The Lived-Experiences of Clinical Supervisors in Rural Mental Health Settings

Supervision is an essential component to the counseling field and is a distinct intervention (Bernard & Goodyear, 2004). The primary purpose of supervision is to enhance a counselor\u27s professional development and ensure client welfare. The role of a supervisor carries a tremendous amount of professional, ethical, and legal responsibilities. Therefore, supervisors require specific training, skills, and knowledge related to the provision of mental health services in rural areas in order to provide quality supervision services. The intent of this study is to provide a rich description of the supervisor\u27s experience of supervision in the rural context and its effect on the development and functioning of the rural supervisor. This study provided the opportunity for supervisors to share the benefits, challenges, and concerns of providing supervision in the rural context. This study contributed to the understanding of the benefits and challenges of rural supervision and provided a basis for recommendations to improve supervision in rural areas. An analysis of relevant themes that emerged from focus group and individual interviews with ten rural supervisors provided a rich description of the experience of supervisors in rural settings. The results of this study demonstrate that working in rural mental health settings provides unique challenges and barriers to the development and functioning of rural supervisors. Rural supervisors struggle with the lack of initial and continuing education and training, lack of peer and professional supports, and lack of resources and funding in rural areas. These challenges are unique to the rural context and can have a profound effect on the quality of supervision and the quality of services provided in rural areas. The findings of this study identify the need for specific training and field experiences to prepare workers for the challenges often faced working in rural settings. This study provides specific recommendations to counselor educators to prepare people for work in rural areas. This study identifies risk factors and protective factors that enhance or impede supervisor development, and it provides specific recommendations to support supervisors currently practicing in rural areas

Endodontic Residents: Factors Influencing the Decision to Become a Dental Educator

Significance and Introduction: Dental schools in the United States are faced with a shortage of faculty. Endodontic residencies and pre-doctoral clinics are not immune to the faculty scarcity. The purpose of this study was to assess factors that influence endodontic residents’ decisions on whether to pursue a career as a dental educator. This information may be used to inform future recruitment and retention efforts for endodontic faculty. Materials and Methods: All United States American Association of Endodontists (AAE) members designated as “resident members” (525) were sent an electronic survey. The survey included demographic data, and factors impacting their career decisions. Results: One hundred and seven (107) respondents completed the survey. Twenty-six (26) respondents (24.3%) stated they plan to pursue a career in dental education at some point in the future. Four (4) respondents (3.7%) stated they would never consider a career in dental education. The remaining 72% indicated they would be open to pursuing a career in dental education if the conditions were favorable. Factors that respondents reported would motivate them toward pursuing a career in dental education were: “Salary” (76.6%), “Loan Reimbursement or Loan Forgiveness” (61.7%), “A Reduced Number of Work Days per Week” (29.9%) and “Opportunity to Practice Outside the University” (29.9%). Over half (56.7%) of residents anticipated incurring an educational debt of $200,000 or more, and only 17% of the respondents anticipated graduating with no debt. Financial compensation and work-life balance were major factors impacting residents’ decisions to pursue a career in dental education. In addition, infrequent discussions between residents and faculty about the components of an academic career were statistically correlated with a response of “unsure” about becoming a dental educator. Residents with one to three (1-3) years of experience as a general dentist before residency were statistically more likely to be interested in pursuing a career in dental education. Importantly, they were also statistically more likely to intend to begin their teaching careers within five years of finishing residency. No significant differences in responses or preferences existed based on gender or underrepresented minority (URM) status. Discussion and Conclusion: Financial factors and desire for independence were major contributors to the decision to pursue a career in dental education. The average educational debt reported by respondents was more than double the debt for endodontic residents in a 2002 study. Respondents recommended solutions to these issues, including loan repayment options and the ability to practice outside of the university at least once per week. They also expressed an interest in increased training and mentorship options, including fellowships, teaching assistantships, and instruction of general dentistry residents. Additional reasons for avoiding a career in dental education included a desire to avoid the politics and bureaucracy of academic institutions and the need for a convenient location for work and family

Polymeric Scaffolds for Dental Pulp Tissue Engineering: A Review

Objectives: The purpose of this review is to describe recent developments in pulp tissue engineering using scaffolds and/or stem cells. It is crucial to understand how this approach can revitalize damaged dentin-pulp tissue. Widespread scaffold materials, both natural and synthetic, and their fabrication methods, and stem-progenitor cells with the potential of pulp regeneration will be discussed. Data and Sources: A review of literature was conducted through online databases, including MEDLINE by using the PubMed search engine, Scopus, and the Cochrane Library. Study Selection: Studies were selected based on relevance, with a preference given to recent research, particularly from the past decade. Conclusions: The use of biomaterial scaffolds and stem cells can be safe and potent for the regeneration of pulp tissue and re-establishment of tooth vitality. Natural and synthetic polymers have distinct advantages and limitations and in vitro and in vivo testing have produced positive results for cell attachment, proliferation, and angiogenesis. The type of biomaterial used for scaffold fabrication also facilitates stem cell differentiation into odontoblasts and the resulting biochemistry of tissue repair for each polymer and cell type was discussed. Multiple methods of scaffold design exist for pulp tissue engineering, which demonstrates the variability in tissue engineering applications in endodontics. This review explains the potential of evidence-based tissue engineering strategies and outcomes in pulp regeneration. © 2019 The Academy of Dental Material

Decolonizing Risk Communication: Indigenous Responses to COVID-19 using Social Media

In this exploratory study, we examine how American Indian and Alaska Native (AIAN) governments and organizations are using social media to share critical health information about coronavirus disease 2019 (COVID-19) with their citizens.  Through a thematic analysis of 119 public Facebook posts made by Tribal governments and organizations, we identified three broad categories and 13 subthemes. Tribal governments and organizations created risk communication material for their respective communities that fell under (1) risk reduction, (2) meeting community members’ needs, and (3) staying connected to community and culture.  Our findings suggest that through social media AIAN communities and organizations played a crucial role in disseminating reliable culturally adapted risk communication and vital community information to Tribal citizens during the COVID-19 pandemic. Such communication included clear illustrations, posts and messages about the importance of masking up, social distancing and washing one’s hands; mandated border closures; and suggestions for maintaining a sense of connectedness with community.  By doing so they are filling a gap that ensures their communities receive the relevant information they need to mitigate and manage risks.  In order to understand how to better meet community needs, more work is needed to improve the wellbeing and visibility of AIAN people in the areas of health disparities, technology, social media, and the many impacts of COVID-19.&nbsp

Polymeric Scaffolds for Dental Pulp Tissue Engineering: A Review

Objectives The purpose of this review is to describe recent developments in pulp tissue engineering using scaffolds and/or stem cells. It is crucial to understand how this approach can revitalize damaged dentin-pulp tissue. Widespread scaffold materials, both natural and synthetic, and their fabrication methods, and stem-progenitor cells with the potential of pulp regeneration will be discussed. Data and Sources A review of literature was conducted through online databases, including MEDLINE by using the PubMed search engine, Scopus, and the Cochrane Library. Study Selection Studies were selected based on relevance, with a preference given to recent research, particularly from the past decade. Conclusions The use of biomaterial scaffolds and stem cells can be safe and potent for the regeneration of pulp tissue and re-establishment of tooth vitality. Natural and synthetic polymers have distinct advantages and limitations and in vitro and in vivo testing have produced positive results for cell attachment, proliferation, and angiogenesis. The type of biomaterial used for scaffold fabrication also facilitates stem cell differentiation into odontoblasts and the resulting biochemistry of tissue repair for each polymer and cell type was discussed. Multiple methods of scaffold design exist for pulp tissue engineering, which demonstrates the variability in tissue engineering applications in endodontics. This review explains the potential of evidence-based tissue engineering strategies and outcomes in pulp regeneration

Innovative Thermal Management Concepts and Material Solutions for Future Space Vehicles

When entering a planetary atmosphere, space vehicles are exposed to extreme thermal loads. To protect the vehicle’s interior, a thermal protection system is required. Future aerospace transportation demands solutions that exceed the performance of current systems and up-to-date material limits. Therefore, new and disruptive solutions must be envisaged to meet those extreme conditions. In the search of new solutions for sharp leading edges of future hypersonic reentry or transport vehicles, the THOR project, composed of eight European organizations (industries, research centers, and universities) and one Japanese Agency (Japan Aerospace Exploration Agency), is actively working on definition, design, implementation, and simulation of new passive and active thermal management solutions and their verification in relevant environments (high-enthalpy facilities). This paper provides an overview of the recent developments on the four concepts that are targeted in the project, applying different physical methodologies: 1) passive cooling using highly conductive carbon-based fibers, 2) passive cooling with intensive internal radiative exchange, 3) active cooling based on convection heat transfer using a ceramic sandwich/thermal protection system with ceramic foams/lattices, and 4) active transpiration cooling of external surfaces. Details on these thermal management concepts, requirements from end users, and test configurations, as well as results from experimental and numerical verification, are given

Opposing Effects of Climate and Permafrost Thaw on CH4 and CO2 Emissions From Northern Lakes

Funder: Natural Sciences and Engineering Research CouncilFunder: Northern Scientific Training Program, University of AlbertaFunder: UAlberta North, Vanier Canada Graduate ScholarshipW. Garfield Weston FoundationAbstract: Small, organic‐rich lakes are important sources of methane (CH4) and carbon dioxide (CO2) to the atmosphere, yet the sensitivity of emissions to climate warming is poorly constrained and potentially influenced by permafrost thaw. Here, we monitored emissions from 20 peatland lakes across a 1,600 km permafrost transect in boreal western Canada. Contrary to expectations, we observed a shift from source to sink of CO2 for lakes warmer regions, driven by greater primary productivity associated with greater hydrological connectivity to lakes and nutrient availability in the absence of permafrost. Conversely, an 8‐fold increase in CH4 emissions in warmer regions was associated with water temperature and shifts in microbial communities and dominant anaerobic processes. Our results suggest that the net radiative forcing from altered greenhouse gas emissions of northern peatland lakes this century will be dominated by increasing CH4 emissions and only partially offset by reduced CO2 emissions

Understanding patient preference for physician attire in ambulatory clinics: a cross-sectional observational study

OBJECTIVES We explored patient perceptions regarding physician attire in different clinical contexts and resultant effects on the physician-patient relationship. SETTING The 900-bed University Hospital Zurich, Switzerland. PARTICIPANTS A convenience sample of patients receiving care in dermatology, infectious diseases and neurology ambulatory clinics of the University Hospital Zurich participated in a paper-based survey. PRIMARY AND SECONDARY OUTCOME MEASURES The survey instrument was randomised and showed photographs of male or female physicians wearing various forms of attire. On the basis of the respondents' ratings of how the physician's attire affected perceptions across five domains (knowledgeable, trustworthy, caring, approachable and comfort with the physician), a composite preference score for attire was calculated as the primary outcome. Secondary outcomes included variation in preferences by respondent characteristics and context in which care was provided. RESULTS Of 834 patient respondents (140 in dermatology, 422 in infectious diseases and 272 in neurology), 298 (36%) agreed that physician attire was important. When compared with all available choices, the combination of white scrubs with white coat was rated highest while a business suit ranked lowest. Variation in preferences and opinions for attire were noted relative to respondent demographics and the clinical setting in which the survey was administered. For example, compared with younger patients, respondents ≥65 years of age more often reported that physician dress was both important to them and influenced how happy they were with their care (p=0.047 and p=0.001, respectively). CONCLUSIONS Outpatients at a large Swiss University hospital prefer their physicians to be dressed in white scrubs with white coat. Substantial variation among respondents based on demographics, type of physician and clinical setting were observed. Healthcare systems should consider context of care when defining policies related to dress code

Anti-group B Streptococcus antibody in infants born to mothers with human immunodeficiency virus (HIV) infection.

BACKGROUND: HIV-exposed uninfected infants have increased infection risk and mortality compared to HIV-unexposed infants. HIV-exposed infants may be at increased risk of invasive GBS disease due to reduced maternal antibody against GBS. METHODS: We quantified antibodies that bind to the surface of whole Group B Streptococcus (GBS) of serotypes Ia, Ib, II, III and V using novel flow cytometry assays in South African HIV-infected and non-infected mothers and their uninfected infants. Antibody-mediated complement C3b/iC3b deposition onto GBS of these serotypes was also quantified by a novel flow cytometry assay. RESULTS: Geometric mean concentration (GMC) of both surface-binding anti-GBS antibody and antibody-mediated complement deposition onto GBS were reduced in HIV-infected women (n=46) compared to HIV-uninfected women (n=58) for ST1a (surface-binding: 19.3 vs 29.3; p=0.003; complement deposition: 2.9 vs 5.3 SU/mL; p=0.003), STIb (24.9 vs 47.6; p=0.003; 2.6 vs 4.9 SU/mL; p=0.003), STII (19.8 vs 50.0; p=0.001; 3.1 vs 6.2 SU/mL; p=0.001), STIII (27.8 vs 60.1; p=0.001; 2.8 vs 5.3 SU/mL; p=0.001) and STV (121.9 vs 185.6 SU/mL; p<0.001) and in their infants for STIa (complement deposition 9.4 vs 27.0 SU/mL; p=0.02), STIb (13.4 vs 24.5 SU/mL; p=0.02), STII (14.6 vs 42.7 SU/mL; p=0.03), STIII (26.6 vs 62.7 SU/mL; p=0.03) and STV (90.4 vs 165.8 SU/mL; p=0.04). Median transplacental transfer of antibody from HIV-infected women to their infants was reduced compared to HIV-uninfected women for GBS serotypes II (0.42 [IQR 0.22-0.59] vs 1.0 SU/mL [0.42-1.66]; p<0.001), III (0.54 [0.31-1.03] vs 0.95 SU/mL [0.42-3.05], p=0.05) and V (0.51 [0.28-0.79] vs 0.75 SU/mL [0.26-2.9], p=0.04). The differences between infants remained significant at 16 weeks of age. CONCLUSIONS: Maternal HIV infection was associated with lower anti-GBS surface binding antibody concentration and antibody-mediated C3b/iC3b deposition onto GBS bacteria of serotypes Ia, Ib, II, III and V. This may render these infants more susceptible to early and late onset GBS disease