that, therefore, infected children and adolescents can be managed at home highlights the need for a strengthening of territorial pediatric structures. The sharing of hospitalization and therapeutic management criteria for severe cases between professionals is essential to ensure a fair approach based on the best available knowledge. Moreover, the activity of social and health professionals must also include the description, management and limitation of psychophysical-relational damage resulting from the SARS-CoV-2 pandemic on the health of children and adolescents, whether or not affected by COVID-19. Due to the characteristics of COVID-19 pathology in pediatric age, the importance of strengthening the network between hospital and territorial pediatrics, school, educational, social and family personnel both for strictly clinical management and for the reduction in discomfort, with priority in children of more frail families, represents a priority.

Context-aware Model Predictive Control framework for multi-zone buildings

Today, Model predictive control (MPC) has largely been used to optimize energy consumption and maintain thermal comfort in buildings. However, to build an online MPC model in building, the dynamics of the physical system must be accurately modeled, which is a time-consuming and costly task. Neural network models help to overcome the modeling problems especially with the availability of historical data. This research presents a novel online data-driven control framework named Model Predictive Control via Genetic algorithm (MPC-GA) allowing the optimal operation of the heating, ventilation, and air conditioning system and has been experimentally validated in a multi-zone retail building. The MPC-GA combines an attention-based neural network time series multivariate prediction model with a MPC framework. The prediction model used a dual-stream neural networks based on multivariate time series of controlled and uncontrolled inputs. The attention mechanism is applied on controlled parameters to give them more weight to better predict the zone temperature. The prediction model is used as input for the optimization framework which minimizes: energy consumption, peak demand and discomfort during occupied hours under self-tuned setpoint, temperature ramp and equipment cycling constraints. A heuristic search algorithm using a genetic algorithm is used to solve the online data-driven MPC-GA models and obtain the future optimal combination settings of all controls for all the zones over a prediction horizon. The benchmark results showed that the MPC-GA outperforms RBC control systems with more than 50% and 80% reduction in energy consumption and discomfort respectively.

Optimization of the passive house concept for residential buildings in the South-Brazilian region

This paper is focused on the optimization of the Passive House concept for single-family houses in the climatic context of the Southern Brazilian region, using two approaches: 1) Analysing the buildings’ energy performance through the simulation method presented in the Technical Regulation of Quality for the Level of Energy Efficiency of Residential Buildings (RTQ-R); 2) Analysing the buildings’ energy performance according to the Passive House concept approach, with optimization using a multi-objective evolutionary algorithm. Three single-family houses built with basic passive strategies were selected as the case studies for the Bioclimatic Zones BZ1, BZ2 and BZ3 of the Southern Brazilian region. These buildings were geometrically modeled and each profile for usage and occupation were defined. Posteriorly, the thermal and energy performance of the buildings have been performed through the classification of the energy efficiency level of the envelope, according to the RTQ-R standard. Then, the Passive House concept was applied to the three reference buildings and the optimization process has been performed using the multi-objective algorithm to instruct the dynamic simulation software. In the models with the Passive House concept, it has been observed a reduction in energy demand of 83.5%, 56.3% and 55.1%, and a reduction in thermal discomfort, on an annual comfort basis established between 20 and 26 °C, from 83.5%, 73.7% and 86.2% for buildings located in Bioclimatic Zones BZ1, BZ2 and BZ3 respectively. To improve the buildings’ thermal and energy performance in the climates corresponding to Bioclimatic Zones BZ2 and BZ3, it was necessary to adopt the windows opening strategy in order to increase the system's air renewal rate through natural ventilation, combined with the MVHR system. It has been concluded that through the use of the Passive House concept optimized to the Southern Brazilian climate region, a significant increase in terms of thermal comfort was attained whilst drastically decreasing the energy demand of buildings.

Immediate implant placement in fresh extraction sockets

Immediate implant placement (IIP) in fresh extraction sockets exhibits similar survival and success rates to delayed implant placement in healed sockets. Several advantages of IIP involve shortened total treatment time, reduction of the number of invasive surgeries, and subsequent reduction of patient discomfort due to lack of additional surgeries. The major shortcomings in IIP, however, include the inability to obtain early bony support, presence of a gap between the extraction socket and fixture, and the inability to cover the fixture with soft tissue, leading to increased risk of infection and implant loss. When IIP is performed, atraumatic or minimally traumatic extractions, conservation of the septal bone in molars, minimal flap elevation or flapless surgery, bone grafting the gap between the fixture and the extraction socket, and coverage with soft tissue or a membrane must be considered.

Educational building retrofit under climate change and urban heat island effect

Climate change (CC) and urban heat island (UHI) are important environmental forces that have serious consequences for the existing buildings, such as increased resource consumption and environmental footprint, adverse human health effects and reduced occupant comfort. In this context, educational buildings represent a critical category amongst other building typologies, due to their high energy use, high occupant density, atypical daily/annual occupancy patterns, and their occupants’ high vulnerability to heat. Poor indoor conditions can reduce the health and productivity of students and teachers, worsen learning performance and reduce attendance. Retrofitting educational buildings is an effective solution to tackle this challenge. This study investigates the impact of CC&UHI on educational building performance and demonstrates the effectiveness of passive retrofit scenarios targeting CC&UHI mitigation and adaptation. These investigations are based on a systematic approach that consists of (i) the generation and analyses of CC&UHI-modified weather datasets, and (ii) simulation-based comparative analyses of the as-is building and various retrofit scenarios. An existing secondary school building in Ankara, Turkey is selected as a case study for evaluations of the selected performance indicators including energy use, global warming potential (GWP) and thermal comfort. Obtained results indicate that total energy consumption can be reduced up to 50% with retrofit, whereas possible reductions in indoor discomfort are even more pronounced, underlining the significance of selecting the optimal combination of passive measures for maximum impact towards the adaptation of the existing educational buildings to the changes in climatic conditions.

The effect of 17-inch-wide and 18-inch-wide airplane passenger seats on comfort

The pitch and width of airline seats are crucial factors on the comfort of passengers. The aim of this study is to measure the comfort feeling of passengers regarding different widths and together with data from a previous study, to offer suggestions on the aircraft interior design. 311 participants were recruited and were asked to sit in 17-inch-wide and 18-inch-wide aircraft seats in a Boeing 737 fuselage for 10 min, respectively. Questionnaires on psychological comfort and overall discomfort, as well as an additional questionnaire on the discomfort of different body parts, were used to evaluate the comfort and discomfort experience of participants. Experiment results indicated that the comfort scores were significantly higher, and the discomfort scores were significantly lower for sitting in the 18-inch-wide seats than that of sitting in the 17-inch-wide seats. It was also found that rather than the buttock, the shoulders, knees, lower legs and feet contributed significantly to the reduction in overall discomfort by providing more space for movements. Regarding anthropometric measurements, participants with smaller hip-breadth felt more comfort while sitting the 18-inch-wide seat, which highlights the importance of the freedom of movement. By synthesizing the results of a previous study on the relations of the seat pitch and comfort, it was found that given the same amount of additional floor area, widening the seat is more effective on comfort than increasing the pitch.Relevance to industry: This discovery might be useful for the airline industry for a more effective and efficient usage of floor area.

Efficacy of extracranial stereotactic body radiation therapy (SBRT) added to\xa0standard treatment in patients with solid tumors (breast, prostate and non-small cell lung cancer)\xa0with up to 3 bone-only metastases: study protocol for a randomised phase III trial (STEREO-OS)

BackgroundStereotactic Body Radiation Therapy (SBRT) is an innovative modality based on high precision planning and delivery. Cancer with bone metastases and oligometastases are associated with an intermediate or good prognosis. We assume that prolonged survival rates would be achieved if both the primary tumor and metastases are controlled by local treatment. Our purpose is to demonstrate, via a multicenter randomized phase III trial, that local treatment of metastatic sites with curative intent with SBRT associated of systemic standard of care treatment would improve the progression-free survival in patients with solid tumor (breast, prostate and non-small cell lung cancer) with up to 3 bone-only metastases compared to patients who received systemic standard of care treatment alone.MethodsThis is an open-labeled randomized superiority multicenter phase III trial. Patients with up to 3 bone-only metastases will be randomized in a 1:1 ratio.between Arm A (Experimental group): Standard care of treatment & SBRT to all bone metastases, and Arm B (Control group): standard care of treatment.For patients receiving SBRT, radiotherapy dose and fractionation depends on the site of the bone metastasis and the proximity to critical normal structures. This study aims to accrue a total of 196 patients within 4 years.The primary endpoint is progression-free survival at 1 year, and secondary endpoints include Bone progression-free survival; Local control; Cancer-specific survival; Overall survival; Toxicity; Quality of life; Pain score analysis, Cost-utility analysis; Cost-effectiveness analysis and Budget impact analysis.DiscussionThe expected benefit for the patient in the experimental arm is a longer expectancy of life without skeletal recurrence and the discomfort, pain and drastic reduction of mobility and handicap that the lack of local control of bone metastases eventually inflicts.Trials registrationClinicalTrials.gov NCT03143322 Registered on May 8th 2017. Ongoing study