Smartlipo laser liposuction technique explained to prospective Essay

Smartlipo laser liposuction technique explained to prospective patients - Essay Example rtlipo makes use of the tumescent technique, where highly diluted lidocaine and epinephrine are injected into the target fat tissues, so that they swell and become tumescent (meaning firm). Lidocaine is a local anesthetic while epinephrine helps in minimising blood loss. Then, the fat cells are broken down by using calibrated lasers and the fluid formed is easily suctioned off through a cannula, about 1-2mm wide. The traditional methods require the patient to be put under general anesthesia, causing much discomfort. Hospitalization is required, followed by weeks of slow recovery. Besides, surgical blood loss and bruising is higher. Smartlipo requires a very small incision in the skin for inserting the cannula, hence can be performed under local anesthesia. One doesn’t feel any pain during the procedure, and only a little pain after the anesthesia wears off, which can be easily taken care of with minor pain medications. Most patients need just one session of about 45 minutes to one hour for treating one body area. Recovery period is also very less compared to traditional methods. Many people return to work within two hours of the procedure, while some like to rest for a few days. Results can be seen immediately, with continued improvement over a period of three months. From then on, the skin looks completely normal, with hard to spot scars. The fat removed by Smartlipo doesn’t grow back in the treated areas in adults, eliminating the problem of regaining fat after losing it. Besides, the laser technology helps firm up the skin from under which fat removal has been done, thereby preventing ungainly sagging, so commonly seen in traditional liposuction methods. A Smartlipo session is followed by a doctor’s checkup and instructions. It is essential to follow the instructions strictly. One must take pain medications as directed and also use the compression bandages to prevent blood clotting and ensure quick healing. No other medicines like anti-inflammatory

Journal Assignment Example | Topics and Well Written Essays - 250 words - 7

Journal - Assignment Example In the story, the two main characters, a man and a woman, are involved in a decision-making process about an issue that can affect their life. Being both free spirits, they are both hesitant to admit that their life will inevitably change like the hills that look like white elephant that look out of place in the horizon. Because the said issue is of great effect to both their lives, they are continuously talking about it. The man wants the woman to do something but she clearly does not like it. But both of they do not verbalize such feelings instead they are expressing the opposite. The argument between the two main characters can be compared to the factors in life that can affect the decisions that people make. There are people who are like travellers and just depend on fate to lead them to their destinations. There are people who take active actions and make important decisions in life to be able to achieve their goals. The in the story still wanted to have an easy traveller’s life but he is telling the woman that he can accept her decision which ever choice she makes. On the other hand, the woman wanted to arrive at a serious decision but she is telling the man that she is carefree regarding the decision they had to make. The story captures the complexity of life. It also reveals a perspective that no matter how people wanted to have free spirit and leave everything to fate, at one point decisions are needed to be

Immediate Dentin Sealing Of Crown Health And Social Care Essay

Immediate Dentin Sealing Of Crown Health And Social Care Essay Background: Dental crowns are ideal restoration to protect teeth that have been extremely worn down, broken, weakened by caries, and heavily filled or root canal treated. They can be also used for aesthetic purposes. Full crown preparation requires more tooth removal than other restorations and is associated with dentine exposure. When a two-stage crown fabrication is planned, there is a risk of bacterial contamination of the pulpal tissue through dentine and eventually vitality loss. The main objective of this protocol is to assess whether immediate sealing of the exposed dentine surface following crown preparation of back teeth can lead to a decrease in microleakage and bacterial infiltration from the oral environment. Methods: This protocol, immediate dentine sealing of crown preparations, demonstrates a model for a one year, three years and six years follow-up, in-vivo, randomised controlled trial with a balanced treatment allocation of 1:1 (immediate dentine sealing vs. delayed sealing). The treatment will include tooth preparation, impression taking, temporary crown placement and full crown fit on a posterior tooth. Discussion: The results of the study would provide insight into the question of whether immediate sealing of dentine after crown preparation reduces the bacterial ingression and incidence of vitality loss of teeth. The results would also help to provide evidence based suggestions for clinicians and other researchers. Overview This dissertation consists of literature review and a representation of the study design and methodology, followed by data management, statistical analysis and quality assurance of proposed study. Other sections are allocated to ethical consideration and reflection on thesis procedure. DECLARATION No portion of the work referred to in the dissertation has been submitted in support of an application for another degree or qualification of this or any other university or other institute of learning. INTELLECTUAL PROPERTY STATEMENT The author of this dissertation (including any appendices and/or schedules to this dissertation) owns certain copyright or related rights in it (the Copyright) and s/he has given The University of Manchester certain rights to use such Copyright, including for administrative purposes. Copies of this dissertation, either in full or in extracts and whether in hard or electronic copy, may be made only in accordance with the Copyright, Designs and Patents Act 1988 (as amended) and regulations issued under it or, where appropriate, in accordance with licensing agreements which the University has entered into. This page must form part of any such copies made. The ownership of certain Copyright, patents, designs, trade marks and other intellectual property (the Intellectual Property) and any reproductions of copyright works in the dissertation, for example graphs and tables (Reproductions), which may be described in this dissertation, may not be owned by the author and may be owned by third parties. Such Intellectual Property and Reproductions cannot and must not be made available for use without the prior written permission of the owner(s) of the relevant Intellectual Property and/or Reproductions. Further information on the conditions under which disclosure, publication and commercialisation of this dissertation, the Copyright and any Intellectual Property and/or Reproductions described in it may take place is available in the University IP Policy (see http://documents.manchester.ac.uk/display.aspx?DocID=487), in any relevant Dissertation restriction declarations deposited in the University Library, The University Librarys regulations (see http://www.manchester.ac.uk/library/aboutus/regulations) and in The Universitys Guidance for the Presentation of Dissertations. Acknowledgements I have great pleasure to express my gratitude to my Tutor (Juliette Kendall). She has been most helpful and supportive throughout. Introduction, Research question and PICO 1.1 Introduction Restoring teeth with full-coverage crowns is a routine treatment in general dental practice. This normally requires two visits, one for crown preparation and impression taking and one for final cementation of the crown once the restoration has been produced in the dental laboratory. Provisional crowns which will be provided to protect the tooth between two visits could cause problems since they are not bonded to the prepared tooth surface permanently and require removal prior to final cementation. Problems may occur if the bacteria from oral cavity gain access to the pulpal tissue. The consequence could be pulp inflammation or even irreversible pulp infection, which requires endodontic treatment. There are some evidence in the literature that suggests that applying a sealant material on the freshly prepared teeth may reduce the invasion of the pulp by bacteria (Magne et al., 2007). Any effort needs to be made to reduce the risk of vitality loss in teeth requiring a full-coverage crow n. There are other alternatives to reduce the bacterial ingression like CAD/CAM technology. This method allows restoring a tooth with a crown in a single visit. Reis 2006 believes that using this system may decrease the possibility of bacterial infection of the pulp as there is no need for provisional coverage of the prepared tooth. 1.2 Research question Protecting the exposed dentine with a sealant after a crown preparation requires some additional steps and is more expense and time-consuming than the traditional procedure. The research question is if it is clinically necessary to seal the exposed dentine immediately after the preparation with a dentine sealing agent or not. 1.3 PICO Population: NHS and private patients between the age of 18 and 58 years of age in general dental practice requiring full-coverage crowns of a posterior tooth. Intervention: Sealing the exposed dentine of prepared teeth for full crown coverage with a dentine sealing agent instantly after the preparation before taking a final impression and temporisation. Control: Not sealing the exposed dentine of prepared teeth for full crown coverage with a dentine sealing agent instantly after the preparation. Outcome measure: Comparing the vitality loss of the prepared teeth for full crown restoration at one year, three years and six years. Aims and objectives Aims: The aim of the study is to evaluate the efficiency of instant sealing of posterior teeth prepared for full crown coverage prior to impression taking and temporisation in terms of vitality loss compared with teeth without any sealant application. Objectives: The primary objective is to assess whether an instant sealing of prepared posterior teeth for full crown restorations with a dentine sealant results in a reduction in vitality loss. To organise a clinical trial and to allocate two groups of participants (NHS and private) aged between 18 and 58 requiring a crown on a posterior tooth. One group will have their prepared teeth covered and one group not. To analyse the achieved data and to determine whether there is a difference between groups in terms of loss of vitality. Literature review 3.1 Introduction The assumption of this protocol is the proposition that the instantaneous sealing of exposed dentine after crown preparation, will help against the bacterial contamination of the pulpal tissue and decreases the probability of the treated tooth requiring root canal treatment in the future. 3.2 Search Strategy The strategy conducted for this literature review included an electronic search of the following databases: EMBASE (1995 Oct 2011), MEDLINE (1995 Oct 2011) and Cochrane Library. The reference list includes hand-searched articles and key journals related to researching. Key words: REFER TO KEY WORD EITHER HERE OR APPENIX 3.3 Background Where tooth destruction by dental disease is extensive, restoration may only be possible with full coverage restorations or crowns. There is a big number of NHS and private patients in UK requiring a full coverage of posterior teeth due to failed huge previous restorations, fractured cusps or following a root canal therapy. Tooth preparation for full coverage crown requires more tooth removal than other restorations. It should be carried out in a conservative way. The reason is to reduce the post-preparation sensitivity and pulp tissue protection in vital teeth and to maximise the remaining tooth structure. 3.4 Crown Preparation and pulp Health of pulp tissue can be affected by any restorative treatment. This is due to a continuous extension between dentinal and pulpal fluid (Pashley 1992). Preparation for a full-coverage restoration requires removal of most of the enamel resulting in an exposed dentine surface and may affect the pulp. In one study by Jackson et al. (1992) irreversible pulpitis occurred in 5.7% of cases in which crowns were placed. The bigger the exposed dentine surfaces during tooth preparation like for a crown, the greater the risk of bacterial infiltration from the oral environment (Pashley, 1990). Saunders and Saunders (1998) considered the vitality loss in adults who received full crowns in a dental hospital based on radiographic analysis and found that 19% of the patients in the study have lost vitality of the prepared teeth. A study by Cheung et al. (2005) aimed to investigate the influence of factors connected with pulpal damage in teeth restored with porcelain fused to metal (PFM) crowns or crowned as a fixed bridge abutment. The study reveals that the preparation for either of the restorations requires a considerable reduction of dentine and may cause trauma to pulp tissue but the survival rate of pulp in single-unit crowns is higher than in abutment teeth. Bergenholtz and Nyman (1984) and Karlsson (1986) demonstrated a permanent pulpal damage rate of 1% year for vital teeth following a crown restoration. 3.5 Crown Vs. other restorations Many previous studies have supported the use of indirect intracoronal restorations (porcelain or composite) in vital teeth as advantageous against full-coverage restorations due to their less invasively preparation and more conservative nature (Jackson, 2008, Magne et al., 1996, Dietschi et al., 1994). They have been also considered to be easier to do than a crown and are no more expensive than crowns or root canal treatments. A literature review by Kerschbaum and Voß 1981 showed that inlay restorations at 10 years have 9.5% lower rate of vitality loss compared to full crown restorations. When aesthetic aspect is not the first priority properly designed and provided inlays and onlays have the same longevity and durability as crowns (Jackson, 2008). Cusp replacement with resin composite can be considered as alternative to traditional cusp replacement by crowns due to advanced adhesive technology. Deliperi et al. (2006) highlight that if the bonding agent is not stressed, an acceptable success rate could be achieved by using this method. According to van Dijken et al. (2001) an indirect cusp replacement restoration with ceramic might be considered indicated. This has the benefit of saving valuable remaining tooth substance and eventually avoiding endodontic therapy. 3.6 Dentin Bonding There are recommendations in the literature for sealing the dentine with a Dentine Bonding Agent (DBA) following crown preparations in order to minimise the associated complications like hypersensitivity (Clinical Research Associates 1993). Dentine bonding agents have shown to be advantageous over the smear layer itself due to their mechanical retention (Nakabayashi et al. 1982) and moisture and acid resistance (Brunton et al. 2000). Over the last decades they have been considered as a modern way of sealing exposed dentine (Ferrari M. et al. 1999, Swift EJ et.al 2001). Some authors have compared the effectiveness of DBA with smear layer as a natural barrier. Pashley (1984) states that dentine permeability can be reduced up to 98% when smear layer is produced by slow or fast rotary headpieces but it would not last for more than a few days due to acidic PH from the oral cavity (Kerns DG. et al. 1991) .There are several advantages of DBAs over the smear layer like hybrid layer as described by Nakabayashi (1982) and resisting moisture and acid (Brunton et al. 2000). The result of various in-vitro studies on humans teeth (Pashley et al. 1992, White et al. 1992, Al-Fawaz et al. 1993) and animals teeth (Suzuki et al. 1994) supports the idea of sealing the dentine of prepared teeth for a crown restoration. A literature review by Lam, C.W. and Wilson, P.R. (1999) revealed that dentine sealing with bonding agents prior to crown cementation could be beneficial due to fluid flow reduction in dentine tubules. Magne (2005) believes that immediate application of dentine bonding agents or Immediate Dentine Sealing (IDS) prior to impression taking can reduce the postoperative sensitivity and bacterial contamination. 35% H3PO4 is normally used to remove the smear layer before DBA application. There are different ways of sealing dentinal tubules after the preparation. Edward and swift (2009) reviewed several in vitro research studies on the immediate dentine sealing technique in a critical appraisal and came to following conclusions. First, immediate sealing of fresh dentin improves the resin adhesion and the bond strength will be affected by late application. Second, the IDS provide a mechanical barrier which minimises the postoperative sensitivity, bacterial contamination and eventually the necessity of local anaesthesia. Most Practitioners prefer to use self-etch-adhesives. However, Magne et al. (2007) believe that a three-step, etch-and-rinse adhesive has shown to be more efficient. In order to avoid complications after the IDS, some clinical steps need to be taken. The appearance of an O2 -inhibitory layer is not desirable and should be prevented by light-curing the dentine adhesive twice under a glycerine coating. This step avoids the reaction between inhibitory layer and impression material. The reaction between temporary crown and sealed tooth should also be prevented by applying a separating material. The influence of dentine on antimicrobial effect of ingredients added to one-step dentine sealants was assessed by Gondim et al. (2008) and revealed a reduced affectivity after polymerisation with UV light. 3.7 Temporary Crowns Temporary crowns are provisional restorations that are fitted on the teeth between preparation and fit appointment. They have various functions, mainly dentine protection and tooth movement prevention. Their role is often overlooked by practitioners (Wassel et al. 2002). Pre-formed crowns (plastic, metal) and self or light cured resins are usually used in the dental practices as convenient for temporary restorations. Many temporary crowns have poor-fitting margins based on production procedure and material used. Some materials create a gap between the temporary and the prepared tooth due to polymerisation shrinkage (Robinson and Hovijitra, 1982)( Tjan et al. 1987). Cervical border of a temporary crown is the primary area to be reached by bacteria from the oral environment. Richardson et al. (1991) believe that dentine in the cervical margin shows higher permeability than dentine in other surfaces of the prepared tooth and that confirms the importance of good marginal adaptation of temporary crowns. A paper by Cagidiaco et al. (1996) considers the exposure of vital pulp tissue to bacterial contamination and irritants after dentine preparation in the base of a cavity, especially if temporary shows an unsatisfactory sealing. Exposed dentinal tubules after a crown preparation provide a way for transfer of substances between the pulpal tissue and periphery (Garberoglio and Brannstrom M. 1976). These tubules are expected to be sealed by cement. Different researchers (White et al. 1992, White et al. 1994, Lyons. et al, 1997, Baldissare. et al. 1998, Goldman et al. 1992) have found microleakage to be present after either permanent or temporary crown cementation. Literature review supports the evidence of benefit of immediate dentine bonding as a technique during temporisation of indirect provided restorations but reveals a lack of in vivo evidence. This fact supports the requirement for this clinical study. Study design methodology The study design and methodology will be presented in accordance with the CONSORT explanation for reporting on clinical trials (Moher et al., 2010). 4.1 Trial Design This will be a randomised controlled parallel two-armed trial-pragmatic group trial to take place over the duration of a six-year period. The study will provide a 1:1 allocation ratio. One molar tooth will be randomly chosen per participant. The evaluation of the outcome will take place at one year, three years and five years (Fig 1). 4.1.1 Changes to trial design The Data Monitoring Committee (DMC) will have access to the un-blinded data. The study protocol may be altered by DMC due to their recommendations. 4.2 Participants Participant selection will take place utilising new and existing patient population that attends the dental practice. Recruitment will be on a continuous basis until the required numbers of participants have been enrolled into the study (see section 5 for sample size calculation). This will ensure the pragmatic nature of the trial as no proactive recruitment of patients from leaflet drops and advertising will take place. A trained member of staff will administrate the consent process once a patient has been identified as having an eligible tooth suitable for the study. 4.2.1 Inclusion criteria for participants: Healthy adult patients between 18-58 years of age Provide a written informed consent, understand spoken and written English. Regular attenders (at least every six months) with a two-year record Require a full coverage of a Molar (Upper or Lower arch) With a crown Selected tooth must be periodontally healthy. Selected tooth must be vital and without any history of pulpitic symptoms within the last 12 months. Are able to attend follow-up appointments. In terms of periodontal status, the chosen teeth for study have to have a BPE less than three mm as per guidelines published by British Society of Periodontology (BSP). The teeth must be also radiographically free of any pre-operative pathological signs meaning intact pulp with no evidence of radiopaque foreign materials in the pulp chamber and/or root canals(s) and no periradicular radiolucent area. 4.2.2 Exclusion criteria for participants: Irregular attenders to dental practice History of pulpitic symptoms in the last 12 months Patients participating in any other medical trials Notable medical history change or pregnancy Existing periapical pathology (radiographically) Periodontal pockets more than three mm Pulpal exposure or extending caries into the pulp chamber Vulnerable adults or children 4.3 Study location and settings The trial will take place in twenty dental practices based in the United Kingdom. General Dental Practitioners with more than five years experience and qualification in a post-graduate restorative dentistry will be recruited. 4.4 Withdrawals Patients may be disqualified if they experience medical complications or refuse to attend routine check-ups. A patient may also be withdrawn from the study if the tooth suffers from a trauma, requires extraction or develops pockets deeper than 3mm due to insufficient oral hygiene. Information on all patients, including the reason for the withdrawal will be collected and added to trial data report. Patients may also choose to withdraw from the study themselves. 4.5 Randomisation Initial selection process will include all teeth that are suitable per patient. To maintain allocation concealment and to limit the occurrence of selection bias (Vickers A.J. 2006) a remote allocation officer in the central generates the allocation of teeth for either the intervention or control group. The participants initials, gender, date of birth and tooth notation will be submitted to a centre securely, where randomisation will occur within the patients to select the eligible tooth and to allocate the patient to the treatment or control group using a computer generated sequential number list. The trial will include only one allocated tooth per patient per control or treatment group. The indication of allocation will be sent to the general dental practitioner in an envelope with the patients identification code and the tooth number. The code for trial remains hidden until the clinical procedure to treat all eligible teeth is ready. At this time, it will be opened by the operator but not revealed to the participants. The randomisation will be balanced to a 1:1 ratio for each provider in each practice. Simple randomisation is suitable to generate a balanced group. Balance between the groups at each location will be verified by the trial allocation operator regularly. 4.6 Baseline assessment A baseline examination will be carried out by operators once the suitable patients have completed the consent procedure. The assessment will include: Patients Identification, age and gender Medical and social history Dental history Extra-oral examination: Musculoskeletal assessment, Soft tissue profile, TMJ Intra-oral examination: Oral Hygiene, periodontal assessment, soft tissue, occlusal analysis, vitality testing, Ridge mapping, Radiographic evaluation of tooth prior to preparation Reason for Crown placement 4.7 GDP training Each of the operators will attend a one-day training program on techniques. Clinical consensus will be ensured and standardised in a discussion with investigators in a separate session and will include a clinical protocol for the preparation of teeth for a full coverage with a crown, impression taking and temporisation. Additional clinical protocols will be prepared for immediate dentine sealing after preparation and for final cementation of the restoration. A clinical team member will be appointed as the independent observer to evaluate the compliance to the study criteria. All materials and Instruments used will be applied as per manufacturers instructions. The Crown system used in the study is Cercon ht (Dentsply) full Contour Zirconia. The high strength of zirconia-based ceramic restorations increases the indications for choice. They can be a near ideal choice for restoring crowns, fixed partial dentures, and implants in aesthetic areas. Because of their high strength, zirconia-based ceramic restorations can be cemented with traditional cements or bonded with adhesive resin cements. Like gold, Cercon ht has a simple, clinical protocol, requiring conservative tooth reductions of as little as 0.5 to 1.0 mm. A feature that is friendly to both patients dentition and dentists chair time. All clinical and laboratory techniques for teeth involved in the study are specified as per Dentsply protocol. 4.8 Intervention A universal self-priming dental adhesive system (Prime Bond NT Dual cure, Dentsply) and a dual cure resin cement (Calibra, Dentsply) will be used to bond the indirect restoration to the tooth. The literature supports the chosen material for this proposed study (Barnes et al., 2006). 4.8.1 Intervention protocol for Immediate Dentine Sealing (IDS) The teeth will be sealed immediately after preparation with Prime Bond NT Dual Cure (Dentsply). To avoid any bond contamination, retraction cord will be placed before dentine sealing. The protocol for dentine bonding is as manufacturers instructions: Clean freshly instrumented dentine with water spray and air dry. It is recommended not to etch dentine to minimize the possibility of post-operative sensitivity. Place 1-2 drops of Prime Bond NT adhesive into a clean plastic mixing well. Place an equal number of drops of Self Cure activator into the same mixing well. Mix Contents for 1-2 seconds with a clean, unused brush tip. Immediately apply mixed adhesive/activator to thoroughly wet all the tooth surfaces. These surfaces should remain wet for 20 seconds and may necessitate additional application of mixed adhesive/activator. Remove excess solvent by gently drying with clean, dry air at least for 5 seconds. Surface should have a uniform glossy appearance. Cure mixed adhesive/activator for 10 seconds using a curing light. Check curing light for minimum curing output of at least 550mw/cm2 and a spectral output, including 470nm (peak absorption of the CQ photoinitiator). Control Group Exactly the same procedure will be used for the control group prior to final bonding of the Crown. 4.8.2 Protocol for Impression taking Study Group (IDS) In practice, freshly cut dentin is present only at the time of tooth preparation (before impression). Freshly cut dentin is the ideal substrate for dentin bonding. Most studies on Dentine Bonding Agents (DBA) bond strength use freshly prepared dentin (Magne 2005). There is a possibility for the oxygen inhibition layer of filled resin of the dentine bonding agent to inhibit the setting of the impression material. The bonded teeth have to be cleaned with pumic and a rubber prophylactic cup and washed with water and air dried before the impression (Magne and Nielsen, 2009b). Impressions will be taken with an A-silicone double-mix technique (Aquasil ultra, Dentsply) as per manufactures Instruction. Control Group (no sealing) Impressions will be taken as per study group without sealing the dentine with DSA. 4.8.3 Protocol for temporisation Study Group (IDS) A prefabricated light curable temporary Crown (Protemp Crown temporisation material, 3M ESPE) will be fitted on the prepared tooth standard temporary cements. The occlusion will be controlled and if necessary adjusted. Control group A temporary crown will be fitted as above without any DBA application and after Impression taking as per clinical consensus guidelines. 4.8.4 Protocol for final cementation Study group (IDS) Just prior to the luting procedures (when placing the final restoration), it is recommended to roughen the existing adhesive resin using a coarse diamond bur at low speed or by microsandblasting (Magne 2005). The tooth and the restoration will be treated as per manufacturers instructions, and the crown can be cemented with dual cure resin (Calibra, Dentsply). Control group The same procedure as for study group will be carried out except the adhesive resin roughening step. 4.9 Outcomes The outcome measures will be assessed, and the CRF forms updated at baseline and at recall appointments of 1 year, 3 years and 5 years. Any relevant clinical incident between these times affecting the trial tooth needs to be recorded on CRF. Base-line findings and post-operative taken periapical (PA) of each trial tooth at one year and five years will be studied, assessed and recorded by two blind assessors. These precalibrated, independent observers will examine the radiographs and categorize the periapical status of the selected teeth according to a written set of criteria (Cheung et al. 2005) (Table 1). Categories 1, 2 or 3 are deemed to be associated with a non-vital pulp. If there are any disagreement, a third assessor will be involved as an arbitrator before a final score is reached. The protocol for Periapicals will adhere to the guidelines produced by the faculty of General Dental Practitioners (Pendlebury et al., 2004). An Independent assessor will audit each practice participating in the study to ensure compliance with radiology regulations (IRMER). 4.10 Blinding Every effort will be made to prevent disclosure of the exact nature of the study aim and to which arm of the study the participants have been allocated. This will be specified to minimise assessment reactivity, which has been hypothesised by McCambridge and Strang (2005). The date collection statistician who assesses and calculates the outcome results will also be blinded to the individual patient allocation to limit detection bias. The operators will not be blinded but the allocation of whether the tooth is to be control or intervention will be concealed until intervention procedure is to be carried out. 4.11 Follow up An important selection criterion to minimise drop-out is the eligibility of the patients to be regular attenders at the relevant dental practices. Patients lost to follow up will be recorded.. Category Status Description 0 Intact pulp No evidence of radiopaque foreign material in pulp chamber and/or root canal(s), and no periradicular radiolucent area 1 Widening of the PDL space Widening of the apical part of the periodontal ligament space, not exceeding two times the width of the lateral periodontal ligament space 2 Periapical radiolucency Radiolucency in connection with the apical part of the root, the diameter exceeding two times the width of the lateral periodontal ligament space 3 Endodontically treated tooth Tooth with radiopaque material in pulp chamber (if discernible) and/or root canal(s) Table 1- Radiographic categorization of pulpal status (Cheung et al. 2005) 4.12 Safety This study will not be utilising any investigational medicinal products; it will therefore be classed as a non- Clinical Trial of an Investigative Medicinal Product trial (non-CMITP). All untoward incidents will be adverse events rather than adverse reaction. The study is also compatible with Data Protection and Mental Capacity Act. The treatment options being studied are non-life threatening on non-vulnerable adults with no risk of harm and no unknown or uncertain risks. A Data Monitoring Committee (DMC) will be appointed who makes recommendations, as required, to the chair of the Trial Steering Committee. This committee is responsible for ensuring that the intervention and control techniques will be carried out under the guidance provided by the EU directive for Good Clinical Practice. 4.12.1 Assessment of Safety There are no expected unexpected adverse events since the intervention is used routinely in general dental practice. The using of etching gel has expected adverse events should it come into contact with the soft tissues (Material Safety Data Sheet (MSDS) sheet). All other dental materials involved (Prime Bond NT Dual Cure, Calibra dual cure resin cement (Dentsply), Protemp Crown temporisation material, 3M ESPE) are fully licensed within the medical devices regulations for use in dentistry in UK. All operators are experienced dental practitioners having handled these materials routinely and will be trained in dealing with expected adverse reactions should the product inadvertently come into contact with pati

The Omega Directive :: essays research papers

I was on my way into the ‘office’ and I saw the secretary; â€Å"Hey Cheryl.† â€Å"Hey Martin. Here, isn’t it the big day today?† she asked â€Å"Yep, she’s finally coming online.† I replied, with a bit of an excited tone in my voice â€Å"Christ! What is it with men always having to call things ‘she’?† Her voice had something of a viscous snap to it. â€Å"Hey, don’t blame me dear. I just work here don’t I?† She giggled. I like it when she giggles. It’s got a sweetness to it that, for some reason, most other women lacked. I smiled at her. â€Å"So†¦Ã¢â‚¬ ¦..are you, going to let me in? Or shall I just stand all day looking at you, which I wouldn’t actually mind doing?† I heard a buzz and then a click at the door. â€Å"I’ll take that as a ‘yes’ then, shall I? Or are you just messing with my head?† â€Å"Go on, in, now! Or do I have to smack your rear end to get you in there?† She said. â€Å"Well, come on over here and try it baby!† I said to her with one great big cheesy grin on my face. â€Å"Oh you dirty man, you!† She said, sarcastically. We always were saying stuff like that in our own little way. It was†¦different. I’d never been like this with anyone else. It was always just us two. Then there would be a great booming voice from inside the ‘office’. â€Å"BRYSON!!!!!!!!!!!!!!!! GET YOUR SCRAWNY ASS IN HERE, NOW!!!!!!!!!!† â€Å"Oh dear, General Solomon’s calling.† I said with some remorse. â€Å"Don’t you mean ‘great wind-bag of Alcatraz’?† She said. I laughed. That’s the nickname I’d given him when I had started at the Pentagon. He was supposedly an ex guard over on Alcatraz prison island†¦. supposedly. I crossed the threshold into a huge room. Dimly lit, only the centre table was illuminated. I could see the General’s face. â€Å"I told you not to be late. I watched you out there flirting with Cheryl, it’s not on. I’ve told you before to leave my daughter alone!† Everyone turned and looked at me. I couldn’t help but say:- â€Å"Who, me?† I got a warm laugh from everyone in the room. Except of course from Mr. Stern faced – lover’s father – who – hates – me. His emotionless face and piercing stare were enough to make anyone cower for fear of their lives. He always looked like he was going to attack you or something.

Learning Programs in the American Express Learning Network

Background American Express is very large, world-wide company, which originally started as freight forwarding and delivery services. Now with the main focus being on financial services they want to train their employees with the knowledge to be efficient, knowledgeable, with good listening and speaking skills. Jeanette Harrison, a vice president at American Express, feels that compliance and control should be very important for customer care. Today American Express is the largest card issuer by purchase volume. Issued AddressedAmerican Express developed American Express Learning Network (AELN), whose main purpose is to address the performance capabilities of their employees. With a mission statement of â€Å"ready all those who serve† the company AmEx’s main goal is to teach with their employees effective jobs skills with the best possible learning method. There were three learning techniques the company tried. The first being a completely online based, the second being classroom, & the third a â€Å"blended† technique which was a combination of the first two.Janette’s personal learning theory and goal-setting theory is â€Å"learning literally changes lives†. She feels that education is the key to success and that if would help not only in work place but at home and in the community. Analysis of Issues Everyone has there on learning styles. So, it is no surprise that technique number three, â€Å"blended† learning, worked the best overall. It gave the most diverse style of learning. There was not one main style. The classroom style was incorporated with the encouragement of question asking and brainstorming and also online tools were also used to help teach as well.With all the different types of learning utilized the employees will get to see the information in many different ways and would most likely have a higher attention rate. The three styles were evaluated at six different levels to see which was most effective . The first level testing reaction from the learner, the second was the retention of the knowledge, the third was the behavior towards improved learning skills, the fourth was how it impacted the company, the fifth was the cost effectiveness of the learning style, and the sixth the application of the information into the actual job.Conclusions The â€Å"blended learning† I feel is the best method. And it holds strong to Jeanettes learning and goal-setting theories. When the results came in on the three techniques the third scored or rated the best hands down. The company feels it has the upper hand in the leadership development program. The blue box values set by the company are a true testament to what the company wanted to achieve with the AELN program: customer commitment, quality, integrity, teamwork, respect for people, good citizenship, a will to win, and personal accountability.The three operating principals also hold strong to the values Jeanette believes in and wante d to achieve with the American Express Learning Network program. One the principals being to offer superior propositions to all of their customers, another being to operate with best in class economics, and last to be support American Express brand. References http://about. americanexpress. com/oc/whoweare/

Morality & Ethics Essay

J. M. FINNIS: Rules made, in accordance with regulative legal rules, by a determinate and effective authority (itself identified and standard constituted as an institution by legal rules) for a ‘complete’ community, and buttressed by sanctions in accordance with the rule-guided stipulations of adjudicative institutions. [1] NATURALISTS ST. THOMAS AQUINAS: A rational ordering of things which concern the common good, promulgated by whoever is charged with the care of the community. [2] SOCIOLOGISTS ROSCOE POUND: Law is more than a set of abstract norms, it is also a process of balancing conflicting interests and securing the satisfaction of the maximum wants with the minimum of friction. [3] WHAT IS MORALITY? No single definition can be offered to describe what morality is, but in general morality can be understood as a rule prescribing between what is wrong and what is wrong. It could also mean a value of the acceptable and unacceptable norm of a given society. Some reserve terms moral and immoral only for the realm of sexuality and use the words ethical and unethical instead of the word moral when discussing how the business and professional communities should behave towards their members or toward the public. [4] RELATIONSHIP BETWEEN LAW AND MORALITY 1. The existence of unjust laws proves that morality and law are not identical and do not coincide. 2. The existence of laws that serve to defend basic values, law and morality can work together. 3. Laws can state what overt offenses count as wrong and punishable. 4. Laws govern conduct at least partly through fear of punishment. 5. Morality can influence the law in the sense that it can provide the reason for making whole groups of immoral elections illegal. 6. Law can be a public expression of morality which codifies in a public way the basic principles of conduct which a society accepts. [5] PUBLIC PROSECUTOR v MOHD ROMZAN BIN RAMLI[6] BRIEF EXPLANATION ON THE CASE: Mohd Romzan bin Ramli was charged under the offence of incest under the provision of section 376A of the Penal Code- a person is said to commit incest if he or she has sexual intercourse with another person whose relationship to him or her is such that he or she is prohibited, under the law, religion, custom or usage applicable to him or her, to marry that person; and was sentenced to six years of imprisonment and one stroke of rotan under section 376B(1)- punish with imprisonment between 6 to 20 years and whipping; of the same Code. The accused had committed the crime in between early January 2006 to 26th May 2006 in a room at his house in Kulai, Johor Bharu, Johor. To an 11-year old girl, Nurul Atikah bte Abdul Kadir, which is also his stepdaughter. In 2006, the girl was forced to undress by the accused and was disturbed sexually by him. He had done the disturbance to her several times. In addition, he threatened her not to tell anyone and had beaten her. Father of the victim, lodged a police report after he had noticed changes in his daughter after he had picked her from his ex-wife’s home. After medical check-ups were done by the doctor, the victim suffered from injuries in her private part and was treated by a psychologist. The accused pleaded guilty in front of the judge,Zawawi Salleh in the High Court of Johor Bharu, prosecuted by the Deputy Public Prosecutor, Husmin Hussin (Johor, State Legal Advisor Office). However, his sentences was changed to eleven years of imprisonment and three strokes of rotan, after the case was appealed to the High Court Of Johor Bharu from the Sessions Court Johor Bharu. The sentences were changed as it was unfair to the victim by taking her trauma and injuries into account and the public views about this case. OPINION/CONCLUSION In my opinion, the action of appealing the judgement made by the Sessions Court of Johor Bharu was a just and fair decision. Six years of imprisonment with one stroke of rattan is too little compared to the crime. According to John Austin, he defines law as a command given by a sovereign who may be a King, council or parliament. Such a command in his view is backed by coercion so that any person who violates the law, suffer the pain provided by law. [7] The accused needs to be punished for what he had done to the victim. The victim was just a little, innocent girl compared to him whose already old enough to think about right and wrong. Secondly, punishments for committed crimes are not only to punish the criminals, it is also as a deterrence to the public to not commit the same crime as they will be punished in accordance with the law too. Six years imprisonment and one stroke of rattan are not sufficient enough to deter the crime. As John Austin stated on why do we have to obey the law? It is because of the fear of sanction. Austin view is the fear by which the law, by its coercive power, strikes in the heart of the people is what makes people obey the law. If we remove the element of fear from the law, it would not be obeyed as there would be no deterrence. In other words, if a law is made without sanction, it would be disobeyed. [8] Lastly, after the High Court Judge of Johor Bharu sentenced the accused to eleven years of imprisonment and three strokes of rattan, only then, the justice can be seen. Bentham refers justice as maximum happiness of maximum number of people. [9] The public’s views on the case are also need to be considered. Minimum sentences given could cause an uproar in the society. Even Hart mentioned that justice is a shared concept; everybody wants justice seen and done. This is also supported by the aim of having law is to maintain peace and harmony. ———————– [1] M. D. A Freeman, Lloyd’s Introduction to Jurisprudence, page 178. [2] M. D. A Freeman, Lloyd’s Introduction to Jurisprudence, page 143. [3] Hari Chand, Modern Jurisprudence, 1994, International Law Book Services, Kuala Lumpur, page 205. [4] Jacques T. Ethics Theory and Practice, (5th ed. ). New Jersey: Prentice Hall, (1995): 3. [5] Basic Observations on Law and Morality. 10 September 2001. Web. 13 August 2012. [6] â€Å"Public Prosecutor v Mohd Romzan bin Ramli. † Malayan Law Journal, 22nd January 2012. Web. 13th August 2012. . [7] Hari Chand, Modern Jurisprudence, page 72,80,81. [8] Hari Chand, Modern Jurisprudence, page 74. [9] â€Å"Jeremy Bentham. † N. p. Web. 14th August 2012. .

Leadership Analysis Napoleon Essay Example

Leadership Analysis Napoleon Essay Example Leadership Analysis Napoleon Paper Leadership Analysis Napoleon Paper But one of the retreat leaders who have marked Europe and a large part of the world Is Napoleon Bonaparte. To understand the Impact he had on the modern world you just have to look around, mainly in France. All the typical architecture of Paris was designed by the Baron Houseman originated by Napoleon himself and the main evidence of his legacy is the Napoleonic code which is still a fundamental text of the French law. Concerning his code Napoleon said: My true glory is not to have won 40 battles Waterloo will erase the memory of so many victories. But Hat will live forever is y Call Code . This code has Is still enforced In a quarter of the worlds Jurisdiction Including Europe, the Americas and Africa. HIS story still fascinates many people all around the world. Description of Napoleon Napoleons Origins Napoleon Bonaparte was born In Ciao on August 1 5th minion, Just one year after ten treaty AT Versailles wanly transporter Corsica Trot ten Repelled AT Genoa to France. He was born into a noble family, his father, Carlo Maria Bonaparte, was Corsican representative to the court of Louis XVI in 1777. Thanks to his familys injections, he was admitted to the military academy of Paris where he already showed good skills to command. His Political Career On November 19th, 1799, Napoleon, helped by his brother Lucien Bonaparte (speaker of the Council of Five Hundred), Talleyrand, Ducks and Sissies (members of the directory), organized a coup to overthrow the constitutional government. He first intended to initiate a parliamentary takeover but due to a tactless speech he was accused to be an outlaw by the Council of Five Hundred and threaten to be imprisoned. To rescue him, his brother, Lucien, called the guards pretending that embers of the Council are trying to stab Napoleon and turned, in fact, the coup into a military turnover. The French Consulate was then created and Napoleon together with Ducks and Sissies were elected provisional Consuls of France. During that time, Ducks totally supported Napoleon whereas Sissies did not want to let Napoleon have full powers but Napoleon maneuver in order to get the Constitution of the Year VIII voted which ensured Napoleon to be designated First Consul, the most powerful in France. Sissies was then relegated to simply President of the Senate. As the First Consul of France, Napoleon reformed many institutions like education, the territorial organization centralizing administration, the banking system creating the Bank of France. He also increased his power by imposing the Constitution of the Year X which first article was: The French people name and the Senate proclaims Napoleon- Bonaparte First Consul for Life . Because of that Napoleon had to face royalist and Jacobin plots but that will actually help him to become emperor. In fact, he proposed to the senate to become emperor to prevent the Bourbon family (former rulers of France) to have the possibility to gain the throne again and to preserve the principles of the French Revolution. The Senate finally accepted in 1804 and Napoleon became the first emperor of France. Now Emperor, Napoleon invaded Germany and Austria to dissolute the Holy Roman Empire and, after he won the battle at Austerity in 1805 against the Russian and Austrian armies, he created the Confederation of the Rhine which he was named its Protector. Master of War After his training at the military academy of Paris, Napoleon was sent to serve on garrison duty in Valence as second lieutenant where he gained experience to be an army leader. Then he was appointed artillery commander of the republican forces at the siege of Talon. During the siege, Napoleon drew a plan in order to capture a hill that would allow republican guns to dominate the citys harbor and force the British ships to evacuate. Napoleon succeeded to capture the city that promoted him to the rank of brigadier general. In 1795, the Royalists caused an insurrection in Paris at the Utilities Palace. Napoleon was called by Barras commander of the Interior Army to cease the insurrection. He dispersed Royalists mob a whiff of grapeshot and was remoter commander of the Interior Army, replacing Barras who became member of ten Directory, plus nee was given command AT ten Army AT Italy. As ten leader AT ten Army of Italy, Napoleon was very efficient to motivate his troops and innovated in war strategy by using, for example, artillery as mobile force support to infantry attacks which helped him to win many battles like during his Italian campaign where he defeated five Austrian armies within a year. Sent by the Directory, Napoleon conquered Egypt in 1798 defeating, battles after battles, the army of the Ottoman Empire. Later Egypt returned to the Turkish and British armies because of the bubonic plague which stroke French army after Napoleon left to return to France. It was as an emperor that Napoleon won his most famous battles. On the first anniversary of his coronation, he had his greatest victory at Austerity over the Austrian and Russian armies (two of the best armies at this time) and for this occasion, Napoleon edified the Arc De Triumphed monument in Paris. Napoleon would say about this victory: The battle of Austerity is the finest of all I have fought. War pet going between the French empire, the United Kingdom, Russia, Prussia and Spain. From alliance with ones and betrayal from others, Napoleon and the French Empire was still victorious during the period 1804-1812 but soon the French Empire would be surrounded with enemies including Prussia, Russia, Great Britain, Sweden, Austria, Spain and Portugal which was called the war of the Sixth Coalition. Napoleons fall started when he tried to invade Russia in 1812, where had success going deep in the Russian Territory but found nothing to take as Russian used their famous scorched earth tactics. When he returned to France, the war of the Sixth Coalition started, Napoleon still had few victories at Dressed in 1813 but suffered a severe defeat in the battle of Leipzig. In 1814, the Coalition army captured Paris. Napoleon tried to counter attack but his Marshals especially Nee decided to mutiny and Napoleon was forced to abdicate. He then went into exile on the island Elba where he stayed until 1815. At this time, it could have been over but Napoleon figured out a way to escape from Elba, landed on the French Riviera and went to Greenbelt where he met the 5th regiment led by the marshal Nee, sent to intercept IM. Napoleon approached the regiment alone, dismounted his horse and shouted: Here I am. Kill your Emperor, if you wish. The soldiers responded with: Vive L Emperor! and marched with Napoleon to Paris. Scared Louis XVIII, who took the power, fled and Napoleon regained the power for a period now called the Hundred Days. In that time, he rallied 200,000 soldiers to his cause but Great Britain, Russia, Netherlands and Prussia allied their forces to end his rule. In 181 5, they fought at the battle of Waterloo where Napoleon was defeated for good and captured to be sent to he island of Saint Helena, where he will die in 1821. Charismatic Leadership Theory This Theory was defined by the German socialist Macmillan Weber in the sasss and developed by Robert House in 1977. Max Weber explained Charisma as a quality of an individual, by virtue of which he is set apart from ordinary men and treated as endowed supernatural, superhuman or at least specifically exceptional powers or qualities. These are such as are not accessible to the ordinary person, but are regarded as of divine origin or as exemplary, and on the basis of them the individual concerned is treated as a leader ( How the quality in question would be ultimately league Trot an tentacle, aesthetic or toner sun pollen AT blew Is naturally In I a Torrent for the purpose of definition. To Weber charismatic leaders can be sort out in three types: Charismatic domination (sport captains). Feudal domination (kings). Bureaucracy domination (Coos). Later, Robert House described charismatic leadership with four designations: Dominant (army leaders). Strong desire to influence others (politicians). Self confident (entrepreneurs). Strong sense of ones own moral values (religious leaders). More recently, in 1998, Conger defined five behaviors for charismatic leaders:- Vision and communication. Sensitivity to the environment. Sensitivity to the needs of others. Personal risk taking. Use of unconventional strategies. Charismatic leadership is very often used in difficult times to solve critical situations. Charismatic leaders are capable to get out of difficult circumstances because they are visionary; they provide a better horizon which people will see thanks to their communication skills. They also make followers work harder simply making them feeling that they are capable and giving them confidence. Charismatic leaders inspire trust to go forward and will carry the risks. Jay Conger, in 1989, has adapted a four- step process to approach charismatic leadership. The first one is that the leader has to analyses his environment and create a vision out of it. The second step is communicating the vision by motivating followers with the use of effective vocabulary and strong arguments. For the third stage, charismatic leaders need build trust and commitment among the followers. Subordinates must be emotionally involved in the mission and support the goals; this could be done through personal risk taking, unconventional expertise and self-sacrifice. The strengths of charismatic leadership are: Group members are willingly obedient where leaders. The ability to deal efficiently with critical situation. Lead by example providing vision, unconventional strategies and huge energy. The limitations of charismatic leadership are: Strong obedience tends to attract weak followers which lead to poor delegation. People having charisma are relatively rare. Narcissism, lose of reality and insensitive to others. Depending on the personality of the leaders, charismatic leadership can tangentially turn into a cult of the leader unpredictable and dangerous. The Path- Goal Theory The Path-Goal theory was first inspired by Martin G. Evans in 1970 and developed by Robert House in 1971. House formulated that leaders can affect performance, satisfaction and motivation of group by using those means:- Offering rewards for achieving performance goals. Clarifying paths towards these goals. Removing costless to performance. To do so leaders can adopt different styles of leadership: Directive leadership where the leader has to give specific instruction to subordinates for performance. Supportive leadership, leaders need be warmth and friendly to motivate and involve followers. Participative leadership where leaders consult the group member and take into account their suggestions. Achievement- orientated leadership, the leader sets high-level performance goals and expects the best from his subordinates. The choice of the style of leadership depends on the situation. According to House there the situational factors of the Path-Goal theory are: Subordinates personality: Locus of control. A participative leader is suitable for subordinates with internal coco of control; a directive leader is suitable for subordinates with external locus of control. Self-perceived ability. Subordinates that believe they have a high ability themselves do not like directive leadership. Characteristics of the environment: When a group is working on a task that has a high structure, directive leadership is redundant and less effective. When a highly formal authority system is in place, directive leadership can reduce workers satisfaction. When subordinates are in a team environment offering great social support, the supportive leadership style becomes less necessary. Napoleon Leadership Analysis Napoleons Charismatic leadership Concerning the three types of Weepers charismatic leadership Napoleon was probably in between charismatic and feudal domination. Feudal domination, simply because he created the French Empire and charismatic because even when he lost, or he had not, his emperor status he impressed many people. Regarding the four Houses designations of charismatic leadership, Napoleon was clearly a dominant. He was the one who conquered Italy, Germany, Spain, etc And during all his reign he kept on trying to invade the United Kingdom and Russia. He was willing influence people to reach his goals, he convinced the Senate to set up his Empire which was obviously not in the interest of the Senate. Napoleon had confidence in himself like no other; he was not afraid to challenge two to six nations at one time and even when he was sent into exile, he returned and took the power again with a small amount of soldiers. Even if Napoleon set up an Empire, he was a strong believer in the principles of the French Revolution and that showed that he believed hard in his values. As a general, he was an unorthodox leader using unconventional strategies. But his charisma led him to the dark side of the theory he had all the negative behavior of the theory. This was during his last years of reign, he became narcissistic and lost his sense of reality, he wanted to invade Russia even if all his Marshals advised him not to. This move cost his empire and the lives of thousands of soldiers. He did not trust anybody anymore, he sent spies to his Marshals afraid of a conspiracy. Path-Goal theory Robert Houses Path-Goal theory helps us to understand how Napoleon succeeded to motivate and get the best out of his soldier. By instituting the LÂ ©goon denouncer which was a substitute for the old royalist decorations, Napoleon intended to encourage Cleveland Ana military assessments During Tattles, nee 010 not insolate to do the things that were the responsibilities of the lieutenants or the generals below him. Throughout his reign, we can notice that Napoleon used different type of leadership relating to the Path-Goal theory. He was a directive leader as a general of the army in his early career and as the Emperor. He was a supportive leader his soldiers when he had regain the throne after his first exile. In 1805, when he decided o stop the invasion of the United Kingdom, he consulted all his Marshals to take this decision. Napoleon was very demanding to his soldiers and Marshals, he expected them to give their best on the battle field even if death is required and this was the absolute achievement-orientated leadership. Ever since Napoleon had any amount of power while he was a lieutenant or an emperor, he always wisely adapted his leadership style to the situation. Conclusion In the public opinion Napoleon is seen as a charismatic leader and looking at the Charismatic leadership theory, he was the perfect type of a leader with great harms. The theory admits that charismatic leadership useful in difficult times and when Napoleon arrived to power he transformed France from a fuzzy period post revolution to the greatest empire that the country had never known. The Path-Goal theory allows us to understand how so much people Joined his vision, even against their own interest, and why he was so convincing to politicians, to soldiers and to the people. References Leadership, 2nd Asia-Pacific edition, Dublin, Dahlias, Miller. http://en. Wisped. Org/ wick/Napoleon_l_of_France http://en. Wisped. Org/wick/Leadership http://en. Wisped. Org/wick/path-goal_theory Napoleon-series. Org/research/napoleon/c_Generalizing. http:// www. Potentialities. Com/Napoleonbonaparteleadership. Manage. Com/methods_Weber_charismatic_leadership. http:// homeworks. About. Com/odd/sisterhoods/as/leadership_4. Manage. Com/methods_path_goal_theory. http://changings. Org/disciplines/leadership/styles/path_goal_leadership. Valetudinarianism. Net/methods_path_goal_theory. http:// www. Dooryard. Com/miscellaneous/path_goal_theory. HTML