Four “Lessons Learned” While Implementing a Multi-Site Caries Prevention Trial

As the number of dental-related randomized clinical trials (RCTs) increases, there is a need for literature to help investigators inexperienced in conducting RCTs design and implement studies. This commentary describes four “lessons learned,” or considerations important in the planning and initial implementation of RCTs in dentistry that to our knowledge have not been discussed in the general dental literature describing trial techniques. These considerations are 1) preparing or securing a thorough systematic review, 2) developing a comprehensive set of study documents, 3) designing and testing multiple recruitment strategies, and 4) employing a run-in period prior to enrollment. Attention to these considerations in the planning phases of a dental RCT can help ensure that the trial is clinically relevant while also maximizing the likelihood that its implementation will be successful

Results from the Xylitol for Adult Caries Trial (X-ACT)

Although caries is prevalent in adults, few preventive therapies have been tested in adult populations. This randomized clinical trial evaluated the effectiveness of xylitol lozenges in preventing caries in elevated caries-risk adults

Examiner Training and Reliability in Two Randomized Clinical Trials of Adult Dental Caries

This report describes the training of dental examiners participating in two dental caries clinical trials and reports the inter- and intra- examiner reliability scores from the initial standardization sessions

Potential treatment mechanisms in a mindfulness-based intervention for people with progressive multiple sclerosis

Objectives To explore putative mediators of a mindfulness-based intervention to decrease distress in people with multiple sclerosis (MS) and to explore the patients’ perspectives on this intervention. Design We used an explanatory mixed methods design incorporating quantitative data from a pilot randomized control trial and a qualitative interview study with people who completed the mindfulness intervention. Methods People with MS (n = 40) completed standardized measures of distress (outcome), and acceptance, decentring, self-compassion, and self-efficacy (potential mediators). Semi-structured interviews (n = 15) of patients’ experiences of the mindfulness intervention were analysed deductively and inductively. Results Decentring post-intervention explained 13% of the 3-month change in distress and between 27% and 31% of concurrent changes in distress. Acceptance changed only slightly, and as a result, the indirect effect accounts for only 2% of future distress and between 3% and 11% of concurrent distress. Qualitative data showed that acceptance and self-compassion needed more time to develop, whereas decentring could be implemented readily after being introduced in the sessions. Self-efficacy also had a large mediating effect. Participants in their interviews talked about group dynamics and prior expectations as essential elements that determine their engagement with the course and their level of satisfaction. Conclusions Mindfulness interventions for people with a chronic progressive condition may benefit from focusing on helping them to accept daily challenges and teach them to recognize their thoughts and feelings, allowing time for acceptance and self-compassion to develop. Group dynamics also play a fundamental role in the success of the mindfulness interventions

A globally rare coastal salt pond marsh system at Odiorne Point State Park, Rye NH

Vegetation patterns in the coastal salt pond marsh system at Odiorne Point State Park in Rye, New Hampshire, the state\u27s only viable example, are described based on recent surveys and historical data. Four natural communities occur within the system: coastal salt pond flat, coastal salt pond emergent marsh, coastal salt pond meadow marsh, and highbush blueberry–winterberry shrub thicket. The first three communities are newly described in New Hampshire and the northeastern US coastline. A total of 69 native or naturalized vascular plant taxa from 54 genera and 33 families have been documented in the system at Odiorne Point between 1967 and 2011. The families best represented were Cyperaceae (10 taxa), Poaceae (9 taxa), and Asteraceae (6 taxa); the largest genera were Eleocharis (4 taxa), Hypericum (4 taxa), and Agrostis (3 taxa). In 2011, only 35 of the 69 plant taxa were documented; a difference that can be attributed, at least partially, to the variable nature of hydrologic and salinity influences on the system. Of the 69 plant taxa, three are rare in New Hampshire and five are both non-native and invasive in the state and region. The uncertainty of the nativity status of Typha angustifolia, the dominant species in the marsh, has significant implications for future management decisions. Measurement of surface and pore water salinity in late summer of 2011 revealed essentially fresh water conditions at the surface (1.1 ± 0.5 ppt SE), whereas pore water occurring 10 cm and 40 cm below the soil surface was mesohaline (5.8 ± 1.8 and 8.1 ± 1.8 ppt SE, respectively). Mean pore water salinity differed significantly among the natural communities examined, suggesting that hydrology and salinity influence species composition and distribution within coastal salt pond marsh systems. This globally rare system, distributed from Maine to New Jersey, shares similar dominant species across its range, although some of the state rare species it supports differ along a latitudinal gradient