Improving a Dental School's Clinic Operations Using Lean Process Improvement

The term "lean production," also known as "Lean," describes a process of operations management pioneered at the Toyota Motor Company that contributed significantly to the success of the company. Although developed by Toyota, the Lean process has been implemented at many other organizations, including those in health care, and should be considered by dental schools in evaluating their clinical operations. Lean combines engineering principles with operations management and improvement tools to optimize business and operating processes. One of the core concepts is relentless elimination of waste (non-value-added components of a process). Another key concept is utilization of individuals closest to the actual work to analyze and improve the process. When the medical center of the University of Kentucky adopted the Lean process for improving clinical operations, members of the College of Dentistry trained in the process applied the techniques to improve inefficient operations at the Walk-In Dental Clinic. The purpose of this project was to reduce patients' average in-the-door-to-out-the-door time from over four hours to three hours within 90 days. Achievement of this goal was realized by streamlining patient flow and strategically relocating key phases of the process. This initiative resulted in patient benefits such as shortening average in-the-door-to-out-the-door time by over an hour, improving satisfaction by 21%, and reducing negative comments by 24%, as well as providing opportunity to implement the electronic health record, improving teamwork, and enhancing educational experiences for students. These benefits were achieved while maintaining high-quality patient care with zero adverse outcomes during and two years following the process improvement project.

Genetic associations of short- and long-term aggressiveness identified by skin lesion with growth, feed efficiency, and carcass characteristics in growing pigs

The objective of this study was to investigate the genetic relationships between skin lesion traits in group housed growing pigs as a measure of short- (in a newly mixed group) and long- (in a socially stable group) term aggression and commonly used commercial performance measures: growth, feed intake, feed efficiency, and carcass traits. Data on 2,413 growing pigs (138 groups) were available. Pigs were mixed into new social groups of 18 animals, and skin lesions were counted 24 h (SL24h) and 5 wk (SL5wk) postmixing. The animal model was used to estimate genetic parameters for skin lesion traits, test daily gain, lifetime daily gain, daily feed intake, feed efficiency (calculated as test daily gain divided by daily feed intake), loin depth, back fat, and HCW. Skin lesions had a heritable component, ranging from 0.08 for anterior SL24h to 0.22 for central SL5wk and would, therefore, be suitable as a method of phenotyping aggression for selection purposes. Significant positive genetic correlations were found between SL24h and SL5wk (0.46 to 0.81). Positive genetic correlations were also found between SL24h (central and posterior body regions) or SL5wk (all body regions) and the production traits lifetime daily gain, test daily gain, and HCW (0.29 to 0.54). Central SL24h, anterior SL5wk, and posterior SL5wk were found to correlate positively with feed efficiency (0.39 to 0.50), suggesting that pigs with more lesions convert feed more efficiently. Where significant, the magnitude of phenotypic correlations was low but positive (0.07 to 0.10). These results suggest that, genetically, animals that receive many lesions show improved performance compared to those with few lesions, except for anterior SL24h, which had previously been shown to be genetically positively correlated with the initiation of nonreciprocal attacks. It may, therefore, be possible, via selection against anterior skin lesions at mixing, to reduce this form of 1-sided aggression without adversely affecting production traits.

Social Media in the Dental School Environment, Part A: Benefits, Challenges, and Recommendations for Use

Social media consist of powerful tools that impact not only communication but relationships among people, thus posing an inherent challenge to the traditional standards of who we are as dental educators and what we can expect of each other. This article examines how the world of social media has changed dental education. Its goal is to outline the complex issues that social media use presents for academic dental institutions and to examine these issues from personal, professional, and legal perspectives. After providing an update on social media, the article considers the advantages and risks associated with the use of social media at the interpersonal, professional, and institutional levels. Policies and legal issues of which academic dental institutions need to be aware from a compliance perspective are examined, along with considerations and resources needed to develop effective social media policies. The challenge facing dental educators is how to capitalize on the benefits that social media offer, while minimizing risks and complying with the various forms of legal constraint.

Social Media in the Dental School Environment, Part B: Curricular Considerations

The goal of this article is to describe the broad curricular constructs surrounding teaching and learning about social media in dental education. This analysis takes into account timing, development, and assessment of the knowledge, skills, attitudes, and behaviors needed to effectively use social media tools as a contemporary dentist. Three developmental stages in a student's path to becoming a competent professional are described: from undergraduate to dental student, from the classroom and preclinical simulation laboratory to the clinical setting, and from dental student to licensed practitioner. Considerations for developing the dental curriculum and suggestions for effective instruction at each stage are offered. In all three stages in the future dentist's evolution, faculty members need to educate students about appropriate professional uses of social media. Faculty members should provide instruction on the beneficial aspects of this communication medium and help students recognize the potential pitfalls associated with its use. The authors provide guidelines for customizing instruction to complement each stage of development, recognizing that careful timing is not only important for optimal learning but can prevent inappropriate use of social media as students are introduced to novel situations.

Use of social media in dental schools: pluses, perils, and pitfalls from a legal perspective

One of the ways dental education is changing the way it is preparing the next generation of learners is through efficient utilization of interactive social media. Social media, which facilitates interaction and sharing of new ideas, is being utilized to educate students, residents, and faculty. Unfortunately, as with most improvements in technology, there are growing pains. Faculty, student, and patient interaction on social media platforms, such as Facebook and Twitter, can lead to inappropriate or embarrassing situations. Striking the appropriate balance between free speech rights of students and faculty and the need for colleges and universities to have efficient operations is often left to the judicial system. The concepts of free speech and contract law and how each is applied in educational settings should be understood by students, faculty, and administrators. This article provides a review of legal cases that led to current social media policies, as well as present-day cases that exemplify the application of these principles, to help dental educators gain a greater understanding of the boundaries of protected speech. It also provides a set of sample guidelines for communicating through these media.

Short-term temperament tests in beef cattle relate to long-term measures of behavior recorded in the home pen

Handling temperament tests for beef cattle have been related to production traits, with calmer temperaments having greater growth rates. In most tests of temperament or personality, observation of the animal takes place over a short period of time, sometimes completed in a matter of minutes. This study investigated whether behavior observed in a temperament test was reflective of the steer's behavior in the home pen. Indoor-housed, crossbred, Bos taurus beef steers (n = 67) were fitted with triaxial activity monitors (IceTags; IceRobotics Ltd., South Queensferry, Edinburgh, Scotland) and activity was recorded for 2 periods of 14 d each. Also, each steer was scored on 4 measures of temperament: 2 handling tests (flight speed and chute score) and 2 feeding behavior scores (aggression at feeders and ability to displace at feeders). Each temperament observation was repeated 4 times, with repeatability of the traits ranging from 0.23 (aggression) to 0.48 (flight speed). Activity measures derived from the accelerometer data, such as bout lengths, were found to be highly repeatable between the 2 periods of activity monitoring (repeatabilities of 0.67 and 0.70 for average lying bout duration and average standing bout duration, respectively). Steers with high flight speeds were also more active in the home pen (MotionIndex: rs = 0.35, P = 0.004; average step count: rs = 0.34, P = 0.005) than steers with low flight speeds. Steers that were more capable of displacing other steers at feeders had longer average standing bout durations (rs = 0.26, P = 0.036), which were more variable (standing time SD: rs = 0.27, P = 0.030), and lay down for less time (rs = -0.35, P = 0.004). No correlations were found between aggression at feeders or chute score and home pen behavior. Results of this study are the first to demonstrate that short-term temperament tests are related to longer-term behavior data in beef steers and these results should be taken into consideration for future research.

Precalving temperament and maternal defensiveness are independent traits but precalving fear may impact calf growth

Human safety can be compromised by the response of beef cows to handling or when defending their calf. However, little is known about how precalving temperament, postcalving defensiveness, and maternal care are related. The impacts of cow temperament on calf neonatal vigor and ADG are also unknown. Data were collected on 2 farms (Farm 1, n = 143, 1 parity; Farm 2, n = 237, 2 parities). Temperament was recorded before calving when restrained in a crush (crush score), on exit from the crush (flight speed), and when isolated with a handler. Defensiveness was recorded within 4 d after calving during handling of the calf. Maternal interactions with the calf and calf vigor were recorded for 3 h after calving (Farm 1 only) and ADG was measured over 7 mo. Crush score and flight speed were repeatable within a parity (range in repeatability 0.33 to 0.49; P < 0.001). Crush score (0.50; P < 0.001) and defensiveness (up to 0.71; P < 0.001) were repeatable across parities. Temperament and defensiveness were unrelated on Farm 1; on Farm 2 a fearful crush score was associated with heightened defensiveness as measured by vigorous movement during calf handling (P < 0.001). Temperament and defensiveness were unrelated to calving ease or the amount of maternal behavior shown to the calf. At Farm 1, cows that exited the crush quickly had calves with a lighter birth weight (P = 0.023) and those that were agitated when isolated had calves with a decreased ADG (P = 0.017). Defensiveness was unrelated to ADG and neither temperament nor defensiveness affected calf vigor. Cow precalving temperament and postcalving defensiveness are repeatable but appear to be independent traits, neither of which is related to maternal interactions with the neonatal calf. Reducing precalving fearfulness should not affect postcalving behavior and changing postcalving defensiveness should not affect other maternal care traits. Fearful cows may produce calves with decreased birth weight and ADG, which, if confirmed, suggests that cow fearfulness may have wider economic implications than previously realized.

Genetic associations between behavioral traits and direct-social effects of growth rate in pigs

This study examined the behavioral consequences of selecting pigs using a social genetic model for growth. Calculations enable each member of a group of pigs to be given a direct breeding value (DBV) and a social breeding value (SBV), which can be summarized into a total breeding value (TBV) for growth. Selection for growth TBV could affect animal behavior because social effects account for within-group interactions. Data were recorded from 96 groups of Yorkshire and Yorkshire × Landrace pigs in a nucleus herd. Each group contained 15 pigs fed ad libitum from 2 feeders; the space allowance was 0.85 m2/pig. Average daily gain was quantified from 35 to 100 kg of BW. Fighting and bullying activity at mixing (period 1), lying frequency 3 wk after mixing (period 2), and counts of skin lesions in periods 1 and 2 were recorded. The DBV for these traits were estimated with a classic animal model. We simulated different correlations between the direct genetic effect and the social genetic effect on growth rate (r(DS)), 2 components that respectively determine a pig's genetic capacity to grow and its genetic influence on growth of group mates: r(DS) was successively assumed to be 0 and ±0.12, ±0.20, ±0.29, and ±0.58. Finally, the correlations between DBV, SBV, and TBV for ADG, as well as the DBV for behavior and skin lesions, were calculated and tested for a level of significance at P < 0.05. The gradient from negative to positive values of r(DS) refers to a progressive path running from genetic antagonism to genetic mutualism for growth. If rDS in the population truly ranged between -0.58 and -0.20, correlations for TBV for ADG with DBV for fighting and bullying progressively increased with rDS. Consequently, if rDS was low (between -0.12 and +0.12) or positive (>+0.12), pigs with high TBV for ADG had higher DBV for bullying other pigs in the group and for fighting than pigs with lower TBV for ADG. Pigs with high TBV for ADG did not differ from other pigs in their DBV for lesions to the anterior part of the body, but they had a lower DBV for posterior lesions, whereas in period 2, they had higher DBV for posterior lesions and lower DBV for lying. Under genetic mutualism for growth and in housing conditions similar to those in the present study, selection for growth TBV would promote the rapid establishment of the dominance relationships, with more aggressive contests among group mates at mixing. Pigs would subsequently be more active but, judging by skin lesions, less willing to fight in a more stable social situation.

Board invited review: The importance of the gestation period for welfare of calves: maternal stressors and difficult births

The prenatal period is of critical importance in defining how individuals respond to their environment throughout life. Stress experienced by pregnant females has been shown to have detrimental effects on offspring biology in humans and a variety of other species. It also is becoming increasingly apparent that prenatal events can have important consequences for the behavior, health, and productivity of offspring in farmed species. Pregnant cattle may experience many potentially important stressors, for instance, relating to their social environment, housing system and physical environment, interactions with humans and husbandry procedures, and their state of health. We examined the available literature to provide a review of the implications of prenatal stress for offspring welfare in cattle. The long-term effects of dystocia on cattle offspring also are reviewed. To ensure a transparent and repeatable selection process, a systematic review approach was adopted. The research literature clearly demonstrates that prenatal stress and difficult births in beef and dairy cattle both have implications for offspring welfare and performance. Common husbandry practices, such as transport, were shown to influence offspring biology and the importance of environmental variables, including thermal stress and drought, also were highlighted. Maternal disease during pregnancy was shown to negatively impact offspring welfare. Moreover, dystocia-affected calves suffer increased mortality and morbidity, decreased transfer of passive immunity, and important physiological and behavioral changes. This review also identified considerable gaps in our knowledge and understanding of the effects of prenatal stress in cattle.

Associations between response to handling and growth and meat quality in frequently handled Bos taurus beef cattle

Fearful behavioral responses to handling (temperament) are undesirably associated with ADG and meat quality in infrequently handled Bos indicus cattle. It has never been assessed whether these relationships exist in calmer Bos taurus breeds in systems where handling is more frequent. Such systems predominate in some countries where beef production is a major agricultural activity. During fattening, 144 crossbred cattle from Limousin and Aberdeen Angus sires were assessed for temperament using 4 approaches: response to movement along a race (race score; 4 occasions), restraint in a crush (crush score; 4 occasions), flight speed from the crush (flight speed; 4 occasions), and isolation in a pen with a human (isolation score; 1 occasion in yr 1, 2 occasions in yr 2). Measurements of ADG were made between birth and slaughter and between 16 and 18 mo of age during fattening. Fattening occurred indoors on a complete mixed diet fed for ad libitum intake. Meat quality was measured by pH, color, and Volodkevitch shear force and by a sensory panel. The repeatability of temperament traits was 0.17 (race score), 0.35 (crush score), 0.51 (flight speed), and 0.36 (isolation score). The proportion of the total variance of temperament traits attributable to the sire and the social group was low (0.003 to 0.402). However, the sire did affect behavior in all tests apart from the crush score (ranging from P = 0.02 to P < 0.001). Correlations between behavior in the different tests (ranging from r = 0.21 to 0.54, and P = 0.02 to P < 0.001) apart from between-flight speed and isolation score indicate that fearful behavior was consistently shown across assessment methods. A calm response in the crush score test was associated with a greater ADG during fattening (P = 0.05), whereas a calm response during the isolation test was associated with a greater ADG in cold carcass weight (P = 0.02). Animals with a calm isolation score had less tender meat as judged by the sensory panel (P = 0.03), but no other effects were apparent between temperament and meat quality measures, although several tendencies (0.06 ≤ P ≤ 0.10) were found. Temperament did not appear to relate to meat quality in this study of frequently handled Bos taurus genotypes, which is in contrast to other studies using different beef production systems. Genetic correlations between temperament and meat quality under these conditions could, although not measured in this study, still exist in the absence of phenotypic correlations.

Genetic validation of postmixing skin injuries in pigs as an indicator of aggressiveness and the relationship with injuries under more stable social conditions

The objective of the study was to estimate genetic correlations between skin lesions and aggressive behavior postmixing and under more stable social conditions as a potential means of selecting against pig aggressiveness. Postmixing aggression in commercial pig production is common, compromises welfare and profitability, and cannot be significantly reduced by low-cost changes to the environment. A genetic component to individual aggressiveness has been described in pigs and other species. Selective breeding against aggressiveness ought to be possible if an easily measured indicator trait can be shown to be genetically associated with aggressive behavior. Aggressive behavior was recorded continuously for 24 h after mixing, and a count of skin lesions (lesion count, LC) was recorded at 24 h and 3 wk postmixing on 1,663 pigs. Two behavioral traits were found to have a moderate to high heritability similar to that of growth traits; duration of involvement in reciprocal fighting (0.43 +/- 0.04) and delivery of nonreciprocal aggression (NRA; 0.31 +/- 0.04), whereas receipt of NRA had a lower heritability (0.08 +/- 0.03). Genetic correlations (r(g)) suggested that lesions to the anterior region of the body 24 h after mixing were associated with reciprocal fighting (r(g) = 0.67 +/- 0.04), receipt of NRA (r(g) = 0.70 +/- 0.11), and to a lesser extent, delivery of NRA (r(g) = 0.31 +/- 0.06). Lesions to the center and rear were primarily genetically associated with receipt of NRA (r(g) = 0.80 +/- 0.05, 0.79 +/- 0.05). Genetic correlations indicated that pigs that engaged in reciprocal fighting delivered NRA to other animals (r(g) = 0.84 +/- 0.04) but were less likely to receive NRA themselves (r(g) = -0.41 +/- 0.14). A genetic merit index using lesions to the anterior region as one trait and those to the center or rear or both as a second trait should allow selection against animals involved in reciprocal fighting and the delivery of NRA. Positive correlations between LC 24 h and 3 wk after mixing were found, especially for lesions to the center and rear of the body, indicating that postmixing lesions are predictive of those received under more stable group conditions. As well as reducing immediate aggression at mixing, selection on postmixing LC is expected to have a long-term impact on injuries from aggression, even after dominance relationships are established.

A dental dean's perspective on ethical remediation of practitioners

A dental dean reviews the recently reported work of Dr. Muriel Bebeau providing an ethics remediation program for dental professionals in Minnesota who have been referred by the Board of Dentistry for disciplinary reasons. Dean Turner notes that the program is grounded in evidence, theory, practical cases, and critical thinking--all important elements on effective professional pedagogy. Issues associated with extending this approach to other states and into predoctoral education are explored. It is concluded that the documented effectiveness of the program belie claims that ethics cannot be taught.

Dental education in a flat world: advocating for increased global collaboration and standardization

Globalization is a broad term referring to the increasing connectivity, integration, and interdependence of economies, societies, technologies, cultures, and political and ecological spheres across the world. This position paper was developed by a working group of the 2007 American Dental Education Association (ADEA) Leadership Institute. The authors explore the effect that globalization has had on dentistry and dental education to date and hypothesize what dental education could look like in the years ahead. While the paper is written from a North American perspective, some of the authors bring international expertise and experience to the topic of global dental education in a flat world. Specific issues and barriers addressed in this position paper include variations in accreditation and licensure requirements in dental education throughout the world; the historical development of dental education models (odontology and stomatology) and the need for congruency of these models in the global environment; the competency-based model of education and its relevance to development and implementation of global dental competencies; and the slow adoption of technological advances in dental education for promoting collaborations and encouraging resource sharing among countries. These challenges are discussed as they affect the implementation of a standardized global dental education that can lead to improved access to oral health care services and better oral and overall health for the citizens of the world.

Strategic partnerships between academic dental institutions and communities

BACKGROUND

A landmark report from the U.S. surgeon general identified disparities in oral health care as an urgent and high-priority problem. A parallel development in the dental education community is the growing consensus that significant curriculum reform is long overdue.

METHODS

The authors performed a literature review and conducted a series of structured interviews with key institutional and community stakeholders from seven geographical regions of the United States. They investigated a wide range of partnerships between community-based dental clinics and academic dental institutions.

RESULTS

On the basis of their interviews and literature review, the authors identified common themes and made recommendations to the dental community to improve access to care while enhancing the dental curriculum.

CONCLUSIONS

Reducing disparities in access to oral health care and the need for reform of the dental curriculum may be addressed, in part, by a common solution: strategic partnerships between academic dental institutions and communities. Practice Implications. Organized dentistry and individual practitioners, along with other major stakeholders, can play a significant role in supporting reform of the dental curriculum and improving access to care.

Enhancing academic integrity: formulating effective honor codes

Academic integrity continues to be of concern in higher education as the data from undergraduate schools shows an increasing prevalence of cheating behaviors and changing values of students who are entering dental education. The use of honor codes has been reported to positively influence the attitudes and behaviors of students. This paper discusses the elements of an effective and valid honor code and its possible role in enhancing the dental school environment.

On the time-scales of magmatism at island-arc volcanoes

Precise information on time-scales and rates of change is fundamental to an understanding of natural processes and the development of quantitative physical models in the Earth sciences. U-series isotope studies are revolutionizing this field by providing time information in the range 10(2)-10(4) years, which is similar to that of many modern Earth processes. I review how the application of U-series isotopes has been used to constrain the time-scales of magma formation, ascent and storage beneath island-arc volcanoes. Different elements are distilled-off the subducting plate at different times and in different places. Contributions from subducted sediments to island-arc lava sources appear to occur some 350 kyr to 4 Myr prior to eruption. Fluid release from the subducting oceanic crust into the mantle wedge may be a multi-stage process and occurs over a period ranging from a few hundred kyr to less than one kyr prior to eruption. This implies that dehydration commences prior to the initiation of partial melting within the mantle wedge, which is consistent with recent evidence that the onset of melting is controlled by an isotherm and thus the thermal structure within the wedge. U-Pa disequilibria appear to require a component of decompression melting, possibly due to the development of gravitational instabilities. The preservation of large (226)Ra disequilibria permits only a short period of time between fluid addition and eruption. This requires rapid melt segregation, magma ascent by channelled flow and minimal residence time within the lithosphere. The evolution from basalt to basaltic andesite probably occurs rapidly during ascent or in magma reservoirs inferred from some geophysical data to lie within the lithospheric mantle. The flux across the Moho is broadly andesitic, and some magmas subsequently stall in more shallow crustal-level magma chambers, where they evolve to more differentiated compositions on time-scales of a few thousand years or less.

Craniometric variation in a population of mantled howler monkeys (Alouatta palliata): evidence of size selection in females and growth in dentally mature males

A large body of work on monkey cranial metrics (involving conclusions about interspecific variation, sexual dimorphism, and ontogeny) depends on the assumptions that growth effectively ceases with dental maturity and that intraspecific variation is negligible. We test these assumptions by examining variation in 39 measurements of 166 dentally mature Alouatta palliata skulls from animals found dead on Barro Colorado Island (BCI), Panama. We also investigate whether this population is under size-based selection, since our found-dead sample reflects the natural mortality in this population. The sample was divided into three age stages by occlusal wear (A-C, least to most wear). Female stage A means are significantly smaller than female stage B means for three cranial measures. Female stage B means are significantly smaller than female stage C means for five cranial measures. Male stage A means are significantly smaller than male stage B means for 21 cranial measures. Multivariate analyses confirm this trend of expansion between adult age stages. The dental metric and suture closure data suggest that the cranial expansion in females is due to size-based selection, while the cranial expansion in males is due to significant growth after dental maturity. Sexual dimorphism ratios are highly variable across different samples of A. palliata, indicating that dimorphism varies between populations of this species. These results provide insight into the selective forces operating on the BCI howlers and challenge the validity of the many studies which pool subspecies and assume growth ceases with maturity.

The interaction of liveweight and the degree of competition on drinking behaviour in growing pigs at different group sizes

The pattern of drinking behaviour in pigs, and the influence of social factors such as competition on this behaviour, have been poorly documented. If competition for access to a limited resource is substantial, access to that resource may be allocated disproportionately to different members of a group. Priority may be based on a dominance hierarchy, or on physical characteristics, such as weight. The pattern of drinking behaviour was examined and the effect of pig liveweight on drinking behaviour under conditions likely to produce different levels of competition was investigated. Four replicates of a 2x2 factorial design of two group sizes (20 vs. 60) and two drinker:pig ratios (1:10 vs. 1:20) used a total of 640 growing pigs (start weight 36+/-5.0 kg). The drinking behaviour, skin lesion score and performance of nine focal pigs (three each of heavy (41.9 S.E.M. 0.57 kg), medium (35.7 S.E.M. 0.51 kg) and light weight (30.9 S.E.M. 0.63 kg)) per pen were recorded. For all focal pigs, the maximum time spent at the drinkers occurred between the 1800 and 1900 h and the minimum time between 0700 and 0800 h. The mean number of drinking bouts per pig per day was 30.9 S.E.M. 1.41, the median bout length was 21 s and the mean daily duration spent at the drinkers was 832 s. The frequency of visits to the drinkers, drinking bout duration and daily drinking time were affected by group size and drinker allocation, but not by weight or the interaction of treatments and weight. The diurnal spread of drinking was similar for each of the four treatment combinations and each weight category. Heavy pigs had the greatest number of lesions, and light weight pigs the least (13.2 vs. 8.8 S.E.D. 1.18, P<0.005), but this was not affected by the four treatment combinations. Lesion score correlated poorly with the parameters of drinking behaviour. The treatments, in isolation, or in interaction with weight, did not affect performance. No treatment encouraged sufficient competition to compromise the drinking behaviour, social behaviour or performance of the lightest animals in the pen.

Hypoglossal canal size and hominid speech

The mammalian hypoglossal canal transmits the nerve that supplies the motor innervation to the tongue. Hypoglossal canal size has previously been used to date the origin of human-like speech capabilities to at least 400,000 years ago and to assign modern human vocal abilities to Neandertals. These conclusions are based on the hypothesis that the size of the hypoglossal canal is indicative of speech capabilities. This hypothesis is falsified here by the finding of numerous nonhuman primate taxa that have hypoglossal canals in the modern human size range, both absolutely and relative to oral cavity volume. Specimens of Australopithecus afarensis, Australopithecus africanus, and Australopithecus boisei also have hypoglossal canals that, both absolutely and relative to oral cavity volume, are equal in size to those of modern humans. The basis for the hypothesis that hypoglossal canal size is indicative of speech was the assumption that hypoglossal canal size is correlated with hypoglossal nerve size, which in turn is related to tongue function. This assumption is probably incorrect, as we found no apparent correlation between the size of the hypoglossal nerve, or the number of axons it contains, and the size of the hypoglossal canal in a sample of cadavers. Our data demonstrate that the size of the hypoglossal canal does not reflect vocal capabilities or language usage. Thus the date of origin for human language and the speech capabilities of Neandertals remain open questions.

U-Th Isotopes in Arc Magmas: Implications for Element Transfer from the Subducted Crust

Uranium-thorium isotope results from island arc volcanic rocks were used to investigate the rates of transfer of fluids and sediments from the downgoing slab. Uranium, but not thorium, is readily mobilized in the fluid. A negative array between thorium/cerium and neodymium-143/neodymium-144 indicates that significant amounts of the thorium in arc rocks are derived from subducted sediments, although perhaps only about 30 percent of the thorium in subducted sediments is returned to the crust in this way. The transfer times for fluid through the mantle wedge are about 30,000 to 120,000 years, whereas those for sediment melts may be several million years. The low average uranium/thorium ratios of bulk crust primarily reflect different crustal generation processes in the Archaean.

Physical fitness and its relationship to other indices of health status in children with chronic arthritis

OBJECTIVE

To compare aerobic and anaerobic fitness of a group of children w-th chronic arthritis with that of healthy controls, and to explore the relationship between physical fitness and other indices of health status in these children.

METHODS

Thirty-one children aged 8 to 17 years with chronic arthritis of varying type and severity and 16 physically healthy controls participated in the study. Using a cycle ergometer, aerobic fitness was assessed by measuring peak oxygen uptake achieved in a 15 s period during exercise to volitional fatigue. Anaerobic fitness was assessed by measuring peak power in the legs in a 5 s period and total work completed (Wingate test). Joint pain experienced over the week before testing and during testing was measured using a 10 cm visual analog scale. Self-esteem was measured using the Self Perception Profile for Children Questionnaire.

RESULTS

There were no significant differences between mean peak O2 uptake or mean peak anaerobic power for patients and controls; however, the mean values for both controls and patients were significantly lower than reported values for healthy children. Peak O2 uptake controlled for age, sex, and sum of skinfolds was negatively associated with disease severity, measured by physician global assessment (p = 0.04), but peak power was not. Neither aerobic nor anaerobic fitness were associated with disease activity measured by physician global assessment or active joint count, or with disease duration. There was a tendency for children with active arthritis to experience less pain during fitness testing than over the previous week (p = 0.06). Testing did not seem to exacerbate joint symptoms. Self-ratings of athletic competence were significantly correlated with peak O2 uptake achieved for children with arthritis (r = 0.43, p = 0.02), but not for controls. Global self-esteem was moderately correlated with self-rated athletic competence in controls (r = 0.49, p = 0.09), but was not in children with arthritis.

CONCLUSION

In this sample of children, most of whom had limited joint involvement, we failed to demonstrate significant group differences in fitness between patients and controls. Disease severity may be related to fitness levels, but psychosocial factors may perhaps be more important determinants of fitness. Children with arthritis seem to have realistic perceptions of their own physical capabilities, and even those children who are less fit and perceive themselves as having less athletic competence do not appear to have lowered self-esteem.

Radiographic materials, methods, and film-ordering patterns among orthodontic educators and private practitioners

Orthodontic private practitioners and training institutions were surveyed in regard to the various radiographic materials and methods used in their practices and for ascertaining film-ordering patterns for various types of patients. The reasons for the survey were to assess the degree of acceptance of more radiation-efficient imaging systems into orthodontic practice and to add to the data on orthodontic patient selection criteria and radiographic prescription patterns. All orthodontic programs in the United States and Canada were surveyed, along with all of the practicing orthodontists in the state of North Carolina. The response rates were 61% and 55%, respectively. It was found that a majority of practitioners and training institutions used more radiation-efficient rare earth screen systems, but more institutions used prepatient soft-tissue enhancement beam alteration methods, thus sparing thyroid dose. Lateral cephalometric and panoramic films were found to be the most frequently ordered films, and training institutions ordered more supplemental and follow-up radiographs than private practitioners. In general, patients requiring orthognathic surgery generated a greater number and variety of films than other patient types in both surveyed populations.

Chronic TM disorder and non-TM disorder pain: a comparison of behavioral and psychological characteristics

The purpose of this paper is to determine whether patients with chronic temporomandibular disorder (TMD) pain manifest behavioral, experimental, and psychological characteristics similar to patients with other chronic pain illnesses. The Chronic Pain Battery (CPB), a multidimensional assessment tool for chronic pain patients, was used to compare several important variables between 78 TM disorder (TMD) patients and 98 non-TMD chronic pain patients. The study found that chronic TMD patients had lower "usual" pain intensity and suffering levels, fewer vegetative symptoms associated with depression, higher pain tolerance, less impairment of activity, more hope about treatment outcome, lower health care system utilization, but higher reported stress levels than non-TMD chronic pain patients. The two groups manifested no significant differences in use of narcotics, sedatives, and sleeping pills; levels of depression, anxiety, somatization, hostility, or psychoticism; illness behavior reinforcement in their social surroundings; or ratings of problems with work, family, self-esteem, or suicidal impulses. These findings suggest that chronic TMD pain patients (with a symptom duration of over six months) are behaviorally and psychologically similar to non-TMD chronic pain patients, but that they differ in their perceptions of their disorder, rendering them less handicapped by their problems. Psychological, social, and behavioral treatment methods useful for treating chronic pain syndrome may thus also be applied along with dental therapy for optimal treatment of TMD associated with chronic pain.

Experimental ulcerative herpetic keratitis. IV. Preliminary observations on the efficacy of a herpes simplex subunit vaccine

Systemic vaccination of rabbits with an inactivated type 1 virus subunit vaccine induced humoral and cell-mediated immune responses. Following ocular infection with type 1 herpes virus corneal ulceration and virus excretion were reduced in the vaccinated rabbits.

The preparation, efficacy and safety of 'antigenoid' vaccine NFU1 (S-L+) MRC toward prevention of herpes simplex virus infections in human subjects

Vaccine NFU1 (S-L+) MRC was prepared by high multiplicity infection of serum-deprived human embryonic lung (MRC 5) cells with type 1 Herpes simplex virus. The preparative process removed inoculum virus particles and virus DNA while virus particle and DNA synthesis was inhibited by the presence of lithium chloride in the cell culture medium. The vaccine stimulated neutralising antibody in vaccinated mice and provided long-term protection against intra-vaginal challenge with type 2 herpes virus. The safety of the vaccine was confirmed by inoculation into newborn mice and cell lines of human, mammalian, and rodent origin. There was no evidence of cell transformation in vitro or of oncogenicity or teratogenicity in rodent species. It is intended to investigate the efficiency of this vaccine in human subjects.

The effects of psychological factors and physical trauma on recovery from oral surgery

This study evaluated the effects of several psychological factors on postsurgical recovery while controlling for and also evaluating the effects of the physical trauma induced by the surgery. Subjects were 38 patients (18 males and 20 females) who were scheduled to have four third molars surgically removed. The psychological factors measured included anxiety and expectations about recovery, trait anxiety, coping behaviors, and health locus of control. Surgical trauma was rated after surgery, and the following aspects of recovery were monitored: postoperative pain, interference with normal function, swelling, and healing. Poorer postoperative recovery was significantly predicted by each of the psychological variables and by higher levels of surgical trauma. In addition, the effects of the psychological variables on recovery were shown to be largely independent of the trauma effects. The data suggest that (a) future studies which give patients more positive expectations and reduce their anxiety about recovery may improve their recovery and (b) the types of patients most in need of preoperative psychological support would be those who have higher trait anxiety, vigilant coping behaviors, or an internal locus of control.