Outcomes of Primary Endodontic Therapy in Medicaid Enrollees

The objective of this study was to determine factors affecting survival of teeth after nonsurgical root canal therapy (NSRCT) among enrollees of Wisconsin Medicaid during the years 2001-2009. Only permanent teeth with NSRCTs and that had permanent restorations within 60 days after treatment completion were included in the analysis. Patients with less than 60 days of insurance coverage after treatment completion were excluded. NSRCTs and untoward events (extraction) were identified based on Code on Dental Procedures and Nomenclature (CDT). Kaplan-Meier methods were used to plot the survival distribution for the overall cohort and subgroups by age, gender, race, tooth location, geographic area (urban vs. rural), and restoration type (crown vs. other). Univariate and multivariable Cox proportional hazards regression were used to model time from root canal restoration to extraction. The multiple regression model included all baseline covariates: age, gender, race, tooth location, geography, and restoration type. After applying the inclusion and exclusion criteria, 14,281 teeth among 11,788 patients were included in the final analysis. The overall 5-year survival rate was 88.67%. Survival rates were higher among younger individuals, males, anterior teeth, and when post-operative restoration was a crown as opposed to a filling. This study concludes that the success of primary endodontic therapy in a Medicaid population can be significantly improved by using post-operative crown restorations

Faith, service and ownership: the life and changing identity of Eastbridge Hospital throughout the Reformation

Eastbridge Hospital (alias Kingsbridge Hospital, and The Hospital of St Thomas the Martyr) in Canterbury is an institution with a long and troubled history. Having been founded in the height of Catholic religiosity and pilgrimage in medieval England, it found itself deeply embroiled in the turmoil of the Reformation. Unable to preserve its Catholic background, the Hospital was transformed greatly by the Protestant Reformers who took control of the English Church. As the Reformation developed, the Hospital faced financial, social, and religious change. This thesis aims to uncover the dramatic transformation that the Hospital underwent which preserved its existence against the odds, and in contrast to many pilgrimage hospitals of its day. By investigating its financial viability, transformed structure, and reformed religious outlook, it is the aim of this study to understand how fortunate Eastbridge was to come out of the Reformation safely and into the modern age. By investigating its existing financial records, it will be important to see how much land it held, and potentially had seized, alongside its income and expenditure – which will, in turn, reveal significant attitudes towards its principle of poor relief. With a new Protestant structure, it is also necessary to evaluate how far this affected Eastbridge’s attitudes to aiding the impoverished and which practises it gained and lost in doing so. Lastly, the religious reforms enforced upon the Hospital will help to show the attitude of a former Catholic institution and how far it was run in line with Protestant theology

The Role of Low Carbon Alcohol Fuels in Advanced Combustion

The production of alcohol fuels from bioderived feedstocks and the performance of next generation stratified low temperature combustion (LTC) modes for internal combustion engines are two research areas that have recently undergone rapid growth independently. Now, there is a need to bridge these two fields and identify the optimal combustion strategy for these low-carbon and carbon-neutral alcohol fuels as well as potential synergies. The large set of next generation stratified LTC modes are generalized into two groups based on how the heat release process proceeds in the compositionally stratified combustion chamber: lean-to-rich or rich-to-lean burn stratified combustion. It was found that the C1-C4 alcohol fuels are prime candidates to enable lean-to-rich burn stratified combustion based on their high cooling potentials and lack of cool flame reactivity (pre-ignition reactions). Previous experimental work by the author showed that a lean-to-rich burn stratified combustion mode, thermally stratified compression ignition (TSCI), can be enabled using a split injection of wet ethanol to gain control over the heat release process. The current work further investigates TSCI with wet ethanol experimentally on a diesel engine architecture, finding that the effectiveness of TSCI’s heat release control strategy is not affected by the use of external, cooled exhaust gas recirculation or intake boost. Further, it was shown that the effectiveness of TSCI’s heat release control strategy is highly coupled to the hardware used. Specifically, an injector whose spray targets high local heat transfer regions in the cylinder during the compression stroke is more effective at controlling the heat release process than an injector whose spray targets the adiabatic core. Additionally, a piston whose geometry allows regions with high compression stroke heat transfer to be distinct from the adiabatic core, such as a re-entrant bowl piston, will also increase the effectiveness of TSCI’s heat release control strategy. Using a split injection strategy to enable TSCI is not the only way to increase natural thermal stratification and control the heat release process. In this work, high-load LTC is experimentally enabled with wet ethanol on a light-duty gasoline engine architecture by employing a side-mounted, single hole injector with a relatively low injection pressure in a fairly quiescent combustion chamber. The low mixing propensity of this architecture results in a self-sustaining increase of thermal stratification that allows the high-load limit of LTC to be oxygen limited rather than noise limited. Following the experimental work with TSCI with wet ethanol, the LTC performance of seven bio-synthesizable C1-C4 alcohol fuels (methanol, ethanol, n-propanol, isopropanol, n-butanol, isobutanol, and sec-butanol) is experimentally characterized, showing that with the exception of n-butanol, the LTC performance of these fuels are similar, implying the remaining six fuels could form an equivalence class of fuels for LTC. To further explore this possibility, two previously proposed LTC fuel metrics are considered: critical compression ratio, a metric that describes the ignition propensity of a fuel in LTC, and normalized φ-sensitivity, a metric that describes how the local ignition delay time responds to a change in φ. The critical compression ratio, experimentally measured on a cooperative fuel research (CFR) engine, was shown to accurately predict the HCCI ignition propensity of the alcohol fuels near the critical compression ratio operating conditions. Similarly, the normalized φ-sensitivity showed the potential to predict the effectiveness of a fuel to control the heat release process of LTC using small amounts of in-cylinder stratification. The normalized φ-sensitivity could then serve as a blending benchmark for multi-alcohol water fuel blends

The efficacy of using platelet rich plasma in treating chronic tendinopathies

As a common source of long-term pain and physical disability, overuse injuries, such as chronic tendinopathies, severely impact a patient’s quality of life. Caused by repetitive trauma, chronic tendinopathies affect hundreds of millions of people each year. The exact pathogenic mechanism in developing this musculoskeletal injury is still largely unknown, making clinical recommendations on the best course of treatment highly debatable. Nonetheless, advancements in biotechnology have made autologous blood products, specifically the use of platelet rich plasma injections, an increasingly popular method in the orthopedic field. Studies have shown that the concentrated platelet sample harbors a number of bioactive mediators. Once activated and injected at the site of injury, these growth factors and cytokines augment the natural healing process in tendinopathic cases. With limited reported complications, many clinicians believe that platelet rich plasma therapy is a safe and accessible treatment option for patients diagnosed with chronic tendinopathy. As such, the primary purpose of this paper is to determine the efficacy of platelet rich plasma injections in treating chronic tendinopathies. This literature review determined that current published studies and research on the effectiveness of PRP injections have produced contradictory results. Due to its autologous characteristic, platelet concentration differs significantly from patient to patient, contributing to high variability in terms of its effectiveness between patients. However, with low long-term costs and fast recovery, PRP injections are a promising, non-surgical intervention for treating chronic tendinopathies. Several patient-centered clinical studies have reported significant improvements in range of motion and pain management when compared to traditional injection treatments. These effects are maximized when administered under ultrasound guidance or when used in conjunction with a strict eccentric exercise program. Nonetheless, continued research is needed to determine optimal injection standards so that clinical recommendations can be further developed and supported

Building resilience for stronger communities

Much of the early research in crisis management and crisis communication centered on the core competencies of crisis response: why do we need to plan for crises; what are the stages of effective crisis planning; what theoretical perspectives are helpful to scholars and practitioners; and what are the steps of an up-to-date crisis plan. Delineation of these core competencies goes on. Among these competencies, the crisis stage meriting the least attention arguably is post-crisis, the critical days and weeks immediately following the formal resolution of the crisis. Research attention has often focused on recovery and learning, positioning the organization for the future. Another critical component of effective crisis response merits further study. In these days of black swan crises that take a huge toll on organizations and their communities, more focus is needed on building individual, organizational, and community resilience to destructive crises. While resilience can be best measured in the post-crisis phase, this assessment should lead to new efforts to educate and prepare individuals, organizations, and communities for the new threats to come. This research proposes strategies for building resilience to strengthen organizational and community response when confronted by major crisis events

Prison Theocracy

This research hopes to understand justice by inquiring about control over definitions of justice. Further questions also include if and how justice works in America’ criminal justice system; who does it define as inclusive/exclusive to society; and how does the system and those who run it choose to protect inclusive members of society? Examples of the Prison Industrial Complex- such as mass incarceration and police brutality- exist as proof that American facilities of law & order lack justice in equity for all its citizen. Both religious and non-religious based grassroots organizations have developed instrumental changes that push to reform and reshape the system to be inclusive with the goal of redefining and actualizing justice. Still, there are more incomprehensible troubles to come in the inevitable gaps of whatever system replaces the current. This framework supplies an avenue for critical analysis for the current criminal justice system and how it impacts its citizens by utilizing current experiences of organizers in the Prison Abolition Movement. Further, this research critically frames organizers’ efforts in the Prison Abolition Movement to acknowledge potential how their aims at a new system can affect the future definitions of justice

An Investigation into Transitions in Clay Mineral Chemistry on Mars

This dissertation is comprised of three studies investigating clay mineralogy on, or near the martian surface, with an introductory chapter, introducing and linking the three studies. Chapter two is on the subject of clay mineral synthesis, including Fe/Mg clay minerals which have been detected at multiple locations across the southern highlands. These Fe/Mg clay minerals have been previously interpreted as forming in anoxic/reducing environments, conducive to the preservation of organic matter. The results of this study suggest that the previous interpretation of Fe/Mg-rich clay as requiring anoxic/reducing conditions may not be accurate, as the minor presence of Mg (below what is found in many naturally occurring nontronites) allowed for the rapid precipitation of Fe-rich clay minerals under oxidized conditions. These results would prompt a reinterpretation of clay-bearing environments on the martian surface and may explain the relative dearth of detectable organic carbon on Mars. Chapter three is on the subject of nontronite dissolution kinetics and its implications for Mars. Nontronite is a Fe-rich smectite and has been identified on the martian surface with orbital Visible Near InfraRed (VNIR) spectrometers. The results of this study suggest nontronite is stable relative to the primary minerals in basalt under acidic and oxidizing conditions and once formed may remain on the martian surface for significant durations. Nontronite dissolution is more rapid than other clay minerals, such as kaolinite and montmorillonite (under acidic and oxidizing conditions). These results suggest the dissolution of mixed clay units may produce stratigraphy (e.g. Al-rich clay minerals overlying Fe/Mg-rich phyllosilicates) similar to that observed in the Mawrth Vallis region and other localities on the martian surface and may therefore imply surficial weathering. In chapter four, reactive transport modeling was applied to investigate potential weathering profiles detected at, or near the martian surface. These result suggest that when Fe/Mg rich clay minerals are exposed to pedogenic conditions they alter to montmorillonite and kaolinite (i.e. the Al-rich overlying layer). The models included four scenarios where the parent materials consisted of: nontronite; nontronite and montmorillonite; nontronite and saponite and pure saponite. In all scenarios and in all cases (i.e. regardless of temperature, pH and flow rate) the weathering of the parent material resulted in the precipitation of an Al-rich layer. Similar stratigraphy has been observed in the Mawrth Vallis region and other localities on the martian surface. These results would suggest that the observed transitions in clay mineral chemistry are the result of weathering, implying the surface of Mars may have been exposed to long-term liquid water at its surface

An Examination of Trans Fat Labeling: Splitting the Third & Ninth Circuit

At first glance, consumer claims alleging misleading labeling would seem to find a simple resolution. Under 21 U.S.C. § 343, which governs misbranded food, a food product is misbranded if “its labeling is false or misleading.” However, controversial interpretation of seemingly straightforward statutory language, together with evolving case law, have blurred a once clear picture. Disagreement over the federal preemption of consumer claims regarding trans fat, underscored by a dispute regarding standing, have combined to create a divergence of opinions between courts across the country. In 2011, the United States District Court for the Northern District of California considered a class action trans fat misbranding claim alleging that a food manufacturer had deceptively labeled certain ice cream products as containing zero grams of trans fat even though the products contained partially hydrogenated oil, a source of trans fat. The district court found that the class of consumers had standing to bring a trans fat misbranding claim. However, the district court ultimately dismissed the case, holding that the trans fat misbranding claims were preempted by federal law. The Ninth Circuit Court of Appeals later affirmed the district court’s dismissal on federal preemption grounds. In 2015, the Ninth Circuit returned to the issue in a different case, but this time it reached the opposite conclusion, holding that claims by consumers alleging that a “No Trans Fat” label was misleading as applied to a product containing partially- hydrogenated oil were not preempted by federal law. The Third Circuit on the other hand, dismissed a similar consumer protection claim. In Young, products that contained trans fat but stated, “NO TRANS FAT, directly above a symbol of a heart to convey heart health” were found not to be misleading. The Third Circuit pronounced that the consumer’s claims were contradicted by both FDA regulations governing trans fats, as well as disclosures made on the product’s own packaging. The FDA requires that fat levels of less than 0.5 grams per serving shall be expressed as zero. Thus, the Third Circuit determined that because the product in question contained less than 0.5 grams of trans fat per serving, the manufacturer’s “claims that [their product] contains ‘NO TRANS FAT’ and ‘No Trans Fatty Acids’ [were] consistent with FDA regulations.”11 The part of the label, and the substance that courts choose to apply the FDA regulation to, drastically changes the meaning and impact of the regulation. The Ninth Circuit’s interpretation is supported by logic and a greater weight of evidence. Warning letters issued by the FDA, overturned cases relied on by the Third Circuit, and the structure and text of the regulations all reinforce the Ninth Circuit’s decision

Math I Benchmark Testing: Friend or Foe?

This quantitative study addresses the ability of locally developed Math I benchmark assessments to predict student performance on the Math I end-of-course (EOC) state assessment for a rural county in North Carolina. Many districts in North Carolina lack funds to purchase commercially developed benchmarks and must rely on district personnel to develop these assessments. Locally developed benchmark assessments are not typically validated or considered psychometrically sound. Signal Detection Theory (SDT) was used to determine cut-off values on the locally developed Math I benchmark assessments for pass/fail grouping of students that will inform instructional interventions prior to the Math I EOC state assessment. The Math I benchmark assessments were determined to be accurate predictors of student performance on the North Carolina Math I EOC assessment, and the sensitivity and specificity of the Math I benchmark assessments were calculated to greater than 70% accuracy for each benchmark based on the identified cut-off scores

INCLUSIVE CLASSROOMS: ELEMENTARY REGULAR CLASSROOM TEACHERS’ PERCEIVED STRESSORS AND SUPPORTS NEEDED TO EFFECTIVELY TEACH STUDENTS WITH SPECIAL NEEDS

The purpose of this study was to examine the relationships between the proportions of students with special needs in elementary classrooms and regular elementary teachers’ stressors and needs for professional development support. The conceptual framework for the study was derived from critical mass theory and tipping point theory. The design of this dissertation study was non-experimental survey research of a non-random, purposive sample of 52 regular elementary classroom teachers who taught students with special needs. The researcher used a broad definition of students with special needs to include those who were working on a RtI Tier 2 or Tier 3 plan in addition to the students with Individual Education Plans or 504 Plans. In this sample of elementary teachers, the mean proportion of all special needs students to total students was .55 or 55%. Survey respondents indicated the extent to which the domains of student behavior, parent, administrative, classroom, professional competency, and personal competency issues were stressful on a four-point Likert scale. All six of the survey’s domains of teachers’ stressors were significantly related to the sample’s mean composite stressor score (Mean = 2.52; p ≤ .001); however, there was no significant relationship (p \u3c .34) between the proportion of students with special needs and teachers’ stressors. Seventy-six percent of the teachers agreed or strongly agreed on the need for more professional development related to meeting the needs of special learners. The relationship between the proportion of students with special needs and teachers’ needs for professional development approached significance (p \u3c .07). Teachers reported that their greatest stressors were related to work required outside contract hours. Keywords: teacher stress; teacher burnout; critical mass theory; tipping points; inclusive education; teacher attrition; teacher turnover; teacher chur