Progress on the Cu-Catalyzed 1,4-Conjugate Addition to Thiochromones.

Carbon-carbon bond formation is one of the most important tools in synthetic organic chemists' toolbox. It is a fundamental transformation that allows synthetic chemists to synthesize the carbon framework of complex molecules from inexpensive simple starting materials. Among the many synthetic methodologies developed for the construction of carbon-carbon bonds, organocopper reagents are one of the most reliable organometallic reagents for this purpose. The versatility of organocuprate reagents or the reactions catalyzed by organocopper reagents were demonstrated by their applications in a variety of synthetic transformations including the 1,4-conjugate addition reactions. Sulfur-containing heterocyclic compounds are a much less studied area compared to oxygen-containing heterocycles but have gained more and more attention in recent years due to their rich biological activities and widespread applications in pharmaceuticals, agrochemicals, and material science. This paper will provide a brief review on recent progress on the synthesis of an important class of sulfur-heterocycles-2-alkylthiochroman-4-ones and thioflavanones via the conjugate additions of Grignard reagents to thiochromones catalyzed by copper catalysts. Recent progress on the synthesis of 2-substituted thiochroman-4-ones via alkynylation and alkenylation of thiochromones will also be covered in this review.

Primary school mobile dental program in New South Wales, Australia: protocol for the evaluation of a state government oral health initiative.

BACKGROUND: Socioeconomically disadvantaged children are disproportionately affected by oral disease. Mobile dental services help underserved communities overcome barriers to accessing health care, including time, geography, and trust. The NSW Health Primary School Mobile Dental Program (PSMDP) is designed to provide diagnostic and preventive dental services to children at their schools. The PSMDP is mainly targeted toward high-risk children and priority populations. This study aims to evaluate the program's performance across five local health districts (LHDs) where the program is being implemented. METHODS: The evaluation will use routinely collected administrative data, along with other program-specific data sources, from the district public oral health services to conduct a statistical analysis that determines the reach and uptake of the program, its effectiveness, and the associated costs and cost-consequences. The PSMDP evaluation program utilises data from Electronic Dental Records (EDRs) and other data sources, including patient demographics, service mix, general health, oral health clinical data and risk factor information. The overall design includes cross-sectional and longitudinal components. The design combines comprehensive output monitoring across the five participating LHDs and investigates the associations between socio-demographic factors, service patterns and health outcomes. Time series analysis using difference-in-difference estimation will be conducted across the four years of the program, involving services, risk factors, and health outcomes. Comparison groups will be identified via propensity matching across the five participating LHDs. An economic analysis will estimate the costs and cost-consequences for children who participate in the program versus the comparison group. DISCUSSION: The use of EDRs for oral health services evaluation research is a relatively new approach, and the evaluation works within the limitations and strengths of utilising administrative datasets. The study will also provide avenues to improve the quality of data collected and system-level improvements to better enable future services to be aligned with disease prevalence and population needs.

Noninvasive ventilation of air transported infants with respiratory distress in the Canadian Arctic.

Objectives: Since 2016, use of nasal continuous positive airway pressure (nCPAP) in Nunavut for air transport in select patients has become common practice. This study examines the outcomes of patients transferred by air from the Qikiqtaaluk Region during air transport. We examined intubation rates, adverse events during transfer, and respiratory parameters at departure and upon arrival. Methods: This was a retrospective review from September 2016 to December 2019 including patients under 2 years of age transferred by air on nCPAP from the Qikiqtaaluk Region of Nunavut. Results: Data were collected for 40 transfers involving 34 unique patients. Six transfers were from remote communities in Nunavut to Iqaluit, and 33 transfers were from Iqaluit to CHEO. The primary outcome measure was whether the patient required intubation during transport, or urgent intubation upon arrival to CHEO. The median nCPAP setting during transport was 6 cm H2O (5-7 cm H2O) and at arrival to CHEO was 6 cm H2O (6-7 cm H2O). Six of the 33 (18.2%) patients required intubation during their hospital stay and five (15.2%) in a controlled ICU setting. There were no discernible adverse events that occurred during transport for 28 patients (84.5%). Four patients (12.1%) required a brief period of bag-mask ventilation and one patient had an episode of bradycardia. Conclusions: nCPAP on air transport is a safe and useful method for providing ventilatory support to infants and young children with respiratory distress.

Comparison of Infectious Complications after Surgical Fixation versus Epidural Analgesia for Acute Rib Fractures.

Background: Surgical stabilization of rib fractures (SSRF) is associated with decreased mortality and respiratory complications. Patients who are not offered SSRF are often treated with epidural analgesia (EA) to reduce pain and improve pulmonary mechanics. We sought to compare infectious complications in patients undergoing either SSRF or EA. We hypothesized that infectious complications are equivalent between the two treatment groups. Patients and Methods: We performed a retrospective cohort study of adult trauma patients with acute rib fractures within the Trauma Quality Improvement Program (TQIP) 2017 dataset and used International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes to identify patients who underwent SSRF or EA. We excluded patients who received both treatments in the same admission. Our primary outcome was the development of sepsis. Secondary outcomes were specific infections including ventilator-associated pneumonia (VAP), catheter-associated urinary tract infection (CAUTI), and central line-associated blood stream infections (CLABSI). Multiple logistic regression analyses were used to adjust for age, injury severity score (ISS), chest Abbreviated Injury Scale (AIS), flail chest, traumatic brain injury (TBI), and comorbidities. Results: We identified 2,252 and 1,299 patients who underwent SSRF and EA, respectively. Patients with SSRF were younger with higher ISS and longer length of stay (LOS). There was no difference in mortality, however, SSRF had higher rate of sepsis (1.6% vs. 0.5%; p = 0.001), VAP (5.1% vs. 0.9%; p < 0.001), CAUTI (1.7% vs. 0.5%; p = 0.001), and CLABSI (0.2% vs. 0%; p = 0.05). On multiple regression, SSRF was associated with higher odds of sepsis (odds ratio [OR], 2.63; 95% confidence interval [CI], 1.04-6.63), CAUTI (OR, 2.96; 95% CI, 1.11-7.88), and VAP (OR, 3.24; 95% CI, 1.73-6.06). Among those who developed sepsis, there was no significant difference in mortality or LOS between groups. Conclusions: Despite no difference in mortality, SSRF was associated with increased risk of septic complications in patients with rib fractures compared to epidural analgesia. Identifying, and addressing, risk factors of sepsis in this patient population is a critical performance improvement process to optimize outcomes without increased adverse events.

Exploring the career experiences of Australian oral health therapists in different practice settings.

OBJECTIVE: To examine the reasons behind Australian oral health therapists (OHTs) pursuing different career pathways. BASIC RESEARCH DESIGN: Qualitative study with thematic analysis within an inductive realist approach. METHODS: A convenience sample of OHTs completed semi-structured interviews on Zoom. Participants discussed their experiences working as OHTs and commented on the future directions for the profession in Australia. RESULTS: Participants (n=21) chose clinical practice due to excellent job availability, good remuneration, and the opportunity to use their knowledge. Many indicated that non-clinical careers helped relieve the stress and fatigue of clinical practice. Some also enjoyed the variety that non-clinical jobs brought and viewed them as a means to advance their career. Participants indicated the need to better communicate the professional role and scope of practice of the OHT profession to other healthcare providers such as dentists and the general public. Some viewed independent practice as a way to serve the community. Others did not feel that they had the knowledge and skills to do so. CONCLUSION: These findings may help individual OHTs in career decision-making. OHTs could assume a major role in addressing oral healthcare inequality in Australia.

Dentists' Perspectives on Commercial Practices in Private Dentistry.

BACKGROUND: Dentistry is predominantly provided in a commercial context in Australia. Despite this, little is known about how dentists navigate potential tensions that may arise between commercial and professional obligations in private dental practice. This analysis uses a qualitative approach to explore dentists' perceptions and attitudes toward the commercialized nature of private dental practice and how these affect their professional role in providing care. METHODS: Participants were recruited by advertising on social media, as well as through a professional association and a corporate dental group's graduate training program. Data were collected from participants through interviews and written reflections. The data were subjected to thematic analysis to reveal deeper meanings and linkages between different emergent themes. RESULTS: Twenty dentists who worked in private practice environments were recruited to take part. The analysis revealed the following themes within the data: dentistry devalued, commercial influences on professional behavior, the effect of advertising and competition on dentistry, ethical selling, and the impacts of commercialism on consumers of dentistry. CONCLUSIONS: Consumers of dentistry may only be superficially empowered by the commercialized context of private dental practice. Empowerment to decide which services to access and from whom does not address the inherent disparities that exist within the dentist-patient clinical relationship. Advertising and the active "selling" of oral health services are all designed to create dental consumers, not to empower them. While advertising might assist patients to understand available treatments, the primary objective of marketing is not health education. Increasing competition and consumer choice within dentistry may help to empower consumers of dental services but only if the dentist-patient relationship remains founded in altruistic intent, with the doctrine of "caveat emptor" (buyer beware) having no place within dentistry. KNOWLEDGE TRANSFER STATEMENT: This research provides novel insights into how dentists experience the commercial context of private dental practice and how this is perceived to be both beneficial and detrimental to the consumers of dental services. This work will help to guide policy development to address the commercial determinants of oral health generated by the nature of commercialized dental practice environments.

Private practice dentists' views of oral health injustice.

OBJECTIVES: There is a lack of research examining how dentists in private practice conceptualise the challenge presented by oral health injustice and how attitudes towards low-income patients might be influenced by the commercial nature of private dental care. This study provides insights into how dentists navigated the interactions between the commercial nature of dental practice and the provision of care to patients who either struggled to (or could not) afford the cost of self-funded care in private practice. METHODS: Participants took part in semi-structured interviews and were invited to keep an online diary of reflections. Thematic analysis was used to examine the data to extract and synthesise understanding of how practitioners conceptualised issues surrounding providing care for the disadvantaged and how this related to the economic realities of private practice. RESULTS: Twenty participants were recruited and interviewed from a variety of private practice environments and roles. This report focuses on one specific theme within the data that explored how participants viewed patients who received public dental care, as well as those privately funded patients who could ill-afford their treatment. CONCLUSIONS: The findings raise how neoliberal attitudes towards oral healthcare and dental disease may act as a social determinant of health and contribute to the sustaining of structural barriers and inaction towards oral health injustice. For low-income patients, practitioners distinguish between (a) those who are deemed to be deserving of professional care and the charitable endeavours of the profession, and (b) those who are not. There appears to be no overt professional obligation to actively work towards the amelioration of oral health injustice.

A simple adaptation of a handheld ECG recorder to obtain chest lead equivalents.

Hand held ECG recorders are transforming the way we detect and diagnose heart rhythm disorders. The Kardia 6 L was launched in 2019 to detect and diagnose heart rhythm disorders recording a six lead (limb lead) ECG. Recording and analysis of precordial leads are currently not supported by the Kardia 6 L. In this study we aim to assess if reliable chest lead data can be obtained using a simple modification to the recording system.

Outcomes of a co-designed, community-led oral health promotion program for Aboriginal children in rural and remote communities in New South Wales, Australia.

OBJECTIVE: Improving the oral health of Aboriginal children is an Australian priority. Public policy recommends the development of evidence-based, culturally competent oral health promotion programs. Positive health outcomes are more likely for Aboriginal people when programs are co-designed with the community and tailored to local needs. This study aims to determine the impact of a community-led oral health promotion program for Aboriginal children in rural and remote communities. BASIC RESEARCH DESIGN: Consecutive surveys. Baseline data were collected on the oral health of Aboriginal children aged five-12 years in rural and remote communities in Central Northern New South Wales in 2014. Then, an evidence-based oral health promotion program was co-designed with local Aboriginal communities. It included daily toothbrushing, water bottle program, regular application of fluoride varnish, regular distribution of toothbrushes and fluoride toothpaste and dental health education and commenced in 2016 in three schools in the region. In 2018, oral health status and oral hygiene behaviours of participating children were compared against baseline data to evaluate the program. RESULTS: There was a significant reduction in tooth decay, plaque scores and gingivitis. The mean number of teeth affected by tooth decay was 4.13, compared to 5.31 in 2014. An increase was also seen in positive oral hygiene behaviour. CONCLUSIONS: The co-design elements of the program are critical to its success. Engaging local Aboriginal communities to co-design and deliver oral health promotion can reduce the burden of tooth decay experienced by Aboriginal children.

Dentistry and Oral Health in Online Media Sources: A Discourse Analysis.

BACKGROUND: This analysis examines the discourses within online media that relate to dentistry and oral health, contributing to developing understanding of the underlying social and political contexts that may affect the promotion of oral health. The increased mediatisation of society means that media representations of the dental profession and oral health are of increasing importance. METHODS: A search for online media sources relevant to dentistry and oral health was carried out using Google News. Discourse analysis was used to explore online media sources that discussed oral health, the dental profession and dentistry more generally. RESULTS: 171 articles were included, and three overarching discourses were identified from the selected online sources; 1) Power and Professional Status; 2) Advancement of Social Control and; 3) Neo-liberal Attitudes Towards Oral Healthcare. CONCLUSIONS: The theory of the social contract provides a conceptual framework to explore the relationship between the dental profession and society, the nature of this is discoverable through analysis of the discourses within online media. Within the sources examined, the dental profession frequently invokes neo-liberal discourses that place personal responsibility to be an important factor in preventative oral health. There was also frequent suggestion of a stronger link between oral and systemic health than is evidenced within the academic literature. Analysis of the media sources examined also suggests that the representations of oral health and dentistry also serve to reinforce the artificial separation of the mouth and the body, with dental services being separate from other healthcare activities.

Audit of minimally-invasive surgery for submandibular sialolithiasis.

Sialolithiasis is one of most common diseases to affect major salivary glands, with a symptomatic incidence of 27 cases per million per annum. The majority form within the submandibular gland where minimally-invasive treatments have all but eliminated adenectomy. All records of patients presenting with submandibular stones between 1997 and 2015 were reviewed. Stones <5mm were retrieved through endoscopic or radiographic techniques, 5-7mm stones were initially considered for extra-corporeal shock wave lithotripsy, but after poor results were treated through intraoral surgical removal with those >7mm. Follow up was performed at 1 week and 3 months with current status performed with postal and telephone questionnaires. 378 patients had 424 stones removed, successful retrieval in 94% (n=356), with 50 having had previous failures. Median number of stones per patient was 1 (range 1-4), with a mean size of 8.6mm (SD 4.5mm) mainly located at the hilum (50.5%), anterior duct (30%) and Genu (17%). 256 patients (65%) treated through intraoral surgical extraction, 92 (24%) endoscopic alone. Inpatient stay was 1.4 days in first third and 0.5 days in final third. Adenectomy occurred in 14 patients, due to failure to retrieve the sialolith or unresolved symptoms. Complications involved 11 patients with permanent paraesthesia, 7 ranulas and 14 strictures. Patients with preoperative strictures were more likely to develop complications (p=0.002) with paraesthesia being most common. Intraoral minimally-invasive surgery is aesthetic, curative and spares the risk to marginal mandibular nerve and submandibular gland. Length of inpatient stay improved and ranula risk reduced throughout the study.

Nasal CPAP on paediatric air transport in the Canadian Arctic: A case series.

AIMS: Paediatric transport in remote regions of Canada represents a huge challenge given the acuity of the patients, immense distances, weather and lack of road infrastructure. Transport of patients in the Baffin region of Nunavut is completed entirely by air transport. Two very common paediatric transports are in regards to lower respiratory tract infections and premature deliveries in small rural communities north of Iqaluit. Recently, the advent of noninvasive ventilation has been introduced to the region. METHOD: We report five cases of long-distance air transport of paediatric patients in respiratory distress using nasal continuous positive airway pressure (nCPAP). Two cases involve lower respiratory tract infections, and three cases involve neonates (two premature infants and one term infant). RESULTS: Overall, these cases highlight effective and safe use of noninvasive ventilation in air transport of patients in respiratory distress and demonstrate how this modality can improve patient transport in rural and remote regions.

In-school toothbrushing programs in Aboriginal communities in New South Wales, Australia: A thematic analysis of teachers' perspectives.

OBJECTIVE: This qualitative analysis explores how school staff interacted with a daily in-school toothbrushing program in three schools in rural areas in Central Northern New South Wales, Australia, with a high population of enrolled Aboriginal students. RESEARCH DESIGN: Three focus groups were conducted in the schools. Participants included school teachers and one Aboriginal Oral Health Aide who manage the daily program. Focus groups were conducted, and where permitted, audio-recorded and transcribed verbatim. Thematic analysis was used to analyse the transcripts. This study was granted ethics approval by the New South Wales Aboriginal Health and Medical Research Council (App 1281/17). RESULTS: Four themes were identified: 1) Belief of Program Need and Benefit; 2) Forming routine; 3) Children's responses and 4) Sustainability. School staff embraced the program and valued the need for and benefit of the program for children in their school, seeing it as part of the extended role of the school to promote students' health and well-being. Two important enablers for the program's sustainability emerged; promoting and supporting local school leadership and training existing school staff or local Aboriginal people to manage it. CONCLUSION: Training local Aboriginal people or existing school staff to implement a daily in-school toothbrushing program and facilitating school leadership is an important enabler for sustainable oral health promotion, including in-school toothbrushing programs, in Aboriginal communities.

Embarrassing Realities: the Portrayal of Dentistry in Reality TV 'Dentertainment'.

BACKGROUND: Dentists are not common subjects within reality TV. When presented in film, the overall impression has been reported to be negative. The British reality TV show 'Embarrassing Bodies' includes within its format, cases where complex and extensive dental treatment is presented. This analysis examines how these cases frame dentistry, as a rare example of the profession and its activities upon the small screen. METHODS: 14 dental cases from the show were located and transcribed. Semiotic and thematic analysis was used to explore the deeper and hidden meanings and signs within the cases. This developed understanding of the implications of the show upon the public presentation of dentistry, oral health and disease, patients and dental professionals. RESULTS: Five distinct themes were identified within the corpus of cases; Professional Values and Portrayal of Cosmetic Dentistry; The Presentation of Oral Health and Disease; Dental Physiognomy; Dentistry as Empowerment and Unequal Professional Relationships. CONCLUSIONS: 'Embarrassing Bodies' portrays a presentation of dentistry that focuses disproportionately upon restorative dental interventions, especially cosmetic dental therapies, in preference to preventative treatment. Dental disease is presented in a way that associates oral health conditions with dirt and as being caused by neglect and carelessness.

Professionalism by proxy: a case for the formal regulation of dental assistants in Australia.

Dental assistants are the most numerous member of the dental team in Australia, responsible for many clinical and non-clinical duties. Despite this, dental assistants are not registered and regulated in the same manner as their clinical colleagues within the dental profession. In this article, the authors argue that this is an unacceptable situation within the Australian dental context. In the examination of events within the profession both within Australia and overseas, it becomes apparent that this is an untenable position with regards to promoting the safety of the public. The current stance towards dental assistants is often perpetuated by a dental profession whose motives would not seem to be free from issues of professional dominance. Dental assistants may also be an essential division of the dental profession in providing culturally competent, economically viable and sustainable oral healthcare to those communities that are traditionally difficult to access.

Biopsy of the sentinel lymph node in oral squamous cell carcinoma: analysis of error in 100 consecutive cases.

UK national guidelines in 2016 recommended that sentinel lymph node biopsy should be offered to patients with early oral cancer (T1-T2 N0) in which the primary site can be reconstructed directly. This study describes the pitfalls that can be avoided in the technique of biopsy to improve outcomes. We retrospectively analysed the data from 100 consecutive patients and recorded any adverse events. Lymphatic drainage of tracer failed in two patients as a result of procedural errors. Two patients with invaded nodes developed recurrence after total neck dissection, one after micrometastases had been diagnosed, and the other as a result of extranodal spread that had led to understaging and therefore undertreatment. Two results would not have been mistakenly classified as clear if all the harvested nodes had been analysed histologically according to the protocol. The disease-specific (96%) and disease-free (92%) survival were better than expected for a group of whom a third had stage 3 disease. If all harvested nodes had been analysed by the correct protocol then two of the three nodes wrongly designated clear would have been detected, two deaths potentially avoided, and the false-negative rate would have fallen from 8.3% to 2.7%. We conclude that minor deviations from protocol can result in a detrimental outcome for the patient.

Consumer-driven and commercialised practice in dentistry: an ethical and professional problem?

The rise and persistence of a commercial model of healthcare and the potential shift towards the commodification of dental services, provided to consumers, should provoke thought about the nature and purpose of dentistry and whether this paradigm is cause for concern. Within this article, whether dentistry is a commodity and the legitimacy of dentistry as a business is explored and assessed. Dentistry is perceived to be a commodity, dependent upon the context of how services are to be provided and the interpretation of the patient-professional relationship. Commercially-focused practices threaten the fiduciary nature of the interaction between consumer and provider. The solution to managing commercial elements within dentistry is not through rejection of the new paradigm of the consumer of dental services, but in the rejection of competitive practices, coercive advertising and the erosion of professional values and duty. Consumerism may bring empowerment to those accessing dental services. However, if the patient-practitioner relationship is reduced to a mere transaction in the name of enhanced consumer participation, this empowerment is but a myth.

What do dental codes of ethics and conduct suggest about attitudes to raising concerns and self-regulation?

Background The ability of the dental profession to self-regulate and address poor performance or impairment is crucial if practitioners are to demonstrate a public commitment to patient safety. Failure of the profession to actively engage in this activity is likely to call into question trustworthiness and ability to place the interests of patients and the public first.Aim To investigate attitudes towards self-regulation and the raising of concerns as expressed through the ethical codes of different dental professional and regulatory organisations.Method A qualitative review of professional codes of ethics written and published by dental associations and regulatory bodies using thematic analysis to discern common attitudes and perspectives on self-regulation.Results Four main themes were identified; (1) explicit expression of the need to report; (2) warning against frivolous reporting; (3) acceptance of reporting being difficult and; (4) threshold requiring a professional to report. From these themes, common and differing attitudes were then explored.Conclusions This review shows that often codes of ethics and practice do discuss an obligation to self-regulate and raise concerns but that this is accompanied by an anxiety surrounding unsubstantiated or malicious reporting. This gives the collective guidance a defensive tone and message that may be unhelpful in promoting a culture of openness and candour.

The future of failure to warn in dentistry after Montgomery: reflections from Australia.

The switch from the standard of the reasonable professional, to that of the reasonable patient in cases where it is alleged that a health professional has not imparted sufficient information to allow the gaining of valid consent, has created anxiety and confusion within the dental profession. The ruling in Montgomery v Lanarkshire Health Board is relatively young; there have been insufficient subsequent cases to truly allow a deep exploration of the real changes that the case will bring to the way dentistry and other health activities are provided. One way that light may be shone onto the significance of Montgomery is to examine the development of the law in this area from Australia. Australia and the UK share a common history and while each legal system is independent from the other, they hold significant influence upon each other's destiny. This article seeks to shed light on the true relevance of Montgomery to dentistry in the UK through examination of the Australian position towards the gaining of valid consent which has enjoyed somewhat of a head-start in this area of the law.