Establishment, management, and maintenance of the phoenix islands protected area.

The Republic of Kiribati's Phoenix Islands Protected Area (PIPA), located in the equatorial central Pacific, is the largest and deepest UNESCO World Heritage site on earth. Created in 2008, it was the first Marine Protected Area (MPA) of its kind (at the time of inception, the largest in the world) and includes eight low-lying islands, shallow coral reefs, submerged shallow and deep seamounts and extensive open-ocean and ocean floor habitat. Due to their isolation, the shallow reef habitats have been protected de facto from severe exploitation, though the surrounding waters have been continually fished for large pelagics and whales over many decades. PIPA was created under a partnership between the Government of Kiribati and the international non-governmental organizations-Conservation International and the New England Aquarium. PIPA has a unique conservation strategy as the first marine MPA to use a conservation contract mechanism with a corresponding Conservation Trust established to be both a sustainable financing mechanism and a check-and-balance to the oversight and maintenance of the MPA. As PIPA moves forward with its management objectives, it is well positioned to be a global model for large MPA design and implementation in similar contexts. The islands and shallow reefs have already shown benefits from protection, though the pending full closure of PIPA (and assessments thereof) will be critical for determining success of the MPA as a refuge for open-ocean pelagic and deep-sea marine life. As global ocean resources are continually being extracted to support a growing global population, PIPA's closure is both timely and of global significance.

Use of an Electronic Patient Record system to evaluate restorative treatment following root canal therapy.

Electronic Patient Record (EPR) systems are rapidly gaining acceptance as an important tool for managing patient information. The purpose of this project was to evaluate the use of an EPR system for assessment of quality of care in an academic dental institution. The primary outcome of interest was the timeliness and completeness of restorative care following completion of nonsurgical root canal therapy. An initial query of the EPR database was performed using the following inclusion criteria: root canal treatment performed in the postgraduate endodontics clinic between September 2002 and June 2004, patient age > or =18 years old, and posterior tooth (premolars and molars). A total of 925 patients with 1,014 endodontically treated teeth met the inclusion criteria. A random sample of 30 percent of the treated teeth (302 teeth on 281 patients) was selected for detailed review. This sample of 302 teeth was then screened to determine if any restorative treatment had been performed between September 2002 and November 2005. Forty-eight percent (n=146) of the 302 teeth did not receive any form of permanent restoration over the time period studied. Twenty-five percent (n=75) of the teeth received a buildup only, and 27 percent (n=82) received the recommended treatment, a full occlusal coverage restoration. This study documents the use of an EPR system to objectively and efficiently assess one aspect of quality of care in a dental school environment.