Laypeople's interpretation of, and preference for, orthodontic images.

BACKGROUND: Good communication is fundamental to provision of information and patient engagement in orthodontic treatment. Images can be used to support verbal and written information, but little is known about how laypeople interpret orthodontic images. OBJECTIVE: To explore laypeople's understanding and preferences for images (clinical photographs and medical illustrations) relating to orthodontic diagnoses and treatments. DESIGN: Cross-sectional survey. SETTING: UK. POPULATION: Laypeople aged ⩾16 years. METHODS: Participants were recruited through social media to complete an online questionnaire containing six pairs of images (clinical photograph and medical illustration) relating to orthodontic diagnoses and treatment. Photographs were selected from a bank with input from laypeople, then a matching medical illustration was created. Images were presented with questions relating to interpretation, preferences and reasons for preferences. RESULTS: A total of 898 people completed the questionnaire. Interpretation of images by laypeople was variable and, in some cases, normal intra-oral features and image orientation caused confusion. A combination of photograph and illustration were preferred for images representing diagnosis (by 41%-50% participants), whereas the illustration alone or both photograph and illustration together was preferred for explaining treatment (43%-48% and 35%-44%, respectively). Photographs were liked for their realism and relatability, while illustrations were often found to be clearer. Arrows aided participants' understanding of the images, but annotations were requested to further improve the value of images. Only 26% of participants reported having previously been shown dental images, but 96% felt they would be helpful to support verbal and written information. CONCLUSION: Laypeople may not interpret orthodontic images in the way that professionals expect, and unfamiliar intra-oral features may distract people from the intended focus of the image. A combination of photographs and illustrations together may improve the usefulness of images, alongside annotation or explanation.

Recent climate change is creating hotspots of butterfly increase and decline across North America.

Some insect populations are experiencing dramatic declines, endangering the crucial ecosystem services they provide. Yet, other populations appear robust, highlighting the need to better define patterns and underlying drivers of recent change in insect numbers. We examined abundance and biodiversity trends for North American butterflies using a unique citizen-science dataset that has recorded observations of over 8 million butterflies across 456 species, 503 sites, nine ecoregions, and 26 years. Butterflies are a biodiverse group of pollinators, herbivores, and prey, making them useful bellwethers of environmental change. We found great heterogeneity in butterfly species' abundance trends, aggregating near zero, but with a tendency toward decline. There was strong spatial clustering, however, into regions of increase, decrease, or relative stasis. Recent precipitation and temperature appeared to largely drive these patterns, with butterflies generally declining at increasingly dry and hot sites but increasing at relatively wet or cool sites. In contrast, landscape and butterfly trait predictors had little influence, though abundance trends were slightly more positive around urban areas. Consistent with varying responses by different species, no overall directional change in butterfly species richness or evenness was detected. Overall, a mosaic of butterfly decay and rebound hotspots appeared to largely reflect geographic variability in climate drivers. Ongoing controversy about insect declines might dissipate with a shift in focus to the causes of heterogeneous responses among taxa and sites, with climate change emerging as a key suspect when pollinator communities are broadly impacted.

No net insect abundance and diversity declines across US Long Term Ecological Research sites.

Recent reports of dramatic declines in insect abundance suggest grave consequences for global ecosystems and human society. Most evidence comes from Europe, however, leaving uncertainty about insect population trends worldwide. We used >5,300 time series for insects and other arthropods, collected over 4-36 years at monitoring sites representing 68 different natural and managed areas, to search for evidence of declines across the United States. Some taxa and sites showed decreases in abundance and diversity while others increased or were unchanged, yielding net abundance and biodiversity trends generally indistinguishable from zero. This lack of overall increase or decline was consistent across arthropod feeding groups and was similar for heavily disturbed versus relatively natural sites. The apparent robustness of US arthropod populations is reassuring. Yet, this result does not diminish the need for continued monitoring and could mask subtler changes in species composition that nonetheless endanger insect-provided ecosystem services.

A Case Study Approach to Reducing the Risks of Child Sexual Exploitation (CSE).

The risk of child sexual exploitation is a growing concern, both within community and child care settings. Within community services working with vulnerable young people, the risks of exploitation are pervasive and present a constant management problem for professionals. This makes the need for focused educational interventions within such settings all the more vital. This case study aims to describe the assessment, formulation, intervention, and outcomes of a young female considered to be at risk of sexual exploitation. It was hypothesised that, after completion of a psychoeducational group designed to enhance knowledge and skills around child sexual exploitation, positive outcomes would be seen in psychometric assessment, risk-taking behavior, and risk awareness. Results demonstrated no clinically significant change for measures of impulsivity, resourcefulness, or self-reported difficulties. A significant increase was seen for self-reported self-esteem, and all outcomes revealed a positive direction of change. Observational accounts of behavioral and attitudinal change produced more positive results, revealing an increase in prosocial behaviors and a reduction in risk-taking behaviors. Outcomes are discussed in relation to the individual's history and the residential care environment. Implications for future research and practice are outlined, and the study limitations are considered.

Incidence and characteristics of needlestick injuries among medical trainees at a community teaching hospital: A cross-sectional study.

OBJECTIVES: This field study aimed to determine the incidence and distribution of needlestick injuries among medical trainees at a community teaching hospital in Toronto, Canada. METHODS: The study was performed during the 2013-2015 academic years at Toronto East General Hospital (TEGH), a University of Toronto-affiliated community-teaching hospital during the 2013-2015 academic years. Eight-hundred and forty trainees, including medical students, residents, and post-graduate fellows, were identified and invited via email to participate in an anonymous online fluidsurveys.com survey of 16 qualitative and quantitative questions. RESULTS: Three-hundred and fifty trainees responded (42% response rate). Eighty-eight (25%) respondents reported experiencing at least one injury at TEGH. In total, our survey identified 195 total injuries. Surgical trainees were significantly more likely to incur injuries than non-surgical trainees (IRR = 3.03, 95% CI 1.80-5.10). Orthopaedic surgery trainees had the highest risk of a needlestick injury, being over 12 times more likely to be injured than emergency medicine trainees (IRR = 12.4, 95% CI 2.11-72.32). Only 28 of the 88 most recent needlestick injuries were reported to occupational health. Trainees reported a perception of insignificant risk, lack of resources and support for reporting, and injury stigmatization as reasons for not reporting needlestick injuries. CONCLUSIONS: Needlestick injuries were a common underreported risk to medical trainees at TEGH. Future research should investigate strategies to reduce injury and improve reporting among the high-risk and reporting-averse trainees.

Factors Affecting Early Services for Children Who Are Hard of Hearing.

PURPOSE: To describe factors affecting early intervention (EI) for children who are hard of hearing, we analyzed (a) service setting(s) and the relationship of setting to families' frequency of participation, and (b) provider preparation, caseload composition, and experience in relation to comfort with skills that support spoken language for children who are deaf and hard of hearing (CDHH). METHOD: Participants included 122 EI professionals who completed an online questionnaire annually and 131 parents who participated in annual telephone interviews. RESULTS: Most families received EI in the home. Family participation in this setting was significantly higher than in services provided elsewhere. EI professionals were primarily teachers of CDHH or speech-language pathologists. Caseload composition was correlated moderately to strongly with most provider comfort levels. Level of preparation to support spoken language weakly to moderately correlated with provider comfort with 18 specific skills. CONCLUSIONS: Results suggest family involvement is highest when EI is home-based, which supports the need for EI in the home whenever possible. Access to hands-on experience with this population, reflected in a high percentage of CDHH on providers' current caseloads, contributed to professional comfort. Specialized preparation made a modest contribution to comfort level.

Quantity and Quality of Caregivers' Linguistic Input to 18-Month and 3-Year-Old Children Who Are Hard of Hearing.

OBJECTIVES: The primary objective of this study was to examine the quantity and quality of caregiver talk directed to children who are hard of hearing (CHH) compared with children with normal hearing (CNH). For the CHH only, the study explored how caregiver input changed as a function of child age (18 months versus 3 years), which child and family factors contributed to variance in caregiver linguistic input at 18 months and 3 years, and how caregiver talk at 18 months related to child language outcomes at 3 years. DESIGN: Participants were 59 CNH and 156 children with bilateral, mild-to-severe hearing loss. When children were approximately 18 months and/or 3 years of age, caregivers and children participated in a 5-min semistructured, conversational interaction. Interactions were transcribed and coded for two features of caregiver input representing quantity (number of total utterances and number of total words) and four features representing quality (number of different words, mean length of utterance in morphemes, proportion of utterances that were high level, and proportion of utterances that were directing). In addition, at the 18-month visit, parents completed a standardized questionnaire regarding their child's communication development. At the 3-year visit, a clinician administered a standardized language measure. RESULTS: At the 18-month visit, the CHH were exposed to a greater proportion of directing utterances than the CNH. At the 3-year visit, there were significant differences between the CNH and CHH for number of total words and all four of the quality variables, with the CHH being exposed to fewer words and lower quality input. Caregivers generally provided higher quality input to CHH at the 3-year visit compared with the 18-month visit. At the 18-month visit, quantity variables, but not quality variables, were related to several child and family factors. At the 3-year visit, the variable most strongly related to caregiver input was child language. Longitudinal analyses indicated that quality, but not quantity, of caregiver linguistic input at 18 months was related to child language abilities at 3 years, with directing utterances accounting for significant unique variance in child language outcomes. CONCLUSIONS: Although caregivers of CHH increased their use of quality features of linguistic input over time, the differences when compared with CNH suggest that some caregivers may need additional support to provide their children with optimal language learning environments. This is particularly important given the relationships that were identified between quality features of caregivers' linguistic input and children's language abilities. Family supports should include a focus on developing a style that is conversational eliciting as opposed to directive.

Speech sound production in 2-year-olds who are hard of hearing.

PURPOSE: The purpose of the study was to (a) compare the speech sound production abilities of 2-year-old children who are hard of hearing (HH) to children with normal hearing (NH), (b) identify sources of risk for individual children who are HH, and (c) determine whether speech sound production skills at age 2 were predictive of speech sound production skills at age 3. METHOD: Seventy children with bilateral, mild-to-severe hearing loss who use hearing aids and 37 age- and socioeconomic status-matched children with NH participated. Children's speech sound production abilities were assessed at 2 and 3 years of age. RESULTS: At age 2, the HH group demonstrated vowel production abilities on par with their NH peers but weaker consonant production abilities. Within the HH group, better outcomes were associated with hearing aid fittings by 6 months of age, hearing loss of less than 45 dB HL, stronger vocabulary scores, and being female. Positive relationships existed between children's speech sound production abilities at 2 and 3 years of age. CONCLUSION: Assessment of early speech sound production abilities in combination with demographic, audiologic, and linguistic variables may be useful in identifying HH children who are at risk for delays in speech sound production.