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Typescript (photocopy). / Digitized by Kansas Correctional Industries

Master of Dental Surgery / It has been considered for the purpose of this review unnecessary to discuss in detail the Morphology of the dental pulp and dentine, as this may be found in any recognised text-book, but to concentrate on the clinical problems involved. The materials discussed are those in current usage for exposed pulp preservation, whilst other materials may be touched upon and it is the endeavour of the author to review as many results as possible in this field and to draw sound conclusion from statements made. The field of corticosteroids in dentistry is comparatively new and here it is the aim to provide a basis from which further research may be undertaken. Thus, this thesis is divided into two distinct sections. The first section dealing with non-corticoid drugs and the second sections dealing with cortico-steriods and their combinations, exclusively, utilising the commercial product Ledermix as their prime example. However, when considering pulp therapy one must delve into the past to understand the thought and effort that has gone into this realm of dentistry and to note the lack of the true scientific attitude by some into this work. This may then allow us to look again at our own statements to note how much controversy there was, and still is concerning a question such as “should an attempt on the pulp once exposed ever be made to maintain its vitality?” It will be shown at a later stage that the pulp has marvellous recuperating powers if treated in a conservative manner, something which was hardly considered even early this century. Castognola, Quigleyand Berman have all reviewed this subject before. However, my aim is to bring together all of their information as a preface to the important work of considering the immediate study being carried out in this field. The first attempted vital capping was carried out by Philip Pfaff in 1756 with a small piece of gold foil adapted to the base of the cavity. Then in 1826 it was reported that Lenoard Koeker cauterized the exposed pulp with a hot iron wire and placed silver or lead caps over the exposures. It then appeared that little further was written concerning pulp capping until the middle of the 19th century when Albrecht (1856) utilised opiates, caustics and eugenol on the exposed pulp. McKown (1859) recommended cotton soaked in creosote and tannic acid, whilst Taft (1859) was in favour of cauterizing recently exposed pulps with nitric acid and placing a filling immediately. These results were purely a subjective evaluation. In fact Mc Kown’s results were produced on one of his own teeth. The history of pulp preservation really begins in the early 1860’s. Allport (1866) and Atkinson (1866-1868) suggested amputation of all projecting cornua of exposed pulps and placement of a temporary filling until it was healthy. Allport used the b lood clot formed during operation as his means of capping. J Foote (1866) also, believed the blood clot to be the best means of covering the pulp. This certainly appeared to be a reasonable assumption, considering medical knowledge of the day.

Oral administration of live probiotics such as Lactobacillus and Bifidobacterium spp. possess numerous beneficial effects. However, delivering viable probiotics to the host intestine has been a challenge due to poor survival of these bacteria during the gastric transit. An improved oral delivery system (modified alginate microcapsules) was developed in this study for targeted release of viable probiotics to the host intestine. Effect of various encapsulation parameters such as capsule size, alginate concentration, calcium chloride concentration, gelling/hardening time of microcapsules, addition of prebiotics and polymer coating, were individually investigated for improving the stability of microcapsules under simulated gastrointestinal (GI) conditions. Ability of microcapsules in protecting the viability of encapsulated bacteria improved significantly (p<0.05) in improving the stability of microcapsules. Optimisation of encapsulation parameters significantly improved the viability of encapsulated probiotics under simulated GI conditions. Furthermore, co-encapsulation of probiotics with complementary prebiotics (such as Hi-Maize starch) and chitosan coating provided additional protection to the encapsulated bacteria under simulated GI conditions. Release profile of chitosan-coated alginate-starch (CCAS) encapsulated bacteria was investigated in the GI tracts of different animal models. Addition of CCAS encapsulated bacteria to porcine GI contents (ex vivo) resulted in complete release of microencapsulated bacteria in the ileal contents within 8 h, while there was no significant release (p>0.05) of encapsulated bacteria in the gastric contents even after 24 h of incubation. In another experiment, CCAS microcapsules containing Lactobacillus casei Shirota (LCS) was orally administered to mice and the release profile of encapsulated bacteria was monitored throughout the murine GI tract for 24 h. Partial release of microencapsulated LCS was observed in duodenal and jejunal regions, while no significant (p>0.05) release of microencapsulated bacteria was observed in the stomach during the 24 h monitoring period. However, a significant release (nearly complete release) of microencapsulated bacteria was observed in ileal and colon of murine GI tract after 24 h. Elevated counts of LCS in ileum and colon indicated the most favorable site for the release of CCAS encapsulated bacteria. Further studies investigated the immunomodulatory activity of microencapsulated probiotic bacteria in a murine model. Lactobacillus casei Shirota was orally administered to mice either as microencapsulated or as free bacteria (non encapsulated) for two weeks. On day 14, the splenocytes from different experimental groups were harvested and assessed for ConA induced cytokine levels. A significant increase (p>0.05) in IFN-γ levels was observed in the activated splenocytes of groups treated with microencapsulated and free (non-encapsulated) LCS, compared to the control group (no LCS treatment). However, there was no significant difference (p<0.05) in the IFN-γ concentration between the groups treated with microencapsulated and free (non-encapsulated) LCS. No significant difference (p<0.05) in the IL-10 concentration was observed in the activated splenocytes of groups treated with microencapsulated and free (non-encapsulated) LCS. Finally, the stability of microencapsulated probiotics in different dairy products was investigated. CCAS microcapsules significantly protected the viability of probiotic bacteria in set and stirred yoghurts over 6-week refrigerated storage conditions compared to free (non-encapsulated) probiotics. Overall, chitosan-coated alginate-starch microcapsules developed in this study effectively protected the viability of probiotics from adverse gastric conditions and released the bacteria in the host intestine without detrimentally affecting its immunomodulatory properties. / Doctor of Philosophy

The aim of this project was to investigate a range of medicinal herbs which have radical scavenging and antioxidant activities and then apply novel mass spectrometric techniques to investigate and analyse active components responsible for their pharmaceutical actions. A sensitive electron capture negative ionization of gas chromatography-mass spectrometry (ECNI-GC-MS) method was developed to assess hydroxyl radical production, as indicated by 3.4-dihydroxyphenylacetic acid (DOPAC) production, which allows excellent evaluation of hydroxyl radical scavenging and antioxidant activity of a number of medicinal Chinese herbs. Melatonin is an effective multiple radical scavenger and antioxidant and has been used in this study for the comparison of radical scavenging activity with medicinal herbs. To analyse active compounds from herbal extracts, mass spectrometric techniques were used to separate components that suppressed hydroxyl radical production from Dimocarpus longan Lour, determine known ginsenosides from ginseng extracts as well as to identify and quantify melatonin in ten herbal extarcts. The results obtained indicated that 1) the utilization of alumina in the ECNI-GC-MS method diminished interferences from ???noise??? products in a Fenton-type reaction, which allows obtaining pure final hydroxyl radical product and this method demonstrated optimal sensitivity and reliability; 2) Aqueous extracts of all herbs analysed showed different levels of hydroxyl radical scavenging activity. Dimocarpus longan Lour, Chrysanthemum morifolium Ramat, Lonicera hypoglauca Miq, Ginkgo biloba L, Rehmannia flutinosa and Libosch Cornus officinalis Sieb all exhibited stronger inhibitory effect on hydroxyl radical production than melatonin. 3) Aqueous extract of Dimocarpus longan Lour. showed the greatest inhibitory effect on hydroxyl radical production among the other herbs tested. The active fractions of this herb eluted just after the void volume using HPLC suggesting that the active compounds responsible for radical scavenging activity are polar and water soluble. They may belong to phenol group of chemicals. 4) Herbal extracts using non-polar solvents showed no effect on hydroxyl radical production suggesting active compounds in those herbs are water soluble. 5) Different species and origins of ginseng were compared for their radical scavenging activity. Chinese fresh ginseng (Oriental ginseng) showed higher activity than Korean ginseng tablet and American ginseng. Seven known active ginsenosides were identified using HPLC-MS-MS. 6) Melatonin was found at varying concentrations in ten herbs, which may contribute to the radical scavenging activity of herbs, on the other hand, it may provide the justification of clinical use and food resources, particularly for those herbs contain high level of melatonin.

Decision support systems (DSS) are traditionally designed to optimise the outcomes of a decision. This thesis explores how DSS design can also be driven by the optimisation of the decision process leading to the decision, and how it may enhance the human uptake and use of DSS. It identifies which tasks could be simplified by decision support, and how to build DSS that are likely to be readily adopted and so improve decision outcomes. It tests the hypotheses that: (a) The analysis of specific process attributes of a given clinical decision task, as well as the information needs of its users, improves the design of DSS and enhances systems?impact and acceptance. (b) The complexity of the decision task is the key process attribute that, in conjunction with the information seeking of users, shapes the outcome of the design process. The work is applied to the domain of antibiotic prescribing in critical care. To explore the first hypothesis, the key attributes of prescribing decisions associated with specific prescribing subtasks and different decision-makers and decision contexts are identified and then analysed. Based on our findings, an information-processing model of decision support for an antibiotic-prescribing task is proposed. The second hypothesis is addressed by applying and comparing metrics for decision complexity including minimum message length, cognitive effort assessment and clinical algorithm structure analysis to the prescribing task. A framework is developed to select clinical decision tasks that may benefit from automation, by characterizing decision support as a process of complexity reduction for users, and these ideas are tested in the context of antibiotic prescribing for ventilator-associated pneumonia. The hypotheses are then tested by applying the task complexity framework to the design of a DSS for antibiotic prescribing in critical care. A web-based experiment and a clinical trial of the DSS are described, both of which study the acceptability and effectiveness of the system and verify the usefulness of the design framework. Specifically, in a before-after controlled trial, with no difference in patient mortality or severity of presentation between the two periods, the use of the DSS was associated with statistically significant improvements in patient outcomes and a reduction in antibiotic usage. The length of stay and total consumption of antibiotics decreased respectively from 7.15 to 6.22 days (P=0.02) and from 1767 to 1458 defined daily doses/1000 patient days (P=0.04). The introduction of a hand-held computer-based DSS was associated with less administration of ???broad-spectrum?antibiotics. The relative impact of the uptake of the DSS on the prescribing quality was quantified. Clinicians chose to use guidelines for one third, and pathology data or the DSS for about two thirds of cases for which they were available to assist their prescribing decisions. When used, the DSS plus pathology data improved the agreement of decisions with those of an expert panel - from 65% to 97% (P=0.002). The impact of the DSS was more significant on prescribing decisions of higher complexity. The level of decision complexity appeared to affect the choice of decision support type. Prescribing guidelines were accessed more often for lower complexity decisions, whereas the infection risk DSS plus pathology data were preferred for decisions of higher complexity. The need for measurement of the effectiveness of a DSS in improving decisions, as well as their likely rate of adoption in the clinical environment, was demonstrated. The thesis concludes with a proposal to apply the framework described to the modelling of the DSS adoption and to include task complexity and user information seeking as determinants of the design and evaluation of clinical DSS.

The purpose of this research was to evaluate the effects of a long-term static stretching program on flexibility and spinal reflexes in the human soleus muscle. Day-to-day reliability over two days of H-reflex gain (Hslp/Mslp) and pre-synaptic inhibition of spinal reflexes in the human soleus was measured in an initial study. Thirty subjects (age=23.4 ± 3.9 yr, height=175.64 ± 10.87 cm, weight=84.5 ± 24.18 kg) with no history of lower leg pathology and/or injury within the previous 12 months volunteered. The slopes of the ascending portions of the H-reflex and M-wave recruitment curves were used to evaluate H-reflex gain (Hslp/Mslp). The mean soleus H-reflex from 10 conditioning stimulations and 10 unconditioned stimulations was used to calculate the amount of pre-synaptic inhibition. Measurements of H-reflex gain and pre-synaptic inhibition yielded test-retest reliability of R=.95 and R=.91, respectively. The contribution of pre-synaptic and post-synaptic reciprocal mechanisms in flexibility adaptations has not been measured during the same study. A long-term static stretching program (5 times per week for 6 weeks) of the soleus implemented within an experimental group of 20 subjects was used as an intervention to measure both spinal control flexibility changes. Additionally, 20 control subjects were measured that did not participate in the stretching program. Passive ankle dorsiflexion, Hmax/Mmax, H-reflex gain (Hslp/Mslp), pre-synaptic and post-synaptic reciprocal mechanisms were measured at baseline, 3 weeks, and 6 weeks for all 40 subjects. A 2 (Group) X 2 (Sex) X 3 (Time) mixed MANOVA with Tukey HSD with (a<0.05) was used. Only ROM had a significant interaction between Group and Time, whereas, a significant difference was not detected in the other dependent variables. The experimental group demonstrated significantly improved dorsiflexion ROM from baseline to 3 weeks (mean=6.2 ± .88, P<0.001), 3 weeks to 6 weeks (mean=4.9 ± .84, P<0.001), and baseline to 6 weeks (mean=11.2 ± .91, P<0.001). Consequently, the increase in flexibility by 42% after 30 stretching sessions was not the result of spinal reflex changes. / Graduation date: 2006

The purpose of this research was to describe the use of autohypnosis as a psychotherapeutic intervention with hearing impaired college students specific to four clinical questions: A. Are hearing impaired persons susceptible to hypnosis? B. Can written hypnotic induction be used to introduce hearing impaired persons to relaxation technics? C. Can hearing impaired persons use autohypnosis to achieve a state of relaxation? D. While in a hypnotic state of relaxation can a hearing impaired subject engage in a predetermined fantasy?Eight oral hearing impaired undergraduates, between 18-22 years old, for eight consecutive days completed questionnaires germane to their use of hypnosis. Sixty four questionnaires were submitted to data analysis. Each subject's response as to perceived state of hypnosis was cross-tabulated with: five nonhypnotic state indicators;the amount of time displacement reported per hypnotic session; and three outcome indicators of subject having engaged in predetermined fantasy. The total absolute frequency of incidence(s) of hypnosis having occurred was calculated to be 49 out of 64 reported attempts. The relative frequency percentage was calculated as 75.6% which was interpreted as a descriptive indicator that oral hearing impaired persons utilizing a written autohypnotic technic are susceptible to and can induce, for self, a hypnotic state of relaxation. Additionally it was interpreted that for oral hearing impaired persons the induction technic does not have to deviate extensively from the traditional autohypnotic technic(s) used by (for) aural populations.The findings of this study were limited to the described sample, conditions, time frame and measurement instrument. However, from the 75.6% positive response to the clinical questions it was inferred that the overall outcome of the study was positive. Future research might affirm the appropriateness of autohypnotic relaxation therapy as a possible service to the deaf consumer of psychological counseling.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences