Humanizing clinical dentistry through a person-centred model

oai:ojs.iwpc.mcgill.ca:article/2The clinical approach in dentistry stems from a biomedical model of health that is anchored in positivism. This biomedical model was never explicitly developed or reflected on, but rather implicitly acquired as a product of historical circumstance. A reductionist understanding of health served dentistry well in the past, when health afflictions were mostly acute. Today, however, in the age of chronic illnesses, the current clinical approach is no longer adequate: patients and dentists are both dissatisfied, and there are problems with dental education and dental public health. After a thorough review of the literature, highlighting the current state of the profession, we propose an alternative clinical model upon which updated approaches can be based. We call this model "Person-Centred Dentistry". Our proposed model is rooted on the notion of sharing of power between the dentist and the patient: a sharing of power in the relationship and epistemology. This leads to an expanded understanding of the person and the illness; a co-authoring of treatment plans; and interventions that focus not only on eliminating disease but also on patient needs.

Monitoring of the biodegradation of toluene-contaminated sand in columns by SIP measurements, CO2 content and its 13C/12C isotopic signature.

Hydrocarbon contaminated soils represent an environmental issue as it impacts on ecosystems and aquifers. Bioremediation uses the ability of bacteria naturally present in the ground to degrade hydrocarbons. It represents an effective solution to fight the pollution but in situ monitoring before and during soil treatment is difficult and challenging. Indeed, where significant subsurface heterogeneity exists, conventional intrusive groundwater sampling can be insufficient to obtain a robust monitoring as the information they provide is restricted to vertical profiles at discrete locations, with no information between sampling points. In order to obtain wider information, complementary methods can be used like geo-electrical techniques. Induced polarization (IP) seems to be the more promising to study the effects of biodegradation processes. Indeed, laboratory and field experiments have shown an enhancement of real and imaginary parts of electrical conductivity while bacterial treatment is progressing (Abdel Aal et al., 2006 ; Atekwana et Atekwana, 2010). Moreover, microbial activity induced CO2 production and isotopic deviation of carbon (Aggarwal and Hinchee, 1991). The ratio δ13C(CO2) will come closer to δ13C(hydrocarbon). From these findings, the French project BIOPHY, supported by the French National Research Agency (ANR), proposes to use electrical methods and gas analyses to develop a non-destructive method for monitoring in situ biodegradation of hydrocarbons in order to optimize soil treatment. Laboratory experiments in columns are carried out to demonstrate its feasibility. Our objectives were to monitor aerobic microbial activity in toluene-contaminated sand columns using complex electrical resistivity measurements (SIP, Spectral Induced polarization and GEIS, Galvanostatic Electrochemical Impedance Spectroscopy) and measuring concentration and δ13C isotopic ratio of produced CO2

What is preventing dentists from providing person-centred care?

Most healthcare professions have shifted the way they teach clinical approaches from a biomedical to a person-centred perspective. Yet, dentistry remains strongly anchored in a biomedical world.The objective of this project was to understand the barriers practicing dentists face to provide what we consider person-centred care. We conducted a qualitative descriptive study that comprised semi-structured interviews with dentists in private practice in the Greater Montreal area. After the analysis, we identified six barriers:•     Fear of interpersonal conflict: participants thought that engaging in genuine conversations with patients would lead to situations of disagreement and even conflicts.•     Fear of litigation: dentists considered that the legal and licensing infrastructure would judge the treatment they provide through a strict biomedical framework.•     Fear of loss of money: participants thought that providing person-centred care was more time consuming and thus financially penalizing. •    Pleasure to excel technically: some dentists did not consider offering interventions that provided less procedural pleasure than technical ones.•    Narrow interpretation of health: participants considered the biomedical dimension as the only important dimension.•    Lack of information: participants knew nothing or very little about person or patient-centred care. They seemed willing to integrate it into their practice had they had known more about it.These findings should help academic institutions to design their programs on person-centred care and respond to the fears expressed by professionals.Also, legal infrastructures must recognize the paradigm shift from the biomedical to the person-centred.

Person-Centered Care: Perspectives of free dental clinic users in Montréal, Canada

There has been a relatively slow incorporation of person-centered care into dental care. Despite the efforts to sustain this approach in dental health care delivery, the perspectives of patients have yet to be considered, especially those using free dental clinics. Our objectives were: (1) to describe the perspectives of adults unable to access private dental clinics when using free dental clinics, (2) to document their suggestions for improvements to dental care. This qualitative descriptive study included 13 adults using a free dental clinic. To select participants, we adopted a maximum variation sampling strategy regarding age, sex, marital status, education level and employment status. We used in-depth, semi-structured interviews to collect data and thematic content analysis to analyze the verbatim transcripts. Participants were generally satisfied with the dental care they received in private and free dental clinics. However, they did not appreciate the long wait times at free clinics, and were bothered by the cost at private clinics. They emphasized a desire for quality time with the dentist allowing for more informed and shared decisions about their care, regardless of the clinic they visited. Participants want to feel cared for through a trustworthy relationship with the clinician, and suggested incorporating a walk-in concept into free clinics to address access to care. Adults using free dental clinics have various experiences with private and public dentistry, but they all need clinicians who adopt a comprehensive approach when providing information. This could improve patients’experiences through a more person-centered approach to dental care

Full modal analysis of the Brillouin gain spectrum of an optical fiber

We present a numerical study of stimulated Brillouin scattering in optical fibers based on a full modal analysis of the acoustic and optical properties. The computation of each acoustic mode supported by the fiber structure allows us a deep and detailed investigation of the characteristics of the Brillouin gain spectrum. We focus our attention on optical fibers acting as acoustic antiwaveguides where the biggest contribution to the Brillouin response often comes from very high-order modes but it is sometimes overlooked because of computational issues. Our analysis clearly highlights their role and their dependence on the physical and geometrical structure of the fiber

Validation and Modeling of Aeronautical Composite Structures Subjected to Combined Loadings: the VERTEX Project. Part 1: Experimental Setup, FE-DIC Instrumentation and Procedures

The development and certification of aeronautical composite structures is still largely based on the pyramid of tests. This approach is extremely costly in terms of number of tests and design loops. Moreover, this is made up of uniaxial tests whereas the real structures are mostly subjected to combined forces. The aim of the collaborative research program "VERTEX" is to make progress towards Predictive Virtual Testing and to significantly reduce the development costs of aeronautical and space programs. In this first part, the specific methodology for multiaxial tests of aeronautical structures is presented. The concept of technical specimen and their size are justified. Then, the development of a specific test device is presented. Compression / traction, shear, internal pressure and any combination are possible. Since structural tests were complex to be instrumented, a specific method of field measurement was developed. It is based on multi-camera instrumentation and an original approach named Finite Element Stereo Digital Image Correlation (FE-SDIC). A mechanical regularization with the use of Finite Element (FE) of the optical field measurements allows to calculate the translation or rotation displacement field. Thus this measured field is used for boundary conditions of the VERTEX tests. The experimental procedure, the measurement methodologies and the calculation / test dialogue are validated on isotropic metal plates in this paper

Contamination of Cereals (Sorghum Bicolor L. Moench and Pennisetum Glaucum (L.) R. Br.) During Storage: Farmer’s Perception and Management of Mold’ Contamination Risks

This study aimed to report the traditional technics used in Benin to store sorghum and millet grains and assess the knowledge level of the farmers and sellers on the problematic of mold contamination during the grain storage. Entire sorghum and millet production areas were carried out. Face-to-face interview of 1,040 farmers and sellers of both cereals were conducted. The data were collected according to an adapted set of questions based on direct observation, group discussions, individual interviews and garret visits containing sorghum and millet. The results were analyzed using SAS software. The survey results provided by this approach showed that 93.24% of farmers were men and 100 % of sellers were women. 68.92% of farmers had over 50 years old while 64.29% of sellers had less than 35 years. Their education level was relatively low and marked by 70% of unlettered. Several storage technics are used. The most widely used is solar drying, but it has the lowest shelf life compared to the second widely used to apply the chemical pesticides to cereals product. According to them, this technic allows a long shelf life for the cereals. The most of interviewed farmers and sellers (69%) use moldy grains in animal feed while 11% used it in human consumption. 13 % of both cereals were destroyed and 7 % of them ignore that mold can have caused the sanitary risks. In view of the socio-economic importance of the cereals and their role in the nutritional needs of people it become necessary to trained the farmer and sellers in other drying and storage technics in order to prevent food-borne diseases

From micro-OPs to abstract resources: constructing a simpler CPU performance model through microbenchmarking

This paper describes PALMED, a tool that automatically builds a resource mapping, a performance model for pipelined, super-scalar, out-of-order CPU architectures. Resource mappings describe the execution of a program by assigning instructions in the program to abstract resources. They can be used to predict the throughput of basic blocks or as a machine model for the backend of an optimizing compiler. PALMED does not require hardware performance counters, and relies solely on runtime measurements to construct resource mappings. This allows it to model not only execution port usage, but also other limiting resources, such as the frontend or the reorder buffer. Also, thanks to a dual representation of resource mappings, our algorithm for constructing mappings scales to large instruction sets, like that of x86. We evaluate the algorithmic contribution of the paper in two ways. First by showing that our approach can reverse engineering an accurate resource mapping from an idealistic performance model produced by an existing port-mapping. We also evaluate the pertinence of our dual representation, as opposed to the standard port-mapping, for throughput modeling by extracting a representative set of basic-blocks from the compiled binaries of the Spec CPU 2017 benchmarks and comparing the throughput predicted by existing machine models to that produced by PALMED

Validation and modeling of aeronautical composite structures subjected to combined loadings: The VERTEX project. Part 2: Load envelopes for the assessment of panels with large notches

One of the important issues in the certification of composite aeronautical structures is large notches. In this paper, tests are carried out on technological specimens and under tensile, shear stresses and combined loadings using the VERTEX means presented in the first part of this publication. Strong interactions between postbuckling and propagation of cuts were observed. The FE-SDIC methodology developed specifically allows a first dialog between calculation / testing. The Discrete Ply Modeling method is able to compute the onset of failure of such complex tests. New tests responses called "envelop" are proposed and realized by following a load path that allows to validate the behavior of the notched structure for certification purposes. This methodology should eventually lead to a new vision of the tests pyramid by "Predictive Virtual Testing"