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When lawmakers and insurers ask nurse practitioners how NPs differ from physicians and why they should be incorporated into patient care systems, NPs answer that they are better listeners, pay more attention to prevention, and that they give safe care and have a high level of patient satisfaction. Lawmakers and insurers are not always impressed with this type of answer. These policy makers may understand that NPs do some of the same things as physicians, but they do not always understand why anyone should seek out NPs when physicians are available. This article outlines the types of data needed to support NP practice before lawmakers, bureaucrats, and business-people. The article examines impressive facts and figures that are emerging and suggests what is needed in the way of further data collection and continuing advancement of the profession.
Mouthguards are expected to reduce sports-related orofacial injuries. Numerous studies have been conduced to improve the shock absorption ability of mouthguards using air cells, sorbothane, metal wire, or hard material insertion. Most of these were shown to be effective; however, the result of each study has not been applied to clinical use. The aim of this study was to develop mouthguards that have sufficient prevention ability and ease of clinical application with focus on a hard insertion and space. Ethylene vinyl acetate (EVA) mouthguard blank used was Drufosoft and the acrylic resin was Biolon (Dreve-Dentamid GMBH, Unna, Germany). Three types of mouthguard samples tested were constructed by means of a Dreve Drufomat (Type SO, Dreve-Dentamid) air pressure machine: the first was a conventional laminated type of EVA mouthguard material; the second was a three layer type with acrylic resin inner layer (hard-insertion); the third was the same as the second but with space that does not come into contact with tooth surfaces (hard + space). As a control, without any mouthguard condition (NOMG) was measured. A pendulum type impact testing machine with interchangeable impact object (steel ball and baseball) and dental study model (D17FE-NC.7PS, Nissin, Tokyo, Japan) with the strain gages (KFG-1-120-D171-11N30C2: Kyowa, Tokyo, Japan) applied to teeth and the accelerometer to the dentition (AS-A YG-2768 100G, Kyowa) were used to measure transmitted forces. Statistical analysis (anova, P < 0.01) showed significant differences among four conditions of NOMG and three different mouthguards in both objects and sensor. About acceleration: in a steel ball which was a harder impact object, shock absorption ability of about 40% was shown with conventional EVA and hard-insertion and about 50% with hard + space. In a baseball that was softer compared with steel ball, a decrease rate is smaller, reduction (EVA = approximately 4%, hard-insertion = approximately 12%, hard + space = approximately 25%) was admitted in the similar order. A significant difference was found with all the combinations except for between EVA and hard-insertion with steel ball (Tukey test). About distortion: both buccal and lingual, distortions had become small in order of EVA, hard-insertion, and hard + space, too. The decrease rate is larger than acceleration, EVA = approximately 47%, hard-insertion = 80% or more, and hard +space = approximately 98%, in steel ball. EVA = approximately 30%, hard-insertion = approximately 75%, and hard + space = approximately 98% in baseball. And a significant difference was found with all the combinations (Tukey test). Especially, hard + space has decreased the distortion of teeth up to several percentages. Acceleration of the maxilla and distortions of the tooth became significantly smaller when wearing any type of mouthguard, in both impact objects. But the effect of mouthguard was clearer in the distortion of the tooth and with steel ball. Considering the differences of mouthguards, the hard-insertion and the hard + space had significantly greater buffer capacity than conventional EVA. Furthermore, hard + space shows quite high shock absorption ability in the tooth distortion. Namely, hard + space has decreased the distortion of teeth up to several percentages in both impact objects.
In this study, the effect of hardness on the combined outcome of metal mixtures was investigated using Daphnia magna. The toxic unit (TU) was calculated using modified LC(50) values based on the hardness (i.e., LC(50-soft) and LC(50-hard)). From a bioassay test, the degree of sensitivity to hardness on the toxicity changes was in the order: Cd<Cu<Zn<Pb, with 25, 66, 77 and 88% decreases in the LC(50) values, respectively, when the hard test solution was replaced with a soft test solution. In mixture toxicity tests, the difference in the test solution hardness was found to clearly cause different toxicities, as determined by the TU calculated by the LC(50-hard), using the toxicity of a standard culture medium as the reference. That is, approximately four to five times higher toxicity was observed in soft (i.e., 44+/-4 mg/L as CaCO(3)) rather than hard water (i.e., 150+/-10mg/L as CaCO(3)) test solutions. In the tests where the modified reference toxicity values (i.e., LC(50-soft) and LC(50-hard) for soft and hard test solution, respectively) obtained from the individual metal toxicity tests with different hardness were used to calculate the TU, the results showed very similar D. magna toxicities to those of the TU from the mixture of soft and hard test solutions, regardless of the hardness. According to the toxicity results of the mixture, the aquatic toxic effects of the acid mine drainage (AMD) collected from mine areas that contained metal mixtures were investigated using Daphnia magna and the modified LC(50) value of the TU hardness function calculated for varying solution hardness. The results of the biological WET test closely matched our overall prediction, with significant correlation, having a p-value of 0.513 in one way ANOVA test (n=19). Therefore, this study revealed that the predicted toxicity of the metal mixture agreed well with the biological toxicity test when the modified LC(50) value was employed as the basis of hardness in the TU calculation.
The aim of the present study was to determine the intra- and interobserver variation during measurement of muscle hardness with a new instrument, a so-called hardness meter. In addition, we investigated the factors which may influence the recording of muscle hardness and whether the hardness differs within the same muscle. Hardness was measured at a standardized point on the trapezius muscle in 20 volunteers by 2 observers in random order and again by 1 of the observers after 30 min. Muscle hardness was then measured at 3 different locations on the trapezius muscle. In addition, the muscle hardness at the standard point was measured in 10 volunteers by both observers at 3 different speeds of the applied pressure. The intraobserver variation was 10% and the interobserver variation was 12% for recording of muscle hardness. There was no significant difference in hardness values from time to time within the same observer (p=0.12), while there was a significant difference in hardness measurements between observers (p=0.007). Muscle hardness differed significantly among the 3 anatomical locations (p=0.03). For both observers, there was a significant difference among hardness recordings obtained at 3 different speeds (p=0.01 and p=0.0001). In conclusion, we have shown that the hardness meter can measure muscle hardness reliably if the same observer is used throughout a study. The speed factor was a major source of variability In addition, we have demonstrated that muscle hardness differs within the same muscle. We suggest that the muscle hardness meter will be an important tool in future research of the mechanisms leading to myofascial pain.
The hardness of seven proprietary, light-cured, posterior composite resins was evaluated by three different hardness testers: the Knoop hardness tester, the Barcol indenter and the Rockwell 15T hardness meter. Specimens were measured after light-curing and 24-hour immersion in 37 degrees C water. Barcol hardness numbers ranged from 79.2 to 85.0. The Rockwell 15T hardness data had a range from 73.3 to 80.3 and the Knoop hardness numbers varied from 39.9 to 79.0. Relatively small variations were determined between results of Barcol hardness numbers and Rockwell 15T hardness data. Great variation was revealed in the results from Knoop hardness numbers. According to the dimensions of the indentations, the results of Barcol and Rockwell hardness represent the bulky part of tested composites rather than superficial hardness. Knoop hardness testing is found to be relatively feasible and a suitable measurement for the determination of superficial hardness of highly filled composite resins.
The purpose of this study was to examine the hardness of the masseter and trapezius muscles at various head positions and to explore the relationship of these two muscles to each other in terms of their respective levels of muscle hardness at different head positions. Twenty-two asymptomatic male subjects participated in this study. Using a hand-held hardness meter, muscle hardness was first measured in a relaxed position as a baseline. The subjects were then asked to assume five deviated head positions, and the muscle hardness was measured again. The data obtained at each deviated head position were compared to those at baseline. In addition, the subjects were asked to maintain a five minute sustained anterior flexion of the head, and muscle hardness was also measured and compared to the baseline. As a result, there was a significant increase in muscle hardness at the point of the whole trapezius with 30-degree anterior flexion, while there was a significant decrease at the point of the right masseter. A significant increase in hardness was seen in the upper trapezius muscle in conjunction with right side bending and in the right upper trapezius muscle on left side bending. Also, a significant decrease in hardness was observed in the right masseter with right side bending. With reference to the axial rotation, there was a significant increase in hardness in the upper right trapezius muscle upon right axial rotation. Moreover, there was a significant increase in the muscle hardness in the whole trapezius after the five minute anteriorly sustained head task. This study provides evidence that deviated head positions lead to an increase in hardness of the trapezius muscle. The data also revealed the simultaneous occurrence of the elevation of muscle hardness in the upper trapezius muscle and the decrease in muscle hardness in the masseter muscle associated with right side bending and anterior flexion.
PURPOSE: To measure and compare three-body wear and Vickers hardness at depths of 0 mm and 2 mm in two composite resin materials cured with either a low irradiance light emitting diode (LED) or a quartz tungsten halogen (QTH) light-curing unit (LCU) in which exposure duration with the LED was increased to deliver equivalent radiant exposure in the 450-490 nm wavelength range. METHODS: The VIP QTH and Freelight LED LCU's were obtained and the emission spectrum of each was determined using a Spectra Pro 750 spectrograph. Irradiance in the 450-490 nm range for each LCU was determined by calculating the area under the spectral curve. Curing of two composite resins (Z100 and Esthet-X) with equivalent radiant exposure within this prescribed wavelength range was achieved by increasing the irradiation time of the LED 33% from 30-40 seconds to compensate for its lower irradiance (Table 1). The resulting radiant exposure of 8.40 J/cm2 was roughly equivalent to the radiant exposure produced in 30 seconds by the QTH LCU (8.67 J/cm2). The cured specimens were polished with progressively fine wet silicon carbide papers to 600 grit and stored in distilled water at 37 degrees C for 24 hours prior to evaluating hardness and wear. Indentations for Vickers hardness testing were produced by applying a 0.5 kg load with a 15-second dwell time. Equivalent degree of cure was established indirectly through Vickers hardness numbers for the top and bottom surface of 2 mm thick disks of each material cured with each light (N = 3/group). Hardness ratios were computed by dividing mean bottom hardness by mean top hardness within each group. Three-body wear testing (N = 10/group) was performed on similarly fabricated specimens with a mechanical wear device using 44 microm unpolymerized PMMA beads as a simulated food bolus. The composite resin samples opposed spherical, stainless steel styli. A 75 N contact force was applied at 1.2 Hz for 100,000 cycles. Profilometry was used to quantify localized wear of the resin. Multivariate ANOVA and the Tukey-Kramer post hoc test (alpha = 0.05) were used to assess differences in hardness and wear of the materials. RESULTS: With respect to hardness, no difference was noted between top and bottom specimen sides based on material or curing method. Specimens cured using the LED exhibited hardness ratios approaching unity. No significant difference in hardness was found for the main effect of light used, but the main effect of material was highly significant. This was primarily because Z100 cured with the LED demonstrated statistically higher hardness than the other three groups, which were statistically similar. No significant difference in wear was found based on the light used, with the lowest mean wear seen in Z100 cured with the LED. Overall, Z100 exhibited significantly greater surface hardness (P < 0.001) and significantly less wear (P < 0.01) compared to Esthet-X
"Soft" and "hard" are the two main market classes of wheat (Triticum aestivum L.) and are distinguished by expression of the Hardness gene. Friabilin, a marker protein for grain softness (Ha), consists of two proteins, puroindoline a and b (pinA and pinB, respectively). We previously demonstrated that a glycine to serine mutation in pinB is linked inseparably to grain hardness. Here, we report that the pinB serine mutation is present in 9 of 13 additional randomly selected hard wheats and in none of 10 soft wheats. The four exceptional hard wheats not containing the serine mutation in pinB express no pinA, the remaining component of the marker protein friabilin. The absence of pinA protein was linked inseparably to grain hardness among 44 near-isogenic lines created between the soft variety Heron and the hard variety Falcon. Both pinA and pinB apparently are required for the expression of grain softness. The absence of pinA protein and transcript and a glycine-to-serine mutation in pinB are two highly conserved mutations associated with grain hardness, and these friabilin genes are the suggested tightly linked components of the Hardness gene. A previously described grain hardness related gene termed "GSP-1" (grain softness protein) is not controlled by chromosome 5D and is apparently not involved in grain hardness. The association of grain hardness with mutations in both pinA or pinB indicates that these two proteins alone may function together to effect grain softness. Elucidation of the molecular basis for grain hardness opens the way to understanding and eventually manipulating this wheat endosperm property.