Cholinergic system correlates of postural control changes in Parkinson's disease freezers.

Postural instability and freezing of gait are the most debilitating dopamine-refractory motor impairments in advanced stages of Parkinson's disease because of increased risk of falls and poorer quality of life. Recent findings suggest an inability to efficaciously utilize vestibular information during static posturography among people with Parkinson's disease who exhibit freezing of gait, with associated changes in cholinergic system integrity as assessed by vesicular acetylcholine transporter PET. There is a lack of adequate understanding of how postural control varies as a function of available sensory information in patients with Parkinson's disease with freezing of gait. The goal of this cross-sectional study was to examine cerebral cholinergic system changes that associate with inter-sensory postural control processing features as assessed by dynamic computerized posturography and acetylcholinesterase PET. Seventy-five participants with Parkinson's disease, 16 of whom exhibited freezing of gait, underwent computerized posturography on the NeuroCom© Equitest sensory organization test platform, striatal dopamine, and acetylcholinesterase PET scanning. Findings demonstrated that patients with Parkinson's disease with freezing of gait have greater difficulty maintaining balance in the absence of reliable proprioceptive cues as compared to those without freezing of gait [ß = 0.28 (0.021, 0.54), P = 0.034], an effect that was independent of disease severity [ß = 0.16 (0.062, 0.26), P < 0.01] and age [ß = 0.092 (-0.005, 0.19), P = 0.062]. Exploratory voxel-based analysis revealed an association between postural control and right hemispheric cholinergic network related to visual-vestibular integration and self-motion perception. High anti-cholinergic burden predicted postural control impairment in a manner dependent on right hemispheric cortical cholinergic integrity [ß = 0.34 (0.065, 0.61), P < 0.01]. Our findings advance the perspective that cortical cholinergic system might play a role in supporting postural control after nigro-striatal dopaminergic losses in Parkinson's disease. Failure of cortex-dependent visual-vestibular integration may impair detection of postural instability in absence of reliable proprioceptive cues. Better understanding of how the cholinergic system plays a role in this process may augur novel treatments and therapeutic interventions to ameliorate debilitating symptoms in patients with advanced Parkinson's disease.

Decreased vestibular efficacy contributes to abnormal balance in Parkinson's disease.

BACKGROUND AND PURPOSE: Abnormal balance is poorly responsive to dopaminergic therapy in Parkinson's disease (PD). Decreased vestibular efficacy may contribute to imbalance in PD. The purpose of this study was to investigate the relationship between vestibular measures of dynamic posturography and imbalance in PD while accounting for confounder variables. METHODS: 106 patients with PD underwent dynamic posturography for the 6 conditions of the sensory integration test (SOT) using the Neurocom Equitest device. All SOT measures, nigrostriatal dopaminergic denervation ((+)-[11C]DTBZ PET), brain acetylcholinesterase ([11C]PMP PET), age, duration of disease, cognitive and parkinsonian motor scores, and ankle vibration sensitivity were used as regressors in a stepwise logistic regression model comparing PD patients with versus without imbalance defined as Hoehn and Yahr (HY) stage 2.5 or higher. RESULTS: The presence of imbalance was significantly associated with vestibular ratio COP RMS (P = 0.002) independently from visual ratio COP velocity (P = 0.012), thalamic acetylcholinesterase activity (P = 0.0032), cognition (P = 0.006), motor severity (P = 0.0039), age (P = 0.001), ankle vibration sensitivity (P = 0.0008), and borderline findings for somatosensory ratio COP velocity (P = 0.074) and visual ratio COP RMS (P = 0.078). Nigrostriatal dopaminergic denervation did not achieve significance. CONCLUSIONS: The inability to efficaciously utilize vestibular information to retain upright stance is a determinant of imbalance in PD independent from visual and somatosensory processing changes and nigrostriatal dopaminergic losses. Thalamic, but not cortical, cholinergic denervation incrementally predicted balance abnormality. Further research is needed to investigate an intrinsic role of the cholinergic thalamus in multi-sensory, in particular vestibular, processing functions of postural control in PD.

Atraumatic restorative treatments and oral health-related quality of life and dental anxiety in Australian Aboriginal children: A cluster-randomized trial.

OBJECTIVES: The management of early childhood caries is challenging and the impacts of its treatment on child oral health-related quality of life (COHRQoL) and dental anxiety among Australian Aboriginal children is relatively unknown. The aim of the study was to compare the impact on COHRQoL and dental anxiety after approximately 12 months among Aboriginal children treated for early childhood caries (ECC) using the Atraumatic Restorative Treatment and the Hall Technique (ART/HT: test) or standard care (control). METHODS: Consenting Aboriginal communities in the North-West of Western Australia were randomized into early (test) or delayed (control) intervention for the management of ECC. Children and parents/carers completed a questionnaire at baseline and at follow-up. The questionnaire sought information on COHRQoL using the proxy-reported Early Childhood Oral Health Impact Scale (ECOHIS) and the self-reported Caries Impacts and Experiences Questionnaire for Children (CARIES-QC). The test group was provided with the ART/HT care at baseline while the control group was advised to seek care through the usual care options available within the community. At follow-up, both groups were offered care using the ART/HT approach. Changes in the mean scores from baseline to follow-up within groups were evaluated using appropriate paired (t-test, Wilcoxon paired test), and between groups with unpaired tests (t-test). Multivariate regression analysis after multiple imputations of missing data used generalized estimating equation (GEE) controlling for clustering within communities. RESULTS: Twenty-five communities and 338 children (mean age = 3.6 years, sd 1.7) participated in the study (test = 177). One child was excluded from the analysis because of a missing questionnaire and clinical data at baseline and follow-up. At baseline, test group children were older (test = 3.8 years, 95% CI 3.6-4.1;control = 3.3 years, 95% CI 3.1-3.6) and had higher caries experience (test dmft = 4.4, 95% CI 3.8-5.0;control dmft = 3.1, 95% CI 2.5-3.7), but there was no significant difference in COHRQoL or anxiety levels between the groups. At follow-up, parents in the delayed intervention reported worsening of COHRQoL (70% worsening of the family impact section of the ECOHIS and 37% worsening of the total ECOHIS scale), and there was an 8% reduction in child dental anxiety among the early treatment group. CONCLUSIONS: The application of the ART/HT approaches was feasible, effective, and impacted positively on child oral health-related quality of life and child dental anxiety among Aboriginal children in remote communities. The model of care as tested in this study should be further developed for inclusion in main-stream service delivery programmes.

Diagnostic and Prognostic Value of Lung Ultrasound B-Lines in Acute Heart Failure With Concomitant Pneumonia.

Purpose: To evaluate the potential confounding effect of concomitant pneumonia (PNM) on lung ultrasound (LUS) B-lines in acute heart failure (AHF). Methods: We enrolled 86 AHF patients with (31 pts, AHF/PNM) and without (55 pts, AHF) concomitant PNM. LUS B-lines were evaluated using a combined antero-lateral (AL) and posterior (POST) approach at admission (T0), after 24 h from T0 (T1), after 48 h from T0 (T2) and before discharge (T3). B-lines score was calculated at each time point on AL and POST chest, dividing the number of B-lines by the number of explorable scanning sites. The decongestion rate (DR) was calculated as the difference between the absolute B-lines number at discharge and admission, divided by the number of days of hospitalization. Patients were followed-up and hospital readmission for AHF was considered as adverse outcome. Results: At admission, AHF/PNM patients showed no difference in AL B-lines score compared with AHF patients [AHF/PNM: 2.00 (IQR: 1.44-2.94) vs. AHF: 1.65 (IQR: 0.50-2.66), p = 0.072], whereas POST B-lines score was higher [AHF/PNM: 3.76 (IQR: 2.70-4.77) vs. AHF = 2.44 (IQR: 1.20-3.60), p < 0.0001]. At discharge, AL B-lines score [HR: 1.907 (1.097-3.313), p = 0.022] and not POST B-lines score was found to predict adverse events (AHF rehospitalization) after a median follow-up of 96 days (IQR: 30-265) in the overall population. Conclusions: Assessing AL B-lines alone is adequate for diagnosis, pulmonary congestion (PC) monitoring and prognostic stratification in AHF patients, despite concomitant PNM.

Methotrexate Hampers Immunogenicity to BNT162b2 mRNA COVID-19 Vaccine in Immune-Mediated Inflammatory Disease

ObjectiveTo investigate the humoral and cellular immune response to mRNA COVID-19 vaccines in patients with immune-mediated inflammatory diseases (IMIDs) on immunomodulatory treatment. MethodsEstablished patients at NYU Langone Health with IMID (n=51) receiving the BNT162b2 mRNA vaccination were assessed at baseline and after second immunization. Healthy subjects served as controls (n=26). IgG antibody responses to the spike protein were analyzed for humoral response. Cellular immune response to SARS-CoV-2 was further analyzed using high-parameter spectral flow cytometry. A second independent, validation cohort of controls (n=182) and patients with IMID (n=31) from Erlangen, Germany were also analyzed for humoral immune response. ResultsAlthough healthy subjects (n=208) and IMID patients on biologic treatments (mostly on TNF blockers, n=37) demonstrate robust antibody responses (over 90%), those patients with IMID on background methotrexate (n=45) achieve an adequate response in only 62.2% of cases. Similarly, IMID patients do not demonstrate an increase in CD8+ T cell activation after vaccination. ConclusionsIn two independent cohorts of IMID patients, methotrexate, a widely used immunomodulator for the treatment of several IMIDs, adversely affected humoral and cellular immune response to COVID-19 mRNA vaccines. Although precise cut offs for immunogenicity that correlate with vaccine efficacy are yet to be established, our findings suggest that different strategies may need to be explored in patients with IMID taking methotrexate to increase the chances of immunization efficacy against SARS-CoV-2 as has been demonstrated for augmenting immunogenicity to other viral vaccines. KEY MESSAGESO_ST_ABSWhat is already known about this subject?C_ST_ABSO_LIThe impact of COVID-19 has been felt across the globe and new hope has arisen with the approval of mRNA vaccines against the SARS-CoV-2. Studies have shown immunogenicity and efficacy rates of over 90% in the immunocompetent adult population. However, there is a lack of knowledge surrounding the response of patients with immune-mediated inflammatory diseases (IMIDs) who may also be on immunomodulatory medications. C_LIO_LIPatients with IMID have been shown to have attenuated immune responses to seasonal influenza vaccination. C_LI What does this study add?O_LIThis study looks at the humoral and cellular immune response to two doses of BNT162b2 mRNA COVID-19 Vaccine in participants with IMID (on immunomodulators) compared with healthy controls. C_LIO_LIIndividuals with IMID on methotrexate demonstrate up to a 62% reduced rate of adequate immunogenicity to the BNT162b2 mRNA vaccination. Those on anti-cytokine or non-methotrexate oral medications demonstrate similar levels of immunogenicity as healthy controls (greater than 90%). C_LIO_LISimilarly, vaccination did not induce an activated CD8+ T cell response in participants on background methotrexate, unlike healthy controls and patients with IMID not receiving methotrexate. C_LI How might this impact of clinical practice or future developments?O_LIThese results suggest that patients on methotrexate may need alternate vaccination strategies such as additional doses of vaccine, dose modification of methotrexate, or even a temporary discontinuation of this drug. Further studies will be required to explore the effect of these approaches on mRNA vaccine immunogenicity. C_LI

Use of graded responsibility and common entrustment considerations among United States emergency medicine residency programs.

PURPOSE: The Accreditation Council for Graduate Medical Education (ACGME) requires all residency programs to provide increasing autonomy as residents progress through training, known as graded responsibility. However, there is little guidance on how to implement graded responsibility in practice and a paucity of literature on how it is currently implemented in emergency medicine (EM). We sought to determine how emergency medicine (EM) residency programs apply graded responsibility across a variety of activities and to identify which considerations are important in affording additional responsibilities to trainees. METHODS: We conducted a cross-sectional study of EM residency programs using a 23-question survey that was distributed by email to 162 ACGME-accredited EM program directors. Seven different domains of practice were queried. RESULTS: We received 91 responses (56.2% response rate) to the survey. Among all domains of practice except for managing critically ill medical patients, the use of graded responsibility exceeded 50% of surveyed programs. When graded responsibility was applied, post-graduate year (PGY) level was ranked an "extremely important" or "very important" consideration between 80.9% and 100.0% of the time. CONCLUSION: The majority of EM residency programs are implementing graded responsibility within most domains of practice. When decisions are made surrounding graded responsibility, programs still rely heavily on the time-based model of PGY level to determine advancement.

Use of graded responsibility and common entrustment considerations among United States emergency medicine residency programs / 보건의료교육평가

Purpose@#The Accreditation Council for Graduate Medical Education (ACGME) requires all residency programs to provide increasing autonomy as residents progress through training, known as graded responsibility. However, there is little guidance on how to implement graded responsibility in practice and a paucity of literature on how it is currently implemented in emergency medicine (EM). We sought to determine how EM residency programs apply graded responsibility across a variety of activities and to identify which considerations are important in affording additional responsibilities to trainees. @*Methods@#We conducted a cross-sectional study of EM residency programs using a 23-question survey that was distributed by email to 162 ACGME-accredited EM program directors. Seven different domains of practice were queried. @*Results@#We received 91 responses (56.2% response rate) to the survey. Among all domains of practice except for managing critically ill medical patients, the use of graded responsibility exceeded 50% of surveyed programs. When graded responsibility was applied, post-graduate year (PGY) level was ranked an “extremely important” or “very important” consideration between 80.9% and 100.0% of the time. @*Conclusion@#The majority of EM residency programs are implementing graded responsibility within most domains of practice. When decisions are made surrounding graded responsibility, programs still rely heavily on the time-based model of PGY level to determine advancement.

Standardized mounting method of (zebrafish) embryos using a 3D-printed stamp for high-content, semi-automated confocal imaging.

BACKGROUND: Developmental biology relies to a large extent on the observation and comparison of phenotypic traits through time using high resolution microscopes. In this context, transparent model organisms such as the zebrafish Danio rerio in which developing tissues and organs can be easily observed and imaged using fluorescent proteins have become very popular. One limiting factor however is the acquisition of a sufficient amount of data, in standardized and reproducible conditions, to allow robust quantitative analysis. One way to improve this is by developing mounting methods to increase the number of embryos that can be imaged simultaneously in near-to-identical orientation. RESULTS: Here we present an improved mounting method allowing semi-automated and high-content imaging of zebrafish embryos. It is based on a 3D-printed stamp which is used to create a 2D coordinate system of multiple µ-wells in an agarose cast. Each µ-well models a negative of the average zebrafish embryo morphology between 22 and 96 h-post-fertilization. Due to this standardized and reproducible arrangement, it is possible to define a custom well plate in the respective imaging software that allows for a semi-automated imaging process. Furthermore, the improvement in Z-orientation significantly reduces post-processing and improves comparability of volumetric data while reducing light exposure and thus photo-bleaching and photo-toxicity, and improving signal-to-noise ratio (SNR). CONCLUSIONS: We present here a new method that allows to standardize and improve mounting and imaging of embryos. The 3D-printed stamp creates a 2D coordinate system of µ-wells in an agarose cast thus standardizing specimen mounting and allowing high-content imaging of up to 44 live or mounted zebrafish embryos simultaneously in a semi-automated, well-plate like manner on inverted confocal microscopes. In summary, image data quality and acquisition efficiency (amount of data per time) are significantly improved. The latter might also be crucial when using the services of a microscopy facility.

Psychometric properties of the Child Oral-care Performance Assessment Scale.

OBJECTIVES: This study aimed to assess the psychometric properties of Child Oral-care Performance Assessment Scale (COPAS). METHODS: Items for the instrument were developed and pilot tested. This questionnaire was implemented in the Australian National Child Oral Health Study 2012-2014, whose aims included the assessment of oral care performance. This nationally representative sample of 23 538 respondents with complete data was divided into five groups: a main validation group and four cross-validation groups, using blocked randomization. Two scales were constructed, full scale with 37 items (COPAS) and a partial scale with a subset of 31 items (COPAS-Partial). Internal consistency was assessed using Cronbach's alpha. Construct validity was assessed using correlation coefficients, and structural validity was ascertained in the main validation group and confirmed in the cross-validation groups using structural equation models. RESULTS: Cronbach's alpha for COPAS was 0.95, and for COPAS-Partial was 0.94. The convergent validity of global satisfaction with oral care and the subscales was r = 0.29-0.51, and that with the overall scales was r = 0.59 for COPAS and r = 0.59 for COPAS-Partial. COPAS (Root mean squared error of approximation (RMSEA) = 0.06, Comparative fit index (CFI) = 0.90, Tucker-Lewis index (TLI) = 0.89, and Coefficient of determination(COD) = 0.99) and COPAS-Partial (RMSEA = 0.07, CFI = 0.91, TLI = 0.90, COD = 0.97) had adequate fit. Structural invariance was present (P-value = 0.97). CONCLUSION: There was acceptable structural validity, construct validity and internal consistency in the models tested for COPAS and COPAS-Partial. COPAS has potential use in the evaluation of the delivery of dental services to children.

Cancer Detection at your Fingertips: Smartphone-Enabled DNA Testing.

High molecular weight cell-free DNA (hmw cfDNA) found in biological fluid, such as blood, is a promising biomarker for cancer detection. Due to the abundance of background apoptotic cell-free DNA in blood, quantifying the native concentration of hmw cfDNA using existing methods is technically challenging, time consuming, and expensive. We have developed a novel technology which utilizes Alternating Current Electrokinetics (ACE) to isolate hmw cfDNA directly from blood. Furthermore, we integrated this technology into a handheld device which utilizes a smartphone for power, instruction transmission, optical detection, image processing, and data transmission. The detection of hmw cfDNA in blood plasma demonstrated the performance of the device. We are continuing development of this device as a future point of care in vitro diagnostic.

Investigation of Methylene Blue Release from Functional Polymeric Systems Using Dielectric Analysis.

BACKGROUND: Methylene blue (MB) is a photosensitizer used in photodynamic therapy (PDT) to treat colorectal cancer tumors and leishmaniasis infection. The clinical efficacy of PDT using MB is dependent on the physicochemical characteristics of the formulation. Bioadhesive thermoresponsive systems containing poloxamer 407 and Carbopol 934P have been proposed as platforms for PDT. However, the effect of MB on the physicochemical properties of these platforms is not fully understood, particularly in light of the MB availability. OBJECTIVE: The aim of this study was to investigate the dielectric characteristics of functional polymeric systems containing MB and their influence on mucoadhesion and drug release. METHODS: Binary polymeric systems containing different concentrations of poloxamer 407, Carbopol 934P and MB were evaluated as dielectric and mucoadhesive properties, as well as in vitro drug release profile. RESULTS: MB, temperature and polymeric composition influenced the physicochemical properties of the systems. The presence of MB altered the supramolecular structure of the preparations. The mucoadhesive properties of systems were influenced by MB presence and the formulation with the lowest amount of MB displayed faster release. CONCLUSION: The lower MB concentration in the systems displayed better results in terms of ionic mobility and drug release, and is indicative of a suitable clinical performance.

Detection of human papilloma virus-E6/E7 proteins of high-risk human papilloma virus in saliva and lesional tissue of oral squamous cell carcinoma patients using nested multiplex polymerase chain reaction: A comparative study.

INTRODUCTION: Human papilloma virus (HPV)-associated oral squamous cell carcinoma (OSCC) shows different biological behavior as compared to tobacco-induced OSCC. Mere presence of HPV in OSCC is of no clinical significance; however, the integration of HPV-DNA through E6/E7 gene into the host genome is important as it affects the development and progression of OSCC. AIM: The aim of this study was to determine the presence of E6/E7 proteins of high-risk (HR) HPV (HPV16 and HPV18) in saliva as well as lesional tissue of OSCC patients and to determine the use of saliva as an alternative to tissue for E6 and E7 proteins in OSCC. MATERIALS AND METHODS: Histopathologically confirmed 47 cases of OSCC were taken up for the study. The tumor tissue and saliva sample of each patient were obtained to detect the presence of HPV16 and HPV18 along with E6/E7 proteins in both samples by nested multiplex polymerase chain reaction (NMPCR). The data were analyzed using Student t-test (2 tailed) and Wilcoxon signed-ranks test. RESULTS: In tumor tissue, 40.42% of cases showed HPV16 (19/47) positivity while 34.04% were HPV18 (16/47) positive; whereas, in salivary sample, 31.91% showed HPV16 (15/47) positivity while 25.53% of cases were HPV18 positive (12/47). Mean age of participants was 46.7 years, males showed no significant difference from females in the prevalence of HPV 16/18 with tongue being the most common site for the occurrence. There was no statistically significant difference for HPV16/18 presence in tissue and saliva sample of OSCC. Taking lesional tissue sample as standard, sensitivity and specificity for HPV16 and HPV18 in saliva by NMPCR was estimated at 68.42% and 92.86%, respectively. The accuracy level of NMPCR detection for HPV16 was 82.98% and HPV18 was 65.96%. CONCLUSION: The study revealed no significant difference in the prevalence of HPV (16/18) among tissue and saliva of OSCC patients in Indian population. The study also found no difference in the level of DNA content of HPV in saliva and tissue indicating that saliva can be used as an alternative predictor of HPV positivity in OSCC.

Morphometric Analysis of Odontometric Parameters for Gender Determination.

INTRODUCTION: In contemporary human population, males exhibit larger size of dentition as compared to females. Additionally, these odontometric parameters show variation in members of same species and also show regional variation. AIM: To evaluate sexual dimorphism of four maxillary odontometric parameters such as Intercanine Width (ICW), Interpremolar Width (IPW), Arch Length (AL) and Combined Width (CW) of six maxillary anterior teeth, to determine percentage of sexual dimorphism of all four odontometric parameters singly or in combination and also to determine sensitivity, specificity and overall accuracy of odontometric parameters for sex determination. MATERIALS AND METHODS: This cross-sectional study was conducted on 200 subjects (100 males, 100 females). Four odontometric parameters ICW, IPW, AL and CW were measured directly on the subject and the data thus collected was subjected to statistical analysis. RESULTS: Discriminant statistical analysis (d square test) revealed that all the four odontometric maxillary parameters exhibited greater mean values in males as compared to females. The difference was found to be statistically highly significant (p<0.001) for ICW and IPW for sexual dimorphism. Also, combination of parameters such as ICW, IPW further improved assessment. CONCLUSION: The study concluded that linear odonotometric parameters ICW, IPW along with AL, CW show significant sexual dimorphism. Hence, odontometric parameters offer simple, reliable and cost-effective way of determining sex in any forensic investigation.

Tooth loss and general quality of life in dentate adults from Southern Brazil.

PURPOSE: This study aimed to estimate the association between the number of teeth and general quality of life in adults. METHODS: A population-based study was conducted with 1720 individuals aged 20-59 years residing in Florianópolis, Brazil, in 2009. Data were collected at participants' households using a structured questionnaire. In 2012, a second wave was undertaken with 1222 individuals. Oral examinations were performed for number of teeth, prevalence of functional dentition (≥21 natural teeth), and shortened dental arch (SDA), which were considered the main exposures. General quality of life was the outcome and was assessed with the WHO Abbreviated Instrument for Quality of Life (WHOQOL-BREF). Covariates included sociodemographic factors, health-related behaviors, and chronic diseases. Multivariable linear regression models were performed to test the associations between the main exposures and the outcome adjusted for covariates. RESULTS: In 2012, 1222 individuals participated in the study (response rate = 71.1%). Having more teeth was associated with greater scores on physical domain of the WHOQOL-BREF [ß = 0.24 (95% CI 0.01; 0.46)] after adjustment for covariates. Absence of functional dentition was associated with lower scores on the physical domain [ß = -3.94 (95% CI -7.40; -0.48)] in the adjusted analysis. There was no association between both SDA definitions and the domains of general quality of life. CONCLUSIONS: Oral health as measured by tooth loss was associated with negative impacts on general quality of life assessed by the WHOQOL-BREF. There was a lack of evidence that SDA is a condition that negatively affects general quality of life.

Health-Related Quality of Life in Adult Cochlear Implant Users: A Descriptive Observational Study.

Cochlear implantation has a significant impact on patients' social life, performance of activities, and self-esteem. The objective of this retrospective study was to assess the health-related quality of life of cochlear implant users aged under and over 60 years by a self-report using the Glasgow Health Status Inventory and the Abbreviated Profile of Hearing Aid Benefit. It was observed that quality of life values increased very rapidly straight after implantation regardless of age. Bilateral cochlear implant users showed better results in environments with background noise and in a reverberant room than unilateral cochlear implant users. Quality of life improved independently of hearing performance benefits for patients over 60 years at implantation.

The international migration of dentists: directions for research and policy.

In 2010, the World Health Organization Global Code of Practice for International Recruitment of Health Personnel (the WHO Code) was adopted by the 193 Member States of the WHO. The WHO Code is a tool for global diplomacy, providing a policy framework to address the challenges involved in managing dentist migration, as well as improving the retention of dental personnel in source countries. The WHO Code recognizes the importance of migrant dentist data to support migration polices; minimum data on the inflows, outflows and stock of dentists are vital. Data on reasons for dentist migration, job satisfaction, cultural adaptation issues, geographic distribution and practice patterns in the destination country are important for any policy analysis on dentist migration. Key challenges in the implementation of the WHO Code include the necessity to coordinate with multiple stakeholders and the lack of integrated data on dentist migration and the lack of shared understanding of the interrelatedness of workforce migration, needs and planning. The profession of dentistry also requires coordination with a number of private and nongovernmental organizations. Many migrant dentist source countries, in African and the South-Asian WHO Regions, are in the early stages of building capacity in dentist migration data collection and research systems. Due to these shortcomings, it is prudent that developed countries take the initiative to pursue further research into the migration issue and respond to this global challenge.

Rodas de conversa entre a educação e a psicanálise / Conversation circles involving education and psychoanalysis

Os autores apresentam a experiência de um trabalho em parceria de um grupo de psicanalistas da Sociedade Psicanalítica de Porto Alegre (SPPA) com a Secretaria Municipal de Educação de Porto Alegre (SMED) junto às instituições de educação infantil. Na atividade (Rodas de Conversa), participam os profissionais envolvidos na educação cotidiana das crianças em comunidades de alta vulnerabilidade social. Ressaltam que, a partir de uma atitude de acolhimento e continência das vivências compartilhadas, mais do que respostas/soluções às perguntas, os participantes conversam sobre as situações com vistas a encontrar alternativas possíveis e a tolerar não ter condições para resolver todos os problemas, a ouvir o que o outro tem a dizer e a aprender com a narrativa do outro. Observa-se que a autoestima dos educadores se fortalece percebendo que são capazes de avançar em sua trajetória pessoal e profissional. Finalizam trazendo questionamentos sobre o alcance do trabalho realizado, reconhecendo que segue sendo uma atividade em construção nestes nove anos.

The authors report on the experience of a series of meetings held by a group of psychoanalysts from the Psychoanalytical Society of Porto Alegre (SPPA) in collaboration with the Municipal Secretariat for Education of Porto Alegre (SMED) together with early childhood education institutions. Professionals involved on a daily basis in the education of children from communities with a high degree of social vulnerability took part in this activity (Conversation Circles). They highlight that, by embracing and containing shared experiences, rather than merely answering/solving questions, the participants discussed the situations with the aim of finding possible alternatives and accepting the inability to solve all problems, and also of listening to what the other has to say and of learning from the other's narrative. It was observed that the educators' self-esteem increased as they realized to be able to make steps forward in their personal and professional trajectory. The authors conclude by raising questions about the scope of the work carried out, while recognizing it remains as an activity in progress over the past nine years(AU)

Los autores presentan la experiencia de un trabajo conjunto de un grupo de psicoanalistas de la Sociedade Psicanalítica de Porto Alegre (SPPA) y de la Secretaría Municipal de Educación de Porto Alegre (SMED) en instituciones de educación inicial. En la actividad (Ruedas de Diálogo), participaron profesionales involucrados en la educación cotidiana de niños pertenecientes a comunidades de alta vulnerabilidad social. Resaltan los autores que, a partir de una actitud de acogida y contención de las vivencias compartidas, más que respuestas/soluciones para sus preguntas, los participantes conversaron sobre las situaciones con vistas a encontrar alternativas posibles y a tolerar no tener condiciones para solucionar todos los problemas, a escuchar lo que el otro tiene para decir y a aprender con el relato del otro. Se observó que la autoestima de los educadores se fortalece cuando perciben que son capaces de avanzar en su trayectoria personal y profesional. Esta presentación culmina con planteamientos sobre el alcance del trabajo realizado, reconociendo que sigue siendo una actividad en construcción en estos nueve años(AU)

Income-based life-course models of caries in 30-year-old Australian adults.

OBJECTIVES: To assess income-based life-course models between the age of 13 and 30 years and caries in young adults. METHODS: In 1988-89, n = 7673 South Australian school children aged 13 years were sampled with n = 4604 children (60.0%) and n = 4476 parents (58.3%) returning questionnaires. In 2005-06, n = 632 baseline study participants aged 30 years responded (43.0% of those traced and living in Adelaide). Life-course models representing critical period, cumulative risk and social mobility were constructed using income tertiles at ages 13 and 30 years. Critical period was evaluated by comparing the low tertile with the middle and higher tertiles at age 13. Cumulative risk was evaluated by coding the low tertile as 2, the middle tertile as 1 and highest tertile as 0, and summing to produce a cumulative risk score categorized into lower (score 0-1), moderate (score of 2) and higher risk (scores 3-4). Social mobility was classified using tertiles into stable disadvantaged, downwardly mobile, stable middle income, upwardly mobile and stable advantaged. RESULTS: Models adjusting for sex, visiting and toothbrushing at age 30 showed no association between caries at age 30 and low income at age 13 years (critical period model). Compared to the low cumulative risk group based on income, decayed teeth (RR = 1.6) and missing teeth (RR = 7.2) were higher (P < 0.05) in the higher risk group, and missing teeth (RR = 6.0) were higher in the moderate risk group (cumulative risk model). There were more (P < 0.05) decayed teeth in the disadvantaged (RR = 3.1) and stable middle income groups (RR = 2.2), more missing teeth for those classified as disadvantaged (RR = 6.4), stable middle (RR = 6.3) and downwardly mobile (RR = 2.8), and higher DMFT for the disadvantaged group (RR = 1.5) compared to the upwardly mobile group (social mobility model). CONCLUSIONS: Socioeconomic advantage and upward mobility were associated with fewer decayed and missing teeth at age 30 years. Life-course models of cumulative risk and social mobility influenced oral health outcomes across childhood to adulthood.

The influence of the volume of dental treatment on change in self-reported oral health.

OBJECTIVES: To find an association between self-reported change in oral health and dental treatment volume. METHODS: Baseline data were obtained from the Tasmanian component of the National Survey of Adult Oral Health 2004-06 and 12-month follow-up data from service use logbooks and mail self-complete questionnaires. The global oral health transition statement indicated change in oral health. Many putative confounders were analyzed and Poisson regression with robust variance estimation was used to calculate the prevalence ratios and 95 percent confidence intervals for bivariate- and multivariate-adjusted relationships. RESULTS: One-eighth (12.4 percent) of the participants reported that their oral health had improved. Over half visited a dentist (n=176, 52.6 percent), of whom 105 received less than six dental services and 71 received six or more dental services. Baseline oral disease (P=0.01), having a treatment need (P<0.01), usually visiting a dentist for a problem (P<0.05), and having a lot of difficulty paying a $100 dental bill (P=0.01) were significantly associated with the same or worsening oral health. The regression model indicated that having six or more dental services (P<0.01) was significantly associated with improvement in oral health, indicating a threshold effect. Usually visiting a dentist for a check-up was significantly associated with improvement in oral health (P<0.01). CONCLUSION: Having six or more dental services was significantly associated with a greater self-reported improvement in oral health than having less than six dental services. The greater prevalence ratios with increasing dental service volume suggested a threshold effect.

Image change detection using paradoxical theory for patient follow-up quantitation and therapy assessment.

In clinical oncology, positron emission tomography (PET) imaging can be used to assess therapeutic response by quantifying the evolution of semi-quantitative values such as standardized uptake value, early during treatment or after treatment. Current guidelines do not include metabolically active tumor volume (MATV) measurements and derived parameters such as total lesion glycolysis (TLG) to characterize the response to the treatment. To achieve automatic MATV variation estimation during treatment, we propose an approach based on the change detection principle using the recent paradoxical theory, which models imprecision, uncertainty, and conflict between sources. It was applied here simultaneously to pre- and post-treatment PET scans. The proposed method was applied to both simulated and clinical datasets, and its performance was compared to adaptive thresholding applied separately on pre- and post-treatment PET scans. On simulated datasets, the adaptive threshold was associated with significantly higher classification errors than the developed approach. On clinical datasets, the proposed method led to results more consistent with the known partial responder status of these patients. The method requires accurate rigid registration of both scans which can be obtained only in specific body regions and does not explicitly model uptake heterogeneity. In further investigations, the change detection of intra-MATV tracer uptake heterogeneity will be developed by incorporating textural features into the proposed approach.