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Phase maps of Co–Cr alloys bonded to dental porcelain cycled through an incremental number of porcelain firings at two separate thicknesses (0.5 and 1 mm) were analyzed. Bulk hexagonal close-packed (hcp) phase vol% of the alloy was found to increase with the number of porcelain firings for both 0.5 and 1 mm specimens. At the metal-porcelain interface, a uniform fine-grained hcp phase was observed. The depth and grain size of this hcp layer increased with the number of porcelain firings with the thicker specimens undergoing more substantial growth and transformation. Simple heat transfer modeling of the specimens during heat treatment cycles indicated that the thicker specimen had more time at high temperature to affect the face-centered cubic to hcp phase transformation. Therefore, the amount of porcelain firings and the thickness of the alloy should be considered and kept to a minimal when manufacturing metal-porcelain restoration.
To identify clinical signs and symptoms (ie, “terms”) that accurately predict laboratory-confirmed influenza cases and thereafter generate and evaluate various influenza-like illness (ILI) case definitions for detecting influenza. A secondary objective explored whether surveillance of data beyond the chief complaint improves the accuracy of predicting influenza.
Retrospective, cross-sectional study.
Large urban academic medical center hospital.
A total of 1,581 emergency department (ED) patients who received a nasopharyngeal swab followed by rRT-PCR testing between August 30, 2009, and January 2, 2010, and between November 28, 2010, and March 26, 2011.
An electronic surveillance system (GUARDIAN) scanned the entire electronic medical record (EMR) and identified cases containing 29 clinical terms relevant to influenza. Analyses were conducted using logistic regressions, diagnostic odds ratio (DOR), sensitivity, and specificity.
The best predictive model for identifying influenza for all ages consisted of cough (DOR=5.87), fever (DOR=4.49), rhinorrhea (DOR=1.98), and myalgias (DOR=1.44). The 3 best case definitions that included combinations of some or all of these 4 symptoms had comparable performance (ie, sensitivity=89%–92% and specificity=38%–44%). For children <5 years of age, the addition of rhinorrhea to the fever and cough case definition achieved a better balance between sensitivity (85%) and specificity (47%). For the fever and cough ILI case definition, using the entire EMR, GUARDIAN identified 37.1% more influenza cases than it did using only the chief complaint data.
A simplified case definition of fever and cough may be suitable for implementation for all ages, while inclusion of rhinorrhea may further improve influenza detection for the 0–4-year-old age group. Finally, ILI surveillance based on the entire EMR is recommended.
Infect Control Hosp Epidemiol 2015;00(0): 1–8
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