Patterns of Oral Microbiota Diversity in Adults and Children: A Crowdsourced Population Study.

Oral microbiome dysbiosis has been associated with various local and systemic human diseases such as dental caries, periodontal disease, obesity, and cardiovascular disease. Bacterial composition may be affected by age, oral health, diet, and geography, although information about the natural variation found in the general public is still lacking. In this study, citizen-scientists used a crowdsourcing model to obtain oral bacterial composition data from guests at the Denver Museum of Nature & Science to determine if previously suspected oral microbiome associations with an individual's demographics, lifestyle, and/or genetics are robust and generalizable enough to be detected within a general population. Consistent with past research, we found bacterial composition to be more diverse in youth microbiomes when compared to adults. Adult oral microbiomes were predominantly impacted by oral health habits, while youth microbiomes were impacted by biological sex and weight status. The oral pathogen Treponema was detected more commonly in adults without recent dentist visits and in obese youth. Additionally, oral microbiomes from participants of the same family were more similar to each other than to oral microbiomes from non-related individuals. These results suggest that previously reported oral microbiome associations are observable in a human population containing the natural variation commonly found in the general public. Furthermore, these results support the use of crowdsourced data as a valid methodology to obtain community-based microbiome data

Filling the gap. Clinical skill acquisition with interactive online modules to supplement traditional instruction

PURPOSE The purpose of this study was to assess the effectiveness of interactive e-learning modules to supplement traditional instruction for range of motion (ROM) clinical skill acquisition in a doctor of physical therapy(DPT) curriculum. BACKGROUNDS/SIGNIFICANCE Online resources have become highly favored to augment learning especially by millennials for convenience, self-paced content, and versatility in learning styles. It has been reported that elearning platforms are as effective as traditional face-to-face instruction, but may be best utilized as an adjunctive resource for teaching psychomotor skills. Student confidence has also been analyzed with reports of increased self-efficacy with use of online learning materials. There are deficiencies in the literature related to the use of e-learning and student outcomes. There are no studies investigating the use of online technologies to supplement ROM skill acquisition and an overall deficiency regarding interactive learning platforms in DPT curriculum. During the last two years at one institution, only about half of the class passed the ROM lab practical on the first attempt. Requests by students for a supplemental resource beyond the textbook as well as faculty searching for an option that would appeal to the millennial generation and address common errors lead to the development of interactive e-learning modules to fill in the gap. This study aims serve as a comprehensive evaluation of modules by analyzing pass rates, confidence, usage, and student satisfaction. We hypothesized the modules would be highly regarded, utilized by students, and result in increased lab practical pass rates. SUBJECTS 52/53 first-year DPT students consented to participate. METHODS AND MATERIALS This was prospective cohort study about supplemental modules created by a faculty-student team to be highly-engaging and media rich where the learner decides the pace and order of content delivered. Embedded quizzes provided immediate feedback for the learner to reflect on their understanding. Modules supplemented 4 labs with faculty demonstrations, peer practice and lab assistant feedback. Students were assessed by a high-stakes lab practical of ROM measurements on a standardized patient: upper extremity (UE), lower extremity(LE) and spine. At the beginning of the semester, students were randomly divided into 2 groups with 1 group receiving access to the UE modules and the other having access to the LE modules. To reduce the crossover effect between the groups and maintain the integrity of the study, students were educated on the importance of only viewing the modules they had access to and faculty were blinded to group assignment. Mid-way through the semester all students had the option to choose if they wanted access to the last set of modules focused on the spine. Students rated confidence on a 10-point Likert scale and self-reported module usage was confirmed by the learning management system. Student satisfaction was assessed by an end of semester course evaluation. ANALYSES Chi-square tests were used to determine associations between groups for lab practical pass rates. Logistic regression was used to analyze differences between cohorts by year (α= 0.05). RESULTS Data was analyzed from 44/52 students. 8 students were excluded (6 for not using modules, 1 had previously taken the class, 1 viewed modules not of their assigned group). There were 34 females and 10 males with a mean age of 23 years (21-28), who reported race as Caucasian (n=41), Asian (n=2) and Hispanic (n=1). There were no significant differences between groups for gender, age or race. The average module usage per person was 2.4hours (10 min-7 hours). The average self-reported confidence for both groups combined increased from 4.3/10 to9.0/10 at the end of the semester. There was no significant difference between groups in the first time lab practical pass rate (p=0.30) and no significant differences in passing the UE (p=0.23) or LE (p=0.66) measurement. The first time lab practical pass rate for all students in 2015 was 71%. Without modules available, first time pass rates were 63% in 2013 and 47% in 2014.Individual year effects show a significant difference between 2015 and 2014 (p=0.02), but no difference for 2015 and2013 (p=0.40).All students requested access to the spine modules. Student satisfaction results of the modules: 78% reported appropriate interactivity, 80% wanted access beyond the semester, 76% said it helped them learn, and 85%recommended using them in the future. CONCLUSIONS The results support the use of interactive e-learning modules to supplement ROM clinical skill acquisition in a DPT curriculum. It appears that the interactive modules were well utilized by the students, increased confidence, and had a high rate of satisfaction as indicated by the course evaluation and students wanting access to the spine modules. Additionally, there were significant improvements in first time pass rates from the previous year when the modules were not available. Our results are congruent with previous studies that reported online technologies are best used to supplement traditional instruction. Limitations include a small sample size from a single institution and the inherent inaccuracies in students’ recall of self-reported data. Strengths include outcomes that went beyond student satisfaction. Furthermore, this interactive module served as a readily accessible resource and allowed students to study at their own pace and learning style. This platform for supplemental materials should be strongly considered for attainment of ROM psychomotor skills and could be valuable for instruction of other foundational clinical skills in physical therapy. FUNDING SOURCE University of Nebraska Medical Center College of Allied Health Professions and the Office of the Vice Chancellor for Academic Affairs

Comparative and Cumulative Energetic Costs of Odontocete Responses to Anthropogenic Disturbance

Odontocetes respond to vessels and anthropogenic noise by modifying vocal behavior, surface active behaviors, dive patterns, swim speed, direction of travel, and activity budgets. Exposure scenarios and behavioral responses vary across odontocetes. A literature review was conducted to determine relevant sources of disturbance and associated behavioral responses for several odontocete species (bottlenose dolphin, killer whale, harbor porpoise, and beaked whales). The energetic costs of species-specific responses to anthropogenic disturbance were then estimated. The energetic impact varies across species and scenarios as well as by behavioral responses. Overall, the cumulative energetic cost of ephemeral behavioral responses (e.g., performing surface active behaviors, modifying acoustic signals) and modifying swim speeds and activity budgets likely increases daily energy expenditure by ≤4%. In contrast, the reduction in foraging activity in the presence of vessels and/or exposure to sonar has the potential to significantly reduce individuals’ daily energy acquisition. Indeed, across all odontocete species, decreased energy acquisition as a result of reduced foraging undoubtedly has a larger impact on individuals than the increased energy expenditure associated with behavioral modification. This work provides a powerful tool to investigate the biological significance of multiple behavioral responses that are likely to occur in response to anthropogenic disturbance

Transgender and Gender Non-Binary Healthcare Coverage in State Medicaid Programs: Recommendations for More Equitable Approaches

Transgender and gender non-binary (TGNB) individuals face discrimination in healthcare settings and barriers to healthcare access, resulting in health disparities. These inequities are compounded by the intersection of lower socioeconomic status and geography. To understand the differences in how states provide healthcare to TGNB individuals in poverty, we ask: What are state Medicaid programs offering TGNB residents, and how can coverage be more equitable across jurisdictions? To answer these questions, we examine medical services covered by 15 diverse Medicaid programs and compare them to the services recommended by the World Professional Association for Transgender Health (WPATH). Unsurprisingly, the analysis reveals inconsistent TGNB health coverage across states. While some states include coverage for TGNB-related care, some do not, and others place access to services in the hands of medical providers. These coverage disparities leave many TGNB Medicaid recipients across the U.S. without coverage for medically necessary services, prompting equity questions for both research and practic

Near-monochromatic tuneable cryogenic niobium electron field emitter

Creating, manipulating, and detecting coherent electrons is at the heart of future quantum microscopy and spectroscopy technologies. Leveraging and specifically altering the quantum features of an electron beam source at low temperatures can enhance its emission properties. Here, we describe electron field emission from a monocrystalline, superconducting niobium nanotip at a temperature of 5.9 K. The emitted electron energy spectrum reveals an ultra-narrow distribution down to 16 meV due to tunable resonant tunneling field emission via localized band states at a nano-protrusion's apex and a cut-off at the sharp low-temperature Fermi-edge. This is an order of magnitude lower than for conventional field emission electron sources. The self-focusing geometry of the tip leads to emission in an angle of 3.7 deg, a reduced brightness of 3.8 x 10exp8 A/(m2 sr V), and a stability of hours at 4.1 nA beam current and 69 meV energy width. This source will decrease the impact of lens aberration and enable new modes in low-energy electron microscopy, electron energy loss spectroscopy, and high-resolution vibrational spectroscopy.Comment: to be published in Phys. Rev. Lett. (2022

A Cluster-Randomized Trial to Assess the Efficacy of Targeting Trachoma Treatment to Children.

Background: The World Health Organization recommends annual treatment of entire trachoma-endemic communities, although children typically have a higher load, longer duration, and greater likelihood of infection. Methods: Forty-eight communities in Matameye, Niger, were randomized to annual oral azithromycin treatment of the entire community or biannual treatment of children aged 0-12 years only. Both children and adults were monitored for ocular chlamydial infection by polymerase chain reaction. Results: The prevalence of childhood infection was reduced in the annually treated arm from 21.2% (95% confidence interval [CI], 15.2%-28.0%) at baseline to 5.8% (95% CI, 3.2%-9.0%) at 36 months (P < .001) and in the biannual arm from 20.2% (95% CI, 15.5%-25.3%) to 3.8% (95% CI, 2.2%-6.0%; P < .001). Adult infection in the annual arm was reduced from 1.7% (95% CI, .9%-2.7%) to 0.3% (95% CI, .0%-.7%) and in the biannual arm from 1.2% (95% CI, .5%-2.2%) to 0.0% (95% CI, .0%-.7%; P = .005). The effect of biannual treatment of children compared with annual treatment of the entire community in both children (95% CI, -.04% to .02%) and adults (95% CI, .9%-2.7%) excluded the prespecified noninferiority threshold of 6% (P = .003 and P < .001, respectively). Conclusions: Periodic distribution of antibiotics to children in trachoma-endemic communities reduces chlamydial infection in both children and untreated adults, suggesting a form of herd protection. Biannual treatment of children was comparable to (specifically, noninferior to) annual treatment of the entire community, and may offer lower antibiotic use and other logistical advantages. Clinical Trials Registration: NCT00792922

Visión general de las percepciones regionales sobre el rol de la educación superior para el desarrollo humano y social

Nuestro informe ha estudiado en su Parte I temas globales seleccionados acerca del rol de la educación superior para el desarrollo humano y social. Este trabajo es una síntesis de las perspectivas regionales -África Subsahariana, Estados Árabes, Asia y el Pacífico, Europa, América del Norte y América Latina y el Caribe- acerca del rol de la educación superior para el desarrollo humano y social basado en la contribución de los autores en cinco áreas claves: una de ellas es el estado de la educacion superior en cada región desde la celebración de la Conferencia Mundial sobre Educación Superior (CMES, 1998); y otra de las cuatro áreas clave se refiere a los posibles roles futuros, estrategias y acciones de la educación superior para promover el desarrollo humano y social.Peer Reviewe

Mass Azithromycin and Malaria Parasitemia in Niger: Results from a Community-Randomized Trial.

Studies designed to determine the effects of mass administration of azithromycin on trachoma have suggested that mass azithromycin distributions may also reduce the prevalence of malaria. These studies have typically examined the impact of a small number of treatments over short durations. In this prespecified substudy of a cluster-randomized trial for trachoma, we compared malaria parasitemia prevalence in 24 communities in Niger randomized to receive either annual or biannual mass azithromycin distributions over 3 years. The 12 communities randomized to annual azithromycin received three treatments during the high-transmission season, and the 12 communities randomized to biannual azithromycin received a total of six treatments: three during the high-transmission season and three during the low-transmission season. Blood samples were taken to assess malariometric indices among children in all study communities at a single time point during the high-transmission season after 3 years of the intervention. No significant differences were identified in malaria parasitemia, parasite density, or hemoglobin concentration between the annual and biannual treatment arms. When compared with annual mass azithromycin alone, additional mass azithromycin distributions given during the low-transmission season did not significantly reduce the subsequent prevalence of malaria parasitemia or parasite density after 3 years, as measured during the high-transmission season