High plaque levels at gingival margins after oral hygiene were observed in an unselected sample of young German adults. After 12 weeks, plaque levels after oral hygiene were slightly reduced in the group who had received training of the Fones technique but effects trailed off afterwards. The study failed to prove effects of the training on signs of gingival inflammation.

The tetradymite compound BiSbTeSe2 is one of the most bulk-insulating three-dimensional topological insulators, which makes it important in the topological insulator research. It is a member of the solid-solution system Bi2−xSbxTe3−ySey, for which the local crystal structure, such as the occupation probabilities of each atomic site, is not well understood. We have investigated the temperature and polarization dependent spontaneous Raman scattering in BiSbTeSe2, revealing a much higher number of lattice vibrational modes than predicted by group theoretical considerations for the space group R3m corresponding to an ideally random solid-solution situation. The density functional calculations of phonon frequencies show a very good agreement with experimental data for parent material Bi2Te3, where no disorder effects were found. In comparison to Bi2Te3 the stacking disorder in BiSbTeSe2 causes a discrepancy between theory and experiment. Combined analysis of experimental Raman spectra and DFT calculated phonon spectra for different types of atomic orders showed coexistence of different sequences of layers in the material and that those with Se in the center and a local order of Se-Bi-Se-Sb-Te, are the most favored.

Background Uncompleted emergency department care and against-medical-advice discharge represent relevant medical problems with impact on patient safety and potential medicolegal and socioeconomic consequences. They may also indicate structural or procedural problems in the emergency department (ED) relating to patient management and flow. While patients with neurological complaints frequently leave the ED against medical advice or without being seen, no dedicated analysis of this group of patients aiming at the identification of characteristics associated with irregular ED discharge has been performed so far. Methods A chart review was performed of all patients with neurological complaints presenting to a German interdisciplinary emergency department between January and December 2017 for neurological evaluation. Demographics, mode of presentation, process times, presenting symptoms and diagnosis were recorded. Patients leaving against medical advice after an informed consent discussion and signing of documentation (DAMA) or leaving prematurely without notifying ED staff (PL) were compared to the total of patients who were admitted or discharged (non-DAMA/PL). Results Of all patients presenting with neurological symptoms or complaints, 3% left against medical advice and 2.2% left prematurely. DAMA/PL patients were younger (p < .001), and they were more frequently self-presenting (p < 0.001). Headaches, seizures and sensory deficits were the most frequent presenting symptoms in DAMA/PL patients, and 56.1% of those presenting with a seizure had a history of epilepsy. The most common documented reason for leaving was the duration of door-to-doctor time. Conclusions Younger age, self-presenting mode of presentation and presentation with headache, seizures or sensory deficits are associated with premature leave or against-medical-advice discharge of patients with neurological complaints from the ED, and long waiting times were given as the major reason for leaving the ED. Increasing ED staff’s awareness of these factors and the optimization of pre-hospital assessment and demand management, thereby positively impacting on patient flow and ED process times, may help to prevent irregular discharges from the ED.