Smear layer is a controversial topic in the field of operative dentistry and endodontics. This presentation includes composition, concepts, structure, advantages, disadvantages, and removal methods of smear layer.
Smear layer is a controversial topic in the field of operative dentistry and endodontics. This presentation includes composition, concepts, structure, advantages, disadvantages, and removal methods of smear layer.
The second phase of a root canal treatment.
This presentation covers the most basic techniques of root canal shaping.
provides the reader with a concise overview of the big picture.
A concise and brief presentation on cleaning and shaping of root canals. Colorful and well pictured. Ideal for UG students and PG students to get a good understanding of BMP techniques.
In this lecture I explain the basic concept of root canal filling or what called obturation. The lectures discuss different techniques used in that matter in step-by-step fashion and explanatory pictures.
It is directed to the level of undergraduate mind.
An inlay may cap none, or may cap all but one cusp.
Sturdevant’s 4th ed. page579
Inlays may be used as single-tooth restorations for proximo-occlusal or gingival lesions with minimal to moderate extensions
Shillingburg page 1
An inlay may be defined as a restoration which has been constructed out of mouth from gold, porcelain, or other material & then cemented into the prepared cavity of a tooth.
William McGehee pg410
The second phase of a root canal treatment.
This presentation covers the most basic techniques of root canal shaping.
provides the reader with a concise overview of the big picture.
A concise and brief presentation on cleaning and shaping of root canals. Colorful and well pictured. Ideal for UG students and PG students to get a good understanding of BMP techniques.
In this lecture I explain the basic concept of root canal filling or what called obturation. The lectures discuss different techniques used in that matter in step-by-step fashion and explanatory pictures.
It is directed to the level of undergraduate mind.
An inlay may cap none, or may cap all but one cusp.
Sturdevant’s 4th ed. page579
Inlays may be used as single-tooth restorations for proximo-occlusal or gingival lesions with minimal to moderate extensions
Shillingburg page 1
An inlay may be defined as a restoration which has been constructed out of mouth from gold, porcelain, or other material & then cemented into the prepared cavity of a tooth.
William McGehee pg410
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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Root Canal Irrigants or Endodontic irrigants surabhisoumya1
This presentation is all about the various irrigants and the irrigation systems used currently in dental practice ( in cleaning and shaping of Root canal systems)
removal of the smear layer /rotary endodontic courses by indian dental academyIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Composite Resin Luting cements (2nd edition) presentation powerpoint
A type of dental cement
Used for cementation of indirect restorations & brackets
A summary of five textbooks
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Irrigants in endodontics
1. Irrigants in endodontics
1
Simply discussed
A summary of 4 endodontic textbooks
(Torabinejad &Walton, Pathways,
Weine and Ingle) and a review
2. By
Ahmed Mostafa Hussein
Assisstant lecturer
Dental Biomaterials Department
Faculty of Dentistry, Mansoura University, Egypt
2014
ahmadmostafahussein3@yahoo.com
2
3. Requirements and functions of irrigants
1. Dissolve organic and inorganic tissue.
2. Remove smear layer. (Pathway)
Disinfecting and cleaning areas inaccessible to
endodontic instruments. (pathway)
3. Flush out and remove debris → prevent apical
blockage by debris. (Ingle)
3
5. Advantages of smear layer removal
(Walton & Weine)
1. Allows penetration of irrigants into dentinal tubules.
2. Enhances penetration and adhesion of sealer to dentin.
3. Filling materials adapt better to the canal wall.
4. Reduces coronal and apical leakage.
N.B: The small particles of the smear layer are primarily
inorganic. (Walton)
5
6. Functions of lubricants (Pathway)
1. Facilitate the mechanical action of endodontic
hand or rotary files
2. Increase cutting efficiency → better removal of
debris
3. Reduce torque → the files and reamers are less
likely to break (Weine)
6
8. * No single irrigating solution covers all of the
functions required from an irrigant.
* The alternating use of different irrigants in
the correct sequence contributes to a
successful treatment outcome.
8
9. 1. Saline (Review)
* Lacks antibacterial activity when used alone.
* Doesn't dissolve tissue.
* Has the risk of contamination if used from
containers that have been opened more than once.
9
10. 2. Sodium hypochlorite (NaOCl)
* NaOCl is one of the most widely used irrigating
solutions.
* Household bleach such as chlorox contains 5.25%
NaOCl. (Ingle)
* Full strength (5.25%) NaOCl is highly irritating to
periapical tissues and reduces the flexural strength
& elastic modulus of dentin.
10
11. * A common concentration of NaOCl is 2.5% which
decreases toxicity and still maintains some tissue
dissolving and antimicrobial activity.
11
12. Advantages of NaOCl (Walton)
1. Dissolve organic tissue: NaOCl is the only root-
canal irrigant that dissolves necrotic and vital
organic tissue (unique property). (Review)
2. Antimicrobial action
3. Lubricant
4. Inexpensive and readily available
12
13. Disadvantages of NaOCl
1. Irritant to periapical tissues, mucous membrane
and skin. (Ingle)
2. Unpleasant odour.
3. Can damage clothes.
4. The use of NaOCl as the final rinse following
EDTA or citric acid (CA) produces severe erosion
of the canal-wall dentin and should be avoided.
13
14. 5. Causes haemolysis & ulceration, inhibits
neutrophil migration and damages endothelial &
fibroblast cells.
N.B: In vivo, the presence of organic matter
(inflammatory exudate and tissue remnants)
weakens NaOCl effect.
14
15. 3. Chlorhexidine (CHX)
* Relative absence of toxicity. (Ingle)
* Broad spectrum antimicrobial substantive activity
(continued antimicrobial effect), because
chlorhexidine (CHX) binds (is adsorped) and
released gradually from the hydroxyapatite
surfaces. (Review)
* 2% CHX has similar antimicrobial action as
5.25% NaOCl and is more effective against
Enterococcus faecalis. (Walton)
15
16. * Recent reports have indicated that several
disinfecting agents such as CHX, Iodine potassium
iodide (IKI) and Ca(OH)2 are inhibited in the
presence of dentin. (Pathway)
* The activity of CHX is greatly reduced in the
presence of organic matter. (Review)
* CHX cannot be the main irrigant in standard
endodontic cases, because CHX doesn't dissolve
the smear layer or necrotic tissue. (disadvantage)
16
17. Indications of CHX
1) 2ry endodontic infections.
2) At the end of chemomechanical preparation,
because CHX doesn't cause erosion of dentin like
NaOCl does as the final rinse after EDTA.
17
18. 4. Iodine potassium iodide (IKI)
* Iodine is less cytotoxic & irritating to vital tissues
than NaOCl & CHX, but obvious disadvantage of
iodine is a possible allergic reaction in some
patients.
* 2 & 4% Iodine potassium iodide (IKI) has
considerable antimicrobial activity, but no tissue-
dissolving property. It can be used at the end of
chemomechanical preparation like CHX.
18
19. * Although Ca(OH)2 alone was unable to kill E.
faecalis inside dentinal tubules, Ca(OH)2 mixed
with either IKI or CHX effectively disinfected
dentin (may be able to kill Ca(OH)2-resistant
bacteria). (Pathway)
19
20. 5. Hydrogen peroxide (H2O2) (Weine)
* H2O2 destroys anaerobic microorganisms.
* The solvent action of H2O2 is less than that of
NaOCl, so H2O2 is less damaging to periapical
tissues.
20
21. * Many clinicians use the solutions (H2O2 & NaOCl)
alternately during treatment. This method is
strongly suggested for irrigating canals of teeth
that have been left open for drainage, because the
effervescence is effective in dislodging food
particles & other debris that may have packed the
canal.
* H2O2 shouldn't be the last irrigant used in a canal,
because nascent oxygen may remain and cause
pressure. Therefore NaOCl should be used to react
with H2O2 and liberate the oxygen remaining.
21
22. 6. MTAD (Walton and review)
* Mixture of tetracycline isomer (doxycycline), an
acid (citric acid) & detergent.
* Biocompatible.
* MTAD may be superior to NaOCl in antimicrobial
action.
* MTAD is effective in killing E. faecalis found in
failing treatments.
22
23. * Although earlier studies showed promising
antibacterial effects by MTAD, recent studies have
indicated that NaOCl/EDTA combination is
equally or more effective than NaOCl/MTAD.
(Review)
* MTAD helps in removal of smear layer.
* MTAD doesn't dissolve organic tissue.
(disadvantage)
* It doesn't alter physical properties of dentin.
* It could be used at the end of chemomechanical
preparation after NaOCl. (Review)
23
24. 7. Citric acid (CA)
* EDTA & citric acid (CA) effectively dissolve
inorganic material, including hydroxyapatite.
(Review)
* Help in smear layer removal. (Walton)
24
25. 8. EDTA (ethylene diamine tetraacetic acid)
* Lubricant, chelator & decalcifying agents.
* EDTA is the most effective chelating agent in
endodontic therapy.
* In general, files remove dentin faster than the
chelators can soften the canal walls. (Walton)
25
26. * 17% EDTA for 1 min remove inorganic
components.
* EDTA is effective in smear layer removal only in
coronal & middle thirds, but not in the apical
third.
N.B: NaOCl is necessary for removal of organic
component.
* EDTA has little effect on periapical tissue.
26
29. Contraindications of EDTA (Weine page 225)
1) A ledged or blocked canal: If a sharp instrument
is forced or rotated against a wall softened by the
chelate, a new but false canal will be started.
2) Curved canals once the larger-sized instruments
(size 30 or greater) are being used. These
instruments are not as flexible as the smaller sizes
and may produce root perforation.
29
30. Indication of EDTA
The best use of chelating agents is to aid and
simplify preparation for very sclerotic canals after
the apex has already been reached with a fine
instrument.
30
31. * Chelating agents are placed in the orifice of a
canal to be enlarged on the flutes of the enlarging
instrument or by plastic syringe.
N.B: EDTA reacts with glass, so glass syringes of
that material may not be used. (Weine pages 224 & 225)
31
32. Precaution
EDTA will remain active within the canal for 5 days
if not inactivated. If the apical constriction has been
opened, the chelate may seep out & damage the
periapical bone. For this reason, at the completion
of the appointment, the canal must be irrigated with
NaOCl to inactivate EDTA. (Weine page 226)
32
33. Conventional irrigation by syringe
* Disposable 2.5 or 5 ml plastic syringes are useful
for endodontic irrigation. (Weine)
N.B: Larger syringes are difficult to control for
pressure, and accidents may happen. (Review)
* A commonly used needle is the 27-gauge needle
with a notched tip, allowing for solution flowback,
or the blunt-tip ProRinse. (Ingle)
33
38. * All syringes for endodontic irrigation must have a
Luer-Lok design. (Review)
* The irrigating needle must be placed loosely in the
canal. To control the depth of insertion, the needle is
bent slightly at the appropriate length or a rubber
stopper is placed on the needle. (Walton)
38
40. * Irrigants must be gently placed within the canals.
It is the action of intracanal instruments that
distributes the irrigant into the canal. (Weine)
* The needle is moved up and down constantly to
produce agitation & prevent binding or wedging of
the needle. (Walton)
N.B: Severe complications have been reported from
forcing irrigating solutions beyond the apex by
wedging the needle in the canal and not allowing an
adequate backflow. (Ingle)
40
41. * The irrigant doesn't move apically more than 1
mm beyond the irrigation tip. (Walton)
* The closer the needle tip to the apex, the greater
the potential for damage to the periradicular tissues.
* The volume of irrigant is more important than the
concentration or type of irrigant. (Ingle page 502)
41
42. * The apical 5 mm are not flushed until they have
been enlarged to size 30 and more often size 40
file. (Ingle)
42
43. * Separate syringes should be used for each irrigant
to avoid chemical reactions between them. (Review)
* N.B: Ultrasonics proved superior effect to syringe
irrigation alone when the canal narrowed to 0.3 mm
(size 30 instrument) or less. (Ingle)
* N.B: The US Army reported the importance of
recapitulation–re-instrumentation with a smaller
instrument following each irrigation. (Ingle page 503)
43
44. Questions
What are the irrigants that can be used for final
irrigation and why?
* CHX, IKI and MTAD can be used at the end of
chemomechanical preparation, because they doesn't
cause erosion of dentin.
N.B: Some patients have allergy to iodine.
N.B: CHX has continued antimicrobial activity, why?
44
45. * What are the irrigants that cannot be used for
final irrigation and why?
1) EDTA: why?
2) NaOCl: why?
3) H2O2: why?
45
46. Main references
1. Torabinejad M, Walton RE. Endodontics principles and
practice. 4th ed. Saunders; 2009. p. 391-404.
2. Cohen S, Hargreaves KM. Pathways of the pulp. 9th ed.
St. Louis: Mosby; 2006. p. 318-323.
3. Ingle JI,Bakland LK. Endodontics. 5th ed. BC Decker;
2002. p. 498-505.
4. Weine FS. Endodontic therapy. 6th ed. St. Louis:
Mosby; 2004. p. 221-226
5. Haapasalo M, Shen Y, Qian W, Gao Y. Irrigation in
endodontics. Dent Clin N Am. 2010; 54: 291-312.
(Review)
46