A proposed oral health management pathway for children with orofacial cleft in New Zealand

Background: Orofacial clefts (OFC) are the most common craniofacial anomalies in the new born with an incidence of approximately 1.79 per 1,000 live births in New Zealand. OFC represent a complex heterogeneous group of structural anomalies caused by a partial or complete breakdown in the normal early embryological formation of the face. Children born with an OFC require numerous multidisciplinary interventions aimed at restoring near normal form and function. These treatments are coordinated and staged by dedicated multidisciplinary teams and can extend from infancy to early adulthood. Children with OFC require optimal oral health as it can impact upon some of these treatment outcomes. However, children with OFCs in New Zealand have been reported as having generally poorer oral health with a greater dental caries experience than children without cleft.Objectives: This article proposes the establishment of an oral health management pathway for children with OFC in New Zealand. This was initiated in response to a recent Ministry of Health workshop which highlighted general inequities of care and poor health outcomes experienced by children with OFC.Conclusions:The establishment of a clear strategy to address inequities and inequalities of care for children with OFC is long overdue. The proposed oral health pathway will ensure there is appropriate access to care that is consistent throughout the country, with provision for targeted early preventative and management measures for those OFC considered high risk

Organization specific predictors of job satisfaction: findings from a Canadian multi-site quality of work life cross-sectional survey

BACKGROUND: Organizational features can affect how staff view their quality of work life. Determining staff perceptions about quality of work life is an important consideration for employers interested in improving employee job satisfaction. The purpose of this study was to identify organization specific predictors of job satisfaction within a health care system that consisted of six independent health care organizations. METHODS: 5,486 full, part and causal time (non-physician) staff on active payroll within six organizations (2 community hospitals, 1 community hospital/long-term care facility, 1 long-term care facility, 1 tertiary care/community health centre, and 1 visiting nursing agency) located in five communities in Central West Ontario, Canada were asked to complete a 65-item quality of work life survey. The self-administered questionnaires collected staff perceptions of: co-worker and supervisor support; teamwork and communication; job demands and decision authority; organization characteristics; patient/resident care; compensation and benefits; staff training and development; and impressions of the organization. Socio-demographic data were also collected. RESULTS: Depending on the organization, between 15 and 30 (of the 40 potential predictor) variables were found to be statistically associated with job satisfaction (univariate analyses). Logistic regression analyses identified the best predictors of job satisfaction and these are presented for each of the six organizations and for all organizations combined. CONCLUSIONS: The findings indicate that job satisfaction is a multidimensional construct and although there appear to be some commonalities across organizations, some predictors of job satisfaction appear to be organization and context specific

Ultrasound Biomicroscopy for Longitudinal Studies of Carotid Plaque Development in Mice: Validation with Histological Endpoints

Atherosclerosis is responsible for the death of thousands of Americans each year. The carotid constriction model of plaque development has recently been presented as a model for unstable plaque formation in mice. In this study we 1) validate ultrasound biomicroscopy (UBM) for the determination of carotid plaque size, percent stenosis, and plaque development in live animals, 2) determine the sensitivity of UBM in detecting changes in blood flow induced by carotid constriction and 3) test whether plaque formation can be predicted from blood flow parameters measured by UBM. Carotid plaques were induced by surgical constriction in Apo E-/- mice. Arteries were imaged bi-weekly by UBM, at which time PW-Doppler measurements of proximal blood flow, as well as plaque length and percent stenosis were determined. Histology was performed 9 weeks post surgery. When compared to whole mount post-mortem measurements, UBM accurately reported carotid plaque length. Percent stenosis, based on transverse B-mode UBM measurements, correlated well with that calculated from histological sections. PW-Doppler revealed that constriction reduced maximum systolic velocity (v(max)) and duration of the systolic velocity peak (t(s)/t(t)). Pre-plaque (2 week post-surgery) PW-Doppler parameters (v(max) and t(s)/t(t)) were correlated with plaque length at 9 weeks, and were predictive of plaque formation. Correlation of initiating PW-Doppler parameters (v(max) and t(s)/t(t)) with resulting plaque length established the degree of flow disturbance required for subsequent plaque development and demonstrated its power for predicting plaque developmen

Astrocyte Indoleamine 2,3-Dioxygenase Is Induced by the TLR3 Ligand Poly(I:C): Mechanism of Induction and Role in Antiviral Response▿

Indoleamine 2,3-dioxygenase (IDO) is the first and rate-limiting enzyme in the kynurenine pathway of tryptophan catabolism and has been implicated in neurotoxicity and suppression of the antiviral T-cell response in HIV encephalitis (HIVE). Here we show that the Toll-like receptor 3 (TLR3) ligand poly(I:C) (PIC) induces the expression of IDO in human astrocytes. PIC was less potent than gamma interferon (IFN-γ) but more potent than IFN-β in inducing IDO. PIC induction of IDO was mediated in part by IFN-β but not IFN-γ, and both NF-κB and interferon regulatory factor 3 (IRF3) were required. PIC also upregulated TLR3, thereby augmenting the primary (IFN-β) and secondary (IDO and viperin) response genes upon subsequent stimulation with PIC. In HIVE, the transcripts for TLR3, IFN-β, IDO, and viperin were increased and IDO immunoreactivity was detected in reactive astrocytes as well as macrophages and microglia. PIC caused suppression of intracellular replication of human immunodeficiency virus pseudotyped with vesicular stomatitis virus G protein and human cytomegalovirus in a manner dependent on IRF3 and IDO. The involvement of IDO was demonstrated by partial but significant reversal of the PIC-mediated antiviral effect by IDO RNA interference and/or tryptophan supplementation. Importantly, the cytokine interleukin-1 abolished IFN-γ-induced IDO enzyme activity in a nitric oxide-dependent manner without suppressing protein expression. Our results demonstrate that IDO is an innate antiviral protein induced by double-stranded RNA and suggest a therapeutic utility for PIC in human viral infections. They also show that IDO activity can be dissociated from protein expression, indicating that the local central nervous system cytokine and nitric oxide environment determines IDO function

Percent stenosis calculated from UBM parameters correlates with histological measurements.

<p>(a) Transverse B-mode image of RCCA 2 and 9 weeks after surgery. Upper Images, Adventitia is marked “A”, plaque “P”, “Medial layer M”. Lower, images are identical, but the inner elastic lamina is outlined with dotted white line, lumen with a red dotted line. Trichrome-stained transverse sections of the same 9 wk artery; internal elastic lamina (IEL) and lumen are outlined in white and red, respectively. (b) IMT measurements of casted and cuffed animals after 2 and 9 weeks of surgery. n.s. Not significant. (c) Linear regression analysis of percent stenosis estimated by UBM and histology. See Materials and <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029944#s2" target="_blank">Methods</a> for calculations of percent stenosis. Dotted lines indicate 95% confidence intervals; correlation coefficient = 0.75, n = 10 casts. (d) Comparison of UBM and histology measurements using Bland-Altman analysis. Dotted lines indicate 95% limits of agreement. Bias is indicated by solid line, was calculated as −4.76 mm±13.3 SD.</p

Plaques Progress More Rapidly in Casted vs Cuffed Animals.

<p>The rate of plaque growth was determined by performing individual linear regression analysis of plaque length or stenosis over time for each animal. The slopes (rates) were compared by unpaired t-test. (a) Rate of plaque growth in length (b) Rate of plaque growth in terms of stenosis. Data are mean±SEM, n = 7 cuffs, 10 casts “*” indicates p<0.05. (See <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029944#pone.0029944.s002" target="_blank">Fig. S2</a> for source data.)</p

Sensitivity and Specificity of PW-Doppler parameters t_s/t_T and v_max as predictors of plaque formation.

<p>Sensitivity and Specificity of PW-Doppler parameters t_s/t_T and v_max as predictors of plaque formation.</p

Changes in Lumen and IEL area upon carotid constriction.

<p>Data was analyzed by One Way ANOVA.</p><p>“*”indicates p<0.05 as compared to presurgery.</p>“†”<p>indicates p<0.05 as compared to 2 weeks post surgery.</p

Study time-line.

<p>Study time-line.</p

Pre-plaque PW-Doppler parameters correlate with plaque length at 9 weeks.

<p>(a) Representative PW-Doppler tracing of a proximal RCCA before and after surgery. Note the dramatic decrease in velocity. Measurements of v_max, time in systole (t_s) and t_T (total time) are indicated. (b) v_max and t_s/t_T were calculated from pre-surgery tracings and 2 and 9 weeks after device placement. Data (mean±SEM, n = 7 cuffs, 10 casts), were analyzed by 2 way ANOVA. There was a highly significant effect of device on v_max and t_s/t_T ratio (p<0.005), but no significant difference between cast and cuffs on either parameter. “*” p<0.05 compared to pre-surgery. (c) Using 39 animals fitted with casts, 2 week t_s/t_T and v_max values were calculated and plotted against plaque length at 9 weeks and the correlation determined by linear regression. t_s/t_T positively correlated with plaque length (p<0.0005, r = 0.66) between, v_max and plaque length were negatively correlated (p<0.0005, r = 0.59). Dotted lines indicate 95% confidence interval.</p