Lithiation Gradients and Tortuosity Factors in Thick NMC111-Argyrodite Solid-State Cathodes.

Achieving high energy density in all-solid-state lithium batteries will require the design of thick cathodes, and these will need to operate reversibly under normal use conditions. We use high-energy depth-profiling X-ray diffraction to measure the localized lithium content of Li1-xNi1/3Mn1/3Co1/3O2 (NMC111) through the thickness of 110 µm thick composite cathodes. The composite cathodes consisted of NMC111 of varying mass loadings mixed with argyrodite solid electrolyte Li6PS5Cl (LPSC). During cycling at C/10, substantial lithiation gradients developed, and varying the NMC111 loading altered the nature of these gradients. Microstructural analysis and cathode modeling showed this was due to high tortuosities in the cathodes. This was particularly true in the solid electrolyte phase, which experienced a marked increase in tortuosity factor during the initial charge. Our results demonstrate that current distributions are observed in sulfide-based composites and that these will be an important consideration for practical design of all-solid-state batteries.

Methods for Tomographic Segmentation in Pseudo-Cylindrical Coordinates for Bobbin-Type Batteries.

High-resolution X-ray computed tomography (CT) has become an invaluable tool in battery research for its ability to probe phase distributions in sealed samples. The Cartesian coordinates used in describing the CT image stack are not appropriate for understanding radial dependencies, like that seen in bobbin-type batteries. The most prominent of these bobbin-type batteries is alkaline Zn-MnO2, which dominates the primary battery market. To understand material radial dependencies within these batteries, a method is presented to approximate the Cartesian coordinates of CT data into pseudo-cylindrical coordinates. This is important because radial volume fractions are the output of computational battery models, and this will allow the correlation of a battery model to CT data. A selection of 10 anodes inside Zn-MnO2 AA batteries are used to demonstrate the method. For these, the pseudo-radius is defined as the relative distance in the anode between the central current collecting pin and the separator. Using these anodes, we validate that this method results in averaged one-dimensional material profiles that, when compared to other methods, show a better quantitative match to individual local slices of the anodes in the polar θ-direction. The other methods tested are methods that average to an absolute center point based on either the pin or the separator. The pseudo-cylindrical method also corrects for slight asymmetries observed in bobbin-type batteries because the pin is often slightly off-center and the separator often has a noncircular shape.

Older patients' preferences and views related to non-face-to-face diabetes chronic care management: a qualitative study from southeast Louisiana.

Background: Management of diabetes may be uniquely challenging for older individuals with multiple chronic conditions. Health systems and policymakers have attempted to reduce barriers to chronic care management (CCM) through incentives to provide non-face-to-face care. This qualitative study aimed to investigate and present views on non-face-to-face care management held by elderly patients with diabetes and other chronic conditions in order to contribute to improved programming for this population. Materials and methods: Semi-structured interviews were conducted with patients over the age of 64 who have been diagnosed with diabetes and at least one other chronic health condition. Interview recordings were transcribed and analyzed by experienced researchers using a thematic analytic approach, and an illustrative case study was developed. Results: Thirty individuals participated in this study. Participants were drawn from three health systems in south Louisiana, an area with high rates of morbidity and mortality related to chronic diseases. We identified themes related to lived experiences with diabetes and other medical conditions, perception of personal health status, perceived value of non-face-to-face programs, and support needs for future programming. Additionally, we present one case study describing in detail an individual patient's experience with non-face-to-face CCM. Conclusion: Health systems should consider intentionally recruiting participants who would benefit most from non-face-to-face care, including higher-need, less self-sufficient patients with resource constraints, while continuing to offer in-person services. Future research should examine whether tailoring non-face-to-face programming and support to address unique barriers can further enhance diabetes care at the population level.

Can Academic Detailing Move the Needle for Patients with Diabetes in a State-Based Prescription Drug Benefit Program?

BACKGROUND: Publicly funded prescription drug programs, such as state pharmacy assistance programs, provide critical benefits for the care of individuals, but they are frequently limited in their resources to optimize patient outcomes. The application of quality metrics to prescription drug claims may help to determine whether prescribers' adherence to national standards can be augmented through academic detailing. OBJECTIVE: To evaluate changes in diabetes drug prescribing patterns after an academic detailing educational intervention in 2013 and 2014 for prescribers in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) program. METHODS: We used a retrospective, quasiexperimental study design that applied interrupted time series and segmented regression analysis, and examined PACE pharmacy claims data for 1 year before and 1 year after the academic detailing intervention. Four diabetes prescribing metrics were evaluated at monthly intervals for a sample of 574 prescribers who received academic detailing and for a propensity score-matched comparison sample of 574 prescribers who did not receive the intervention. RESULTS: The prescribers who received academic detailing did not differ significantly after the intervention from the providers who did not receive the intervention in their prescribing trends for the 4 diabetes metrics. The observed time series patterns suggest that diabetes-related ceiling effects were likely, with relatively small room for improvement at the group level during the study period. CONCLUSION: The results of this study did not demonstrate group differences in prescribing trends that were attributable to the intervention. However, many prescribers in the detailed group had been exposed to similar educational outreach by PACE before 2013, which limits the interpretation of this finding. In addition, the diabetes quality metrics had been the standard of care during the preceding decade, with a broad dissemination of the treatment guidelines to the provider community. These results are consistent with a ceiling effect in the measured metrics, suggesting that most prescribers in both groups were largely following core diabetes guidelines before and after the intervention.

ILAE/IBE/WHO Global Campaign Against Epilepsy: a partnership that works.

PURPOSE OF REVIEW: Epilepsy can hijack the lives of many persons of all ages. It is an unpredictable disease that can manifest itself in seizures, brain damage and cognitive and psychiatric disabilities, although some people with epilepsy can have a relatively normal life. People with epilepsy are among the most vulnerable in any society because the disease is misunderstood and often stigmatizing. Thus, many patients and their families are reluctant to admit that they suffer from epilepsy. This in turn affects public policy in terms of patient care, early diagnosis, medical research, advocacy, cure and their very lives. RECENT FINDINGS: A survey to evaluate the results of Global Campaign Against Epilepsy activities on a national level was performed in 2009. Data from the demonstration projects have already changed the public policies in several countries. SUMMARY: On the occasion of the launch of phase II of the Campaign, the WHO Director General stated: 'The collaboration between the IBE, ILAE and WHO has shown that when people with different backgrounds and roles come together with a shared purpose, creativity is released and expertise is used in innovative and constructive ways'. Indeed, this partnership led to many activities and all over the world to many people 'standing up for epilepsy'.

The evolution of dental education as a profession, 1936-2011, and the role of the journal of dental education.

This article describes selected changes in dental education from 1936 to 2011 and describes how the Journal of Dental Education (JDE) has assisted in both reporting and, at times, championing change. The review provides a series of selective contextual milestones as a backdrop and running commentary for the changing profession of dental education. An assessment of the current state of knowledge in this field is articulated, as are some of the drivers of change. The article poses a series of questions in seven categories that define the extraordinary opportunities ahead. A vision of the future of the JDE and dental education is described including the use of the journal as a futurist forum to educate, cajole, and advocate for continuous movement toward realizing an enlightened destiny.

Reconstruction of a maxillectomy patient with an osteocutaneous flap and implant-retained fixed dental prosthesis: a clinical report.

This clinical report describes a multidisciplinary approach in the implant rehabilitation of a 53-year-old white male diagnosed with chondrosarcoma. Following a maxillectomy and insertion of a surgical obturator, the patient was unable to adapt physically and psychologically to the removable prosthesis. The patient underwent a microvascular free tissue transfer using an osteocutaneous free fibula flap to reconstruct a right/left infrastructure maxillectomy defect, a soft tissue modification of the skin component using an implant retained stent, and placement of maxillary dental implants to retain a fixed prosthesis. Prosthodontic planning and treatment considerations are discussed.

Pharmacist instruction of physical assessment for pharmacy students.

OBJECTIVE: To assess the impact of a change from nurse to pharmacist instructors and a new curriculum intended to encourage students' use of physical assessment skills. DESIGN: Pharmacist faculty members redesigned the physical assessment curriculum to focus on those assessment skills most likely to be performed by practicing pharmacists. The 5 focus areas were general assessment skills, gastrointestinal system, pulmonary system, central and peripheral nervous system, and cardiovascular system. Instructional methods used included prelaboratory assignments, brief introductory lectures, demonstration of assessment techniques, application of techniques with a laboratory partner, and demonstration of competence using a mannequin. ASSESSMENT: A 16-item survey instrument was administered to determine students' perceptions of the revised curriculum. Students who received instruction from pharmacist faculty members used their physical assessment skills more, especially during advanced pharmacy practice experiences (APPEs), than students who received instruction from nurse faculty members. Students instructed by pharmacist faculty members also felt more comfortable with their skills and rated the instruction as more practical. CONCLUSION: A redesigned curriculum and pharmacist-led instruction resulted in improved pharmacy student comfort with and use of physical assessment skills.

Envisioning success: the future of the oral health care delivery system in the United States.

The elimination of oral health disparities in the US will require enhancing access to oral health care services. The workshop convened in 2009 by the Institute of Medicine on the "US Oral Health Workforce in the Coming Decade" highlighted both the current workforce's failure to meet the nation's needs as well as the promising opportunities presented by various workforce strategies to significantly enhance access and improve oral health outcomes. In this article, we have briefly reviewed and expanded on the contributions in this special issue of the Journal of Public Health Dentistry, with the goal of identifying common themes and providing a framework for evaluation. There are several key areas where change is critically needed in order to ensure successful implementation of any new workforce models. These areas include a) the public and private financing of dental care, b) the dental educational system, and c) state and federal policies.

Autism, fever, epigenetics and the locus coeruleus.

Some children with autism spectrum disorders (ASD) exhibit improved behaviors and enhanced communication during febrile episodes. We hypothesize that febrigenesis and the behavioral-state changes associated with fever in autism depend upon selective normalization of key components of a functionally impaired locus coeruleus-noradrenergic (LC-NA) system. We posit that autistic behaviors result from developmental dysregulation of LC-NA system specification and neural network deployment and modulation linked to the core behavioral features of autism. Fever transiently restores the modulatory functions of the LC-NA system and ameliorates autistic behaviors. Fever-induced reversibility of autism suggests preserved functional integrity of widespread neural networks subserving the LC-NA system and specifically the subsystems involved in mediating the cognitive and behavioral repertoires compromised in ASD. Alterations of complex gene-environmental interactions and associated epigenetic mechanisms during seminal developmental critical periods are viewed as instrumental in LC-NA dysregulation as emphasized by the timing and severity of prenatal maternal stressors on autism prevalence. Our hypothesis has implications for a rational approach to further interrogate the interdisciplinary etiology of ASD and for designing novel biological detection systems and therapeutic agents that target the LC-NA system's diverse network of pre- and postsynaptic receptors, intracellular signaling pathways and dynamic epigenetic remodeling processes involved in their regulation and functional plasticity.

The relationship of periodontal disease to diseases and disorders at distant sites: communication to health care professionals and patients.

BACKGROUND: The body of research defining relationships among periodontal disease and certain systemic diseases and disorders has been expanding, and questions have been raised regarding what information should be conveyed to health care professionals and patients. METHODS: Representatives from dentistry, medicine, the academic community and the insurance industry convened a two-day workshop July 23 and 24, 2007. RESULTS: The workshop participants achieved general consensus on a number of issues, including the need for greater cooperation between the health care professions. This cooperation should translate into improved clinical care as physicians refer patients for dental care, and dentists are proactive in regard to the general health of their patients. CONCLUSION: Communication to health care professionals requires a multifaceted approach that includes publication of research findings in medical and dental journals, cooperation among professional organizations and initiatives at the local level such as presentations at medical grand rounds. Dental schools should play a role in their health science centers. Communication with patients may improve through the use of targeted informational brochures in the offices of medical specialists, appropriate media campaigns and efforts led by local dental organizations. PRACTICE IMPLICATIONS: It is too early to provide specific recommendations regarding the treatment of periodontal disease to improve specific health outcomes, but dentists can become advocates for a general health promotion and disease prevention message. The lifestyles approach includes an improved diet, smoking cessation, appropriate hygiene practices and stress reduction. These strategies can improve oral and general health outcomes.

The revitalization of U.S. dental education.

Revitalization of dental education in the United States is an imperative, but it depends mainly on the willingness of dental school faculty to make great changes. My remarks address a system of education of dental professionals in relation to other health professionals whose vision seems at times to have surpassed ours. I advocate for a revitalization of our profession in order to stand at the fore when it comes to ensuring the health and well-being of the public. Thanks to advances in molecular medicine, health care is being transformed from a system of treating disease to one that provides predictive, preemptive, and personalized care. This presentation makes recommendations for rethinking the current system of dental education in order to elevate dentistry to its rightful place as a vibrant health care leader. Dental education needs to be a source of new knowledge, discovery, and innovation to sustain its legacy as a learned profession. Graduates must be lifelong learners who can critically evaluate science and technology for the good of their patients. Future dentists should be providers of primary care, yet data suggest that the organizational structure to support this vision is lacking. The accreditation system, interrelated with licensure and National Boards, needs to set a better floor. While independence is an admirable goal, I see too much variation in the accreditation system. We must overcome fears and politics to upgrade the profession as pharmacy did when it introduced the Pharm.D. degree. With that came a change in the entire system of pharmacy education and clinical practice and recognition of pharmacists as members of an interdisciplinary health care team. Dentistry and dental education are doing a lot that is good, but we must and can do even better if the profession is to thrive as a respected member of the health professions delivering high-quality, evidence-based care to the public. Dental students, faculty, and practitioners must have command of new and coming scientific advances and technologies that will have a profound impact on the practice of dentistry. We must take the long view in educating our students so they will, as practitioners, be able to expertly evaluate and use new technologies throughout their careers. With regard to technologies, three examples may help clarify their future importance in dentistry: 1) oral fluids and tissues are natural tools for health surveillance; 2) within the next five to ten years, microarrays of all 700 bacterial species will be available for diagnostic purposes as will treatment tied to this diagnostic tool; and 3) biomarkers of inflammation will continue to develop into chair-side technologies with appropriate treatments. These three examples-along with spectacular advances in imaging, materials science, stem cell biology, and regenerative medicine-signal the need for rigorous change in dental education and practice. If we desire twenty-first century clinicians, we are obligated to teach students to "learn how to learn." We must teach them to practice evidence-based dental medicine. We must teach them to operate as members of interdisciplinary, primary health care teams. Moreover, we must ensure that the face of the profession-its practitioners-reflects the rich diversity of the community. Attendees at the Macy convocation are in a position to provide leadership, to work with appropriate organizations, and to enable Pharm.D.-like consensus. It behooves us to agree on a unified vision for revitalizing dental education. The vision should be based on a set of principles, either those originally laid out by W.J. Gies in 1926 or ones that may be a better fit with this day and age. The following are several recommendations for transformative change in dental education. In my view, based on my experience as a dental professional and leader, and by looking beyond our educational boundaries to places like MIT, I believe that they may be the most promising: 1) think BIG!; 2) involve students in hands-on learning experiences from day one; and 3) provide students and the profession with the tools to tackle major biomedical, clinical care, and societal issues including access to care, cost of care, HIV, emerging infectious diseases, elder care, and many others. In fact, I believe that we already know what to do to upgrade the dental profession. We need to make it happen. We need to act as catalysts for change. We understand that change is necessary but continue to struggle with implementing sustained curriculum reform and regulatory reform. Why? Partly because we have not convinced the dental profession and the education community that a crisis really exists. "Crisis" may sound to the uninformed like crying wolf, especially in a climate in which dentists in private practice are doing exceedingly well. Further, we have not provided a compelling vision for the future. Transformation will require a profound reexamination of what we are doing today and what is necessary for survival and sustained growth. We must keep pace with new knowledge and methods of teaching-unless, of course, we choose to subscribe to the facetious message of W. Edwards Deming, who is credited with rebuilding the Japanese economy after World War II: "It is not necessary to change. Survival is not mandatory."

Tissue engineering solutions for cleft palates.

PURPOSE: Clefts of the lip and palate are the most prevalent congenital craniofacial birth defect in humans. The developing field of tissue engineering is considered for the management of clefts of the lip and palate. MATERIALS AND METHODS: A review of the literature was carried out by using electronic databases (such as PubMed and ISI Web of Science) to search topics including "cleft palate," "tissue engineering," "bone engineering," "palate engineering," and "alveolar bone grafting." To reflect current practice and research, these searches were limited primarily to articles published after the year 2000. RESULTS: Current approaches for the treatment of clefts of the lip and palate include surgery and bone grafts; however, there are limitations associated with these therapies. Tissue engineering strategies, particularly alveolar bone engineering and soft tissue engineering, may provide clinicians with new alternatives. The application of these emerging technologies to a pediatric population must be well considered. CONCLUSIONS: A tissue engineering approach may be a useful alternative for the treatment of cleft palates as it mitigates the concerns of donor site morbidity as well as provides additional options including scaffold implantation and growth factor delivery.

Endocannabinoid-mediated long-term plasticity requires cAMP/PKA signaling and RIM1alpha.

Endocannabinoids (eCBs) have emerged as key activity-dependent signals that, by activating presynaptic cannabinoid receptors (i.e., CB1) coupled to G(i/o) protein, can mediate short-term and long-term synaptic depression (LTD). While the presynaptic mechanisms underlying eCB-dependent short-term depression have been identified, the molecular events linking CB1 receptors to LTD are unknown. Here we show in the hippocampus that long-term, but not short-term, eCB-dependent depression of inhibitory transmission requires presynaptic cAMP/PKA signaling. We further identify the active zone protein RIM1alpha as a key mediator of both CB1 receptor effects on the release machinery and eCB-dependent LTD in the hippocampus. Moreover, we show that eCB-dependent LTD in the amygdala and hippocampus shares major mechanistic features. These findings reveal the signaling pathway by which CB1 receptors mediate long-term effects of eCBs in two crucial brain structures. Furthermore, our results highlight a conserved mechanism of presynaptic plasticity in the brain.

Reforming dental health professions education: a white paper.

The oral health education system is in need of major reform! This is especially apparent in university-based education for the health professions. So-called preclinical as well as clinical education simply has not kept pace with or been responsive enough to shifting patient demographics and patient/population desires and expectations, changing health system expectations, evolving interdisciplinary expertise and practice requirements, new scientific discoveries and scientific information, focus on quality improvement, and/or integration of emerging technologies. Moreover, university-based "dental education" is the most costly professional degree education within the entire university portfolio, and dental student accumulated debt is increasing each year well beyond national inflation estimates. Today, we have an enormous opportunity to explore major reforms in health professional education. Through the Santa Fe "process" of open and candid engagements and discussions (see www.santafegroup.org), we advance an argument as well as a national strategy that can enable major reforms in the oral health education system. We further suggest that major revisions can result in an outcome-based education system that prepares oral health professionals to meet both the needs of patients/families/communities and the requirements of a changing health system.