Introduction: One factor that contributes greatly to the lower face appearance and orthodontists have the ability to affect is lip profile. Clinical assessment of the lip profile is an important element in the decision of orthodontic treatment planning and in the evaluation of treatment progress and outcome. Three known factors influence the lip profile; the lip thickness, the underlying bone, and the tooth position. The positions and inclinations of the anterior teeth can affect the lip position, but it is unclear whether orthodontic brackets bonded to the labial surface of anterior teeth move the lip position and thereafter change the lip profile. Therefore, it is necessary to determine if orthodontic brackets bonded to the labial surface of the anterior dentition have any impact on lip profile. Objective: The objective of this project was to determine the effect that bonded brackets have on lip profile utilizing a standardized lateral photographic cephalogram analysis during the bonding and debonding stages. Methods: To determine the effect of bonded brackets on lip profile, digital photographic cephalometry was used. The patient was seated against a white backdrop in the standardized natural head position. Photographs were taken 5 feet from the patient, centered and level with the middle of the tragus of the right ear and were digitally analyzed using Dolphin Imaging software. Photos were acquired from 4 time points: before bonding (BT0) and after bonding (BT1) for the bonding group, and before debonding (DT0) and after debonding (DT1) for the debonding group. Upper and lower lip to E-plane, subnasale and lower lip to H-Line, superior sulcus depth, nasolabial angle, Z angle, upper and lower lip protrusion, and upper and lower lip to S-line were measured and analyzed statistically. The correlation of tooth angulation, lip thickness (determined using existing cephalometric radiographs), and bracket thickness on effect of lip position was also determined. Results: There are significant differences in all measurements of the lip profile, except superior sulcus depth and nasolabial angle, between BT0 and BT1 at the bonding stage. In the bonding stage, change in Z angle was correlated to initial lower lip thickness and change in upper lip protrusion was correlated to the initial upper lip thickness at the vermilion boarder and upper incisor bracket thickness. There was no significant difference noted between DT0 and DT1 at the debonding stage. Conclusion: Brackets have a significant effect on lip profile when bonding labial orthodontic brackets. Brackets have no significant effect on lip profile when debonding brackets. Therefore, a direct clinical assessment of lip profile before debonding is valid with no interference imposed by bonded orthodontic brackets.

Purpose. It has been documented previously that the push up (PU) and pull away (PA) methods overestimate accommodative amplitude (AA), while the minus lens-to-blur (MLB) method underestimates it. It also has been shown that the PU and PA methods produce similar results. We sought to compare data obtained from these three clinically used methods to determine AA in children and young adults with base-line normative data predicted by Hofstetter. Methods. Ninety healthy subjects (mean 11.7 years, range: 6-36 and 50F/40M), split into two groups, children (mean 9.8 years, range: 6-13 and 38F/22M) and young adults (mean 25.5 years, range: 21-36 and 16F/14M), were recruited from the patient and student populations of two schools of optometry. The subjects completed three accommodative tests presented in a random order: PA, PU, and MLB methods. Results.Findings from the MLB technique varied significantly from Hofstetter's normative values (P Conclusions. As compared with Hofstetter's normative values, this study demonstrates that the MLB technique gives a lower AA in children, while the PU and PA methods yielded consistent findings with each other and with Hofstetter's normative values. The PU method yielded values that compared closest with Hofstetter's normative data for the oldest subjects 4 tested in this study and indicates that the most consistent methods to measure AA in children is either the PU or PA methods, and the PU method for adults.

Purpose: The purpose of this study was to investigate the relationship between anthropometric measurements, proximal and distal lower extremity muscle performance, core muscle endurance, lower extremity flexibility, and neuromuscular control with the incidence of injury in recreational runners over one season. Also, when a relationship was established, we sought to evaluate the predictive validity for any of the variables being investigated for risk of injury in this population. Study Design: Prospective cohort Methods: Anthropometric measurements, proximal and distal isometric lower extremity muscle performance, isometric core muscle endurance, lower extremity flexibility and neuromuscular control were measured in 75 recreational runners prior to the start of a graded marathon training program. Incidence of injury was tracked over the course of 18 weeks, May 2014 – October 2014. Data was analyzed comparing the differences between injured and non-injured groups. Results: There were 33 repetitive stress injuries yielding a gross injury rate of 46% (male n=13, female n=20). Of all the variables analyzed, 5 variables emerged as possible a predictors including age, dominant limb rear foot posture, non dominant limb ankle DF ROM (extended), limb difference of Y balance scale composite scores and limb difference in the 6 M hop test. These variables were entered into a binary logistic regression analysis. Results of the regression indicated only the composite Y balance score difference variable as yielding a significant contribution (p = 0.01), with and predictive validity, (OR = 1.46, 95% CI =1.127 – 1.892). The model predicted 69.2% of the injuries with a specificity of 82% and sensitivity of 54.5%. A cutoff point of 3.6% was determined using a receiver operating characteristic curve. Runners were 3 times more likely to get injured with an asymmetry ≥ 3.6%. Conclusions: An asymmetry of lower extremity neuromuscular control ≥ 3.6% measured by the Y balance scale has been identified as a potential risk factor for injury in recreational runners. Clinical Relevance: This test can be performed as part of a pre-training screening or physical and may be helpful in identifying recreational runners at risk for injury.

The purpose of this study was to explore the types and patterns of occupational therapy services implemented with clients who are cancer survivors, which utilized a mixed methods approach, specifically an explanatory sequential design. The Occupational Therapy Practice Inventory (OTPI) was used to gather information regarding the type and patterns of occupational therapy services provided for clients receiving oncology care. The results of the OTPI were analyzed and used to further develop semi-structured questions for exploring the perspectives of occupational therapy practitioners who practice in the area of oncology in the United States. The data were analyzed to generate a portrayal of occupational therapy practice in oncology settings and examine factors that may be predictors for certain practice approaches. Frequency data indicated that interventions related to activities of daily living were performed most frequently. Phi coefficient indicated strong positive relationships with multiple components of the OTPI. Analysis of the qualitative results were completed by following the principles of grounded theory The data yielded one central phenomenon identified as wanting to provide the best care. Providing the best care was influenced by internal aspects and the external aspects of therapist. The integration of both qualitative and quantitative data supported the findings that interventions, most specifically activities of daily, were the most frequently indicated and discussed services provided by occupational therapy practitioners for cancer survivors in the Northeast, Midwest, and South. The practice of client-centered care and an occupation-based intervention strategy across the continuum of care for individuals who are cancer survivors was supported by the results.

According to the Centers for Disease Control and Prevention (CDC) (2017), at the end of 2014, approximately 428,724 people 50 years or older were diagnosed and living with HIV in the United States. A contributing factor to the high incidence of HIV in this population is unknown HIV/AIDS serostatus (Fenton, 2007). The U.S. Department of Health and Human Services (2018), terms serostatus as the state of having or not having detectable antibodies against a specific antigen (https://aidsinfo.nih.gov/understanding-hiv-aids/glossary/1632/serostatus). Contributing to the lack of knowledge about HIV serostatus, is that those over 50 are less likely to be tested for HIV even when engaging in sexually risky behavior and may underestimate their risk for acquiring the disease (Pilowsky & Wu, 2015) This dissertation research study will examine how people over the age of 50 perceive their risks for contracting HIV and the reasons why they are or are not getting tested for the disease. The study will also assess whether there is a difference in HIV testing behavior among those 50, 60, 70 and 80+ years of age. Finally, this research will evaluate whether there is a relationship between obtaining a routine health screening like cholesterol, diabetes or blood pressure and the likelihood of seniors in the Coachella Valley, California getting a HIV test. This is a cross sectional study using secondary data from the Health Assessment and Research for Communities (HARC) with variables and related data being analyzed using frequency analyses and logistic regression.

Vitreomacular traction (VMT) is a condition characterized by an incomplete posterior vitreous detachment resulting in traction on the macula and decreased visual acuity. The process of vitreomacular traction can lead to a number of maculopathies including cystoid macular edema, epiretinal membranes, and macular holes. VMT is more common in patients over 40 years of age; however no population-based studies documenting the prevalence of VMT in this age group has been published. Purpose: The current study was undertaken to evaluate the prevalence of vitreomacular traction syndrome in the population aged above 40. Clinical examination does not adequately illustrate the extent of vitreomacular adhesion; therefore, Optical Coherence Tomography (OCT) was used to determine the presence of VMT. High-definition OCT has provided new insight into vitreomacular traction syndrome by allowing for better visualization of the tractional forces at the vitreoretinal interface. This investigation will analyze the vitreomacular interface with regard to VMT in correlation to age through use of the Spectral Domain OCT. Methods: One hundred and thirty-one eyes of 67 patients (36 females/31 males) were examined by optical coherence tomography (OCT). OCT was performed to obtain high-resolution cross-sectional images of the vitreoretinal interface in the posterior fundus. Results: The status of the posterior vitreoretinal interface was evaluated as follows; (1) Intact Vitreous- No posterior vitreous abnormality is depicted on OCT. (2) Vitreomacular adhesion/incomplete PVD- the posterior vitreous is partially attached and can be seen in contact with the macula on OCT. (3) Vitreomacular traction- the posterior vitreous is partially adhered to the inner retina resulting in distortion of the retinal architecture. (4) Complete posterior vitreous detachment, indicating no contact between the vitreous and retina. Conclusion: OCT results found no vitreous abnormality in 39.7% of all eyes; PVD in 6.87% of eyes, VMA in 51.1% of eyes, and VMT in 2.29% of eyes. Age was a significant risk factor to the development of VMT, while gender was not. As age increases, the probability of having VMT increases by 1.2%. Due to the association between vitreomacular traction and a variety of maculopathies, recognition and diagnosis of this entity is crucial. High definition OCT has allowed for outstanding visualization of the vitreomacular interface, which has allowed for a better understanding of this entity.

Handwriting difficulties affect 10% to 30% of children in elementary school often hindering their successful participation in a number of occupations, including academic participation. Occupational therapists provide treatments for handwriting difficulties; however, many of these interventions have limited to no evidence to support their effectiveness. One of these interventions is the use of a slant board, a treatment strategy often combined with handwriting practice. Clinicians commonly combine the use of slant boards and handwriting practice to facilitate the development of handwriting skills in young children. However, the effectiveness of this combination of interventions in improving the quality of handwriting remains unclear. The aim of this study was to investigate the difference in the change of letter formation scores in children who have practiced handwriting on slant boards compared with those who have practiced on a horizontal surface. A randomized block design was employed. Children entering the second through third grades who participated in a 19-day summer enrichment program were recruited via mailed recruitment letters and/or email. Twenty-one children were enrolled. Children were blocked by classroom and randomly assigned to a group that practiced handwriting on a slant board or a group that practiced on a horizontal surface. Children completed a total of 15 group sessions lasting 15 minutes each. These sessions occurred 3 to 5 days a week over the course of 4 weeks. During these sessions, they practiced writing letters and words utilizing the Handwriting Without Tears curriculum. There was no significant difference in average group change in letter formation performance as determined by independent samples t test. Children with below average handwriting at baseline made statistically significant changes in their handwriting, regardless of writing surface, when compared with their peers that was identified by secondary analyses.

Introduction: An optimal orthodontic bonding system must minimize damage to the enamel during conditioning, have enough bond strength to prevent bracket de-bonding during treatment, and allow bracket removal at treatment completion, such that minimal damage is inflicted to the tooth.1 Pumice followed by acid etching has been the standard for many years; however, Groman Inc. (Margate, FL, USA) has stated that using their air-abrasion product will result in a tripling of bond strength. This method claims a three-fold increase in bond strength compared to traditional acid etching techniques by substituting air-abrasion using the EtchMaster® (Groman Inc., Margate, FL) 50 μm aluminum oxide in place of pumice prophy prior to acid etching. The purpose of this study is to see if this combination does in fact triple shear bond strength, and if so, what impact it has on the residual enamel surface after bracket removal, or de-bonding. Methods: Ninety recently extracted bovine incisors were randomly divided into three groups. Each of the three groups underwent different conditioning methods prior to bracket bonding. Group A: pumice + acid etch (N=30), Group B: air-abrasion + acid etch (N=30), and Group C: air-abrasion only (N=30). Enamel surface conditions were characterized using a Quanta 200 Scanning Electron Microscope (SEM) (FEI, Hillsboro, OR) and a SZX7 Stereomicroscope System (Olympus, Center Valley, PA). American Orthodontics Master Series System twin MBT mandibular incisor brackets (Sheboygan, WI, USA) were then bonded to each tooth. Following bonding, teeth were stored for twenty-four hours in water at 37°C +/- 2°C. All groups then underwent thermocycling of five hundred cycles in water baths set at five and fifty-five degrees Celsius. Next, the samples were mounted in dental stone and brackets de-bonded using a universal testing machine (Instron, Canton, MA) to obtain shear bond strength (SBS) values. SEM and optical stereomicroscopy were again utilized to evaluate the enamel surface and determine the adhesive remnant index (ARI) was score of each specimen. Results: The mean of Group A (pumice + acid etch) was 21.52 MPa with a standard deviation of 4.97 MPa. The mean of Group B (air-abrasion + acid etch) was 21.83 MPa with a standard deviation of 7.55 Mpa. The mean of Group C (air-abrasion only) was 8.12 MPa with a standard deviation of 3.05 MPa. Analysis of variance showed a main effect of Group on MPa, F(2, 87) = 60.66, p < 0.001, ηp2= 0.58. Post-hoc analyses using Tukey’s HSD indicated that SBS values were higher for teeth in Group A than for those in Group C (p < 0.001), teeth in Group B had higher SBS values than those in Group C (p < 0.001), but no difference was found for SBS between teeth in Group A and Group B (p =0.981). Results from the Fisher’s Exact test, where we controlled the Type I error using a Bonferroni correction, reveals that ARI scores differed by group (p < 0.001). Stereomicroscope images at 38.75x magnification obtained following enamel conditioning show Groups A (P+AE) and B (AA+AE) are almost indistinguishable; however, Group C (AA) has visual differences. Group C had a speckled reflective property that appeared to be residual aluminum oxide particles. Following de-bond, stereomicroscopic and SEM images showed no enamel defects on the tooth. Conclusions: SBS was not significantly different between Group A (pumice + acid etch) and Group B (air-abrasion + acid etch). SBS was significantly different between Groups A and B, and Group C (air-abrasion only). This means there is not a three-fold increase in SBS when using air-abrasion and acid etch, when compared to pumice and acid etch, as claimed by the manufacturer of the air-abrasion unit used in this study. Additionally, the air-abrasion only group displayed a significantly lower SBS than Group A and B. Air-abrasion only is not a suitable enamel preparation method for orthodontic bonding. Images obtained from the stereomicroscope and SEM reveal no observational damage to the enamel surface topography after de-bonding for any group.

Background: Correctional nurses make up a large part of the corrections workforce and have increasing responsibility for making decisions about patient care in the opioid dependent incarcerated patients. The National Commission on Correctional Health Care (NCCHC) has intoxication and withdrawal standards that advocate individuals entering a correctional facility under the influence or undergoing withdrawal from opioids have their therapy continued, or a plan for appropriate referral for treatment. The NCCHC standard that incarcerated opioid dependent inmates have their therapy continued or a plan for appropriate referral for treatment is not adhered to consistently, as the current process lacks organization. Purpose: The purpose of this quality improvement project was to develop an adult opioid dependence referral for treatment tool for opioid use dependent patients to be utilized by correctional nurses and providers working in the corrections intake medical facility with posttest evaluation. Theoretical Framework: Peplau’s nurse-patient relationship theory was used. Methods: A descriptive, exploratory design was utilized. Results: A majority of the nurses acknowledged the usefulness of the Nursing Opioid Referral for Treatment Algorithm (NORTA) in facilitating the adult opioid dependence referral process. In addition, of the 20 nurses surveyed, 18 nurses agreed that the NORTA tool was relevant to the adult opioid dependence referral process. Most claimed that the NORTA facilitated the opioid dependence referral process. Conclusion: The pain management algorithm is an effective referral method for opioid users as it contributes to patient safety through safe prescription and careful assessment of patient risk regarding opioid use. The findings from this project may impact nursing practice by identification of a new organized approach to enhance the current opioid dependence referral process.

Introduction: The stabilization of dentinal collagen fibers against enzymatic degradation by the use of biocompatible cross-linker agents is of clinical importance for effective dentin bonding to surpass the test of time. Objective: The present study aims to evaluate and compare the effect of the application of two versions of a desensitizer solution to sound coronal dentin, on the microtensile bond strength (μTBS) of the resin-sound coronal dentin using 4th and 6th generation dentin bonding systems. Materials and Methods: Extracted human third molars were collected from an unidentified bank of teeth followed by IRB approval. A flat surface of all 12 teeth was prepared utilizing a water-cooled high-speed diamond disc, leaving an entire hard sound dentinal area for testing. Subsequently, according to the assigned group, specimens followed specific manufacturer’s instructions for application of dentin bonding systems: specimens were subdivided into 6 groups (n=20). Group 1 (G1) First positive control group. Specimens received an application of a 4th generation dentin bonding system (DBS). Group 2 (G2) Second positive control group. Specimens received an application of a 6th generation DBS. Group 3 (G3) Specimens were exposed to Gluma Desensitizer agent, blot-dried and followed by application of a 4th generation DBS. Group 4 (G4) Specimens were exposed to Gluma Desensitizer agent, blot-dried and followed by application of a 6th generation DBS. Group 5 (G5) Specimens were exposed to Gluma Desensitizer PowerGel agent, blot-dried and followed by application of a 4th generation DBS. Group 6 (G6) Specimens were be exposed to Gluma Desensitizer PowerGel agent, blot-dried and received an application of a 6th generation DBS. After application of the adhesive systems, all specimens were restored using a microhybrid resin composite. The root portion was sectioned 1mm below the CEJ, and discarded. All specimens were thermocycled at 5-55 Cº for 7000 cycles on distilled water. Then each restored tooth was sectioned perpendicular to the bonding interface into 1mm x 1mm x 8mm beams with a slow speed diamond wafering blade under thorough irrigation. Then specimens were subjected to μTBS testing at a crosshead speed of 1mm/min. Subsequently; specimens were subjected to fracture analysis and SEM evaluation of the different failure’s mode of the involved surfaces. Statistical analysis was performed by usingone- way ANOVA, two-way ANOVA and Fisher’s PLSD test (p<0.05). Results: For the first aim of the study and after obtaining the μTBS in MPa: Group G1: 15.50 ± 6.28, Group G2: 13.06 ± 11.53, Group G3: 19.20 ± 9.43, Group G4: 12.76 ± 4.61, Group G5: 14.38 ± 5.95, Group G6: 18.54 ± 9.49. Statistical analysis showed that there is no significant influence of variables on the μTBS (Welch ANOVA [F (5,114) =2.21, p=0.057]). Treatment with Gluma desensitizing agent and Gluma desensitizing PowerGel has no significant influence on the bond strength. For the second aim of the study and to analyze group differences for type of fracture data was first recoded into two groups: (1) Adhesive failure and (2) Cohesive failure. Group differences were analyzed by type of fracture using a Fisher’s exact test. No difference was found between the groups by type offracture (5, N = 120) = 8.62, p = 0.090 Conclusion: Within the limitations of this in vitro study it can be concluded that Gluma desensitizing agent and Gluma desensitizing PowerGel did not significantly affect the μTBS of both 4th and 6th generation bonding system using extracted human teeth.