Predictors of Unmet Dental Health Needs in US Adults in 2018: A Cross-Sectional Analysis.

OBJECTIVE: To identify predictors of unmet dental needs for adults 18 y of age or older in the United States. METHOD: Using the Aday and Andersen framework and data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), we ran logistic regression to estimate predictors for adults of not having a dental visit within 5 y and having lost any teeth using a national sample of 155,060 survey respondents. RESULTS: Results showed that predisposing factors (age, race/ethnicity, gender, and educational attainment) and enabling factors (income and health insurance status) are important predictors for losing teeth due to decay or gum disease. Men, the elderly, and less educated and low-income residents were less likely to have seen a dentist within the past 5 y and more likely to have lost their permanent teeth. Compared to non-Hispanic White adults, Hispanics adults were more likely to have had a dental visit within the past 5 y. Unmet dental needs varied across states. People living in states with extensive Medicaid dental care benefit coverage were less likely to lose their teeth and more likely to have had a dental visit within the past 5 y. CONCLUSION: Efforts to improve oral health should address unmet dental needs of men and adults with low socioeconomic status. Studying the variation between state oral health care programs could further our understanding of how public policy can improve population oral health. KNOWLEDGE TRANSFER STATEMENT: Men, non-Hispanic Blacks, mixed and other race minorities, and low socioeconomic status adults are most at risk of unmet dental needs. States can address these needs by expanding Medicaid coverage for adults.

Prevalence, risk factors, and type of sleep apnea in patients with paroxysmal atrial fibrillation.

BACKGROUND: Recent studies have suggested an association between sleep apnea (SA) and atrial fibrillation (AF). We aimed to study the prevalence, characteristics, risk factors and type of sleep apnea (SA) in ablation candidates with paroxysmal AF. METHODS/RESULTS: We prospectively studied 579 patients with paroxysmal AF, including 157 women (27.1%) and 422 men (72.9%). Mean age was 59.9 ± 9.6 years and mean body mass index (BMI) 28.5 ± 4.5 kg/m2. SA was diagnosed using polygraphy for two nights at home. The Epworth Sleepiness Scale (ESS), STOP-Bang Questionnaire, and Berlin Questionnaire (BQ) assessed the degree of SA symptoms. A total of 479 (82.7%) patients had an apnea-hypopnea index (AHI) ≥ 5, whereas moderate-severe SA (AHI ≥ 15) was diagnosed in 244 patients (42.1%). The type of SA was predominantly obstructive, with a median AHI of 12.1 (6.7-20.6) (range 0.4-85.8). The median central apnea index was 0.3 (0.1-0.7). AHI increased with age, BMI, waist and neck circumference, body and visceral fat. Using the Atrial Fibrillation Severity Scale and the SF-36, patients with more severe SA had a higher AF burden, severity and symptom score and a lower Physical-Component Summary score. Age, male gender, BMI, duration of AF, and habitual snoring were independent risk factors in multivariate analysis (AHI ≥ 15). We found no association between ESS and AHI (R2 = 0.003, p = 0.367). CONCLUSIONS: In our AF population, SA was highly prevalent and predominantly obstructive. The high prevalence of SA detected in this study may indicate that SA is under-recognized in patients with AF. None of the screening questionnaires predicted SA reliably.

Smart Diabetic Screening and Managing Software, A Novel Decision Support System.

BACKGROUND: Diabetes is a serious chronic disease, and its increasing prevalence is a global concern. If diabetes mellitus is left untreated, poor control of blood glucose may cause long-term complications. A big challenge encountered by clinicians is the clinical management of diabetes. Many IT-based interventions such ad CDSS have been made to improve the adherence to the standard care for chronic diseases. OBJECTIVE: The aim of this study is to establish a decision support system of diabetes management based on diabetes care guidelines in order to reduce medical errors and increase adherence to guidelines. MATERIALS AND METHODS: To start the process, at first the existing guidelines in the field of diabetes mellitus such as ADA 2017 and AACE guideline 2017 were reviewed, and accordingly, flowcharts and algorithms for screening and managing of diabetes were designed. Then, it was passed on to the information technology team to design software. RESULTS: The most significant outcome of this research was to establish a smart diabetic screening and managing software, which is an important stride to promote patients' health status, control diabetes and save patients' information as an important and reliable source. CONCLUSION: Health care technologies have the potential to improve the quality of diabetes care through IT-based intervention, such as clinical decision support systems. In a chronic disease like diabetes, the critical component is the disease management. The advantages of this web-based system are on-time registration, reports of diabetic prevalence, uncontrolled diabetes, diabetic complications and reducing the rate of mismanagement of diabetes, so that it helps the physicians in order to manage the patients in a better way.

Evaluation of different gridded rainfall datasets for rainfed wheat yield prediction in an arid environment.

The accuracy of daily output of satellite and reanalysis data is quite crucial for crop yield prediction. This study has evaluated the performance of APHRODITE (Asian Precipitation-Highly-Resolved Observational Data Integration Towards Evaluation), PERSIANN (Rainfall Estimation from Remotely Sensed Information using Artificial Neural Networks), TRMM (Tropical Rainfall Measuring Mission), and AgMERRA (The Modern-Era Retrospective Analysis for Research and Applications) precipitation products to apply as input data for CSM-CERES-Wheat crop growth simulation model to predict rainfed wheat yield. Daily precipitation output from various sources for 7 years (2000-2007) was obtained and compared with corresponding ground-observed precipitation data for 16 ground stations across the northeast of Iran. Comparisons of ground-observed daily precipitation with corresponding data recorded by different sources of datasets showed a root mean square error (RMSE) of less than 3.5 for all data. AgMERRA and APHRODITE showed the highest correlation (0.68 and 0.87) and index of agreement (d) values (0.79 and 0.89) with ground-observed data. When daily precipitation data were aggregated over periods of 10 days, the RMSE values, r, and d values increased (30, 0.8, and 0.7) for AgMERRA, APHRODITE, PERSIANN, and TRMM precipitation data sources. The simulations of rainfed wheat leaf area index (LAI) and dry matter using various precipitation data, coupled with solar radiation and temperature data from observed ones, illustrated typical LAI and dry matter shape across all stations. The average values of LAImax were 0.78, 0.77, 0.74, 0.70, and 0.69 using PERSIANN, AgMERRA, ground-observed precipitation data, APHRODITE, and TRMM. Rainfed wheat grain yield simulated by using AgMERRA and APHRODITE daily precipitation data was highly correlated (r2 ≥ 70) with those simulated using observed precipitation data. Therefore, gridded data have high potential to be used to supply lack of data and gaps in ground-observed precipitation data.

Intrathecal Autologous Bone Marrow-Derived Hematopoietic Stem Cell Therapy in Neurological Diseases.

BACKGROUND: Cellular transplantation is a promising treatment strategy for neurological diseases. OBJECTIVE: To report the results of intrathecal hematopoietic stem cell therapy in different neurological diseases in the past 6 years in a single center. METHODS: From October 2011 to September 2018, 220 patients with various neurological diseases were transplanted intrathecally by their bone marrow stem cells. To have a longer follow up, we only reported the first 80 patients, transplanted up to July 2015-10 patients had spinal cord injuries and paralysis, 12 had advanced Parkinson's disease, 28 had cerebral palsy, 7 had hypoxic brain damage, 2 had autism, 4 had multiple sclerosis, 5 had progressive cerebellar atrophy, and 12 had other neurological diseases. The patients were admitted to the Bone Marrow Transplant Unit. On the first day, 50-200 (median 100) mL bone marrow was aspirated from the patients' posterior iliac crests, mixed with 120 mL culture media (RPMI), and 12 mL heparin. The samples were then transferred to immunology lab in cold box. Mononuclear cells (MNCs) were separated by a Ficoll-Hypaque gradient, washed, and suspended in ringers. Cell viability was assessed with trypan blue viability test. Transplantation was performed 3-4 hours after bone marrow collection. 5-10 mL of the cerebrospinal fluids were aspirated and about 20 mL MNCs (containing stem cells) in ringers were injected intrathecally (IT). The patients were laid down on their back for 4-5 hours. The median number of MNCs was 4×107 (range 1-450×107). The median viability of the cells was 90% (range 60%-98%). The patients received intravenous ceftriaxone every 12 hours and were discharged from the hospital few days after autologous stem cell therapy. RESULTS: We noted clinical improvements in 9 of 12 patients with Parkinson's disease, 20 of 28 patients with cerebral palsy, 6 of 7 patients with hypoxic brain damage, 2 of 4 patients with multiple sclerosis, and 4 of 5 patients with cerebellar atrophy. The improvements were noted after 2-4 weeks of cell therapy. There were no improvements in patients with spinal cord injury and complete paralysis and those with autism. There were variable improvements in other patients treated. CONCLUSION: Most patients with advanced Parkinson's disease, cerebral palsy, hypoxic brain damage, progressive cerebellar atrophy, and kernicterus neuropathy reported clinical effects of this safe intervention resulting in better functioning and an increased quality of life.

Autolysis control and structural changes of purified ficin from Iranian fig latex with synthetic inhibitors.

The fig's ficin is a cysteine endoproteolytic enzyme, which plays fundamental roles in many plant physiological processes, and has many applications in different industries such as pharmaceutical and food. In this work, we report the inhibition and activation of autolysis and structural changes associated with reaction of ficin with iodoacetamide and tetrathionate using high-performance liquid chromatography (HPLC), ultra filtration membrane, and dynamic light scattering (DLS) methods. The ficin structural changes were also determined using UV-absorption, circular dichroism (CD), fluorescence spectroscopy, and differential scanning calorimetry (DSC) techniques. These techniques demonstrated that iodoacetamide completely inhibited ficin autolysis, which was irreversible. However, tetrathionate partially and reversibility inhibited its autolysis. The ficin structural changes with two synthetic inhibitors were associated with secondary structural changes related to decreased alpha-helix and increased beta sheet and random coil conformations, contributing to its aggregation.

Towards proposition of a diagnostic reference level for mammographic examination in the greater Khorasan Province, Iran.

Although, over the past few years, the application of mammography has risen up sharply in Iran, very little, if any, has been reported of the extent of patient's dose from this type of imaging. The purpose of this study was to establish local diagnostic reference level (DRL) arising from mammography in the great Khorasan province of Iran. It is generally assumed that the glandular tissue is the most vulnerable type of breast tissue. Therefore, the mean glandular dose (MGD) has been widely accepted as the most appropriate dosimetric quantity to predict the risk of radiation-induced cancer. Literary, DRL for mammography is defined as the 75th percentile of MGD distribution. In Khorasan province, 7 out of 40 centres were randomly selected. In this work, 100 patients were studied. Thermoluminescence dosimeters have been used to measure entrance surface doses (ESDs). Since, it is difficult to directly measure MGD, Monte Carlo model-based conversion factors were utilised to conclude MGD from ESD. The results have revealed that patients dose is varied widely. The measured ESDs ranged from 0.74 to 19.81 mGy for the craniocaudal (CC) view and 1.20 to 25.79 mGy for the mediolateral oblique (MLO) view. The average MGDs per image were 0.88 and 1.11 mGy for CC and MLO views, respectively. Based on the internationally adopted definition, DRL arising from mammography tests for Khorasan is 1.33 mGy. Implementation of a dose reduction programme is suggested because of the large variations observed in patient MGD values. In this study, the DRL value is significantly lower than the corresponding values suggested by other researchers elsewhere.

Inverted impacted primary maxillary incisors: a case report.

Tooth impaction rarely occurs in primary dentition. Most of the primary teeth impactions are seen in second molars. The purpose of this article is to present a 4-year-old girl with bilateral impaction of inverted primary maxillary central incisors which trauma had displaced their tooth germ before erupting.

The intermediary role of self-efficacy in relation with stress, glycosylated haemoglobin and health-related quality of life in patients with type2 diabetes.

BACKGROUND: Stress is not always a direct result of stressful conditions, but rather the way they are perceived. Thus individual variables that may be associated with perceived stress should be examined in stress studies. This study investigates the intermediary role of self-efficacy in relation with stress, glycosylated haemoglobin and health-related quality of life in patients with type2 diabetes. METHODS: All women with diabetes in Yazd Diabetes Research Centre, in 2012, were considered and 80 women were selected by random sampling. They completed Shirer's self-efficacy scale questionnaire, depression, anxiety and stress scale (DASS), and ADDQ0L19 questionnaire. Then they were introduced to the lab for blood test. Data were analysed by SPSS software and stepwise regression method. RESULTS: Pearson correlation test results showed that the hemoglobin A1c (r = 0.35) and Quality of Life (r = -0.22) are associated with stress (P <0.05). As so hemoglobin A1c (r = 0.83) and Quality of Life (r = 0.37) with variable of self efficacy are associated positively and significantly (P <0.05). Results of stepwise regression also showed that self efficacy and stress scales 0.697 of variance hemoglobin A1c and 0.140 of variance of Quality of life explaining to do. CONCLUSION: The impact of stress on blood sugar and patients' health-related quality of life can be influenced by their self-efficacy; therefore it is suggested that an educational intervention is done to increase patients' self-efficacy to better cope with stress in their life.

DXRaySMCS: a user-friendly interface developed for prediction of diagnostic radiology X-ray spectra produced by Monte Carlo (MCNP-4C) simulation.

In this work, the general purpose Monte Carlo N-particle radiation transport computer code (MCNP-4C) was used for the simulation of X-ray spectra in diagnostic radiology. The electron's path in the target was followed until its energy was reduced to 10 keV. A user-friendly interface named 'diagnostic X-ray spectra by Monte Carlo simulation (DXRaySMCS)' was developed to facilitate the application of MCNP-4C code for diagnostic radiology spectrum prediction. The program provides a user-friendly interface for: (i) modifying the MCNP input file, (ii) launching the MCNP program to simulate electron and photon transport and (iii) processing the MCNP output file to yield a summary of the results (relative photon number per energy bin). In this article, the development and characteristics of DXRaySMCS are outlined. As part of the validation process, output spectra for 46 diagnostic radiology system settings produced by DXRaySMCS were compared with the corresponding IPEM78. Generally, there is a good agreement between the two sets of spectra. No statistically significant differences have been observed between IPEM78 reported spectra and the simulated spectra generated in this study.

Organ and effective doses of patients arising from coronary angiography and percutaneous transluminal coronary angioplasty at two hospitals in Mashhad-Iran.

A detailed study of radiation doses received by 83 patients who underwent coronary angiography (CA) and 26 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) by the femoral route in two hospitals in Mashhad-Iran is presented. All procedures were undertaken with Siemens angioscope X-ray equipment. Thermoluminescent dosimeters (TLD-100), suitably calibrated, were used to measure the dose received at five locations on the patient's skin (on the thyroid, gonads and lens of eyes). A dose area product (DAP) meter was also used. DAP values and fluoroscopy times were recorded for each patient. The mean values for DAP were 32.47+/-4.03 and 44.49+/-5.64 Gy cm2 for CA and PTCA, respectively. The patient dosimetry results revealed the thyroid receives the highest dose in CA and PTCA examinations. Also, in this study, DAP to effective dose conversion factors were estimated by means of a Rando phantom and the effective dose received by the patients was estimated for CA and PTCA examinations. The estimated mean values of effective dose were 6.75+/-0.85 and 9.61+/-1.24 mSv, respectively.

Highly selective oxalate-membrane electrode based on 2,2'-[1,4-butandiyle bis(nitrilo propylidine)]bis-1-naphtholato copper(II).

A new oxalate-selective electrode based on the complex 2,2'-[1,4-butandiyle bis(nitrilo propylidine)]bis-1-naphtholato copper(II) (CuL) as the membrane carrier was developed. The electrode exhibited a good Nernstian slope of -29.2+/-0.6 mV/decade (mean value+/-standard deviation, n=5) and a linear range of 5.0 x 10(-8) to 1.0 x 10(-1)M for oxalate. The limit of detection was 5.0 x 10(-8)M. This electrode represents a fast response time (i.e. 10-15s) and could be used for more than 3 months. The selectivity coefficients were determined by the fixed interference method (FIM) and could be used in the pH range of 2.0-7.0. It was employed as an indicator electrode for the determination of oxalate in water samples.

Salicylate poly(vinyl chloride) membrane electrode based on (2-[(E)-2-(4-nitrophenyl) hydrazono]-1-phenyl-2-(2-quinolyl)-1-ethanone) Cu(II).

A new salicylate-selective electrode based on the complex of (2-[(E)-2-(4-nitrophenyl)hydrazono]-1-phenyl-2-(2-quinolyl)-1-ethanone) Cu(II) as the membrane carrier was developed. The electrode exhibited a good Nernstian slope of -59.6+/-1.0 mV/decade and a linear range of 1.0 x 10(-6) to 1.0M for salicylate. The limit of detection was 5.0 x 10(-7) M. The electrode had a fast response time of 10 s and can be used for more than 3 months. The selective coefficients were determined by the fixed interference method and could be used in the pH range of 4.0 to 10.5. The electrode was employed as an indicator electrode for direct determination of salicylate in pharmaceutical and biological samples.

Perchlorate-selective membrane electrode based on a new complex of uranil.

A potentiometric ion-selective electrode based on new compound, as a carrier, has been successfully developed for detection of perchlorate anion in aqueous solution. Within the perchlorate ion concentration range 1.0x10(-6) to 1.0 mol L(-1) the electrode had a linear response with a Nernstian slope of 60.6+/-1.0 mV per decade . The limit of detection as determined from the intersection of the extrapolated linear segments of the calibration plot was 8.0x10(-7) mol L(-1). The proposed electrode has fairly a good discriminating ability towards ClO(4) (-) ion in comparison to other anions. The sensor has a response time of < or =10 s and can be used for at least 2 months without substantial divergence in potential. It was successfully applied to direct determination of perchlorate in urine and water.

Nickel-induced substrate inhibition of bovine liver glutamate dehydrogenase.

The effects of nickel ions on reductive amination and oxidative deamination activities of bovine liver glutamate dehydrogenase (GDH) were examined kinetically by UV spectroscopy, at 27 degrees C, using 50 mM Tris, pH 7.8, containing 0.1 M NaCl. Kinetic analysis of the data obtained by varying NADH concentration indicated strong inhibition, presumably due to binding of the coenzyme to the regulatory site. In contrast, almost no inhibition was observed in the forward reaction. The fact that nickel ions have the capacity to enhance binding of NADH to the enzyme was confirmed by an electrochemical method using a modified glassy carbon electrode. Use of NADPH instead of NADH showed only a weak substrate inhibition, presumably related to lower affinity of NADPH for binding to the regulatory site. Lineweaver-Burk plots with respect to alpha-ketoglutarate and ammonium ions indicated substrate and competitive inhibition patterns in the presence of nickel ions, respectively. ADP at 0.2 mM concentration protected inhibition caused by nickel. These observations are explained in terms of formation of a nickel-NADH complex with a higher affinity for binding to the regulatory site in GDH, as compared with the situation where nickel is not present. Such effects may be important for regulation of GDH and other NADH-utilizing enzymes.