Pervasive structural racism in environmental epidemiology

BACKGROUND

Epistemological biases in environmental epidemiology prevent the full understanding of how racism's societal impacts directly influence health outcomes. With the ability to focus on "place" and the totality of environmental exposures, environmental epidemiologists have an important opportunity to advance the field by proactively investigating the structural racist forces that drive disparities in health.

OBJECTIVE

This commentary illustrates how environmental epidemiology has ignored racism for too long. Some examples from environmental health and male infertility are used to illustrate how failing to address racism neglects the health of entire populations.

DISCUSSION

While research on environmental justice has attended to the structural sources of environmental racism, this work has not been fully integrated into the mainstream of environmental epidemiology. Epidemiology's dominant paradigm that reduces race to a mere data point avoids the social dimensions of health and thus fails to improve population health for all. Failing to include populations who are Black, Indigenous, and people of color (BIPOC) in health research means researchers actually know very little about the effect of environmental contaminants on a range of population health outcomes. This commentary offers different practical solutions, such as naming racism in research, including BIPOC in leadership positions, mandating requirements for discussing "race", conducting far more holistic analyses, increasing community participation in research, and improving racism training, to address the myriad of ways in which structural racism permeates environmental epidemiology questions, methods, results and impacts.

It is currently unknown whether SARS-CoV-2 is viable in semen or whether COVID-19 damages spermatozoa

Research is needed to understand the presence of the SARS‐CoV‐2 virus in semen, sexual transmissibility, and impact on sperm quality. Several studies have examined men recovering from COVID‐19, but large‐scale community‐based testing is needed to ascertain the effects on the male reproductive tract, and the potential for prolonged transmission.

Gut microbiome differences between wild and captive black rhinoceros - implications for rhino health

A number of recent studies have shown the importance of the mammalian gut microbiome in host health. In the context of endangered species, a few studies have examined the relationship between the gut microbiome in wild versus captive populations due to digestive and other health issues. Unfortunately, the results seem to vary across taxa in terms of captive animals having higher, lower, or equivalent microbiome diversity relative to their wild counterparts. Here, we focus on the black rhinoceros as captive animals suffer from a number of potentially dietary related health effects. We compared gut microbiomes of wild and captive black rhinos to test for differences in taxonomic diversity (alpha and beta) and in functional diversity of the microbiome. We incorporated a more powerful metagenomic shotgun sequencing approach rather than a targeted amplification of the 16S gene for taxonomic assignment of the microbiome. Our results showed no significant differences in the alpha diversity levels between wild and captive black rhinos, but significant differences in beta diversity. We found that bacterial taxa traditionally associated with ruminant guts of domesticated animals had higher relative abundances in captive rhinos. Our metagenomic sequencing results suggest that unknown gut microbes of wild rhinos are being replaced by those found in conventional human-domesticated livestock. Wild rhinos have significantly different functional bacterial communities compared to their captive counterparts. Functional profiling results showed greater abundance of glycolysis and amino acid synthesis pathways in captive rhino microbiomes, representing an animal receiving sub-optimal nutrition with a readily available source of glucose but possibly an imbalance of necessary macro and micronutrients. Given the differences observed between wild and captive rhino gut microbiomes, we make a number of recommendations for potentially modifying captive gut microbiome to better reflect their wild counterparts and thereby hopefully improve overall rhino health in captivity.

Lymphatic fluid for the detection of Mycobacterium avium subsp. paratuberculosis in cows by PCR, compared to fecal sampling and detection of antibodies in blood and milk

Johne's disease (JD), caused by Mycobacterium avium subsp. paratuberculosis (MAP), can cause considerable economic losses in affected herds. Early diagnosis of JD is hampered by the chronic nature of the disease with a slow subclincal progression. The aim of the present study was to challenge the hypothesis that lymphatic fluid is of diagnostic value in the early stages of the disease. Lymphatic fluid from 122 animals was collected and tested for MAP by nested PCR for IS900 and compared to the results of testing for MAP in feces (culture), blood and milk (ELISA) in 110 of these samples. MAP was detected by PCR in 27.1% of the lymph samples. Agreement between the tests was poor: 6.9% of the lymph positive cows were also positive in all other tests applied, and 69.0% had negative results in fecal culture, blood and milk ELISA. Resampling of 25 cows after 8 to 12 and 16 to 20 months revealed 20.0% lymph positive animals at the first, 5.5% at the second and 27.8% at the third sampling, respectively. Only one cow showed positive lymph-PCR results at more than one sampling date. Lymph-positive cows had a 7.2 times greater likelihood of being culled within 8 to 12 months after sampling, compared to negative cows, mainly due to other health issues than JD. It can be concluded, that lymphatic fluid might be promising for the detection of early MAP-infection in cows, but further studies to elucidate the potential of this diagnostic approach are needed.

NBDE Part II practice analyses: an overview

The Standards for Educational and Psychological Testing emphasize the importance of documenting and describing the procedures followed in developing valid test content. As a result, the Joint Commission on National Dental Examinations, the testing agency responsible for administering the National Board Dental Examination Part I and Part II, routinely communicates information about the validity of Part II to dental schools and other communities of interest. Since 2000, the content of Part II has been validated through the use of three practice analyses. This article provides an overview of these practice analyses, including procedures and findings. In general, the findings confirm that the content of Part II is valid in determining the qualifications of individuals seeking dental licensure.

An investigation of the relationship between fecal and rumen bacterial concentrations in sheep

With no acceptable method for collecting fresh rumen fluid from zoo ruminants, it was proposed that fecal bacterial concentrations may be correlated with rumen bacteria. If so, fecal bacterial concentrations could be used to study both the effects of diet on rumen bacteria as well as rumen abnormalities. Total and cellulolytic bacterial concentrations were determined in whole rumen contents and feces of sheep using a most-probable-number (MPN) assay. In a Latin square design, four crossbred ewes were fed diets of 100% long or chopped orchardgrass hay (OH) and 60% ground or whole shelled corn plus 40% chopped OH. In a second trial, the sheep were fed a pelleted complete feed at varying levels of intake i.e., control at 2.0% of body weight and at 1.8, 1.6, and 1.2% of body weight. Higher total rumen bacterial concentrations (P<0.01) were found on the high concentrate diets as compared with the high forage diets. Grinding the corn also increased total bacterial concentrations (P<0.05). Fecal concentrations of total bacteria were higher (P<0.01) with the high concentrate diets. Chopping the forage decreased the concentration of fecal cellulolytic bacteria (P<0.05) but had no effect on their concentration in the rumen. An inverse linear relationship (P<0.01) was observed between total bacterial concentrations in the feces and diet intake. Although relationships were observed between the rumen and feces for total and cellulolytic bacterial concentrations, they were dependent on diet, particle size, and level of intake. Thus, fecal bacterial concentrations cannot be used to reliably predict rumen bacterial concentrations. Zoo Biol 27:100-108, 2008. (c) 2008 Wiley-Liss, Inc.

Validating the standard for the National Board Dental Examination Part II

As part of the overall exam validation process, the Joint Commission on National Dental Examinations periodically reviews and validates the pass/fail standard for the National Board Dental Examination (NBDE), Parts I and II. The most recent standard-setting activities for NBDE Part II used the Objective Standard Setting method. This report describes the process used to set the pass/fail standard for the 2009 exam. The failure rate on the NBDE Part II increased from 5.3 percent in 2008 to 13.7 percent in 2009 and then decreased to 10 percent in 2010. This article describes the Objective Standard Setting method and presents the estimated probabilities of classification errors based on the beta binomial mathematical model. The results show that the probability of correct classifications of candidate performance is very high (0.97) and that probabilities of false negative and false positive errors are very small (.03 and <0.001, respectively). The low probability of classification errors supports the conclusion that the pass/fail score on the NBDE Part II is a valid guide for making decisions about candidates for dental licensure.

Assessing context effects on test validity of the National Board Dental Examination Part I

In support of actions taken by the Joint Commission on National Dental Examinations, two changes--the inclusion of testlet items and the random presentation of items in an interdisciplinary format--were made to enhance the test validity of the National Board Dental Examination Part I in 2007. As a result, the examination was changed from a conjunctive to a comprehensive format. It was assumed that validity would be enhanced with regard to the examination's internal structure, while not disturbing item performance and examinee score. This study of the results found that 1) three underlying variables were extracted from the conjunctive Part I but only two underlying variables from the comprehensive Part I and 2) the differences in item performance and examinee score were generally small in effect size across formats. Factor analyses revealed that Part I was more discipline-sensitive for the conjunctive format but more item format-sensitive for the comprehensive format. The revision of Part I changed the nature of the examination from a discipline-based format to a more clinically relevant, interdisciplinary format, a favorable outcome anticipated by the Joint Commission. The results of this study provide evidence supporting the validity of the revised Part I examination for its intended purpose in the licensure process.

Generalizability analyses of NBDE Part II

This research applied generalizability theory to assess the effect of varying the number of cases and items nested within cases on generalizability of scores on Part II of the National Board Dental Examinations (NBDE Part II). In this research, sources of error were defined. Measurement conditions were classified. Error variances and generalizability coefficients for different conditions were computed. The data analyzed were the item responses of 1,535 candidates enrolled in accredited dental education programs who all took the same test form in 2007. Results showed that using more cases of fewer items might lead to a greater increase in generalizability than using more items per case. Other practical considerations such as time and cost constraints must be taken into account when applying the results of this research in other testing situations.

The collection of lymphatic fluid from the bovine udder and its use for the detection of Mycobacterium avium subsp. paratuberculosis in the cow

The objective of the current study was to evaluate the feasibility of lymph collection from the bovine udder and to investigate if the lymphatic fluid might be of diagnostic value in cows infected with Mycobacterium avium subsp. paratuberculosis (MAP), the etiologic agent of paratuberculosis. Lymph fluid collection was attempted from 58 cows, and the reactions of the cows as well as the level of difficulty of the procedure were recorded in 56 animals. Lymph samples (51 in total) were tested for the presence of MAP by nested polymerase chain reaction. Collection of the lymphatic fluid caused no or mild signs of discomfort in 94.6% of the cows; in 51.8% of cows, lymphatic fluid was attained on the first attempt, while sample collection was unsuccessful in 12.1%. Mycobacterium avium subsp. paratuberculosis was detected in 43.1% of all lymph samples. The bacterium was present in 66.7% of cows with clinical Johne’s disease, in 42.8% of asymptomatic cows with a positive or suspicious enzyme-linked immunosorbent assay (ELISA) result in blood, and in 38.7% of cows with a negative ELISA result in blood. The present study shows that the procedure was well tolerated by most cows and can easily be performed on farm. The current report of the isolation of MAP from lymph fluid suggests that the present approach could be used for the early detection of Johne’s disease in cattle.

Assessing dental students' competence: best practice recommendations in the performance assessment literature and investigation of current practices in predoctoral dental education

In this article, the Task Force on Student Outcomes Assessment of the American Dental Education Association's Commission on Change and Innovation in Dental Education describes the current status of student outcomes assessment in U.S. dental education. This review is divided into six sections. The first summarizes the literature on assessment of dental students' performance. Section two discusses catalysts, with a focus on problem-based learning, for development of new assessment methods, while the third section presents several resources and guides that can be used to inform selection of assessment techniques for various domains of competence. The fourth section describes the methodology and results of a 2008 survey of current assessment practices in U.S. dental schools. In the fifth section, findings from this survey are discussed within the context of competency-based education, the educational model for the predoctoral curriculum endorsed by the American Dental Education Association and prescribed by the Commission on Dental Accreditation. The article concludes with a summary of assessments recommended as optimal strategies to measure three components of professional competence based on the triangulation model. The survey of assessment practices in predoctoral education was completed by 931 course directors, representing 45 percent of course directors nationwide, from fifty-three of the fifty-six U.S. dental schools. Survey findings indicate that five traditional mainstays of student performance evaluation-multiple-choice testing, lab practicals, daily grades, clinical competency exams, and procedural requirements-still comprise the primary assessment tools in dental education. The survey revealed that a group of newer assessment techniques, although frequently identified as best practices in the literature and commonly used in other areas of health professions education, are rarely employed in predoctoral dental education.

Does faculty development enhance teaching effectiveness?

Academic dentists and members of the practice community have been hearing, for more than a decade, that our educational system is in trouble and that the profession has lost its vision and may be wavering in the achievement of its goals. A core of consistently recommended reforms has framed the discussion of future directions for dental education, but as yet, most schools report little movement toward implementation of these reforms in spite of persistent advocacy. Provision of faculty development related to teaching and assessment strategies is widely perceived to be the essential ingredient in efforts to introduce new curricular approaches and modify the educational environment in academic dentistry. Analyses of the outcomes of efforts to revise health professions curricula have identified the availability and effectiveness of faculty development as a predictor of the success or failure of reform initiatives. This article will address faculty development for purposes of enhancing teaching effectiveness and preparing instructors for potential new roles associated with curriculum changes. Its overall purpose is to provide information and insights about faculty development that may be useful to dental schools in designing professional growth opportunities for their faculty. Seven questions are addressed: 1) What is faculty development? 2) How is faculty development accomplished? 3) Why is faculty development particularly important in dental education? 4) What happens when faculty development does not accompany educational reform? 5) Why are teaching attitudes and behaviors so difficult to change? 6) What outcomes can be expected from faculty development? and 7) What does the available evidence tell us about the design of faculty development programs? Evidence from systematic reviews pertaining to the teaching of evidence-based dentistry, strategies for continuing professional education, and the Best Evidence in Medical Education review of faculty development outcomes are presented to answer this question: does faculty development enhance teaching effectiveness? Characteristics consistently associated with effective faculty development are described.

Realigning the National Board Dental Examination with contemporary dental education and practice

Although the National Board Dental Examination (NBDE) was developed for the purpose of supporting the dental licensure process, it can have significant influence on dental school curricula. Efforts to revise and enhance dental curricula, of necessity, must engage stakeholder communities and promote an assessment process that is both valid and relevant to contemporary dental practice. The NBDE uses a systematic and objective process for test development that involves content experts from dental education and practice. This process could be enhanced by reconsidering the types of individuals who should participate in test construction, reconfiguring the groups involved in the process, augmenting training and development of test constructors, and updating the principles and documents that define the competencies and foundational knowledge required for contemporary dental practice. In addition, there is a need for ongoing research and development to explore new testing strategies that stress understanding and the ability to apply information in a problem-solving context. Finally, examinations could be enhanced with a broader array of high-quality supporting case materials through a more structured collaborative arrangement between dental schools and the National Board testing program.

Revisiting the National Board Dental Examination

The National Board Dental Examination (NBDE) assists state boards of dentistry in determining the qualifications of dentists for initial licensure. This article explains the purpose and rationale for the policies and procedures that guide the NBDE. These examinations have been used for a number of purposes well beyond the assessment of the knowledge and abilities for entry-level dental practice. The article explores the uses and misuses of the National Boards and the relationship between dental licensure examinations and dental curricula. For National Board examinations to remain current and relevant, they must be consistent with standards and best practices for high-stakes testing, and they must focus on competencies and critical thinking skills essential for future practice. The National Board examinations have the potential to stimulate and support curricular reform through collaborative efforts of educators and practitioners who support the test development and standard-setting processes of the examinations.

Validation of the National Board Dental Hygiene Examination

The National Board Dental Hygiene Examination program is a part of the process for licensing dental hygienists. The examination assesses theoretical and applied knowledge in the basic biomedical, dental, and dental hygiene sciences, as well as community health. Standards for licensure examinations recommend that test publishers demonstrate a relationship between examination content and actual practice.

METHOD

To this end, a validity study was conducted, which involved the definition of the domain of entry-level dental hygiene practice using 56 competencies; the conduct of a practice analysis survey designed to rate the importance of these competencies; and the linking of competencies to content elements in accordance with the competencies' importance ratings. Of the 3941 surveys distributed, 1841 participants responded and, of these, 1284 were full-time practitioners. The importance ratings for the competencies were translated into numbers of items. The number of items devoted to each competency was distributed across all applicable elements of the existing content specifications based upon the knowledge needed to support the realization of the competency.

RESULTS AND DISCUSSION

The findings confirmed the adequacy of the content specifications in effect prior to 2005. However, based on this validity study, 2 sub areas of relatively little significance were eliminated, and 2 new areas were introduced. Specifically, Clinical Testing under Assessing Patient Characteristics (one item) and Professional Methods of Administering Fluorides under Using Preventive Agents (one item) were eliminated, and Dental Hygiene Treatment Strategies was incorporated with 4 items, and Professional Responsibilities was added with a total of 28 items.

Interest and responsibility of ADA in dental licensure

Initial licensure is a critical milestone and point of entry to the profession; it should go without saying that the organization that represents more than 70% of professionally active dentists would care deeply about the process that determines the character of its future and defines its image in the eyes of the public. The American Dental Association's (ADA) documented history of activity and leadership on licensure issues and the organization's guiding documents (Strategic Plan, Current Policies, Principles of Ethics and Code of Professional Conduct and Constitution and Bylaws) all lend credence to the Association's role in the licensure process. ADA members, other dental organizations, private and governmental agencies, and the public recognize the ADA as an authority on matters relating to dentistry. These circumstances comprise the best available evidence supporting the important role of the ADA in facilitating communication, collaboration and consensus-building in the continuous enhancement of the licensure process to meet the needs of all stakeholders.

Molecular cytogenetic identification and characterization of a de novo supernumerary neocentromeric derivative chromosome 13

We report a young girl with microphthalmia, conductive deafness, aortic isthmus stenosis, laryngomalacia, and laryngeal stenosis carrying a de novo supernumerary neocentromeric derivative chromosome 13. For the precise identification and characterization of the eu- and heterochromatic content of the marker chromosome, straightforward molecular cytogenetic analyses were performed, such as chromosome microdissection, FISH with different probes (e.g. wcp, alphoid centromeric probes, BAC), centromere-specific multicolor FISH (cenM-FISH), and multicolor banding (MCB). The analyses demonstrated that the marker consisted of an inverted duplication (partial tetrasomy) of the distal portion of chromosome 13 that was separated from the endogenous chromosome 13 centromere. Using an all-centromere probe and multicolor cenM-FISH, no alpha-satellite DNA hybridization signal was detectable on any portion of the derivative chromosome. The presence of a functional and active neocentromere on the derivative chromosome 13 was confirmed by positive immunofluorescence signals with CENP-C antibodies. BAC-FISH confirmed the cytogenetic localization of the neocentromere in band 13q31.3. Thus the patient had a mosaic conventional karyotype mos 47,XX,+inv dup(13)(qter-->q21.3::q21.3-->q31.3-->neo-->q31.3-->qter)[6]/46,XX [49].

Okuläre Manifestationen und chirurgische Ergebnisse beim Marfan-Syndrom

AIM

This retrospective study should examine and judge the surgical indications and the therapeutic possibilities as well as their complications in patients with ocular manifestations of Marfan syndrome (MFS) diagnosed according to the criteria of the Ghent nosology.

PATIENTS AND METHODS

The study included 17 patients. Operative indications were increasing subluxation of the lens, retinal detachments and secondary glaucoma. The operative procedure depended on patient age and findings. Eleven MFS patients were operated in both eyes and six MFS patients in one eye.

RESULTS

Stabilization or functional improvement of visual acuity could be achieved in all patients in whom no disorders limiting visual acuity or amblyopia were present preoperatively. In six eyes of five patients, lens insertion was accomplished via a pars plana approach. Lens removal without implantation of an intraocular lens was performed in 16 eyes of 10 patients. Pars plana vitrectomy was accomplished in 12 eyes. Complications were well controlled by pars plana vitrectomy.

CONCLUSIONS

Difficult preoperative situations and postoperative complications are not rare in MFS patients. However, they can be controlled well by means of modern vitreous surgery.

Smith-Lemli-Opitz syndrome with a classical phenotype, oesophageal achalasia and borderline plasma sterol concentrations

The diagnostic biochemical hallmarks of Smith-Lemli-Opitz syndrome (SLOS) are elevated concentrations of the cholesterol precursors 7- and 8-dehydrocholesterol (7- and 8-DHC). We describe a patient with classical SLOS phenotype and oesophageal achalasia, which has not been reported in SLOS patients before. Plasma 7-DHC and 8-DHC were only marginally elevated. The diagnosis was confirmed by sterol analysis in cultured skin fibroblasts and mutation analysis.

Trends in dental and allied dental education

BACKGROUND

Educational programs play an important role in preparing a qualified dental work force. This article reviews the current status and trends in dental, advanced dental and allied dental education programs in the United States and examines their impact on the dental work force.

OVERVIEW

This analysis focuses on survey data collected by the American Dental Association during the past 10 to 15 years and compares recent patterns in applications, enrollment and graduation with previous trends. The numbers of educational programs, applicants, enrollees and graduates have increased in dentistry, dental hygiene and dental assisting, while dental laboratory technology has declined in all measures. The proportion of women in dentistry has increased, while the ethnic profile of dental and allied personnel has shown little change. Both the cost of dental education and student debt continue to increase.

CONCLUSIONS

Despite increases in the number of educational programs and overall numbers of graduates from dental and allied dental education programs, the proportion of underrepresented groups still lags behind their representation in the overall population, and the number of allied personnel falls short of practice needs.

PRACTICE IMPLICATIONS

Patterns in applications, enrollment and graduation are important determinants of the dental and allied dental work force. The cost and funding of education significantly affect the attractiveness of dental careers and the sustainability of educational programs and should be monitored carefully by the profession.

Novel mutations in the Atlastin gene (SPG3A) in families with autosomal dominant hereditary spastic paraplegia and evidence for late onset forms of HSP linked to the SPG3A locus

Hereditary spastic paraplegias (HSP) comprise a genetically and clinically heterogeneous group of neurodegenerative disorders characterised by progressive spasticity and hyperreflexia of the lower limbs. Autosomal dominant hereditary spastic paraplegia linked to the SPG3A locus on chromosome 14q11-21 accounts for approximately 10% of autosomal dominant hereditary spastic paraplegia (ADHSP). It is caused by mutations in the SPG3A gene encoding the protein atlastin. To date, only five disease-causing mutations in the SPG3A gene have been described. We analysed 13 SPG4-negative families for mutations in the SPG3A gene and identified a mutation in 38% (5/13). Two of the mutations are novel, c.481G>C (p.A161P) and c.740A>C (p.H247P). One of the novel mutations was found both in a family with early onset of symptoms and in a late onset family. Furthermore, we report on numerous polymorphisms detected in the SPG3A gene.

Unexpected death of a 12 year old boy with monosomy 1p36

Monosomy 1p36 may result in a clinically recognizable chromosomal microdeletion syndrome. We report the unexpected death of a 12 year old boy with mildly dysmorphic facial features, short stature at 138 cm (3rd centile), moderate mental retardation and a history of seizures, obesity, transient muscle weakness of the right arm and leg and episodes of transient atonic hemiparesis of the right side of the body. Despite the relatively few congenital anomalies and normal karyotype, the 1p36 deletion was suspected on clinical grounds and was demonstrated by fluorescent in situ hybridisation (FISH). Two months after diagnosis and following a short history of a mild upper airway infection, high fever and severe diarrhea, the patient had a massive circulatory shock and asystolia, resulting in deep coma, brain edema, apallic syndrome and death. To our knowledge there has been no previous report of episodes of transient unilateral muscle weakness and atonic hemiparesis, circulatory shock and sudden death associated with monosomy 1p36.

Spontaneous intracerebral hemorrhage and multiple infarction in Williams-Beuren syndrome

A 7-year-old boy diagnosed with Williams-Beuren syndrome was admitted for spontaneous right hemispheric intracerebral hemorrhage. Cerebral angiography did not reveal any source of bleeding. After a short period of clinical improvement under conservative treatment, the boy deteriorated rapidly. CT showed the beginning of a complete infarction of both hemispheres. Operative evacuation of the bleeding and bilateral osteoclastic decompression had no perceptible influence on the clinical course. To the present day, the boy has remained in a vegetative state. Reports in the literature suggest that Williams syndrome with cerebral infarction is associated with a markedly poorer prognosis when there is additional intracerebral bleeding.

Confirming the validity of Part II of the National Board Dental Examinations: a practice analysis

Successful completion of Part II of the National Board Dental Examinations is a part of the licensure process for dentists. Good testing practice requires that the content of a high stakes examination like Part II be based on a strong relationship between the content and the judgments of practicing dentists on what is important to their practice of dentistry. In an effort to demonstrate this relationship for Part II, the Joint Commission conducted a practice analysis, which involved a two-dimensional model. The sixty-three Competencies of the New Dentist, developed and promulgated by the American Dental Education Association, were used for one dimension, and the current content specifications were used for the other. A survey of 520 practicing dentists was conducted to determine the importance of each of the competencies for patient care. These dentists were recent graduates of accredited programs and passed Part II three to five years prior to the conduct of the practice analysis. The survey directed the respondents to rate the importance of the competencies on a scale from 1 to 5. Of the 520 in the sample, 244 dentists responded. The reliability index was above 0.90. The importance rating for each competency was translated into the associated number of items. The number of items devoted to each competency was allocated to the current content elements that are related to the knowledge and problem-solving skills that support each competency. The findings specified revisions in the relative number of items dedicated to the various elements in the specifications. These findings indicate that the items on the examination under the current distribution adequately reflected practice. In general, there were relatively small changes in the content specifications. The total number of changes in items was forty-eight, which represents changes in slightly less than 10 percent of the overall number of items.

Trends in dental specialty education and practice, 1990-99

Policy issues related to dental specialty education and practice have been the responsibility of the American Dental Association's Council on Dental Education and Licensure. In 2001, the council concluded a comprehensive study of the ADA-recognized dental specialties that included a review of specialty practice and the practice environment, membership in specialty organizations, requirements and trends in board certification, advances in research and technology related to each specialty, and trends in advanced specialty education. This paper provides an overview of the results of this study and the council's analysis of data and information provided by the dental specialty organizations and the ADA Survey Center with an emphasis on dental specialty education. The council concluded that none of the dental specialties should be considered for rerecognition, but identified concerns regarding the shortage of qualified faculty and educational program directors. As a result of the council's study, recommendations have been made to the dental specialty organizations and ADA-recognized dental specialty certifying boards that they continue to monitor the number of board-certified specialists and identify ways to increase the number of board-certified specialists.

Dental esthetic satisfaction in adults

This study determined the influence of teeth, mouth, and face on self-image and personal esthetic satisfaction in adults. A random sample of 125 patients completed a five-item questionnaire about personal esthetic satisfaction and oral self-image. As a group, general dental variables were stronger predictors of esthetic satisfaction than orthodontic variables (P less than .01). Discrepancies between clinical findings and patterns of self-perception and satisfaction suggest the dentist and patient should plan together for esthetic dental treatment.