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The purpose of this study was to investigate the effect of the environmental pressure changes on the bond strength between zirconia ceramics and adhesive resin cement.

In total, 40 rectangular-shaped zirconium-oxide ceramic specimens were prepared. For surface modification, all zirconia specimens were sandblasted with 50 μm alumina particles. The composite resin discs were bonded to modified zirconia surfaces with resin cement. The specimens were divided into four groups; hyperbaric, hypobaric, hyperbaric + hypobaric and control group. The specimen underwent pressure cycles for 30 days. The shear bond strength test was performed by using the universal testing machine, and failures of the debonded samples were examined with scanning electron microscopy and light microscope.

No significant difference in bond strength was found between the hyperbaric, hypobaric and control groups after 30 days (p > 0.05). However, there was a significant difference in the hyperbaric + hypobaric group compared to the control group (p = 0.022). Also, the Weibull modulus was highest in control group and lowest in the hyperbaric + hypobaric group.

Barometric changes due to flying followed by diving may have an adverse effect on the retention of zirconia ceramics. Care should be taken in the selection of materials for dental treatment of people who are exposed to environmental pressure changes.

The purpose of the present study was the development of a methodology for translating predicted rates of decompression sickness (DCS), following tower escape from a sunken submarine, into predicted probability of survival, a more useful statistic for making operational decisions.

Predictions were made, using existing models, for the probabilities of a range of DCS symptoms following submarine tower escape. Subject matter expert estimates of the effect of these symptoms on a submariner’s ability to survive in benign weather conditions on the sea surface until rescued were combined with the likelihoods of the different symptoms occurring using standard probability theory. Plots were generated showing the dependence of predicted probability of survival following escape on the escape depth and the pressure within the stricken submarine.

Current advice on whether to attempt tower escape is based on avoiding rates of DCS above approximately 5%–10%. Consideration of predicted survival rates, based on subject matter expert opinion, suggests that the current advice might be considered as conservative in the distressed submarine scenario, as DCS rates of 10% are not anticipated to markedly affect survival rates.

According to the authors’ knowledge, this study represents the first attempt to quantify the effect of different DCS symptoms on the probability of survival in submarine tower escape.

The purpose of this study is to test the shear-bond-strengths of auto-mixed and manual-mixed self-adhesive resin cement to dentin on long-term high-altitude pressure.

Human molars were embedded in acrylic resin. Sixty composite resin discs were obtained. The composite resin discs were bonded to dentin using hand-mixed and auto-mixed self-adhesive resin cement. After cementation, the samples were stored in artificial saliva and divided into two subgroups (n = 30), hypobaric pressure and the atmospheric pressure group. The specimen underwent three pressure cycles per day for 100 days. The failure types were evaluated after debonding with scanning electron microscopy. The shear bond strength was tested with Universal Testing Machine. Analysis of variances/Tukey post hoc tests were used for statistical analysis. Groups were also evaluated by the Weibull modulus.

Regardless of hypobaric pressure changes, the highest bond strength was examined in auto-mixed Panavia SA samples. A significant difference was found in both auto-mixed MaxCem EC and hand-mixed RelyX U200 group after exposure to hypobaric pressure compared to the control group.

The luting cement-type, mixing methods of cements and environmental pressure changes significantly influence the bond strengths. Dentists can use auto-mixed self-adhesive resins in patients likely to be exposed to hypobaric pressure.

Diabetic foot ulcers are associated with considerable morbidity, mortality and costs to the NHS. This paper describes a review of publications reporting randomised controlled trials examining the clinical effectiveness of interventions for diabetic foot ulcers for 1986–1996. Only 23 studies were identified that described randomised controlled trials and, of these, only 4 fulfilled three criteria shown to influence reliability of results: adequate description of randomisation, double blinding and description of withdrawals and drop‐outs. No cost‐effectiveness studies conducted alongside trials were identified from the searches. This shortage of rigorous trials highlights the need for more well designed research in the prevention and treatment of diabetic foot ulcers to determine clinical effectiveness as well as relative cost‐effectiveness.

This chapter is a comprehensive discussion of autism spectrum disorder (ASD) across the globe (e.g., United States, China, Brazil, Japan and Turkey). Topics that are discussed include the following: diagnostic criteria and approaches; international perspectives of ASD; western and eastern assessment practices; cultural considerations of assessment of ASD; educational and medical interventions; behavioral and emotional interventions; complementary and alternative medical interventions; variations in educational services among countries; early intervention practices; adult services; national and international resources; and current needs and future directions.

Understanding how health status and physiological factors affect performance is a daunting task. This chapter will discuss physiological, behavioral, and psychological factors that influence or determine the capacity to fight, and will consider metrics that can be used to measure their status. The premise of this discussion is that there is a set of physiological and psychological factors that intimately affect performance and that the relative contribution of these variables is individually unique. These factors can be identified and assessed, and are amenable to modification. A fuller understanding of these variables can lead the effort to maintain and improve performance in the adverse and challenging environments of military operations.

Studies of institutional logics have emphasized two fundamental conceptions: first, that there is continuous competition between the various logics embedded in any context and, second, that certain mechanisms influence the promotion or modification of existing logics. The purpose of this paper is to contribute to these studies by broadening the propositions on the mechanisms used by the actors to disguise the fact that they are not prioritizing non-prevailing logics.

The paper examines the disguise mechanisms used in the regulation of the private health field in Brazil, which has still been rarely explored in the literature on the theme. The research strategy was qualitative, involving documentary research that provided information to create a script for interviewing different actors in this field, such as health plan companies, service providers, medical associations, trade unions, regulatory agency, consumer defense organizations and the judiciary, lending credibility to the study.

The field data suggest important findings. Field actors pursue exerting influence in defining the outcomes of the institutional logics prevailing at each event. In this pursuit, they work to keep representative parts of prescribed practices non-transparent to allow them a margin in which to maneuver when confronted with a non-prevailing logic.

This paper emphasizes that, in any context, actors, while following the prescriptions of a prevailing logic, might have to disguise not following the prescriptions of other logics; thus, they will have to seek for mechanisms to do so. This paper, by identifying disguise mechanisms that operate in the specific field of private health in Brazil, finally sheds light on disguise mechanisms, contributing to the general literature on institutionalism.

The purpose of this paper is to introduce lean concept to the field of healthcare management, expands the conceptualization of lean management beyond the manufacturing companies to consider key waste reduction opportunities which are posited to be requisites to lean practices and implements the proposed framework in the three public hospitals in Abu Dhabi.

This research is designed by decomposing complex and unstructured issue into a set of components organized in a multi-level hierarchical form. To deal with this complexity of multi criteria decision-making process, analytical hierarchical process (AHP) method is used in this research.

AHP framework for this study resulted in a ranking of 21 healthcare wastes based on the evaluations of local situations by experienced healthcare professionals. It has been found that management in healthcare systems of Abu Dhabi is putting more emphasis on the inventory waste.

The future directions of the research would be to apply a lean set of tools for the value stream optimization of the prioritized key improvement areas.

This is a contribution to the continuing research into lean management, giving practitioners and designers a practical way for measuring and implementing lean practices across health organizations.

The contribution of this research, through successive stages of data collection, measurement analysis and refinement, is a set of reliable and valid framework that can be subsequently used in conceptualization, prioritization of the waste reduction strategies in healthcare management.

As the world of healthcare changes rapidly, healthcare leaders and managers must hone their leadership competencies in order to remain effective in their organizations. With changes such as the Affordable Care Act, increasing medical school costs, decreased graduation rates, and increased needs for care, how are current and future healthcare leaders adapting? In light of the large-scale changes in the healthcare field in recent years, the purpose of this study was to investigate which National Center for Healthcare Leadership (NCHL) competencies were referenced by exemplary healthcare leaders as most important for success in today’s changing healthcare environment. Interviews were conducted with 26 mid- and upper-level healthcare leaders identified by the C-level executives in their organizations as exemplary performers. Change leadership, self-development, talent development, and team leadership were the top four NCHL competencies most frequently referenced, with thematic analysis revealing additional underlying themes in the exemplary leaders’ dialogue.

Mumbai needs to be transformed into a world-class city as stated in the 2005–2025 development plan of Municipal Corporation. For this initiative, hospital management information system (HMIS) has to be implemented across 400+ health facilities in the city.

A case study methodology was adopted to study HMIS implementation. Wave 1 of Phase 1 implementation of HMIS is carried out as a pilot project at Film City’s Hospital, Mumbai, which “go-live” on 21st June 2018. The work for hardware and software implementation was awarded to HardSystems and Solutions Limited and SoftSolutions India Private Limited, respectively, through e-tender.

Provision of inadequate quantity of hardware, slowness of network or system, non-satisfactory training after observation confirmation and sign-off process, lack of data entry operators, mismatch in numbering systems in blood bank and many other challenges concerned with the specific departments had become a major impediment in the efforts to maximize number of patients registered into HMIS.

Even after providing many clinical and managerial benefits, being the first cloud-based centrally located HMIS in any of the hospitals in the city, it imposes a major challenge for the management in terms of resistance of employees toward technology and need for the adoption of theoretical models for implementing change for the overall organizational development.

To the best of the authors’ knowledge, no other teaching case study is conducted to study the HMIS implementation in large-scale public health-care services. This is a dummy case study for teaching exercises. The identity of the stakeholders, organizations and events has been masked to maintain confidentiality.