Grouping of tooth surfaces by susceptibility to caries: a study in 5–16 year-old children

BACKGROUND: The decline in caries has slowed and this may be indicative of variation in the susceptibility of differing teeth to caries. This study tests the hypothesis that in children, there are groups of tooth sites that exhibit differences in caries susceptibility. METHODS: Probit analysis of caries data collected from a 4-year longitudinal study of 20,000 schoolchildren aged between 5 and 16 years in 10 differing locations in the United States. RESULTS: The development of dental caries within the mouth followed a fixed hierarchy indicating that tooth surfaces show variation in caries susceptibility. Certain teeth and tooth sites have similar susceptibilities and can be grouped, the sizes of the groups vary. The most susceptible group consists of six tooth surfaces: the buccal pits and occlusal fissured surfaces of the first molar teeth. The second group consisted of 12 sites on the second molar and premolar teeth. The group formed by the least susceptible sites included the largest number of tooth surfaces and consists of the majority of the lower anterior teeth and canines. CONCLUSION: Variation in the caries susceptibility of tooth surfaces exists. Surfaces can be grouped according to caries susceptibility. An effect that reduces the cariogenic challenge of one of the sites within a group is likely to affect all the other sites within the particular group

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Oral health education in the undergraduate nursing curriculum of Australian and Malaysian institutions

INTRODUCTION: A high degree of training is necessary to prepare student nurses for their roles as oral healthcare partners that can promote a holistic approach to health in the community. This study aims to determine the extent of oral health education in Australian and Malaysian nursing institutions, as well as investigate educators' perceptions of education and practice in this area of care. METHODOLOGY: An audio-recorded, semi-structured qualitative phone interview was conducted with the heads of 42 nursing schools across Australia (n = 35) and Malaysia (n = 7) during the 2015 academic year. Qualitative data were analysed via thematic analysis. Quantitative data, wherever appropriate, were measured for frequencies. RESULTS: The response rate was 34.2% (n = 12) and 71.4% (n = 5) for the Australian and Malaysian subjects, respectively. Findings revealed that although all the nursing schools measured provided didactic and clinical training in oral health, curriculum content, expected learning outcomes, amount of clinical exposure and assessment approach lacked consistency. Most nursing educators across both countries perceived an overloaded curriculum as a barrier to providing oral health education. Whilst educators demonstrated their support for training in this area of care, they expressed the need for an established national guideline that highlights the educational requirement for future nurses in oral health maintenance and their scope of practice. CONCLUSION: This study provides valuable information for further developing oral health education for nurses, to improve their competency and ultimately the health of the communities that they will serve

5-benzoyl-1-ethyl-4-phenyl-1H-pyrimidin-2-one

In the title compound, C19H16N2O2 the pyrimidine ring is distorted from planarity. The dihedral angle between the two phenyl rings is 88.3 (1)degrees. The two phenyl rings form dihedral angles of 114.6(1) and 141.2(1)degrees with the pyrimidine ring

Bis[hexaaquacerium(III)] tetraaquacopper(II) tetrasquarate dihydrate

The cerium ion in the title compound, [Ce(OH2)(6)](2) [Cu(OH2)(4)](C4O4)(4) . 2H(2)O, is nine-coordinate in a monocapped square-prismatic geometry. The squarate (3,4-dihydroxy-3-cyclobutene-1,2-dionate) group links the cerium and copper ions into a three-dimensional network structure

X-Ray and spectroscopic re-investigation of urotropine-p-nitrophenol complex

The product of the reaction between urotropine and p-nitrophenol, reported as a 1:1 adduct that belongs to the triclinic P 1 space group, is, in fact, a 1:2 [C6H12N4]. (p-HOC6H4NO2](2). [H2O] hydrate that crystallizes in the monoclinic C2 space group. In the crystal structure, one nitrogen atom of the urotropine moiety is linked by a hydrogen bond to the hydroxyl group of a p-nitrophenol molecule [N . . .O = 2.655 (7) Angstrom]; the [C6H12N4]. [p-HOC6H4NO2] entities are linked into a linear one-dimensional chain through the lattice water molecule [O . . .N = 2.871 (8), O . . .O = 2.878 (7) Angstrom]. The other p-nitrophenol moiety is disordered over two positions across the two-fold axis; its interaction with adjacent water molecules [O . . .O = 2.53 (1), 2.57 (2) Angstrom] holds neighboring chains together. The FTIR spectrum of the complex in the solid indicate the formation of OH . . .N intermolecular hydrogen bond described by an asymmetric double minimum potential and weak Zundel's polarizability. The spectroscopic measurements in solution demonstrate the dissociation of the complex observed in the solid and prove the presence of the 1:1 complexes urotropine-p-nitrophenol. In these complexes no proton transfer from p-nitrophenol to urotropine is observed. (C) 2001 Elsevier Science B.V. All rights reserved

Aminoguanidinium (ethylenediamine-N,N,N ',N '-tetraacetato)antimonate(III) monohydrate

In the title complex, (CH7N4)[Sb(C10H12N2O8)]. H2O, the lone-pair electrons of the Sb atom occupy an axial site in the psi-pentagonal bipyramidal polyhedron [Sb-N 2.265 (2)-2.507 (2) and Sb-O 2.144 (1)-2.543 (2) Angstrom]. The (ethylenediaminetetraacetato)antimonate anion, the aminoguanidinium cation and the lattice water are linked by hydrogen bonds into a two-dimensional network structure

On the short carbonyl bond in bis[mu-1,2-benzisothiazol-3(2H)-one 1,1-dioxido-kappa N-2 : O]bis{[1,2-benzisothiazol-3(2H)-one 1,1-dioxido-kappa N]-bis(imidazole)copper(II)}

The short carbonyl bond in the title compound, [Cu-2(C7H4-NO3S)(4) (C3H4N2)(4)] [Liu, Huang, Li & Lin (1991). Acta Cryst. C47, 41-43], is an artifact of disorder in the isothiazol-3(2H)-one 1,1-dioxide part of the 1,2-benzisothiazol-3(2H)-one entity. In the present redetermination, all bond dimensions in the centrosymmetric dinuclear molecule are normal. The five-coordinate Cu atom shows trigonal-bipyramidal coordination. Hydrogen bonds from the imidazole donor ligand link adjacent molecules into a two-dimensional layer structure