Humanizing clinical dentistry through a person-centred model

oai:ojs.iwpc.mcgill.ca:article/2The clinical approach in dentistry stems from a biomedical model of health that is anchored in positivism. This biomedical model was never explicitly developed or reflected on, but rather implicitly acquired as a product of historical circumstance. A reductionist understanding of health served dentistry well in the past, when health afflictions were mostly acute. Today, however, in the age of chronic illnesses, the current clinical approach is no longer adequate: patients and dentists are both dissatisfied, and there are problems with dental education and dental public health. After a thorough review of the literature, highlighting the current state of the profession, we propose an alternative clinical model upon which updated approaches can be based. We call this model "Person-Centred Dentistry". Our proposed model is rooted on the notion of sharing of power between the dentist and the patient: a sharing of power in the relationship and epistemology. This leads to an expanded understanding of the person and the illness; a co-authoring of treatment plans; and interventions that focus not only on eliminating disease but also on patient needs.

Monitoring of the biodegradation of toluene-contaminated sand in columns by SIP measurements, CO2 content and its 13C/12C isotopic signature.

Hydrocarbon contaminated soils represent an environmental issue as it impacts on ecosystems and aquifers. Bioremediation uses the ability of bacteria naturally present in the ground to degrade hydrocarbons. It represents an effective solution to fight the pollution but in situ monitoring before and during soil treatment is difficult and challenging. Indeed, where significant subsurface heterogeneity exists, conventional intrusive groundwater sampling can be insufficient to obtain a robust monitoring as the information they provide is restricted to vertical profiles at discrete locations, with no information between sampling points. In order to obtain wider information, complementary methods can be used like geo-electrical techniques. Induced polarization (IP) seems to be the more promising to study the effects of biodegradation processes. Indeed, laboratory and field experiments have shown an enhancement of real and imaginary parts of electrical conductivity while bacterial treatment is progressing (Abdel Aal et al., 2006 ; Atekwana et Atekwana, 2010). Moreover, microbial activity induced CO2 production and isotopic deviation of carbon (Aggarwal and Hinchee, 1991). The ratio δ13C(CO2) will come closer to δ13C(hydrocarbon). From these findings, the French project BIOPHY, supported by the French National Research Agency (ANR), proposes to use electrical methods and gas analyses to develop a non-destructive method for monitoring in situ biodegradation of hydrocarbons in order to optimize soil treatment. Laboratory experiments in columns are carried out to demonstrate its feasibility. Our objectives were to monitor aerobic microbial activity in toluene-contaminated sand columns using complex electrical resistivity measurements (SIP, Spectral Induced polarization and GEIS, Galvanostatic Electrochemical Impedance Spectroscopy) and measuring concentration and δ13C isotopic ratio of produced CO2

What is preventing dentists from providing person-centred care?

Most healthcare professions have shifted the way they teach clinical approaches from a biomedical to a person-centred perspective. Yet, dentistry remains strongly anchored in a biomedical world.The objective of this project was to understand the barriers practicing dentists face to provide what we consider person-centred care. We conducted a qualitative descriptive study that comprised semi-structured interviews with dentists in private practice in the Greater Montreal area. After the analysis, we identified six barriers:•     Fear of interpersonal conflict: participants thought that engaging in genuine conversations with patients would lead to situations of disagreement and even conflicts.•     Fear of litigation: dentists considered that the legal and licensing infrastructure would judge the treatment they provide through a strict biomedical framework.•     Fear of loss of money: participants thought that providing person-centred care was more time consuming and thus financially penalizing. •    Pleasure to excel technically: some dentists did not consider offering interventions that provided less procedural pleasure than technical ones.•    Narrow interpretation of health: participants considered the biomedical dimension as the only important dimension.•    Lack of information: participants knew nothing or very little about person or patient-centred care. They seemed willing to integrate it into their practice had they had known more about it.These findings should help academic institutions to design their programs on person-centred care and respond to the fears expressed by professionals.Also, legal infrastructures must recognize the paradigm shift from the biomedical to the person-centred.

Validation and Modeling of Aeronautical Composite Structures Subjected to Combined Loadings: the VERTEX Project. Part 1: Experimental Setup, FE-DIC Instrumentation and Procedures

The development and certification of aeronautical composite structures is still largely based on the pyramid of tests. This approach is extremely costly in terms of number of tests and design loops. Moreover, this is made up of uniaxial tests whereas the real structures are mostly subjected to combined forces. The aim of the collaborative research program "VERTEX" is to make progress towards Predictive Virtual Testing and to significantly reduce the development costs of aeronautical and space programs. In this first part, the specific methodology for multiaxial tests of aeronautical structures is presented. The concept of technical specimen and their size are justified. Then, the development of a specific test device is presented. Compression / traction, shear, internal pressure and any combination are possible. Since structural tests were complex to be instrumented, a specific method of field measurement was developed. It is based on multi-camera instrumentation and an original approach named Finite Element Stereo Digital Image Correlation (FE-SDIC). A mechanical regularization with the use of Finite Element (FE) of the optical field measurements allows to calculate the translation or rotation displacement field. Thus this measured field is used for boundary conditions of the VERTEX tests. The experimental procedure, the measurement methodologies and the calculation / test dialogue are validated on isotropic metal plates in this paper

Person-Centered Care: Perspectives of free dental clinic users in Montréal, Canada

There has been a relatively slow incorporation of person-centered care into dental care. Despite the efforts to sustain this approach in dental health care delivery, the perspectives of patients have yet to be considered, especially those using free dental clinics. Our objectives were: (1) to describe the perspectives of adults unable to access private dental clinics when using free dental clinics, (2) to document their suggestions for improvements to dental care. This qualitative descriptive study included 13 adults using a free dental clinic. To select participants, we adopted a maximum variation sampling strategy regarding age, sex, marital status, education level and employment status. We used in-depth, semi-structured interviews to collect data and thematic content analysis to analyze the verbatim transcripts. Participants were generally satisfied with the dental care they received in private and free dental clinics. However, they did not appreciate the long wait times at free clinics, and were bothered by the cost at private clinics. They emphasized a desire for quality time with the dentist allowing for more informed and shared decisions about their care, regardless of the clinic they visited. Participants want to feel cared for through a trustworthy relationship with the clinician, and suggested incorporating a walk-in concept into free clinics to address access to care. Adults using free dental clinics have various experiences with private and public dentistry, but they all need clinicians who adopt a comprehensive approach when providing information. This could improve patients’experiences through a more person-centered approach to dental care

Full modal analysis of the Brillouin gain spectrum of an optical fiber

We present a numerical study of stimulated Brillouin scattering in optical fibers based on a full modal analysis of the acoustic and optical properties. The computation of each acoustic mode supported by the fiber structure allows us a deep and detailed investigation of the characteristics of the Brillouin gain spectrum. We focus our attention on optical fibers acting as acoustic antiwaveguides where the biggest contribution to the Brillouin response often comes from very high-order modes but it is sometimes overlooked because of computational issues. Our analysis clearly highlights their role and their dependence on the physical and geometrical structure of the fiber

Validation and modeling of aeronautical composite structures subjected to combined loadings: The VERTEX project. Part 2: Load envelopes for the assessment of panels with large notches

One of the important issues in the certification of composite aeronautical structures is large notches. In this paper, tests are carried out on technological specimens and under tensile, shear stresses and combined loadings using the VERTEX means presented in the first part of this publication. Strong interactions between postbuckling and propagation of cuts were observed. The FE-SDIC methodology developed specifically allows a first dialog between calculation / testing. The Discrete Ply Modeling method is able to compute the onset of failure of such complex tests. New tests responses called "envelop" are proposed and realized by following a load path that allows to validate the behavior of the notched structure for certification purposes. This methodology should eventually lead to a new vision of the tests pyramid by "Predictive Virtual Testing"

A self-affine geometrical model of dynamic RT-PMMA fractures: implications for fracture energy measurements

Profilometric imaging of fracture surfaces of rubber toughened polymer has been performed at two different resolutions (a) at large scales [10 μ\upmu m–25 mm] using an opto-mechanical profilometer and (b) at small scales [0.195 μ\upmu m–0.48 mm] using an interferometric optical microscope. We introduced a self-affine geometrical model using two parameters: the Hurst exponent and the topothesy. We showed that for rubber toughened materials the approximation of the created surface by a mean flat plane leads to a poor estimation of the dynamic fracture energy GIdcG_{Idc}. The description of the created rough fracture surface by a self-affine model is shown to provide a significantly better approximation. A new and original geometrical method is introduced to estimate self-affine parameters: the 3D surface scaling method. Hurst exponents are shown to be unique, χ=0.6±0.1\chi =0.6\pm 0.1 for the different fracture zones and measurement scales. Topothesy ratios indicate a significant difference of fracture surface roughness amplitude depending on the observation resolution when the detrending technique is not correctly introduced.ANR Carenc

Microbiological safety of flours used in follow up for infant formulas produced in Ouagadougou, Burkina Faso

The prevalence of diarrheal diseases in children aged from 6 to 24 months in Burkina Faso is 38%. These diarrheas may be due to the consumption of contaminated weaning food. Therefore, the microbiological quality of follow up infant flours used as supplement foods is a key-point to reduce children diseases. In this study, the microbiological safety of locally-produced infant flours was investigated. One hundred and ninety-nine (199) samples were collected mainly in retails outlets and in Recovery and Nutrition Education Centers. According to the Burkina Faso regulations, microbiological analyses were carried out for Total Aerobic Mesophilic Flora (TAMF), thermotolerant coliforms, Salmonella spp. and yeasts/molds. The bacterial and fungal isolates were identified using phenotypic and genotypic methods and the study of the production of mycotoxins was carried out from the fungal isolates. In collected samples, the TAMF count ranged from 0 to 1.8 × 106 CFU/g with a total average of 6.3 × 104 CFU/g. About 2% of the samples had a microbial load exceeding the standards (105 CFU/g). No Salmonella spp. was isolated in the final infant flours. However, the presence of Enterobacteriaceae (Klebsiella spp. Enterobacter spp. and Cronobacter spp.) was detected and molecular characterization revealed also the presence of fungal species of the genus Aspergillus spp., Penicillium spp. and Fusarium spp. Some of these species were found to produce aflatoxins, ochratoxin A and fumonisins, which are potential carcinogenic toxins. These results demonstrated the need for a preventive approach based on the application of Hazard Analysis Critical Control Point in the food industry to ensure food safety of infant flours in Burkina Faso