Instituting an Oral Health Preventive Service Program, Including Fluoride Varnish, for Preschool Children Birth to Five Years in a Rural Health Clinic: A clinical Scholarship Project

Abstract This project was designed to institute an oral health preventive program in a rural health clinic, in a dental provider shortage area, promoting oral health in preschool children birth to five years by: (a) instituting a program that supports the Missouri preventive service program in oral health, (b) promoting oral screenings and fluoride varnish twice yearly, (c) assessing the risk of caries, (d) referring to appropriate dental services and (e) educating parents or guardian about the importance of oral health and how to maintain oral health at home with children birth to five years. This project sought to answer the following questions: (1) Will children birth to five years in a rural health clinic have low, moderate, or high risk for caries? (2)Are there specific risk factors in children birth to five years in a rural health clinic that are more common in the high risk category for caries? (3) Is there a specific ethnic group in children birth to five years in rural health clinics that are at a higher risk for caries? (4) Are oral health educational materials an effective tool for the parents? Key findings were: The majority of the children 35 (97.2%) had never been seen by a dentist; 27 (75%) were in the High Risk category for early childhood cavities, 3 (8.3%) were found to have white spot lesions, the first sign of decay, 8 (22%) had evidence of rampant decay (seven or more cavities), 9 (25%) had untreated decay, 10 (27.8%) had evidence of early childhood cavities; urgent referral for extensive cavities was needed by 9 (25%) of the children, 6 (67%) were African American and Hispanic. There was insufficient time to evaluate if educational materials were an effective tool. Findings from this study clearly demonstrate that an oral health preventive service program, which includes the application of fluoride varnish, be a part of the well child exam and should begin earlier than school age children

Assessing the validity of the Global Activity Limitation Indicator in fourteen European countries.

BACKGROUND: The Global Activity Limitation Indicator (GALI), the measure underlying the European indicator Healthy Life Years (HLY), is widely used to compare population health across countries. However, the comparability of the item has been questioned. This study aims to further validate the GALI in the adult European population. METHODS: Data from the European Health Interview Survey (EHIS), covering 14 European countries and 152,787 individuals, were used to explore how the GALI was associated with other measures of disability and whether the GALI was consistent or reflected different disability situations in different countries. RESULTS: When considering each country separately or all combined, we found that the GALI was significantly associated with measures of activities of daily living, instrumental activity of daily living, and functional limitations (P < 0.001 in all cases). Associations were largest for activity of daily living and lowest though still high for functional limitations. For each measure, the magnitude of the association was similar across most countries. Overall, however, the GALI differed significantly between countries in terms of how it reflected each of the three disability measures (P < 0.001 in all cases). We suspect cross-country differences in the results may be due to variations in: the implementation of the EHIS, the perception of functioning and limitations, and the understanding of the GALI question. CONCLUSION: The study both confirms the relevance of this indicator to measure general activity limitations in the European population and the need for caution when comparing the level of the GALI from one country to another

Dialogue Act Modeling for Automatic Tagging and Recognition of Conversational Speech

We describe a statistical approach for modeling dialogue acts in conversational speech, i.e., speech-act-like units such as Statement, Question, Backchannel, Agreement, Disagreement, and Apology. Our model detects and predicts dialogue acts based on lexical, collocational, and prosodic cues, as well as on the discourse coherence of the dialogue act sequence. The dialogue model is based on treating the discourse structure of a conversation as a hidden Markov model and the individual dialogue acts as observations emanating from the model states. Constraints on the likely sequence of dialogue acts are modeled via a dialogue act n-gram. The statistical dialogue grammar is combined with word n-grams, decision trees, and neural networks modeling the idiosyncratic lexical and prosodic manifestations of each dialogue act. We develop a probabilistic integration of speech recognition with dialogue modeling, to improve both speech recognition and dialogue act classification accuracy. Models are trained and evaluated using a large hand-labeled database of 1,155 conversations from the Switchboard corpus of spontaneous human-to-human telephone speech. We achieved good dialogue act labeling accuracy (65% based on errorful, automatically recognized words and prosody, and 71% based on word transcripts, compared to a chance baseline accuracy of 35% and human accuracy of 84%) and a small reduction in word recognition error.Comment: 35 pages, 5 figures. Changes in copy editing (note title spelling changed

‘Super disabilities’ vs ‘Disabilities’?:Theorizing the role of ableism in (mis)representational mythology of disability in the marketplace

People with disabilities (PWD) constitute one of the largest minority groups with one in five people worldwide having a disability. While recognition and inclusion of this group in the marketplace has seen improvement, the effects of (mis)representation of PWD in shaping the discourse on fostering marketplace inclusion of socially marginalized consumers remain little understood. Although effects of misrepresentation (e.g., idealized, exoticized or selective representation) on inclusion/exclusion perceptions and cognitions has received attention in the context of ethnic/racial groups, the world of disability has been largely neglected. By extending the theory of ableism into the context of PWD representation and applying it to the analysis of the We’re the Superhumans advertisement developed for the Rio 2016 Paralympic Games, this paper examines the relationship between the (mis)representation and the inclusion/exclusion discourse. By uncovering that PWD misrepresentations can partially mask and/or redress the root causes of exclusion experienced by PWD in their lived realities, it contributes to the research agenda on the transformative role of consumption cultures perpetuating harmful, exclusionary social perceptions of marginalized groups versus contributing to advancement of their inclusion

An assessment of the aversive nature of an animal management procedure (clipping) using behavioral and physiological measures

Animal management often involves procedures that, while unlikely to cause physical pain, still cause aversive responses. The domestic horse ( Equus caballus ) regularly has excessive hair clipped off to facilitate its use as a riding/driving animal and this procedure causes adverse behavioral responses in some animals. The aim of this study was to compare behavioral and physiological measures to assess the aversive effect of this procedure. Ten horses were selected on the basis of being either compliant (C: n = 5) or non-compliant (NC: n = 5) during this procedure. The horses were subjected to a sham clipping procedure (SC: where the blades had been removed from the clippers) for a period of ten minutes. Measures were taken pre, during and post SC (−10 min to +30 min) and mean values calculated for ALL horses and for C and NC separately. Behavioral activity was scored (scale 1-5) by twenty students from video footage in (phase/group-blind scoring). Heart rate (HR), salivary cortisol and eye temperature were monitored throughout the procedure. The NC horses were found to be significantly more behaviorally active/less relaxed throughout the trial than C horses(p b 0.05) with the greatest difference occurring during the SC procedure (p b 0.01). NC horses were more active/less relaxed during, compared with pre or post SC (p b 0.05), but showed no behavioral difference pre and post SC. HR of the NC horses was higher than that of the C horses throughout the trial but only significantly so after 10 min of SC (p b 0.01). ALL horses showed significant increase in HR between +5 and +10 min into the procedure (p b 0.05). There was a significant increase in salivary cortisol concentration in ALL horses post procedure (p b 0.01) with levels peaking at 20 minute post SC. No significant differences in salivary cortisol concentration between C and NC were found at any stage of the trial. Eye temperature increased significantly in ALL horses during SC, peaking at +10 min into the procedure (p b 0.05) and then decreased substantially when SC had ceased (p b 0.01). Although no significant differences were found between C and NC per se, there was a significant interaction between group and phase of trial (p b 0.05) with the NC group showing a greater decrease in eye temperature post SC. There was a significant positive correlation between changes in salivary cortisol concentration and eye temperature (p b 0.01) but no correlation between any of the other measures. Although the behavioral response of C and NC to this procedure was significantly different the physiological responses indicated that ALL horses found the procedure aversive. Eye temperature could be used as an objective and immediate measure of how an animal is responding to a specific situation in order to evaluate management procedures and adapt them where appropriate to reduce the negative impact on animal health and welfare

Children's International Polyposis (CHIP) study : a randomized, double-blind, placebo-controlled study of celecoxib in children with familial adenomatous polyposis

Objective: To evaluate the efficacy and safety of celecoxib versus placebo in the prevention and treatment of colorectal polyposis in children with familial adenomatous polyposis (FAP). Methods: In this Phase III, double-blind, randomized, placebo-controlled, multicenter trial patients aged 10-17 years with FAP were randomized to celecoxib (16 mg/kg/day) or placebo for up to 5 years. Patients underwent annual assessments, including colonoscopies, to detect the time from randomization to the earliest occurrence of >= 20 polyps (> 2 mm in size) or colorectal malignancy. The study was terminated early due to low rate of observed endpoints combined with a lower than expected enrollment rate. Descriptive results are provided. Results: Of 106 randomized patients, 55 were treated with celecoxib (mean age 12.6 years; 52.7% female) and 51 were given placebo (mean age 12.2 years; 54.9% female). Disease progression (>= 20 polyps, > 2 mm in size) was observed in seven (12.7%) and 13 (25.5%) patients, respectively. The median time to disease progression was 2.1 years in the celecoxib group and 1.1 years for placebo. No patient developed colorectal cancer. The rate of adverse events (AEs) was similar in both groups (75.5% and 72.9%, respectively). Three patients in the celecoxib group (none in the placebo group) experienced serious AEs. Conclusion: In children with FAP, celecoxib was a well-tolerated treatment that was associated with a lower rate of colorectal polyposis and a longer time to disease progression compared with placebo. Due to the low rate of observed endpoints, the long-term impact of these results could not be ascertained

The effect of smoking on the duration of life with and without disability, Belgium 1997-2011

Background: Smoking is the single most important health threat yet there is no consistency as to whether non-smokers experience a compression of years lived with disability compared to (ex-)smokers. The objectives of the manuscript are (1) to assess the effect of smoking on the average years lived without disability (Disability Free Life Expectancy (DFLE)) and with disability (Disability Life Expectancy (DLE)) and (2) to estimate the extent to which these effects are due to better survival or reduced disability in never smokers. Methods. Data on disability and mortality were provided by the Belgian Health Interview Survey 1997 and 2001 and a 10 years mortality follow-up of the survey participants. Disability was defined as difficulties in activities of daily living (ADL), in mobility, in continence or in sensory (vision, hearing) functions. Poisson and multinomial logistic regression models were fitted to estimate the probabilities of death and the prevalence of disability by age, gender and smoking status adjusted for socioeconomic position. The Sullivan method was used to estimate DFLE and DLE at age 30. The contribution of mortality and of disability to smoking related differences in DFLE and DLE was assessed using decomposition methods. Results: Compared to never smokers, ex-smokers have a shorter life expectancy (LE) and DFLE but the number of years lived with disability is somewhat larger. For both sexes, the higher disability prevalence is the main contributing factor to the difference in DFLE and DLE. Smokers have a shorter LE, DFLE and DLE compared to never smokers. Both higher mortality and higher disability prevalence contribute to the difference in DFLE, but mortality is more important among males. Although both male and female smokers experience higher disability prevalence, their higher mortality outweighs their disability disadvantage resulting in a shorter DLE. Conclusion: Smoking kills and shortens both life without and life with disability. Smoking related disability can however not be ignored, given its contribution to the excess years with disability especially in younger age groups

Health and zoonotic infections of snow leopards Panthera unica in the South Gobi desert of Mongolia

Background: Snow leopards, Panthera uncia, are a threatened apex predator, scattered across the mountains of Central and South Asia. Disease threats to wild snow leopards have not been investigated.Methods and Results: Between 2008 and 2015, twenty snow leopards in the South Gobi desert of Mongolia were captured and immobilised for health screening and radio-collaring. Blood samples and external parasites were collected for pathogen analyses using enzyme-linked immunosorbent assay (ELISA), microscopic agglutination test (MAT), and next-generation sequencing (NGS) techniques. The animals showed no clinical signs of disease, however, serum antibodies to significant zoonotic pathogens were detected. These pathogens included, Coxiella burnetii, (25% prevalence), Leptospira spp., (20%), and Toxoplasma gondii (20%). Ticks collected from snow leopards contained potentially zoonotic bacteria from the genera Bacillus, Bacteroides, Campylobacter, Coxiella, Rickettsia, Staphylococcus and Streptococcus.Conclusions: The zoonotic pathogens identified in this study, in the short-term did not appear to cause illness in the snow leopards, but have caused illness in other wild felids. Therefore, surveillance for pathogens should be implemented to monitor for potential longer- term disease impacts on this snow leopard population