An exploratory study of perfectionism, professional factors and psychological well-being of dentistry academics.

BACKGROUND: Well-being might be lower among dentistry professionals than other health professionals, and differ by personal, professional and sociodemographic factors. Few studies have considered dentistry academics who have different work roles and functions than clinicians. This exploratory study focused on well-being among dentistry academics and aimed to explore associations with perfectionism, professional factors and sociodemographics. METHOD: An online survey was carried out with academic staff in Dentistry and Oral Health departments of nine Universities in Australia and New Zealand. Well-being was assessed using the 22-item Psychological General Well-Being Index, with a maximum score of 110 indicating good well-being. Perfectionism was assessed using the 8-item Short Almost Perfect Scale, with a maximum score of 56 and a higher score indicating perfectionism. Twenty items were used to assess professional and 7 items assessed sociodemographic factors. Associations were explored using correlation and multiple linear regression. RESULTS: There was no significant bivariate association between perfectionism and well-being. Multiple linear regression indicated a significant association between hours of undergraduate teaching and psychological well-being, after adjustment for age, gender, income and overall health. CONCLUSION: This exploratory study showed poor well-being among dentistry academics, particularly in those teaching undergraduate students for more than 6 h/week.

A randomised trial of peri-operative positive airway pressure for postoperative delirium in patients at risk for obstructive sleep apnoea after regional anaesthesia with sedation or general anaesthesia for joint arthroplasty.

Previous pilot work has established an association between obstructive sleep apnoea and the development of acute postoperative delirium , but it remains unclear to what extent this risk factor is modifiable in the 'real world' peri-operative setting. In a single-blind randomised controlled trial, 135 elderly surgical patients at risk for obstructive sleep apnoea were randomly assigned to receive peri-operative continuous positive airway pressure (CPAP) or routine care. Of the 114 patients who completed the study, 21 (18.4%) experienced delirium. Delirium was equally common in both groups: 21% (12 of 58 subjects) in the CPAP group and 16% (9 of 56 subjects) in the routine care group (OR = 1.36 [95%CI 0.52-3.54], p = 0.53). Delirious subjects were slightly older - mean (SD) age 68.9 (10.7) vs. 64.9 (8.2), p = 0.07 - but had nearly identical pre-operative STOP-Bang scores (4.19 (1.1) versus 4.27 (1.3), p = 0.79). Subjects in the CPAP group used their devices for a median (IQR [range]) of 3 (0.25-5 [0-12]) nights pre-operatively (2.9 (0.1-4.8 [0.0-12.7]) hours per night) and 1 (0-2 [0-2]) nights postoperatively (1.4 (0.0-5.1 [0.0-11.6]) hours per night). Among the CPAP subjects, the residual pre-operative apnoea-hypopnea index had a significant effect on delirium severity (p = 0.0002). Although we confirm that apnoea is associated with postoperative delirium, we did not find that providing a short-course of auto-titrating CPAP affected its likelihood or severity. Voluntary adherence to CPAP is particularly poor during the initiation of therapy.

Exploring the consistency, transparency and portability of dental technology education: benchmarking across Norway, Ireland and Australia.

Dental technology programmes of study must prepare students to practice in a broad range of contemporary workplaces. Currently, there is limited evidence to benchmark dental technology education - locally, nationally or internationally. This research aims to improve consistency, transparency and portability of dental technology qualifications across three countries. Data were accessed from open-source curriculum documents and five calibrated assessment items. Three institutions collaborated with Oslo and Akershus University College, Norway; Trinity College Dublin, Ireland; and Griffith University, Australia. From these, 29-44 students completed 174 assessments. The curricula reflect the community needs of each country and display common themes that underpin professional dental technology practice. Assessment results differed between institutions but no more than a normal distribution. Face-to-face assessment moderation was critical to achieve consistency. This collaborative research has led to the development of a set of guidelines for other dental technology education providers interested in developing or aligning courses internationally to enhance the portability of qualifications.

Chitin-glucan fiber effects on oxidized low-density lipoprotein: a randomized controlled trial.

BACKGROUND/OBJECTIVES: Elevated oxidized low-density lipoprotein (OxLDL) may promote inflammation, and is associated with increased risk of atherosclerotic coronary heart disease and worsening complications of diabetes mellitus. The primary objective of this study was to evaluate the efficacy of chitin-glucan (CG), alone and in combination with a potentially anti-inflammatory olive oil (OO) extract, for reducing OxLDL in subjects with borderline to high LDL cholesterol (LDL-C) levels. SUBJECTS/METHODS: This 6-week, randomized, double-blind, placebo-controlled study of a novel, insoluble fiber derived from the Aspergillus niger mycelium, CG, evaluated 130 subjects free of diabetes mellitus with fasting LDL-C 3.37-4.92 mmol/l and glucose ≤ 6.94 mmol/l. Participants were randomly assigned to receive CG (4.5 g/day; n=33), CG (1.5 g/day; n=32), CG (1.5 g/day) plus OO extract (135 mg/day; n=30), or matching placebo (n=35). RESULTS: Administration of 4.5 g/day CG for 6 weeks significantly reduced OxLDL compared with placebo (P=0.035). At the end of study, CG was associated with lower LDL-C levels relative to placebo, although this difference was statistically significant only for the CG 1.5 g/day group (P=0.019). CG did not significantly affect high-density lipoprotein cholesterol, triglycerides, glucose, insulin or F2-isoprostane levels. Adverse events did not substantively differ between treatments and placebo. CONCLUSIONS: In this 6-week study, CG (4.5 g/day) reduced OxLDL, an effect that might affect the risk for atherosclerosis.

Interprofessional learning enhances knowledge of roles but is less able to shift attitudes: a case study from dental education.

INTRODUCTION: Interprofessional education (IPE) purports to improve team working through improved knowledge of the roles of others, and by engendering mutual respect. This case study aimed to determine the impact of an IPE curriculum on knowledge and attitudes of dentistry and dental technology students undertaking these curricula in the new School of Dentistry and Oral Health at Griffith University. All dental technology students and third- and final- (fifth) year dentistry students were invited to participate. METHOD: A mixed-method approach was used to compare attitudes, perceptions and experiences of students involved in our IPE curricula. Quantitative data were evaluated with the Statistical Package for the Social Sciences (SPSS), and qualitative findings were explored through an Excel(®) spreadsheet coding frame tested against Leximancer™ qualitative software for consistency. RESULTS: Forty-six of the 131 eligible students participated. Readiness for Interprofessional Learning Scales (RIPLS) and focus groups consistently showed that IPE positively influenced professional identity and improved communication between and amongst all students and assisted them in developing their roles. A prevailing sense of greater importance and a lack of mutual respect between dentistry and dental technology students were, unfortunately, evident. The process was, however, sufficient to enhance teamwork and collaboration when planned learning revolved around explicit patient care in the provision of dental prostheses. CONCLUSION: Further development of such curricula is needed to maximise IP learning (IPL) opportunities, to shift traditional attitudes and, potentially, to improve the outcomes of patient care. To enable this, academic and clinical leaders need to embrace the ideals of IPE.

Declining sexually transmitted infections among female sex workers: the results of an HIV and sexually transmitted infection prevention strategy in Honduras, 2006-08.

In 2006, we implemented an HIV and sexually transmitted infection (STI) prevention programme for female sex workers (FSWs) in three Honduran cities. All FSW attending STI clinics underwent regular examinations and STI testing. Information on condom use with different partners was collected at each visit. After three years, we detected a significant decline in the prevalence of syphilis from 2.3% at the first screening to 0.0% at the third screening (P = 0.05), and of chlamydia, from 6.1% to 3.3% (P = 0.01). No changes were observed in the prevalence of gonorrhoea or trichomoniasis. The cumulative HIV prevalence remained constant (P = 0.44). Reports of condom use with clients increased from 93.8% to 98.9% (P < 0.001). The implementation of an HIV/STI prevention programme in FSW has contributed to increases in condom use with clients and the reduction in syphilis and chlamydia prevalence. The intervention should be strengthened and considered as part of a national health policy strategy.

Hepatitis B virus infection and immunization status in a new generation of injection drug users in San Francisco.

Hepatitis B virus (HBV) infection is common among injection drug users (IDU). Younger IDU, however, may be less susceptible to infection due to the implementation of public health interventions, such as universal immunization programs and syringe exchange programs. To investigate the current epidemiology of HBV infection and control among a new generation of drug users in the United States, we conducted interviews and examined HBV serologic markers in a cross-section of street-recruited IDU under age 30 in San Francisco, CA. Of the 831 persons studied, 21% showed serologic evidence of current or past infection; 22% had isolated antibodies to hepatitis B surface antigen consistent with vaccine-mediated immunity; and 56% had no HBV markers. In multivariate analyses, HBV infection was associated with drug use behaviour in heterosexual males; sexual behaviour in males who have sex with males; and both drug use and sexual behaviour in females. Vaccine-mediated immunity was independently associated with female sex and younger age. In conclusion, HBV transmission persists among young IDU in San Francisco. Few young injectors show evidence of successful immunization and the majority remains susceptible to disease. Until the broad effects of universal vaccination are seen, targeted and innovative approaches to immunizing young IDU in the US are needed to prevent a substantial number of new HBV infections.

Additive genetic relationships between heifer pregnancy and scrotal circumference in Nellore cattle.

To estimate heritability (h2) for yearling heifer pregnancy and to estimate the genetic correlation between heifer pregnancy and scrotal circumference, 18,145 records of Nellore heifers exposed to breeding at an age of approximately 14 mo and 25,466 records of contemporary young bulls were analyzed. Heifer pregnancy was considered as a categorical trait, with the value 1 (success) assigned to heifers that were pregnant after rectal palpation approximately 60 d after the end of a 90-d breeding season and the value 0 (failure) otherwise. A single-trait animal model for heifer pregnancy and a two-trait animal model including heifer pregnancy and scrotal circumference were used. Contemporary groups were defined in two ways: including (CG2) or not including (CG1) weaning management of the heifer. Heritability estimates obtained by Method R in single-trait analyses were 0.68 +/- 0.09 and 0.61 +/- 0.10 using CG1 and CG2 definitions, respectively. Heritability estimates for two-trait analyses were 0.69 +/- 0.09 (CG1) and 0.63 +/- 0.08 (CG2) for heifer pregnancy and 0.57 +/- 0.03 (both CG) for scrotal circumference. The genetic correlation estimates between the two traits were 0.20 +/- 0.12 (CG1) and 0.20 +/- 0.13 (CG2). Based on the results of this study, EPD for heifer pregnancy can be used to select bulls for the production of precocious daughters and will be more effective than selecting on scrotal circumference EPD in Nellore cattle. However, scrotal circumference can be incorporated in a two-trait analysis to increase the accuracy of prediction for heifer pregnancy EPD for young bulls. Using contemporary group without heifer weaning management gave higher h2 and, for two-trait analysis, converged more quickly.

Genetic evaluation of the probability of pregnancy at 14 months for Nellore heifers.

To estimate the heritability for the probability that yearling heifers would become pregnant, we analyzed the records of 11,487 Nellore animals that participated in breeding seasons at three farms in the Brazilian states of São Paulo and Mato Grosso do Sul. All heifers were exposed to a bull at the age of about 14 mo. The probability of pregnancy was analyzed as a categorical trait, with a value of 1 (success) assigned to heifers that were diagnosed pregnant by rectal palpation about 60 d after the end of the breeding season of 90 d and a value of 0 (failure) assigned to those that were not pregnant at that time. The estimate of heritability, obtained by Method R, was 0.57 with standard error of 0.01. The EPD was predicted using a maximum a posteriori threshold method and was expressed as deviations from 50% probability. The range in EPD was -24.50 to 24.55%, with a mean of 0.78% and a SD of 7.46%. We conclude that EPD for probability of pregnancy can be used to select heifers with a higher probability of being fertile. However, it is mainly recommended for the selection of bulls for the production of precocious daughters because the accuracy of prediction is higher for bulls, depending on their number of daughters.

A randomized trial to reduce passive smoke exposure in low-income households with young children.

OBJECTIVE: Passive smoke exposure among children is widespread in the United States; estimates suggest that almost 40% of children who are younger than 5 years live with a smoker. Few randomized studies of passive smoke exposure reduction among children have been conducted, and the impact of interventions that have been evaluated has been limited. The objective of this study was to determine whether a motivational intervention for smoking parents of young children will lead to reduced household passive smoke exposure. METHODS: Project KISS (Keeping Infants Safe From Smoke), a theory-driven exposure reduction intervention targeting low-income families with young children, was a randomized controlled study in which participants-smoking parents/caregivers (N = 291) who had children who were younger than 3 years and who were recruited through primary care settings-were randomly assigned to either the motivational intervention (MI) or a self-help (SH) comparison condition was used. Follow-up assessments were conducted at 3 and 6 months. The MI condition consisted of a 30- to 45-minute motivational interviewing session at the participant's home with a trained health educator and 4 follow-up telephone counseling calls. Feedback from baseline household air nicotine assessments and assessment of the participant's carbon monoxide level was provided as part of the intervention. Participants in the SH group received a copy of the smoking cessation manual, the passive smoke reduction tip sheet, and the resource guide in the mail. Household nicotine levels were measured by a passive diffusion monitor. RESULTS: The 6-month nicotine levels were significantly lower in MI households. Repeated measures analysis of variance across baseline, 3-month, and 6-month time points showed a significant time-by-treatment interaction, whereby nicotine levels for the MI group decreased significantly and nicotine levels for the SH group increased but were not significantly different from baseline. CONCLUSIONS: This study targeted a large sample of racially and ethnically diverse low-income families, in whom both exposure and disease burden is likely to be significant. This is the first study to our knowledge that has been effective in reducing objective measures of passive smoke exposure in households with healthy children. These findings have important implications for pediatric health care providers, who play an important role in working with parents to protect children's health. Providers can help parents work toward reducing household passive smoke exposure using motivational strategies and providing a menu of approaches regardless of whether the parents are ready to quit.

An emergent account of language impairments in children with SLI: implications for assessment and intervention.

While current theoretical accounts of language impairments in children with specific language impairment (SLI) provide clear direction with regard to intervention goal setting, these same accounts say little with regard to the intervention process. Current developments in connectionist modeling and the extension of principles of dynamical systems theory to cognitive and language development have resulted in a new theory of language development known as emergentism. In contrast to traditional formal linguistic accounts, the emergentist view holds that language is a dynamic evolving system that can be represented as a distribution of probabilistic information. Language acquisition, from this perspective, emerges from the child's simultaneous integration of multiple acoustic, linguistic, social and communicative cues within the context of the communicative interaction. An alternative account of SLI grounded within this emergentist view is presented, and preliminary implications are explored with respect to assessment and intervention.

Intervention and policy issues related to children's exposure to environmental tobacco smoke.

BACKGROUND: Children's exposure to environmental tobacco smoke (ETS) is unacceptably high; almost 40% of children in the United States are regularly exposed to ETS. METHODS: This paper presents a review of the literature that evaluates interventions designed to reduce ETS exposure among young children. In addition, it presents the study design for Project KISS (Keeping Infants Safe from Smoke), an intervention designed to utilize exposure-related feedback to increase parents' motivation for ETS reduction and to reduce household ETS levels. Baseline data are presented to illustrate factors that should be addressed in ETS interventions. RESULTS: The literature review demonstrates the dearth of studies in the literature targeting ETS reduction among children. Participants in Project KISS believed that smoking had affected their children's health and were in later stages of motivational readiness to quit smoking than is typically observed. However, they face a number of challenges to smoking, such as high prevalence of nicotine dependence, high prevalence of living with other smokers, and socioeconomic and stress-related barriers. CONCLUSIONS: The policy implications of this research are discussed, and recommendations are made for future research.

Protection against oxidative stress-induced insulin resistance in rat L6 muscle cells by mircomolar concentrations of alpha-lipoic acid.

In diabetic patients, alpha-lipoic acid (LA) improves skeletal muscle glucose transport, resulting in increased glucose disposal; however, the molecular mechanism of action of LA is presently unknown. We studied the effects of LA on basal and insulin-stimulated glucose transport in cultured rat L6 muscle cells that overexpress GLUT4. When 2-deoxy-D-glucose uptake was measured in these cells, they were more sensitive and responsive to insulin than wild-type L6 cells. LA, at concentrations < or = 1 mmol/l, had only small effects on glucose transport in cells not exposed to oxidative stress. When cells were exposed to glucose oxidase and glucose to generate H2O2 and cause oxidative stress, there was a marked decrease in insulin-stimulated glucose transport. Pretreatment with LA over the concentration range of 10-1,000 pmol/l protected the insulin effect from inhibition by H2O2. Both the R and S isomers of LA were equally effective. In addition, oxidative stress caused a significant decrease (approximately 50%) in reduced glutathione concentration, along with the rapid activation of the stress-sensitive p38 mitogen-activated protein kinase. Pretreatment with LA prevented both of these events, coincident with protecting insulin action. These studies indicate that in muscle, the major site of insulin-stimulated glucose disposal, one important effect of LA on the insulin-signaling cascade is to protect cells from oxidative stress-induced insulin resistance.

Validity evidence for using a general critical thinking test to measure nursing students' critical thinking.

This study examined validity evidence for using a general test of critical-thinking skills and dispositions to measure nursing students' critical-thinking abilities. Content evidence indicated strong support for the theoretical framework underlying the test but less support for the way in which the critical-thinking constructs were specifically measured. Scores related to critical-thinking skills demonstrated significant but low correlations with grade point averages, were moderately correlated with SAT scores, and were uncorrelated with scores related to critical-thinking dispositions. The evidence suggests that nursing programs may need to reconsider how critical thinking should be measured and evaluated.

Effects of metformin and vanadium on leptin secretion from cultured rat adipocytes.

OBJECTIVE: We have reported that glucose utilization regulates leptin expression and secretion from isolated rat adipocytes. In this study, we employed two antidiabetic agents that act to increase glucose uptake by peripheral tissues, metformin and vanadium, as pharmacological tools to examine the effects of altering glucose utilization on leptin secretion in primary cultures of rat adipocytes. RESEARCH METHODS AND PROCEDURES: Isolated adipocytes (100 microL of packed cells per well) were anchored in a defined matrix of basement membrane components (Matrigel) with media containing 5.5 mM glucose and incubated for 96 hours with metformin or vanadium. Leptin secretion, glucose utilization, and lactate production were assessed. RESULTS: Metformin (0.5 and 1.0 mM) increased glucose uptake in the presence of 0.16 nM insulin by 37 +/- 10% (p < 0.005) and 62 +/- 8% (p < 0.0001) over insulin alone, respectively. Metformin from 0.5 to 5.0 mM increased lactate production by 105 +/- 43% (p < 0.025) to 202 +/- 52% (p < 0.0025) and at 1.0 and 5.0 mM increased the proportional rate of glucose conversion to lactate by 78 +/- 18% (p < 0.005) and 166 +/- 41% (p < 0.0025), respectively. At concentrations less than 0.5 mM, metformin did not affect leptin secretion, but at 0.5 mM, the only concentration that significantly increased glucose utilization without increasing glucose conversion to lactate, leptin secretion was modestly stimulated (by 20 +/- 9%; p < 0.05). Concentrations from 1.0 to 25 mM inhibited leptin secretion by 25 +/- 8% (p < 0.005) to 89 +/- 4% (p < 0.0001). Across metformin doses, leptin secretion was inversely related to the percentage of glucose taken up and released as lactate (r = -0.74; p < 0.0001). Vanadium (5 to 20 microM) increased glucose uptake from 20 +/- 7% (p < 0.01) to 34 +/- 13% (p < 0.02) and increased lactate production at 5 microM by 17 +/- 8% (p < 0.025) and 10 microM by 61 +/- 20% (p < 0.02) but did not alter the conversion of glucose to lactate. Vanadium (5 to 50 microM) inhibited leptin secretion by 33 +/- 6% (p < 0.0025) to 61 +/- 8% (p < 0.0001). DISCUSSION: Both metformin and vanadium increase glucose uptake and inhibit leptin secretion from cultured adipocytes. The inhibition of leptin secretion by metformin is related to an increase in the metabolism of glucose to lactate. The inhibition by vanadium most likely involves direct effects on cellular phosphatases. We hypothesize that the effect of glucose utilization to stimulate leptin production involves the metabolism of glucose to a fate other than anaerobic lactate production, possibly oxidation or lipogenesis.

Hemorrhagic lymphadenopathy as a presenting feature of primary al amyloidosis.

Lymphadenopathy associated with hemorrhage as a presenting feature of primary (AL) amyloidosis has not previously been described. We report two such cases one of whom had an acquired factor X and IX deficiency. The clinical presentations were characterized by sudden spontaneous enlargement of lymph nodes followed by partial regression. In both cases significant delay in diagnosis, and hence treatment, occurred due to the mode of presentation. One patient died with rapidly progressive disease but the other has had an excellent response to therapy with high-dose melphalan (HDM, 200 mg/m2) and peripheral blood stem cell rescue. AL amyloid should be considered in all patients presenting with hemorrhagic lymphadenopathy.

Alpha-lipoic acid: a multifunctional antioxidant that improves insulin sensitivity in patients with type 2 diabetes.

Alpha-Lipoic acid (LA) is a disulfide compound that is produced in small quantities in cells, and functions naturally as a co-enzyme in the pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase mitochondrial enzyme complexes. In pharmacological doses, LA is a multifunctional antioxidant. LA has been used in Germany for over 30 years for the treatment of diabetes-induced neuropathy. In patients with type 2 diabetes, recent studies have reported that intravenous (i.v.) infusion of LA increases insulin-mediated glucose disposal, whereas oral administration of LA has only marginal effects. If the limitations of oral therapy can be overcome, LA could emerge as a safe and effective adjunctive antidiabetic agent with insulin sensitizing activity.

Additive genetic relationships between heifer pregnancy and scrotal circumference in Hereford cattle.

The objective of this study was to determine an appropriate method for using yearling scrotal circumference observations and heifer pregnancy observations to produce EPD for heifer pregnancy. We determined the additive genetic effects of and relationship between scrotal circumference and heifer pregnancy for a herd of Hereford cattle in Solano, New Mexico. The binary trait of heifer pregnancy was defined as the probability of a heifer conceiving and remaining pregnant to 120 d, given that she was exposed at breeding. Estimates of heritability for heifer pregnancy and scrotal circumference were .138+/-.08 and .714+/-.132, respectively. Estimates of fixed effects for age of dam and age were significant for heifer pregnancy and bull scrotal circumference. The estimate of the additive genetic correlation between yearling heifer pregnancy and yearling bull scrotal circumference was .002+/-.45. Additional analyses included models with additive genetic groups for scrotal circumference EPD for heifer pregnancy or heifer pregnancy EPD for scrotal circumference to account for a potential nonlinear relationship between scrotal circumference and heifer pregnancy. Results support the development of a heifer pregnancy EPD because of a higher estimated heritability than previously reported. The development of a heifer pregnancy EPD would be an additional method for improving genetic merit for heifer fertility.

Language sample analysis in the 21st century.

Time requirements inherent in transcription and analysis of spontaneous language samples represent a significant barrier to the regular use of language sample analysis in clinical settings. Taking advantage of the options provided by new large, fast, and affordable personal microcomputers, two language analysis programs, the Systematic Analysis of Language Transcripts and The Child Language Data Exchange System have been developed to provide automated analysis of a wide range of language indices, as well as tools designed to reduce and simplify the time-intensive process of transcribing and analyzing children's language samples from both typical and clinical populations. In this article we provide a historical context for the development of these language analysis programs and a brief introduction to the transcription editors and language sample databases for both systems. In addition, a case study highlighting the interactive use of both analysis systems is provided.