A theory of oral healthcare decision-making in Appalachia

INTRODUCTION

People make oral healthcare decisions regardless of having partial information, misinformation, sources that deliberately mislead, or information that is culturally influenced. This is particularly true in the Appalachian culture where oral healthcare decision-making practices are not well understood by researchers and dental professionals. Despite efforts to improve dental care utilization, the Appalachia region remains low in oral healthcare utilization. There is a need for a theory to identify concepts in decision-making when seeking oral healthcare. The theory could be useful in creating oral health interventions. The study objective is to develop a theory to identify concepts that influence oral healthcare decision-making in Appalachia (OHDA).

METHODS

The researchers used a grounded theory qualitative study design to explain data for a theory of OHDA. Participants from Appalachia, in 20-minute interviews, provided insights into concepts that influence OHDA from August 22, 2017 to May 26, 2022. Notes/memos were written during and after the interviews and coding was conducted after the interviews. Open coding categories emerged through constant comparison of responses.

RESULTS

Five overarching concepts that embody OHDA were discovered: Affect (Level of Pain/Emotion/Stress involvement), Awareness, Trust/belief, Resources, and Risk Perception. All participants discussed the impact of social media toward these concepts.

CONCLUSION

To influence a person's OHDA, public health officials and researchers need to address the person's affect, level of awareness, trust/belief, available resources, and risk perception. Social media is very important in awareness concerning oral health information. These factors are important to consider for similar research in oral healthcare utilization at the population level.

Association of general anxiety and pediatric dental preventive examination utilization, National Survey of Children's Health, 2021

INTRODUCTION

Many factors influence preventive dental health service access for children. The objective of this research was to examine one factor, general anxiety, in accessing at least one preventive dental examination in the past 12 months in children with special healthcare needs (CSHCN) and children without special healthcare needs (CWSHCN).

METHODS

National Survey of Children's Health (NSCH) 2021 were obtained for this cross-sectional research. Chi-square and logistic regression analyses were used to determine association of anxiety and past 12-month preventive dental examinations.

RESULTS

The sample included 10 493 CSHCN, and 35 675 CWSHCN. Overall, 72.7% had past 12-month preventive dental examinations, and 9.9% had a healthcare provider indicate they had general anxiety. CSHCN with anxiety, CWSHCN with anxiety, and CSHCN without anxiety were more likely to have a past 12-month preventive dental examination visit than CWSHCN without anxiety (Adjusted Odds Ratios: 1.86, 1.39, 1.32, respectively).

CONCLUSION

Our results suggest children with general anxiety (both CSHCN and CWSHCN) are more likely to have had at least one regular preventive dental visit within the past 12 months than CWSHCN and without general anxiety. There is a need for further understanding the relationship of general anxiety and dental health to improve the health of all children.

PRACTICAL IMPLICATIONS

CWSHCN without anxiety need individualized, comprehensive care with enough time, attention, instruction, and rewards to demonstrate to parents/guardians the importance of making routine preventive dental examinations a priority for their child.

Beta-defensin index: A functional biomarker for oral cancer detection

There is an unmet clinical need for a non-invasive and cost-effective test for oral squamous cell carcinoma (OSCC) that informs clinicians when a biopsy is warranted. Human beta-defensin 3 (hBD-3), an epithelial cell-derived anti-microbial peptide, is pro-tumorigenic and overexpressed in early-stage OSCC compared to hBD-2. We validate this expression dichotomy in carcinoma in situ and OSCC lesions using immunofluorescence microscopy and flow cytometry. The proportion of hBD-3/hBD-2 levels in non-invasively collected lesional cells compared to contralateral normal cells, obtained by ELISA, generates the beta-defensin index (BDI). Proof-of-principle and blinded discovery studies demonstrate that BDI discriminates OSCC from benign lesions. A multi-center validation study shows sensitivity and specificity values of 98.2% (95% confidence interval [CI] 90.3-99.9) and 82.6% (95% CI 68.6-92.2), respectively. A proof-of-principle study shows that BDI is adaptable to a point-of-care assay using microfluidics. We propose that BDI may fulfill a major unmet need in low-socioeconomic countries where pathology services are lacking.

The use of predator tags to explain reversal movement patterns in Atlantic salmon smolts (Salmo salar L.)

Acoustic telemetry has seen a rapid increase in utility and sophistication in recent years and is now used extensively to assess the behavior and survival rates of many aquatic animals, including the Atlantic salmon. As part of the salmon's complex life cycle, salmon smolts are thought to make a unidirectional migration from fresh water to the sea, which is initiated by changes in their physiology. However, some tag movement patterns do not conform with this and can be difficult to explain, particularly if the tagged fish has been eaten by a predator. This study combines the use of predator tags with machine learning techniques to understand the fate of migrating salmon smolts and thereby improve estimates for migration success. Over 3 years between 2020 and 2022, 217 salmon smolts (including wild and hatchery-reared ranched fish) were acoustically tagged and released into an embayment on the west coast of Ireland. Some tagged smolts were observed to return from the estuary back into a saline lagoon through which they had already migrated. To distinguish between the movement of a salmon smolt and that of a predator, predator tags were deployed in migrating smolts in 2021 and 2022. The addition of a temperature sensor in 2022 enabled the determination of predator type causing the returning movement. A significant number of predator tags were triggered, and the patterns of movement associated with these triggered tags were then used with two types of machine learning algorithms (hierarchical cluster analysis and random forest) to identify and validate the behavior of smolts tagged without extra sensors. Both models produced the same outputs, grouping smolts tagged with predator tags with smolts tagged without the additional sensors but showing similar movements. A mammalian predator was identified as the cause of most reversal movement, and hatchery-reared ranched smolts were found to be more likely predated upon by this predator than wild smolts within the lake and the estuary. However, overall migration success estimates were similar for both wild and hatchery-reared ranched fish. This study highlights the value of predator tags as an essential tool in the overall validation of detection data.

Sex gaps in perception of tobacco conversations between adult patients who now smoke cigarettes and oral health care providers: National Health and Nutrition Examination Survey 2017-March 2020 prepandemic

BACKGROUND

Smoking cessation is difficult. A potential gap based on sex exists in the tobacco cessation aid that dental care professionals provide to patients. The purpose of this research was to examine whether there is a sex difference in dental patients' reports of having a direct conversation about the benefits of giving up cigarettes or other types of tobacco products with their oral health care provider.

METHODS

National Health and Nutrition Examination Survey 2017-March 2020 prepandemic data were used in this cross-sectional study for participants 18 years and older who reported that they "now smoke cigarettes," had a dental visit within the previous year, self-reported their sex, and responded whether their oral health care provider had a direct conversation about the benefits of giving up cigarettes or other types of tobacco products to improve dental health at their last visit (n = 582). Multivariable logistic regression analysis was conducted to compare data according to sex.

RESULTS

Overall, 50.7% of patients (59.2% of men, 42.9% of women; P = .0037) reported having a conversation about tobacco cessation at their dental visit. The odds of women reporting having no such discussion were twice those of men (odds ratio, 2.17; 95% CI, 1.10 to 4.28; P = .0270).

CONCLUSIONS

One-half of the participants reported having no tobacco cessation conversation about the benefits of giving up cigarettes or other types of tobacco with their dental care provider. Women were twice as likely to report no such discussion.

PRACTICAL IMPLICATIONS

Oral health care providers need to ensure that primary and secondary prevention information and intervention programs about the benefits of giving up cigarettes or other types of tobacco products are provided equitably to all patients.

The Effect of Patency Files on Apical Canal Anatomy Using SEM Imaging

Introduction

There are many reasons to maintain apical patency during routine endodontic treatment. Thousands of canals are treated utilizing a patency file every year all around the world. The effect patency has on the apical anatomy of the root has been controversial for generations.

Objective

This ex vivo descriptive study was created to show the effect patency files actually have on the apical root canal anatomy using visually detailed SEM images supported by dental radiographs.

Materials and Methods

Three extracted maxillary anterior teeth that represent the multitude of canals in vivo were instrumented utilizing patency files. Two of the three maxillary anterior teeth were instrumented with hand files, the other maxillary anterior tooth with a .06 taper rotary file. The teeth were then scanned with an electron microscope to view the effect that the instruments had on the apical canal anatomy. A fourth tooth, a maxillary second molar, was shaped with an .06 taper rotary file and cone fitted. This tooth was radiographed with a gutta percha cone fitted to reveal the position of the narrowest constriction after patency was achieved.

Results

The patency files, both hand files and rotary, were shown not to adversely affect the apical canal anatomy. Additionally, the SEM's revealed a precise demarcation of cementum to dentin which was at the root surface after patency was achieved.

Conclusion

The patent use of greater tapered rotary files provides a clear demarcation of the CDJ which allows a precise acquisition of the narrowest constriction of the canal with the use of an electronic apex locator for establishing the ideal working length and precision placement of a gutta percha cone.

Long-Term Outcomes Following Manipulation Under Anaesthetic for Patients with Primary and Secondary Frozen Shoulder

Background

Frozen Shoulder (FS) is a common, debilitating condition for which manipulation under anaesthetic (MUA) is a non-invasive and effective treatment option. Current literature evaluates short to medium-term outcomes, but there is a paucity of long-term (>10 years) studies. Knowledge of long-term outcomes is also needed to evaluate whether FS or its treatment pre-disposes to other shoulder pathology in the long-term.

Methods

A retrospective analysis of 398 shoulders undergoing MUA for FS between Jan 1999 and Jan 2010; 240 complete datasets were obtained. Outcomes were Oxford Shoulder Score (OSS), recurrence and development of other shoulder pathology (arthritis or rotator cuff tear).

Results

At long-term follow-up (mean 13.2 years), 71.3% had no symptoms (OSS 48), 16.6% had minor symptoms (OSS 42-47) and 12.1% had significant symptoms (OSS < 42). There were 4/240 (1.7%) self-reported recurrences > 5 years after initial MUA and 2/240 (0.8%) repeat MUAs. In the long-term 6.7% developed rotator cuff pathology and 3.8% shoulder OA.

Discussion

This study suggests that long-term outcome after MUA for FS is favourable. Late recurrence of FS is uncommon and the development of OA or rotator cuff pathology is no greater than that of the general population.

Detergent Pod-Related Oral-aerodigestive/ocular Injuries in Children, Ages >0 to <18 years

Purpose Detergent pod-related aerodigestive/ocular chemical burns/ingestion poisoning injuries are a group of injuries of concern to parents/guardians of young children as well as oral healthcare professionals. Each year detergent pod injuries result in thousands of emergency department (ED) visits and significant oral, eye, airway, and digestive trauma. The purpose of this study was to investigate trends in detergent pod injuries resulting in ED visits in children ages >0 to <18 years from 2016-2020.Methods This cross-sectional study used data collected from the National Electronic Injury Surveillance System (NEISS). A secondary data analysis was performed on the NEISS data from 2016-2020 for children ages >0 to <18 years. Injuries were identified as detergent pod-related oral-aerodigestive/ingestion poisonings, detergent pod-related ocular injuries, or other product-related injuries among children. Time trends and demographic characteristics were analysed by age, sex, and race.Results There were an estimated 13,176 detergent pod-related oral-aerodigestive injuries/ingestion poisonings and 8,654 detergent pod-related ocular injuries with ED visits during 2016 - 2020. In adjusted logistic regression, white children were more likely to have oral-aerodigestive injuries/ingestion poisonings than black children (p=0.0006). Time trend (p=0.4358), and sex (p=0.3905) failed to reach significance. Children, ages 5 to<18 years, were less likely to have ED visits for oral-aerodigestive injuries/ingestion poisonings, or any detergent pod-related injury than younger children. Children, ages 3 to ≤5 years, were more likely to have detergent pod-related ocular injuries than younger or older children.Conclusion Time trends for detergent-pod related injuries requiring ED visits remained unchanged from 2016-2020 for oral-aerodigestive injuries/ingestion poisonings. Given the significant health risks associated with detergent pods and the fact that the injuries have not declined, there is a need for improved parent/guardian education and practices in safeguarding detergent pods from children. Dental hygienists are well positioned to provide anticipatory guidance on this safety issue.

Increase in body mass index during the COVID-19 pandemic among people who smoke: An analysis of multi-site electronic health records

The effects of the COVID-19 period among people who smoke (compared by sex) are largely unknown. The purpose of this study was to compare body mass index (BMI) increase among men and women who smoked during the pandemic. We used a retrospective longitudinal, observational study design of secondary data. We used electronic health records from TriNetX network (n = 486,072) from April 13, 2020-May 5, 2022 among adults aged 18-64 who smoked and had a normal BMI prior to the pandemic. The main measure was a change of BMI from < 25 to ≥25. Risk ratio was determined between men and women with propensity score matching. Overall, 15.8% increased BMI to ≥25; 44,540 (18.3%) were women and 32,341 (13.3%) were men (Risk Ratio = 1.38, 95% CI: 1.36, 1.40; p < .0001). Adults with diabetes, hypertension, asthma, COPD or emphysema or who were women, were more likely to develop BMI≥25 during the pandemic. Women who smoked were more likely to have an increase in BMI than men who smoked during the COVID-19 period.

All-Terrain Vehicle-Related Emergency Department Visits: Interaction of Sex and Age, NEISS, 2019

BACKGROUND

Epidemiologic patterns of all-terrain vehicle (ATV)-related emergency department (ED) visits by male and female individuals may vary at different ages. To our knowledge, this has not been researched previously.

OBJECTIVE

The purpose of this study was to determine the interaction of sex and age differences in their association with ATV-related ED visits.

METHODS

Data from the 2019 National Electronic Injury Surveillance System were extracted for ATV-related ED visits, including sex, age, race, location of crash, injured body part, and whether alcohol was involved. Descriptive statistics and logistic regression analyses were conducted. We modeled sex in separate multivariable models, adjusting for the same independent variables.

RESULTS

There were an estimated 95,995 (unweighted n = 1999) ATV-related ED visits. There was a significant age-by-sex interaction in the association between ATV-related ED visits vs. other ED injuries, indicating that the effect of age on ATV-related ED visits differed by sex and vice versa. Overall, male individuals were 1.7 times as likely to have an ATV-related ED visit as female individuals. In the stratified analysis for female individuals, odds were substantially greater for girls younger than 18 years (adjusted odds ratio [AOR] 2.33; 95% confidence interval [CI] 1.61-3.69) and women aged 18-35 years (AOR 4.76; 95% CI 3.48-6.51) compared with woman older than 35 years. For men, odds were significant for ages 18-35 years (AOR 2.21; 95% CI 1.72-2.85) compared with men older than 35 years.

CONCLUSIONS

As newer ATVs become more powerful and faster, there is a need to know who is at greatest risk for ATV-related ED visits to develop policies and safety measures.

MO323: Effects of Patient Frailty and Comorbidity on Duration of Hospitalisation as an Outcome Among Adults With Acute Kidney Injury

BACKGROUND AND AIMS

Acute kidney injury (AKI) is commonly associated with an adverse outcome in hospitalised patients. Frailty and comorbidity are risk factors for acute kidney injury. The aim of this study was to assess the strength of association between frailty and comorbidity as modifiers for duration of hospitalisation (LOS) as an outcome among inpatients with acute kidney injury in our institution.

METHOD

A retrospective observational study as part of a service assessment of adult inpatients, in a 1-month period, during the pre-pandemic phase was conducted to evaluate for changes needed to existing care pathways in our institution. AKI was identified with the help of the national algorithm endorsed by NHS England, which is incorporated in hospital reporting systems. Clinical frailty and comorbidity were estimated using the Rockwood Clinical Frailty Scale (CFS) and the Charlson comorbidity index (CCI). Pairwise correlations between LOS, CFS and CCI were estimated and tested for statistical significance using Bonferroni-adjusted significance levels. Ordinary least-squares linear regression was used to assess the prediction of LOS using CFS and CCI in separate models.

RESULTS

In 148 patients in our cohort, the mean age was 76.4 [95% confidence interval (95% CI) 74.1–78.8] years. Of these, 54% were male, 24.3% were diabetic, 29.7% had at least one criterion for prior vascular disease and 16.2% had a history of cancer. A total of 22.3% had a prior history of chronic kidney disease. In terms of severity at presentation, 67.6% had stage 1 AKI, 18.9% had stage 2, and 13.5% had stage 3 AKI.

The mean CCI was 5.4 (95% CI 5.06–5.81) and the mean RFI was 4.6 (95% CI 4.3–5.0). 50% were both at least moderately frail (CFS ≥ 5) and had a CCI of &gt;5.

The mean duration of hospitalisation was 8.7 days.

Spearman's correlation coefficient constant for CFS with LOS was 0.23 and was 0.11 with CCI, with only the correlation between LOS and CFS being statistically significant at the 5% level after Bonferroni correction. As expected, there was a statistically significant correlation between CCI and CFS (0.49). Beta coefficients for ordinary least-squares linear regression individual models with LOS as the outcome variable were 0.69 (95% CI 0.18–1.19; P &lt; .007) for CFS and 0.27 (95% CI –0.16 to 0.70; P = .22) for CCI.

CONCLUSION

Compared with patient comorbidity, clinical frailty has a stronger and statistically significant association with the duration of hospitalisation among hospitalised adults with AKI. This study quantifies the magnitude of factors over and above those resulting from patient comorbidity that are contributory to frailty in adult inpatients with AKI. Further studies are required to improve understanding of how clinical frailty affects duration of hospitalisation in patients with AKI, to help inform future clinical care pathways and improve duration of hospitalisation as a clinical outcome.

Abstract 447: Deficiency Of Serum Amyloid A Exacerbates Sepsis-induced Acute Lung Injury In Mice

Objectives: Serum Amyloid A (SAA) is a family of proteins whose plasma levels increase > 1000-fold in acute inflammatory states such as sepsis. We and others have demonstrated that SAA plays a causal role in mouse models of atherosclerosis. However, SAA may not be a valid therapeutic target if it is needed for host defense in inflammation. Here, we investigated the role of SAA in sepsis using mice deficient in all three acute-phase SAA isoforms (TKO).

Approach and results: SAA deficiency significantly increased mortality rates in three experimental sepsis models. Survival rates in TKO and wild-type (WT) mice were: 25% and 55% after cecal ligation and puncture (CLP; p=0.02; n=10 each strain/gender); 0% and 45% after cecal slurry injection (p<0.0001; n=9 each strain); and 55% and 90 % after lipopolysaccharide injection (p<0.0001; n=10 each strain/gender). 24-hours after CLP, there were no apparent differences in liver, heart or kidney histology between genotypes. However, TKO mice had exacerbated lung pathology, including consolidation of lung tissues and atelectasis, compared to WT mice. RNAseq analysis of lungs excised 24-hours after CLP identified 664 genes differentially expressed (404 upregulated and 260 downregulated) in TKO compared to WT (p<0.05). Some of the genes that showed profound induction in the lungs of TKO compared to the WT were Proz, Dbp, Cxcl1, Cxcl2, Arg1 and Ackr1 . Gene ontology analysis revealed a significant enrichment of differentially expressed genes associated with chemokine production, chemokine and cytokine-mediated signaling, neutrophil chemotaxis and neutrophil migration in TKO lung tissues compared to WT tissues (p<0.01).

Conclusions: SAA protects mice against sepsis-induced mortality, potentially by protecting the lung from tissue damage. Thus, the risk of infection should be considered when targeting SAA to ameliorate atherosclerosis.

SP10.2.5 It SOCS: Surgical On-Call Simulation for final year Medical Students

Introduction

Simulation is a well-known method of effectively teaching Medical students. Surgical simulation is a gap within the curriculum, especially Surgical on-call simulations. To improve this, we ran simulation sessions designed to replicate a General Surgery themed on-call shift that junior doctors should be able to manage. We aimed to improve confidence in clinical prioritisation and confidence in being an on-call Junior doctor, managing the most common on-call surgical tasks.

Method

Groups of 3-4 final year Medical students participated in a 2 hour-long simulated “on-call” shift, throughout the hospital. There were 8 scenarios, which ranged from prescribing to acute clinical scenarios. Students were given bleeps and were called at set times. They had to receive/give handovers and prioritise tasks according to clinical importance. A debrief following the session focussed on prioritisation and highlighted key learning points. The students completed a pre- and post-session questionnaire as assessment.

Results

The percentage of students who felt confident or very confident in the following domains were compared pre- and post-simulation respectively: confidence in clinical prioritisation (17% vs 86%); confidence in prescribing medication (0% vs 14%); confidence in escalation to seniors (33% vs 71%). 87.5% of the participants felt the session was an effective way to learn how to prioritise clinical tasks, and 100% felt this an effective way to learn about common General Surgical queries whilst on-call.

Conclusion

This project demonstrates how simulation is also effective in improving confidence in prioritisation and knowledge within clinical practice, especially surgery.

1505 EASiE: ENT and Airway Simulation in Emergencies

Aim

A literature review of undergraduate ENT teaching found that most final year medical students and junior doctors did not feel adequately prepared for clinical practice in ENT. Other surveys found junior doctors lack confidence in recognising or initiating management in patients with blocked tracheostomies. To improve this, we ran a simulation session designed to replicate airway emergencies that junior doctors should be able to manage. The aim was to improve confidence in and knowledge of basic management of airway emergencies, including tracheostomies.

Method

Groups of 4-6 final year medical students participated in 3 scenarios: 2 tracheostomy-related and 1 partially compromised airway. The students had attended a session introducing tracheostomies and the algorithms produced by the National Tracheostomy Safety Project for tracheostomy emergencies. A semi-structured debrief followed each scenario, highlighting key learning points. The students completed a pre- and post-session questionnaire, rating confidence in several domains related to the scenarios.

Results

Of 24 participants, the percentage of students who felt confident or very confident in the following domains were compared pre- and post-simulation respectively: recognising a potential airway problem (0% vs 71%); identifying an altered airway (0% vs 75%); managing a potentially compromised surgical airway (4% vs 71%); initially managing a compromised airway (8% vs 67%); and identifying when to escalate with a potential airway problem (25% vs 96%).

Conclusions

Simulation is a valuable tool that can be used to improve both knowledge and confidence in managing potential airway problems in final year medical students. This supports findings from other studies.

1617 SOCS: Surgical On-Call Simulation

Introduction

Simulation is a well-known method of effectively teaching Medical students. The majority of the simulation scenarios are related to Medicine. Surgical simulation is a gap within the curriculum, especially Surgical on-call simulations. To improve this, we ran simulation sessions designed to replicate a General Surgery themed on-call shift that junior doctors should be able to manage. We aimed to improve confidence in clinical prioritisation and confidence in being an on-call Junior doctor, managing the most common on-call surgical tasks.

Method

Groups of 3-4 final year Medical students participated in a 2 hour-long simulated “on-call” shift, throughout the hospital. There were 8 scenarios, which ranged from prescribing to acute clinical scenarios. Students were given bleeps and were called at set times. They had to receive/give handovers and prioritise tasks according to clinical importance. A debrief following the session focussed on prioritisation and highlighted key learning points. The students completed a pre- and post-session questionnaire as assessment.

Results

The percentage of students who felt confident or very confident in the following domains were compared pre- and post-simulation respectively: confidence in clinical prioritisation (17% vs 86%); confidence in prescribing medication (0% vs 14%); confidence in escalation to seniors (33% vs 71%). 87.5% of the participants felt the session was an effective way to learn how to prioritise clinical tasks, and 100% felt this an effective way to learn about common General Surgical queries whilst on-call.

Conclusions

This project demonstrates how simulation is effective in improving confidence in prioritisation and knowledge within clinical practice, especially surgery.

1438 The Past, Present and Future Management of Complex Chyle Fistulae

Background

Chyle leak/fistula is a rare complication of oesophageal surgery, usually consequent on an unintended breach of the thoracic duct, its tributaries, or the cisterna chyli. For high volume persistent leaks further surgery has been the traditional approach, however two cases have resulted in a new management approach at this Centre.

Case Series

The first patient, a 49-year-old, developed high volume drain output post three stage oesophagectomy. His jejunostomy feeding was discontinued, total parenteral nutrition and a somatostatin analogue, were commenced. Despite these measures, the drain output remained &gt;1.5litres per day and an exploratory thoracotomy was performed. The second patient, an 81-year-old underwent a transhiatal-oesophagectomy. On postoperative day 10 he developed acute onset shortness of breath, CXR demonstrated a large left sided pleural effusion. CT thorax demonstrated multiloculated complex pleural effusions. US guided pig tail drain was placed in the largest targetable effusion. The fluid was chylous in appearance. In both cases, an interventional radiological approach, not previously performed at this centre, provided definitive management. Lymphangiography was performed via injection of 1mL of Lipoidol® every 5 minutes into the inguinal lymph nodes to identify the cisterna chyli. A guidewire was advanced via the cisterna chyli with coils and glue used to embolize the leaking tracts.

Discussion

The lessons from this experience provide an algorithm for the management of chyle leaks, that will change practice at this centre. Embolization or disruption of thoracic duct and cisterna chyli leaks will be first line therapy for complex chyle leaks, with surgery reserved for where this fails.

Face-touching Behavior during the COVID-19 Pandemic: Self-inoculation and transmission potentials

Purpose: Face-touching behavior has the potential for self-inoculation and transmission of the SARS-2 Coronavirus. The purpose of this study was to observe unconscious face-touching behaviors of dental hygiene and dental students in a non-clinical setting.Methods: Twenty minutes of archived proctoring videos of dental and dental hygiene students (n=87) while taking final examinations were watched for incidents of face-touching behavior. Data were analyzed for descriptive frequencies; independent sample t-tests were used to determine differences between dental and dental hygiene students and between males and females.Results: There was a significant difference in face touching behaviors between the student groups. Dental hygiene students (n=42) were observed 11.9 times (SD. 11.4) and dental students (n=45) were observed 8.9 times (SD, 7.9) touching the nose, mouth, and eyes (T-zone) (p=0.049). Differences in frequencies of touching the T-zone failed to reach significance between genders.Conclusion: Findings suggest both dental hygiene and dental students frequently touch their faces in non-clinical settings and need to be aware of this unconscious behavior. Given the significance of the COVID-19 pandemic, it is important to identify and quantify known risk factors that can be easily addressed to prevent/reduce infection transmission.

SARS-CoV-2 Spike Protein Regulation of Angiotensin Converting Enzyme 2 and Tissue Renin-Angiotensin Systems: Influence of Biologic Sex

Angiotensin converting enzyme 2 (ACE2) is an enzyme that limits activity of the renin-angiotensin system (RAS) and also serves as a receptor for the SARS-CoV-2 Spike (S) protein. Binding of S protein to ACE2 causes internalization which activates local RAS. ACE2 is on the X chromosome and its expression is regulated by sex hormones. In this study, we defined ACE2 mRNA abundance and examined effects of S protein on ACE2 activity and/or angiotensin II (AngII) levels in pivotal tissues (lung, adipose) from male and female mice. In lung, ACE2 mRNA abundance was reduced following gonadectomy (GDX) of male and female mice and was higher in XX than XY mice of the Four Core Genotypes (FCG). Reductions in lung ACE2 mRNA abundance by GDX occurred in XX, but not XY FCG female mice. Lung mRNA abundance of ADAM17 and TMPRSS2, enzymes that shed cell surface ACE2 and facilitate viral cell entry, was reduced by GDX in male but not female mice. For comparison, adipose ACE2 mRNA abundance was higher in female than male mice and higher in XX than XY FCG mice. Adipose ADAM17 mRNA abundance was increased by GDX of male and female mice. S protein reduced ACE2 activity in alveolar type II epithelial cells and 3T3-L1 adipocytes. Administration of S protein to male and female mice increased lung AngII levels and decreased adipose ACE2 activity in male but not female mice. These results demonstrate that sex differences in ACE2 expression levels may impact local RAS following S protein exposures.

Effects of Sleep Duration on Falls in a West Virginia Population-Based Study, BRFSS, 2018

Introduction

West Virginia is a state in which most counties are rural, as well as a state with multiple health disparities among its population. The purpose of this study was to determine the association of sleep duration and falls for non-institutionalized West Virginia adults, aged 40 years and above, using the National Sleep Foundation's definition of "may be appropriate" and "not recommended" sleep durations for specific ages.

Methods

Behavior Risk Factor Surveillance System (BRFSS) 2018 data concerning West Virginia residents were extracted for sleep duration and number of falls within the previous year. Data were analyzed with Chi square and logistic regression analyses on falls.

Results

There were 2780 participants, aged 45 years and above. Slightly more than half (51.0%) were female. In adjusted logistic regression analysis, the adjusted odds ratio for falls in participants who did not have the recommended sleep duration was 1.77; 95%CI: 1.38, 2.27; p<0.0001 as compared with participants who did have the recommended sleep duration.

Conclusion

Inadequate sleep duration, based on age, was associated with ≥1 falls within the previous year in a West Virginia Appalachian population.

Epidemiology and Characteristics of People with Injury Due to Volatile Substance Use to Induce Euphoria

Unhealthy substance use is a public health challenge. Much of the focus of interventions is upon narcotics, stimulants, hallucinogens, central nervous system depressants, and alcohol. However, inhalants are also commonly used in an unhealthy manner and are under-recognized. The purpose of this study is to describe incident emergency department visits for volatile substance use to induce euphoria (VSUIE) injuries in the U.S. Methods: Data were obtained from the National Electronic Injury Surveillance System (NEISS) for the years 2015 to 2018. Descriptive frequencies, bivariate analyses using Rao-Scott Chi-Square, and multivariable logistic regression analyses were conducted to describe and examine the association between ED visits and VSUIE. Results: The estimated (weighted) number of VSUIE ED visits during 2015-2018 was 13,130 (95% Confidence Interval, CI: 8,383-17876; Coefficient of variation, CV = 0.18) and accounted for 0.02% of all ED visits. Males were more likely than females (p < .0001), and young adults (ages ≥18 to ≤ 35 years) were more likely than older adults to have a VSUIE ED visit (p <.0001). Conclusion: VSUIE ED visits occur more commonly in young adults than older adults and adolescents. The widespread use of volatile substances to induce euphoria is an under-reported public health issue with life-threatening consequences. Use of volatile substances by adolescents is a particular concern which needs attention and interventions to prevent its initiation.

The association of Toxoplasma gondii IgG and cognitive function scores: NHANES 2013-2014

Toxoplasma gondii (T. gondii) causes chronic, latent infections of global concern. Its subclinical influence on behavior and cognition are poorly understood. The objective of this research is to determine the relationship of T. gondii IgG with cognition using National Health and Nutrition Examination Survey data, 2013-2014 in older adults ≥60 years. A composite cognitive function score was created by adding the scores of the memory test, language/verbal fluency, and working memory test. T. gondii IgG was dichotomized at <33 IU/mL (negative) and ≥33 IU/mL (positive). There were 19.2% of the participants who were T. gondii IgG+. The memory function and language/verbal fluency subtests failed to reach significance; however, the difference in the working memory test was significant. In the multivariable ordinal logistic regression analysis, controlling for potential confounders, the odds of cognitive function scores decreasing in quartiles among people with positive vs. negative T. gondii IgG are 1.55 (95% CI: 1.08, 2.21; p = .0170). Establishing an evidence base for the association of T. gondii IgG and cognition is complex, but essential.

Adolescents' Perceived Risk of Harm Due to Smoking: The role of extracurricular activities

Purpose: Tobacco use initiated during adolescence often leads to continued use in adulthood. There are multiple factors influencing initiation, including low perceived risk of harm. Adolescents involved in school-based extracurricular activities have opportunities to interact with coaches, leaders, and group supervisors who may influence their perception of risk. The purpose of this study was to examine the role of extracurricular activities and adolescents' perceived risks of harm of tobacco use, utilizing an existing dataset.Methods: The 2016 National Survey on Drug Use and Health (NSDUH) dataset was used for a cross-sectional study of youth, ages 12 to <18 years. Adolescents involved in one or more school-based, extracurricular activities were compared with adolescents involved in no activities. The key variable was the response to the NSDUH question regarding perceived risk of harm from daily smoking (≥1 packs of cigarettes). Chi-square tests and multinomial logistic regression were used to analyze the data.Results: At the time of the 2016 NSDUH study period, among the adolescents aged 12 to <18 years (n=4,308), 17.5% indicated that they did not participate in any extracurricular activities and 10.6% reported no/slight perceived risk of harm associated with tobacco use. Adolescents who did not participate in extracurricular activities were more likely to report no/slight risk of harm from smoking (Adjusted Odds Ratio, AOR= 2.21 [95%CI: 1.62, 3.02]) as opposed to the perception of great risk of harm.Conclusion: Adolescents who are not involved in extracurricular activities are more likely to endorse the perception that cigarettes have no/slight risk of harm. School-based extracurricular activities may provide unintended benefits to adolescents; health care professionals, including dental hygienists, should be aware of this associated health benefit.

Self-rated health of Middle Eastern immigrants in the US: a national study

OBJECTIVES

The aim of the study was to examine self-rated health (SRH) of Middle Eastern immigrants in the US compared with US-born non-Hispanic whites and to examine factors associated with fair/poor SRH among Middle Eastern immigrants in the US.

STUDY DESIGN

We used a cross-sectional design to analyze the National Health Interview Survey from 2001 to 2015.

METHODS

Secondary survey analysis procedures were conducted using the SAS program, with a total of 3,966 Middle Eastern and 731,285 US-born non-Hispanic whites. Descriptive statistics and regression analyses were used.

RESULTS

Middle Eastern immigrants had significantly higher rates of fair/poor SRH than US-born whites across the three survey waves. Reporting symptoms of serious psychological distress, older age (60+ years), current alcohol-drinking status, and having a family member with disability were the factors associated significantly with higher odds of reporting fair/poor SRH in Middle Eastern immigrants, whereas education was a protecting factor of fair/poor SRH.

CONCLUSIONS

This study indicates that Middle Eastern immigrants are one of the US immigrant populations that report poor health status, which reveals the need for health policy attention to reduce health disparities.

Perfluoroalkyls/polyfluoroalkyl substances and dental caries experience in children, ages 3-11 years, National Health and Nutrition Examination Survey, 2013-2014

OBJECTIVE

The objective of this research is to determine the association of seven perfluoroalkyl and polyfluoroalkyl substances versus dental caries experience in US children, ages 3-11 years.

METHODS

A cross-sectional study design was used in the analysis of National Health and Nutrition Examination Survey 2013-2014 serological data of perfluoroalkyl and polyfluoroalkyl substances. The seven perfluoroalkyl and polyfluoroalkyl substances were: 2-(N-methyl-perfluorooctane sulfonamide) acetic acid; perfluorodecanoic acid; perfluorononanoic acid; perfluorohexane sulfonic acid; linear isomers of perfluorooctanoate; linear perfluorooctane sulfonate; and monomethyl branched isomers of perfluorooctane sulfonate. Two summative variables were created: monomethyl branch isomers of perfluorooctane sulfonic acid with linear isomer of perfluorooctane and branch isomers of perfluorooctanoate with linear isomer perfluorooctonate.

RESULTS

In unadjusted logistic regression, in which the comparison was between the less than 75th percentile reference group and the 75th and above percentile group, higher perfluorodecanoic acid was associated with dental caries experience [unadjusted odds ratio: 1.79 (95% CI: 1.19, 2.46; P = 0.0069); adjusted odds ratio: 1.54 (95% CI: 1.03, 2.30; P = 0.0385)].

CONCLUSIONS

Of the seven examined perfluoroalkyl and polyfluoroalkyl substances, only perfluorodecanoic acid had an association with dental caries experience in an unadjusted model and adjusted logistic regression model.

U.S. Re-Licensure Opioid/Pain Management Continuing Education Requirements in Dentistry, Dental Hygiene, and Medicine

Drug-induced deaths have been accelerating over the last two decades. The aim of this study was to determine if states with high opioid-induced deaths and overall drug-induced deaths were more likely to have continuing education (CE) requirements related to opioid use/pain management than states with fewer opioid-induced deaths. Almost 200 state dental and medical law boards' websites were examined for CE requirements, license renewal periods, and CE requirements for opioid use/pain management in December 2018 and January 2019. Drug-induced death data were obtained from the Centers for Disease Control and Prevention online database. States were categorized into quartiles of opioid-induced deaths per 100,000 population. A similar categorization was created for all drug-induced deaths. The results showed that states in the second, third, and fourth quartiles of opioid-induced deaths were more likely to have dental boards requiring opioid use/pain management CE than states in the first quartile in dentistry. This pattern was not the case with the medical boards' requirements. Dentists and physicians in states with higher all drug-induced deaths per 100,000 population were as likely to be required to attend opioid use/pain management CE as dentists and physicians in states with lower opioid-induced deaths. Although many licensing boards require opioid use/pain management CE in relation to their opioid-induced death rates, there is a need for policies to increase education in substance use disorders to reduce the number of drug-induced deaths.

Hypodontia, Oligodontia and Anodontia in West Virginia Appalachia

Purpose: Children in West Virginia have a high prevalence of missing permanent teeth when compared to children in the rest of the nation. The purpose of this study is to determine the prevalence of permanent tooth hypodontia/oligodontia/anodontia in West Virginia children and to compare the prevalence by sex.Methods: Five hundred panoramic radiographs of West Virginia children, ages 6-11 years, were examined for missing permanent tooth buds/permanent teeth. Data analyses included frequency determinations, Chi square analyses, and logistic regression.Results: Sixty children (12.0%, n=500) had at least one missing permanent tooth bud/permanent tooth. There were 15.5% of females and 8.8% of males who had at least one missing permanent tooth bud/permanent tooth. In adjusted logistic regression on at least one missing permanent tooth bud/permanent tooth, females had an adjusted odds ratio of 2.11 [95% Confidence Interval: 1.18, 3.75; p = .011] compared with males. Other variables in the analysis failed to reach significance.Conclusion: In this sample of West Virginia children, females were more likely to have at least one missing permanent tooth bud/permanent tooth compared to males. Early recognition and treatment planning for dental care is needed for children with hypodontia/oligodontia/anodontia.

Comparison of Dental Students' Self-Evaluation and Faculty Evaluation of Communication Skills During a Standardized Patient Exercise

The aims of this retrospective study, conducted in 2017, were to explore dental students' perceptions of their first standardized patient encounters and to assess the relationship between students' self-evaluation and faculty members' evaluation of students' communication skills in those encounters. Data from a simulation training laboratory at one U.S. dental school were obtained for all 46 second-year students, who had a standardized patient communication learning session. The students had completed self-evaluations before and after a debriefing with a clinical psychology and/or social work faculty member and three or four student peers. The faculty members had also completed evaluations of the students' communications skills. The results showed that the students found the standardized patient encounter helpful. The students rated "making an introduction" most positively. Students had a weighted Kappa agreement of 0.22 (p=0.024) with the faculty evaluations on their post-debriefing evaluation of overall communication skills, which was within the 0.21-0.40 range of fair agreement. This study found that, during their first standardized patient simulation exercise, the second-year students rated their overall communication skills in fair agreement with the faculty member after debriefing.

Personal Oral Infection Control, Low Birthweight, and Preterm Births in Appalachia West Virginia: A Cross-Sectional Study

INTRODUCTION

Appalachia West Virginia has a higher prevalence of preterm and low birthweight babies than the US national prevalence. Many factors have been studied which are known to influence preterm births and low birthweight babies. There are limited interventions that are available to decrease the likelihood of preterm and low birthweight babies; however oral health and personal oral infection control may be helpful. The purpose of this study was to evaluate the association of limited personal oral infection control among pregnant West Virginia Appalachian women and poor birth outcomes (preterm and low birthweight babies).

METHODS

A secondary data analysis of data from the West Virginia Healthy Start Helping Appalachian Parents and Infants (HAPI) Project from 2005 to 2016 was conducted. The researchers determined the odds ratio of personal oral infection control with a powered toothbrush (use of the brush fewer than 13 times per week versus use of the brush 13 or more times per week) on poor birth outcomes.

RESULTS

There were 845 women who completed the oral health program within the HAPI project. In unadjusted logistic regression, women who used the powered toothbrush and brushed less frequently had greater odds of poor birth outcomes than women who brushed more frequently (odds ratio of 2.07 [1.18, 3.62] P = 0.011 for low birthweight babies; and an odds ratio of 1.78 [1.04, 3.02] P = 0.034 for preterm birth). The results remained positive but were no longer significant in adjusted analysis.

CONCLUSION

There is a need to identify interventions that will benefit pregnant women so that their pregnancies result in healthy pregnancy outcomes.

Alpha galactosidase A activity in Parkinson's disease

Glucocerebrosidase (GCase, deficient in Gaucher disease) enzymatic activity measured in dried blood spots of Parkinson's Disease (PD) cases is within healthy range but reduced compared to controls. It is not known whether activities of additional lysosomal enzymes are reduced in dried blood spots in PD. To test whether reduction in lysosomal enzymatic activity in PD is specific to GCase, we measured GCase, acid sphingomyelinase (deficient in Niemann-Pick disease types A and B), alpha galactosidase A (deficient in Fabry), acid alpha-glucosidase (deficient in Pompe) and galactosylceramidase (deficient in Krabbe) enzymatic activities in dried blood spots of PD patients (n = 648) and controls (n = 317) recruited from Columbia University. Full sequencing of glucocerebrosidase (GBA) and the LRRK2 G2019S mutation was performed. Enzymatic activities were compared between PD cases and controls using t-test and regression models adjusted for age, gender, and GBA and LRRK2 G2019S mutation status. Alpha galactosidase A activity was lower in PD cases compared to controls both when only non-carriers were included (excluding all GBA and LRRK2 G2019S carriers and PD cases with age-at-onset below 40) [2.85 μmol/l/h versus 3.12 μmol/l/h, p = 0.018; after controlling for batch effect, p = 0.006 (468 PD cases and 296 controls)], and when including the entire cohort (2.89 μmol/l/h versus 3.10 μmol/l/h, p = 0.040; after controlling for batch effect, p = 0.011). Because the alpha galactosidase A gene is X-linked, we stratified the analyses by sex. Among women who were non-carriers of GBA and LRRK2 G2019S mutations (PD, n = 155; control, n = 194), alpha galactosidase A activity was lower in PD compared to controls (2.77 μmol/l/h versus 3.10 μmol/l/h, p = 0.044; after controlling for a batch effect, p = 0.001). The enzymatic activity of acid sphingomyelinase, acid alpha-glucosidase and galactosylceramidase was not significantly different between PD and controls. In non-carriers, most lysosomal enzyme activities were correlated, with the strongest association in GCase, acid alpha-glucosidase, and alpha galactosidase A (Pearson correlation coefficient between 0.382 and 0.532). In a regression model with all five enzymes among non-carriers (adjusted for sex and age), higher alpha galactosidase A activity was associated with lower odds of PD status (OR = 0.54; 95% CI:0.31-0.95; p = 0.032). When LRRK2 G2019S PD carriers (n = 37) were compared to non-carriers with PD, carriers had higher GCase, acid sphingomyelinase and alpha galactosidase A activity. We conclude that alpha galactosidase A may have a potential independent role in PD, in addition to GCase.

Estimating chronic disease rates in Canada: which population-wide denominator to use?

INTRODUCTION

Chronic disease rates are produced from the Public Health Agency of Canada's Canadian Chronic Disease Surveillance System (CCDSS) using administrative health data from provincial/territorial health ministries. Denominators for these rates are based on estimates of populations derived from health insurance files. However, these data may not be accessible to all researchers. Another source for population size estimates is the Statistics Canada census. The purpose of our study was to calculate the major differences between the CCDSS and Statistics Canada's population denominators and to identify the sources or reasons for the potential differences between these data sources.

METHODS

We compared the 2009 denominators from the CCDSS and Statistics Canada. The CCDSS denominator was adjusted for the growth components (births, deaths, emigration and immigration) from Statistics Canada's census data.

RESULTS

The unadjusted CCDSS denominator was 34 429 804, 3.2% higher than Statistics Canada's estimate of population in 2009. After the CCDSS denominator was adjusted for the growth components, the difference between the two estimates was reduced to 431 323 people, a difference of 1.3%. The CCDSS overestimates the population relative to Statistics Canada overall. The largest difference between the two estimates was from the migrant growth component, while the smallest was from the emigrant component.

CONCLUSION

By using data descriptions by data source, researchers can make decisions about which population to use in their calculations of disease frequency.

The Prevalence of Oral Flora in the Biofilm Microbiota of the Endotracheal Tube

The endotracheal tube (ETT) is recognized as an independent factor for infection in intubated patients. The presence of biofilm contributes to the development of pneumonia. Standard culturing techniques are inadequate to detect many of the bacteria present in a biofilm. Delineation of the microbiota in the ETT is needed to further understand infections in ventilated patients. A prospective, observational study was performed at a university, Level I trauma center. Twenty ETT were collected at extubation. Bioluminal accretions were removed and quantified. DNA was extracted and 16S ribosomal RNA gene analysis performed using the Human Oral Microbe Identification Microarray. Twenty ETT were evaluated. Mean age was 47.5 years (19-82). Five were smokers. Mean ventilator days was 3.6 ± 3.1. Mean intensive care unit days was 7.8 ± 6.3. In those ETT, 87 different bacterial species were identified. Mean number of bacterial species identified was 16 ± 9 (3-35). There was no relationship between duration of intubation and number of species (P = 0.5). Nonsmokers had a greater variety of bacteria than smokers (P = 0.03). Patients with pneumonia did not have a greater variety of bacteria (P = 0.14). Parvimonas micra presence was associated with reintubation (P = 0.01). The most common species in smokers were different from nonsmokers. There is a wide variety of bacteria present in an ETT, many of which cannot be cultured by standard means. Variation is not correlated to duration of intubation or accretion volume. Studies to evaluate these bacteria and their interaction with the biofilm may further delineate factors in development of infections.

Sharing the sandbox: Evolutionary mechanisms that maintain bacterial cooperation

Microbes are now known to participate in an extensive repertoire of cooperative behaviors such as biofilm formation, production of extracellular public-goods, group motility, and higher-ordered multicellular structures. A fundamental question is how these cooperative tasks are maintained in the face of non-cooperating defector cells. Recently, a number of molecular mechanisms including facultative participation, spatial sorting, and policing have been discovered to stabilize cooperation. Often these different mechanisms work in concert to reinforce cooperation. In this review, we describe bacterial cooperation and the current understanding of the molecular mechanisms that maintain it.

Stellar dynamics. The fastest unbound star in our Galaxy ejected by a thermonuclear supernova

Hypervelocity stars (HVSs) travel with velocities so high that they exceed the escape velocity of the Galaxy. Several acceleration mechanisms have been discussed. Only one HVS (US 708, HVS 2) is a compact helium star. Here we present a spectroscopic and kinematic analysis of US 708. Traveling with a velocity of ~1200 kilometers per second, it is the fastest unbound star in our Galaxy. In reconstructing its trajectory, the Galactic center becomes very unlikely as an origin, which is hardly consistent with the most favored ejection mechanism for the other HVSs. Furthermore, we detected that US 708 is a fast rotator. According to our binary evolution model, it was spun-up by tidal interaction in a close binary and is likely to be the ejected donor remnant of a thermonuclear supernova.

Decoupling HZSM-5 catalyst activity from deactivation during upgrading of pyrolysis oil vapors

The independent evaluation of catalyst activity and stability during the catalytic pyrolysis of biomass is challenging because of the nature of the reaction system and rapid catalyst deactivation that force the use of excess catalyst. In this contribution we use a modified pyroprobe system in which pulses of pyrolysis vapors are converted over a series of HZSM-5 catalysts in a separate fixed-bed reactor controlled independently. Both the reactor-bed temperature and the Si/Al ratio of the zeolite are varied to evaluate catalyst activity and deactivation rates independently both on a constant surface area and constant acid site basis. Results show that there is an optimum catalyst-bed temperature for the production of aromatics, above which the production of light gases increases and that of aromatics decrease. Zeolites with lower Si/Al ratios give comparable initial rates for aromatics production, but far more rapid catalyst deactivation rates than those with higher Si/Al ratios.