The Value of Evidence-Based Computer Simulation of Oral Health Outcomes for Management Analysis of the Alaska Dental Health Aide Program

Objectives: To create an evidence‐based research tool to inform and guide policy and program managers as they develop and deploy new service delivery models for oral disease prevention and intervention. Methods: A village‐level discrete event simulation was developed to project outcomes associated with different service delivery patterns. Evidence‐ based outcomes were associated with dental health aide activities, and projected indicators (DMFT, F+ST, T‐health, SiC, CPI, ECC) were proxy for oral health outcomes. Model runs representing the planned program implementation, a more intensive staffing scenario, and a more robust prevention scenario, generated 20‐year projections of clinical indicators; graphs and tallies were analyzed for trends and differences. Results: Outcomes associated with alternative patterns of service delivery indicate there is potential for substantial improvement in clinical outcomes with modest program changes. Not all segments of the population derive equal benefit when program variables are altered. Children benefit more from increased prevention, while adults benefit more from intensive staffing. Conclusions: Evidence‐ based simulation is a useful tool to analyze the impact of changing program variables on program outcome measures. This simulation informs dental managers of the clinical outcomes associated with policy and service delivery variables. Simulation tools can assist public health managers in analyzing and understanding the relationship between their policy decisions and long‐term clinical outcomes.The Ford Foundation

Report on an Arts Administration internship with the Ogden Museum of Southern Art

This internship report describes my experiences and impressions while working with The Ogden Museum of Southern Art (OMSA). The OMSA will be a museum devoted to the visual arts heritage of the American South. The museum is scheduled to open in 1998. At the time of my internship the OMSA was in the middle of a capital campaign to raise the necessary funds to house and endow the collection. My internship consisted of planning and implementing an educational program. The event introduced the new director to the various groups that are cooperating to make the OMSA a reality

Characterization of Angiotensin Ii Receptor Subtypes in the Brain

The present studies explore binding, distribution, and function of angiotensin II (AII) receptors (AT\sb1 and AT\sb2) in the brain. The discovery that sulfhydryl reducing agents masked some but not all AII receptors in the brain prompts an evaluation of commonly used binding assay buffer constituents. EDTA enhances binding (40%) at both AT\sb1 and AT\sb2 nuclei, while bacitracin did not alter binding at either receptor subtype. Phenanthroline and BSA differentially altered binding at AT1 (220% of control) and AT\sb2 (118% of control) receptors. The results indicate that phenanthroline and BSA would be poor buffer constituents for studies comparing binding at AT\sb1 and AT\sb2 receptors. All receptors were mapped in normotensive and genetically hypertensive hamster brains and the subtype composition estimated for a number of brain nuclei and the pituitary. Binding in the hamster was similar to that previously observed in the rat brain with exceptions: (1) additional binding in the medial habenula and interpeduncular nuclei, (2) absence of binding in the inferior olive, suprachiasmatic nucleus, medial amygdala, piriform cortex, and subthalamic nucleus and (3) quantitative differences in the dorsomotor nucleus of the vagus, striatum, hippocampus and anterior pituitary. Unlike studies of the normotensive and spontaneously hypertensive rat, we found no significant differences in binding distribution, density or subtype composition when comparing normal and genetically hypertensive hamsters. Finally, the effects of brain angiotensin II (AII) on central catecholamine utilization were determined. We found no significant differences in norepinephrine, epinephrine or dopamine utilization in rat brain homogenates following intracerebroventricular injection of AII. Although there is evidence that AII alters catecholamine utilization in some brain nuclei, these alterations appear limited (anatomically and/or quantitatively) to a relatively small portion of the brain catecholaminergic system. The results indicate that the selection of buffer constituents is an important consideration for AII binding studies, that there are minor species differences in the distribution of AII receptors in the brain and that despite substantial functional and anatomical overlap, only a relatively small portion of the brain catecholaminergic system is modulated by angiotensin II

Report on an Arts Administration internship with the Ogden Museum of Southern Art

This internship report describes my experiences and impressions while working with The Ogden Museum of Southern Art (OMSA). The OMSA will be a museum devoted to the visual arts heritage of the American South. The museum is scheduled to open in 1998. At the time of my internship the OMSA was in the middle of a capital campaign to raise the necessary funds to house and endow the collection. My internship consisted of planning and implementing an educational program. The event introduced the new director to the various groups that are cooperating to make the OMSA a reality

Atmospheric circulation patterns, cloud-to-ground lightning, and locally intense convective rainfall associated with debris flow initiation in the Dolomite Alps of northeastern Italy

The Dolomite Alps of northeastern Italy experience debris flows with great frequency during the summer months. An ample supply of unconsolidated material on steep slopes and a summer season climate regime characterized by recurrent thunderstorms combine to produce an abundance of these destructive hydro-geologic events. In the past, debris flow events have been studied primarily in the context of their geologic and geomorphic characteristics. The atmospheric contribution to these mass-wasting events has been limited to recording rainfall and developing intensity thresholds for debris mobilization. This study aims to expand the examination of atmospheric processes that preceded both locally intense convective rainfall (LICR) and debris flows in the Dolomite region. 500 hPa pressure level plots of geopotential heights were constructed for a period of 3 days prior to debris flow events to gain insight into the synoptic-scale processes which provide an environment conducive to LICR in the Dolomites. Cloud-to-ground (CG) lightning flash data recorded at the meso-scale were incorporated to assess the convective environment proximal to debris flow source regions. Twelve events were analyzed and from this analysis three common synoptic-scale circulation patterns were identified. Evaluation of CG flashes at smaller spatial and temporal scales illustrated that convective processes vary in their production of CF flashes (total number) and the spatial distribution of flashes can also be quite different between events over longer periods. During the 60 min interval immediately preceding debris flow a majority of cases exhibited spatial and temporal colocation of LICR and CG flashes. Also a number of CG flash parameters were found to be significantly correlated to rainfall intensity prior to debris flow initiation

Prostate Cancer Survivorship: Prevention and Treatment of the Adverse Effects of Androgen Deprivation Therapy

BACKGROUND: More than one-third of the estimated 2 million prostate cancer survivors in the United States receive androgen deprivation therapy (ADT). This population of mostly older men is medically vulnerable to a variety of treatment-associated adverse effects. MEASUREMENTS AND RESULTS: Androgen-deprivation therapy (ADT) causes loss of libido, vasomotor flushing, anemia, and fatigue. More recently, ADT has been shown to accelerate bone loss, increase fat mass, increase cholesterol and triglycerides, and decrease insulin sensitivity. Consistent with these adverse metabolic effects, ADT has also recently been associated with greater risks for fractures, diabetes and cardiovascular disease. CONCLUSION: Primary care clinicians and patients should be aware of the potential benefits and harms of ADT. Screening and intervention to prevent treatment-related morbidity should be incorporated into the routine care of prostate cancer survivors. Evidence-based guidelines to prevent fractures, diabetes, and cardiovascular disease in prostate cancer survivors represent an important unmet need. We recommend the adapted use of established practice guidelines designed for the general population

Use of the Delphi Technique in Instrument Development to Assess Debriefing Facilitation

Debriefing is an essential part of the simulation experience because this is where most of the learning occurs (Arafah, Hansen & Nichols, 2010). To date, there are no validated instruments to measure the ability of a facilitator to effectively debrief learners after a patient simulation. This poster describes phase one of a pilot study to develop and evaluate an instrument that assesses the effectiveness of a debriefing facilitator. The instrument is based on the current scientific literature and was tested to establish reliability and validity. In phase one, the Delphi Technique was selected as it has been shown to be a cost effective method of generating ideas and achieving consensus on a particular issue where there is a lack of empirical evidence (Powell, 2003). The process for establishing the panel, collecting and analyzing responses and achieving acceptable level of consensus will be described. Arafeh, J. M. R., Hansen, S. S. & Nichols, A. (2010). Debriefing in simulated-based learning: Facilitating a reflective discussion. Journal of Perinatal Neonatal Nursing, 24(4), 302-309. Powell, C. (2003). The Delphi Technique: Myths and realities. Journal of Advanced Nursing, 41(4), 376-382. Objectives: After viewing this poster the participants should be able to: 1. Describe best practice for effective facilitation of debriefing following simulation in health professions education. 2. Describe the process of the Delphi Technique in establishing instrument reliability and validity. 3. Discuss the benefits and challenges of using the Delphi Technique in instrument development

Genetic Testing and Other Healthcare Use by Black and White Individuals in a Genomic Sequencing Study

INTRODUCTION: Early adopters play a critical role in the diffusion of medical innovations by spreading awareness, increasing acceptability, and driving demand. Understanding the role of race in the context of other characteristics of potential early adopters can shed light on disparities seen in the early implementation of genomic medicine. We aimed to understand the association between self-identified race and individual experience with genetic testing outside of the research context. METHODS: We assessed factors associated with the odds of having ever received genetic testing prior to enrollment in a genomic sequencing study among 674 self-identified white and 407 self-identified African, African American, or Afro-Caribbean ("Black") individuals. RESULTS: Controlling for individual determinants of healthcare use (demographics, personality traits, knowledge and attitudes, and health status), identifying as Black was associated with lower odds of prior genetic testing (OR = 0.43, 95% CI [0.27-0.68], p < 0.001). In contrast, self-identified race was not associated with the use of non-genetic clinical screening tests (e.g., echocardiogram, colonoscopy). Black and white individuals were similar on self-reported personality traits tied to early adoption but differed by sociodemographic and resource facilitators of early adoption. CONCLUSION: Persistent racial disparities among early adopters may represent especially-entrenched disparities in access to and knowledge of genomic technologies in clinical settings

Measurement of Unpolarized and Polarized Cross Sections for Deeply Virtual Compton Scattering on the Proton at Jefferson Laboratory with CLAS

This paper reports the measurement of polarized and unpolarized cross sections for the ep→e′p′γ reaction, which is composed of deeply virtual Compton scattering (DVCS) and Bethe-Heitler (BH) processes, at an electron beam energy of 5.88 GeV at the Thomas Jefferson National Accelerator Facility using the Large Acceptance Spectrometer CLAS. The unpolarized cross sections and polarized cross section differences have been measured over broad kinematics, 0.10 \u3c xB \u3c 0.58, 1.0 \u3c Q2 \u3c4.8 GeV2 and 0.09\u3c−t \u3c2.00 GeV2. The results are found to be consistent with previous CLAS data, and these new data are discussed in the framework of the generalized parton distribution approach. Calculations with two widely used phenomenological models are approximately compatible with the experimental results over a large portion of the kinematic range of the data