Comparison of CBCT Prescriptions among Different Campuses of East Carolina University School of Dental Medicine

OBJECTIVES: East Carolina University School of Dental Medicine (ECU SoDM) has established a unique education model that delivers the dental curriculum through student rotations at community service learning centers (CSLCs) in underserved areas across North Carolina in their senior year. The objective of the study is to analyze the patient composition and CBCT prescription patterns at the main campus (Ross Hall) and eight CSLCs, to determine if students have comparable training at various sites. METHODS: CBCTs taken at ECU SoDM in 2017–2021 were evaluated. One-way analysis of variance and the Wilcoxon Rank Sum Test were used to determine any differences in demographics, Medicaid coverage, and scan indications at various sites. RESULTS: A total of 1444 patients were included, with an age range of 4–90 years old; male 685, female 758; 1130 non-Hispanic/Latino, 71 Hispanic/Latino. For races, Caucasian 1106, African-American 156, American Indian/Alaskan Native 32, Asian 18, mixed 13, other 73. For Medicaid, there are 75 with and 1369 without coverage. Ross Hall has the largest amount of patients at 537, followed by Davidson 218, Brunswick 189, and Lillington 169, with Elizabeth City being the least with 45 patients. The top four reasons for taking CBCTs were implants, endodontics, oral pathology, and 3rd molar assessment. There was no significant difference in the indications for CBCTs or Medicaid coverage, among various sites. CONCLUSIONS: The demographics, Medicaid coverage and CBCT prescription patterns were comparable among various sites. There was a site-related difference in the amount of scans taken, warranting the necessity to monitor CSLC rotation selections to ensure a consistent learning experience

A meta-analysis and real-world cohort study on the sex-related differences in efficacy and safety of immunotherapy for hepatocellular carcinoma

Background & Aims: Sex-related differences in the immune pathogenesis of hepatocellular carcinoma (HCC), particularly related to oestrogen-dependent secretion of pro-tumourigenic cytokines, are well-known. Whether sex influences the efficacy and safety of immunotherapy is not known. Methods: We performed a restricted maximum likelihood random effects meta-analysis of five phase III trials that evaluated immune checkpoint inhibitors (ICIs) in advanced HCC and reported overall survival (OS) hazard ratios (HRs) stratified by sex to evaluate sex-related differences in OS. In a real-world cohort of 840 patients with HCC from 22 centres included between 2018 and 2023, we directly compared the efficacy and safety of atezolizumab + bevacizumab (A+B) between sexes. Radiological response was reported according to RECIST v1.1. Uni- and multivariable Cox regression analyses were performed for OS and progression-free survival (PFS). Results: In the meta-analysis, immunotherapy was associated with a significant OS benefit only in male (pooled HR 0.79; 95% CI 0.73–0.86) but not in female (pooled HR 0.85; 95% CI 0.70–1.03) patients with HCC. When directly comparing model estimates, no differences in the treatment effect between sexes were observed. Among 840 patients, 677 (81%) were male (mean age 66 ± 11 years), and 163 (19%) were female (mean age 67 ± 12 years). Type and severity of adverse events were similar between the two groups. OS and PFS were comparable between males and females upon uni- and multivariable analyses (aHR for OS and PFS: 0.79, 95% CI 0.59–1.04; 1.02, 95% CI 0.80–1.30, respectively). Objective response rates (24%/22%) and disease control rates (59%/59%) were also similar between sexes. Conclusion: Female phase III trial participants experienced smaller OS benefit following ICI therapy for advanced HCC, while outcomes following A+B treatment were comparable between sexes in a large real-world database. Based on the ambiguous sex-related differences in survival observed here, further investigation of sex-specific clinical and biologic determinants of responsiveness and survival following ICIs are warranted. Impact and implications: While immune checkpoint inhibitors have emerged as standard of care for the treatment of hepatocellular carcinoma, there are conflicting reports on whether the efficacy of cancer immunotherapy differs between females and males. Our study suggests ambiguous sex-related differences in outcomes from immunotherapy in hepatocellular carcinoma. Further investigation of sex-specific clustering in clinicopathologic and immunologic determinants of responsiveness to immune checkpoint inhibitor therapy should be prioritised. Systematic review registration: PROSPERO CRD42023429625

Report from the Annual Conference of the British Society of Echocardiography, November 2017, Edinburgh International Conference Centre, Edinburgh

No abstract available

Fish assemblage responses to flow seasonality and predictability in a tropical flood pulse system

Hydropower dams are looming in the Mekong Basin, affecting river flows that structure aquatic communities. Here, we quantitatively assessed flow seasonality and predictability in three sites located in three rivers displaying a gradient in flow alterations caused by upstream dams and investigated how fish assemblages responded seasonally and inter-annually to this gradient. By analyzing 7-yr daily fish and water monitoring data, we found that dams disturbed the natural flow seasonality and predictability. While the river displaying the lower seasonality-predictability was characterized by a distinct seasonal variation in assemblage composition with high species turnover, rivers with stronger flow seasonality-predictability exhibited broadly similar seasonal patterns in fish assemblage composition with low species turnover and regular annual peaks of fish migration. These results challenge the expectation of higher species turnover in systems displaying higher flow seasonality and predictability and may be partly due to the strong adaptation of fish assemblages to these specific systems. By enhancing our understanding of biological systems in the highly seasonal-predictable and aseasonal-unpredictable environments of the lower Mekong system, these findings suggest that hydropower-related pulsed flows that can mimic as far as possible natural pulsed flows are critical to reduce downstream effects on aquatic organisms

Developing and marketing sustainable construction services

Increasing calls for action on addressing the negative impact of human activities on the natural environment have lead to the growth of new markets for sustainable solutions. At a more macro level, the role of construction and marketing in economic development has been well established. In striving towards economic growth, a balance between marketing and construction should be considered to achieve sustainability. Engineering consultancies and other businesses have been developing the provision of \u91sustainability services\u92 to a diverse range of sectors including construction, energy and transportation, corporate and others. This has also been stimulated by policies enshrined in governmental legislation. Market growth in developed countries such as the UK and Singapore has been fast due to the implementation of more stringent regulations. This paper considers how the principles and practice of marketing may be applied to the promotion of sustainability services offered by engineering and construction consultancies and contractors. It will also consider the constraints and barriers, together with the opportunities for sustainability service markets in developed and developing countries

Designing freshwater protected areas (FPAs) for indiscriminate fisheries

Freshwater protected areas (FPAs) are increasingly important for biodiversity conservation, given the intensive use of these systems for water, energy and food production. However, the fisheries benefits of FPAs are not well understood, particularly for indiscriminate fisheries typical of tropical systems. Here we report the results of a model that tests the fisheries effects of no-take protected areas in conditions unique to indiscriminate riverine/floodplain systems. The model has a generalized form applicable to a wide range of systems. We report the results of the general model, as well as those from a specialized form parameterized for the Tonle Sap lake, Cambodia. Both the general and Tonle Sap versions of the model show that FPAs can pay important fisheries benefits, especially where it is difficult to control fishing mortality through gear restrictions or other means. The harvest and profit benefit response curves have similar shapes, with additional FPAs paying high dividends at less than approximately 50% FPA coverage, and then truncating and declining thereafter. In the specific setting of the Tonle Sap of Cambodia, FPAs would pay a large increase in harvest because current FPA coverage is low. It may be counterintuitive to community fisheries managers in Cambodia that the best way to increase harvest is to restrict fishing, but at very high levels of fishing effort, reducing effort or area fished will improve both harvest and profit. In Cambodia, it may make sense to maximize harvest rather than profit because fishers living in poverty need to maximize protein offtake, but the benefits of FPAs remain. Similar considerations may apply in many freshwater and indiscriminate fisheries