Oral Health Literacy Inventories for Caregivers of Preschool-aged Children: A systematic review.

Purpose: The purpose of this systematic review was to describe the oral health literacy (OHL) inventories that have been used among caregivers of preschool-aged children.Methods: Four databases were searched (CINAHL, Cochrane Database of Systematic Reviews, Dentistry & Oral Sciences Source, PubMed), to identify peer-reviewed, full-text studies published in English on the oral health literacy among caregivers of preschool-aged children from 2010-2021. All studies were assessed for eligibility using PRISMA guidelines. Inclusion criteria were experimental, non-experimental, or mixed methods peer-reviewed studies, conducted in the United States. Eligible studies were independently evaluated using the Effective Public Health Practice Project's Quality Assessment Tool.Results: The initial search yielded 182 articles; 11 studies met the inclusion criteria after screening: observational (n=8), experimental (n=2), and quasi-experimental (n=1). Main outcome measures included: oral health literacy, oral health knowledge, oral health attitudes and behaviors, child oral health status (COHS), child oral health-related quality of life (C-OHRQoL), and child oral health-related expenditures. However, this review focused only on caregivers' OHL and the associated measurements for this variable. Most studies utilized the Rapid Estimate of Adult Literacy in Dentistry (REALD-30); the remainder used the Basic Research Factors Questionnaire (BRFQ), the Oral Health Literacy Inventory for Parents (OH-LIP), or self-designed survey questions.Conclusions: Few studies met the inclusion criteria. There was an uneven distribution of studies using different inventories for the measurement of oral health literacy limiting the generalizability of the findings to low-income and minority groups. Most caregiver OHL studies focused on dental word recognition, only a few measured knowledge and comprehension. More comprehensive inventories could be designed to evaluate caregivers' knowledge and understanding of dental terms.

Caregivers' Comprehension of the Terms Decay and Cavities: A qualitative analysis.

Purpose: Tooth decay and cavities are the most common oral health consequences for young children that may result from inadequate oral health literacy (OHL) or understanding of their caregivers. The purpose of this study was to describe the understanding of terms related to decay and cavities among caregivers of preschool-aged children.Methods: English-speaking caregivers with children aged <6 years were recruited from two private dental practices located in Washington State. A qualitative analysis was performed using responses regarding the terms decay and cavities as part of the 36 item Oral Health Literacy Inventory for Parents (OH-LIP). Responses were recorded, transcribed, coded, and assigned to domains and categories.Results: Responses from 111 participants were included in the analysis. About one fifth of the participants (19.8%, n=22) indicated that they did not know what decay was or provided an incorrect response. The majority (71.2%, n=79) made the association that decay was something bad that happens to the teeth. However only a minority of the participants (9%, n=10) correctly identified decay as destruction of the tooth surface because of bacterial action. When asked to define the word cavities, more than half (68.5%) indicated that cavities were something harmful to teeth, while only about one quarter (27%, n=30) correctly identified cavities as resulting from the decay process.Conclusion: Knowledge disparities related to the terms decay and cavities among caregivers suggest that more education is needed regarding the tooth decay process and factors causing dental caries to ensure timely preventive services are received. Gaps in oral health literacy should be addressed by health care professionals. Dental hygienists are in an ideal position to educate caregivers as well as non-dental health care professionals who provide services to caregivers and children.

Exploration of the visibility of patient input in final recommendation documentation for three health technology assessment bodies.

Health technology assessment (HTA) recommendations informed by patient concerns are seen to ensure democracy and legitimacy. We explored how written and oral patient involvement in two HTAs was reported on in publicly available final recommendations and discussion summaries of appraisal committees from three HTA bodies. We aimed to gain insights into how patient input was utilized by appraisal committees to better understand the goals of patient involvement and how these are being achieved. In each of the three HTA bodies, templated submission questionnaires provide a formal process for seeking written patient group input. Additionally, the National Institute for Health and Care Excellence (NICE) selects patient experts to provide a templated submission and attend appraisal committee meetings. For Scottish Medicines Consortium (SMC), a patient advocate and clinician combined meeting (PACE) discussed the cancer drug, referred to in the final recommendation. The discussion summaries of all appraisal committees contained references to patient involvement. Where two mechanisms for patient involvement were provided, oral input from the expert patients and PACE were more clearly documented than information from written patient group submissions. NICE reports focused on the perspective of the patient expert. The SMC report highlighted feedback from the PACE throughout. We suggest that the lack of clear reporting on the use of patient group input in deliberations and therefore accountability to patient groups limits progress in patient involvement in HTA. Patient groups may therefore not have a clear understanding of what information they can best provide to inform deliberations, and in reporting back to members.

End of life in acute hospital setting-A systematic review of families' experience of spiritual care.

AIMS AND OBJECTIVES: To systematically review qualitative studies exploring families' experiences of spiritual care at the end of life in acute hospital settings. BACKGROUND: Although there is a widespread belief that the consideration of spiritual and religious needs is outdated in the context of secularism, from a practical perspective patients and families appear to benefit from spiritual support at the end of life. METHODS: Six key databases, CINAHL, MEDLINE, EMBASE, Global Health Library, Web of Science and Applied Social Sciences Index and Abstracts (ASSIA), were searched, and three reviewers independently extracted the data and coded them into themes and subthemes. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used as a reporting framework. RESULTS: Five main themes emerged: anticipating needs; honouring the family by honouring the patient; personal connection; lack of sensitivity; and making space for religious and spiritual practices. CONCLUSIONS: Families experiencing end-of-life care in acute hospital settings may benefit from spiritual care. While this can also be considered as fundamental care, understanding this through the lenses of spiritual care allows for incorporation of religious and spiritual practices that many seek at this time, irrespective of their faith perspectives. RELEVANCE TO CLINICAL PRACTICE: Although hospice care is well established internationally, many families experience end-of-life care in acute hospital settings. Nurses usually get to know families well during this time; however, the demands of the clinical environment place restrictions on family care and perceptions of lack of communication, limited support and/or limited sensitivity can compound families' suffering. Consideration of families' spiritual needs can help to support families during this time. Nurses are ideally placed for this and can anticipate and plan for patient and family needs in this regard, or refer to a specialist, such as the Healthcare Chaplain.

Methane Emissions from Natural Gas Production Sites in the United States: Data Synthesis and National Estimate.

We used site-level methane (CH4) emissions data from over 1000 natural gas (NG) production sites in eight basins, including 92 new site-level CH4 measurements in the Uinta, northeastern Marcellus, and Denver-Julesburg basins, to investigate CH4 emissions characteristics and develop a new national CH4 emission estimate for the NG production sector. The distribution of site-level emissions is highly skewed, with the top 5% of sites accounting for 50% of cumulative emissions. High emitting sites are predominantly also high producing (>10 Mcfd). However, low NG production sites emit a larger fraction of their CH4 production. When combined with activity data, we predict that this creates substantial variability in the basin-level CH4 emissions which, as a fraction of basin-level CH4 production, range from 0.90% for the Appalachian and Greater Green River to >4.5% in the San Juan and San Joaquin. This suggests that much of the basin-level differences in production-normalized CH4 emissions reported by aircraft studies can be explained by differences in site size and distribution of site-level production rates. We estimate that NG production sites emit total CH4 emissions of 830 Mg/h (95% CI: 530-1200), 63% of which come from the sites producing <100 Mcfd that account for only 10% of total NG production. Our total CH4 emissions estimate is 2.3 times higher than the U.S. Environmental Protection Agency's estimate and likely attributable to the disproportionate influence of high emitting sites.

Tau Kinetics in Neurons and the Human Central Nervous System.

We developed stable isotope labeling and mass spectrometry approaches to measure the kinetics of multiple isoforms and fragments of tau in the human central nervous system (CNS) and in human induced pluripotent stem cell (iPSC)-derived neurons. Newly synthesized tau is truncated and released from human neurons in 3 days. Although most tau proteins have similar turnover, 4R tau isoforms and phosphorylated forms of tau exhibit faster turnover rates, suggesting unique processing of these forms that may have independent biological activities. The half-life of tau in control human iPSC-derived neurons is 6.74 ± 0.45 days and in human CNS is 23 ± 6.4 days. In cognitively normal and Alzheimer's disease participants, the production rate of tau positively correlates with the amount of amyloid plaques, indicating a biological link between amyloid plaques and tau physiology.

Putting research in place: an innovative approach to providing contextualized evidence synthesis for decision makers.

BACKGROUND: The Contextualized Health Research Synthesis Program (CHRSP), developed in 2007 by the Newfoundland and Labrador Centre for Applied Health Research, produces contextualized knowledge syntheses for health-system decision makers. The program provides timely, relevant, and easy-to-understand scientific evidence; optimizes evidence uptake; and, most importantly, attunes research questions and evidence to the specific context in which knowledge users must apply the findings. METHODS: As an integrated knowledge translation (KT) method, CHRSP: Involves intensive partnerships with senior healthcare decision makers who propose priority research topics and participate on research teams; Considers local context both in framing the research question and in reporting the findings; Makes economical use of resources by utilizing a limited number of staff; Uses a combination of external and local experts; and Works quickly by synthesizing high-level systematic review evidence rather than primary studies. Although it was developed in the Canadian province of Newfoundland and Labrador, the CHRSP methodology is adaptable to a variety of settings with distinctive features, such as those in rural, remote, and small-town locations. RESULTS: CHRSP has published 25 syntheses on priority topics chosen by the provincial healthcare system, including: Clinical and cost-effectiveness: telehealth, rural renal dialysis, point-of-care testing; Community-based health services: helping seniors age in place, supporting seniors with dementia, residential treatment centers for at-risk youth; Healthcare organization/service delivery: reducing acute-care length of stay, promoting flu vaccination among health workers, safe patient handling, age-friendly acute care; and Health promotion: diabetes prevention, promoting healthy dietary habits. These studies have been used by decision makers to inform local policy and practice decisions. CONCLUSIONS: By asking the health system to identify its own priorities and to participate directly in the research process, CHRSP fully integrates KT among researchers and knowledge users in healthcare in Newfoundland and Labrador. This high level of decision-maker buy-in has resulted in a corresponding level of uptake. CHRSP studies have directly informed a number of policy and practice directions, including the design of youth residential treatment centers, a provincial policy on single-use medical devices, and most recently, the opening of the province's first Acute Care for the Elderly hospital unit.

Amyloid ß concentrations and stable isotope labeling kinetics of human plasma specific to central nervous system amyloidosis.

INTRODUCTION: Cerebrospinal fluid analysis and other measurements of amyloidosis, such as amyloid-binding positron emission tomography studies, are limited by cost and availability. There is a need for a more practical amyloid ß (Aß) biomarker for central nervous system amyloid deposition. METHODS: We adapted our previously reported stable isotope labeling kinetics protocol to analyze the turnover kinetics and concentrations of Aß38, Aß40, and Aß42 in human plasma. RESULTS: Aß isoforms have a half-life of approximately 3 hours in plasma. Aß38 demonstrated faster turnover kinetics compared with Aß40 and Aß42. Faster fractional turnover of Aß42 relative to Aß40 and lower Aß42 and Aß42/Aß40 concentrations in amyloid-positive participants were observed. DISCUSSION: Blood plasma Aß42 shows similar amyloid-associated alterations as we have previously reported in cerebrospinal fluid, suggesting a blood-brain transportation mechanism of Aß. The stability and sensitivity of plasma Aß measurements suggest this may be a useful screening test for central nervous system amyloidosis.

Methane Emissions from Conventional and Unconventional Natural Gas Production Sites in the Marcellus Shale Basin.

There is a need for continued assessment of methane (CH4) emissions associated with natural gas (NG) production, especially as recent advancements in horizontal drilling combined with staged hydraulic fracturing technologies have dramatically increased NG production (we refer to these wells as "unconventional" NG wells). In this study, we measured facility-level CH4 emissions rates from the NG production sector in the Marcellus region, and compared CH4 emissions between unconventional NG (UNG) well pad sites and the relatively smaller and older "conventional" NG (CvNG) sites that consist of wells drilled vertically into permeable geologic formations. A top-down tracer-flux CH4 measurement approach utilizing mobile downwind intercepts of CH4, ethane, and tracer (nitrous oxide and acetylene) plumes was performed at 18 CvNG sites (19 individual wells) and 17 UNG sites (88 individual wells). The 17 UNG sites included four sites undergoing completion flowback (FB). The mean facility-level CH4 emission rate among UNG well pad sites in routine production (18.8 kg/h (95% confidence interval (CI) on the mean of 12.0-26.8 kg/h)) was 23 times greater than the mean CH4 emissions from CvNG sites. These differences were attributed, in part, to the large size (based on number of wells and ancillary NG production equipment) and the significantly higher production rate of UNG sites. However, CvNG sites generally had much higher production-normalized CH4 emission rates (median: 11%; range: 0.35-91%) compared to UNG sites (median: 0.13%, range: 0.01-1.2%), likely resulting from a greater prevalence of avoidable process operating conditions (e.g., unresolved equipment maintenance issues). At the regional scale, we estimate that total annual CH4 emissions from 88 500 combined CvNG well pads in Pennsylvania and West Virginia (660 Gg (95% CI: 500 to 800 Gg)) exceeded that from 3390 UNG well pads by 170 Gg, reflecting the large number of CvNG wells and the comparably large fraction of CH4 lost per unit production. The new emissions data suggest that the recently instituted Pennsylvania CH4 emissions inventory substantially underestimates measured facility-level CH4 emissions by >10-40 times for five UNG sites in this study.

Methane emissions from natural gas compressor stations in the transmission and storage sector: measurements and comparisons with the EPA greenhouse gas reporting program protocol.

Equipment- and site-level methane emissions from 45 compressor stations in the transmission and storage (T&S) sector of the US natural gas system were measured, including 25 sites required to report under the EPA greenhouse gas reporting program (GHGRP). Direct measurements of fugitive and vented sources were combined with AP-42-based exhaust emission factors (for operating reciprocating engines and turbines) to produce a study onsite estimate. Site-level methane emissions were also concurrently measured with downwind-tracer-flux techniques. At most sites, these two independent estimates agreed within experimental uncertainty. Site-level methane emissions varied from 2-880 SCFM. Compressor vents, leaky isolation valves, reciprocating engine exhaust, and equipment leaks were major sources, and substantial emissions were observed at both operating and standby compressor stations. The site-level methane emission rates were highly skewed; the highest emitting 10% of sites (including two superemitters) contributed 50% of the aggregate methane emissions, while the lowest emitting 50% of sites contributed less than 10% of the aggregate emissions. Excluding the two superemitters, study-average methane emissions from compressor housings and noncompressor sources are comparable to or lower than the corresponding effective emission factors used in the EPA greenhouse gas inventory. If the two superemitters are included in the analysis, then the average emission factors based on this study could exceed the EPA greenhouse gas inventory emission factors, which highlights the potentially important contribution of superemitters to national emissions. However, quantification of their influence requires knowledge of the magnitude and frequency of superemitters across the entire T&S sector. Only 38% of the methane emissions measured by the comprehensive onsite measurements were reportable under the new EPA GHGRP because of a combination of inaccurate emission factors for leakers and exhaust methane, and various exclusions. The bias is even larger if one accounts for the superemitters, which were not captured by the onsite measurements. The magnitude of the bias varied from site to site by site type and operating state. Therefore, while the GHGRP is a valuable new source of emissions information, care must be taken when incorporating these data into emission inventories. The value of the GHGRP can be increased by requiring more direct measurements of emissions (as opposed to using counts and emission factors), eliminating exclusions such as rod-packing vents on pressurized reciprocating compressors in standby mode under Subpart-W, and using more appropriate emission factors for exhaust methane from reciprocating engines under Subpart-C.

Measurements of methane emissions from natural gas gathering facilities and processing plants: measurement results.

Facility-level methane emissions were measured at 114 gathering facilities and 16 processing plants in the United States natural gas system. At gathering facilities, the measured methane emission rates ranged from 0.7 to 700 kg per hour (kg/h) (0.6 to 600 standard cubic feet per minute (scfm)). Normalized emissions (as a % of total methane throughput) were less than 1% for 85 gathering facilities and 19 had normalized emissions less than 0.1%. The range of methane emissions rates for processing plants was 3 to 600 kg/h (3 to 524 scfm), corresponding to normalized methane emissions rates <1% in all cases. The distributions of methane emissions, particularly for gathering facilities, are skewed. For example, 30% of gathering facilities contribute 80% of the total emissions. Normalized emissions rates are negatively correlated with facility throughput. The variation in methane emissions also appears driven by differences between inlet and outlet pressure, as well as venting and leaking equipment. Substantial venting from liquids storage tanks was observed at 20% of gathering facilities. Emissions rates at these facilities were, on average, around four times the rates observed at similar facilities without substantial venting.

Dietary carotenoids do not improve motility or antioxidant capacity in cichlid fish sperm.

Carotenoids may act as antioxidants under many circumstances. We examined the importance of carotenoids as antioxidants in the gonads of male convict cichlids (Amatitlania nigrofasciata), a species in which males lack the carotenoid-based breeding coloration that characterizes females. Male fish were fed one of four diets that included different combinations of xanthophyll and carotene carotenoids, and then we measured carotenoid concentration of the gonads, gonadosomatic index (GSI), sperm motility, and the antioxidant capacity of the gonads. Significant differences were found in gonadal carotenoid content among treatment groups, suggesting that dietary carotenoids were indeed sequestered in the gonads. There were no differences among diet groups, however, in GSI, sperm motility, or gonadal antioxidant capacity. These findings suggest that carotenoids are required only in small amounts in the testes of male convict cichlids or that they play a limited role in protecting sperm from oxidative damage.