Long-term mood, quality of life, and seizure freedom in intracranial EEG epilepsy surgery.

OBJECTIVES: To determine the long-term outcomes in patients undergoing intracranial EEG (iEEG) evaluation for epilepsy surgery in terms of seizure freedom, mood, and quality of life at St. Vincent's Hospital, Melbourne. METHODS: Patients who underwent iEEG between 1999 and 2016 were identified. Patients were retrospectively assessed between 2014 and 2017 by specialist clinic record review and telephone survey with standardized validated questionnaires for: 1) seizure freedom using the Engel classification; 2) Mood using the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E); 3) Quality-of-life outcomes using the QOLIE-10 questionnaire. Summary statistics and univariate analysis were performed to investigate variables for significance. RESULTS: Seventy one patients underwent iEEG surgery: 49 Subdural, 14 Depths, 8 Combination with 62/68 (91.9%) of those still alive, available at last follow-up by telephone survey or medical record review (median of 8.2 years). The estimated epileptogenic zone was 62% temporal and 38% extra-temporal. At last follow-up, 69.4% (43/62) were Engel Class I and 30.6% (19/62) were Engel Class II-IV. Further, a depressive episode (NDDI-E > 15)was observed in 34% (16/47), while a 'better quality of life' (QOLIE-10 score < 25) was noted in 74% (31/42). Quality of life (p < 0.001) but not mood (p = 0.24) was associated with seizure freedom. SIGNIFICANCE: Long-term seizure freedom can be observed in patients undergoing complex epilepsy surgery with iEEG evaluation and is associated with good quality of life.

Social Determinants and Teen Pregnancy Prevention: Exploring the Role of Nontraditional Partnerships.

Addressing the social determinants of health (SDOH) that influence teen pregnancy is paramount to eliminating disparities and achieving health equity. Expanding prevention efforts from purely individual behavior change to improving the social, political, economic, and built environments in which people live, learn, work, and play may better equip vulnerable youth to adopt and sustain healthy decisions. In 2010, the Centers for Disease Control and Prevention in partnership with the Office of Adolescent Health funded state- and community-based organizations to develop and implement the Teen Pregnancy Prevention Community-Wide Initiative. This effort approached teen pregnancy from an SDOH perspective, by identifying contextual factors that influence teen pregnancy and other adverse sexual health outcomes among vulnerable youth. Strategies included, but were not limited to, conducting a root cause analysis and establishing nontraditional partnerships to address determinants identified by community members. This article describes the value of an SDOH approach for achieving health equity, explains the integration of such an approach into community-level teen pregnancy prevention activities, and highlights two project partners' efforts to establish and nurture nontraditional partnerships to address specific SDOH.

Lincoln Sign: A Rare Presentation of Medication-related Osteonecrosis of the Jaw.

A 52-year-old female patient with metastatic breast cancer receiving denosumab for 7 years presented with marked diffuse tracer uptake in the mandible on Tc-99m-methylene diphosphonate bone scintigraphy, resembling the Lincoln sign. A diagnosis of medication-related osteonecrosis of the jaw (MRONJ) was confirmed, leading to immediate discontinuation of denosumab. Conservative therapy, including limited debridement and oral rinses, was initiated. MRONJ, a potential complication of bone-modifying agents, is more prevalent in advanced malignancy cases. The Lincoln sign has not been previously reported in MRONJ, emphasizing its consideration in cancer patients undergoing bone-modifying agent treatment.

Tapered Versus Inverted Body-Shift Implants Placed Into Anterior Post-extraction Sockets: A Retrospective Comparative Study.

BACKGROUND: A retrospective comparative radiographic and clinical studywas performed to evaluate primary stability, bone volume, and esthetic outcomes of tapered (T) implants (control group) versus inverted body-shift (INV) implants (test group). METHODS: A total of 42 platform-switched implants, 21 T and 21 INV, were used to replace nonrestorable teeth in maxillary central incisor post-extraction sockets. Implant primary stability and insertion torque values in addition to radiographic differences in labial plate dimension, tooth-to-implant distance, and marginal bone levels were correlated with clinical outcomes using the pink esthetic score (PES). RESULTS: Statistically significant differences (P ≤ .05) were found between groups, with T implants having not only lower primary stability at immediate implant placement than INV implants but also less circumferential bone volume at recall. Consequently, lower PESs were seen in the T implant group that equated to an increased frequency of midfacial recession, tissue discoloration, and papilla loss. CONCLUSIONS: INV implants, which feature a unique macro hybrid design, may offer advantages over T implants in maxillary anterior post-extraction sockets with regard to achieving both higher primary stability and superior esthetic outcomes.

A Paradigm Change in Macro Implant Concept: Inverted Body-Shift Design for Extraction Sockets in the Esthetic Zone.

An innovative macro hybrid implant design is aimed at enhancing labial plate dimension and tooth-implant distance while achieving consistent esthetic outcomes. This unique "body-shift" concept in diameter and shape combines a tapered apical portion with a cylindrical coronal portion in a singular implant body design. The overall configuration of the implant is inverted and "convergent" in form toward the implant-abutment interface where bone is thinnest. Conversely, the tapered apical portion is wider where the bone is greatest in volume and vascularity. By reducing the coronal portion of the implant with the inverted body-shift design, a coronal circumferential chamber is created, thereby allowing larger amounts of graft material to be placed labially and interdentally to create a net increased bone dimension. Use of the implant is demonstrated in a case report.

Minimally Invasive Direct Lateral Corpectomy of the Thoracolumbar Spine for Metastatic Spinal Cord Compression.

Objectives To evaluate the feasibility, safety, clinical, and radiologic outcomes of a minimally invasive direct lateral-approach corpectomy (MIDLaC) for decompression and stabilization of symptomatic metastatic spinal cord compression (MSCC). Methods A retrospective study on a prospective cohort was conducted. Nineteen patients were consecutively treated with MIDLaC and posterior pedicle screw fixation between May 2012 and July 2014. Demographic information and radiologic outcomes including sagittal deformity correction and vertebral body height were recorded. Operative variables (operative duration, blood loss) and clinical variables (Tokuhashi score, mortality, complication rate, pain visual analogue scale [VAS], opioid usage, and Frankel grade) were recorded and analyzed. Results All nineteen patients (mean age: 67.6 ± 12.7 years) successfully underwent MIDLaC with excellent neural decompression. Operative duration was 188.4 ± 30.3 minutes for single-level MIDLaC and 327.2 ± 71.9 minutes for multilevel surgery (p < 0.0001). Mean blood loss per spinal level was 390.8 mL with a decrease to 102.3 mL excluding renal cell MSCC. A total of 47.4% of patients had a Tokuhashi score of 0 to 8. There was one approach-related complication and one perioperative mortality. The overall complication rate was 15.8% (n = 3) with no postoperative wound infections. Kaplan-Meier survival estimates at 6 months were 0.50. Overall, 31.6% of patients improved by one or more Frankel grades, and no patients demonstrated worsening neurology postoperatively. VAS was significantly improved postoperatively (p < 0.05). Vertebral body height was significantly increased (+7.6 ± 8.1 mm; p = 0.002), with improvements in lumbar lordosis (8.3 ± 7.3 degrees) and thoracic kyphosis (2.4 ± 7.1 degrees) postoperatively. Conclusion MIDLaC is a safe and feasible palliative approach in the management of MSCC with encouraging early clinical outcomes. Further prospective studies are required to define the role of MIDLaC in the management of MSCC vis-à-vis other mini-open or minimally invasive techniques.

Analysis of buccolingual dimensional changes of the extraction socket using the "ice cream cone" flapless grafting technique.

The socket or ridge preservation approach known as the "ice cream cone" technique was used in type 2 sockets in this retrospective analysis of 11 extraction sites. A type 2 extraction socket is defined as having the presence of facial soft tissue with a partial or complete dehiscence of the buccal bone plate. All teeth were extracted atraumatically without flap elevation. A resorbable collagen membrane was contoured into an ice cream cone- shape, placed into the socket defect, and grafted with human freeze-dried bone allograft. Buccolingual dimensional changes were measured manually with a digital caliper sensitive to 0.01 mm on pre- and posttreatment casts using an acrylic template and a three-dimensional (3D) digital scanner, as well as radiographically with pre- and post-cone beam computed tomography (CBCT) scans. All implants were placed 6 months after socket preservation and achieved primary stability with a minimum torque value of 35 Ncm with a mean buccal-lingual dimensional loss of 1.32 mm. The dimensional change of the ridge from pre- to postextraction reflective of the healed grafted site ranged from a loss of 0.46 to 2.25 mm with a mean of 1.28 mm (CBCT), 0.31 to 2.71 mm with a mean of 1.36 mm (digital calipers), and 0.21 to 2.80 mm with a mean of 1.32 mm (3D digital scanner). All 11 implants were immobile and clinically osseointegrated. The so-called ice cream cone technique allows for the reconstruction of a buccal plate dehiscence to enable the placement of an implant; however, the ridge dimension was diminished by 1.32 mm compared with the width of the extraction socket prior to tooth removal.

A novel prosthetic device and method for guided tissue preservation of immediate postextraction socket implants.

Preservation of the surrounding hard and soft tissues associated with an immediate postextraction socket implant to replace a nonrestorable tooth in the esthetic zone is one of the greatest challenges facing the dental team. Several studies have documented the biologic and esthetic benefits of bone graft containment with either a custom healing abutment or provisional restoration. Use of a prefabricated shell that replicates the extracted tooth at the cervical region can help achieve guided tissue preservation and sustainable esthetic outcomes in an easy, simple, consistent, and less time consuming way. The following case report of a hopeless maxillary right central incisor in a female patient possessing adjacent teeth with a thin periodontal phenotype illustrates this new treatment device, method, and concept.

Provider's perspectives on the impact of Immigration and Customs Enforcement (ICE) activity on immigrant health.

INTRODUCTION: Increasing Immigration and Customs Enforcement (ICE) activities such as raids, detention, and deportation may be affecting the health and well-being of immigrants. This study sought to understand the impact of ICE activities on immigrant health from the perspective of health care providers. METHODS: An online survey of primary care and emergency medicine providers was conducted to determine whether ICE activity was negatively affecting immigrant patients. RESULTS: Of 327 providers surveyed, 163 responded (50%) and 156 (48%) met criteria for inclusion. Seventy-five (48%) of them observed negative effects of ICE enforcement on the health or health access of immigrant patients. Forty-three providers gave examples of the impact on emotional health, ability to comply with health care recommendations, and access. CONCLUSIONS: Health care providers are witnessing the negative effects of ICE activities on their immigrant patients' psychological and physical health. This should be considered an important determinant of immigrant health.

Community-engaged pedagogy: a strengths-based approach to involving diverse stakeholders in research partnerships.

BACKGROUND: To help build community capacity to partner in translational research partnerships, new approaches to training that incorporate both adult learning models and community-based participatory research (CBPR) are needed. OBJECTIVES: This article describes the educational approach-"community-engaged pedagogy"-used in a capacity-building training program with community partners in Boston. Drawing from adult learning theory and CBPR community-engaged pedagogy embraces co-learning and is rooted in a deep respect for the prior knowledge and experiences that community partners bring to the conversation around CBPR. This approach developed iteratively over the course of the first year of the program. Participating community partners drove the development of this educational approach, as they requested the application of CBPR principles to the educational program. METHODS: The dimensions of community-engaged pedagogy include (1) a relational approach to partnership building, (2) establishment of a learning community, (3) organic curriculum model, (4) collaborative teaching mechanism with diverse faculty, and (5) applied learning. CONCLUSIONS: Using a community-engaged pedagogical approach helps to model respect, reciprocity, and power sharing, core principles of CBPR. Although community partners appreciate this approach, traditionally trained academics may find this method unfamiliar and uncomfortable.

A funding initiative for community-based participatory research: lessons from the Harvard Catalyst Seed Grants.

BACKGROUND: The National Institutes of Health-funded Clinical and Translational Science Awards (CTSA) have increasingly focused on community-engaged research and funded investigators for community-based participatory research (CBPR). However, because CBPR is a collaborative process focused on community-identified research topics, the Harvard CTSA and its Community Advisory Board (CERAB) funded community partners through a CBPR initiative. OBJECTIVES: We describe lessons learned from this seed grants initiative designed to stimulate community-academic CBPR partnerships. METHODS: The CBPR program of the Harvard CTSA and the CERAB developed this initiative and each round incorporated participant and advisory feedback toward program improvement. LESSONS LEARNED: Although this initiative facilitated relevant and innovative research, challenges included variable community research readiness, insufficient project time, and difficulties identifying investigators for new partnerships. CONCLUSION: Seed grants can foster innovative CBPR projects. Similar initiatives should consider preliminary assessments of community research readiness as well as strategies for meaningful academic researcher engagement.

Analysis of multilocus sequence typing schemes for 35 different bacteria revealed that gene loci of 10 bacteria could be replaced to improve cost-effectiveness.

Although multilocus sequence typing (MLST) has been widely used for bacterial typing, the contribution of the gene loci to the discriminatory power of each MLST scheme is unknown. We analyzed the discriminatory powers of 36 MLST schemes using all combinations of the 7 loci and contributions of each locus to the schemes. In 10 schemes, sequencing 6 loci can achieve the discriminatory powers of 7 loci. For the other 26 schemes, the median marginal increase in discriminatory power when 7 instead of 6 loci were used is 0.0004. Sequencing the 7 loci of 50 strains each of Pseudomonas aeruginosa and Acinetobacter baumannii revealed that the discriminatory power for P. aeruginosa was 0.9861 when either 6 (without trp) or 7 loci were used and that for A. baumannii was 0.9363 when 5, 6, or 7 loci were used. Genes that have no additional or minimal contribution to the overall discriminatory powers should be replaced.

The impact of Immigration and Customs Enforcement on immigrant health: perceptions of immigrants in Everett, Massachusetts, USA.

U.S. immigrants have faced a changing landscape with regard to immigration enforcement over the last two decades. Following the passage of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, and the creation of the Immigration and Customs Enforcement (ICE) agency after the attacks of September 11, 2001, detention and deportation activity increased substantially. As a result, immigrants today are experiencing heightened fear of profiling and deportation. Little research exists on how these activities affect the health and well-being of U.S. immigrant communities. This study sought to address this gap by using community-based participatory research to investigate the impact of enhanced immigration enforcement on immigrant health in Everett, Massachusetts, USA, a city with a large and diverse immigrant population. Community partners and researchers conducted 6 focus groups with 52 immigrant participants (documented and undocumented) in five languages in May 2009. The major themes across the groups included: 1) Fear of deportation, 2) Fear of collaboration between local law enforcement and ICE and perception of arbitrariness on the part of the former and 3) Concerns about not being able to furnish documentation required to apply for insurance and for health care. Documented and undocumented immigrants reported high levels of stress due to deportation fear, which affected their emotional well-being and their access to health services. Recommendations from the focus groups included improving relationships between immigrants and local police, educating immigrants on their rights and responsibilities as residents, and holding sessions to improve civic engagement. Immigration enforcement activities and the resulting deportation fear are contextual factors that undermine trust in community institutions and social capital, with implications for health and effective integration processes. These factors should be considered by any community seeking to improve the integration process.