Preventing community-wide transmission of Cryptosporidium: a proactive public health response to a swimming pool-associated outbreak--Auglaize County, Ohio, USA.

The incidence of recreational water-associated outbreaks in the United States has significantly increased, driven, at least in part, by outbreaks both caused by Cryptosporidium and associated with treated recreational water venues. Because of the parasite's extreme chlorine tolerance, transmission can occur even in well-maintained treated recreational water venues (e.g. pools) and a focal cryptosporidiosis outbreak can evolve into a community-wide outbreak associated with multiple recreational water venues and settings (e.g. childcare facilities). In August 2004 in Auglaize County, Ohio, multiple cryptosporidiosis cases were identified and anecdotally linked to pool A. Within 5 days of the first case being reported, pool A was hyperchlorinated to achieve 99·9% Cryptosporidium inactivition. A case-control study was launched to epidemiologically ascertain the outbreak source 11 days later. A total of 150 confirmed and probable cases were identified; the temporal distribution of illness onset was peaked, indicating a point-source exposure. Cryptosporidiosis was significantly associated with swimming in pool A (matched odds ratio 121·7, 95% confidence interval 27·4-∞) but not with another venue or setting. The findings of this investigation suggest that proactive implementation of control measures, when increased Cryptosporidium transmission is detected but before an outbreak source is epidemiologically ascertained, might prevent a focal cryptosporidiosis outbreak from evolving into a community-wide outbreak.

Activation of oxygen at metal surfaces.

Oxygen chemisorption at metal surfaces has been shown through a combination of scanning tunnelling microscopy and photoelectron spectroscopy to involve transient states that provide low energy pathways for a wide range of surface reactions including the catalytic oxidation of ammonia and hydrocarbons. The kinetically 'hot' transients are disordered and mobile, become unreactive when they form ordered structures, and are characterized by non-classical kinetic behaviour. The role of surface additives (caesium) in controlling oxygen structures and the implications of oxygen transients for theory and reaction mechanisms in applied catalysis are considered.

A cost analysis of treating pediatric dental patients using general anesthesia versus conscious sedation.

The purpose of this pilot study is to report a cost comparison of general anesthesia (GA) versus oral conscious sedation (CS) for pediatric dental patients. The study sample included 22 children whose parents or guardians selected GA care for their child. Selection criteria limited inclusion to healthy children (American Society of Anesthesiologists' classification I) aged 24-60 months. The subjects acted as their own comparison group to an estimation CS model. Models were developed to assess societal costs for treatment under GA and CS. Treatment rendered was equalized using the dental relative based value unit scale.

Clinic observations of structured parent-child interaction designed to evaluate externalizing disorders.

Observing structured parent-child interaction in clinic analogs has been a tradition in child clinical assessment since the 1960s. The clinic analog is designed to re-create important conditions from natural contexts such that dysfunctional parent-child patterns can be observed and modified. To those basic goals, the modern clinician would add diagnosis and treatment evaluation. Three classes of parent-child clinic analogs designed to evaluate preadolescent children with externalizing disorders were reviewed: free play, parent-directed play, and parent-directed chores. Free-play analogs and parent-directed chore analogs were found to have merit, but remain psychometrically underdeveloped. Practitioner reliance on questionnaires and interviews appears likely to continue until observational analogs have attained sufficient psychometric qualities to facilitate routine clinical decisions.

The social impact of multiple sclerosis--a study of 305 patients and their relatives.

PURPOSE: to assess the effects of multiple sclerosis (MS) on the patients' ability to fulfil their chosen family and social roles and to examine the impact of the disease on their relatives. METHODS: a population-based survey of all known patients with MS and their relatives in Hampshire County, England, between 1986 and 1989. RESULTS: Seventy-four% of the total study population of 411 completed the study. The patients' mean age was 48.3 years (range 19-82) and the mean disease duration was 15.8 years. About 16% of patients were depressed on a mood rating scale and a similar number also exhibited symptoms of anxiety. The marital status of most patients had not changed since the onset of MS but 53% of those who were employed at the time of diagnosis gave up their jobs and the standards of living of 37% of patients and their families had declined as a direct result of the disease. The ability to continue in gainful employment or to maintain social contacts and leisure activities correlated with the course and severity of the disease and cognitive function. Most carers reported symptoms that clearly related to organic pathologies, anxiety and symptoms of depression. The occurrence of these symptoms was associated with disease severity. The professional career of 57% of relatives was also adversely affected by the patient's illness. CONCLUSIONS: MS has a profound impact on the patients' social roles and their relatives' well-being. In contrast to previous studies, a high divorce/separation rate among patients with MS was not observed. Severe disability and cognitive impairment are predictors of loss of employment, decline in the standards of living and withdrawal from social and leisure activities among patients and are strong indicators of stress among relatives.

A cost analysis of treating pediatric dental patients using general anesthesia versus conscious sedation.

PURPOSE: The purpose of this pilot study is to report a cost comparison of general anesthesia (GA) versus oral conscious sedation (CS) for the treatment of pediatric dental patients. METHODS: The study sample included 22 children whose parents/guardian selected GA care for their child. Selection criteria limited inclusion to healthy children (ASA I) ages 24-60 m.o. The subjects acted as their own comparison group to an estimation CS model. Models were developed to assess societal costs for treatment under GA and CS. Treatment rendered was equalized using the dental Relative Based Value Units Scale (RBVU). RESULTS: Ordinary Least Squares Regression analysis techniques showed the association of RBVU to the total societal costs of GA and CS to be significant (P < 0.01) with an adjusted R2 of .64 and .78 respectively. When regression lines were plotted, the intersection represented RBVU level at which societal costs of GA and CS were the same. CONCLUSION: Under the conditions of this pilot study, it is concluded that CS costs exceed GA costs at a RBVU level of 66.4, which would equate to more than three CS appointments.

Terminal deoxynucleotidyl transferase-negative acute lymphoblastic leukemia.

OBJECTIVE: Terminal deoxynucleotidyl transferase (TdT) is a useful marker in the diagnosis of acute lymphoblastic leukemia (ALL) (French-American-British [FAB] L1 and L2) and is most useful in distinguishing ALL from mature B-lymphoid neoplasms, such as Burkitt lymphoma (FAB L3) and other lymphoid malignancies. The frequency of TdT-negative ALL is not known. Here we report 3 TdT-negative ALL cases that met the criteria for T-cell ALL. DESIGN: We reviewed approximately 200 cases of ALL retrieved from the database at our institution. All cases were evaluated using Wright-Giemsa, myeloperoxidase, butyrate, and TdT staining; immunophenotyped using flow cytometry; and studied using Southern blot analyses for T-cell receptors and immunoglobulin gene rearrangement. RESULTS: All ALL cases (L1 and L2) were TdT-positive, except for 3 cases that were of early T-cell lineage. None of the 3 cases demonstrated positivity for TdT in immunofluorescence staining with polyclonal antibodies or flow cytometry with monoclonal antibodies. Flow cytometric analysis confirmed a pre-T-cell immunophenotype in all 3 cases. One of the cases showed rearrangement of a T-cell antigen receptor and immunoglobulin heavy chain (J(H)). A second case showed germline configuration of T-cell receptors, but also showed rearrangement of the J(H), despite the expression of T-cell markers only.

Evaluation of the carbon dioxide laser on vital human primary pulp tissue.

PURPOSE: The purpose of this study was to evaluate the response of the human primary pulp to the carbon dioxide laser and formocresol for vital pulp therapy. METHODS: Fifteen healthy children with intact, caries-and-restoration-free, contralateral primary cuspids with at least two-thirds of the roots remaining who were scheduled for orthodontic extraction were randomly assigned to pulpotomy treatment with a carbon dioxide laser or formocresol. The treated teeth were clinically and radiographically evaluated at 28 and 90 days post-treatment prior to extraction. The extracted teeth were evaluated histologically for pulpal response. RESULTS: All teeth were asymptomatic and clinically normal at both observation periods. Internal root resorption was observed in one formocresol and two laser treated teeth. There was a significant inverse correlation between the laser energy applied to the pulp and the degree of inflammation at 28 days (P = .01) but not at 90 days (P = .27). CONCLUSION: Carbon dioxide laser treatment compared favorably to formocresol for pulpotomy in primary teeth.

Pattern of permanent teeth present in individuals with ectodermal dysplasia and severe hypodontia suggests treatment with dental implants.

PURPOSE: The objective of this study was to assess the pattern of permanent teeth present in a self-selected sample of 17 female and 35 male patients with ectodermal dysplasia presenting for treatment with dental implants. METHODS: Mean age of sample: 18.7 years, age range: 5.9 to 60.9 years. Panoramic radiographs were examined independently by two investigators to determine the permanent teeth present. None of the sample reported extractions of permanent teeth prior to presenting for implants. RESULTS: Permanent teeth most likely to be present, reported as a percentage of the patient sample with that tooth, were: maxillary central incisors (42%), maxillary first molars (41%), mandibular first molars (39%), maxillary canines (22%), mandibular second molars (17%), maxillary second premolars (15%), and mandibular premolars (12%). Comparing dentition by quadrants, mandibular anterior teeth (canines and incisors) were least likely to be present. CONCLUSIONS: Results support previous findings that the maxillary central incisors, maxillary first molars, mandibular first molars, and maxillary canines are the most conserved teeth in hypodontia. Successful use of osseointegrated implants in the anterior mandibles of most of these patients suggests that habilitation of the mandible with dental implant-supported prostheses is a reasonable option.

Factors affecting the mobility of pediatric dentistry faculty.

PURPOSE: A questionnaire was used to develop a profile of current pediatric dentistry faculty to determine whether current faculty would consider relocating to accept another position in academia, and to identify what factors are most important to current full-time faculty when considering another faculty position. RESULTS: Responding males had a significantly higher mean age (49.3 years) than the females (39.3 years). A significantly greater proportion of women (87%) than men (66%) reported that they were prepared to move if offered an improved career opportunity. Both women and men ranked an improved opportunity for professional growth followed by salary increase as the highest rated factors in considering relocation. There was no statistical difference between women and men at the assistant professor level relative to the importance of academic promotion opportunity. However, women at the associate professor level ranked an opportunity for academic promotion statistically higher than did men.

A comparison of two measurements of child compliance with normal preschool children.

Observed normal preschool children from 2 through 5.9 years of age and their mothers using 2 established measurements of child compliance: the Compliance Test and the Clinic Task Analog. The diagnosis of oppositional defiant disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders (4th ed., American Psychiatric Association, 1994) currently requires subjective integration of interview, questionnaire, and behavioral data. Knowledge of normal child behavior within a parent-controlled task context is needed. Normal 4- and 5-year olds were found to be more compliant than were normal 2- and 3-year olds; no sex effects were detected. The Compliance Test yielded stronger age associations, better observer reliability, and more individual differences than the Clinic Task Analog. Clinic Task Analog data masked child compliance, probably as a result of maternal instruction-giving style. The Compliance Test is recommended for diagnostic purposes over the Clinic Task Analog.

Case review section of the American Board of Pediatric Dentistry: stumbling blocks and pitfalls.

The Directors of the American Board of Pediatric Dentistry are eager for eligible candidates to become Diplomates. It is important to the profession as well as to the individual that more of our colleagues become Board certified. Failure on a Section of the examination is distressing to us as well as to the candidate. Requirements for the Case Review Section are very specific and are intended to assist the candidate in preparing the cases. Carefully following the guidelines will minimize potential disappointment.

Fluoride supplement prescribing and dental referral patterns among academic pediatricians.

OBJECTIVE: To determine how well the current fluoride supplementation schedule was known by academic pediatricians and to examine the fluoride supplement prescribing and dental referral practices among primary care faculty pediatricians at four medical centers. SETTING: Four university medical centers in North Carolina. SUBJECTS: Primary care faculty pediatricians. METHOD: A questionnaire pretested for clarity was distributed to all identified full-time primary care pediatric faculty (42 members). RESULTS: A total of 40 completed questionnaires were returned. Thirty-seven (93%) primary care faculty pediatricians reported that they routinely addressed the need for fluoride supplements for their patients, but only 28 (70%) determined the fluoride content of the drinking water before prescribing supplements. Thirty-five (87.5%) began supplements at the correct age, but fewer knew the correct doses for children of various ages. Only 23 (58%) referred their patients for oral examination and preventive care before the age of 36 months, contrary to American Academy of Pediatrics recommendations. CONCLUSIONS: Pediatricians in an academic setting would be expected to be more knowledgeable of current recommendations than those in private practice. Failure to know and teach correct fluoride supplement recommendations and failure to recommend early professional dental involvement can result in less than optimum oral health.

Factors that affect career choices of pediatric dentistry advanced education students.

A questionnaire addressing factors that affect career choices by pediatric dentistry advanced education students was mailed to 52 training programs. Two hundred and thirty-two completed surveys from 45 responding programs were returned. The responses were analyzed for women and men and citizens and noncitizens. Concern for spouse career opportunities affected women's personal career decisions significantly more (P < 0.05) than it did for men. Women rated previous federal/military experience significantly less (P < 0.05) influential on their career choice than did men. Geographic preference when making career decisions was significantly more (P < 0.001) important to citizens than it was for noncitizens. Noncitizens assigned significantly higher (P < 0.001) ratings to an interest in teaching and research than did citizens. A preference for practicing with a parent or relative and previous federal/military experience affected career choices by noncitizens significantly more (P < 0.05) than they did citizens. This study suggests that numerous career-influencing factors in pediatric dentistry are perceived differently by women and men, and citizens and noncitizens.

Oral self-injurious behavior in the developmentally disabled: review and a case.

Self-injurious behavior occurs in conjunction with a variety of psychiatric disorders as well as various developmental disabilities and some syndromes. The behavioral and biochemical aspects of self-injurious behavior are poorly understood and several etiologies have been suggested. Treatments for self-injurious behavior in developmentally disabled individuals fall into three main categories: pharmacological, behavior modification and physical restraints. The dental management of self-injurious behavior is often difficult. Numerous appliances of various design have been reported in the literature. Osteotomies or extraction of the offending teeth may have to be considered if less invasive methods are unsuccessful. A case is reported where a child engaged in tonic lip biting secondary to a neurological and seizure disorder is treated using a removable lip-protruding device. No impression or lab construction is required. The appliance presents minimal interference with oral hygiene procedures and it can be removed and reinserted as needed. We conclude that a removable lip-bumper may be a viable option in treating transient and acute episodes of self-injurious behavior involving the lower lip and buccal mucosa.

Cardiopulmonary responses to intravenous infusion of soluble and relatively insoluble gases.

BACKGROUND: Carbon dioxide is the current gas of choice for pneumoperitoneum, but hemodynamic and acid-base effects secondary to its systemic absorption have been reported. Various studies have suggested inert gases as alternatives. METHODS: We studied the cardiopulmonary responses to intravenous infusion of carbon dioxide, nitrous oxide, argon, helium, and nitrogen in anesthetized swine. The gas was infused into the femoral vein at a rate of 0.1 ml . kg-1 . min-1 for 30 min. The changes in end-tidal CO2, mean arterial pressure, hemodynamics, and arterial blood gases were compared to baseline values. RESULTS: No animals died during infusion of the soluble gases (CO2 and N2O). Three of the five pigs infused with nitrogen died suddenly at 20 and 30 min of infusion. The animals in the insoluble gas groups (Ar, He, N2) experienced clinical pulmonary gas embolism and severe acidemia, hypercapnea and tachycardia. CONCLUSIONS: Venous gas embolism is poorly tolerated when the gas is relatively insoluble. Insoluble gases should not be used for pneumoperitoneum when there is any risk of venous gas embolism.

Career preferences of pediatric dentistry advanced education students.

A questionnaire addressing career preferences of pediatric dentistry advanced education students was mailed to 52 training programs. Two hundred and thirty-two completed surveys from 45 responding programs were returned. Men were in combined specialty programs significantly more than women (P < 0.05, chi-square) and U.S. citizen students were significantly older than non-citizens (P < 0.05, t-test). The collected data reflected differences in career preferences between men and women, and citizens and noncitizens. Women reported a significant preference for private practice, part-time associate and public health practice than did men. Although not significant, men declared equal preference for full-time private practice either solo or as an associate. Noncitizens were found to have a significant preference when compared to citizens for academic full- and part-time, hospital/institutional full- and part-time, research, full- and part-time positions, and for additional training.