Reviewing Assessment Strategies in European Dental Schools.

OBJECTIVES: Effectively assessing dental students' knowledge and skills is an important part of their education. Assessment techniques available to teachers, have become more diverse as new technologies are introduced. This study aimed to investigate what dental educators thought about current and future assessment techniques. METHODS: This was a mixed method study; quantitative data being collected at an annual dental educators' conference, via on-screen questions requesting: i) demographic information; ii) type of student assessment currently used; iii) impact of Covid-19 on student assessment, and iv) future perceptions of assessment. Questions were posed in real time using the 'Vevox' platform. Descriptive statistical analysis was employed. Qualitative data were collected on 'post-its' and analysed thematically. RESULTS: 101 participants attended the study. 59.1% (n=60) had >11 years' experience. 64% (n=55) considered their summative and formative assessments were effective in developing student learning. Few participants reported students' involvement in creating their own assessments (n=8; 9.75%). 41.68% (n=36) participants agreed it was a good idea for students to be involved in developing assessments, but only 9.75% (n=8) reported it was already happening. Qualitative data indicated a reluctance to wholeheartedly embrace technology (including AI) when planning assessments. Most participants were not in favours of Co-creation or the use of some technologies. CONCLUSIONS: Participants, reflected on the challenges of adopting a universal assessment approach. Dental educators should be given the institutional support and autonomy to implement the best assessment methods for their students. Most of this cohort of experienced dental educators reported that assessments facilitated student learning. CLINICAL SIGNIFICANCE: The role of assessment for dental students is essential as dental educators must ensure that dental students graduate with appropriate knowledge and technical skills to be safe when in general dental practice. The use of various assessment techniques needs to reflect the diversity of skills the students need to demonstrate.

Teacher feedback and student learning-The students' perspective.

INTRODUCTION: Feedback from teachers to students plays an important role in informing students about the outcome of their assessments. It contributes to students' ongoing learning. The aim of this study was to investigate dental students' perceptions of the feedback given to them by their teachers in Europe. MATERIALS & METHODS: An online questionnaire was completed by dental students throughout Europe in this quantitative study. Data were collected via Google Forms, transferred to an excel spreadsheet and analysed using SPSS software Version 24. RESULTS: 234 students studying in 9 different European countries completed the questionnaire. These students were born in 36 different countries within and beyond Europe. 84% (n = 197) were undergraduate students. 20.3% (n = 48) students reported receiving feedback following summative assessments. 81.2% (n = 190) students reported constructive criticism as their preferred mode of receiving feedback. 11.3% (n = 26) students did not know who delivered the feedback to them. 71% (n = 166) students felt that the feedback they received had a significant impact on their future learning. CONCLUSION: It would appear that there is some diversity in dental students' perceptions of: i) who delivers feedback, ii) when feedback is given, iii) the consistency of feedback received, and iv) the style of feedback they preferred compared to that delivered by tutors. Feedback is being provided to dental students in an appropriate and helpful manner, although there is still room for improvement. Students were aware of the significance of feedback and its impact on future learning. CLINICAL SIGNIFICANCE: Most European dental students prefer to receive constructive feedback. Feedback was seen to have a significant impact on future learning despite over one in five students not knowing who had delivered their feedback. Feedback following clinical teaching should have a positive effect on students' skills and motivation to learn.

Teachers' feedback practices in COVID-19: Has anything changed?

OBJECTIVES: Feedback delivered by teachers to dental students has a profound impact on students' ongoing learning and development. The aim of this study was to investigate changes to feedback practices as a result of the global COVID-19 pandemic and the ensuing challenges to delivering quality dental education. METHODS: This was a mixed method study. Quantitative data were collected through a bespoke questionnaire delivered to attendees of the Association for Dental Education in Europe (ADEE) annual conference. Qualitative data were collected via four focus groups at the conference, each discussing a particular theme. The questionnaire and conference were delivered online via Gmail and MS Teams, respectively. Quantitative data were analysed descriptively; qualitative data were analysed narratively, and both were triangulated. RESULTS: 67 questionnaire responses were received which represented a 26% response rate. Respondents came from 12 different countries within Europe and beyond and reported having a variety of roles in their dental schools. 77.6% (n = 52) respondents indicated they had changed their delivery of feedback due to the pandemic. One-third of respondents reported giving more feedback and 76% (n = 51) increased their quantity of feedback delivered online. The increased incidence of online learning had resulted in a greater emphasis on teaching small groups, increased use of technology, increased emphasis on student centred learning and heightened awareness of changing the style of feedback delivery. CONCLUSIONS: The COVID-19 pandemic has enforced rapid changes to the delivery of feedback by teachers to dental students, which could pave the way for a more positive, inclusive, individualistic and effective approach for delivering feedback now and in the future. CLINICAL SIGNIFICANCE: The COVID-19 pandemic resulted in a significant shift from face-to-face teaching to online tuition, which promoted a need to re-evaluate the best method of delivering feedback to students. The ongoing changes in teaching approaches have a profound impact on clinical skills acquisition for dental students. The quality of the feedback students receive may help to enhance the synergies between theoretical online teaching and hands-on clinical skills acquisition, which has been altered and disrupted due to the ongoing pandemic.

Assessing dentists' knowledge and experience in restoring endodontically treated teeth using post & cores.

OBJECTIVES: The restoration of endodontically, heavily filled teeth has been a challenge for the dental profession for decades. The aims of this study were to investigate dentists' experience and knowledge in the use of post & core when restoring endodontically treated teeth. METHOD: This was a mixed method study incorporating quantitative and qualitative data collection. An online questionnaire was developed and distributed, comprised of 18 questions. It was calculated that 93 respondents were needed to validate the study of which 60% should meet a minimum knowledge requirement. RESULTS: 173 respondents completed the questionnaire. 109 (63% (95%CI56%,70%) demonstrated proficient knowledge of post & core restorations. Recent graduates were more likely to follow current guidelines (F = 4.570: P<0.034). As the age of respondent dentists increases the number of posts placed (F = 18.85; p<0.001) and the perceived confidence level increases (Spearman's Rho 0.43: P<0.01). Experience of postgraduate education also positively influenced clinical confidence. CONCLUSION: The placement of post & cores is influenced by age. Confidence is also influenced by age. More evidence on post usage is required and several questions remain to be answered on what drives decision making and perceived long-term success. CLINICAL SIGNIFICANCE: There is a general acceptance of when a post and core restoration should be used. Clinician experience and age can have an impact on what type of restorations are used. Fibre posts are more commonly used due their accessibility and cost.

The Influence of Varying Gingival Display of Maxillary Anterior Teeth on the Perceptions of Smile Aesthetics.

OBJECTIVES: The aim of the study was to investigate the influence of gingival display on perceived smile aesthetics and to compare aesthetic gingival display preference amongst dental professionals and lay people. METHODS: This cross-sectional study was based on the analysis of quantitative data collected via questionnaires. Two sets of digitally altered smile images with variations of gingival amount and architecture displays were produced. Ranking order scale was used to record aesthetic preferences, from the most attractive to the least attractive. RESULTS: There were 124 respondents (60 lay people, 32 general dentists [GDPs] and 32 orthodontists). Average smile line, tangent to the zeniths of maxillary anterior teeth, was found to be the most attractive gingival amount (53.2%, χ2 = 144.15, p < 0.045) amongst lay people, GDPs and orthodontists. High smile line was ranked as the least attractive amount amongst all respondents (88.7%, χ2 = 359.37 p < 0.002). Class III gingival outline, where all gingival levels are symmetrical and in line, was found as the most attractive gingival architecture (65.3%, χ2 = 10.87 p < 0.001). CONCLUSION: No particular amount of gingival display is universally perceived as attractive although high smile lines are generally disliked. Class III gingival architecture is the most preferred gingival archetype when excessive amount of maxillary gingiva is exposed. CLINICAL SIGNIFICANCE: A general acceptance to smile line variations demonstrates that the harmony amongst all smile components is more important than merely focusing on a single ideal smile constituent. However, when designing the smile with an inherent high lip line, a Class III gingival architecture might be more preferable since it reduces the negative impact of excessive gingival display.

Investigating working practices of dentists on shade taking: Evidence based good practice versus observed practice.

OBJECTIVES: The aim of this study was to investigate UK dentists' working practices on shade taking and to assess whether these clinical practices are in accordance with evidence-based guidelines. MATERIALS & METHODS: A cross-sectional survey was carried out using a questionnaire designed to elicit quantitative and qualitative data. This included two clinical scenarios (vignettes), which required respondents to describe the steps they would take during shade taking and the prescription sent to the dental technician. RESULTS: 170 completed questionnaires were analyzed. 167 respondents (98.9 %) used manual methods for shade taking. 98 (57.6 %; 95% CI: 50 %, 65 %) respondents followed guidelines on the first vignette, 73 (42.9 %; 95% CI:35 %,51 %) followed guidelines on the second and 41(26.5 %; 95% CI:20 %,33 %) followed guidelines for both. Specialist Professional status (χ24= 10.76;p = 0.03) and more frequent use of daylight (χ2 lin = 6.09;p = 0.01) were both predictive of good practice. Qualitative data analyses revealed several themes: a) the time shade was taken, b) light source used, c) shades for different aspects of the tooth, d) dental care professional (DCP) opinion, and e) photographic support. CONCLUSION: This study demonstrated that dentists needed to improve their shade taking techniques. A quarter of respondents consistently followed evidence-based good practice guidelines; the remaining three quarters undertook shade taking with a degree of chance and possibly guesswork, potentially generating errors in communication with dental laboratories, resulting in sub-optimal clinical outcomes. Appropriate training needs to be incorporated in the relevant dental curricula. This study highlighted the importance of compiling accurate and detailed laboratory prescriptions in relation to the shade of the restorations to be fabricated.

The Fifth Asian Indoor and Martial Arts Games in Turkmenistan - A dentist's perspective.

This article is a personal view of two dentists who were invited to attend the recent Fifth Asian World Indoor and Martial Arts Championships in Ashgabat, Turkmenistan. We relate the issues of getting to the venue, challenges during our stay and the role of the dentist in the sporting arena.

Clinical performance of the Solana® Point-of-Care Trichomonas Assay from clinician-collected vaginal swabs and urine specimens from symptomatic and asymptomatic women.

BACKGROUND: Solana® (Quidel) is a new rapid (<40 min.) point-of-care (POC) test for qualitative detection of Trichomonas vaginalis (TV) DNA. The assay has two steps: 1) specimen preparation, and 2) amplification and detection using isothermal Helicase-Dependent Amplification (HDA). The objective was to demonstrate the performance of Solana for vaginal swabs and female urines based on comparison to wet mount and TV culture. Performance was also compared to the Aptima-TV assay. METHODS: Urine and four clinician-collected vaginal swabs were collected. The first two were used for FDA composite reference (wet mount; InPouch TV Culture). The third swab was used for Solana. Sensitivity/specificity were based on the reference method. A specimen was considered positive if either test was positive. The fourth swab was for Aptima-TV. RESULTS: Vaginal swabs and urines were obtained from 501 asymptomatic and 543 symptomatic women. Prevalence of TV by was 11.5%. For swabs, Solana® demonstrated high sensitivity and specificity from asymptomatic (100%/98.9%) and symptomatic (98.6%/98.5%) women, as well as for urines from asymptomatic (98.0%/98.4%) and symptomatic (92.9%/97.9%) women, compared to the reference method. Compared to Aptima-TV, the sensitivity/specificity was 89.7%/99.0% for swabs and 100%/98.9% for urines. CONCLUSION: The Solana® assay performed well compared to the reference assays.

Risk factors for Mycobacterium tuberculosis infection in 2-4 year olds in a rural HIV-prevalent setting.

BACKGROUND: Mycobacterium tuberculosis infection in children acts as a sentinel for infectious tuberculosis. OBJECTIVE: To assess risk factors associated with tuberculous infection in pre-school children. METHOD: We conducted a population-wide tuberculin skin test (TST) survey from January to December 2012 in Malawi. All children aged 2-4 years residing in a demographic surveillance area were eligible. Detailed demographic data, including adult human immunodeficiency virus (HIV) status, and clinical and sociodemographic data on all diagnosed tuberculosis (TB) patients were available. RESULTS: The prevalence of M. tuberculosis infection was 1.1% using a TST induration cut-off of 15 mm (estimated annual risk of infection of 0.3%). The main identifiable risk factors were maternal HIV infection at birth (adjusted OR [aOR] 3.6, 95%CI 1.1-12.2), having three or more adult members in the household over a lifetime (aOR 2.4, 95%CI 1.2-4.8) and living in close proximity to a known case of infectious TB (aOR 1.6, 95%CI 1.1-2.4), modelled as a linear variable across categories (>200 m, 100-200 m, <100 m, within household). Less than 20% of the infected children lived within 200 m of a known diagnosed case. CONCLUSION: Household and community risk factors identified do not explain the majority of M. tuberculosis infections in children in our setting.

Using discussion groups as a strategy for postgraduate implant dentistry students to reflect.

INTRODUCTION: More than undergraduates, postgraduate students have the day-to-day clinical experience to reflect upon. Nevertheless, reflection in postgraduate dental education is less well studied. Hence, the purpose was to investigate the attitude towards reflection and the content of reflections in postgraduate implant dentistry education in the UK and Belgium. MATERIALS AND METHODS: To investigate the attitude towards reflection, a questionnaire was administered to the 10 postgraduates at UCL Eastman Dental Institute (EDI) and 6 postgraduates at Ghent University (UGent). Additionally, students were invited to attend two reflective sessions (60-90 minutes). The sessions' audio recordings were transcribed and analysed using a thematic approach. RESULTS: In total, 16 postgraduate implant dentistry students participated. Although the majority reported prior experience with reflection, there was variation in the provided definitions of reflection. EDI students agreed with reflection being beneficial for professional development/clinical reasoning and were positive about discussing clinical experiences in groups, but were divided about individual/group reflections. Their UGent counterparts were more indecisive (=neutral), but were positive about discussing clinical experiences. Thematic analysis identified recurring themes as individual learning process, learning and clinical experiences, attitude towards implant dentistry and course programme. EDI postgraduates' reflections focussed on specific clinical situations, while UGent postgraduates' reflections described general considerations. CONCLUSION: Although students/professionals often report to reflect, it is not clear whether/how they actually reflect, due to the all-purpose word reflection has become. A strategy, using group discussions along with supervision/guidance in how to reflect, demonstrated to expand clinical reasoning into reflections about postgraduate students' clinical actions and professional growth.

Large-scale whole genome sequencing of M. tuberculosis provides insights into transmission in a high prevalence area.

To improve understanding of the factors influencing tuberculosis transmission and the role of pathogen variation, we sequenced all available specimens from patients diagnosed over 15 years in a whole district in Malawi. Mycobacterium tuberculosis lineages were assigned and transmission networks constructed, allowing ≤10 single nucleotide polymorphisms (SNPs) difference. We defined disease as due to recent infection if the network-determined source was within 5 years, and assessed transmissibility from forward transmissions resulting in disease. High-quality sequences were available for 1687 disease episodes (72% of all culture-positive episodes): 66% of patients linked to at least one other patient. The between-patient mutation rate was 0.26 SNPs/year (95% CI 0.21-0.31). We showed striking differences by lineage in the proportion of disease due to recent transmission and in transmissibility (highest for lineage-2 and lowest for lineage-1) that were not confounded by immigration, HIV status or drug resistance. Transmissions resulting in disease decreased markedly over time.

Epidemiological analysis of an outbreak of foot-and-mouth disease (serotype SAT2) on a large dairy farm in Kenya using regular vaccination.

During August-September 2012, an outbreak of Foot-and-mouth Disease (FMD) due to serotype Southern African Territories-2 (SAT2) occurred on a large, extensively grazed dairy farm in Nakuru County, Kenya. Over 29 days, 400/644 (62.1%) cattle were recorded as displaying clinical signs consistent with FMD. Out of the 18 management groups present, 17 had clinical cases (weighted mean incidence rate 3.5 per 100 cattle-days, 95% CI 2.4, 5.1; range 0.064-10.9). Transmission may have been encouraged when an infected group was moved to a designated isolation paddock. A four to five day minimum incubation period was apparent in five groups for which a point source exposure was evident. Further transmission was associated with the movement of individual animals incubating infection, use of a common dip and milking parlour, and grazing of susceptible groups in paddocks neighbouring to infectious cases. Animals over 18 months old appeared to be at highest risk of disease possibly due to milder clinical signs seen among younger animals resulting in reduced transmission or cases not being recorded. Cows with a breeding pedigree containing a greater proportion of zebu appeared to be at lower risk of disease. The outbreak occurred despite regular vaccination (three times per year) last performed approximately three months before the index case. Incidence risk by the lifetime number of doses received indicated limited or no vaccine effectiveness against clinical disease. Reasons for poor vaccine effectiveness are discussed with antigenic diversity of the SAT2 serotype and poor match between the field and vaccine strain as a likely explanation. Detailed field-derived epidemiological data based on individual animals are rarely presented in the literature for FMD, particularly in East-Africa and with the SAT2 serotype. This study provides a detailed account and therefore provides a greater understanding of FMD outbreaks in this setting. Additionally, this is the first study to provide field-derived evidence of poor vaccine effectiveness using a SAT2 vaccine. Further field-based measures of vaccine effectiveness in line with evaluation of human vaccines are needed to inform FMD control policy which has previously relied heavily upon experimental data and anecdotal experience.

Consensus statement: Oral health and elite sport performance.

While the research base is limited, studies have consistently reported poor oral health in elite athletes since the first report from the 1968 Olympic Games. The finding is consistent both across selected samples attending dental clinics at major competitions and more representative sampling of teams and has led to calls from the International Olympic Committee for more accurate data on oral health. Poor oral health is an important issue directly as it can cause pain, negative effects on appearance and psychosocial effects on confidence and quality of life and may have long-term consequences for treatment burden. Self-reported evidence also suggests an impact on training and performance of athletes. There are many potential challenges to the oral health of athletes including nutritional, oral dehydration, exercise-induced immune suppression, lack of awareness, negative health behaviours and lack of prioritisation. However, in theory, oral diseases are preventable by simple interventions with good evidence of efficacy. The consensus statement aims to raise awareness of the issues of oral health in elite sport and recommends strategies for prevention and health promotion in addition to future research strategies.

Science and society: vaccines and public health.

Most public health research is devoted to the measurement of disease burdens and of the costs and effectiveness of control measures. The history of immunization provides many colourful examples of various ways in which such measurements are made, of how they have influenced policies, and of the importance of public perception of the magnitudes of the various burdens, benefits and risks. Improving the public's ability to evaluate evidence is itself an important aspect of public health.

Survival of Seasonal Flooding in the Amazon by the Terrestrial Insect Conotrachelus dubiae O'Brien & Couturier (Coleoptera: Curculionidae), a Pest of the Camu-Camu Plant, Myrciaria dubia (Myrtaceae).

The weevil Conotrachelus dubiae O'Brien & Couturier (Coleoptera: Curculionidae) is a pest of an economically important Amazonian fruit tree Myrciaria dubia (Myrtaceae). This tree grows in seasonally flooded environments, and how weevil larvae survive flooding has not been studied. From December 2004 to May 2009, five experiments were conducted in natural conditions and in the laboratory, with the aim of understanding the mechanisms that allow the survival of C. dubiae larvae in seasonal floods in Amazonia. The larvae of C. dubiae were kept under water for over 93 days. Older instars exposed to periodic circulation of water survived better than younger instars in addition to all larvae that were kept continuously under uncirculated water. Individuals that were collected from plots of M. dubia located in flooded soils and non-flooded soils did not exhibit statistically significant differences in their levels of survival indicating that the variation in survival of flooding events is due to phenotypic plasticity of the species and not to local adaptation by the populations in different environments. We speculate that larvae can survive floods without major physiological changes as larvae appear to obtain oxygen from water by cutaneous diffusion, assisted by caudal movements.

Systematic review and meta-analysis of the current evidence on the duration of protection by bacillus Calmette-Guérin vaccination against tuberculosis.

BACKGROUND: Recent evidence suggests that the duration of protection by bacillus Calmette-Guérin (BCG) may exceed previous estimates with potential implications for estimating clinical and cost-efficacy. OBJECTIVES: To estimate the protection and duration of protection provided by BCG vaccination against tuberculosis, explore how this protection changes with time since vaccination, and examine the reasons behind the variation in protection and the rate of waning of protection. DATA SOURCES: Electronic databases including MEDLINE, Excerpta Medica Database (EMBASE), Cochrane Databases, NHS Economic Evaluation Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE), Web of Knowledge, Biosciences Information Service (BIOSIS), Latin American and Caribbean Health Sciences Literature (LILACs), MEDCARIB Database, Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from inception to May 2009. Index to Theses, System for Information on Grey Literature in Europe (SIGLE), Centre for Agricultural Bioscience International (CABI) Abstracts, Scopus, Article First, Academic Complete, Africa-Wide Information, Google Scholar, Global Health, British National Bibliography for Report Literature, and clinical trial registration websites were searched from inception to October 2009. REVIEW METHODS: Electronic databases searches, screening of identified studies, data extraction and analysis were undertaken. Meta-analysis was used to present numerical and graphical summaries of clinical efficacy and efficacy by time since vaccination. Evidence of heterogeneity was assessed using the tau-squared statistic. Meta-regression allowed the investigation of observed heterogeneity. Factors investigated included BCG strain, latitude, stringency of pre-BCG vaccination tuberculin testing, age at vaccination, site of disease, study design and vulnerability to biases. Rate of waning of protection was estimated using the ratio of the measure of efficacy after 10 years compared with the efficacy in the first 10 years of a study. RESULTS: Study selection. A total of 21,030 references were identified, providing data on 132 studies after abstract and full-text review. Efficacy. Protection against pulmonary tuberculosis in adults is variable, ranging from substantial protection in the UK MRC trial {rate ratio 0.22 [95% confidence interval (CI) 0.16 to 0.31]}, to absence of clinically important benefit, as in the large Chingleput trial [rate ratio 1.05 (95% CI 0.88 to 1.25)] and greater in latitudes further away from the equator. BCG vaccination efficacy was usually high, and varied little by form of disease (with higher protection against meningeal and miliary tuberculosis) or study design when BCG vaccination was given only to infants or to children after strict screening for tuberculin sensitivity. High levels of protection against death were observed from both trials and observational studies. The observed protective effect of BCG vaccination did not differ by the strain of BCG vaccine used in trials. DURATION: Reviewed studies showed that BCG vaccination protects against pulmonary and extrapulmonary tuberculosis for up to 10 years. Most studies either did not follow up participants for long enough or had very few cases after 15 years. This should not be taken to indicate an absence of effect: five studies (one trial and four observational studies) provided evidence of measurable protection at least 15 years after vaccination. Efficacy declined with time. The rate of decline was variable, with faster decline in latitudes further from the equator and in situations where BCG vaccination was given to tuberculin-sensitive participants after stringent tuberculin testing. LIMITATIONS: The main limitation of this review relates to quality of included trials, most of which were conducted before current standards for reporting were formulated. In addition, data were lacking in some areas and the review had to rely on evidence from observational studies. CONCLUSIONS: BCG vaccination protection against tuberculosis varies between populations, to an extent that cannot be attributed to chance alone. Failure to exclude those already sensitised to mycobacteria and study latitude closer to the equator were associated with lower efficacy. These factors explained most of the observed variation. There is good evidence that BCG vaccination protection declines with time and that protection can last for up to 10 years. Data on protection beyond 15 years are limited; however, a small number of trials and observational studies suggest that BCG vaccination may protect for longer. Further studies are required to investigate the duration of protection by BCG vaccination. FUNDING: The National Institute for Health Research Health Technology Assessment programme.

Uptake of cadmium by hydroponically grown, mature Eucalyptus camaldulensis saplings and the effect of organic ligands.

The potential suitability of Eucalyptus camaldulensis for Cd phytoextraction was tested in a hydroponic study. Saplings were exposed to 4.5 and 89 microM Cd for one month, with and without EDTA and s,s-EDDS at 0.1, 1, and 5 mM. The saplings' growth was not affected at the 4.5 microM Cd concentration, yet it decreased 3-fold at 89 microM, and almost all the Cd taken up was immobilized in the roots, reaching 360 and 5300 mg Cd kg(-1), respectively (approximately 75% of which was non-washable in acid). The respective Cd root-to-shoot translocation factors were 0.14 and approximately 5*10(-4). At 0.1 mM concentration, EDTA and EDDS had no effect or even a positive effect on the saplings growth. This was reversed at 1 mM, and the chelants became lethal at the 5 mM concentration. At 89 microM Cd in the growth medium, 0.1 mM EDTA increased Cd translocation into the shoots by almost 10-fold, however it strongly reduced Cd content inside the roots. This hydroponic study indicates the feasibility of E. camaldulensis use for cleanup Cd-contaminated soils at environmental concentrations, both for site stabilization (phytostabilization) and gradual remediation (phytoextraction). EDTA was shown to be much more efficient in enhancing Cd translocation than s,s-EDDS.

Pilot study of high-performance air filtration for classroom applications.

UNLABELLED: A study was conducted to investigate the effectiveness of three air purification systems in reducing the exposure of children to air contaminants inside nine classrooms of three Southern California schools. Continuous and integrated measurements were conducted to monitor the indoor and outdoor concentrations of ultrafine particles (UFPs), fine and coarse particulate matter (PM2.5 and PM10 , respectively), black carbon (BC), and volatile organic compounds. An heating, ventilating, and air conditioning (HVAC)-based high-performance panel filter (HP-PF), a register-based air purifier (RS), and a stand-alone air cleaning system (SA) were tested alone and in different combinations for their ability to remove the monitored pollutants. The combination of a RS and a HP-PF was the most effective solution for lowering the indoor concentrations of BC, UFPs, and PM2.5 , with study average reductions between 87% and 96%. When using the HP-PF alone, reductions close to 90% were also achieved. In all cases, air quality conditions were improved substantially with respect to the corresponding baseline (preexisting) conditions. Data on the performance of the gas-absorbing media included in the RS and SA unit were inconclusive, and their effectiveness, lifetime, costs, and benefits must be further assessed before conclusions and recommendations can be made. PRACTICAL IMPLICATIONS: The installation of effective air filtration devices in classrooms may be an important mitigation measure to help reduce the exposure of school children to indoor pollutants of outdoor origin including ultrafine particles and diesel particulate matter, especially at schools located near highly trafficked freeways, refineries, and other important sources of air toxics.

Married to M. tuberculosis: risk of infection and disease in spouses of smear-positive tuberculosis patients.

OBJECTIVES: To quantify the risk of infection and disease in spouses of tuberculosis patients and the extent to which intervention could reduce the risk in this highly exposed group. METHODS: We compared HIV prevalence, TB prevalence and incidence and tuberculin skin test (TST) results in spouses of TB patients and community controls. HIV-positive spouses were offered isoniazid preventive therapy (IPT), and TST was repeated at 6, 12 and 24 months. RESULTS: We recruited 148 spouses of smear-positive patients ascertained prospectively and 3% had active TB. We identified 203 spouses of previously diagnosed smear-positive patients, 11 had already had TB, and the rate of TB was 2.4 per 100 person years(py) over 2 years (95% CI 1.15-5.09). 116 were found alive and recruited. HIV prevalence was 37% and 39% in the prospective and retrospective spouse groups and 17% in controls. TST was ≥10 mm in 80% of HIV negative and in 57% of HIV-positive spouses ascertained retrospectively; 74% HIV negative and 62% HIV-positive spouses ascertained prospectively, and 48% HIV negative and 26% HIV-positive community controls. Of 54 HIV-positive spouses, 18 completed 6-month IPT. At 2 year follow-up, 87% of surviving spouses had TST ≥10 mm and the rate of TB was 1.1 per 100 py (95% CI 0.34-3.29). CONCLUSIONS: Spouses are a high-risk group who should be screened for HIV and active TB. TST prevalence was already high by the time the spouses were approached but further infections were seen to occur. Uptake and adherence to IPT was disappointing, lessening the impact of short-duration therapy.