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Q: Concurrent MySQL writing with GORM leads to an error I have implemented a complex csv import script in Golang.
I use a Workerpool implementation for it. Inside that workerpool,  workers run through 1000s of small csv files, categorizing, tagging and branding the products.
And they all write to the same database table. So far so good.
The problem i'm facing is, that if i chose more than 2 workers, the process crashes with the following message randomly

The workflow is
foreach (csv) {
 workerPool.submit(csv)
}

func worker(csv) {
 foreach (line) {
   import(line)
 }
}

import(line) {
 product = get(line)
 product.category = determine_category(product)
 product.brand = determine_brand(product)
 save(brand)
 product.tags = determine_tags(product)
 //and after all
 save(product)
}

I tried to wrap the save() calls in transactions, but it didn't help.
Now i have the following questions:

*

*Is MySQL suited to save concurrently to 1 table?

*If transactions are need to accomplish this, where should they be set?

*Is the Go SQL Driver (where the error ALWAYS happens in packets.go:1102) suited to do this ?

*Could anyone help me (maybe by hiring for a few hours)?

I'm completely stuck. I can also share the sourcecode if that helps. But I first wanted to know i you guess that it's rather my code or a general issue.

A: Open a new db connection in each goroutine (or thread, for languages that use threads).
MySQL's protocol is stateful, which means if multiple goroutines attempt to use the same connection, the requests and responses get very confused.
You would have the same problem trying to share any other kind of stateful protocol connection between goroutines.
For example ftp is also a stateful protocol, and that may be easier to understand. A client goroutine might send a message like "get file x" and the response should be a series of messages containing the content of that file. If another goroutine tries to use the same connection while that request/response is inprogress, both clients will be confused. The second goroutine will read packets that belong to a file it didn't request. The first goroutine who requested the file will find some packets it was expecting have already been read.
Similarly, MySQL's protocol does not support multiple client goroutines sharing a single connection.

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text:
poet laureate love
noun A poet appointed for life by a British monarch as a member of the royal household and expected to write poems celebrating occasions of national importance and honoring the royal family.
noun A poet appointed to a similar honorary position or honored for artistic excellence.
noun A poet acclaimed as the most excellent or most representative of a locality or group.
noun A poet officially appointed by a government, often expected to compose poems for state occasions and other government events
noun obsolete One who received an honorable degree in grammar, including poetry and rhetoric, at the English universities; -- so called as being presented with a wreath of laurel
noun UK Formerly, an officer of the king's household, whose business was to compose an ode annually for the king's birthday, and other suitable occasions; now, a poet officially distinguished by such honorary title, the office being a sinecure. It is said this title was first given in the time of Edward IV
noun the poet officially appointed to the royal household in Great Britain
noun a poet who is unofficially regarded as holding an honorary position in a particular group or region
ry commented on the word poet laureate
Who was talking about Joy Harjo? Was it fbharjo? Today, Joy Harjo was appointed the US poet laureate by the Librarian of Congress and became the first Native American so appointed.
https://www.loc.gov/item/prn-19-066/
bilby commented on the word poet laureate
Yes it was.
fbharjo commented on the word poet laureate
Joy Harjo's memoir 'Crazy Brave' is a great read. Her journey is a meracious wonder.

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Lockheed Martin is to team with Rheinmetall in its bid to replace the German Navy's (Deutsche Marine - DM) ageing Westland Mk 88A Sea Lynx anti-submarine warfare/anti-surface warfare (ASW/ASuW) helicopters, the US manufacturer announced on 12 October.
The two companies signed a letter of intent (LOI) to partner on offering the Sikorsky MH-60R Seahawk helicopter as a replacement for the DM's 21 Sea Lynxes.
Although the precise timeline for Sea Lynx replacement programme has yet to be disclosed, Jane's was told by industry representatives at the Berlin Security Conference (BSC) in 2017 that a contract is expected in 2020/21 time, ahead of an entry-into-service date of 2023 and full-operating capability in 2025.
In all, the DM is looking for between 18 and 24 new helicopters to replace the Sea Lynxes, with the chosen platform being able to fulfil both a shipborne ASW and an ASuW capability.
While the details of the Lockheed Martin and Rheinmetall bid have not been disclosed, the MH-60R is equipped with the Thales/Raytheon AQS-22 Airborne Low-Frequency Sonar (ALFS) and previous Foreign Military Sales of the type have included torpedos, 12.7 mm GAU-21 (M3M) and 7.62 mm M240 (FN MAG) machine guns, AGM-114 Hellfire laser-guided missiles, and 70 mm rockets that have been upgraded with BAE's Advanced Precision Kill Weapon System laser guidance kit.
Besides Lockheed Martin and Rheinmetall, other contenders will comprise Leonardo with its AW159 Lynx Wildcat and Airbus Helicopters with its NH90-derived Sea Lion. The Lynx Wildcat can be configured to carry active dipping sonar (ADS), sonobuoys, and torpedoes, while for the anti-surface warfare role it can be armed with anti-ship missiles, rockets, and guns. An upgraded version of the Sea Lion, known as the Prospective Sea Lion, has been fitted with ASW and ASuW equipment required for the Sea Lynx replacement effort.


text:
Hiroshima Castle
452A4841.jpg by Bo Mertz CC SA
Castle in Hiroshima Castle, Hiroshima
Varies by season
Closed: New Year holidays
About Hiroshima Castle
Concrete reconstruction of the 1589 castle destroyed in the atomic bombing.
Originally built in 1589, Hiroshima Castle was once a stronghold and remains a great example of a castle built on the plain rather than a hill. However, the original castle was destroyed in the atomic bombing of Hiroshima and what stands today is a ferro-concrete replica built in 1958.
The interior of the five story keep has recently been restored and renovated into a history museum. Each floor offers a number of displays about the history of Hiroshima, the castle and the reconstruction. Reaching the top floor offers panoramic views of the grounds and the city.
A wide moat wraps around the castle grounds, which have been turned into a pleasant park hiding scattered ruins of former buildings. A few buildings in the Ninomaru - the second circle of defence - have been reconstructed using original techniques and materials, including the main gate, a long storehouse, and two turrets. Visitors can enter these to find out more information on their history and reconstruction.
The grounds are free to enter, with only the main keep requiring a ticket.
Shukkeien Garden
in Hiroshima Castle, Hiroshima
A traditional Japanese garden with a history dating back to around 1620 in the Edo Period.
Hiroshima Genbaku Dome
The only structure left standing in the area when the first atomic bomb exploded. UNESCO world heritage listed, it has been preserved in the same state as immediately after the bombing.
in Himeji Castle Area, Himeji
Considered to be the most beautiful castle in Japan, Himeji Castle is one of only 12 castles still standing as original. A not to be missed highlight of the Kansai region.
in Morinomiya, Osaka
A stunning modern reconstruction of a 1583 castle with a very important - and turbulent - part to play in Japanese history.


Viper2 Garment Printer The DTG brand is well known globally as the leading innovator in the garment decorating industry. There are more successful apparel printing companies using DTG Digital printers than any other brand. Our experience will lead to your success!
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Utilizing our latest high performance piezoelectric print head technology, the DTG Viper2 is among the most productive direct to garment printers in the industry. With the ability to print four smaller or two larger garments at a time and preload additional platens – your interface time per image printed is extremely low. The Viper2 is also One Pass Fast enabled allowing simultaneous white and color prints to increase production rates by up to 50%.
Prod_Viper2_pallet21_709x592The DTG 4-2-1 garment pallet system is truly unique to the DTG Viper2 and prints multiple garments at a time as standard with our specialty pallet assembly with auto registration built in. Simply bring your designs from most major graphics software into our DTG RIP templates and your artwork is easily positioned with pinpoint registration (achieved via a unique conveyor garment loading system). The micro servo motor driven conveyor system produces perfect dot registration accurate to 0.017mm.
As with all current models of DTG Brand Direct to Garment printers – the Viper2 is available with the patented WIMS – White Ink Management System (option). Gone are your concerns regarding periods of moderate inactivity causing lost time and wasted money on head cleanings and struggles to get your printer ready to produce the quality images you expect.
With the industry's leading RIP and the backing of the largest tech support staff in the direct to garment marketplace globally – it is easy to see why DTG Brand is the most recognized direct to garment printer brand in the global market. You can count on the DTG Viper2 to help you grow your eco-friendly, short run apparel decoration business.


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Pocket Dentistry
Fastest Clinical Dentistry Insight Engine
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Oral and Maxillofacial Radiology
6 Treatment of Nonvital Teeth
Treatment of Nonvital Teeth
By definition, a nonvital tooth is a tooth with a necrotic pulp. Pulp necrosis is suspected when a tooth does not react to thermal, electric, or mechanical stimulation, but the definite diagnosis is established only after inspection and probing of the pulp chamber and the root canal. As was discussed above, the necrotic pulp tissue and the root canal space are infected almost without exception, even in teeth which clinically appear intact (Fig. 6.1). Over time, bacteria in the root canal will induce inflammation outside the tooth, resulting in the formation of an apical granuloma or cyst (see p. 33). Treatment of a nonvital tooth, therefore, invariably involves the treatment of an infectious disease process.
The objective of treating a nonvital tooth is to remove the necrotic tissue and tissue breakdown products from the root canal, eliminate infection, seal the root canal bacteria-tight, and thereby establish a functioning tooth in a healthy periodontium. An apical periodontitis which is refractory to conservative endodontic treatment may be treated successfully by a surgical–endodontic approach in which the apical granulation tissue, which may be infected, is curetted out.
a Colonies of microorganisms in necrotic tissue in a root canal.
b Bacterial colonies in tissue and on the root canal wall.
c Large bacterial colony in the cervical area of a root canal subjacent to dentin exposed to the oral cavity. The root canal of this tooth was sealed to the mouth, and the bacteria have gained access to the canal through the tubules of the exposed dentin (Brown–Brenn stain).
Conservative Endodontic Treatment
In principle, a conservative approach is indicated in the treatment of all nonvital teeth. Traditionally, there have been some doubts as to whether large periapical lesions would heal following treatment of the root canal, but with modern methods the size of the lesion is of no real concern when the treatment plan is made (Fig. 6.2). However, there is still no definite evidence that periapical cysts respond to nonsurgical treatment, although the circumstantial evidence to that effect is considerable (Fig. 6.2). The main rule, therefore, is that all nonvital teeth with or without apical periodontitis should be treated conservatively.
Treatment Principles
The treatment of the root canal of a nonvital tooth can be divided into three main phases:
1) Chemomechanical instrumentation of the canal with removal of necrotic pulp tissue and bacteria;
2) Final disinfection of the canal and creation of favorable conditions for periapical healing; and
3) Obturation of the canal with materials rendering a bacteria-tight seal.
Chemomechanical instrumentation. The mechanical instrumentation of the root canal is of the utmost importance in the treatment of nonvital teeth. During this phase the necrotic tissue with its colonies of bacteria is physically removed from the main root canal. By enlarging and preparing the canal and giving it its shape for obturation, most bacteria in the dentinal tubules are physically removed as well. However, the mechanical instrumentation obviously has no effect in crevices and lateral or accessory root canals where the instruments do not reach.
The effect of the mechanical instrumentation can be enhanced by the use of chemically active preparations during the instrumentation phase. These preparations are referred to as root canal irrigants, or irrigation solutions, and they are injected continuously or at intervals into the canal during the instrumentation. Different irrigants may be used in an alternate fashion to obtain a combined effect of the medicaments. Thus, medicaments are available which have a cleansing effect, an antibacterial effect, a detoxifying and denaturing effect, and a hard- and soft-tissue dissolving effect. Depending on the clinical situation, different medicaments may be selected. However, the main purpose of a root canal irrigant should be to aid in the removal of necrotic tissue and tissue components, bacteria, blood clots, exudate, and pus. Irrigants with a tissue-dissolving ability have a good cleansing effect, even in crevices and lateral canals where the mechanical instrumentation has no effect. The cleansing action and the tissue dissolution will further lead to an exposure of bacteria that are normally embedded in and protected by necrotic tissue and tissue components or by bacterial extracellular polymeric materials so that the antimicrobial action of the irrigant and other root canal antiseptics is maximized.
a Radiographs showing a large radiolucent lesion extending from the maxillary right central incisor to the third molar. Note the deviation of the roots of the teeth. The right lateral incisor is non-vital.
b Radiographs showing resolution of the lesion over a 4-year period following endodontic treatment of the lateral incisor.
The classic root canal irrigant is 0.5% sodium hypochlorite at pH 9. This solution was first used in medicine in the form of a drip in the treatment of soldiers with grenade wounds in World War I. By constantly dripping onto a wound surface, the sodium hypochlorite would cleanse the wound, dissolve necrotic tissue at the wound surface, and keep the wound clean and bacteria-free. The effect of the medicament is virtually the same in the root canal. It has an excellent cleansing ability, dissolves and detoxifies necrotic tissue, has a certain antibacterial effect, and is well tolerated by vital tissue. However, the effect of sodium hypochlorite is quickly neutralized by organic components like tissue remnants, blood, and exudate in the root canal, and consequently the irrigant has to be renewed continuously or at frequent intervals. An amount of at least 10 mL should be used during the instrumentation of a single-rooted tooth and comparably more in premolars and molars.
Sodium hypochlorite is used in concentrations between 0.5 and 10%. Since the medicament when used for irrigation is applied in excess, a low concentration will be about as effective as a solution with higher concentration, and it will be less toxic. Thus, a 5% solution is 10 times as toxic as a 0.5% solution, but has only about twice the antibacterial effect. However, in a 5% concentration, sodium hypochlorite has an improved tissue-dissolving effect. This may be beneficial when mechanical removal of tissue is difficult, as in side canals and in teeth with resorption defects.
Chlorhexidine gluconate is an antiseptic that is effective against oral bacteria and has been used in the treatment of periodontal disease for two generations. Lately, chlorhexidine has been used as a root canal irrigant to replace sodium hypochlorite, apparently since sodium hypochloride leaves an oxygen-rich surface in the root canal that might influence negatively the bonding action of resin-based root filling materials. Unlike sodium hypochlorite, chlorhexidine lacks bleaching and tissue dissolving properties. It is therefore not well suited for irrigation of the root canal during the instrumentation phase of the treatment.
Quaternary ammonium compounds are surface-active agents with a soap-like character, and because of these characteristics are widely used as root canal irrigants. They have a bacteriostatic effect and are well tolerated by the tissues. However, like sodium hypochlorite and chlorhexidine, their effect is quickly reduced by organic components, and renewed injection into the canal at frequent intervals is necessary for maximal effect. Like chlorhexidine, the quaternary ammonium compounds lack bleaching and tissue dissolving properties.
Fig. 6.3 Scanning electron micro-graph of a root canal wall following instrumentation and irrigation with sodium hypochlorite. A smear layer is covering the wall so that the dentin surface cannot be seen (×470).
Fig. 6.4 Scanning electron micro-graph of a root canal wall following instrumentation and irrigation with sodium hypochlorite as well as a final rinse with EDTA. The smear layer is removed and the dentin surface with its tubule orifices can be seen (×300).
Oxidizing agents like a 3% solution of hydrogen peroxide are used as root canal irrigants as well, usually in combination with sodium hypochlorite. However, sodium hypochlorite is as effective when used alone as when combined with hydrogen peroxide, and hydrogen peroxide, therefore, is presently not widely used.
None of the irrigants mentioned above has an effect on hard tissue or on the smear layer of the root canal walls (Fig. 6.3). However, irrigation of the root canal with a chelating agent like ethylenediamine tetraacetic acid (EDTA) which binds Ca++ ions, will effectively remove the smear layer and dentin chips remaining on the canal wall after the instrumentation (Fig. 6.4).
In the root canal ethylenediamine tetraacetic acid (EDTA) is used in a 15% solution at pH 7.4. A certain volume of the solution can only bind a limited number of Ca++ ions, and additional EDTA must be injected into the canal at frequent intervals in order for continued Ca++-binding to take place. EDTA is well tolerated by soft tissues and, from a biological point of view, can be used safely. The most effective use of EDTA as an irrigant is in combination with sodium hypochlorite. These two irrigants supplement each other in that one has its effect on necrotic tissue, bacteria, and other organic components in the root canal system, whereas the other gives a clean root canal wall. Clinically, sodium hypochlorite and EDTA may be used alternately during the instrumentation phase. Excellent results are also obtained when sodium hypochlorite is used during the instrumentation, and EDTA is used for a final irrigation of the canal after the instrumentation is completed.
A new irrigating solution, MTAD, containing a mixture of a tetracycline isomer, an acid and a detergent has come on the market. It was initially meant to replace both sodium hypochlorite and EDTA, but is now recommended to be used together with sodium hypochlorite. The acid in MTAD may remove the smear layer of the canal walls, but the antibacterial effect of the combined use of sodium hypochlorite and EDTA is reported to be superior to the effect of the MTAD and sodium hypochlorite combination.
If at all possible, the chemomechanical instrumentation of the root canal should be completed in the first visit. If a partial instrumentation is done, the environment in the canal is changed and the balance that existed in the bacterial flora is altered as well. Chances are that certain pathogenic bacteria now may have an opportunity to dominate the infection and cause a flare-up or exacerbation of the periapical inflammation.
Iatrogenic flare-ups occur first and foremost during treatment of teeth with apical periodontitis, and with optimal treatment will be seen in about 5% of such teeth. The frequency with which flare-ups occur is an excellent indicator of a dentist's effectiveness and carefulness in endodontic treatment of nonvital teeth. If the overall frequency is much higher than 2–3% (5% in teeth with apical periodontitis), it is a clear message that something is wrong with the dentist's therapeutic approach, either conceptually, clinically, or both.
Disinfection of the root canal. A thorough and complete chemomechanical instrumentation in the first visit may render the root canal system bacteria-free. However, in most instances it results in only an effective reduction in the number of bacteria, and an antiseptic medicament must be applied to the root canal for a period of time in order to assure that the last remnants of the root canal flora are eliminated.
Presently, there is disagreement about how important this is. It is felt by many that it is of no clinical consequence that bacteria are left in the root canal system if only the root canal is obturated bacteria-tight. Remaining bacteria will then be sealed in the root and have no effect on the periapical tissues. However, from a medical point of view this concept may seem hard to defend. Firstly, pathogenic bacteria should not be left in a patient if they can be eradicated, and secondly, not all bacteria may be "blocked off," but be present in root canal deltas and lateral canals that are in continuity with the periodontium. With our present methods and techniques, therefore, endodontic treatment of a nonvital tooth should as a rule not be completed in the first visit, but in a second visit after a period of final disinfection of the root and root canal system.
In traditional endodontic treatment of nonvital teeth, little emphasis was put on instrumentation and tissue management, and much emphasis was put on disinfection. Sophisticated disinfection methods such as diathermy and iontophoresis were advocated, and a large number of imaginative concoctions of powerful antiseptics were used as well. Today, we know that medicaments which are effective against microorganisms also, as a rule, kill human cells, and consequently may cause tissue damage. The damage which is caused by uncritical use of medicaments in the root canal may, therefore, at times exceed the advantages of their use. Recognition of this fact led to attempts to find antiseptics which have the desired effect on the microorganisms of the root canal system without causing unacceptable injury to the periapical tissues (selective toxicity). Iodine and chlorine preparations as well as quaternary ammonium compounds and chlorhexidine have shown the best results in these studies, and from the point of view of selective toxicity, are suitable intracanal medicaments in the treatment of nonvital teeth. Formocresol and monochlorphenol are other medicaments used widely for this purpose (Fig. 6.5).
a Radiograph of a mandibular molar with apical and interradicular periodontitis. The tooth was completely instrumented under irrigation with sodium hypochlorite and EDTA in the first visit and formocresol was placed in the pulp chamber by means of a cotton pellet.
b In the second visit after 1 week, the patient was asymptomatic and the root canals were dry. The canals were then obdurated.
c After 6 months, resolution of the lesion is observed.
a A cotton pellet with fresh formocresol is placed on a pour plate with Streptococcus species. After incubation for 24 h, a zone of inhibition of the growth of the bacteria is seen surrounding the cotton pellet with the medicament.
b Cotton pellet with formocresol which was sealed in the pulp chamber of an instrumented, nonvital dog tooth for 24h is placed on a pour plate with Streptococcus species. After incubation for 24h, the bacteria are seen growing in contact with the cotton pellet. The formocresol had lost its antibacterial effect.
Although the selective toxicity of the medicaments mentioned above varies, and thereby their suitability for use, they have one feature in common, namely the fact that they are quickly rendered inactive by contact with the dental tissues and tissue fluids, usually within 24 hours (Fig. 6.6). Thus, if any of these medicaments is used in the root canal, the canal will be unprotected 1 day after the placement of the medicament or even sooner. This means that if the bacteria in the root canal system are not killed during the first day, surviving organisms will begin to multiply again, since the canal will contain tissue fluids, exudate, and blood, which constitute an excellent substrate for bacterial growth. Also, when the root canal is no longer protected by the antiseptic, it may become reinfected by bacteria from outside the root canal system.
Ideally, a root canal antiseptic should have a long-lasting antimicrobial effect. In the future, intracanal medicaments in controlled-release delivery systems will undoubtedly be available (Fig. 6.7). At present, prolonged antibacterial action can be readily and effectively obtained by filling the root canal with a paste of calcium hydroxide and isotonic saline. The use of calcium hydroxide in the treatment of nonvital teeth developed empirically. It was noted that when placed in the root canal, calcium hydroxide has a striking effect on periapical exudation. This was taken as evidence that the material has an anti-inflammatory effect, i.e., it has the ability to bring a periapical inflammation from the exudative stage to a stage of repair. It was also noted that periapical lesions quickly show radio-graphic signs of healing in teeth with calcium hydroxide in the root canal, and that complete repair regularly occurs in 2–3 months (Fig. 6.8).
The modes of action of calcium hydroxide are only partially understood. When mixed with saline, the resulting paste has a pH of 12.5. Moreover, calcium hydroxide has a disassociation coefficient of 0.17, which means that if placed in the root canal, it will become ionized and dissolve slowly and steadily in the fluids of the dentinal tubules, the lateral and accessory canals, and the periapical tissue. In other words, there is a controlled, long-lasting release of Ca++ and OH– ions from the paste in the root canal. Consequently, calcium hydroxide will have a controlled, long-lasting therapeutic effect.
The therapeutic effect of calcium hydroxide is clearly related to the hydroxyl ions, which will lead to a lowered oxygen tension and an increase in the pH in the inflamed periapical tissue. A low oxygen tension in the tissue favors bone formation and repair, and a favorable effect of an alkaline environment on mineralization is also evidenced by the high pH found in the growth plate at the mineralization front of bones. A possible therapeutic effect of the calcium ions is less well understood, but apparently they may have a stimulating effect on certain alkaline phosphatases, which are enzymes connected with hard-tissue formation. It is also possible that the calcium ions have a beneficial effect on the local immune response.
Fig. 6.7 Antiseptic in a controlled-release delivery system. The dispensers were sealed in the pulp chamber of instrumented, nonvital dog teeth for 6 weeks and were, after removal, placed on a pour plate with Streptococcus species. After incubation for 24 h, zones of inhibition of bacterial growth are seen surrounding the dispensers, indicating that the antiseptic is still being released after 6 weeks of contact with dentin and tissue fluids in the root canal.
a Radiograph of a maxillary incisor with root fracture and a large radiolucency in conjunction with the fracture line. Calcium hydroxide treatment of the coronal fragment (apexification) is initiated.
b After 2 months, near complete resolution of the radiolucent lesion is observed.
c Radiograph of a maxillary molar with interradicular periodontitis and suspected oral communication. Long-term calcium hydroxide treatment is initiated.
d After 10 weeks, resolution of the radiolucent lesion is evident.
a Radiograph of a maxillary molar with apical periodontitis and a palatal fistula from the palatal root. The tooth was completely instrumented in the first visit (buccal root canals calcified) and treated with calcium hydroxide for 3 weeks. At the second visit, the patient was asymptomatic, the fistula had closed, and the root canals were obturated.
b At 3-month control, the palatal fistula has recurred, the root filling is removed from the palatal canal and long-term calcium hydroxide treatment is initiated.
c The fistula closed immediately, and after 3 months the periapical lesion had resolved. Only then was the palatal root canal again permanently obturated.
With a pH of 12.5, a calcium hydroxide paste has an excellent and exceptionally broad antibacterial effect. No known endodontopathogens can survive at this pH, and will be killed instantly when directly exposed to the paste. However, in crevices of the main canal and especially in lateral and accessory canals where the chemomechanical instrumentation has only a limited effect, the bacteria may be embedded in and protected by necrotic tissue components and bacterial extracellular material, and may survive the influence of an antiseptic for considerable time. Even in such inaccessible areas of the root canal system, the bacteria can be expected to eventually die out under the constant and long-lasting influence of calcium hydroxide, but a long-term exposure to the drug, i. e., weeks and even months may be necessary in some instances (Fig. 6.9).
The long-lasting antibacterial effect of the calcium hydroxide paste is highly dependent on a constant, high alkalinity of the paste. Thus, rather common root canal organisms like Enterococcus faecalis may survive in an environment with a pH up to 11. Blood, exudate, dental tissues, and tissue fluids will readily lower the pH of the calcium hydroxide paste, and in teeth with severe exudation from the periapical tissues, the paste in the apical part of the canal may have a pH of 8 within 2–3 weeks after placement. The paste will then have lost its antibacterial effect. However, due to its anti-inflammatory effect, even a severe periapical exudation may have stopped at this time. The "used" calcium hydroxide paste is, therefore, removed, the root canal is irrigated and dried, and new, clean calcium hydroxide paste with the right alkalinity is packed into the canal. Bacteria anywhere in the root canal system that might have survived the first application of calcium hydroxide should now effectively be killed. However, in most instances the root canal can be dried to such an extent at the first visit that a one-time application of calcium hydroxide for 2–3 weeks is sufficient to obtain a bacteria-free root canal system.
An additional aspect of the therapeutic effect of calcium hydroxide is its ability to denature proteins. Necrotic tissue influenced by calcium hydroxide will swell to twice its size and be dissolved by sodium hypochlorite twice as fast as tissue untreated by calcium hydroxide. Tissue remnants left behind in the root canal after the chemomechanical instrumentation can, therefore, readily be dissolved and rinsed out with sodium hypochlorite following a period of a week or longer with calcium hydroxide in the canal. Similarly, the content of lateral and accessory canals and other areas in the root canal system which cannot be reached by instruments will be influenced by the combined action of calcium hydroxide and sodium hypochlorite, resulting in an optimally cleaned root canal system.
It also appears that the actual filling of the root canal with a material with the properties of a calcium hydroxide–saline paste is beneficial for the periapical repair processes. When a traditional antiseptic is applied to an empty root canal by means of a cotton pellet, an exudate consisting of tissue fluids, cells, bacteria, and bacterial products and components will fill the canal. The exudate as such may maintain a periapical inflammation, but most importantly it is an excellent substrate for bacterial growth. The possibilities of reinfection of the root canal between visits under these circumstances are quite real. The use of calcium hydroxide, on the other hand, will effectively prevent exudate from filling the root canal, and by virtue of its presence and its long-lasting antibacterial effect will prevent reinfection of the canal.
Obturation of the root canal. The effectiveness of the chemomechanical instrumentation and disinfection of the root canal is normally evaluated clinically. If the patient is asymptomatic and the root canal remains dry after the intracanal medicament has been removed and the canal has been irrigated and dried, it is assumed that the periapical inflammation is at a stage of repair. This can be expected at the first visit following the visit with complete instrumentation of the canal, i. e., usually in the second visit, and the root canal can then be permanently obturated.
Fig. 6.10 Radiograph showing perforations of teeth in the cervical area during preparation of access cavities under a rubber dam. The operator has clearly misjudged the longitudinal direction of the teeth.
Sometimes the criteria for final obturation are not achieved in two visits. The reasons for the unfavorable tissue reactions should then be determined, if possible, before the treatment is continued. The primary concern is whether the chemomechanical instrumentation has been performed satisfactorily. The canal may not have been enlarged enough or a canal may have been missed. In any case, insufficient instrumentation with remaining infection is by far the dominating cause of persistent tissue reactions. Microbiological culturing of the root canal content may provide useful information in such instances (see p.117).
If infection is suspected at the second visit, and the instrumentation of the root canal appears to have been carried out well, the problem may be caused by reinfection because of a leaky temporary filling, inadequate old restorations, caries, cracks, fractures, or similar causes. Therefore, after renewed chemomechanical instrumentation and application of the intracanal antiseptic, the coronal seal must be checked most carefully. Remember that a temporary filling should preferably be 4–5 mm thick in order to provide a safe bacteria-tight seal. If symptoms, exudation, or fistulae persist after repeated treatment of a tooth, it is useless to keep changing the intracanal dressing. An analysis of the probable causes of the problem must be carried out and effective therapeutic measures taken (see p.116).
Clinical Considerations
The access cavity is prepared in the tooth and the root canal orifices are located before a rubber dam is applied. This is even more important in nonvital than in vital teeth in that, in these teeth, the root canals are often calcified because of a long-standing chronic inflammation before the pulp finally necrotizes. It may, therefore, be difficult to localize the root canal orifices, and calcified tissue may have to be removed with rotating instruments. In this situation it is helpful to see the entire tooth and the neighboring teeth with adjacent structures for orientation purposes so as to avoid root perforations and other mishaps (Fig. 6.10).
When the orifices are located, a rubber dam is applied and the field of operation is disinfected as described for vital teeth (see p.101). The treatment then continues with sterile instruments and under surgical–aseptic conditions. First, the length of the root canal is established by means of a tooth-length radiograph taken with an instrument in the root canal or with an apex locator. Theoretically, the root canal of a nonvital tooth should be instrumented to the apical foramen to ensure the removal of all necrotic tissue. However, as with vital teeth, it is usually not possible to determine the exact position of the foramen. Therefore, the practical rule to follow in nonvital teeth is to end the mechanical instrumentation of the root canal 1 mm short of the radiographic apex. In this way practically all necrotic tissue will be removed, and in most instances the instrumentation will be confined within the canal with the possibility of creating an apical stop to facilitate the obturation of the canal (Fig. 6.11).
Remember that over-instrumentation of the root canal of nonvital teeth is an effective way to carry bacteria to the periapical tissues, often resulting in an exacerbation of an asymptomatic periapical inflammation.
As discussed above, the root canal will not routinely be bacteria-free after the chemomechanical instrumentation. Consequently, the root canal in nonvital teeth should not be obturated in the first visit. For further disinfection of the canal it is important to understand that the antiseptic medicament used has to come in contact with the bacteria in order to kill them. Thus, vaporizing medicaments like iodine- and formalin-containing drugs may be applied to the pulp chamber, whereas nonvaporizing medicaments will have to fill the root canal system to have an effect.
If calcium hydroxide is used, it is mixed with saline to a creamy mix. It is applied to the pulp chamber with a plastic instrument and introduced into the root canal by means of a lentulo. When the canal appears filled, excess water is removed with paper points and the paste is condensed with a plugger or similar instrument. Additional calcium hydroxide paste is then applied with the lentulo and condensed at the canal orifice with cotton pellets. When the canal is adequately filled, excess paste on the walls of the access cavity is carefully removed and a temporary filling which gives a bacteria-tight seal is finally placed in the access cavity.
The time between the first and second visit depends on the type of intracanal antiseptic used. With a traditional antiseptic the time should be short (days) since the medicament loses its effect within hours of placement in the canal. A third appointment may, therefore, become necessary before the criteria for obturating the root canal are fulfilled (asymptomatic patient, dry root canal). An antiseptic in a controlled-release delivery system offers greater convenience because the time interval between appointments may be considerably increased. Possible symptoms of an apical periodontitis may then have time to subside and periapical exudation may stop. At present a calcium hydroxide–saline paste appears to fulfill these requirements of an intracanal antiseptic the best. The paste in the canal will act as a depot and continuously release Ca++ and OH– ions for weeks and months. A period of 2–3 weeks between appointments is as a rule enough in that the pH in the dentinal tubules reaches its peak during this time. The bacteria in the root canal system and the root dentin should then be killed and the peri-apical inflammation will have subsided so that the root canal can be dried and filled under optimal conditions. This method, which is referred to as short-term calcium hydroxide treatment, makes for effective and problem-free endodontics (Fig. 6.12).
Fig. 6.11 Section of a nonvital dog tooth. The instrumentation of the root canal has been carried out according to the apical box method and ends 1 mm short of the apex. In this way, a stop to facilitate the obturation of the canal has been created in spite of apical resorption. The root canal is clean and if the infection has been eliminated, periapical healing will be predictable and fast (hematoxylineosin).
Fig. 6.12
a Radiograph of a mandibular premolar with asymptomatic apical periodontitis. The root canal is completely instrumented in the first visit and calcium hydroxide is packed into the canal to complete the disinfection of the root. (When an ill-fitting crown is not removed until after the endodontic treatment, it is imperative to establish an intracoronal bacteria-tight seal.)
b In the second visit after 3 weeks, the patient remains asymptomatic and no periapical exudation is seen. The root canal is then obturated.
c At the 3-month control, resolution of the periradicular lesion is evident.
Long-term calcium hydroxide treatment may be the method of choice in special cases. It is used in the treatment of teeth with large periapical lesions, severe periapical exudation, incomplete root formation, progressive external inflammatory resorption, and in the retreatment of teeth where conventional treatment has failed. In other words, the long-term calcium hydroxide method is used in situations in which we want to maximize the effect of our treatment.
With this method the tooth is treated with calcium hydroxide until periapical healing is complete or is at least well under way, i. e., for 3–12 months or even longer (Figs. 6.8, 6.9, 6.13, 6.14). The medication is changed after 2–3 weeks and then if necessary after 3 months. The purpose of the treatment is to maximize the antibacterial treatment of the root canal system and to favorably influence hard- and soft-tissue repair processes in the tooth and periradicular tissues. An additional benefit of the method is that apical repair or, just as importantly, lack of repair can be determined relatively quickly. This may be important for the overall treatment plan of the patient.
Antibiotics should be given prophylactically in conjunction with endodontic treatment of nonvital teeth to certain patients. They are patients with heart valve injury, acute glomerulonephritis, or diabetes that is difficult to control, patients on steroid therapy, and a steadily increasing number of patients who have undergone open heart surgery. Patients with implants and pacemakers should also be included in this group. Prophylactic antibiotic treatment should be performed with bactericidal medicaments, normally amoxicillin. The dose is given a half to 1 hour before the treatment begins, which means that the patient may receive the medicament in the waiting room. The regime for prophylactic use of antibiotics may differ somewhat from country to country. For legal reasons, therefore, one should use the regime exactly as recommended by local authorities, heart associations, or similar institutions.
Follow-up Examinations and Prognosis
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Tags: Clinical Endodontics
Jan 2, 2015 | Posted by mrzezo in Endodontics | Comments Off on 6 Treatment of Nonvital Teeth
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text:
Dzhambov A
Dimitrova D
Displaced aggression
Year : 2014 | Volume : 16 | Issue : 69 | Page : 95-101
Neighborhood noise pollution as a determinant of displaced aggression: A pilot study
Angel Dzhambov1, Donka Dimitrova2
1 Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
2 Department of Health Management, Health Economics and Primary Care, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
Date of Web Publication 7-May-2014
Noise pollution is still a growing public health problem with a significant impact on psychological health and well-being. The aim of this study was to investigate the impact of noise on displaced aggression (DA) in different subgroups of residents in one of the neighborhoods of Plovdiv city. A cross-sectional semi-structured interview survey was conducted using specially designed data registration forms and 33 close-ended and open-ended questions, divided into two major panels - one original and a modified version of the Displaced Aggression Questionnaire (DAQ). The mean score for DA was 61.12 (±19.97). Hearing noises above the perceived normal threshold, higher noise sensitivity and continuous noises were associated with higher levels of DA. Low frequency and high intensity noises were also associated with higher DA scores. Multiple regression model supported these findings. Contradictory to previous research age was positively correlated with noise sensitivity and aggression. We speculated that this might be due to the relatively lower socio-economic standard and quality of life in Bulgaria. Therefore, social climate might be modifying the way people perceive and react to environmental noise. Finally, the DAQ proved to be a viable measurement tool of these associations and might be further implemented and modified to suit the purposes of psychoacoustic assessment.
Keywords: Displaced aggression, neighborhood, noise pollution
Dzhambov A, Dimitrova D. Neighborhood noise pollution as a determinant of displaced aggression: A pilot study. Noise Health 2014;16:95-101
Dzhambov A, Dimitrova D. Neighborhood noise pollution as a determinant of displaced aggression: A pilot study. Noise Health [serial online] 2014 [cited 2022 Jan 29];16:95-101. Available from: https://www.noiseandhealth.org/text.asp?2014/16/69/95/132090
Noise pollution is one of the current public health problems associated with urbanization and modern life. A recent publication of the Regional Office for Europe of the World Health Organization estimated that applying the epidemiological measure of disability-adjusted life years at least 1 million healthy life years are lost every year from traffic-related noise in the Western Europe. [1] Noise levels above 55 dB are considered disturbing for the hearing comfort. Noise is a common cause for psychological distress, cognitive impairment, sleep disturbances, increase in social conflicts, anxiety, nervousness, emotional instability, argumentativeness, etc. [2],[3],[4],[5] Even at levels that are not harmful to the hearing, it is perceived subconsciously as a danger signal, even during sleep. [6] Noise pollution continues to grow in extent, frequency and severity as a result of population growth, urbanization and technological developments. [7]
The effects of noise were found to be strongest for annoyance. [8] Living along arterial urban streets increased risk of noise annoyance by 40%. [9] In their study Bluhm et al., stated that starting at about 57 dB, there was a large increase in percentage of people annoyed by sound [10] and Öhrström et al., found that at higher dB levels (65 dB), 75% of people were annoyed by road traffic noise. [11]
In some experimental studies aggression was found to be directly related to noise and annoyance. [12] Other authors do not believe that noise exposure per se could produce aggressive behavior. In combination with provocation, pre-existing anger or hostility, etc., however, noise could trigger aggressive behavior. [13],[14]
Investigations on the topic of aggression have been constrained to instances of direct aggression, which is retaliation toward the provoking agent. [15] This also implies the relationship noise - aggression. We hypothesized that a new measure of noise induced aggression had to be utilized in order to study the indirect noise induced aggressive behavior of all community members, including elderly people, women, severely impaired, etc. who are unlikely to directly retaliate toward a provoking agent but who still suffer the health and psycho-social consequences of it. We believe that displaced aggression (DA) is such measure. It occurs when a person is provoked, is unwilling or unable to retaliate against the original provocateur and subsequently aggresses against a seemingly innocent target. [16] Individuals high in trait DA may be especially prone to experiencing physical health problems, [15] as well as to undermining the human capital of other community members and relatives, that affects health and well-being.
In Bulgaria community aggression is common, but its associations with neighborhood noise pollution still lack scientific grounding. On the other hand, the proportion of elderly and impaired people is constantly rising. [17] Having in mind all of this, we aimed to investigate the impact of noise on DA in different subgroups of residents in one of the neighborhoods of Plovdiv city - one of the most populated Bulgarian cities, high in traffic and neighborhood confrontation.
During the period of 1 June to 1 July 2013, a cross-sectional semi-structured interview survey was conducted amongst residents in one of the neighborhoods of Plovdiv city. We used a two stage random sampling method. To determine the sample size in the first stage of the study a pilot run results from 30 residents were used to determine the standard deviation (SD) and relative shares for the quantitative variable of greatest interest: Total score for 20-item Displaced Aggression Questionnaire (20-item DAQ). The determined number of participants calculating for 95% degree confidence and an error of 5% from the mean value of the score was 150. After adjusting for the expected non-response rate, we determined that 225 participants were to be recruited. Totality of 226 residents were contacted and the response rate was 84% (n = 190).
The survey was voluntary and anonymous, sociomedical, non-interventional and self-report and therefore was not subject to ethical evaluation by our University. It was carried out after obtaining participants' informed consent about the objectives and conditions of the study.
Methods of selection
In order to determine the noisiest non-industrial neighborhood we undertook a widely accepted strategy. We used data from the online noise monitoring system of Plovdiv Municipality. [18],[19] The city of Plovdiv (42°9′N, 24°45′E) is the second-largest city in Bulgaria with a population of 339,077 inhabitants as of December 2012 and a territory of 101.98 km 2 . The studied neighborhood is located in the Eastern district of the city, which has 61,149 inhabitants, a territory of 6.34 km 2 , 9644.95 people/km 2 and 11.5 m 2 roadways per capita. In the neighborhood, the main type of housing is 6-7 storey residential blocks. It should be noted that in this neighborhood is located the central cemetery of the city.
For the assessment of traffic noise the French National Method "NMPB-Routes-96" and the French standard "XPS 31-133" were used. Sound levels were measured with "Bròel and Kjær Type 2240" sound meter and "Brüel & Kjær Type 4231" calibrator. We also used satellite images in order to determine the radius of interest around the noise monitoring station [Figure 1]. [20] The selected neighborhood was situated in approximately 600 m radius of the noise monitoring station, on the both sides of one of the boulevards with most intense traffic and leading to a highway. On May 15, 1000 cars/h and 100 trucks/h were registered on that boulevard and the traffic-generated equivalent continuous noise level (L Aeq ) was 71.9 dB. Overall neighborhood L Aeq during the last 3 months (1 March to 1 June 2013) was above 60 dB with maximums of approximately 80 dB. The sound level meter was "Brüel & Kjær 3639-E-100".
Figure 1: Satellite image of the neighborhood where the study was conducted
A couple of students were recruited to help the authors with data collection and compensated with 10 leva (5 euros) a day for their time. They were instructed how to interview the residents of the neighborhood asking them to think about the last 3 months when answering the questions. The interviewers started their routes in four directions from the terminal location. They selected one individual over 18 years in every third household. If there was more than one person in the household, the one, whose birthday was closest to the date of the beginning of the survey was invited to participate. The interviews took place at a convenient time (5-8 p.m.) at residents' homes. In order to minimize reporting bias we presented the aim of the interview as assessment of residents' attitude toward noise pollution, because the word "aggression" is somewhat suggestive and concerning in Bulgarian.
Especially designed data registration forms and 33 close-ended and open-ended questions, divided into two major panels, were used. First panel comprised three original batteries assessing demographic and health characteristics, noise sensitivity and noise characteristics. The second panel was a modified version of the DAQ, comprising only "Angry Rumination" and "Behavioral DA" subscales because we found the "Revenge Planning" subscale unsuitable for our purpose (Courtesy of Assoc. Prof. Denson). [15],[21] Because DA is usually provoked by another person, in our study it would not be relevant to attribute such properties to noise as a phenomenon. The summary composite score of the two retained subscales was used as an indicator of DA and will be referred to when DA is discussed further in this paper. All items were rated on bipolar seven-point Likert-type scales ranging from 1 (extremely uncharacteristic of me) to 7 (extremely characteristic of me). The English version of the questionnaire was adapted and translated according to guidelines that are widely accepted for the successful translation of instruments in cross-cultural research - translation, back-translation and a pretest with a representative sample. [22],[23],[24]
Inclusion criteria: Adults dwelling in the neighborhood for at least the past 3 months. Exclusion criteria: Decline to participate, dwelling for <3 months, incomplete completion of the data registration form, minors.
Descriptive statistics, parametric and non-parametric analyzes were performed. When appropriate, ordinal and nominal data was transformed into numeric. To check the normality of the distribution the D'Agostino-Pearson K2 test was used. Mann-Whitney test was used for comparison of quantitative variables in independent samples with distribution other than normal. Pearson and Spearman's correlation analyzes were used to assess the correlations between "20-item DAQ score" and variables from "demographic", "noise acoustical characteristics" and "noise sensitivity" panels. When testing hypotheses for incidental (accidental) effect of a factor, Fisher's exact χ2 test and the criterion for significance level of P < 0.05 (two-tailed) were used. The main analysis was multiple linear regression. Results are presented as the number and percentage, mean and ±SD and correlation coefficients. Graphical analysis was applied as well. Statistical data processing was performed using the software SPSS v.17 (SPSS Inc., 2008. SPSS for Windows (17.0.0), Chicago, USA).
Out of the 190 people interviewed eight were excluded based on exclusion criteria (incomplete completion of the data registration forms by the interviewers). The excluded participants represented only 4.2% of the sample and therefore they did not have to be compared with the included participants and did not affect the statistical processing. The remaining 182 residents were included in further statistical analyses.
The characteristics of the participants are presented in [Table 1]. The mean age was 36.93 (±18.13) years where the youngest participant was 18 years old and the oldest - 92 years old. The majority were 21-40 years old. No significant differences were found in reference to sex. Nearly half of the participants had bachelor or master's degree, followed by those with upper secondary education. More than a half were married or were living with a spouse. We believe that the demographic profile of the residents, although not homogenous, somewhat representative of the studied population and corresponds with their age structure. This was supported by the direct observations of the interviewers. However, there are no official records for Plovdiv demographics on the neighborhood level because it is too small unit. Assessing the "Municipality plan for development of Plovdiv 2005-2013" confirmed our findings regarding the representativeness of the sample for the Eastern district population, although some discrepancies are due to the fact that we included only individuals over 18 years of age and the official data is from 2001. "Occupation", "health status" and "years of residency" were also explained to a great extent by the age of the participants. We hypothesized that the latter factors could be confounders in reference to the level of aggressiveness and predicting the outcome and hence, had to be explored.
Table 1: Characteristics of the residents and 20-item DAQ scores
The scores for the 20-item DAQ approximated normality sufficiently to be included in parametric tests (K2 = 6.488, P = 0.039). The mean was 61.12 (±19.97) with a minimum of 23 and a maximum of 113 points. The mean scores for the "Angry Rumination" and "Behavioral DA" subscales were 31.73 (±11.05) and 29.4 (±9.17), respectively.
As shown in [Table 2], the "noise panel", aimed to examine the self-reported noise sensitivity and annoyance, the idea of normal and abnormal noise levels and some of the acoustical characteristics of noise. In reference to the latter, the interviewers explained to the participants "noise frequency", "noise intensity" and "type of noise exposure" by giving them common examples from everyday life (a turbine sound, train, truck, whistle, vacuum cleaner, etc.).
Table 2: Noise sensitivity, noise characteristics and 20-item DAQ scores
As an introduction to the main analysis, at [Table 3] is presented the correlation-matrix for DAQ and other demographic and noise-related variables of interest.
Table 3: Correlation-matrix for the demographic and noise related variables associated with displaced aggression
We will comment on the correlations of interest from [Table 3]. It was found that DAQ was higher in women and in older people living in the neighborhood for a longer time, in people with better education and in those reporting poorer health (the positive coefficient is due to reverse coding of the variable). Moreover, low frequency and continuous noises resulted in more DA. The frequency of hearing noises above the normal threshold was positively correlated with DA as was noise annoyance. Only a small part of the participants reported "very high" noise sensitivity, but it was the strongest correlate of DAQ.
In order to seek for a model predicting the higher values of the 20-item DAQ, we performed a multiple regression analysis with "total 20-item DAQ score" as dependent variable logically associated with it as predictors - "perceived sensitivity to noise", "type of noise exposure", "frequency of hearing noises above the normal threshold", "annoying noise frequency", "age" and "years of residency". They were all entered simultaneously [Table 4]. We also included an interaction-term of "age" and "years of residency" in order to find whether there could be an explanation for the higher DA in senior citizens. The model showed with 64% power of prediction that the significant factors determining DA levels were "perceived noise sensitivity", "type of noise exposure" and "frequency of hearing neighborhood noises considered above the normal threshold".
Table 4: Coefficients for multiple regression model predicting the 20-item DAQ score from "perceived noise sensitivity", "type of noise exposure", "noise frequency", "frequency of hearing noises above the normal threshold", "age", "years of residency" and an interaction-term (age×years of residency)
The age and years of residency of the participants were not significant predictors of DA when included in the model along with the noise characteristics. Moreover, the effect of age did not vary across values of "years of residency" (P < 0.05 for interaction-term), suggesting it was not a moderator of that effect.
The analyses of the "demographic panel" demonstrated that women, older people, those living in the neighborhood for a longer time, those who were retired, with higher educational level and poorer health, were prone to higher levels of DA. These findings indicated that age, which is determinant of the other factors to a greater extent, is probably the key confounding factor correlating with DA. The fact that in our study age was positively related to both noise sensitivity and DA, in contrast to the findings of other authors, [15] could not be explained by years of residency as a possible moderator. However, we speculate that this is due to several reasons. There is a steady trend over the last decade for increasing the rate of elderly people at risk of poverty in Bulgaria. [25] Moreover, the health care system in the country needs serious reforms and currently does not function as it should. [26] Elderly people are often deprived of basic medical care and social acceptance and are generally more dissatisfied with their lives. [27] Having all of this in mind, we hypothesize that various social antecedents of noise sensitivity and aggression confound our findings and are responsible for the discrepancies with other authors'. In addition, the fact that the neighborhood was located close to a cemetery could have additional psychological impact on the assessed constructs of DA and noise sensitivity, which should also be addressed in future research.
Following this line of thoughts, we could say that better education was associated with higher DA, simply because it was a function of age. Moreover, such discrepancies may occur in cross-cultural research especially when the measures are taken in countries with diametrically different social standards. Nevertheless, it was beyond the scope of this paper to study in detail these inter-relationships and this should be a topic for a follow-up study.
The more often people were hearing noises above the normal threshold, the more noise sensitive they considered themselves to be and the more annoying they considered the neighborhood noises-the higher levels of DA. Low frequency, high intensity and continuous noises were associated with significantly higher levels of DA. The regression model supported these findings suggesting that frequent interaction with continuous noises in combination with higher noise sensitivity could be predicting the majority of urban DA in non-industrial neighborhoods. This was true even after controlling for age and years of residency, which were also significantly correlated with DA. However, age and years of residency were not significant predictors when included in the model. In follow-up studies structural equation modeling might help to uncover some unmodeled relationships between these variables.
It should be noted that because of the cross-sectional design of the study and the lack of different noise condition groups, the actual noise exposure could not be included as a predictor in the model. On the other hand, we do not consider this fact particularly troublesome because noise sensitivity is not predicted by noise exposure but rather by personality traits and psycho-social experiences. [28] Annoyance, which has acoustical antecedents, is mainly conditioned by noise sensitivity, which is a stronger predictor of annoyance than noise and can predict it above and beyond noise exposure, probably by moderating their relationship. [29],[30] Thus, it can be argued that because in our sample noise sensitivity was the strongest DA predictor, noise exposure was irrelevant. Moreover, it might be hypothesized that the psycho-social antecedents of noise sensitivity (the mentioned above low quality of life in Bulgaria) are causing higher DA through noise sensitivity, which on the other hand moderates the effect of noise exposure on annoyance thus resulting in higher DA. It was beyond the scope of this study to reveal these associations, but they are very plausible and by setting ground for their research this paper contributes to the field of psychoacoustics.
Although our study undertook a novel approach toward a better understanding of the psycho-social impact of noise pollution, we confirmed the findings of other authors about the significant contribution of noise to annoyance. [8],[9],[10],[11],[12] Noise may not be the sole predictor of aggression, [31] as there are some social and demographic confounders, but in combination with them it is associated with higher levels of DA, which could be harmful to the psycho-social well-being of people. Residents with poorer health presented with higher levels of DA, which is considered a possible contributor to physical health problems, [15] but we failed to determine the causal relations between the two variables. We confirmed that low frequency noises were more annoying and resulted in more substantial DA. [32] Elderly people were also found to be more susceptible to noise annoyance and DA. [4],[33] Secondary analysis of the collected data might elucidate other intrinsic aspects of psycho-acoustical perception.
The cross-sectional design of the study does not permit us to determine causal sequences between the assessed variables; the cross-cultural validation protocol for the 20-item DAQ did not assess internal consistency of the subscales; not all cultural and psychological factors of the participants were taken into consideration and might be possible confounders. Finally, a measure of socio-economic class could not be included due to poor reporting for this variable in particular, as it is a sensitive topic for many Bulgarians.
Future studies should replicate our results utilizing designs capable of establishing causal relationships, larger samples and assessing the psycho-cultural characteristics of the residents. Our results could help politicians, health care managers and other researchers better understand the psychology of neighborhood acoustics and to implement DA as a reliable measure for the indirect negative social and health impact of noise pollution.
DA is strongly associated with continuous noise exposure and subjective susceptibility to noise. It is influenced by some of the acoustical properties of noise as well. With age and impairment of their health people living in lower socio-economic conditions might become more noise sensitive and prone to DA. Therefore, the social climate might be affecting the way people perceive and react to residential noise. The 20-item DAQ proved to be a viable measurement tool of these associations and should be further implemented and modified to suit the purposes of psycho-acoustical assessment.
We hope that our results will point the attention to this underestimated environmental problem that has only in the recent years raised concern among Bulgarian health care politicians. By assessing the responses of citizens to different urban settings more active and evidence-based decisions could be made improving the infrastructure of the endangered neighborhoods. In addition, an interdisciplinary public health approach should be taken in order to counteract the damage of noise pollution using validated programs for coping with psychological distress and preventing social confrontations.
1. WHO European Centre for Environment and Health. Burden of Disease from Environmental Noise: Quantification of Healthy Life Years Lost in Europe. Copenhagen: Regional Office for Europe; 2011. Available from: http://www.euro.who.int/__data/assets/pdf_file/0008/136466/e94888.pdf. [Last cited on 2013 Oct 02; Last accessed on 2013 Oct 02].
2. Babisch W, Beule B, Schust M, Kersten N, Ising H. Traffic noise and risk of myocardial infarction. Epidemiology 2005;16:33-40.
3. Ohrström E. Longitudinal surveys on effects of changes in road traffic noise-annoyance, activity disturbances, and psycho-social well-being. J Acoust Soc Am 2004;115:719-29.
4. Goines L, Hagler L. Noise pollution: A modern plague. South Med J 2007;100:287-94.
5. Hume KI, Brink M, Basner M. Effects of environmental noise on sleep. Noise Health 2012;14:297-302.
6. Babisch W. Noise and health. Environ Health Perspect 2005;113:A14-5.
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9. Seto EY, Holt A, Rivard T, Bhatia R. Spatial distribution of traffic induced noise exposures in a US city: An analytic tool for assessing the health impacts of urban planning decisions. Int J Health Geogr 2007;6:24.
10. Bluhm G, Nordling E, Berglind N. Road traffic noise and annoyance - An increasing environmental health problem. Noise Health 2004;6:43-9.
11. Ohrström E, Barregård L, Andersson E, Skånberg A, Svensson H, Angerheim P. Annoyance due to single and combined sound exposure from railway and road traffic. J Acoust Soc Am 2007;122:2642-52.
12. Cohen S, Spacapan S. The social psychology of noise. In: Jones DM, Chapman AJ, editors. Noise and Society. Chichester: John Wiley & Sons; 1984. p. 227-31.
13. Konecni VJ. The mediation of aggressive behavior: Arousal level versus anger and cognitive labeling. J Pers Soc Psychol 1975;32:706-12.
14. Jones DM, Chapman AJ, Auburn TC. Noise in the environment: A social perspective. J Environ Psychol 1981;1:43-59.
15. Denson TF, Pedersen WC, Miller N. The displaced aggression questionnaire. J Pers Soc Psychol 2006;90:1032-51.
16. Dollard J, Doob LW, Miller NE, Mowrer OH, Sears RR. Frustration and Aggression. Oxford, England: Yale University Press; 1939.
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18. Plovdiv.webnoise.eu. Plovdiv: Municipality Plovdiv. Available from: http://www.plovdiv.webnoise.eu/index_en.php. [Last cited on 2013 Jul 02].
19. Plovdiv.bg. Plovdiv: Municipality Plovdiv. Available from: http://www.plovdiv.bg/item/ecology/noise/мониторинг/. [Last cited on 2013 Jul 02].
20. Source: "Plovdiv." 42.147580° N and 24.770250° E. Google Earth. [Last updated on 2011 Jun 22; Last cited on 2013 May 26]. Available from: http://goo.gl/maps/BUEuk.
21. Psychexperiment.net. Thomas F. Denson′s personal website. Available from: http://www.psychexperiment.net/denson/index. [Last cited on 2013 Jul 02].
22. Brislin RW. Back translation for cross-cultural research. J Cross Cult Psychol 1970;1:185-216.
23. Tsocheva I, Sasagawa S, Georgiou1 G, Essau C. Psychometric properties of the Bulgarian translation of the Spence children′s anxiety scale. J Psychol Abnorm Child 2013;1:101. [about 6 p.]. Available from: http://www.webcitation.org/6NOoeyf12. [Last cited on 2013 Jul 02].
24. Su CT, Parham LD. Generating a valid questionnaire translation for cross-cultural use. Am J Occup Ther 2002;56:581-5.
25. Zaidi A. Poverty risks for older people in EU countries - An update, 2010. Available from: http://www.euro.centre.org/data/1264603415_56681.pdf. [Last cited on 2013 Oct 02].
26. Dimova A, Rohova M, Moutafova E, Atanasova E, Koeva S, Panteli D, et al. Bulgaria health system review. Health Syst Transit 2012;14:1-186.
27. Marginean I, Precupetu I, Tzanov V, Preoteasa AM, Voicu B. First European Quality of Life Survey: Quality of life in Bulgaria and Romania. Luxembourg: Office for Official Publications of the European Communities; 2006. Available from: http://www.eurofound.europa.eu/pubdocs/2006/67/en/1/ef0667en.pdf. [Last cited on 2013 Oct 02].
28. Stansfeld SA. Noise, noise sensitivity and psychiatric disorder: epidemiological and psychophysiological studies. Psychol Med Monogr Suppl 1992;22:1-44.
29. Taylor SM. A path model of aircraft noise annoyance. J Sound Vib 1984;96:243-60.
30. Miedema HM, Vos H. Noise sensitivity and reactions to noise and other environmental conditions. J Acoust Soc Am 2003;113:1492-504.
31. Job RF. Noise sensitivity as a factor influencing human reaction to noise. Noise Health 1999;1:57-68.
32. Leventhall HG. Low frequency noise and annoyance. Noise Health 2004;6:59-72.
33. Berglund B, Lindvall T, editors. Community Noise. Archives of the Center for Sensory Research. Vol. 2.; 1995. p. 1-195. This document is an updated version of the document published by the World Health Organization in 1995. Available from: http://www.who.int/docstore/peh/noise/guidelines2.html. [Last cited on 2013 Jul 02].
Angel Dzhambov
MMSc student, Faculty of Medicine, Medical University of Plovdiv, No. 15-A, "Vasil Aprilov" Blvd., 4002 Plovdiv
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How to start off a vegetable patch.
A well-placed vegetable plot will be positioned so that it is in full sun for most of the year, especially from early March to late November. Some vegetables such as Brussels Sprouts continue to grow and need sun in the winter so take this into consideration as well.
Many vegetables are hungry feeders and almost all need a constant supply of water. So don't start your vegetable plot next to trees or hedges both of which will take the lion's share of water and nutrients.
During the summer months a constant supply of water can only be guaranteed by hand watering, either by a hosepipe or watering can. So make sure the plot is near a supply of water. You may also want herbs to be near the house so that they can easily be harvested when needed.
Shelter also needs to be considered. If your area suffers from strong winds it will be necessary to create a windbreak to protect your vegetable patch. A low hedge (not too high or it will take water and nutrients from the soil) can be effective. Strong shrubs such as potentillas will provide some shelter and summer colour.
Consider also using raised beds, they are ideal for beginners to gardening. Click here to go to our page on raised beds.
Another "green" method of clearing weeds is to cover the ground with old carpets for a couple of months. This will kill most weeds but not all. Click here for another GardenAction page on how to clear strong weeds such as couch grass.
As well as clearing weeds, other objects on the proposed site need to be cleared as well. This includes rubbish and large stones.
All that is required are a fork and lots of effort. Dig the soil to a spade's depth with a fork, turning the soil and breaking it up as you go. Remove any roots and weeds in the soil.
If the vegetable plot is large, a good compromise is to dig half of it in the first year, and cover the other half with old carpet. Leave the carpet on until next year and then it can be dug over when all the weeds are dead.
Message: I have a problem with my rhubarb which I only planted about 4/5 months ago, it is quite large and some of the stems are splitting and peeling back.
Is this a common problem and if so what can I do about it. I know you are not supposed to remove any stems in the first year but it is really big and I had to as it was taking over the path along side it.
I've just tried to make a veg patch but I can't so please cam you help me because I am 8 years old.
Message: Hi, I'm just starting a veg patch which is about 5m square, but I'm not sure what to do with the turf I've cut. Shall I skip it or rotavate it into the area I've taken it from along with well rotted manure from the dung heap?
Message: i am a complete beginner. i have moved into my new home which had a good size gareden. i have 2 decked areas and a large lawn area, the grass was not looked after by the previous owner and is in bad condition. i do want to take a small portion of the garden and grow some veg but just dont know where to start. i have 2 large dogs so the patch will be sectioned off so they wont have access to it. i also want to plant flowers, shrubs, a tree maybe and some climbers to grow over the fences and i just dont know where to start with that. im sorry but i am keen but clueless hope you can help.
Message: I would like to plant some winter veg but i am a beginer, i have area ready, i just need to know what is the best to plant now.
Message: I am a beginner on the veg growing scene and would like to know if it is ok to put fresh horse manure onto the patch so I can start growing next year.


I was excited to see this program being remade, since I was a fan of the old cartoon - watching it in reruns on Nickelodeon back in the early 90's, and still enjoyed it as an adult as I began to understand the other references made in the show. However, this program thrives on more "offbeat" humor than the witty banter that was a key characteristic of the old program. The tongue in cheek references to pop culture and politics are gone, as is the charm of the low-budget, hand drawn animation.
Granted, I may not be the intended audience for this program, but I wish it hadn't tried to adopt a beloved universe in order to make another dumb kids program.
DreamWorks' first series to air on a streaming service other than Netflix.
Bullwinkle (2018): An alien was in my suitcase Rock. Do you know what this means?
Rocky (2018): He's seen your underwear?


Dowden Health Media has been sold to Lebhar-Friedman, Inc.
Dowden Health Media, located in Montvale, NJ, and Northbrook, IL, is one of the few health media companies that specialize in healthcare communications to both consumers and physicians. This dual specialization gives Dowden a complete perspective on the real world of clinical care, bringing added value to its audiences and its clients. Dowden's peer-review titles include: Contemporary Surgery for general surgeons; Current Psychiatry for psychiatric specialists; The Journal of Family Practice for family physicians; Mayo Clinic Proceedings for internal medicine specialists; and OBG Management for Ob/Gyns. Dowden also publishes the recently launched interior design publication New York Spaces, which reaches more than 325,000 households bimonthly.
Lebhar-Friedman, Inc. is the leading independent publisher and provider of information serving the retail and food service communities and their vast supplier network. Owned by the family that founded it 80 years ago, Lebhar-Friedman's diverse interests include Nation's Restaurant News, Drug Store News, Chain Store Age, and event and association management activities. Lebhar-Friedman's principal office is in New York with other facilities in Tampa, FL and Louisville, KY, as well as business interests in Japan and Spain.


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Nursing Scholarships in Oregon
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Becoming an RN in Oregon
The Oregon Center for Nursing has a slogan, "Because Oregon's Health Depends On It". What is it that Oregon is counting on for a healthy future? A workforce of highly qualified professional nurses! This isn't a given. As the RN workforce ages, and as the population as a whole does, the demand for professional nurses increases. This is the premise behind the OCN, a nursing workforce site.
Interested in becoming a registered nurse in Oregon? You can earn RN licensing by completing a degree program that has been approved by the Oregon State Board of Nursing. The degree may be at either the associate's or baccalaureate level. If you take an associate's level course, you will have the opportunity to bridge to a higher degree later. Nationwide, higher levels of education are associated with better patient outcomes.
If nursing is your first degree, there are a number of ADN and BSN programs to choose from. The Oregon Board of Nursing recommends that students ask about transferable credits as well as admission requirements and accreditations. Whichever program you select, you can expect to put in a significant number of clinical hours toward the end of the program. When you have successfully completed the program, you can apply to take the licensing exam, NCLEX-RN.
RN Education & Professional Pathways
The program that you enroll in now is determined by your prior education and licensing. If you have a practical nursing license, you can take an LPN to RN bridge program. There is currently one program in the state, at Carrington University.
If on the other hand, you have a degree in a field other than nursing, you have the option of enrolling in an accelerated program. Post-baccalaureate students at Oregon Health Sciences University and the University of Portland have the option of enrolling in master's programs. These programs allow them to earn a BSN, and licensing as an RN, en route to a master's and an advanced practice RN license.
If your current licensing is as a CNA, there are no Oregon programs designed specifically to help you bridge. However, your experience can still be very valuable. Portland Community College reports that an applicant can score a few extra points by having previous experience as a CNA, emergency medical technician, or paramedic.
Registered Nursing Career Outlook in Oregon
In 2010, the American Association of Colleges of Nursing did a nationwide survey of deans of nursing schools. The subject was employment rates of BSN and direct entry master's students who had graduated in the previous two years. 47% of Oregon's students had job offers at graduation. Four to six months later, the figure rose to 85%.
These figures will change from year to year. Nursing is susceptible to short term economic issues because some workers choose to pick up more shifts or delay retirement. However, the age of the RN workforce and the age of the population as a whole, are more predictable indicators long term. In 2008, the Labor Bureau predicted there would be 22% growth over the next decade.
In 2011, the Oregon Center for Nursing is reevaluating the nursing situation in Oregon and putting together recommendations for the future.
Applying for a professional program can be a little intimidating. There are more applicants than slots, though the ratio is not as badly skewed as was once thought. The Oregon Center for Nursing reports that many students who are at first denied admission reapply, eventually getting in. Nursing schools have gotten competitive, though, and some more so than others.
Surprisingly, some community colleges can be tough to crack. Portland Community College reported that 73% of those admitted in 2010 had some healthcare experience (including volunteer work). The average prerequisite GPA is perhaps even more startling: 3.9. A majority, but not all, had completed prerequisites in science and other areas.
You will likely want to begin the process early and apply to more than one school. When it comes time to apply for jobs, you can search on the site of WorkSource Oregon, Oregon's general workforce site.
ADN Programs Approved by the Oregon State Board of Nursing
2411 NW Cardin
(541) 278-5881 Central Oregon Community College
(541) 383-7540 Chemeketa Community College
4000 Lancaster Drive NE or
(503) 399-5058 Clackamas Community College
19600 S. Molalla Ave.
Clatsop Community College
1653 Jerome
(503) 338-2436 Columbia Gorge Community College
400 East Scenic Dr.
541-506-6140 Lane Community College
4000 E. 30th Avenue
(541) 463-5618 Linn-Benton Community College
6500 SW. Pacific Blvd.
26000 SE Stark
(503) 491-6701 Oregon Coast Community College
332 SW Coast Highway
Newport, OR 97365-4928
(541) 574-7124 Portland Community College
12000 SW 49th or PO Box 19000
(503) 977-4205 Rogue Community College
3345 Redwood Highway
Southwestern Oregon Community College
1988 Newmark Ave.
(800) 962-2838 or (541) 888-7340 Treasure Valley Community College
650 College Blvd.
(541) 881-8822, Ext. 345 Umpqua Community College
1140 College Rd., or PO Box 967
BSN Programs Approved by the Oregon State Board of Nursing
Oregon Health & Science University - School of Nursing
The Oregon Health & Science University - School of Nursing BSN program is approved by the Oregon State Board of Nursing. The School of Nursing undergraduate and master programs are accredited by the Commission on Collegiate Nursing Education (CCNE) and approved by the Oregon State Board of Nursing.
Programs Offered: Bachelor of Science with a Major in Nursing, Accelerated BS with a major in Nursing, RN to BSN, Accelerated BS to MSN, Part-Time MSN, MSN - (Tracks: Family Nurse Practitioner, Nurse Anesthesia, Nursing Education (offered as a Post Master's Certificate only), Nursing Education with an emphasis in Community Health Nursing, Nursing Education with an emphasis in Gerontological Nursing, Nurse-Midwifery, Psychiatric/Mental Health Nurse Practitioner), Post-Master's Certificates - (Tracks: same as MSN w/ addition of gerontology and nursing education
Oregon Health & Science University - School of Nursing, 3455 SW US Veterans Hospital Road, Portland, OR 97239
University of Portland - School of Nursing
University of Portland - School of Nursing BSN program is approved by the Oregon State Board of Nursing. The University of Portland School of Nursing is accredited by the Commission on Collegiate Nursing Education (CCNE) and is approved by the Oregon State Board of Nursing.
Programs Offered: BSN, MS - AEM UP (Alternate Entry master's at UP – for students with a non-nursing degree - these students earn an MS clinical nurse leader specialty), MS degree in nursing - clinical nurse leader specialty, RN-MS - (for people with associate degree and have an RN - clinical nurse specialty), Doctorate of Nursing Practice (DNP) - family nurse practitioner specialty
University of Portland School of Nursing, 5000 North Willamette Blvd, Portland, OR 97203
2811 NE Holman Street
(503) 288-9371 George Fox University
414 N. Meridian Street, #6238
Newberg, OR 97132-2697
(503) 554-2951 Linfield-Good Samaritan School of Nursing
2255 NW Northrup, Room 304
(503) 413-8080 Oregon Health & Science University (OHSU) School of Nursing--Portland
3455 SW U.S. Veterans Hospital Rd. (SN-5S)
OHSU School of Nursing at Eastern Oregon University
1 University Blvd.
LaGrande, OR 97850
(541) 962-3383 OHSU School of Nursing at Oregon Institute of Technology
(800) 422-2017 or (541) 552-6226 OHSU School of Nursing at Southern Oregon University
1250 Siskiyou Blvd.
(541) 552-6226 OHSU School of Nursing at Western Oregon University
345 N. Monmouth
Monmouth, OR 97361
University of Portland School of Nursing
5000 N. Willamette Blvd.
(503) 943-7211 Walla Walla College School of Nursing
10345 SE Market St.
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