Sustainability of an Opt-Out Electronic-Health Record-based Tobacco Treatment Consult Service at a large safety-net hospital: A 6-year Analysis.

INTRODUCTION: Our safety-net hospital implemented a hospital-based tobacco treatment intervention in 2016. We previously showed the intervention, an "opt-out" Electronic Health Record (EHR)-based Best Practice Alert (BPA)+order-set that triggers consultation to an inpatient Tobacco Treatment Consult (TTC) service for all patients who smoke, improves smoking abstinence. We now report on sustainability, 6 years after inception. METHODS: We analyzed data collected between July 2016-June 2022 of patients documented as 'currently smoking' in the EHR. Across the 6 years, we used Pearson's correlation analysis to compare Adoption (clinician acceptance of the BPA+order-set, thus generating consultation to the TTC service); Reach (number of consultations completed by the TTC service); and Effectiveness (receipt of pharmacotherapy orders between patients receiving and not receiving consultations). RESULTS: Among 39,558 adult admissions (July 2016-June 2022) with "currently smoking" status in the EHR for whom the BPA triggered, clinicians accepted the TTC order-set on 50.4% (19,932/39,558), though acceptance varied across services [e.g., Cardiology (71%) and Obstetrics-Gynecology (12%)]. The TTC service consulted on 17% (6779/39,558) of patients due to staffing constraints. Consultations ordered (r=-0.28, p=0.59) and completed (r= 0.45, p=0.37) remained stable over six-years. Compared to patients not receiving consultations, patients receiving consultations were more likely to receive pharmacotherapy orders overall (inpatient: 50.8% vs 35.1%, p<.0001; at discharge: 27.1% vs 10%, p<.0001) and in each year. CONCLUSIONS: The "opt-out" EHR-based TTC service is sustainable, though many did not receive consultations due to resource constraints. Healthcare systems should elevate priority of hospital-based tobacco treatment programs to increase reach to underserved populations. IMPLICATIONS: Our study shows that opt-out approaches that utilize the EHR are a sustainable approach to provide evidence-based tobacco treatment to all hospitalized individuals who smoke, regardless of readiness to stop smoking and clinical condition.

A Longitudinal Study of Perceptions of the Massachusetts Menthol Ban and Its Impact on Smoking Behaviors among Marginalized Individuals.

Menthol cigarettes have had a profound adverse effect on public health. On 1 June 2020, Massachusetts became the first state to ban the sale of menthol cigarettes. We explored how perceptions of the ban and smoking behaviors changed over time among a group of 27 individuals who smoked menthol cigarettes at our safety-net hospital. In a convergent mixed methods study, we administered questionnaires and interviews simultaneously at two timepoints: 1 month pre-ban and 6 months post-ban. Pre-ban, we assessed perceptions of the ban and anticipated smoking behaviors after the ban. Post-ban, we assessed participants' actual smoking behaviors and elicited suggestions to avoid unintended consequences that might undermine intended policy effects. Several respondents perceived the Massachusetts ban as positive because it could promote smoking cessation, prevent youth initiation, and mitigate unfair targeting of socioeconomically disadvantaged populations. Others perceived the ban as an overreach of government policy, financially motivated, and unfairly targeting the Black community. Many continued to smoke menthol cigarettes obtained outside Massachusetts. Individuals suggested promoting tobacco treatment for people affected by the ban and a national ban to circumvent out-of-state purchasing of menthol cigarettes. Our findings suggest that in order to be most effective, healthcare systems must promote tobacco treatment and ensure that treatment is accessible to all individuals affected by the ban.

Structural and functional evolution of an auxin efflux carrier PIN1 and its functional characterization in common wheat.

Particularly PIN1, PIN protein-mediated rate-limiting auxin distribution plays a critical role in plant differentiation. Although well-characterized in Arabidopsis, little is known about the structural and functional relationship of the PIN1 gene among other plants. Here, we report that the gene structure remained conserved among bryophytes and angiosperms while the gene size varied by ~ 17%. Although the positions were conserved, highly variable intron phase suggests preference for specific regions in the gene sequence for independent events of intron insertion. Significant variation was observed across gene length for insertions and deletions that were mainly localized to the exonic regions flanking intron 1, possibly demarcating the sequences prone to deletions/duplications. The N and C-terminals showed a higher protein sequence similarity (~ 80%) compared to the central hydrophilic loop (~ 26%). In addition to the signature domains and motifs, we identified four novel uncharacterized motifs in the central divergent loop of PIN1 protein. Three different homo-loci, one each on chromosome groups 4, 6, and 7, were identified in wheat each showing dramatically different expression patterns during different plant developmental stages. Virus-induced gene silencing of the TaPIN1 gene resulted up to 26% reduction in plant height. Because of its direct role in controlling plant height along with a higher expression during stem elongation, the TaPIN1 gene can be manipulated to regulate plant height.

Effect of Crown Angulation of Maxillary Incisor on Effective Arch Perimeter.

INTRODUCTION: It has been postulated that crown angulation and inclination has potential space implication within the arch. With the insight of space implication of the axial relations of teeth, cases of genuine tooth size discrepancies can be dealt with improved stability. AIM: This in vitro study was designed to investigate and quantify the influence of angulation and inclination of maxillary incisors on the effective arch perimeter. MATERIALS AND METHODS: Acrylic teeth were arranged over typhodont frame with spaced maxillary anterior segment. Known value of tip and torque in increments were incorporated to maxillary incisors through bracket positioning and corresponding consumption of the interdental spaces were measured using coordinate measuring machine. RESULTS: Study revealed that increase in maxillary incisor crown angulation by 1o results in consumption of approximately 0.012 mm of arch perimeter. Similarly, there is a consumption of 0.021 mm of arch perimeter with each degree increase in labial crown inclination. CONCLUSION: The knowledge of the space implication can be included in the space analysis during the orthodontic treatment planning. Depending upon the amount of space discrepancy, an accurate degree of required alteration in the axial relation of one or more teeth can be planned.

Revolution in Orthodontics: Finite element analysis.

Engineering has not only developed in the field of medicine but has also become quite established in the field of dentistry, especially Orthodontics. Finite element analysis (FEA) is a computational procedure to calculate the stress in an element, which performs a model solution. This structural analysis allows the determination of stress resulting from external force, pressure, thermal change, and other factors. This method is extremely useful for indicating mechanical aspects of biomaterials and human tissues that can hardly be measured in vivo. The results obtained can then be studied using visualization software within the finite element method (FEM) to view a variety of parameters, and to fully identify implications of the analysis. This is a review to show the applications of FEM in Orthodontics. It is extremely important to verify what the purpose of the study is in order to correctly apply FEM.

Digital radiographic evaluation of hand-wrist bone maturation and prediction of age in South Indian adolescents.

BACKGROUND: In the growing years, indicators of the level of maturational development of the individual provide the best means for evaluating biologic age and the associated timing of skeletal growth. The relative stage of maturity of a child may be determined by comparing the child's hand-wrist radiograph to the known standards of skeletal development. AIMS AND OBJECTIVES: In this study, we assessed various levels of skeletal maturation and also identified the relationship between chronological age (CA) and maturation stage using the hand-wrist radiographs in adolescents of Indian origin. MATERIALS AND METHODS: Three hundred and thirty hand-wrist digital radiographs of individuals aged 8 to 18 years were evaluated for skeletal maturity levels using Fishman's method. The data was analysed using the SPSS software package (version 12, SPSS Inc., Chicago, IL, USA). Regression analysis was performed for calculating bone age of both males and females. Spearman's rank-order correlation coefficients were estimated separately for males and females to assess the relation between CA and maturation level. RESULTS: An association between skeletal maturation indicator stages and CA (r = 0.82) was significant. Interestingly, female subjects were observed to be advanced in skeletal maturity compared to males. Regression equations were derived to calculate bone age in males, females and the whole sample. CONCLUSION: The results of this study showed significant association between hand-wrist skeletal maturation levels and CA. Digital radiographic assessment of hand-wrist skeletal maturation can be used as a better choice for predicting average bone age of an individual because of its simplicity, reliability and lesser radiation exposure.

Digital radiographic evaluation of mandibular third molar for age estimation in young adults and adolescents of South Indian population using modified Demirjian's method.

UNLABELLED: In recent years, it has become increasingly important to determine the age of living people for a variety of reasons, including identifying criminal and legal responsibility and for many other social events such as birth certificate, marriage, beginning a job, joining the army and retirement. OBJECTIVES: The aim of this study was to assess the developmental stages of mandibular third molar for estimation of dental age (DA) in different age groups and to evaluate the possible correlation between DA and chronological age (CA) in South Indian population. MATERIALS AND METHODS: Digital orthopantomography of 330 subjects (165 males, 165 females) who fit the study and the criteria were obtained. Assessment of mandibular third molar development was performed using Demirjian et al., modified method and DA was assessed using tooth specific stages. RESULTS AND DISCUSSION: The present study showed a significant correlation between DA and CA in both males and females. Third molar development commenced around 9 years and root completion takes place around 18.9 years in males and in females 9 years and 18.6 years respectively. Demirjian modified method underestimated the mean age of males by 0.8 years and females by 0.5 years and also showed that females mature earlier than males in selected population. CONCLUSION: Digital radiographic assessment of mandibular third molar development can be used to generate mean DA using Demirjian modified method and also the estimated age range for an individual of unknown CA. Since the Demirjian method is based on French-Canadian population, to enhance the accuracy of forensic age estimates based on third molar development, the use of population-specific standards is recommended.

Correlation of masseter muscle thickness and intermolar width - an ultrasonography study.

BACKGROUND: To determine the association between the thickness of masseter muscle and the maxillary dental arch width. To explore the influence of gender on masseter muscle thickness. MATERIALS & METHODS: Seventy subjects (35 females and 35 males) of age 18 to 25 years were selected for the study based on class I molar relationship. The masseter muscle thickness of the right and left sides in every subject were found out through ultrasound scanning of the muscle, in both relaxed and clenched states. The maxillary dental arch width was measured on the study model with an electronic caliper. Student t test, Pearson's Correlation Coefficient was performed to assess the sample. RESULTS: Masseter Muscle Thickness showed a positive correlation with Maxillary Dental Arch Width r ≤0.74. The masseter muscle thickness is greater in male subjects in both relaxed (0.001