Feasibility and costs of water fluoridation in remote Australian Aboriginal communities

Background: Fluoridation of public water supplies remains the key potential strategy for prevention of dental caries. The water supplies of many remote Indigenous communities do not contain adequate levels of natural fluoride. The small and dispersed nature of communities presents challenges for the provision of fluoridation infrastructure and until recently smaller settlements were considered unfavourable for cost-effective water fluoridation. Technological advances in water treatment and fluoridation are resulting in new and more cost-effective water fluoridation options and recent cost analyses support water fluoridation for communities of less than 1,000 people.Methods: Small scale fluoridation plants were installed in two remote Northern Territory communities in early 2004. Fluoride levels in community water supplies were expected to be monitored by local staff and by a remote electronic system. Site visits were undertaken by project investigators at commissioning and approximately two years later. Interviews were conducted with key informants and documentation pertaining to costs of the plants and operational reports were reviewed.Results: The fluoridation plants were operational for about 80% of the trial period. A number of technical features that interfered with plant operation were identified and addressed though redesign. Management systems and the attitudes and capacity of operational staff also impacted on the effective functioning of the plants. Capital costs for the wider implementation of these plants in remote communities is estimated at about $US94,000 with recurrent annual costs of$US11,800 per unit.Conclusion: Operational issues during the trial indicate the need for effective management systems, including policy and funding responsibility. Reliable manufacturers and suppliers of equipment should be identified and contractual agreements should provide for ongoing technical assistance. Water fluoridation units should be considered as a potential priority component of health related infrastructure in at least the larger remote Indigenous communities which have inadequate levels of natural fluoride and high levels of dental caries

The Effect of Graduated Driver Licensing on Teen Driver Crash Involvement.

Purpose: The purpose of this dissertation was to answer the following questions: 1. What is the effect of each component of Graduated Driver Licensing (learner license duration, required hours of supervised driving, passenger restrictions and nighttime driving restrictions) on 16- and 17-year-old drivers’ fatal crash rates? 2. What is the effect of GDL on 18-year-old drivers’ crash rates, and what mechanisms might be responsible for any increase in rates? Method: To answer question 1, states that introduced a single GDL component, independent of other components were identified. The effect of the single GDL component on 16- and 17-year-old drivers fatal crashes was estimated using single-state time series analysis, adjusting for adult crashes and gas prices. To answer question 2, single-state time series analysis was used to estimate the effect of GDL on 16-, 17-, and 18-year-old drivers’ crashes in Florida and Michigan, where GDL applies to 15- to 17-year-old drivers, and in Maryland, where GDL applies to novice drivers of all ages, adjusting for adult crashes and gas prices. Results: A learner license period that guaranteed six-months delay in licensure to drive independently was associated with a significant decline in 16- and 17-year-old drivers’ fatal crash rates. In one state, novice drivers’ fatal crash rates increased 34.5% following the introduction of 30 hours of required supervised driving. A passenger restriction for the first 12 months of intermediate licensure was followed by a 46% reduction in fatal passenger crash rates that approached significance (p= .06). Nighttime driving restrictions, implemented alongside supervised driving hours, did not reduce fatal nighttime crashes. The introduction of GDL was followed by a significant increase in possible-injury/property-damage-only crashes among 18-year-old drivers in Michigan and by a significant decrease in possible-injury/property-damage-only crashes among 18-year-old drivers’ rates in Maryland. Conclusion: Some GDL components confer a safety benefit. However, the entire program is responsible for a greater reduction in crashes than the additive contribution of individual components. GDL programs applied exclusively to 16- and 17-year-old drivers may result in some teens not being licensed until age 18. Requiring all novice drivers to complete a GDL program is recommended.PHDHealth Behavior & Health EducationUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/93997/1/jpehsani_1.pd

The Effect of Printed Educational Material from the Coroner in Victoria, Australia, on Changing Aged Care Health Professional Practice: A Subscriber Survey

There are substantial knowledge and research gaps about the effects of printed educational material on professional practice. This study has examined whether the Residential Aged Care Coronial (RACC) Communiqué, an electronic newsletter of narrative case reports about lessons learned from deaths in residential aged care settings reported to the coroner in Victoria, Australia, prompted subscribers to initiate change in professional practice to improve care. An anonymous electronic survey was distributed to all registered subscribers of the RACC Communiqué to collect information about self-reported changes in professional practice, respondent characteristics, reading behavior, and an assessment of effect and content of the publication. Researchers from the Victoria Institute of Forensic Medicine, Victoria, Australia, conducted the study in 2008. Of 778 subscribers invited to participate in the study, 426 (54.8%) provided valid responses. The majority of respondents were aged 45 and older, female, and working at a residential aged care facility in a management role. Half of the survey respondents reported making a change to their professional practice as a result of reading the RACC Communiqué, with one-fifth of these respondents agreeing that they would not have made the self-reported change if they had not read this publication. These findings are greater than the previously reported small effects of education through printed education material and make an important contribution to understanding the use of printed education material for initiating professional practice change.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79369/1/j.1532-5415.2010.02742.x.pd

Comparison evaluation of Curcumin(Curcuma longa extract)with the application of expressed breast milk in the treatment of nipple cracks in lactating primiparous women: A randomized clinical trial

زمینه و هدف: شقاق پستان مشکل شایعی در زنان شیرده می باشد که می تواند باعث قطع زودهنگام شیردهی گردد. زردچوبه یکی از قدیمی ترین گیاهان دارویی است که به دلیل دارا بودن کورکومین، اثر ترمیم کننده روی زخم ها دارد. این مطالعه با هدف تعیین تأثیر عصاره آبی الکلی کورکومین و مقایسه آن با باقی گذاردن قطره شیر مادر در درمان شقاق پستان انجام گردید. روش بررسی: پژوهش حاضر به صورت کارآزمایی بالینی تصادفی در سال 1392 بر روی زنان نخست زای مراجعه کننده به مراکز بهداشتی غرب اهواز انجام گردید. 88 مادر شیرده مبتلا به شقاق پستان، به شکل تصادفی به دو گروه مساوی درمان با کورکومین و گروه باقی گذاردن قطره شیر مادر تقسیم شدند. به منظور بررسی روند بهبود زخم و عوارض جانبی کورکومین، قبل ازدرمان، روز سوم و روز هفتم پس از شروع درمان، مقیاس استور توسط پژوهشگر تکمیل گردید. یافته ها: قبل از مطالعه و همچنین در روز هفتم تفاوت معنی دار بین میانگین نمره شقاق پستان در دو گروه مشاهده نشد؛ اما در روز سوم میانگین نمره شقاق در گروه کورکومین (267/0±761/)0 در مقایسه با گروه باقی گذاردن قطره شیر مادر (426/0±23/1) به طور معنی داری کمتر بود. همچنین اختلاف میانگین نمره شقاق قبل از درمان با روز سوم و همچنین با روز هفتم پس از شروع درمان، در هر دو گروه، معنی دار بود. نتیجه گیری: کورکومین و شیر مادر هر دو در درمان شقاق پستان موثر هستند؛ ولی باتوجه به عوارض جانبی محدود، فعالیت ضد میکروبی و اثر بیشتر کورکومین در کوتاه مدت، پیشنهاد می گردد از این دارو برای درمان شقاق پستان استفاده شود

Greedy Selfish Network Creation

We introduce and analyze greedy equilibria (GE) for the well-known model of selfish network creation by Fabrikant et al.[PODC'03]. GE are interesting for two reasons: (1) they model outcomes found by agents which prefer smooth adaptations over radical strategy-changes, (2) GE are outcomes found by agents which do not have enough computational resources to play optimally. In the model of Fabrikant et al. agents correspond to Internet Service Providers which buy network links to improve their quality of network usage. It is known that computing a best response in this model is NP-hard. Hence, poly-time agents are likely not to play optimally. But how good are networks created by such agents? We answer this question for very simple agents. Quite surprisingly, naive greedy play suffices to create remarkably stable networks. Specifically, we show that in the SUM version, where agents attempt to minimize their average distance to all other agents, GE capture Nash equilibria (NE) on trees and that any GE is in 3-approximate NE on general networks. For the latter we also provide a lower bound of 3/2 on the approximation ratio. For the MAX version, where agents attempt to minimize their maximum distance, we show that any GE-star is in 2-approximate NE and any GE-tree having larger diameter is in 6/5-approximate NE. Both bounds are tight. We contrast these positive results by providing a linear lower bound on the approximation ratio for the MAX version on general networks in GE. This result implies a locality gap of $\Omega(n)$ for the metric min-max facility location problem, where n is the number of clients.Comment: 28 pages, 8 figures. An extended abstract of this work was accepted at WINE'1

Comparison of long-pulsed alexandrite laser and topical tretinoin-ammonium lactate in axillary acanthosis nigricans: A case series of patients in a before-after trial

Background: Acanthosis nigricans (AN) is a brown to black, velvety hyperpigmentation of the skin that usually involves cutaneous folds. Treatment of AN is important regarding cosmetic reasons and various therapeutic modalities have been used for these purposes. The goal of this study was to compare the effectiveness of long-pulsed alexandrite laser and topical tretinoin-ammonium lactate for treatment of axillary-AN. Methods: Fifteen patients with bilateral axillary-AN were studied in Razi Hospital, Tehran, Iran. Diagnosis was confirmed by two independent dermatologists. Each side skin lesion was randomly allocated to either topical mixed cream of tretinoin 0.05- ammonium lactate 12 or long-pulsed alexandrite laser. Duration of treatment was 14 weeks. At endpoint, the mean percent reduction from baseline in pigmentation area was compared between the two groups. Results: The study population consisted of 15 patients three males and 12, females. The mean age of patients was 28.5±4.9 years. The mean percent reduction was 18.3±10.6, in tretinoin/ammonium lactate group and 25.7±11.8 in laser group (P=0.004). Conclusion: These findings indicate that the application of alexandrite laser is a relative effective method for treatment of axillary-AN. However, this issue requires further studies with prolonged follow-up period

Measuring Young Drivers’ Behaviors during Complex Driving Situations

Driving behaviors of teenagers and adults in complex driving situations, viz., merges and intersections, from an 18-month longitudinal naturalistic driving study were analyzed. Variables from multiple sources were selected to create an Unsafe Driving Index to rate drivers’ behaviors in these locations. Teenagers scored lower on this index, corresponding to safer driving behaviors, than adults. However, the teenagers’ scores for the index increased across the study period. The interpretations of these findings are discussed with respect to the methodological aspects of the study and in terms of driver training and rule following

Driving performance in older adults: Current measures, findings, and implications for roadway safety

BACKGROUND AND OBJECTIVES: Over 10,000 people a day turn 65 in the United States. For many older adults, driving represents an essential component of independence and is one of the most important factors in overall mobility. Recent survey studies in older adults suggest that up to 60% of older adult drivers with mild cognitive impairment, and up to 30% with dementia, continue to drive. The purpose of this review is to provide a comprehensive and detailed resource on the topics of cognition and driving for clinicians, researchers, and policymakers working on efforts related to older adult drivers. RESEARCH DESIGN AND METHODS: Publications on PubMed and Medline and discussions with experts working in geriatrics, technology, driving policy, psychology, and diverse aspects of driving performance were utilized to inform the current review. RESULTS: Research indicates that there is a complex and inverse correlation between multiple cognitive measures, driving performance, and risky driving behaviors. The fragmented nature of available peer-reviewed literature, and a reliance on correlative data, do not currently allow for the identification of the temporal and reciprocal nature of the interplay between cognition and driving endpoints. DISCUSSION AND IMPLICATIONS: There are currently no widely accepted definitions, conceptual models, or uniform set of analyses for conducting geriatric research that is focused on driving. Establishing conventions for conducting research that harmonizes the fields of geriatrics, cognition, and driving research is critical for the development of the evidence base that will inform clinical practice and road safety policy