Maintaining a strong rural dental workforce.

AIMS: This study was designed to examine demographics of University of Nebraska Medical Center College of Dentistry graduates over a recent 10-year period and factors related to their choice of rural or urban practice. Findings were compared to similar previous studies to analyze trends. METHODS: Using data from the annual Health Professions Tracking Service 2019 Dentistry Profile survey, we examined the demographic information of 169 graduates from 2009 to 2018 practicing in Nebraska at the end of 2018. We analyzed factors such as rural or urban high school graduation, gender, and other background information to explore associations with their 2018 practice location (urban vs. rural) using chi-square tests and logistic regression. RESULTS: This study found that some demographic variables were associated with future practice location. Specifically, a higher proportion of graduates of rural high schools chose to work in a rural location (60%) relative to those who graduated from an urban high school (18%) (p < 0.0001). A higher proportion of men (50%) selected rural practice compared to women (33%) (p = 0.02). Only 17 graduates who attended high school outside of Nebraska stayed to practice in Nebraska, and there was a lower proportion of these graduates working in rural locations (18%) relative to in-state high school graduates (45%) (p = 0.03). CONCLUSION: We found significant positive associations between dentists who chose rural practice and demographic factors such as being rural high school graduates, male, and in-state predental residents. Our findings differ from descriptive results of similar previous studies.

Factors contributing to student satisfaction with dental loupes and headlights.

PURPOSE: Surgical loupes and headlights are becoming standard equipment for dental professionals and students. Students often purchase these relatively expensive instruments with limited knowledge of which features will affect their satisfaction with use. The purpose of this study was to measure levels of satisfaction with loupes and headlights amongst dental and dental hygiene students after 1, 2 and 3 years of use, and use those findings to guide first-year students in making better purchasing decisions. METHODS: An electronic survey was sent to all second, third and fourth year dental students as well as second-year dental hygiene students at the University of Nebraska Medical Center (UNMC) in October 2018. The survey asked students to respond to multiple questions with a 5-level Likert scale measurement of satisfaction and provide open-ended responses to questions about their loupes and headlights. RESULTS: Ninety-three percent of eligible students responded. Overall, 68% of students were very satisfied with their loupes and 56% were very satisfied with their headlights. Sixty-seven percent of dental students chose 3.5× magnification or higher and 96% of dental hygiene students chose 2.5×. CONCLUSIONS: Of all characteristics evaluated for loupes, customer service and sales representatives received the lowest satisfaction ratings. For headlights, battery-related factors (battery life in hours, rate of recharging, size or weight and on/off controls) received the lowest satisfaction scores. Information collected and reported in this way can help future students make better decisions when selecting products, vendors and features that will best meet their needs.

Qualifications and Characteristics North American Dental Deans Seek in Department Chairpersons.

The aim of this study was to determine whether deans of North American dental schools perceived that one category of department chairperson skills (leadership or management) was more important than the other for their chairpersons to be successful. A secondary purpose was to determine the professional qualifications and personal characteristics these deans perceived contributed most to the success of department chairpersons and whether those differed by the research emphasis of the school. An email survey was sent in 2016 to all 75 deans of U.S. and Canadian dental schools with graduating classes. Section one of the survey was an open response section asking deans to list the five most essential characteristics of a successful department chairperson. Section two asked deans to rank the importance of eight listed professional qualifications, and the last section asked deans to rate the importance of four leadership and four management traits that could contribute to the success of their chairpersons. Questions about characteristics of the deans and the schools were also included. A response rate of 46.7% was obtained. The most frequent characteristics listed in the open response section were in the categories of vision, academic expertise, and integrity. The three most highly ranked professional qualifications were previous teaching experience, previous administrative experience, and history of external research funding. Four of the eight professional qualifications were ranked differently by deans of high compared to moderate research-intensive schools (p<0.05). Overall, the respondents rated leadership skills more highly than management skills (p=0.002) as important for departmental chairpersons.

Current Status of Operation and Management of Dental School Clinics.

This article summarizes the current status of the operation and management of dental school clinics as schools strive to provide excellent patient-centered care in an environment that is educationally sound, efficient, and financially strong. Clinical education is a large component of dental education and an area in which many dental schools have an opportunity to enhance revenue. Clinical efficiencies and alternative models of clinical education are evolving in U.S. dental schools, and this article describes some of those evolutionary changes. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Improving the Fiscal Sustainability of Teaching Clinics at Dental Schools.

Educational patient care clinics are becoming an increasingly important source of revenue for dental schools. Revenue from clinics can help offset the rising cost of dental education. In addition, those clinics represent a source of income over which the schools have reasonably direct control. Recently, a group of nine U.S. dental schools conducted a detailed financial survey of their clinics and shared the confidential results with each other. The purpose of their analysis was to develop benchmarks for key factors related to clinical financial productivity and expenses and to define best practices to guide improvements at each school. The survey found significant variations among the nine schools in revenue produced by predoctoral students and by postdoctoral residents. There were similar variations for levels of clinical staffing. By sharing the results of the survey with each other, the individual schools gained a strong understanding of the business strengths or weakness of their own clinical programs. That information gave each school's leaders the opportunity to investigate how they might improve their clinical fiscal sustainability.

A randomized trial of loading vancomycin in the emergency department.

BACKGROUND: Optimizing vancomycin dosing may help eradicate bacteria while avoiding resistance. The guidelines recommend loading doses; however, there are no data to demonstrate that this may result in a more rapid achievement of therapeutic troughs. OBJECTIVE: To evaluate the percentage of troughs reaching therapeutic levels at 12, 24, and 36 hours following an initial vancomycin dose of 30 mg/kg compared with 15 mg/kg. METHODS: This prospective, randomized study was performed in a community academic medical center. Patients who were to receive vancomycin in the emergency department were randomized to an initial traditional dose of 15 mg/kg or a 30-mg/kg loading dose followed by 15 mg/kg every 12 hours for 3 doses. Patients weighing >120 kg or with creatinine clearances <50 mL/min were excluded. RESULTS: In total, 99 patients were enrolled; 12 hours after the initial dose of vancomycin, there was a significantly greater proportion of patients reaching target trough levels of 15 mg/L among the patients who received a loading dose as compared with a traditional dose (34% vs 3%, P < 0.01). This trend continued at 24 hours but was not statistically significant. At 36 hours, there was no difference in the percentage of patients reaching target levels between the 2 groups. No statistically significant difference in nephrotoxicity or adverse events among the 2 groups was demonstrated. CONCLUSION: A loading dose of 30 mg/kg of vancomycin achieved a higher percentage of therapeutic levels at 12 hours when compared with the traditional dose of 15 mg/kg, without increased nephrotoxicity or adverse events.

Rhinocerebral Mucor circinelloides infection in immunocompromised patient following yogurt ingestion.

The purpose of this case report is to illustrate the cause of this patient's headache and sinus pain in the setting of a unique environmental exposure: the patient ingested yogurt only days before presentation. This particular brand of yogurt caused controversy in early September 2013 when the manufacturer voluntarily recalled all flavors. The yogurt was found to be contaminated with Mucor circinelloides. The recall was triggered by the FDA, after receiving many complaints from consumers affected by temporary gastrointestinal symptoms such as abdominal cramping, diarrhea, and nausea. This patient was diagnosed with Rhinocerebral mucormycosis through fungal culture of the affected area. He was specifically colonized with Mucor circinelloides, a variant that rarely causes disease in humans. According to a literature review, only eight cases of mucormycosis in adults caused by this strain were documented before 2009.

Evaluation of an early step-down strategy from intravenous anidulafungin to oral azole therapy for the treatment of candidemia and other forms of invasive candidiasis: results from an open-label trial.

BACKGROUND: Hospitalized patients are at increased risk for candidemia and invasive candidiasis (C/IC). Improved therapeutic regimens with enhanced clinical and pharmacoeconomic outcomes utilizing existing antifungal agents are still needed. METHODS: An open-label, non-comparative study evaluated an intravenous (i.v.) to oral step-down strategy. Patients with C/IC were treated with i.v. anidulafungin and after 5 days of i.v. therapy had the option to step-down to oral azole therapy (fluconazole or voriconazole) if they met prespecified criteria. The primary endpoint was the global response rate (clinical + microbiological) at end of treatment (EOT) in the modified intent-to-treat (MITT) population (at least one dose of anidulafungin plus positive Candida within 96 hours of study entry). Secondary endpoints included efficacy at other time points and in predefined patient subpopulations. Patients who stepped down early (≤ 7 days' anidulafungin) were identified as the "early switch" subpopulation. RESULTS: In total, 282 patients were enrolled, of whom 250 were included in the MITT population. The MITT global response rate at EOT was 83.7% (95% confidence interval, 78.7-88.8). Global response rates at all time points were generally similar in the early switch subpopulation compared with the MITT population. Global response rates were also similar across multiple Candida species, including C. albicans, C. glabrata, and C. parapsilosis. The most common treatment-related adverse events were nausea and vomiting (four patients each). CONCLUSIONS: A short course of i.v. anidulafungin, followed by early step-down to oral azole therapy, is an effective and well-tolerated approach for the treatment of C/IC. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00496197.

Rural dentists: does growing up in a small community matter?

BACKGROUND: The aging of the dental work-force has implications for both patients and dentists, especially those in rural and underserved areas. Anecdotal information regarding dental workforce trends indicates that students from rural communities are more likely to practice in rural communities than are students from urban areas. Although the medical literature supports this premise relative to physicians, there are no data to verify this statement relative to dentistry. Therefore, the authors decided to study whether this premise applies to dentistry. METHODS: The authors conducted a retrospective analysis of dental student records from a Midwestern dental school for the years 1980 through 2010 to determine if there was a statistical correlation between the size of a dental student's town of origin and the size of the community where he or she practiced after graduation. They also examined what role, if any, the student's sex played. RESULTS: Dentists from rural areas were approximately six times more likely to practice in a rural area than were dentists from urban areas. Female dentists were only slightly less likely to practice in a rural community than were male dentists. CONCLUSION: Dentists from rural communities were more likely to practice in rural communities than were dental students from urban areas. PRACTICE IMPLICATIONS: To ensure future access to care in rural communities, rural dentists may want to recruit actively or work closely with dental students from rural areas when hiring associates or seeking purchasers for their dental practices.

Malignant acanthosis nigricans in rectal adenocarcinoma.

A case of generalized malignant acanthosis nigricans is reported. The patient was asymptomatic of any gastrointestinal complaints and investigations revealed the presence of adenocarcinoma of the rectum. The association between paraneoplastic acanthosis nigricans and internal malignancy is well established and the most common association is with adenocarcinoma of gastrointestinal origin.

An unusual presentation of invasive squamous cell carcinoma of the upper extremities in a patient with a history of severe electrical burns and chronic thermal and chemical exposure.

This is a case report that depicts an atypical presentation of very aggressive, metachronous invasive squamous cell carcinomas of the upper extremities in a patient with no prior history of precancerous or cancerous skin lesions and no significant solar radiation exposure. Potentially causative factors that played a role in the emergence of this aggressive form of skin cancer in this case study are multifactorial: (1) chronic thermal exposure of 3000 degrees F daily to his hands for an eight to ten-year time period; (2) chronic chemical exposure of DMSO solvent and higher levels of chemical contaminants such and finally; (3) a form of chronic immunosuppression as a result of his severe electrical burns that resulted in widespread second and third burns throughout his body.

Rural dentists of the future: dental school enrollment strategies.

The purpose of this study was to determine the relationship, if any, of a dental student's 1) state of residency and 2) gender to his or her practice location in a rural Nebraska community after graduation. Previous research has demonstrated that dental students generally locate their practices near their place of rearing and that male graduates are more likely than female graduates to locate in rural areas. Dental student data for all University of Nebraska Medical Center College of Dentistry graduates from 1989 to 2008 (n=879) were analyzed. Descriptive and quantitative analyses were performed utilizing SPSS software (version 17.0). Chi-square and odds ratio analyses were also conducted. In contrast to previous research, women dentists who remained in the state after graduation were more likely to locate their practice in a rural community than were male dentists: 59 percent and 48.5 percent, respectively. Nonresidents who remained in the state after graduation were also more likely to locate in a rural community than were residents: 69 percent and 51 percent, respectively. Dental schools may find this information useful as state officials and policymakers look to dental schools for leadership in addressing dental workforce needs, especially in rural/underserved areas.

Full Stokes polarimeter for characterization of fiber optic gyroscope coils.

We describe the design, construction, calibration, and validation of a Stokes vector polarimeter for investigating the polarization characteristics of fiber optic gyroscope coils. The device measures the complete Stokes vector, and reports conventional polarization properties including the Degree of Polarization (DoP), the orientation and Degree of Linear Polarization (DoLP), and the handedness and Degree of Circular Polarization (DoCP). The sensor operates at 1550 nm and employs a division of aperture optical architecture to acquire full Stokes vectors at 8 kHz while calculating polarization properties at a rate of 200 Hz. Preliminary measurements performed on both traditionally and unconventionally wound gyroscope coils are also presented.

Effects of repeated fluoride varnish application on different restorative surfaces.

AIM: The aim of this study was to assess the effect of repeated (twice) applications of two fluoride varnishes (Duraflor and CavityShield) on the surface micromorphology of a high-viscosity glass ionomer (Fuji IX GP), a compomer (F2000), and a flowable composite (Filtek Flow) using a profilometer and scanning electron microscope (SEM). METHODS AND MATERIALS: Fifteen specimens were prepared from each material, surface roughness (Ra) was measured with a profilometer, and an impression was made for epoxy replicas. The fluoride varnishes were applied to the experimental specimens of each material at repeated intervals of 48 hours. For all specimens, Ra was measured and SEM replicas were examined. RESULTS: The final Ra of glass ionomer was 3.49 +/- 0.59 (mean +/- SD) for CavityShield, 4.69 +/- 1.33 for Duraflor, and 2.96 +/- 1.53 for the controls. The final Ra of flowable composite was 0.53 +/- 0.20 for CavityShield, 2.61 +/- 3.08 for Duraflor, and 0.15 +/- 0.09 for controls. For glass ionomer and flowable composite, Duraflor was associated with a significantly higher roughness at the final measurement compared to controls (P < 0.05). SEM micrographs showed differing surface topographies which in many specimens confirmed Ra analysis. CONCLUSION: Fuji IX GP and Filtek Flow showed significantly higher roughness after two applications of Duraflor compared to controls.

Phase 2, randomized, dose-ranging study evaluating the safety and efficacy of anidulafungin in invasive candidiasis and candidemia.

This study evaluated the safety and efficacy of anidulafungin, a novel echinocandin, in patients with invasive candidiasis, including candidemia. A total of 123 eligible patients were randomized to one of three intravenous regimens, 50, 75, or 100 mg once daily. Treatment continued for 2 weeks beyond resolution or improvement of signs and symptoms. The primary efficacy criterion was a successful global response rate (i.e., clinical and microbiological success) in the evaluable population at the follow-up (FU) visit, 2 weeks after end of therapy (EOT). One hundred twenty (120) patients received at least one dose of anidulafungin; 68 were evaluable. Review of adverse events and laboratory data indicated no dose response for safety parameters. Non-albicans Candida species accounted for approximately one-half of all isolates. Success rates at EOT were 84, 90, and 89% in the 50-, 75-, and 100-mg groups, respectively. At FU, the success rates were 72, 85, and 83%. Phase 3 studies of anidulafungin for the treatment of invasive candidiasis and candidemia are warranted.

Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever.

BACKGROUND: Patients with neutropenia and persistent fever are often treated empirically with amphotericin B or liposomal amphotericin B to prevent invasive fungal infections. Antifungal triazoles offer a potentially safer and effective alternative. METHODS: In a randomized, international, multicenter trial, we compared voriconazole, a new second-generation triazole, with liposomal amphotericin B for empirical antifungal therapy. RESULTS: A total of 837 patients (415 assigned to voriconazole and 422 to liposomal amphotericin B) were evaluated for success of treatment. The overall success rates were 26.0 percent with voriconazole and 30.6 percent with liposomal amphotericin B (95 percent confidence interval for the difference, -10.6 to 1.6 percentage points); these rates were independent of the administration of antifungal prophylaxis or the use of colony-stimulating factors. There were fewer documented breakthrough fungal infections in patients treated with voriconazole than in those treated with liposomal amphotericin B (8 [1.9 percent] vs. 21 [5.0 percent], P=0.02). The voriconazole group had fewer cases of severe infusion-related reactions (P<0.01) and of nephrotoxicity (P<0.001). The incidence of hepatotoxicity was similar in the two groups. Patients receiving voriconazole had more episodes of transient visual changes than those receiving liposomal amphotericin B (22 percent vs. 1 percent, P<0.001) and more hallucinations (4.3 percent vs. 0.5 percent, P<0.001). Parenteral voriconazole was changed to the oral formulation in 22 percent of the voriconazole group, with a reduction in the mean duration of hospitalization by one day in all patients (P=0.17) but by two days in patients at high risk (P=0.03). CONCLUSIONS: Voriconazole is a suitable alternative to amphotericin B preparations for empirical antifungal therapy in patients with neutropenia and persistent fever.