Predictors of Unmet Dental Health Needs in US Adults in 2018: A Cross-Sectional Analysis.

OBJECTIVE: To identify predictors of unmet dental needs for adults 18 y of age or older in the United States. METHOD: Using the Aday and Andersen framework and data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), we ran logistic regression to estimate predictors for adults of not having a dental visit within 5 y and having lost any teeth using a national sample of 155,060 survey respondents. RESULTS: Results showed that predisposing factors (age, race/ethnicity, gender, and educational attainment) and enabling factors (income and health insurance status) are important predictors for losing teeth due to decay or gum disease. Men, the elderly, and less educated and low-income residents were less likely to have seen a dentist within the past 5 y and more likely to have lost their permanent teeth. Compared to non-Hispanic White adults, Hispanics adults were more likely to have had a dental visit within the past 5 y. Unmet dental needs varied across states. People living in states with extensive Medicaid dental care benefit coverage were less likely to lose their teeth and more likely to have had a dental visit within the past 5 y. CONCLUSION: Efforts to improve oral health should address unmet dental needs of men and adults with low socioeconomic status. Studying the variation between state oral health care programs could further our understanding of how public policy can improve population oral health. KNOWLEDGE TRANSFER STATEMENT: Men, non-Hispanic Blacks, mixed and other race minorities, and low socioeconomic status adults are most at risk of unmet dental needs. States can address these needs by expanding Medicaid coverage for adults.

Deliberate practice as an educational method for learning to interpret the prepubescent female genital examination.

BACKGROUND: Correct interpretation of the prepubescent female genital examination is a critical skill; however, physician skill in this area is limited. OBJECTIVE: To complement the bedside learning of this examination, we developed a learning platform for the visual diagnosis of the prepubescent female genital examination and examined the amount and rate of skill acquisition. PARTICIPANTS AND SETTING: Medical students, residents, and fellows and attendings participated in an on-line learning platform. METHODS: This was a multicenter prospective cross-sectional study. Study participants deliberately practiced 158 prepubescent female genital examination cases hosted on a computer-based learning and assessment platform. Participants assigned the case normal or abnormal; if abnormal, they identified the location of the abnormality and the specific diagnosis. Participants received feedback after every case. RESULTS: We enrolled 107 participants (26 students, 31 residents, 24 fellows and 26 attendings). Accuracy (95 % CI) increased by 10.3 % (7.8, 12.8), Cohen's d-effect size of 1.17 (1.14, 1.19). The change in specificity was +16.8 (14.1, 19.5) and sensitivity +2.4 (-0.9, 5.6). It took a mean (SD) 46.3 (32.2) minutes to complete cases. There was no difference between learner types with respect to initial (p = 0.2) or final accuracy (p = 0.4) scores. CONCLUSIONS: This study's learning intervention led to effective and feasible skill improvement. However, while participants improved significantly with normal cases, which has relevance in reducing unnecessary referrals to child protection teams, learning gains were not as evident in abnormal cases. All levels of learners demonstrated a similar performance, emphasizing the need for this education even among experienced clinicians.

First Report of Puccinia psidii Caused Rust Disease Epiphytotic on the Invasive Shrub Rhodomyrtus tomentosa in Florida.

Rhodomyrtus tomentosa (Aiton) Hassk. (downy-rose myrtle, family: Myrtaceae), of South Asian origin, is an invasive shrub that has formed monotypic stands in Florida (3). During the winter and spring of 2010 through 2012, a rust disease of epiphytotic proportion was observed on young foliage, stem terminals, and immature fruits of this shrub in natural areas of Martin and Lee counties, Florida. Expanding leaves and succulent stems developed chlorotic flecks on the surface that developed into pustules and ruptured to discharge urediniospores. Symptomatic leaves and stems developed severe necrotic spots and resulted in tissue distortion, defoliation, and stem dieback. Based on symptoms and urediniospore morphology and dimensions (17.7 to 26.1 [22.1 ± 0.3] × 14.7 to 21.1 [17.7 ± 0.2] µm; n = 51) (4), the causal agent was identified as Puccinia psidii Winter; teliospores were not observed in samples since it does not produce these spore stages below 20°C ambient temperature (1). This identification was confirmed by a GenBank BLAST of internal transcribed spacer (ITS) sequences (Accession Nos. KC607876 and KC607877) that showed 99% identity with 42 sequences of P. psidii from diverse host species and locations. P. psidii is believed to be of neotropical origin and has a host range of 129 species in 33 genera within Myrtaceae (2). However, P. psidii caused disease of downy-rose myrtle has not been previously reported in Florida, even though severe infections occurred on another invasive tree, Melaleuca quinquenervia (Cav.) S.F. Blake (3), growing in adjacent areas. In December 2011, urediniospores were collected from downy-rose myrtle, established in aqueous suspension (45,000 spores/ml), and spray inoculated on potted downy-rose myrtle plants (n = 3), which were maintained in 100% ambient humidity, at 20°C, with a 12-h light cycle for 72 h. Plants mock-inoculated with water served as the negative control. Disease symptoms, including chlorotic flecks and raised surfaces, appeared on leaf lamina in 3 to 6 days on P. psidii-inoculated plants, while control plants remained symptomless. Raised surfaces developed into distinct pustules and eventually erupted to discharge urediniospores within 6 to 12 days of inoculation. Tests were repeated once during March and April of 2012 with the same results. The latent and incubation periods reported herein are within the previously reported range for P. psidii (2,4). To our knowledge, this is the first confirmed report of P. psidii epiphytotic on downy-rose myrtle populations in Florida. The recent occurrence of P. psidii epiphytotic on downy-rose myrtle raises critical questions as to why this myrtle rust disease is so severe and widespread on this host after decades of presumed exposure to P. psidii in Florida. Because this rust pathogen has emerged as a major invasive threat to many myrtaceous species around the world, further genotyping and cross-inoculation studies are needed to determine the host specificity and potential origin of the P. psidii isolates derived from downy-rose myrtle (2). References: (1) A. C. Alfenas et al. Australas. Plant Pathol. 32:325, 2003. (2) A. J. Carnegie and J. R. Lidbetter. Australas. Plant Pathol. 41:13, 2012. (3) K. A. Langeland and C. K Burks, eds. Identification and biology of non-native plants in Florida's natural areas. University of Florida, Gainesville, 1998. (4) M. B. Rayachhetry et al. Biol. Contr. 22:38, 2001.

Beyond celery and starter culture: advances in natural/organic curing processes in the United States.

Over the past 10years there has been ongoing development of curing processes with natural ingredients designed to meet consumer demand and regulatory requirements for natural and organic processed meats. Initially, these processes utilized celery concentrates with a high nitrate content combined with a nitrate-reducing starter culture. Subsequent advances included celery concentrates with the nitrate converted to nitrite by suppliers. Further, as questions developed concerning reduced concentration of preservatives and the microbiological safety of these processed meats, additional advances have resulted in a wide variety of ingredients and processes designed to provide supplementary antimicrobial effects for improved product safety.

Validation of cooking methods using shell eggs inoculated with Salmonella serotypes Enteritidis and Heidelberg.

Salmonella enterica serotype Enteritidis has long been associated with eggs, and more recently, Salmonella enterica serotype Heidelberg has also become associated with eggs. This study was undertaken to determine whether Salmonella Enteritidis and Salmonella Heidelberg are effectively eliminated from eggs by various cooking methods. Seven cooking methods were chosen--hard and soft cooked, scrambled, over easy, sunny-side up, poached, and free poached--and a pan insert and the free-flowing method were used. Shell eggs, purchased from a grocery store, were inoculated with Salmonella and cooked. The cooked eggs were analyzed by USDA-approved methods for Salmonella recovery. Findings indicated that existing cooking methods for the hard-cooked, soft-cooked, and poaching methods were safe. However, the same was not true for the current sunny-side-up, over-easy, and scrambled egg cooking methods.

Effects of cattle treatment with a fluazuron pour-on on survival and reproduction of the dung beetle species Onthophagus gazella (Fabricius).

While resistance against many other classes of acaricides has been described, products containing benzoylphenyl urea are currently still successfully used against the pesticide-resistant blue tick (Boophilus decoloratus) in South Africa. In order to assess any adverse impact of these tickicides on the important dung beetle (Coleoptera: Scarabaeidae) fauna, a bioassay was undertaken on the ecotoxicological effects of a fluazuron (benzoylphenyl urea) pour-on formulation (Acatak) on the survival and reproduction of the African dung beetles species Onthophagus gazella (Fabricius). The experiment yielded no significant differences in adult or larval survival, egg production, fecundity and fertility between the control and treatment group following three beetle generations over. These results suggested that treatment of cattle with the fluazuron pour-on formulation Acatak was not detrimental to the selected dung beetle species in any notable way.

Effects of cattle treatment with a cypermethrin/cymiazol spray on survival and reproduction of the dung beetle species Euoniticellus intermedius (Coleoptera: Scarabaeidae).

In a bioassay to determine non-target ecotoxicological effects of a pyrethroid spray (Ektoban) on dung beetles, dung from both cypermethrin/cymiazol-treated and control cattle was collected one, two, three, five, seven, 14, 21 and 28 days after treatment and fed to a treatment and control group (respectively) of beetles of the species Euoniticellus intermedius (Reiche). This was done to assess whether a spray formulation of cypermethrin may affect dung beetles differently than previously tested pour-on formulations. Following three beetle generations for two weeks each, the experiment retrieved no significant differences in adult or larval survival, egg production, fecundity and fertility between the control and treatment group. These results demonstrated that the used spray formulation of cypermethrin is likely to be far less detrimental to dung beetles than previously tested pour-ons.

Measurement of refractive error in Native American preschoolers: validity and reproducibility of autorefraction.

PURPOSE: To examine (1) reproducibility of cycloplegic retinoscopy (C-RNS), cycloplegic autorefraction (C-Autoref), and noncycloplegic autorefraction (NC-Autoref), and (2) validity of C-Autoref and NC-Autoref compared with C-RNS in preschoolers with astigmatism. METHODS: Subjects were 36 Native American preschoolers. Three measurements of right eye refractive error were obtained with each of three methods: C-RNS (by three different retinoscopists), C-Autoref, and NC-Autoref (Nikon Retinomax K+). Vector methods (vector dioptric distance, VDD) were used in the analyses. RESULTS: Mean reproducibility was 0.41 D (SD = 0.18) for C-RNS, 0.25 D (SD = 0.17) for C-Autoref, and 0.37 D (SD = 0.21) for NC-Autoref. Mean agreement between C-Autoref and C-RNS ranged from 0.51 to 0.61 VDD (SD = 0.24 to 0.35), and ranged from 1.66 to 1.74 VDD (SD = 1.11 to 1.25) for agreement between NC-Autoref and C-RNS. Mean bias was -0.07 +0.21 x 149 and -1.33 +0.34 x 178 for C-Autoref and NC-Autoref, respectively. CONCLUSIONS: C-Autoref provided reliable and valid measurements of refractive error in young children. NC-Autoref measurements were reliable within subjects, but there was large variability in validity among subjects.

Sex-specific expression of gastrin-releasing peptide receptor: relationship to smoking history and risk of lung cancer.

BACKGROUND: Activation of gastrin-releasing peptide receptor (GRPR) in human airways has been associated with a proliferative response of bronchial cells to gastrin-releasing peptide and with long-term tobacco use. The GRPR gene is located on the X chromosome and escapes X-chromosome inactivation, which occurs in females. Increasing evidence demonstrates that women are more susceptible than men to tobacco carcinogenesis. We hypothesized that the susceptibility of women to the effects of tobacco may be associated with airway expression of GRPR. METHODS: We analyzed GRPR messenger RNA (mRNA) expression in lung tissues and cultured airway cells from 78 individuals (40 males and 38 females) and in lung fibroblasts exposed to nicotine in vitro. Nicotinic acetylcholine receptors in airway cells were assayed by use of radioactively labeled nicotine and nicotine antagonists. A polymorphism in exon 2 of the GRPR gene was used to detect allele-specific GRPR mRNA expression in some individuals. Statistical tests were two-sided. RESULTS: GRPR mRNA expression was detected in airway cells and tissues of more female than male nonsmokers (55% versus 0%) and short-term smokers (1-25 pack-years [pack-years = number of packs of cigarettes smoked per day multiplied by the number of years of smoking]) (75% versus 20%) (P =.018 for nonsmoking and short-term smoking females versus nonsmoking and short-term smoking males). Female smokers exhibited expression of GRPR mRNA at a lower mean pack-year exposure than male smokers (37.4 pack-years versus 56.3 pack-years; P =.037). Lung fibroblasts and bronchial epithelial cells exhibited high-affinity, saturable nicotinic acetylcholine-binding sites. Expression of GRPR mRNA in lung fibroblasts was elevated following exposure to nicotine. CONCLUSIONS: Our results suggest that the GRPR gene is expressed more frequently in women than in men in the absence of smoking and that expression of this gene is activated earlier in women in response to tobacco exposure. The presence of two expressed copies of the GRPR gene in females may be a factor in the increased susceptibility of women to tobacco-induced lung cancer.

Two novel flavanones from Greigia sphacelata.

As part of our continuing phytochemical investigations of plants from arid environments in Chile, the aerial parts of Greigia sphacelata were examined. Two novel flavanones, 5,7,3'-trihydroxy-6, 4',5'-trimethoxyflavanone (1) and 5,3'-dihydroxy-6,7,4', 5'-tetramethoxyflavanone (2), as well as eight known compounds-1, 3-O-di-trans-p-coumaroylglycerol (3), 1-O-trans-p-coumaroylglycerol (4), a mixture of 1-(omega-feruloyldocosanoyl)glycerol (5) and 1-(omega-feruloyltetracosanoyl)glycerol (6), trans-ferulic acid 22-hydroxydocosanoic acid ester (7), arborinone (8), arborinol (9), and isoarborinol (10)-were isolated.

A comparative analysis of metabolic rate in six Scarabaeus species (Coleoptera: Scarabaeidae) from southern Africa: further caveats when inferring adaptation.

Alterations in VO(2) or VCO(2) are amongst the more polemical physiological adaptations ascribed to insects. Generally, metabolic rate is thought to be lowered in response to arid conditions, and elevated in species from cold environments compared to their more temperate relatives. However, most studies have rarely addressed the influence of both environmental factors in unison. To this end, standard metabolic rate and its temperature dependence were measured (at 4 degrees C intervals from 16 to 32 degrees C) in six Scarabaeus dung beetle species (three flightless, three volant) from a variety of habitats (warm, arid to cool, mesic) in southern Africa using flow-through respirometry. Mass specific VCO(2) varied from 0.0158 ml g(-1) h(-1) at 16 degrees C to 0.1839 ml g (-1) h(-1) at 32 degrees C. The slopes of the rate temperature curves were similar for all species (Q(10)s of 2.14-2.84), although the intercepts differed significantly in the direction (warm arid to cool mesic): S. gariepinus

Documentation of care outcomes in an academic nursing clinic: an assessment.

PURPOSE: To assess documentation of client data collected at an academic nursing clinic using the Wilson and Cleary Health Related Quality of Life (HRQOL) conceptual model as a framework. DATA SOURCES: A chart audit of 100 randomly selected active client records was conducted. CONCLUSIONS: Although several significant HRQOL variables were documented, data regarding general health perception and quality of life were not present. The HRQOL conceptual model provided an appropriate structure for evaluating the documentation. Further effort must be made to include key HRQOL dimensions in the clinic's documentation system. IMPLICATIONS FOR PRACTICE: Documenting the quality of care provided in nursing clinics is essential in order for other professionals and the public to recognize nursing professionals as accountable and credible. This project formed the basis for a computerized outcomes-based client record system.

Investigations by HPLC-electrospray mass spectrometry and NMR spectroscopy into the isomerisation of salinomycin.

HPLC-MS studies have indicated that certain polyether ionophore veterinary drugs are prone to degradation when stored as water-methanol solutions at ambient temperature. Salinomycin and narasin were particularly susceptible, disappearing completely within weeks to produce more polar species, which were identified as isomers of the original compounds. Lasalocid appeared to be stable under such conditions. Structural elucidation of the principal ultimate salinomycin isomerisation product was achieved by 2D NMR spectroscopy. This indicated that the isomerisation process consists of the opening of the spiro rings in the salinomycin structure with the concomitant formation of a furan moiety. The MS data indicated that the isomers retain the ability to complex alkali metal ions and may therefore retain their pharmacological activity. These discoveries may have implications both for the development of legislation covering acceptable levels of polyether ionophore residues in foodstuffs and also for analytical protocols designed to detect them.

Discontinuous gas-exchange cycles in Scarabaeus dung beetles (Coleoptera: Scarabaeidae): mass-scaling and temperature dependence.

Although discontinuous gas exchange cycles (DGC) are known from many insects, the effects of body size and temperature on DGC have not been widely examined. Here, these effects are investigated in five Scarabaeus dung beetle species from mesic and xeric habitats. The investigation tests two hypotheses: that previous estimates of the scaling exponents for the DGC and its characteristics are more broadly applicable to insects, and that, in response to temperature, both DGC frequency and the quantity of CO2 emitted during the open (O) phase (O-phase emission volume) are modulated. Like previous workers, we find that V&d2;co2 scaled as mass0.968 and that O-phase emission volume scaled as mass0.833. However, temperature-associated increases in .Vco2 (Q10's of 2.19-2.65) were modulated mostly by increases in DGC frequency since O-phase volumes remained constant across temperature. Flutter (F)-phase and O-phase durations were closely coupled to DGC duration, although the relationship between closed (C)-phase duration and DGC duration was less pronounced. We show that ventilation phase coefficients, previously considered a measure of the proportional duration of each phase of the DGC, calculated from the slopes of these relationships are a measure of change in phase duration with change in DGC duration and not a measure of the way in which total DGC duration is apportioned among phases. We suggest that proportions be used to estimate the contribution of each of the phases to the total duration of the DGC.

Backbone and side chain dynamics of lac repressor headpiece (1-56) and its complex with DNA.

The dynamics of the backbone and (some of) the side chains of lac headpiece (1-56; lac HP56) have been studied for the free protein and for its complex with lac half-operator DNA by 15N T1 and T1p relaxation measurements combined with [1H-15N] NOE experiments. For the structurally well-defined part of the free lac HP56 (i.e., residues 3-49) a rigid backbone was found for residues in the three alpha-helices and for the turn of the helix-turn-helix motif. The loop between helices II and III of lac headpiece, which was characterized by slight disorder in the structure calculations, shows increased mobility. The detected side chains are very mobile. These data are in full agreement with the rms deviations in the structural data of free lac HP56. When lac HP56 is complexed with DNA, several changes in mobility take place. The most remarkable change was found for the loop region between helices II and III: residue His-29 within this loop interacts with Thy-3 of the operator DNA. As a result this mobile loop adapts itself to the DNA and becomes more rigid. Moreover, most DNA-contacting side chains show a significant decrease in flexibility, although these side chains do not become as rigid as the backbone. These results suggest that the mobility of the regions within lac HP56 important for complexation, i.e., the loop and the DNA-contacting side chains, is essential for a good fit onto the counterparts of the target DNA.

Outcome of MDR-TB patients, 1983-1993. Prolonged survival with appropriate therapy.

We analyzed the clinical and laboratory findings and outcome of 173 patients hospitalized at our institution from 1983 to 1994 with multidrug-resistant tuberculosis (MDR-TB) and evaluated outcome. The 173 patients (mean age 40 +/- 1 yr) were predominantly male (92%), African American or Hispanic (80%), and mostly undomiciled. Over half (52%) were known to be HIV-infected. HIV-positive MDR-TB patients had significantly more pulmonary and constitutional symptoms, more extrapulmonary disease, and fewer cavitary lesions on chest radiographs. Fifty-five percent of the patients in the cohort have died; mortality was significantly greater for HIV-positive than HIV-negative (72% versus 20%, p < 0.01). The median duration of survival of MDR-TB patients was 22 +/- 1 mo. Overall, extrapulmonary involvement was a risk factor for shorter survival, while a cavitary lesion on initial chest film and institution of appropriate treatment were positive predictors of survival. In HIV+ patients, only appropriate therapy was associated with prolonged survival (median of 14.1 mo). Interestingly, there was a trend toward better outcome in the first half of the decade reviewed. We conclude that although mortality from MDR-TB is high in both HIV-positive and HIV-negative patients, institution of appropriate therapy is the factor most strongly associated with a favorable outcome. Development of new diagnostic and therapeutic strategies for MDR-TB are urgently needed.

1H- and 13C-NMR characterization of the digalactosylmannopentaose liberated from legume seed galactomannan by beta-mannanase action.

Incubation of Locust bean gum with an Aspergillus niger beta-D-mannanase released a wide variety of galactomannan oligomers. A single heptasaccharide, digalactosylmannopentaose, was obtained from fractionation of the mixture by size exclusion chromatography. The purity and chemical composition of the sample was demonstrated using mass spectrometry, high performance anion-exchange chromatography and monosaccharide composition analysis. The primary structure of this heptasaccharide was unambiguously identified using 2D 1H and 13C homonuclear and heteronuclear NMR. A complete assignment of the 1H and 13C signals of this oligomer was achieved, producing an NMR dataset that will be of importance in the primary structure elucidation of larger and more complex galactomannan oligomers.

Effect of airway pressure on inferior vena cava pressure as a measure of central venous pressure in children.

We evaluated the effect of elevated airway pressure on the validity of intravascular pressure obtained in the distal inferior vena cava (IVC) as a measure of central venous pressure (CVP) in a group of children receiving mechanical ventilation. The IVC pressure correlated well with CVP in the patients without abdominal distention, but the disparity was wider in those with abdominal distention. Elevated mean airway pressure or positive end-expiratory pressure had no effect on the relationship of IVC to CVP.

Structure refinement of the glucocorticoid receptor-DNA binding domain from NMR data by relaxation matrix calculations.

The solution structure of the glucocorticoid receptor (GR) DNA-binding domain (DBD), consisting of 93 residues, has been refined from two and three-dimensional NMR data using an ensemble iterative relaxation matrix approach followed by direct NOE refinement with DINOSAUR. A set of 47 structures of the rat GR fragment Cys440-Arg510 was generated with distance geometry and further refined with a combination of restrained energy minimization and restrained molecular dynamics in a parallel refinement protocol. Distance constraints were obtained from an extensive set of NOE build-up curves in H2O and 2H2O via relaxation matrix calculations (1186 distance constraints from NOE intensities, 10 phi and 22 chi 1 dihedral angle constraints from J- coupling data were used for the calculations). The root-mean-square deviation values of the 11 best structures on the well-determined part of the protein (Cys440 to Ser448, His451 to Glu469 and Pro493 to Glu508) are 0.60 A and 1.20 A from the average for backbone and all heavy atoms, respectively. The final structures have R-factors around 0.40 and good stereochemical qualities. The first zinc-coordinating domain of the GR DBD is very similar to the crystal structure with a root-mean-square difference of 1.4 A. The second zinc-coordinating domain is still disordered in solution. No secondary structure element is found in this domain in the free state. As suggested by crystallographic studies on the estrogen receptor DBD-DNA and GR DBD-DNA complexes, part of this region will form a distorted helix and the D-box will undergo a conformational change upon cooperative binding to DNA.

Carotid blood-flow velocity changes detected by Doppler ultrasound in determination of brain death in children. A preliminary report.

To investigate the value of Doppler ultrasonography of the carotid arteries as a diagnostic test for the determination of brain death in children, we enrolled 17 patients in a blinded fashion in the pediatric intensive care unit of Memorial Miller Children's Hospital of Long Beach between the period of December 1990 and October 1992. After institutional review board approval and parental consent, children who sustained severe brain injury underwent Doppler ultrasonography study of their carotid arteries. Seven of 17 patients were diagnosed as having brain death by clinical criteria (complete loss of cerebral and brainstem functions) and electroencephalogram (EEG). Five of seven (71%) patients with the diagnosis of brain death had bilateral reverse flow (characteristic of increased cerebrovascular resistance and absent cerebral circulation) on their Doppler ultrasonography, yielding a specificity of 100% and sensitivity of 71.4% (P = 0.01). All surviving patients (five) and the five who did not fulfill the brain-death criteria at the time of Doppler ultrasonography and were later taken off life supportive measures had normal Doppler findings. These data indicate that Doppler ultrasonography of the carotid arteries is a very specific test and can be used as an adjunctive modality for determination of brain death in children.