Development of a Needs Assessment for Low-income Seniors in Cleveland Ohio: A student-driven Interprofessional Approach.

BACKGROUND AND OBJECTIVE: Older persons with low socioeconomic status in the United States have different and unique health needs compared to younger persons. As part of a student-led, interprofessional partnership, we performed a needs assessment of community dwelling older persons with low socioeconomic status in an urban location within Ohio, USA. METHODS: Three entities participated in the needs assessment: a student-run health clinic, a Federally Qualified Health Center, and an apartment complex of the study population. Health professional students from medical, dental, nursing, social work, nutrition, and physician assistant programs led the needs assessment process. The process consisted of multiple phases, which included preliminary literature review, survey development, data collection, and analysis. The final survey was multidisciplinary, with six content areas covered in 37 items. RESULTS: One hundred nineteen survey responses were received, and multiple areas of need were identified including food insecurity, dental care access, and mental health. 93% of participants had at least one unmet health need and 39% of respondents met our classification for high need. The needs of the local study population had key differences from previously published data in more generalized populations of older community-dwelling individuals in the United States, notably lower utilization of dental care (43% vs. 66%), increased prevalence of possible food insecurity (30% vs. 17%), and increased use of age-appropriate preventive cancer screening services. CONCLUSIONS: Multiple areas of need were successfully identified through a student-led interprofessional needs assessment. Future student teams can address the identified needs, again through interprofessional collaborations. This process may have unique benefits to help build robust community-academic partnerships, while fostering interprofessional collaborative opportunities among healthcare students.

Maternal and Infant Pathways HUB in NE Ohio: Influence on Birth Outcomes.

INTRODUCTION: This investigation examines the outcomes of the Pathways HUB Community Action, a Maternal and Infant Mortality HUB in NE Ohio. The purpose of a HUB is to provide a one-stop point of contact for primarily minority pregnant women who are low-income and are at high risk for pregnancy complications. As a HUB client, each mother is assigned a community health worker who provides wrap-around support across 20 identified areas of potential need. METHODS: The focus of this evaluation is on the women who were enrolled in the PHCA and gave birth between 2016 and 2020. Pre-existing data was used to examine the association between mother variables and birth outcomes using odds ratio and correlation analysis. RESULTS: Using a within-subjects design, results indicate that there is no significant association between preterm rates for women who have previously experienced one or more preterm deliveries. Likewise, results indicate that there is no significant association on the birth weight of infants of enrolled women who have previously given birth to a low-birth-weight infant. Results indicate that there is a strong significant association between 1st and 2nd-trimester enrollee's dosage of PHCA services and supports and positive birth outcomes. DISCUSSION: These findings suggest that the PHCA is providing needed support and assistance to at-risk pregnant women who are mitigating the likelihood of repeated preterm and low-weight births, therefore lowering the likelihood of infant mortality for their clients in Summit County.

This research is the first known study to investigate the impact of HUB services in reducing infant mortality. Since preterm births are the greatest predictor of infant mortality, reducing the number of preterm births can result in better outcomes. Prior preterm births, for those women receiving support from the PHCA, is not longer a significant predictor of another preterm birth.

A True "Uomo Universale" from the 1800s - Dr. George Watt.

A hot bed of organized dental leadership and visionary thinking in the mid-to-late 1800s came from Ohio, as many presidents of the American Dental Association were from that state. They were quite influential in leading this organization into the 20th century. One of the most dynamic and well-rounded individuals was Dr. George Watt…this paper will highlight his life as viewed by one of his peers.

Correlations between dental wear and oral cavity characteristics: Mandibular torus, palatine torus, and oral exostoses.

OBJECTIVE: This study evaluates the correlations amongst mandibular torus, palatine torus, oral exostoses to dental wear/loss and temporomandibular damage. METHODS: The sample consists of 504 skulls from the Hamann-Todd Osteological Collection; 223 African American and 281 European Americans aged between 30 and 80 years. The sample was analyzed using Pearson's Chi-square for significance of sex, age, ancestry, and wear as well as the interactions between the demographic variables and the presence of mandibular torus, palatine torus and oral exostoses. RESULTS: Wear was statistically significant by age and sex but not ancestry. The maxillary exostoses varied significantly by age, ancestry and wear but not sex. Mandibular torus frequencies varied significantly by wear, sex and ancestry. The palatine torus varied significantly across wear groups, sex and ancestry. DISCUSSION: The etiology of nonmetric oral cavity characteristics, mandibular torus, palatine torus and oral exostosis, is complex. The degree to which traits' presence and expression is the result of genetic and environmental interactions is not fully understood. More than age, sex or ancestry, the degree of dental wear and tooth loss influences the presence and expression of the oral cavity traits. The sample can be characterized as the presence of exostoses in higher frequencies in young African American males with little tooth loss. Males of both ancestral groups with heavy wear have higher frequencies of mandibular tori than females. The palatine torus is more common in edentulous European American females.

Racial and Economic Adversity Differences in Stress Markers and Immune Function Among Urban Adolescents.

BACKGROUND: Exposure to racism and associated adversities, such as poverty, is hypothesized to contribute to racial inequities in health via stress and immune pathways. Furthermore, the effects of adversity may be more salient during sensitive developmental periods. Our study examined racial differences in stress and immune biomarkers during adolescence and the effects of exposure to economic adversity at distinct developmental time periods and cumulatively in accounting for potential racial differences. METHODS: Secondary analysis of the Adolescent Health and Development in Context study was conducted. Data were derived from self-administered surveys; interviews; smartphone-based, geographic-explicit ecological momentary assessment; stress biomarkers (evening salivary cortisol over six nights and hair cortisol); and immune biomarkers (salivary shedding of Epstein-Barr virus [EBV] DNA among EBV-positive adolescents). Current socioeconomic status measures included annual household income and caregiver education. Caregivers also reported experiences of bankruptcy, difficulty paying bills, receipt of food stamps/Supplemental Nutrition Assistance Program/electronic benefit transfer, and job loss when the child was of ages birth-5 years, 6-10 years, and 11 years or older. An affirmative response to any item was defined as exposure to economic adversity for that developmental time period (yes/no). A cumulative economic adversity measure was calculated as the sum of exposures across developmental periods (0 = never exposed to 3 = exposed across all time periods). Descriptive and multivariable regression analyses were conducted, accounting for covariates. RESULTS: Black/African American adolescents had higher salivary cortisol concentration, higher hair cortisol concentration, and an increased odd of salivary shedding of EBV DNA compared to White adolescents. Racial differences were not attenuated by the current socioeconomic status or economic adversity (developmental period or cumulatively). DISCUSSION: Our study provides evidence that stress and immune biomarkers differ by race as early as adolescence and may be one pathway through which racism and associated adversities contribute to racial health inequities. Further research on the contribution of multiple adversities beyond poverty to racial inequities in physiological stress and health is critical for informing effective prevention and intervention efforts.

County-level correlates of dental service utilization for low income pregnant women. Ecologic study of the North Carolina Medicaid for Pregnant Women (MPW) program.

BACKGROUND: Dental care utilization for low income pregnant women is met with challenges in the traditional dentist-centered model of care. County-level measures provide insights for policy and roles for stakeholders that extend beyond the dentist-patient relationship. We examined county-level data to generate hypotheses about factors that influence utilization of dental services in North Carolina's Medicaid for Pregnant Women (MPW) program. METHODS: County-level Medicaid utilization data for dental services for 2014-2016 were pooled to get mean county estimates of dental utilization in the MPW program. Descriptive statistics and multivariate regression models of dental utilization and county-level measures are presented. Data used were collected by NC Child and the Robert Wood Johnson Foundation's County Health Rankings Reports. USDA Economic Research Service data were used to categorize counties in terms of Farming, Recreation, Persistent Poverty, and metro/non-metro status using Rural Urban Continuum Codes. RESULTS: Dental utilization ranged from 1-26% with a median of 8.5% across the 100 counties of North Carolina. Strong patterns linking utilization of dental services in the MPW program to contextual social measures of well-being emerged, specifically, increased reporting of child abuse and neglect, elevated infant mortality, poor quality of life, and worse ranking in years of potential life lost. Counties with persistent poverty had lower rates of dental utilization. CONCLUSIONS: Utilization of dental services in the MPW program is generally low. Patterns identify the potential for enhancing community-clinical linkages to improve birth outcomes and care coordination for pregnant women to enhance dental utilization in this population. Dental coverage in the Medicaid program in most states is administered separately from medical coverage. The separation of the funding mechanisms adds a further layer of complexity to care integration. Efforts to enhance dental care for pregnant women in the Medicaid program may benefit from policy that aligns incentives for care coordination within the community. Policy that extends the window of eligibility for dental benefits to 24 months after the birth of the child will help women complete the dental treatment that is needed. This also leverages the value of care coordination for community stakeholders from diverse child health sectors.

"Shared Decision-Making" in Athletes With Known Cardiac Disease: Interpretation and Implementation in the Real World.

OBJECTIVE: Recommendations for addressing sporting eligibility and disqualification in athletes with heart disease have traditionally used a paternalistic approach with cardiologists making a binary "yes-no" decision. This paradigm has recently evolved to a shared decision-making model recognizing and respecting the autonomy of the athlete while instituting safeguards to mitigate risk where possible. How well this paradigm is understood or has been integrated into the athletic trainer (AT) community is unknown. DESIGN: Athletic trainers from the Ohio High School Athletic Association were surveyed. RESULTS: Of 107 ATs who responded, we found that the majority had not heard of the term "shared decision-making" in the context of sporting participation [62.6%, confidence interval (CI) 0.53-0.72 vs 37.4%, CI 0.28-0.47]. Furthermore, we found large discrepancies as to how ATs would interpret and implement recommendations from cardiologists. CONCLUSIONS: This study highlights the need to educate and improve communication between AT, sports medicine physicians, and sports cardiologists if shared decision-making strategies are to become widely implemented.

Victorian Era Kitten Cuisine?

Humphrey Bogart's mother (Fig. 1)1 undoubtedly had a strange sense of humor. How else can one explain Maud Humphrey's bizarre image, on a stock trade card, of a lovely little lass dressed up in her Sunday best lighting the flame under a chafing dish containing two adorable kittens (Figs. 2-5)? Were kitten fondue or kitty feline stew, dishes du jour in Victorian times? Pictured here are three Victorian trade cards, related to dentistry, featuring Maud Humphrey's adorable little kitten chef. Dr. Eli H. Neiman of York, Pennsylvania, and Dr. Charles S. Decker of Binghamton, New York, chose this stock image to advertise their respective dental practices (Figs. 3 & 4), Ramon's Relief pain medication, including toothache relief, and RAMON'S LIVER PILLS AND TONIC PELLETS were available from W.E. JUDAY in West Manchester, Ohio (Figure 4). Note on the reverse of the Dr. Decker card, that for 50 cents "Vitalized Air for Painless Extracting" was offered. "Vitalized Air" was nitrous oxide altered with small amounts of chloroform and alcohol.2-4 Could it be that Maud had sniffed a bit of Vitalized Air before rendering her shocking kitty-cooking image?

Body Mass Index and Age Affect Maximum Mouth Opening in a Contemporary American Population.

PURPOSE: Although a standard cutoff value of less than 35 mm in the maximum mouth opening (MMO) has been used to diagnose trismus, this value does not account for natural demographic variations. The present cross-sectional study investigated the effects of age, weight, height, body mass index (BMI), and gender on the MMO in a healthy, heterogeneous population. MATERIALS AND METHODS: A volunteer sample from multiple sites in Cincinnati, Ohio, without any reported head and neck pathologies or current dental prostheses and with intact natural incisors were included. The main outcome measure was the average MMO. Key demographic information was collected from each participant. Multivariate regression analysis was completed on the factors of age, gender, weight, and height. One-way analysis of variance was completed for binned categories of BMI. RESULTS: Data from 330 participants (age range, 18 to 86 years; mean, 42.13 ± 18.53 years; 171 men, 159 women) were collected. The range of MMO was 31 to 71 mm. Age, height, and weight were significant predictors of the MMO, and the final model accounted for ∼20% of the variation in the MMO [adjusted r2, 0.208; F(3,326) = 29.731; P = .001]. On average, individuals with a greater BMI had a greater MMO (BMI, ≤25 kg/m2, 50.57 ± 7.16 mm; BMI >25 but ≤30 kg/m2, 51.58 ± 7.13 mm; BMI >30 kg/m2, 53.53 ± 9.84 mm). CONCLUSIONS: In a heterogeneous population of healthy adults, natural variations in age, height, and weight significantly affected the MMO.

Effects of orthognathic surgery on quality of life compared with nonsurgical controls in an American population.

INTRODUCTION: To determine the psychosocial effects of a facial skeletal mal-relationship with its subsequent surgical correction in a group of patients treated using surgical orthodontics compared with a matched group of nontreated controls. METHODS: This study was approved by The Ohio State University Institutional Review Board. Subjects were patients presenting with facial skeletal mal-relationships whose proposed treatment plans included orthognathic surgery. This study used valid and reliable questionnaires: Orthognathic Quality of Life Questionnaire (OQLQ), Beck Depression Inventory II (Children's Depression Inventory - 2), Satisfaction with Life Scale, and State Trait Anxiety Inventory (State Trait Anxiety Inventory for Children), administered at 3 different stages of treatment (time 1 = initial pretreatment, time 2 = before oral surgery, and time 3 = at completion of treatment). Matched controls recruited at each time point completed the same questionnaires. RESULTS: A total of 267 subjects were recruited to participate in this study. There were no significant differences between treatment and control groups in age, sex, education level, or employment status at any of the 3 time points. The randomization test was used to compare values for all outcome variables between groups at the 3 stages of treatment. For the pretreatment period, T1, there were significant differences between patients and controls in domains 1 (P = 0.0126), 2 (P = 0.0000), and 3 (P = 0.0000) of the OQLQ (social aspects, facial esthetics, and oral function, respectively) as well as total OQLQ (P = 0.0000). For the presurgery period, T2, there were significant differences between patients and controls in domains 2 (P = 0.0136) and 3 (P = 0.0001) of the OQLQ (facial esthetics and oral function) as well as total OQLQ (P = 0.0291). Finally, for the posttreatment period, T3, there was a significant difference between patients and controls only in domain 3 (P = 0.0196) of the OQLQ (oral function). CONCLUSIONS: The psychosocial profile of patients with a facial skeletal mal-relationship does not differ from the general population in depression, anxiety, and overall satisfaction with life. However, these patients do report a reduced quality of life based on condition-specific measures in social aspects, facial esthetics, and oral function. Concerns about oral function remain even up to 2 years after treatment is completed.

In utero metal exposures measured in deciduous teeth and birth outcomes in a racially-diverse urban cohort.

A growing number of studies have examined associations of metal exposures with birth outcomes, however, results from these studies have been inconsistent, and hampered by methodological limitations. We measured direct fetal exposure to three metals (lead, manganese and zinc) during the second and third trimester and examined its association with birth weight and gestational age at delivery. Participants in the Wayne County Health, Environment, Allergy and Asthma Longitudinal Study (WHEALS), a population-based birth cohort established between September 2003 and December 2007, were invited to donate teeth to the study. Lead, manganese and zinc during the second and third trimesters were measured via high-resolution microspatial mapping of dentin growth rings, a validated biomarker for prenatal metal exposure. Gestational age at delivery and infant birth weight were obtained from the delivery medical record. A total of 145 children had tooth metal measurements and birth outcome data. Mean birth weight was 3431 ±â€¯472 g and mean gestational age at delivery was 39.0 ±â€¯1.3 weeks. Overall, there was a positive association between second (ß = 0.21, 95% CI: 0.05, 0.37, P = 0.01) and third trimester (ß = 0.21, 95% CI: 0.05, 0.37, P = 0.01) tooth manganese and birth weight Z-score; this remained statistically significant after covariate adjustment. There was also a negative association between second trimester tooth lead level and birth weight Z-score (ß = -0.20, 95% CI: -0.38, -0.02, P = 0.02), however, this was attenuated after adjusting for covariates. Mixture analysis revealed similar findings. There was evidence for a sex-specific effect of manganese with birth weight Z-score, with the association stronger in female compared to male infants. Overall, we found evidence suggesting that higher in utero manganese is associated with larger birth weight Z-scores and that these associations may vary by infant sex.

The association between histological subtype of a first primary endometrial cancer and second cancer risk.

OBJECTIVE: To evaluate the risk of a second primary cancer after endometrial cancer according to histological subtype. METHODS: Using data from the 13 National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registries we identified women diagnosed with a primary endometrial cancer between 1992 and 2014. We calculated standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) for second primary cancer risk (all anatomical sites combined and for individual anatomical sites) among patients with endometrial cancer compared with the general population, in the overall study population and according to histological subtype. RESULTS: Among 96 256 women diagnosed with endometrial cancer, 8.4% (n=8083) developed a second primary cancer. The risk of second primary cancer was higher among patients with endometrial cancer than in the general population (SIR=1.05, 95% CI 1.03 to 1.07). We observed significantly higher second primary cancer risk among women with high grade endometrioid (SIR=1.12, 95% CI 1.05 to 1.19), serous (SIR=1.24, 95% CI 1.11 to 1.38), carcinosarcoma (SIR=1.18, 95% CI 1.02 to 1.35), mixed epithelial (SIR=1.22, 95% CI 1.06 to 1.40), and sarcoma (SIR=1.28, 95% CI 1.12 to 1.45) compared with the general population, but not for women with low grade endometrioid (SIR=1.01, 95% CI 0.98 to 1.03) or clear cell (SIR=1.09, 95% CI 0.88 to 1.33) endometrial cancer. Women with low grade endometrioid endometrial cancer had significantly lower second primary cancer risks in the gum and other mouth (SIR=0.57, 95% CI 0.30 to 0.97), lung and bronchus (SIR=0.72, 95% CI 0.66 to 0.77), and lymphocytic leukemia (SIR=0.71, 95% CI 0.54 to 0.93) while women with high risk endometrial cancer histological subtypes experienced significantly higher second primary cancer risk at several anatomical sites. CONCLUSIONS: Risk of developing second primary cancersat all anatomic sites combined and at individual anatomical sites varied according to histological subtype. Clinicians should be aware that women with different histological subtypes carry different second primary cancer risks .

Should five to eleven-year-olds use manual or electric toothbrushes to clean their teeth?

Design A cohort study design was used. 120 healthy children were randomly assigned to a manual group and an electric tooth brushing group. Plaque scores plus a post-brushing questionnaire examining executive function/motor skills using indices from the occupational and developmental sciences (e.g. shoelace tying), was completed by the parents .Sample selection 120 subjects were recruited from a single site, the Nationwide Children's Hospital in Columbus, Ohio. The entire research project was carried out in the dental department there.All children were fit and healthy and presented with:• No caries• No disability that would affect the task completion• No injury to the dominant hand• Adequate parental literacy to complete a questionnaire• Teeth present to score.All ages were evenly represented in the final sample.Data analysis Two hygienists and one dentist were calibrated and trained in the use of the OHI-S plaque scoring system. Reliability was determined using the Cohen's kappa. Teeth were disclosed and pre-brushing plaque scores were obtained. A set of brief brushing instructions were delivered orally to the patient. The children were given a brush and were asked to brush at a sink with no toothpaste or mirror. The minimum brushing time was 30 seconds but the children were unaware that they were being timed. Post- brushing plaque scores were measured.Results The response rate to the questionnaire was 100%. A chi-square test was carried out on the data. The results showed that if a child can exhibit the following skills/characteristics they were more likely to perform well in the brushing task• Never has poor handwriting• Always writes their address• Always ties their own shoes• Always cuts food into bite-sized pieces• Can cut out complex shapes.There was a positive correlation between pre-brushing scores and post-brushing scores .Conclusions Good handwriting and other motor/cognitive skills were linked to good tooth brushing and manual and electric toothbrushing were equally effective at removing plaque. If a child was able to play a musical instrument well, they were likely to have less plaque. The study also demonstrated that parents are good judges of their children's abilities and motor skills.

How Much Noise Is an Oral and Maxillofacial Surgeon Exposed to?

PURPOSE: A common concern among oral and maxillofacial surgeons (OMSs) is progressive hearing loss throughout their careers. Although this has not been critically studied, there could be several factors that contribute to this detriment, including drills, saws, suction, music, and other sounds within the closed operating environment. This study observed the intensity of noise in operating rooms (ORs) and clinical settings during the use of drills, saws, surgical handpieces, and other tools. MATERIALS AND METHODS: In this cross-sectional study, sound intensities were measured in decibels using a CEM DT-8851 industrial high-accuracy digital sound noise level meter data logger in clinics and ORs. The device measured sound intensities during the entire duration of the procedures. The recorded drilling periods were extracted from the data and t tests were run to determine whether a statistically relevant difference existed between the non-drilling and drilling periods. In addition, the duration during which intensity was greater than or equal to 85 dB was measured. RESULTS: Fifty procedures were recorded in the clinical setting and 50 were recorded in the OR. The results of this study proved that OMSs were indeed exposed to sound intensities in decibels that exceeded Occupational Safety and Health Administration (OSHA) guidelines, but these exposures occurred less than 1% of the time. The maximum recorded intensities in the clinic and OR were during a non-drilling period and these were attributed to suction. CONCLUSION: OSHA guidelines were exceeded in clinical and OR settings, but the results were not relevant. The authors believe this is a very promising study for future endeavors. They found that the threshold set by OSHA was exceeded at points during surgical procedures in the clinic and OR. This will prompt future studies focusing on recordings when suction is used and longitudinal studies of individual OMSs.

Ohio's Medicaid Expansion and Unmet Health Needs Among Low-Income Women of Reproductive Age.

Objective To examine changes in the prevalence and odds of unmet healthcare needs and healthcare utilization among low-income women of reproductive age (WRA) after Ohio's 2014, ACA-associated Medicaid expansion, which extended coverage to non-senior adults with a family income ≤ 138% of the federal poverty level. Methods We analyzed publically available data from the 2012 and 2015 Ohio Medicaid Assessment Survey (OMAS), a cross-sectional telephone survey of Ohio's non-institutionalized adult population. The study included 489 low-income women in 2012 and 1273 in 2015 aged 19-44 years who were newly eligible for Medicaid after expansion in January 2014. Four unmet healthcare need and three healthcare utilization measures were examined. We fit survey-weighted logistic regression models adjusted for race/ethnicity, working status, and educational attainment to determine whether the odds of each measure differed between 2012 and 2015. Results In 2015, low-income WRA had a significantly lower odds of reporting an unmet dental care need (ORadj = 0.72, 95% CI 0.54, 0.95), unmet vision care need (ORadj = 0.68, 95% CI 0.50, 0.93), unmet mental health need (ORadj = 0.57, 95% CI 0.39, 0.83), and unmet prescription need (ORadj = 0.39, 95% CI 0.45, 0.80) compared to 2012. There were no significant differences in the odds of seeing a doctor or dentist in the past year or of having a usual source of care for low-income WRA in 2012 and 2015. Conclusions for Practice After Ohio's 2014 Medicaid expansion the odds of low-income WRA having unmet healthcare needs was reduced. Future research should examine outcomes after a longer period of follow-up and include additional measures, such as self-rated health status.

Effects of Case Western Reserve University's transverse analysis on the quality of orthodontic treatment.

INTRODUCTION: The purpose of this study was to evaluate the effect of using the transverse analysis developed at Case Western Reserve University (CWRU) in Cleveland, Ohio. The hypotheses were based on the following: (1) Does following CWRU's transverse analysis improve the orthodontic results? (2) Does following CWRU's transverse analysis minimize the active treatment duration? METHODS: A retrospective cohort research study was conducted on a randomly selected sample of 100 subjects. The sample had CWRU's analysis performed retrospectively, and the sample was divided according to whether the subjects followed what CWRU's transverse analysis would have suggested. The American Board of Orthodontics discrepancy index was used to assess the pretreatment records, and quality of the result was evaluated using the American Board of Orthodontics cast/radiograph evaluation. The Mann-Whitney test was used for the comparison. RESULTS: CWRU's transverse analysis significantly improved the total cast/radiograph evaluation scores (P = 0.041), especially the buccolingual inclination component (P = 0.001). However, it did not significantly affect treatment duration (P = 0.106). CONCLUSIONS: CWRU's transverse analysis significantly improves the orthodontic results but does not have significant effects on treatment duration.

Community Needs Assessment After Microcystin Toxin Contamination of a Municipal Water Supply - Lucas County, Ohio, September 2014.

On August 1, 2014, routine testing at the Collins Park Water Treatment Plant in Lucas County, Ohio, revealed microcystin toxin levels in drinking water had reached 3.19 µg/L, surpassing the Ohio Environmental Protection Agency (EPA) drinking water advisory threshold of 1.0 µg/L. Microcystin is a hepatoxin released by cyanobacteria in certain harmful algal blooms. Exposure to microcystin has been associated with gastrointestinal and hepatic illness in both humans and animals (1-3). On August 2, a do-not-drink advisory was issued, warning community members not to drink, boil, or use the water for cooking or brushing teeth. Public health officials used traditional and social media outlets to disseminate public health messages to affected communities. On August 4, 2014, the advisory was lifted after multiple water samples confirmed microcystin toxin levels had dropped below the advisory threshold. To assess communication strategies, water exposure, and household needs, the Ohio Department of Health (ODH) and Toledo-Lucas County Health Department (TLCHD) conducted a Community Assessment for Public Health Emergency Response (CASPER) in Lucas County. Most households (88.1%) reported hearing about the advisory the morning it was issued, but 11% reported drinking and 21% reported brushing teeth with municipal water during the advisory. Household members reported physical (16%) and mental (10%) health concerns that they believed were related to the advisory and activity disruptions including temporarily staying outside of the home (6%) during the advisory and continued use of alternative water sources after the advisory was lifted (82%). During a do-not-drink advisory, governmental agencies and community partners need to engage in joint prevention and response efforts to decrease water exposure and prevent activity disruptions.

Nutrient-Controlled Niche Differentiation of Western Lake Erie Cyanobacterial Populations Revealed via Metatranscriptomic Surveys.

Although toxic cyanobacterial blooms in western Lake Erie threaten drinking water supplies and are promoted by nutrient loading, the precise nutrient regime that selects specific cyanobacteria populations is poorly understood. Here, we assess shifts in cyanobacterial abundances and global gene-expression patterns in response to natural and manipulated gradients in nitrogen and phosphorus to identify gene pathways that facilitate dominance by different cyanobacteria. Gradients in soluble reactive phosphorus shaped cyanobacterial communities and elicited the largest transcriptomic responses. Under high-P conditions (closest to the mouth of the Maumee River), Anabaena and Planktothrix were the dominant cyanobacterial populations, and experimental P and ammonium enrichment promoted nitrogen fixation gene (nifH) expression in Anabaena. For Microcystis, experimental additions of P up-regulated genes involved in phage defense, genomic rearrangement, and nitrogen acquisition but led to lower abundances. Within offshore, low-P regions of the western basin of Lake Erie, Microcystis up-regulated genes associated with P scavenging (pstSCAB, phoX) and dominated cyanobacterial communities. Experimental additions of ammonium and urea did not alter Microcystis abundances but did up-regulate protease inhibitors (aer and mcn gene sets) and microcystin synthetase genes (mcy), with urea enrichment yielding significant increases in microcystin concentrations. Our findings suggest that management plans that reduce P loads alone may not significantly reduce the risk of cyanobacterial blooms in western Lake Erie but rather may promote a shift among cyanobacterial populations (Microcystis, Anabaena, and Planktothrix) toward a greater dominance by toxic strains of Microcystis.

Intracemetery biological variation at the fort ancient sunwatch village.

OBJECTIVES: We investigate intracemetery biological variation at the Fort Ancient SunWatch village (800-500 BP.) to test the hypothesis that the SunWatch population consisted of spatially structured biologically differentiated kin groups consisting of distinct local Late Woodland and non-local Mississippian biological populations. MATERIAL AND METHODS: The SunWatch sample contains 166 individuals: 63 adults and 103 subadults. We analyze intracemetery biological variation using two feature sets: the buccolingual diameters of the polar teeth in the permanent (n = 37) and deciduous (n = 26) dentitions. We apply matrix correlation models to biodistance and grave distance matrices in both data sets, evaluate burial outliers and individuals exhibiting a rare dental feature with interindividual biological distances, and evaluate potential cultural subgroups with Mahalanobis' distance. RESULTS: Matrix correlation analyses for both feature sets as well as interindividual and subgroup distances indicate the SunWatch village cemetery was kin structured, contained a single primary biological population, and also contained a small number of non-local individuals most of whom were from closely related populations. We thus reject the hypothesis that the SunWatch population consisted of biologically distinct Late Woodland and Mississippian biological populations. DISCUSSION: Although SunWatch village exhibited cultural attributes characteristic of both local Late Woodland and non-local Mississippian groups, biologically the village was composed of one primary population. The lack of evidence for marked biological differentiation in the SunWatch village area at about 800-500 BP. suggests diffusion and acculturation may account for Mississippian cultural characteristics in southwestern Ohio Fort Ancient villages. If gene flow or migrations from biologically distinct Mississippian populations into southwestern Ohio occurred, either or both likely occurred well before 800 BP. This would have allowed the process of admixture time to produce a relatively homogeneous, nondifferentiated population. The latter alternative is consistent with the appearance in southwestern Ohio of non-local individuals at one site linked to surrounding Mississippian regions at about 950 BP. Am J Phys Anthropol 160:719-728, 2016. © 2016 Wiley Periodicals, Inc.

Shifts in subsistence type and its impact on the human skull's morphological integration.

OBJECTIVE: Here we evaluate morphological integration patterns and magnitudes in different skull regions to detect if shifts in morphological integration are correlated to the appearance of more processed (softer) diets. METHODS: To do so, three transitional populations were analyzed, including samples from groups that inhabited the same geographical region and for which the evidence shows that major changes occurred in their subsistence mode. Ninety three-dimensional landmarks were digitized on 357 skulls and used as the raw data to develop geometric morphometric analyses. The landmark coordinates were divided into several different regions of biomechanical interest, following a three-level hierarchically nested scheme: the whole skull, further subdivided into neurocranium (divided into the vault and basicranium), the facial (divided into the lower and upper facial), and the masticatory apparatus (divided into alveolar, temporal, and temporo-mandibular joint). RESULTS: Our results indicate that the morphological integration and variability patterns significantly vary across skull regions but are maintained across the transitions. The alveolar border and the lower facial are the regions manifesting greater value of morphological integration and variability, while the upper facial, the temporo-mandibular joint, and the basicranium are highly integrated and poorly variable. CONCLUSIONS: The transition to softer diets increased morphological variation across cranial regions that are more exposed to masticatory strains effects.