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Reduction of headache intensity and frequency with maxillary stabilization splint therapy in patients with temporomandibular disorders-headache comorbidity: a systematic review and meta-analysis

  • Manrriquez, Salvador L.;Robles, Kenny;Pareek, Kam;Besharati, Alireza;Enciso, Reyes
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.21 no.3
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    • pp.183-205
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    • 2021
  • This systematic review and meta-analysis aimed to analyze the effectiveness of maxillary stabilization splint (SS) therapy to reduce headache (HA) intensity and HA frequency in patients with temporomandibular disorders (TMD)-HA comorbidity. Randomized controlled trials (RCTs) using full-arch coverage, hard resin, and maxillary SS therapy were included. Electronic databases, including Cochrane Library, MEDLINE through PubMed, Web of Science, and EMBASE, were searched. The risk of bias was analyzed based on Cochrane's handbook. The search yielded 247 references up to January 28, 2020. Nine RCTs were included at a high risk of bias. The comparison groups included other splints, counseling, jaw exercises, medications, neurologic treatment, and occlusal equilibration. Four studies reported a statistically significant reduction in HA intensity, and five studies reported significant improvement in HA frequency from baseline at 2-12 months in patients with TMD-HA comorbidity treated with a full-arch hard maxillary SS. HA frequency in tension-type HA (TTH) comorbid with TMD diagnoses of myofascial pain (MFP) or capsulitis/synovitis improved significantly with SS than that with full-arch maxillary non-occluding splint (NOS) in two studies. Comparison groups receiving hard partial-arch maxillary splint nociceptive trigeminal inhibition (NTI) showed statistically significant improvements in HA intensity in patients with mixed TMD phenotypes of MFP and disc displacement comorbid with "general HA." Comparison groups receiving partial-arch maxillary resilient/soft splint (Relax) showed significant improvements in both HA intensity and frequency in patients with HA concomitant with MFP. The meta-analysis showed no statistically significant difference in the improvement of pain intensity at 2-3 months with comparison of the splints (partial-arch soft [Relax], hard [NTI], and full-arch NOS) or splint use compliance at 6-12 months with comparison of the splints (partial-arch Relax and full-arch NOS) versus the SS groups in patients with various TMD-HA comorbidities. In conclusion, although SS therapy showed a statistically significant decrease in HA intensity and HA frequency when reported, the evidence quality was low due to the high bias risk and small sample size. Therefore, further studies are required.

Diagnosis on Degree of Saturation Model of COSMOS Affected by Geometric and Detection Conditions and Detector Placements (교통조건, 기하구조 조건 및 검지기 설치위치에 따른 실시간신호제어시스템 포화도 산출방식 진단)

  • KIM, Jun-Young;KIM, Jin Tae
    • Journal of Korean Society of Transportation
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    • v.34 no.1
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    • pp.81-94
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    • 2016
  • The Korean real-time traffic responsive control systems, Cycle Offset Split Model of Seoul (COSMOS), employs a single theoretical model to estimate the degree-of-saturation (DS) on approaches. However, the deployment of the system has been accomplished without practical consideration of its field performance. This paper delivers a diagnosis study performed to find the relationships yet known on the DS values against the operational conditions unproved in theory but ordinarily observed in field practice. Based on the analysis of the historical log data (476,505 cycles) obtained from the COSMOS server, it was found; (1) full coverage of lane detections should perform better than the sample coverage of detection in ordinary conditions, (2) the sample coverage of detection perform better than the other case with an exclusive bus lane, (3) detection in which a shared lane is involved provide poor estimation of DS, (4) poor DS estimation when a detection lane is adjacent to a shared lane, and (5) the DS values obtained during a day can hardly be stable all time. The findings suggest traffic engineers a progressive direction to move forward for the next real-time traffic control systems.

Use of Flattening Filter Free Photon Beams for Off-axis Targets in Conformal Arc Stereotactic Body Radiation Therapy

  • Smith, Ashley;Kim, Siyong;Serago, Christopher;Hintenlang, Kathleen;Ko, Stephen;Vallow, Laura;Peterson, Jennifer;Hintenlang, David;Heckman, Michael;Buskirk, Steven
    • Progress in Medical Physics
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    • v.25 no.4
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    • pp.288-297
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    • 2014
  • Dynamic conformal arc therapy (DCAT) and flattening-filter-free (FFF) beams are commonly adopted for efficient conformal dose delivery in stereotactic body radiation therapy (SBRT). Off-axis geometry (OAG) may be necessary to obtain full gantry rotation without collision, which has been shown to be beneficial for peripheral targets using flattened beams. In this study dose distributions in OAG using FFF were evaluated and the effect of mechanical rotation induced uncertainty was investigated. For the lateral target, OAG evaluation, sphere targets (2, 4, and 6 cm diameter) were placed at three locations (central axis, 3 cm off-axis, and 6 cm off-axis) in a representative patient CT set. For each target, DCAT plans under the same objective were obtained for 6X, 6FFF, 10X, and 10FFF. The parameters used to evaluate the quality of the plans were homogeneity index (HI), conformality indices (CI), and beam on time (BOT). Next, the mechanical rotation induced uncertainty was evaluated using five SBRT patient plans that were randomly selected from a group of patients with laterally located tumors. For each of the five cases, a plan was generated using OAG and CAG with the same prescription and coverage. Each was replanned to account for one degree collimator/couch rotation errors during delivery. Prescription isodose coverage, CI, and lung dose were evaluated. HI and CI values for the lateral target, OAG evaluation were similar for flattened and unflattened beams; however, 6FFF provided slightly better values than 10FFF in OAG. For all plans the HI and CI were acceptable with the maximum difference between flattened and unflattend beams being 0.1. FFF beams showed better conformality than flattened beams for low doses and small targets. Variation due to rotational error for isodose coverage, CI, and lung dose was generally smaller for CAG compared to OAG, with some of these comparisons reaching statistical significance. However, the variations in dose distributions for either treatment technique were small and may not be clinically significant. FFF beams showed acceptable dose distributions in OAG. Although 10FFF provides more dramatic BOT reduction, it generally provides less favorable dosimetric indices compared to 6FFF in OAG. Mechanical uncertainty in collimator and couch rotation had an increased effect for OAG compared to CAG; however, the variations in dose distributions for either treatment technique were minimal.

Growth and Ground Coverage of Ophiopogon japonicus 'Nanus' under Different Shade Conditions (차광처리에 따른 애기소엽맥문동의 생장과 피복에 관한 연구)

  • Kang, Ae-Ran;Park, Seok-Gon
    • Journal of the Korean Institute of Landscape Architecture
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    • v.45 no.2
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    • pp.68-75
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    • 2017
  • Demand for dwarf mondo grass (DMG; Ophiopogon japonicus 'Nanus') as an ornamental garden plant is expected to grow in the future. The purpose of this study was to investigate the levels of shade tolerance and ground cover by growing DMG under a variety of shade conditions for 18 months (May 2015~October 2016). DMG plants grown in bare ground for 3 years in Jangheung-gun, Jeonnam were used for testing. In an experimental site created in Naju city in Jeonnam, the DMG was planted in planters ($70cm{\times}70cm{\times}24cm$) and covered with a shading curtain to block natural light. Shaded conditions were then arranged under different levels of shade (0%, 55% and 75%). When the plants were grown, growth (leaf size, the number of leaves, fresh weight and dry weight) and ground coverage of DMG were analyzed. According to the results, DMG growth in terms of leaf size and the number of leaves was statistically higher under zero shade (full sunlight), when compared to other shaded conditions. DMG's fresh and dry weights were significantly greater under 0% and 55% shade, compared to those under 75% shade. The degrees of shade tolerance required for normal growth of DMG were found in the range of 0~50%, meaning that more than 50% shade may decrease plant growth. There were no statistical differences in ground coverage rates of DMG under different levels of shade. When 220 tillers were planted per $1m^2$ of plot, up to 80% of the area was covered by DMG after 18 months. Since DMG requires nutrient-rich soil to grow, sufficient nitrogen fertilizers are proposed to accelerate the ground cover of DMG. As DMG remained alive over the winter in the experiments, this study also suggests that DMG can be planted in the southern temperate region.

Factors influencing the frequency of denture adjustments after delivery of complete denture: a retrospective study (총의치 장착 후 의치 조정 횟수에 영향을 미치는 요인에 관한 후향적 연구)

  • Lee, Seungwon;Yoon, Joon-Ho;Yoo, Jin-Joo
    • The Journal of Korean Academy of Prosthodontics
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    • v.60 no.3
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    • pp.239-245
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    • 2022
  • Purpose. The purpose of this study was to analyze the frequency and duration of adjustments after delivery of complete denture according to age, sex, arch with complete denture, insurance coverage of a denture, type of antagonist, the experience of wearing denture, the period of edentulism, and the type of denture base. Materials and methods. For 5 years, medical records of patients aged 65 or older who had treated full dentures were assessed for the frequency and duration of follow-up visits after complete denture delivery. Statistical analysis was performed at the 5% level of significance to analyze the correlation between the frequency and duration of follow-up according to sex, insurance coverage, arch with the complete denture, type of denture base, type of antagonist, experience of wearing a denture, age, and healing period. Results. 247 complete dentures were included in this study. The median frequency of follow-up visits was 3, and the median duration of follow-up was 36 days. Lower dentures had significantly higher frequency of follow-up visits than upper dentures (P = .036). According to the type of antagonist, dentures opposing a complete denture had a significantly higher frequency of follow-up visits than dentures opposing a removable partial denture (P = .016). There was no statistically significant difference in the frequency and duration of adjustments after delivery of complete denture by age, sex, insurance coverage, healing period, the experience of wearing a denture, and type of denture base. Conclusion. Within the limitations of the present study, lower complete dentures or dentures opposing a complete denture had an increased frequency of follow-up visits.

Seismic and vibration tests for assessing the effectiveness of GFRP for retrofitting masonry structures

  • Michelis, Paul;Papadimitriou, Costas;Karaiskos, Grigoris K.;Papadioti, Dimitra-Christina;Fuggini, Clemente
    • Smart Structures and Systems
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    • v.9 no.3
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    • pp.207-230
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    • 2012
  • Full-scale shake table seismic experiments and low-amplitude vibration tests on a masonry building are carried out to assess its seismic performance as well as study the effectiveness of a new multifunctional textile material for retrofitting masonry structures against earthquakes. The un-reinforced and the retrofitted with glass fiber reinforced polymer (GFRP) strips masonry building was subjected to a series of earthquake excitations of increasing magnitude in order to progressively induce various small, moderate and severe levels of damage to the masonry walls. The performance of the original and retrofitted building states is evaluated. Changes in the dynamic characteristics (lowest four modal frequencies and damping ratios) of the building are used to assess and quantify the damage states of the masonry walls. For this, the dynamic modal characteristics of the structure states after each earthquake event were estimated by performing low-amplitude impulse hammer and sine-sweep forced vibration tests. Comparisons between the modal results calculated using traditional accelerometers and those using Fiber Bragg Grating (FBG) sensors embedded in the reinforcing textile were carried on to investigate the reliability and accuracy of FBG sensors in tracking the dynamic behaviour of the building. The retrofitting actions restored the stiffness characteristics of the reinforced masonry structure to the levels of the original undamaged un-reinforced structure. The results show that despite a similar dynamic behavior identified, corresponding to reduction of the modal frequencies, the un-reinforced masonry building was severely damaged, while the reinforced masonry building was able to withstand, without visual damage, the induced strong seismic excitations. The applied GFRP reinforcement architecture for one storey buildings was experimentally proven reliable for the most severe earthquake accelerations. It was easily placed in a short time and it is a cost effective solution (covering only 20% of the external wall surfaces) when compared to the cost for full wall coverage by GFRPs.

Regression models for interval-censored semi-competing risks data with missing intermediate transition status (중간 사건이 결측되었거나 구간 중도절단된 준 경쟁 위험 자료에 대한 회귀모형)

  • Kim, Jinheum;Kim, Jayoun
    • The Korean Journal of Applied Statistics
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    • v.29 no.7
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    • pp.1311-1327
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    • 2016
  • We propose a multi-state model for analyzing semi-competing risks data with interval-censored or missing intermediate events. This model is an extension of the 'illness-death model', which composes three states, such as 'healthy', 'diseased', and 'dead'. The state of 'diseased' can be considered as an intermediate event. Two more states are added into the illness-death model to describe missing events caused by a loss of follow-up before the end of the study. One of them is a state of 'LTF', representing a lost-to-follow-up, and the other is an unobservable state that represents the intermediate event experienced after LTF occurred. Given covariates, we employ the Cox proportional hazards model with a normal frailty and construct a full likelihood to estimate transition intensities between states in the multi-state model. Marginalization of the full likelihood is completed using the adaptive Gaussian quadrature, and the optimal solution of the regression parameters is achieved through the iterative Newton-Raphson algorithm. Simulation studies are carried out to investigate the finite-sample performance of the proposed estimation procedure in terms of the empirical coverage probability of the true regression parameter. Our proposed method is also illustrated with the dataset adapted from Helmer et al. (2001).

The Effects of Patient and Facility Characteristics On the Resource Use by the Elderly in Long-term Care Services (환자 및 시설 특성이 장기요양서비스 이용 노인의 자원소모량에 미치는 영향)

  • 권순만;김홍수;김선민
    • Health Policy and Management
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    • v.12 no.1
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    • pp.21-53
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    • 2002
  • The purpose of this study is to measure the resource use of the elderly in long-term care services and to examine the effects of patient and facility characteristics on their use of resources. The data were collected from 510 old people over sixty years of age, residing in five long-term care hospitals and two skilled nursing homes during the period between December 1, 2000 and February 28, 2001. For a full sample, when the first level of RUG(Resource Use Group)-III categories were employed as the proxy of patient severity, facility characteristics, such as location, size and ownership, have large effects on the resource use measured by service intensity, whereas patient characteristics such as severity have little or no effect. The resource use is significantly high if the facility: (1) is located in rural areas (gun): (2) has mare than 200 beds; (3) is a long-term care hospital; (4) is private; and (5) has a low percentage of medical aid patients. The analysis of the resource use in each RUG-III categories, for which ADL(Ability of Daily Living) were employed as the prosy of patient severity, shows a similar result. The loose relationship between the needs of residents and the resource use seems to be closely associated with the ineffective reimbursement system for providers. The current reimbursement system has no provision for quality improvement and reimburses facilities simply according to their types: fee-for-service for long-term care hospitals, and monthly-flat-rate or full-coverage-national-aid for skilled nursing facilities. It will be necessary to develop a more reasonable reimbursement system that takes patient's severity into account and gives incentives for long-term care providers to offer cost-effective services.

Investigation of visible light communication transceiver applicable to both of illumination and wireless communication (조명 및 무선통신이 동시에 가능한 가시광 송수신기에 관한 연구)

  • Song, Seok-Su;Kong, Young-Sik;Park, Jin-Woo
    • The Journal of Korean Institute of Communications and Information Sciences
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    • v.37 no.4A
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    • pp.219-226
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    • 2012
  • We investigated the performance of a visible light communication (VLC) transceiver applicable to both of illumination and wireless communication. we considered the visibility of VLC, the easy connection for wireless communication and high-speed transmission and implemented VLC transceiver based on edge-emitting laser diode and silicon photodiode. The proposed VLC transceiver is designated to operate in a full duplex mode at high speed of 120 Mbit/s. The shielding method that is employed as a means to reduce the light cross coupling effect inside the VLC transceiver is proposed and its performance is experimentally measured. We also applied optical antenna to have the larger angle of field of view (FOV) to novel structure of VLC transceiver and examined and analyzed their bit error rate performance, photometric result with respect to the transmission distance, the coverage range and the tilt degree as transmission link characteristic between two transceivers without optical antenna and with optical antenna.

Fundamental Studies on the Landscape Use of Evergreen Ground Cover Plants in KANG WON Area -Propagation, Shade Tolerance, Cold Resistance, and Growth Rate (강원도 지역에서의 상록지피식물의 조경적 이용에 관한 기초적 연구(I) -증식, 내음성, 내한성, 생육량의 차이에 관하여)

  • 홍종운;이기철;허범람;원경렬;임병춘
    • Asian Journal of Turfgrass Science
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    • v.7 no.1
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    • pp.19-30
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    • 1993
  • Experiments were conducted to investigate propagation, shade tolerance, cold resistance and growth rate of evergreen ground cover plants ; Vinca minor K , Ajuga reptans L., Ophiopogon japonicus ker. f nanus hort , and Hedera helix.. The results were as follows : 1.It is convenient to use the growing case for rice seed to grow and transplant Vinca minor seed-ling. The most proper density of transplanting Vinea was 180 plants per 1m$^2$. At the end of growing season, the coverage came up to 90% The rooting ability of Hedera helix was best to cut from April to May (temperature 15~23˚C). The seedling length of Parthenocissus quinguefohlia were irregular and ranged from 5 cm of 200cm. 2. Ajuga reptans L., Ophiopogon j. and Vinca minor L. grew better under 50% light intensity than full sunlight. Particularly, under full sunlight and aestival high temperature, there were a few withering plants in Ajuga reptans L. , and V Vilica minor L. 3. Of Vinca minor K., Ajuga reptans L. , Ophiopogon japonicus ker. f. nanus hort. and Hedera helix. acclimatized in open field, where temperature was from -7~8˚C. There were few plants had damage in low temperature incubator to -16˚C after field acclimatization. 4.Tendrils of Parthenocissus quinguefolia strongly clung to the wire netting stone fence but intruded into the gap and cranny of the precast concrete fence and so clung to, so that it needed to install the bending net on the precast concrete fence.

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