The value of education in special care dentistry as a means of reducing inequalities in oral health

People with disability are subject to inequality in oral health both in terms of prevalence of disease and unmet healthcare needs. Over 18% of the global population is living with moderate to severe functional problems related to disability, and a large proportion of these persons will require Special Care Dentistry at some point in their lifetime. It is estimated that 90% of people requiring Special Care Dentistry should be able to access treatment in a local, primary care setting. Provision of such primary care is only possible through the education and training of dentists. The literature suggests that it is vital for the dental team to develop the necessary skills and gain experience treating people with special needs in order to ensure access to the provision of oral health care. Education in Special Care Dentistry worldwide might be improved by the development of a recognised academic and clinical discipline and by providing international curricula guidelines based on the International Classification of Functioning, Disability and Health (ICF, WHO). This article aims to discuss the role and value of promoting and harmonising education in Special Care Dentistry as a means of reducing inequalities in oral health.

Bisphenol A exposure, effects, and policy: a wildlife perspective

Thousands of anthropogenic chemicals are present in the environment, and mounting evidence indicates that some have endocrine-disrupting effects in a variety of organisms. Of particular concern are chemicals that act as agonists or antagonists on vertebrate estrogen or androgen receptors. One such compound is bisphenol A (BPA), which appears to be both an estrogen receptor agonist and an androgen receptor antagonist. Used in the manufacture of plastic resins, BPA is found at low levels in surface-water, sediments, soils, and biota. Although it degrades quickly, it is pseudo-persistent in the environment because of continual inputs. Due to its environmental ubiquity, organisms may be exposed to BPA chronically or during sensitive life stages. While the impacts of BPA-related endocrine disruption in humans have been extensively studied, the endocrinal and systemic effects in wildlife are less well known. This article reviews the current state of knowledge of BPA inputs to the environment, routes of exposure, and effects on wildlife. We then critically examine the regulatory structure governing the environmental endpoints of BPA in the United States, European Union, and Canada, and discuss major challenges to the effective regulation of BPA. We conclude with a survey of treatment and mitigation options.

ROCView: prototype software for data collection in jackknife alternative free-response receiver operating characteristic analysis

ROCView has been developed as an image display and response capture (IDRC) solution to image display and consistent recording of reader responses in relation to the free-response receiver operating characteristic paradigm. A web-based solution to IDRC for observer response studies allows observations to be completed from any location, assuming that display performance and viewing conditions are consistent with the study being completed. The simplistic functionality of the software allows observations to be completed without supervision. ROCView can display images from multiple modalities, in a randomised order if required. Following registration, observers are prompted to begin their image evaluation. All data are recorded via mouse clicks, one to localise (mark) and one to score confidence (rate) using either an ordinal or continuous rating scale. Up to nine "mark-rating" pairs can be made per image. Unmarked images are given a default score of zero. Upon completion of the study, both true-positive and false-positive reports can be downloaded and adapted for analysis. ROCView has the potential to be a useful tool in the assessment of modality performance difference for a range of imaging methods.

Business Process Modelling is an Essential Part of a Requirements Analysis. Contribution of EFMI Primary Care Working Group

OBJECTIVES

To perform a requirements analysis of the barriers to conducting research linking of primary care, genetic and cancer data.

METHODS

We extended our initial data-centric approach to include socio-cultural and business requirements. We created reference models of core data requirements common to most studies using unified modelling language (UML), dataflow diagrams (DFD) and business process modelling notation (BPMN). We conducted a stakeholder analysis and constructed DFD and UML diagrams for use cases based on simulated research studies. We used research output as a sensitivity analysis.

RESULTS

Differences between the reference model and use cases identified study specific data requirements. The stakeholder analysis identified: tensions, changes in specification, some indifference from data providers and enthusiastic informaticians urging inclusion of socio-cultural context. We identified requirements to collect information at three levels: micro- data items, which need to be semantically interoperable, meso- the medical record and data extraction, and macro- the health system and socio-cultural issues. BPMN clarified complex business requirements among data providers and vendors; and additional geographical requirements for patients to be represented in both linked datasets. High quality research output was the norm for most repositories.

CONCLUSIONS

Reference models provide high-level schemata of the core data requirements. However, business requirements' modelling identifies stakeholder issues and identifies what needs to be addressed to enable participation.

Pharmacological agents for soft tissue and bone infected with MRSA: which agent and for how long?

Methicillin-resistant Staphylococcus aureus (MRSA) infections cause an important number of soft tissue and bone infections, although exact rates vary across different countries and institutions. The length of antibiotic treatment required depends upon the severity of infection and pre-existing co-morbidities. Monitoring response to treatment is important to ensure cure of infection whilst preventing excessive antibiotic use. Debridement and drainage, in addition to prosthesis removal, may be necessary. Numerous antibiotics are effective at treating soft tissue and bone infected with MRSA. Oral antibiotics, such as clindamycin, doxycycline and linezolid, generally offer good bioavailability and tissue penetration. They are separated largely by side effect profile and drug interactions, which should be considered carefully prior to use. There are also several agents only available in the intravenous (IV) form, for example glycopeptides, daptomycin and tigecycline. These are normally reserved for the treatment of severe infections. Whilst tissue penetration is variable within this group, it is the adverse events linked with each antibiotic that are most effective in determining the preferred agent.

Hydrogenated Amorphous Silicon Thin Films with Nanocrystalline Silicon Inclusions

Thin films of hydrogenated amorphous silicon containing nanocrystalline silicon inclusions (a/nc-Si:H) have been synthesized in an RF capacitively coupled PECVD system using a mixture of hydrogen diluted silane and helium, under deposition conditions at the edge of powder formation within the plasma. High resolution TEM confirms the presence of nanocrystallites as small as 2 nm in these films. Measurements of the optical absorption spectrum using CPM and PDS indicates a broadening of the Urbach slope in the a/nc-Si:H, compared to a-Si:H films, but no appreciable increase in midgap absorption. Despite the deposition conditions for the a/nc-Si:H being very different from those associated with producing optimal quality a-Si:H, the dark conductivity and photoconductivity values, and the sensitivity to light-induced defect creation in the a/nc-Si:H films are comparable to those in a-Si:H.

A measure of palliative care in nursing homes

CONTEXT

Efforts to improve care for nursing home residents stand to be enhanced by measures to assess the degree to which staff provide palliative care. As the incidence of death in nursing homes increases with the aging population, the gap in measurement must be addressed. To that end, we report the development and psychometric testing of a nursing home palliative care survey.

OBJECTIVES

The purpose of this study was to evaluate the psychometric properties of the Palliative Care Survey (PCS) for use in nursing homes.

METHODS

Psychometric evaluation of the instrument was completed in two phases. Phase 1 focused on individual item analyses and subsequent revision or deletion of items, and Phase 2 evaluated evidence for reliability and validity. Phase 1 included 26 nursing homes and staff (n=717), and Phase 2 included 85 nursing homes and staff (n=2779). Data were analyzed using item-total correlations, Cronbach's alpha, confirmatory factor analysis, and analysis of variance.

RESULTS

Support was obtained for a 51-item PCS made up of two constructs, Palliative Care Practice and Palliative Care Knowledge.

CONCLUSION

The PCS measures the extent to which the nursing home staff engage in palliative care practices and have knowledge consistent with good end-of-life care. Both practice and knowledge are an essential foundation to providing good end-of-life care to nursing home residents. Efforts to improve care for the dying in nursing homes have been slowed by an absence of measurement tools that capture care processes, a gap that the PCS reported here helps fill.

Warm fish with cold hearts: thermal plasticity of excitation-contraction coupling in bluefin tuna

Bluefin tuna have a unique physiology. Elevated metabolic rates coupled with heat exchangers enable bluefin tunas to conserve heat in their locomotory muscle, viscera, eyes and brain, yet their hearts operate at ambient water temperature. This arrangement of a warm fish with a cold heart is unique among vertebrates and can result in a reduction in cardiac function in the cold despite the elevated metabolic demands of endothermic tissues. In this study, we used laser scanning confocal microscopy and electron microscopy to investigate how acute and chronic temperature change affects tuna cardiac function. We examined the temporal and spatial properties of the intracellular Ca2+ transient (Δ[Ca2+]i) in Pacific bluefin tuna (Thunnus orientalis) ventricular myocytes at the acclimation temperatures of 14°C and 24°C and at a common test temperature of 19°C. Acute (less than 5 min) warming and cooling accelerated and slowed the kinetics of Δ[Ca2+]i, indicating that temperature change limits cardiac myocyte performance. Importantly, we show that thermal acclimation offered partial compensation for these direct effects of temperature. Prolonged cold exposure (more than four weeks) increased the amplitude and kinetics of Δ[Ca2+]i by increasing intracellular Ca2+ cycling through the sarcoplasmic reticulum (SR). These functional findings are supported by electron microscopy, which revealed a greater volume fraction of ventricular SR in cold-acclimated tuna myocytes. The results indicate that SR function is crucial to the performance of the bluefin tuna heart in the cold. We suggest that SR Ca2+ cycling is the malleable unit of cellular Ca2+ flux, offering a mechanism for thermal plasticity in fish hearts. These findings have implications beyond endothermic fish and may help to delineate the key steps required to protect vertebrate cardiac function in the cold.

Immunoliposomal delivery of 213Bi for alpha-emitter targeting of metastatic breast cancer

Current treatment for late-stage metastatic breast cancer is largely palliative. alpha-Particles are highly potent, short-range radiation emissions capable of sterilizing individual cells with one to three traversals of the cell nucleus. The alpha-emitter, (213)Bi (T(1/2) = 45.6 min), was conjugated to a 100-nm diameter liposomal-CHX-A''-DTPA construct, upon which the rat HER2/neu reactive antibody, 7.16.4, was grafted. A conjugation time of 10 minutes was achieved giving a specific activity corresponding to 0.1 (213)Bi atom per liposome; stability in vitro and in vivo was confirmed. Efficacy in a rat/neu transgenic mouse model of metastatic mammary carcinoma was investigated. Three days after left cardiac ventricular injection of 10(5) rat HER-2/neu-expressing syngeneic tumor cells, macrophage-depleted Neu-N mice were treated by i.v. injection with (a) 19.2 MBq (520 muCi) of liposome-CHX-A''-DTPA-(213)Bi, (b) 19.2 MBq of liposome-CHX-A''-DTPA-(213)Bi-7.16.4, (c) 4.44 MBq (120 muCi) of (213)Bi-7.16.4, and (d) cold (nonradioactive) liposome-CHX-A''-DTPA-7.16.4 as control. Treatment with (a) increased median survival time to 34 days compared with 29 days for the untreated controls (P = 0.013) and 27 days for treated cold controls. Treatment with the radiolabeled antibody-conjugated liposome (b) increased median survival time to 38 days (P = 0.0002 relative to untreated controls). The radiolabeled antibody-treated group (c) gave a median survival of 39 days, which was similar to that for the radiolabeled antibody-conjugated liposome-treated group (P = 0.5). We have shown that the (213)Bi radiolabeled immunoliposomes are effective in treating early-stage micrometastases, giving median survival times similar to those obtained with antibody-mediated delivery of (213)Bi in this animal model.

Stimulus equivalence and rule following

The present study examined the occurrence of a novel behavior pattern with respect to a novel configuration of stimuli enabled by the participation of those stimuli in equivalence classes. In Experiment 1, functional substitutabilities were established via equivalence between two independent sets of musical stimuli. Aspects of stimuli from the two sets were then compounded to produce novel stimulus configurations. Behavioral components enabled by each separate class combined to produce novel musical performances and accurate descriptions of them. In Experiment 2, the impact of experimenter-provided names for equivalence classes on the musical performances was investigated in naive subjects by establishing similar classes without experimenter-provided names. The results indicated few differences in the playing performances under these conditions. These experiments demonstrated a possible method for the analysis of rule following.

Rhesus glycoprotein and urea transporter genes in rainbow trout embryos are upregulated in response to alkaline water (pH 9.7) but not elevated water ammonia

Recent studies have shown that genes for the putative ammonia transporter, Rhesus glycoproteins (Rh) and the facilitated urea transporter (UT) are expressed before hatching in rainbow trout (Oncorhychus mykiss Walbaum) embryos. We tested the hypothesis that Rh and UT gene expressions are regulated in response to environmental conditions that inhibit ammonia excretion during early life stages. Eyed-up embryos (22 days post-fertilization (dpf)) were exposed to control (pH 8.3), high ammonia (1.70 mmol l(-1) NH4HCO3) and high pH (pH 9.7) conditions for 48h. With exposure to high water ammonia, ammonia excretion rates were reversed, tissue ammonia concentration was elevated by 9-fold, but there were no significant changes in mRNA expression relative to control embryos. In contrast, exposure to high water pH had a smaller impact on ammonia excretion rates and tissue ammonia concentrations, whereas mRNA levels for the Rhesus glycoprotein Rhcg2 and urea transporter (UT) were elevated by 3.5- and 5.6-fold, respectively. As well, mRNAs of the genes for H+ATPase and Na+/H+ exchanger (NHE2), associated with NH3 excretion, were also upregulated by 7.2- and 13-fold, respectively, in embryos exposed to alkaline water relative to controls. These results indicate that the Rhcg2, UT and associated transport genes are regulated in rainbow trout embryos, but in contrast to adults, there is no effect of high external ammonia at this stage of development.

How a Bayesian Might Estimate the Distribution of Cronbach’s Alpha From Ordinal-Dynamic Scaled Data

We demonstrate the utility of a Bayesian-based approach for calculating intervals of Cronbach’s alpha from a psychological instrument having ordinal responses with a dynamic scale. A small number of response options on an instrument will cause traditional-based interval estimates to be biased. Ordinal-based solutions are problematic because there is no clear mechanism for handling the dynamic scale. One way to remedy the bias is to adjust with a Bayesian approach. The Bayesian approach adjusts the bias and allows theoretically simple calculations of Cronbach’s alpha and intervals. We demonstrate the calculations of the Bayesian approach while at the same time offer a comparison to more traditional-based methods using both credible (or confidence) intervals and mean squared error. Practical advice is offered.

114. HYPERTENSIVE DISORDERS OF PREGNANCY ARE ASSOCIATED WITH IMMUNOREGULATORY GENE POLYMORPHISMS

Pregnancy is a controlled state of inflammation. Deregulation of cytokine networks can lead to adverse pregnancy outcomes including preeclampsia (PE). We aimed to identify single nucleotide polymorphisms in immunoregulatory genes that signify an increased risk of the gestational hypertensive disorders PE and gestational hypertension (GH). 1169 nulliparous pregnant women and their partners were recruited prospectively for the Adelaide SCOPE study. PE and GH were classified using strict guidelines. Uncomplicated pregnancies served as controls. Peripheral blood from couples and cord blood from neonates were collected. DNA was extracted and genotyped for Interleukin (IL)-6 rs1800795, IL-4 rs2243250, IL-10 rs1800896 and rs1800871, mannose binding lectin (MBL) rs1800450, transforming growth factor beta 1 (TGFβ-1) rs1800469 and cyclooxygenase (COX)-2 rs20417 & rs5275 and inducible nitric oxide synthase (NOS2A) rs1137933 using the Sequenom MassARRAY system. Genotypes for Caucasian PE (n = 75) and GH (n = 102) were compared with controls (n = 422) and analysed using Chi-Square. In neonates IL-6 G allele carriage was associated with PE (P = 0.011, OR=2.0, 95% CI = 1.2–3.7) and the CC genotype associated with GH (P = 0.002). Neonatal IL-10 RS180071 AA genotype associated with PE (P = 0.041) and IL-10 RS1800896 AA associated with GH (P = 0.022). Paternal NOS2A C allele was more frequent in PE (P = 0.03, OR = 2.1, 95% CI = 1.1–4.5), and maternal NOS2A CC more frequent in GH (P = 0.018). Increased neonatal carriage of MBL rs1800450 AA+GA genotypes associated with GH (P = 0.03, OR = 2.2, 95% CI = 1.1–4.5). No associations were observed between TGFβ-1 or COX2 genotypes and PE or GH. Associations between neonatal IL-6 G, which confers high placental IL-6 expression, and PE suggest a possible mechanism by which PE is a pro-inflammatory exacerbation of placental origin. Since placental IL-10 is important for maternal tolerance of the fetus, genotypes predisposing to low IL-10 expression in the neonate which associate with both PE and GH, suggest a role for decreased placental IL-10 in these disorders.

Effect of ageing on the immune response of dogs to vaccines

Ageing is associated with a decline in functional competence of the immune system, sometimes referred to as immunosenescence. As this increases the susceptibility of dogs to infectious diseases, it is important to determine if the efficacy of vaccines is affected by ageing. Studies to date suggest that the primary response to vaccines may be compromised in old dogs, but recall responses remain intact. Information on the effect of ageing on the duration of protective immunity following vaccination is needed.

From professional silos to interprofessional education: campuswide focus on quality of care

OBJECTIVES

The Institute of Medicine called for the integration of interprofessional education (IPE) into health professions curricula, in order to improve health care quality. In response, we developed, implemented, and evaluated a campus wide IPE program, shifting from traditional educational silos to greater collaboration.

METHODS

Students (155) and faculty (30) from 6 academic programs (nursing, medicine, public health, allied health, dentistry, and pharmacy) engaged with a university hospital partner to deliver this program. The content addressed principles of IPE, teamwork development and 2 common quality care problems: hospital-acquired infections and communication errors. Pre-/post-surveys, the Readiness for Interprofessional Learning Scale, and the Interprofessional Education Perception Scale, were used for descriptive assessment of student learning.

RESULTS

Students demonstrated increased understanding of health care quality and interprofessional teamwork principles and reported positive attitudes toward shared learning. While responses to the Readiness for Interprofessional Learning Scale grew more positive after the program, scores on the Interprofessional Education Perception Scale were more homogeneous. Both students and faculty highly evaluated the experience.

CONCLUSION

This program was a first step in preparing individuals for collaborative learning, fostering awareness and enthusiasm for IPE among students and faculty, and demonstrating the feasibility of overcoming common barriers to IPE such as schedule coordination and faculty buy-in.

Laboratory evaluation of products to reduce settling of sweetpotato whitefly adults

The impact of trademarked and commercial products on settling of adults of the sweetpotato whitefly, Bemisia tabaci (Gennadius), was studied in the laboratory. A no-choice bioassay using leaf disks of tomato, Solanum esculentum L., was developed to evaluate the impact of concentration series of products on settling of B. tabaci adults. The concentration of each product that would reduce settling by 50% (SC50) was estimated for each product using standard probit analyses, and the values were compared with that of Ultra-Fine Oil, a paraffinic oil product that is known to reduce settling of whitefly adults. Twenty-two trademarked products and 42 other products were evaluated in the laboratory bioassay. Based upon comparisons of fiducial limits of the respective SC50 values, Dawn detergent and E-RASE jojoba oil were the only trademarked products that were as effective as Ultra-Fine Oil in reducing settling of B. tabaci adults. Of the nontrademarked products, 25 were similar to Ultra-Fine Oil, although cedar, geranium, ginger, Hamlin (citrus), patchouli, olive and wintergreen oils, as well as citronellal and limonene, had ratios of respective SC50 values with that of Ultra-Fine Oil of approximately 1.5 or less. Combinations of limonene and citronellal with either olive oil or Ultra-Fine Oil were 15 and 30 times, respectively, more effective than Ultra-Fine Oil alone. Candidate products and combinations of products were further evaluated on tomato seedlings in no-choice screenhouse trials for effects on oviposition and on transmission of Tomato yellow leaf curl virus (family Geminiviridae, genus Begomovirus, TYLCV) by B. tabaci. Ultra-Fine Oil and olive oil reduced oviposition and transmission of TYLCV in the screenhouse trials. Ginger oil and limonene reduced oviposition in at least one screenhouse trial but did reduce transmission of TYLCV. The laboratory bioassay provided a rapid and relatively easy method to compare products for reducing settling of B. tabaci adults. Even though the reduced settling indicated in the laboratory bioassays was not always reflected in reduced oviposition or TYLCV transmission in the screenhouse trials, the bioassay was useful in rapidly identifying products that reduce settling and that could be investigated further.

Complete remissions with weekly dosing of SGN-35, a novel antibody-drug conjugate (ADC) targeting CD30, in a phase I dose-escalation study in patients with relapsed or refractory Hodgkin lymphoma (HL) or systemic anaplastic large cell lymphoma (sALCL)

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Background: A defining feature of HL and sALCL is CD30 expression on malignant cells. The ADC SGN-35 comprises an anti-CD30 antibody conjugated to the antitubulin agent monomethyl auristatin E (MMAE). SGN-35 causes cell cycle arrest and apoptosis by binding to CD30 on the tumor cell surface, internalizing, and releasing MMAE into the cell. In a previous phase 1 study with q3 wk dosing, 54% of pts achieved an objective response (CR/PR) at SGN-35 doses ≥1.2 mg/kg [ASH 2008 abstract 1006]. Methods: To assess if more frequent dosing might maximize anti-tumor activity with acceptable tolerability, a multicenter, phase 1, weekly dosing, dose-escalation study (3+3 design) was conducted in pts with refractory or recurrent HL or sALCL. SGN-35 was administered weekly at doses of 0.4–1 mg/kg (2-hr IV infusions). Pts with stable disease or better (Cheson 2007) after two 28-day cycles (6 doses) were eligible to continue SGN-35 treatment. Results: In 17 pts, median age was 38 yrs (range 25–67). Pts received a median of 4 prior therapies; 65% received an autologous SCT. MTD has not been defined. One related G3 event (diarrhea) and no related G4 events occurred. The most common related adverse events were G1/G2 rash, nausea, and peripheral neuropathy. Exposure to SGN-35 (AUC) increased relative to dose level. Multiple CRs were observed at higher doses ( table ); observed time to response in the 1 mg/kg dose group was approximately 8 wks. The 7 pts with CRs all remain on treatment. Enrollment to SGN-35 monotherapy continues at 1.2 mg/kg; combination therapy will be subsequently explored. Conclusions: SGN-35 was generally well tolerated and induced CRs in 7 of 8 evaluable pts at the two highest doses in heavily pretreated patients. Pivotal trials of this antibody-drug conjugate will initiate in early 2009.

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Pilot- and bench-scale testing of faecal indicator bacteria survival in marine beach sand near point sources

AIM

Factors affecting faecal indicator bacteria (FIB) and pathogen survival/persistence in sand remain largely unstudied. This work elucidates how biological and physical factors affect die-off in beach sand following sewage spills.

METHODS AND RESULTS

Solar disinfection with mechanical mixing was pilot-tested as a disinfection procedure after a large sewage spill in Los Angeles. Effects of solar exposure, mechanical mixing, predation and/or competition, season, and moisture were tested at bench scale. First-order decay constants for Escherichia coli ranged between -0.23 and -1.02 per day, and for enterococci between -0.5 and -1.0 per day. Desiccation was a dominant factor for E. coli but not enterococci inactivation. Effects of season were investigated through a comparison of experimental results from winter, spring, and fall.

CONCLUSIONS

Moisture was the dominant factor controlling E. coli inactivation kinetics. Initial microbial community and sand temperature were also important factors. Mechanical mixing, common in beach grooming, did not consistently reduce bacterial levels.

SIGNIFICANCE AND IMPACT OF THE STUDY

Inactivation rates are mainly dependent on moisture and high sand temperature. Chlorination was an effective disinfection treatment in sand microcosms inoculated with raw influent.