Despite popular intuition, positive world beliefs poorly reflect several objective indicators of privilege, including wealth, health, sex, and neighborhood safety

OBJECTIVES

We tested whether generalized beliefs that the world is safe, abundant, pleasurable, and progressing (termed "primal world beliefs") are associated with several objective measures of privilege.

METHODS

Three studies (N = 16,547) tested multiple relationships between indicators of privilege-including socioeconomic status, health, sex, and neighborhood safety-and relevant world beliefs, as well as researchers and laypeople's expectations of these relationships. Samples were mostly from the USA and included general population samples (Study 2) as well as focused samples of academic researchers (Study 1) and people who had experienced serious illness or trauma (Study 3).

RESULTS

Studies 1-2 found mostly negligible relationships between world beliefs and indicators of privilege, which were invariably lower than researcher predictions (e.g., instead of the expected r = 0.33, neighborhood affluence correlated with Abundant world belief at r = 0.01). Study 3 found that people who had experienced serious illness (cancer, cystic fibrosis) only showed modest differences in beliefs from controls.

CONCLUSIONS

While results do not preclude that some individuals' beliefs were meaningfully affected by life events, they imply that such changes are smaller or less uniform than widely believed and that knowing a person's demographic background may tell us relatively little about their beliefs (and vice versa).

Mitigation of SARS-CoV-2 transmission at a large public university

In Fall 2020, universities saw extensive transmission of SARS-CoV-2 among their populations, threatening health of the university and surrounding communities, and viability of in-person instruction. Here we report a case study at the University of Illinois at Urbana-Champaign, where a multimodal “SHIELD: Target, Test, and Tell” program, with other non-pharmaceutical interventions, was employed to keep classrooms and laboratories open. The program included epidemiological modeling and surveillance, fast/frequent testing using a novel low-cost and scalable saliva-based RT-qPCR assay for SARS-CoV-2 that bypasses RNA extraction, called covidSHIELD, and digital tools for communication and compliance. In Fall 2020, we performed >1,000,000 covidSHIELD tests, positivity rates remained low, we had zero COVID-19-related hospitalizations or deaths amongst our university community, and mortality in the surrounding Champaign County was reduced more than 4-fold relative to expected. This case study shows that fast/frequent testing and other interventions mitigated transmission of SARS-CoV-2 at a large public university.

Mitigation of SARS-CoV-2 transmission at a large public university

In Fall 2020, universities saw extensive transmission of SARS-CoV-2 among their populations, threatening health of the university and surrounding communities, and viability of in-person instruction. Here we report a case study at the University of Illinois at Urbana-Champaign, where a multimodal “SHIELD: Target, Test, and Tell” program, with other non-pharmaceutical interventions, was employed to keep classrooms and laboratories open. The program included epidemiological modeling and surveillance, fast/frequent testing using a novel low-cost and scalable saliva-based RT-qPCR assay for SARS-CoV-2 that bypasses RNA extraction, called covidSHIELD, and digital tools for communication and compliance. In Fall 2020, we performed >1,000,000 covidSHIELD tests, positivity rates remained low, we had zero COVID-19-related hospitalizations or deaths amongst our university community, and mortality in the surrounding Champaign County was reduced more than 4-fold relative to expected. This case study shows that fast/frequent testing and other interventions mitigated transmission of SARS-CoV-2 at a large public university.

Safely opening university campuses has been a major challenge during the COVID-19 pandemic. Here, the authors describe a program of public health measures employed at a university in the United States which, combined with other non-pharmaceutical interventions, allowed the university to stay open in fall 2020 with limited evidence of transmission.

Efficacy of endotracheal tube suctioning in intubated intensive care unit patients determined by in vivo catheter-based optical coherence tomography-a pilot study

Background

Mechanical ventilation using an endotracheal tube (ETT) is one of the critical interventions given to patients in the intensive care unit (ICU). ETTs are associated with the formation of biofilms, placing patients at increased risk for developing ventilator-associated pneumonia (VAP). ETT suctioning is used to remove secretions, reduce bacterial colonization, and reduce the rate of biofilm formation. However, current standard-of-care suctioning procedures do not adequately eliminate all secretions from the ETT.

Methods

This observational study was conducted in a cohort of 4 subjects admitted to the ICU and intubated with an ETT, irrespective of ethnicity, gender, or race. A total of 23 suctioning procedures were evaluated with in vivo three-dimensional (3D) optical coherence tomography (OCT) imaging, before and after suctioning. A secretion density metric was derived from the OCT data to quantify the amount of secretions present within the ETT, and an attenuation coefficient metric was derived to detect and quantify the presence of biofilms. Analyzed OCT images were correlated with clinical and microscopy data.

Results

Data obtained suggests that the current standard-of-care suctioning procedure is inefficient at clearing secretions or preventing the formation of biofilms. The presence of biofilms was corroborated with both post-intubation microscopy of the ETTs, as well as with clinical data.

Conclusions

We conclude that the standard-of-care suctioning method does not eliminate secretions nor reduce the formation of biofilm in ETTs. Our in situ imaging method was sensitive to the presence of secretions, biofilms, and quantitative, and can be used for investigating different suctioning protocols in the future.

Low-Complexity System and Algorithm for an Emergency Ventilator Sensor and Alarm

In response to anticipated shortages of ventilators caused by the COVID-19 pandemic, many organizations have designed low-cost emergency ventilators. Many of these devices are pressure-cycled pneumatic ventilators, which are easy to produce but often do not include the sensing or alarm features found on commercial ventilators. This work reports a low-cost, easy-to-produce electronic sensor and alarm system for pressure-cycled ventilators that estimates clinically useful metrics such as pressure and respiratory rate and sounds an alarm when the ventilator malfunctions. A low-complexity signal processing algorithm uses a pair of nonlinear recursive envelope trackers to monitor the signal from an electronic pressure sensor connected to the patient airway. The algorithm, inspired by those used in hearing aids, requires little memory and performs only a few calculations on each sample so that it can run on nearly any microcontroller.

In vivo detection of endotracheal tube biofilms in intubated critical care patients using catheter-based optical coherence tomography

The formation of biofilms in the endotracheal tubes (ETTs) of intubated patients on mechanical ventilation is associated with a greater risk of ventilator-associated pneumonia and death. New technologies are needed to detect and monitor ETTs in vivo for the presence of these biofilms. Longitudinal OCT imaging was performed in mechanically ventilated subjects at 24-hour intervals until extubation to detect the formation and temporal changes of in vivo ETT biofilms. OCT-derived attenuation coefficient images were used to differentiate between mucus and biofilm. Extubated ETTs were examined with optical and electron microscopy, and all imaging results were correlated with standard-of-care clinical test reports. OCT and attenuation coefficient images from four subjects were positive for ETT biofilms and were negative for two subjects. The processed and stained extubated ETTs and clinical reports confirmed the presence/absence of biofilms in all subjects. Our findings confirm that OCT can detect and differentiate between biofilm-positive and biofilm-negative groups (P < 10-5 ). OCT image-based features may serve as biomarkers for direct in vivo detection of ETT biofilms and help drive investigation of new management strategies to reduce the incidence of VAP.

Evaluation of key sources of variability in the measurement of pharmaceutical drug products by near infrared reflectance spectroscopy

Potential sources of variability in the measurement of solid oral drug products by near infrared reflectance spectroscopy were evaluated with statistical experimental design. Spectra were collected for two different tablet types according to the data collection and treatment parameters defined by the experimental design. Each tablet had three different dose-levels. Libraries were constructed using second-derivative spectra. Key figures-of-merit generated during internal and external library validation were used to calculate which parameters most strongly influence the library performance for dose-level discrimination. These responses and their corresponding experimental conditions were evaluated with the screening model in the JMP program. Segment value used for the second-derivative calculation was an an influential factor and had a complex effect. Orientation on the sampling platform also had an influential effect for embossed tablets. Collection of spectra over fewer days decreased variability within the library. More frequent reference spectrum collection improved the performance of libraries to a small degree. A larger sample population increased the range of spectral variability within a dose-level but apparently not the overall performance of the library. The number of scans averaged per spectrum was not an influential factor in this study. These results are summarized and used to recommend an approach to dose-level discrimination.

Hemodynamics and wall shear rate in the abdominal aorta of dogs. Effects of vasoactive agents

Vasoactive drugs are known to affect impedance (pressure/flow) and vessel wall motion in arteries. The nonlinear theory of oscillatory flow in straight elastic vessels indicates that wall shear rate is affected by changes in impedance phase angle and wall motion. To test whether wall shear rate depends on impedance phase angle and wall motion in vivo, wall shear rate was measured in the abdominal aorta of anesthetized dogs by using a flush-mounted hot-film anemometer, and the hemodynamic state was characterized by pressure, flow, and vessel dimension measurements. Vasodilators (nitroprusside and isoproterenol) and vasoconstrictors (angiotensin II and norepinephrine) were administered acutely, and the responses of wall shear rate and hemodynamics were determined. In the control state (no drugs), peak wall shear rate was 1835 +/- 153 s-1 (mean +/- SEM). The vasodilators induced large increases in impedance phase angle and wall motion concomitant with large increases in peak wall shear rate (62.4 +/- 20.4% for nitroprusside and 68.9 +/- 28.3% for isoproterenol), which were not predicted accurately by Womersley's theory of oscillatory flow in a rigid vessel or the nonlinear theory of oscillatory flow in an elastic vessel, with measured flow and vessel dimension used as inputs. The vasoconstrictors induced small decreases in impedance phase angle and wall motion and small changes in peak wall shear rate (increase, 30.5 +/- 8.0% for norepinephrine; decrease, 18.2 +/- 7.1% for angiotensin II), which were predicted accurately by Womersley's theory. The present study shows that vasoactive drugs, particularly vasodilators, can have significant effects on wall shear rate (stress) in the abdominal aorta that appear to be related to changes in impedance phase angle and vessel wall motion. However, the effects on wall shear rate are not predicted accurately by straight-tube theory.

Febrile infants at low risk for serious bacterial infection--an appraisal of the Rochester criteria and implications for management. Febrile Infant Collaborative Study Group

OBJECTIVE

Prospective studies were conducted to test the hypothesis that infants unlikely to have serious bacterial infections (SBI) can be accurately identified by low risk criteria.

METHODS

Febrile infants (rectal T > or = 38 degrees C) < or = 60 days of age were considered at low risk for SBI if they met the following criteria: 1) appear well; 2) were previously healthy; 3) have no focal infection; 4) have WBC count 5.0-15.0 x 10(9) cells/L (5000-15,000/mm3), band form count < or = 1.5 x 10(9) cells/L (< or = 1500/mm3), < or = 10 WBC per high power field on microscopic examination of spun urine sediment, and < or = 5 WBC per high power field on microscopic examination of a stool smear (if diarrhea). The recommended evaluation included the culture of specimens of blood, cerebrospinal fluid, and urine for bacteria. Outcomes were determined. The negative predictive values of the low risk criteria for SBI and bacteremia were calculated.

RESULTS

Of 1057 eligible infants, 931 were well appearing, and, of these, 437 met the remaining low risk criteria. Five low risk infants had SBI including two infants with bacteremia. The negative predictive value of the low risk criteria was 98.9% (95% confidence interval, 97.2% to 99.6%) for SBI, and 99.5% (95% confidence interval, 98.2% to 99.9%) for bacteremia.

CONCLUSIONS

These data confirm the ability of the low risk criteria to identify infants unlikely to have SBI. Infants who meet the low risk criteria can be carefully observed without administering antimicrobial agents.

Pulpal response after complete crown preparation, dentinal sealing, and provisional restoration

This study evaluated the acute pulpal healing response following preparation, etching, and sealing of the prepared vital dentin with a 4-methacryloxyethyl trimellitate anhydride (4-META) bonding system. Adult monkey teeth received crown preparations with chamfer margins, prepared with a diamond used at ultra high speed with water cooling. Vital dentin was etched with 10% citric acid-3% ferric chloride, rinsed, and sealed with 4-META system. A provisional crown was formed with a low-viscosity light-curing adhesive resin. Teeth were fixed and evaluated histopathologically. Pulpal responses at 3 days showed only minimal disruption of the odontoblastic zone. At 7 days, the pulps presented reorganizing odontoblastoid cells, and, at 10 days, the pulps showed new odontoblastoid cells with a thin rim of reparative dentin. Pulps of crown preparations that were etched and then sealed with the 4-META system presented healing patterns similar to those of pulps associated with Class V preparations lined with calcium hydroxide, observed in (previous) similar studies.

Pulpal response to adhesive resin systems applied to acid-etched vital dentin: damp versus dry primer application

A number of studies have reported that acid etching of dentin is toxic to the cells of the odontoblastic layer and dental pulp. Other studies report that pulpal inflammation is a consequence of bacterial microleakage. The purpose of this study was to observe the degree of pulpal healing after pretreatment of vital dentin prior to placement of All-Bond and Scotch-bond 2 composite resin adhesives. Zinc oxide-eugenol cement and an acidic cement were employed as controls. One hundred twelve Class V nonexposed cavity preparations were placed throughout the dentitions of five healthy adult rhesus monkeys and observed at 3, 25, and 80 days. Various dentinal pretreatment procedures were employed. The All-Bond Universal primer system was placed on air-dried vital dentin in 23 cavities and on damp vital dentin in 27 cavities. Scotchbond 2 was placed as per manufacturer's instructions. All treatment procedures, materials, and times were represented in all animals. Placement of silicate cement resulted in the most severe pulpal responses at all time periods. Stained bacterial profiles in the remaining dentin on the axial walls of inflamed control pulps were associated with severe pulpal inflammation. These results indicate that acid etching of vital dentin does not impair pulpal healing in deep Class V cavities.

Pulpal healing and dentinal bridge formation in an acidic environment

This study was designed to observe the healing and bridging capacity of mechanically exposed pulps that were capped with silicate or zinc phosphate cements and biologically sealed with zinc oxide-eugenol cement to exclude bacteria. In six monkeys, Class V facial cavities with pulpal exposures were randomly distributed throughout 105 teeth, of which 80 were directly capped, 40 with silicate cement and 40 with zinc phosphate cement. Twenty of each group were filled to the cavosurface margin with the respective cement and 20 were surface sealed to the cavosurface margin with zinc oxide-eugenol cement. The remaining 25 exposures were capped with calcium hydroxide and amalgam as controls. Tissues were obtained by perfusion fixation after intervals of 21, 14, 10, 5 and 3 days. The 25 pulps capped with calcium hydroxide showed cell migration and organization at 5 days and dentinal matrix deposition at 10 days. At 3 and 5 days, all exposures in the experimental groups showed clot resolution. At 10 days, fibroblasts had stratified against the cement interface. At 14 days, pulps in both experimental groups showed new dentinal bridge formation directly adjacent to the acidic cements. The 21-day experimentally capped and sealed pulps presented healing similar to the controls. This study indicates that acidic components of silicate and Zinc phosphate cements are not directly responsible for pulpal inflammation or necrosis. The exposed dental pulp possesses an inherent healing capacity for cell reorganization and dentinal bridge formation when a bacterial seal is provided.

The principal islet of the Coho salmon (Oncorhyncus kisutch) contains the BB isoenzyme of creatine kinase

The importance of creatine kinase (E.C. 2.7.3.2) in endocrine tissues has been generally overlooked. Using a specific radiometric assay, we have demonstrated the existence of CK in the Brockmann body (principal islet) of the Coho salmon. We have purified this protein from insular tissue and concurrently purified CK from brain and muscle of the salmon. Purification characteristics, immunological cross-reactivity, and N-terminal sequence analysis have demonstrated that the predominant cytosolic CK from the Brockmann body is indistinguishable from the BB (brain) isoenzyme. Immunocytochemical studies indicated that the enzyme resides in the endocrine parenchyma. Phosphocreatine may serve as a reservoir of energy in the islet and augment its capacity to secrete hormones. The induction of CK-BB in the islet by other hormones could influence the secretion of insular hormones. Interorgan flux of the substrate creatine may be an undescribed mechanism of physiological regulation.

Reparative dentin: factors affecting its deposition

Results of this study showed no correlation between the thickness or amount of reparative dentin deposited and the type of dental restorative material placed at either 5 or 8 weeks in controlled Class V cavity preparations in monkey teeth. Factors such as preparation trauma from the bur, operator hand instrumentation, and microleakage of bacterial toxins played a greater role in the stimulation of reparative dentin than did material irritation or toxicity. Some differences in the thickness of the reparative dentin deposited were noted when teeth were grouped according to the amount of remaining dentin.

Trial base adapted with sealed temporary soft liner

Autopolymerizing acrylic resin is combined with temporary soft reline material to make a record base. Rigid acrylic resin is formed over a wax spacer. The wax is removed and the loose-fitting base is relined on the master cast with soft reline material. The soft material is cured in a pressure pot and sealed with a mono-poly mixture. Visible light-curing material can be used instead of autopolymerizing acrylic resin.

Fixed partial dentures opposing complete dentures

When fixed partial dentures are indicated in an arch opposing a complete denture, it is best to develop the occlusal surfaces of the fixed restorations at the same time that the opposing denture teeth are arranged in wax to permit greater flexibility and reduce the compromise in developing bilateral balanced occlusion. This article describes the development of bilaterally balanced occlusion between casting patterns for fixed partial dentures and a complete denture. The technique emulates the ease of arranging maxillary and mandibular denture teeth and can be used to develop fixed restorations with metal or porcelain occlusal surfaces. Porcelain occlusal surfaces are described because the use of porcelain is more technique sensitive.

Two-stage impression technique for overdentures

Overdentures are supported by hard tissue and resilient tissue. Optimum distribution of functional load between these different tissue types is a challenge. A two-stage impression technique is proposed to eliminate much of the need for finished denture base modification. A first stage impression is made of the resting form of the soft tissue and is used to make a mucostatic metal base. A second impression is developed under occlusal pressure with modeling compound applied to the border and the surfaces of the metal base overlying the abutments. This procedure establishes border seal and relates ridge tissue displacement to the abutments. A final cast is made by using the metal base and modeling compound. Heat-cured acrylic resin is processed to the metal base on this cast. Adjustment of the tissue surface of the base is limited to surfaces overlying free marginal gingivae and axial surfaces of the abutments.

Duplicating natural palatal contours in acrylic resin complete dentures

The form and thickness of maxillary complete dentures is easily controlled with the use of palatal veneers. A technique is described for making individual palatal patterns that are custom-made for each patient.

Professional liability. Etiology

Once again, I find Mr. Cooper quote-worthy for his statement, "It is incumbent upon the trial bar not to support the status quo merely because it is in our economic interest. Change is in the wind, and our tort system will be blown away on the winds of change for change's sake unless we participate in correcting deficiencies in the tort system and civil jury trial process." I suggest that we cannot ask for change for our own economic interest, nor can we lay blame exclusively to the other etiologic elements. We must improve those elements within our purview. The prayer of serenity may serve us well: God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference. In the game of professional liability litigation as played by the rules extant there are clearly winners and losers. The winners are the legal profession, both plaintiff and defense, and the insurers, who in the face of adversity simply increase premiums or withdraw from the market. The losers are the medical profession, the patients for whom they care and, in the broadest sense, our society as a whole. So as not to close on a note of gloom, one last quote. Lawrence H. Cooke, former Chief Judge of New York State, in remarks to the April 1986 National Symposium on Civil Justice Issues stated, "Our justice systems are beset with very real problems.(ABSTRACT TRUNCATED AT 250 WORDS)

A potentiostatic study of the corrosion behavior of anodized and nonanodized aluminum alloy

The clinical implication of this study is that some improvement in the corrosion resistance of denture bases made with aluminum alloy D-214 may be obtained by anodization. However, since this study does not exactly duplicate an oral environment or take into consideration the variation in oral environments, it cannot be assumed that the additional corrosion resistance would be discernible in a particular patient.

Hypertonic formula resulting from added oral medications

Necrotizing enterocolitis developed in a premature infant after a medication in elixir form, calcium glubionate, was added to his feedings. The osmolalities of this medication and four others--theophylline elixir, phenobarbital elixir, dexamethasone elixir, and digoxin elixir--were measured by freezing-point depression and compared with the osmolalities of the analogous intravenous (IV) preparations. The osmolalities of the IV preparations were much lower than those of the corresponding oral preparations, except in the case of digoxin. When clinically appropriate doses of dexamethasone and phenobarbital elixirs were mixed in volumes of formula appropriate for a single feeding for a 1,500-g infant, the osmolalities of the drug-formula mixtures increased at least 300% over formula alone. This effect was less noticeable with digoxin elixir, theophylline elixir, and calcium glubionate.