Threshold Of Acceptability Research Articles

Effect of spectrophotometer biosafety barriers on composite resin color reading

AbstractThe purpose of this study is to verify whether the spectrophotometer makes similar color readings when subjected to the use of biosafety barriers. Eighty specimens were made in four colors of the Llis composite resin (EA1, DA1, EA3, DA3) and four of the Filtek Z350 XT (A1E, A1D, A3E e A3D) (n = 10). The specimens were subjected to color analysis with a VITA Easyshade device according to the groups regarding the physical barrier: the protector supplied with the VITA device, polyvinyl chloride plastic film, high‐density polyethylene bag, and without protection as a control. The color difference (ΔE00) between control and groups was evaluated and compared with the perceptibility and acceptability thresholds. In the Filtek Z350 XT, there was a significant ΔE00 in color A3E, in the polyethylene bag (P < .001), and in color A1D, in the supplied protector (P = .01) in relation to the other groups. For Llis, in color EA1 for all protective barriers (P = .014), and in color DA1 only for polyethylene bag in relation to the other barriers (P = .02). ΔE00 was higher than the perceptible threshold for all groups, colors, and brands. The results below the threshold of acceptability in relation to the ΔE00 did not demonstrate consistency between barriers, colors, and resins. It was not possible to identify a statistically significant pattern of ΔE00 between the barriers. The ΔE00 were above the perceptibility threshold, and few were below the acceptability threshold. It was not possible to suggest that one biosafety barrier was superior to another or could be indicated.

ALARP Criteria to Estimate Acceptability and Tolerability Thresholds of the Investment Risk

Assessing the riskiness of investments in civil works is an integral part of the decision-making process. The main limitation is the absence, both in the regulatory landscape and in the literature of the sector, of threshold values that can guide the analyst in expressing an assessment on the acceptance of the investment risk. The aim of the paper is to define a risk management model that overcomes this gap by introducing acceptability and tolerability thresholds for project risk. The idea is to jointly use: (i) the As Low As Reasonably Practicable (ALARP) logic, from which the concepts threshold of acceptability and tolerability of risk derive, for the first time applied to assess the project risk in the civil field; (ii) the Capital Asset Pricing Model (CAPM) and statistical methods to define an innovative methodology for estimating the aforementioned threshold values. According to the proposed approach, these risk limit values can be specified according to both the investment sector and the socio-economic context of the project. The implementation of the methodology in the civil company sector in Europe allows to validate the described model. The elaborations show that the financial performance of the project is widely acceptable if the Expected Internal Rate of Return is greater than 7.8%; unacceptable if the expected rate of return is less than 5.6%; and tolerable as an ALARP if the expected rate is between 5.6% and 7.8%. The estimated acceptability and tolerability thresholds can provide the economic operator with a more immediate and consistent evaluation of the triangular balance of risks, costs, and benefits. This allows the decision-making process to become more rational and transparent.

Assessing factors influencing communities' acceptability of mass drug administration for the elimination of lymphatic filariasis in Guyana.

BackgroundGuyana is one of four countries in the Latin American Region where lymphatic filariasis (LF) remains endemic. In preparation for the introduction of a new triple drug therapy regimen (ivermectin, diethylcarbamazine, and albendazole (IDA)) in 2019, an acceptability study was embedded within sentinel site mapping in four regions to assess mass drug administration (MDA) coverage and compliance, acceptability, and perceptions about treatment and disease. The results from this survey would inform the rollout of IDA in Guyana in 2019.MethodsData collection for the study occurred in August 2019, using a validated questionnaire administered by trained enumerators. Across all regions, a total of 1,248 participants were sampled by the Filarial Mapping team. Four-hundred and fifty-one participants aged over 18 years were randomly selected for participation in an expanded acceptability questionnaire. All data were captured in Secure Data Kit (SDK).ResultsAcceptability was measured using a mean acceptability score. Unadjusted mean scores ranged from 24.6 to 29.3, with 22.5 as the threshold of acceptability. Regional variation occurred across many indicators of interest: self-rated understanding about LF, mechanisms of LF transmission, LF drug safety and history of treatment during MDA. Region IV (Georgetown) recorded higher knowledge about LF, but lower compliance and acceptability. Number of pills was not perceived as a concern.ConclusionAcceptability of MDA was good across all four regions under study. Results from this study set a baseline level for key indicators and acceptability, from which the acceptability of IDA can be measured. Regional variations across indicators suggest that localized approaches should be considered for social mobilization and MDA delivery to capture these contextual differences.

Effects of Simulated Gastric Acid Exposure on Surface Topography, Mechanical and Optical Features of Commercial CAD/CAM Ceramic Blocks

Gastric acid exposure produces tooth structure demineralization and dental ceramic degradation. The most affected patients are those who suffer from gastroesophageal reflux disease, bulimia nervosa, and pregnant women with prolonged severe nausea. In order to protect this kind of patient, the purpose of this study was to determine whether simulated gastric acid exposure leads to microstructural changes in surface topography, hardness, color changes, and translucency of some ceramic materials, which are already on the market. Forty disks (Triluxe Forte, Cerasmart, Enamic and Empress CAD) were analyzed before and after immersion in simulated gastric acid juice, in terms of microhardness, surface roughness, translucency, and surface morphology using scanning electron microscopy. Color change was assessed by using a spectrophotometer based on CIELab parameters and the results showed that, after exposure, ∆Eab remained under the threshold of acceptability and perceptibility. In terms of microhardness, Cerasmart is the only material that did not undergo changes after immersion. SEM images illustrated observable changes surface topography after acid exposure for all the tested materials. In conclusion, Triluxe Forte suffered the most important changes after simulated gastric acid juice exposure, and Cerasmart proved to be the least affected material.

Understanding Stakeholder Preference for Contralateral Prophylactic Mastectomy: A Conjoint Analysis

Despite increasing numbers of women with unilateral breast cancer undergoing CPM, quantitative evidence of all stakeholder preferences regarding CPM is lacking, particularly for healthy volunteers. Conjoint analysis, a marketing tool, can be used to quantify tradeoffs surrounding CPM. The objective of this study was to quantify preferences for aspects of contralateral prophylactic mastectomy (CPM) decision-making process among key stakeholders. Healthy volunteers, women with cancer (WwCa), surgical oncologists, and plastic surgeons were surveyed with the same conjoint simulation exercise. Respondents chose between either single (SM) or double (DM) mastectomy under varying recurrence and complication rates, surveillance, and symmetry conditions. Hierarchical Bayesian models calculated partworth utilities and importance scores. Overall, 1,244 respondents participated. The top 3 important factors for all stakeholders were surgical complication rates after DM, type of surgery (SM vs DM) independent of other variables, and 10-year future contralateral cancer risk after SM. HV and surgeons placed greatest importance on high rates of surgical complications after DM. WwCa preferred DM, regardless of complication risk or low rates of a 10-year future cancer episode after SM. Surgical oncologists strongly preferred SM and were more accepting of future cancer risk of 3% or 10% than other stakeholders. Symmetry and need for surveillance were least important factors for all stakeholders. The threshold of acceptability for future cancer episodes and risk tolerance for complications varies by stakeholder, with a profound influence upon WwCA. Current findings suggest room for improved provider and patient alignment through behavioral techniques, such as framing, meanwhile highlighting changes in risk perception after a breast cancer diagnosis.

Variations in acceptability of heavy alcohol use and gender double standards across drinking cultures. A U.S.A. – Italy study

Focus group data from 92 youths from Italy and the U.S.A. indicate that Italians and Americans differ in perceived threshold of acceptability of drinking to excess. Youth from the U.S.A. were more accepting of intoxication than Italian youth, reflecting features of each respective dominant drinking culture. Alcohol gender double standards existed in both countries and were conceptually connected to sexuality. However, the social construction behind such connections differed across the two groups: focusing on harms to the woman in the U.S.A. and the respectability of her social group in Italy.

Quantitative evaluation of printing accuracy of multi-color and multi-hardness three-dimensional printing dental model with photopolymer jetting

Objective: To quantitatively evaluate the accuracy of multi-color and multi-hardness dental models printed by using the photopolymer jetting (PJ) technology, and to provide protocol for the clinical application. Methods: A maxillary partially edentulous (Kennedy class Ⅱ subclass 1) standard digital model obtained through scanning and processing was selected as reference data. Five monochromatic DLP (digital light processing) models with single hardness were printed by printer DLP-800d based on DLP technology (DLP group), and five multi-color and multi-hardness PJ models were printed by printer J300Plus based on PJ technology (PJ group). Scan the printed model and register the scanning data to the reference data in Geomagic Studio 2013 software. The three-dimensional (3D) deviations of the whole and each area, including residual dentition, abutments adjacent to the edentulous area, gingiva, gingiva in the distal-extended edentulous area, gingiva in other edentulous areas, gingiva supporting the removable partial denture (RPD), were calculated and represented by the root mean square error (RMS) value. The smaller the RMS value was, the higher the trueness of printing was. The scanning data of the five models in the same group were registered in pairs to calculate the 3D deviation. The smaller the RMS value was, the higher the precision of printing was. The threshold of clinical acceptability was 200 μm. Statistical analysis was performed to compare the difference of trueness and precision between the two groups. Results: The overall trueness of the DLP group [57.70 (2.10) μm] was significantly better than that of the PJ group [71.00 (7.70) μm]. The overall precision of the DLP group [15.20 (5.05) μm] was significantly better than that of the PJ group [37.55 (15.55) μm]. The overall trueness and precision of both groups were within the clinically acceptable range. Conclusions: The domestic PJ printer used in this study can print multi-color and multi-hardness dental models with good trueness and precision, which can provide integrated 3D printing technology support for realizing the simulation of regional hardness differentiation between soft and hard tissues of dental models.

Development and validation of the Physician's Global Assessment of Fingernail Psoriasis

Several clinician-rated scoring systems are available to assess nail psoriasis severity, but only one has been partially validated. To develop and validate the Physician's Global Assessment of Fingernail Psoriasis (PGA-F), a new clinician-rated severity scale. A literature review, concept elicitation, pilot cognitive debriefing and clinical expert consultations informed the development of the PGA-F. A multistage mixed-methods analysis consisted of practising dermatologist cognitive interviews (n=10) for instrument clarity, relevance and comprehensiveness. Inter-rater reliability (IRR) of ratings from dermatologists (n=22) and clinical trial investigators (n=8) was tested using many-facet Rasch analysis. Concurrent validity between the PGA-F and modified Nail Psoriasis Severity Index (mNAPSI) at screening and baseline was assessed along with the degree of discrimination. Intraclass correlation coefficient (ICC) for single raters at multiple assessments determined IRR. The PGA-F synthesizes severity ratings across multiple disease features that classify individuals into 1 of 5 levels (clear to severe). Cognitive interviews confirmed content validity: all (n=10, 100%) participants who agreed clinical criteria were consistent with nail psoriasis; no mismatched severity levels; and training photographs were realistic representations. All PGA-F items were locally independent and targeted patients along the severity continuum with complementary precision (item fit statistics: < the 1.5 acceptability threshold; exact agreements among the dermatologists [44%] and trial investigators [61.5%] exceeded 40% of acceptability threshold). Clinician reliability exceeded the threshold of acceptability for dermatologists and clinical trial investigators: 0.85 and 0.73, respectively. There was adequate correlation (>0.30) between mNAPSI and PGA-F at baseline and Week 26 with significant discrimination of severity and monotonic increases in the mNAPSI for each level of categorical severity on the PGA-F. ICC results for each type of IRR indicate that clinicians were consistent in individual patient ratings. The PGA-F is a rapid, valid and reliable clinician-rated severity scale for use in clinical practice and research.

One Piece Dental Implants in Esthetic Zone

Objectives: In recent years, one-piece dental implants are widely used to replace missing teeth as the technique is minimally invasive, and its special design offers to be used in an atrophied and narrow bone. Few pieces of literature were found regarding the use of these dental implants in the esthetic zone. This study aimed to evaluate the esthetic satisfaction of patients treated with one-piece dental implants in the esthetic zone using a special technique to enhance gingival recontouring and provide an optimum emergence profile. &#x0D; Methods: Twenty patients with single missing maxillary or mandibular teeth were enrolled in the study (25-50 year age group). They were treated by one-piece dental implants performing the flapless technique; a flame-shaped bur was used to create a sulcus around the implant abutment; the sulcus was then filled with flowable composite resin and allowed for seven days to recontour the gingival tissue. Esthetic satisfactions of the patients were evaluated two weeks and six months after the placement of the permanent crown using subjective and objective methods. &#x0D; Results: The esthetic assessment after 14 days and after six months using the objective method Pink Esthetic Score / White Esthetic Score (PES / WES) index showed that 85% to 90% of the cases received PES and WES mean values of 6 or more, which is the threshold of clinical acceptability. Regarding the subjective method using the Visual Analogue Scale (VAS) index. After 14 days, the total means value for all the questions was (7.19), and the results after six months were (7.25). There was a statistically non-significant difference between the two-time intervals in both objective and subjective methods (P&lt; 0.05). &#x0D; Conclusions: It has been concluded that one-piece dental implants can be successfully used in the esthetic zone after the special gingival recontouring technique.

A multicenter, community-based, mixed methods assessment of the acceptability of a triple drug regimen for elimination of lymphatic filariasis.

BackgroundMany countries will not reach elimination targets for lymphatic filariasis in 2020 using the two-drug treatment regimen (diethylcarbamazine citrate [DEC] and albendazole [DA]). A cluster-randomized, community-based safety study performed in Fiji, Haiti, India, Indonesia and Papua New Guinea tested the safety and efficacy of a new regimen of ivermectin, DEC and albendazole (IDA).Methodology/Principal findingsTo assess acceptability of IDA and DA, a mixed methods study was embedded within this community-based safety study. The study objective was to assess the acceptability of IDA versus DA. Community surveys were performed in each country with randomly selected participants (>14 years) from the safety study participant list in both DA and IDA arms. In depth interviews (IDI) and focus group discussions (FGD) assessed acceptability-related themes. In 1919 individuals, distribution of sex, microfilariae (Mf) presence and circulating filarial antigenemia (CFA), adverse events (AE) and age were similar across arms. A composite acceptability score summed the values from nine indicators (range 9–36). The median (22.5) score indicated threshold of acceptability. There was no difference in scores for IDA and DA regimens. Mean acceptability scores across both treatment arms were: Fiji 33.7 (95% CI: 33.1–34.3); Papua New Guinea 32.9 (95% CI: 31.9–33.8); Indonesia 30.6 (95% CI: 29.8–31.3); Haiti 28.6 (95% CI: 27.8–29.4); India 26.8 (95% CI: 25.6–28) (P<0.001). AE, Mf or CFA were not associated with acceptability. Qualitative research (27 FGD; 42 IDI) highlighted professionalism and appreciation for AE support. No major concerns were detected about number of tablets. Increased uptake of LF treatment by individuals who had never complied with MDA was observed.Conclusions/SignificanceIDA and DA regimens for LF elimination were highly and equally acceptable in individuals participating in the community-based safety study in Fiji, Haiti, India, Indonesia, and Papua New Guinea. Country variation in acceptability was significant. Acceptability of the professionalism of the treatment delivery was highlighted.

Identifying Mean Heart Dose Thresholds for Proton Therapy Acceptability in Mediastinal Unfavorable Early-Stage Hodgkin Disease

Proton beam therapy (PBT) decreases radiation doses to healthy tissues distal to the target when compared with intensity-modulated photon radiotherapy (IMRT). This physical property is particularly important for mediastinal Hodgkin lymphomas (MHL), wherein tumors approximate the heart, since higher mean heart doses (MHDs) are associated with a higher incidence of coronary heart disease (CHD). Yet, PBT is more expensive than IMRT, and fewer centers offer PBT. In the absence of long-term clinical data, we sought to determine the MHD thresholds at which PBT would become cost-effective and the effect of age on acceptability, given the bimodal distribution of MHL. We evaluated MHD thresholds for PBT versus IMRT for treatment of MHL to 30.6 Gy. We created a Markov cohort model under which patients age 30 years would possibly experience several health states for which CHD was modified by MHD between RT modalities: health, relapse, CHD, and death. Relapse risk was informed by HD14, and MHD-CHD probability was informed by van Nimwegen et al. CHD baseline risk used Framingham data and differed between men and women. Costs, calculated from a payer perspective were in 2018 USD. Effectiveness was measured in quality-adjusted life years (Q), and the discount rate was 3%. The model terminated at age 80 years, above which Framingham rates are not reported. The model results are reported using incremental cost-effectiveness ratios (ICERs) using willingness to pay (WTP) thresholds of $100K/Q and $200K/Q. We evaluated acceptability at 30 and 60 years of age. Model calibration corroborated estimates from HD14 and van Nimwegen. Results are shown in the table with cells illustrating a given proton MHD threshold of cost acceptability for a given photon MHD comparator, e.g. for a photon MHD of 15Gy, proton therapy was acceptable for a 60-year-old man with an MHD of 12.3 CGE at WTP $100K/Q. With WTP $100K/Q, an MHD reduction of 5, 4, and 3 Gy yielded PBT acceptability in 100%, 75%, and 38% of scenarios, respectively. With WTP $200K/Q, an MHD reduction of 5, 4, 3 and 2 Gy yielded PBT acceptability in 100%, 100%, 100%, and 75% of scenarios, respectively. We present evidence to help establish comparative thresholds for PBT acceptability based on risk of subsequent CHD in the absence of long-term clinical data. Age had minimal impact on PBT acceptability. MHD thresholds in men were higher than those in women given their higher baseline risk of CHD. Future studies should include other toxicities like secondary breast cancer, sarcoma, congestive heart failure, and lung disease.Tabled 1Abstract 2907; TablePhoton MHD (Gy)30 year olds60 year oldsMENWOMENMENWOMEN$100K/Q$200K/Q$100K/Q$200K/Q$100K/Q$200K/Q$100K/Q$200K/Q52.63.612.82.83.81.93.3107.38.55.87.77.68.66.78.2151213.310.612.712.313.511.613.22016.818.215.417.617.118.316.518.12521.42320.322.521.823.221.323 Open table in a new tab

Colour thresholds of the gingival chromatic space

OBJECTIVETo establish the thresholds of chromatic perception and clinical acceptability of gingival colour according to professional category and in accordance with the perceptibility/acceptability threshold of 50:50 (colour differences that can be perceived/accepted by 50 % of the observers). METHODSA total of 21 different coloured samples made of pink gingiva Heraceram porcelain were used. Dentists (n = 54), dental assistants (n = 56), dental students (n = 126) and participants unrelated to dentistry (n = 116) were asked to identify pairs of samples that appeared identical. In addition, they were asked to indicate the pairs of samples whose colour they considered to be acceptable for use in a dental rehabilitation. A least squares regression was adjusted using an S-shaped curve of the equation y = exp (B0 + B1/x). The adjusted model was used to predict a colour difference value for an acceptability percentage of 50 %. RESULTSThe threshold value for the perception of colour changes in human gingiva varies from ΔEab* 2.3 ± 0.38 units and CIEDE2000 (ΔE00) 1.5 ± 0.28units (dental students) to ΔEab* 2.7 ± 0.43 units and ΔE00 1.8 ± 0.30 units (participants unrelated to dentistry). The threshold of gingival acceptability varies from ΔEab* 2.9 ± 0.43 units and ΔE00 2.0 ± 0.31 units (dental assistants) to ΔEab* 3.6 ± 0.54 units and ΔE00 2.5 ± 0.41 units (dental students). CONCLUSIONFrom the total number of samples, the average threshold of perception for the gingival chromatic space is 3.1 units for ΔEab* and 2.1 units for ΔE00. Moreover, the mean gingival acceptance threshold is 4.1 units for ΔEab* and 2.9 units for ΔE00. These thresholds are similar for all professional categories studied. CLINICAL SIGNIFICANCEThe determination of the perception and acceptability thresholds in the gingival chromatic space are of special relevance for designing the physical shade tabs used in gingival colour guides. The results from this work will aid in selecting optimal gingival colour for patients.

Incorporating Fecal Calprotectin Into Clinical Practice for Patients With Moderate-to-Severely Active Ulcerative Colitis Treated With Biologics or Small-Molecule Inhibitors.

We applied the Grading of Recommendations, Assessment, Development, and Evaluation framework to evaluate the performance of fecal calprotectin (FC) as an alternative to endoscopy in patients with moderate-to-severe ulcerative colitis (UC) treated with a biologic agent or tofacitinib. Individual participant data from the trials of infliximab, golimumab, vedolizumab, and tofacitinib for UC were pooled to generate prevalence of endoscopic activity (Mayo endoscopy score) across different combinations of the rectal bleeding score (RBS) and stool frequency score (SFS). These estimates were then combined with the data from an updated systematic review of the operating properties of FC to generate clinical scenario-specific assessments of the performance of FC as a predictor of endoscopic disease activity. A prespecified threshold of acceptability for false-negative (FN) and false-positive (FP) test results was set at 5%. For patients with UC achieving RBS 0 + SFS 0/1, FC ≤ 50 μg/g may avoid endoscopy in 50% patients with a FN rate <5%. Similarly, for patients with RBS 2/3 + SFS 2/3, FC ≥ 250 μg/g potentially avoids endoscopy in approximately 50% patients with an FP rate <5%. The greatest uncertainty in the diagnostic performance for FC was observed in patients with UC achieving RBS 0 but having SFS 2/3, where FN and FP rates were consistently >10%, and endoscopic evaluation may be warranted. Two clinical scenarios were identified where FC can be used with confidence for monitoring treatment response to biologics or tofacitinib in patients with UC without the requirement for endoscopy.

BIOCHEMICAL AND MICROBIOLOGICAL IDENTIFICATION OF COW'S MILK FOR THE MANUFACTURE OF SOFT CHEESE

Our work focuses on the study of the technological process of making a soft cheese, five samples were the subject of our investigations. These were analyzed during the period of high lactation (January to March 2017). Microbiological and biochemical tests were carried out on five microbial groups and pathogenic organisms. Biochemical identifications are performed to target the most likely bacteria. All the results have been compared is validated by contribution to experimental results as well as theoretical work show a compatibilities and validation by contribution to the norm. The microbiological analyzes of the five samples studied show the total absence of the seeds sought with the exception of FTAM, with a low presence not exceeding the threshold of acceptability. These results indicate that the samples of the milk used in the manufacture of soft cheese are very good from a microbiological point of view. Keywords: Milk, Microbiology, Identification.

Estudio de costo-efectividad en hipertensión arterial pulmonar Grupo 1: riociguat y sildenafil

Introducción. En los últimos años se han desarrollado nuevas terapias para el tratamiento de la hipertensión arterial pulmonar (HAP); sin embargo, la adopción de estas conlleva un aumento considerable de los costos por parte de las entidades promotoras de salud.&#x0D; Objetivo. Evaluar la costo-efectividad de riociguat versus sildenafil en monoterapia para pacientes con diagnóstico de HAP del Grupo 1 en las clases funcionales II y III.&#x0D; Materiales y métodos. Se diseñó un modelo de Márkov donde todos los individuos inician en clase funcional II con alguna de las dos terapias evaluadas en monoterapia y tienen como desenlaces principales la progresión a la clase funcional IV y la muerte. Se realizó un análisis probabilístico y determinístico de sensibilidad.&#x0D; Resultados. Se encontró una relación de costo-efectividad de riociguat frente a sildenafil de $529.213.933; sin embargo, en el umbral de aceptabilidad para Colombia este no es costo-efectivo.&#x0D; Conclusión. Se aconseja la implementación de sildenafil como medicamento de primera línea.

How Do Members of the Duchenne and Becker Muscular Dystrophy Community Perceive a Discrete-Choice Experiment Incorporating Uncertain Treatment Benefit? An Application of Research as an Event.

Best-worst scaling methods have been used in several Duchenne and Becker muscular dystrophy (DBMD) studies to quantify patient and caregiver priorities and preferences and promote patient-focused drug development (PFDD). We sought to assess the extent to which different members of the DBMD community would accept a discrete-choice experiment (DCE) that incorporates uncertainty regarding individual-level benefit. A community advisory board encouraged the development and testing of a DCE to further examine treatment preferences in DBMD and to facilitate the inclusion of a policy-relevant uncertainty attribute. The DCE assessed preferences across a primary outcome (muscle strength) and several risks (uncertainty regarding treatment benefit, kidney damage risk, and fracture risk). The single instrument was tested among adult patients, caregivers, and professionals at the national Parent Project Muscular Dystrophy annual meeting. The DCE was analyzed using conditional logit. Instrument acceptability was evaluated using a previously developed set of questions assessing ease of understanding and answering, and if answers reflected the respondents' real preferences. We proposed a 75% agreement rate as a threshold of acceptability, and used a Z score to assess if this was met, exceeded, or rejected. A total of 161 people completed the survey including 9 patients, 87 caregivers, and 65 professionals. Patients reported high acceptability across all evaluation items (p values > 0.21). Caregivers and professionals exceeded the benchmark of acceptability on understanding and reflecting real preferences (p < 0.001). Professionals met the benchmark (p = 0.08) for ease of answering, but caregivers did not (p < 0.01). DCE results demonstrated thatall groups made meaningful trade-offs, with patients being less tolerant of risks than either caregivers or professionals (p < 0.001), and with no significant difference between caregivers and professionals (p = 0.46). This study demonstrates the acceptable application of a single instrument across a multi-stakeholder population that used a complex preference method and included a policy-relevant uncertainty variable. Ease of answering was lowest among caregivers, but a post-hoc analysis revealed that it was most difficult for those with children under the age of 10, while those with older children met the threshold. The success of this study has laid the foundation for a global study of DBMD preferences using this method.

Esthetic Evaluation of Maxillary Single-Tooth Zirconia Implants in the Esthetic Zone.

The purpose of this study was to evaluate ceramic dental implants using different esthetic scores. A total of 53 ceramic dental implants were evaluated using the Pink Esthetic Score (PES), White Esthetic Score (WES), and Peri-Implant and Crown Index (PICI). Prosthodontists, orthodontists, oral surgeons, and dentistry students independently performed assessments. The mean value of combined PES + WES was 17.4 points, and the PICI was 523.2 points. Orthodontists assessed a significantly lower result in both indices compared to all other assessor groups (P ≤ .05). Patient satisfaction was very high. The esthetic scores around ceramic implants were considerably higher than the suggested threshold of clinical acceptability.

COST-EFFECTIVENESS OF PULSE OXIMETRY SCREENING FOR CRITICAL CONGENITAL HEART DEFECTS IN ONTARIO

Abstract BACKGROUND Critical congenital heart defects (CCHDs) are a leading cause of morbidity and mortality in newborns, and late diagnosis is associated with mortality and worse outcomes. Many jurisdictions in the USA and elsewhere have implemented routine pulse oximetry screening (POS) for CCHD, which the Canadian Paediatric Society has recently endorsed. Cost-effective analyses in USA and Europe support this approach, but the geographical setting of Ontario in relation to its vast yet sparsely populated regions presents unique challenges with regard to POS implementation. OBJECTIVES To estimate the cost-effectiveness of POS for CCHD in the context of its implementation in Ontario, Canada. DESIGN/METHODS A cost-effectiveness analysis using a Markov model was conducted inputting values derived from an extensive review of literature, and using relevant local databases. The base-case was a 24-hour clinically stable infant born in Ontario. The model employed the healthcare payer (ministry of health) perspective and a life-time horizon. A number of mutually exclusive health states were created, representative of the natural course of CCHDs. The strategies compared were routine pulse oximetry screening versus no screening. Outcome measures, all discounted 1.5%, were quality-adjusted life months (QALMs), lifetime costs, and incremental cost-effectiveness ratios. An a priori threshold of CAD$4,166.67 per QALM (equivalent to CAD$50,000 per quality adjusted life year) was used. Probabilistic sensitivity analysis was conducted using multiple simulations of the model within expected range of variables included in the model. RESULTS The incremental cost of performing POS was estimated to be $27.27 per individual, with a gain of 0.02455 QALMs (Table 1). This yielded an incremental cost-effectiveness ratio (ICER), [Δ Cost / Δ QALMs] of CAD$1,110.79, well below the pre-determined threshold for cost-effectiveness. A probabilistic sensitivity analysis estimated a 93% chance of routine implementation of POS of being cost-effective, with majority of simulated ICERs lying below the threshold of acceptability (Figure 1). CONCLUSION Routine implementation of POS for CCHD is expected to be cost-effective with a high degree of certainty. Further validation of this model may be conducted following implementation to confirm these findings based on local population data.

Planning a sustainable regional irrigated production and forest protection under land and water stresses with multiple uncertainties

Abstract This study developed a hybrid stochastic-fuzzy model with Green-Z scenario (HFSG) for coordinating regional irrigated production and forest protection (IPFP) under stresses of water and land resources with multiple informations. The novelty of proposed HFSG is that the improvement of handling capacity for various uncertainties can facilitate to generate a practical landscape scale planning and water resources management (land-water plan) with a more robust manner. It not only has advantage of reflecting the meteorological impact (e.g., precipitation) presented as probability distribution, but also identifies natural or artificial vagueness in the process of decision-making. Moreover, Green-Z scenario analysis associated with the risk-averse attitude, threshold of acceptability and coefficient of robustness can discern the tradeoff between expected targets and outcomes under different risk preferences of decision makers. Through the application of proposed HFSG model in a practical land-water plan issue, numbers of results associated with optimized planting scales (including cultivation withdraw and forest recovery), stresses of water and land resources, pollutant mitigations, ecological effects and system benefits under varied Green-Z scenarios can be obtained. The results can support policymaker to produce cleaner strategies for alleviating conflict between irrigated activities and environmental protection, achieving socio-economic and eco-environmental sustainability.

The Effects of Fresh Detox Juices on Color Stability and Roughness of Resin-Based Composites.

To evaluate the effects of three fresh detox juices, including an orange, green, and red beverage, on the color stability and surface roughness of three anterior esthetic resin-based composites (RBCs). Disk-shaped specimens were prepared with three different esthetic RBCs (Amaris, G-aenial Anterior, Clearfil Majesty ES-2) according to the manufacturers' instructions. Forty specimens were prepared for each RBC, and all specimens were stored in artificial saliva at 37°C for 24hours. The initial color values and surface roughness measurements of the specimens were taken using a spectrophotometer and a profilometer. The specimens were then divided into 4 subgroups (n=10). All specimens except the control specimens were immersed in their designated fresh detox juices (green, red, or orange) for 10minutes twice a day. Color and surface roughness measurements were taken on day15 and day30, and the results were analyzed by one-way ANOVA and Tukey HSD test. The association between color change and surface roughness was evaluated by Spearman's Rank Correlation analysis. Color changes and surface roughness increased upon exposure to fresh detox juices for 15 and 30days for all of the RBCs. All of the G-aenial and Amaris groups displayed color changes above the threshold of acceptability, whereas Clearfil Majesty ES-2 displayed a color change above the threshold of acceptability only after exposure to the red beverage for 30days (ΔE>3.7). With regard to surface roughness, Clearfil Majesty ES-2 outperformed the other RBCs (p<0.001). According to Spearman's Rank Correlation analysis, there was no correlation between color change and surface roughness (p>0.001). Exposure to the fresh detox juices used in this study led to similar color changes in the RBCs used in this study.