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Children commonly refuse induction of anesthesia. Anesthesia providers must then decide whether to honor the child's dissent or to proceed over objection. In some circumstances, a forced induction involves restraining the child, incurring both practical and ethical harms to the patient‐provider encounter. This educational review explores the practical dilemma encountered when a child dissents to induction of anesthesia. In the course of exploring this dilemma, dissent and associated terms are defined and compared, and the prominent ethical underpinnings regarding pediatric decision‐making are described to clarify dissent as an ethical and practical concept. Important legal and professional standards are summarized, and practice trends are discussed to depict the current state of practice, including novel approaches to honoring pediatric dissent for elective surgeries. This information is then used to invite providers to consider where they ethically situate themselves within a legally and professionally defined space of acceptable practice. Finally, these considerations are synthesized to discuss important nuances regarding pediatric refusal, and some key questions are presented for clinicians to ponder as they consider their practice of choosing whether to honor pediatric dissent at induction. [ABSTRACT FROM AUTHOR]

The increasing interest in supporting human psychological wellbeing in the workplace should be applauded. Within the animal health industry, especially in veterinary and welfare sectors, the need to support staff has perhaps never been more salient. One support method that can be appealing for organisations is to offer interventions that are group based. Groups can be viewed as cost effective by delivering help to a number of people at one time; however, they are often wrongly perceived as a quick and cheap option. Moreover, groups are commonly believed to be pleasant places which, by their very nature, will be social, kind and healing – but this can be a misplaced belief. Groups may provide few or none of the intended outcomes, or even cause more harm than good. Just as a medication can have unwanted and sometimes harmful side effects, so too can psychological and social interventions. Leaning on our experience of running formal groups in a number of different ways, in this article we aim to share thinking about what is needed to run groups to support staff wellbeing. We also cover factors to consider before embarking on this type of intervention to ensure that groups help staff rather than harm them. [ABSTRACT FROM AUTHOR]

Grassland degradation is challenging the health of grassland ecosystems globally and causing biodiversity decline. Previous studies have demonstrated the impact of grassland degradation on the abundance and behavior of small mammals. Little is known about how it affects the genetic structure of gregarious mammals in the wild. This study explores the effects of grassland degradation on the genetic structure of a small burrowing mammal, plateau pika (Ochotona curzoniae). We used nine microsatellite loci to analyze the genetic diversity and genetic differentiation between colonies and genetic relatedness between individuals within the colony. We found that pikas in severely degraded grasslands had a significantly higher genetic diversity within colonies, a higher level of gene flow between colonies, and a lower genetic differentiation between colonies compared to pikas in less degraded grasslands. Individuals within colonies had a significantly lower genetic relatedness in severely degraded grasslands than in less degraded grasslands. This study has provided potential evidence of a significant impact of grassland degradation on the genetic structure of pikas, which has caused a breakdown of their kin‐selected colony structure. [ABSTRACT FROM AUTHOR]

Background: Shielding was introduced to protect clinically extremely vulnerable people during the COVID‐19 pandemic. For junior doctors who had to shield, this meant pausing in‐person clinical duties to protect their health. There is limited literature regarding this, and the available evidence is predominantly surveys or blogs that describe mainly negative experiences including guilt, isolation, inadequate support and Return To Work (RTW) concerns. Exploring the experiences of this group is valuable to understand the impact on them, and their support needs moving forward. Methods: This was a qualitative study using individual semi‐structured interviews. Three junior doctors were recruited using volunteer and snowball sampling. Interview transcripts were analysed using thematic analysis. Findings: Seven themes were finalised: (1) Professional value, (2) Threatened autonomy, (3) Self‐motivated, (4) Educational impact, (5) Mental health, (6) Inadequate support and (7) Return To Work concerns. Discussion: Participant experiences largely reflected the evidence base including increased skill and knowledge acquisition, alongside guilt, isolation and inadequate support whilst shielding and upon RTW. These findings add valuable qualitative data to a scarcity of literature. However, caution should be applied when transferring these findings to other junior doctors, noting the small sample and regional setting. A small research grant has been secured for further research with a larger sample size incorporating the supervisor perspective. Conclusion: These findings demonstrate that shielding was a challenging experience for these junior doctors including impacts on mental health and insufficient support. This lack of support requires further attention to refine and strengthen available support structures. [ABSTRACT FROM AUTHOR]

Globally, grassland degradation is an acute ecological problem. In alpine grassland on the Tibetan Plateau, increased densities of various small mammals in degraded grassland are assumed to intensify the degradation process and these mammals are subject to lethal control. However, whether the negative impact of small mammals is solely a result of population size or also a result of activity and behavior has not been tested. In this study, we use plateau pika as a model to compare population size, core area of colony, and the number of burrow entrances and latrines between lightly and severely degraded grassland. We test whether the alleged contribution of pika to grassland degradation is a result of increased population size or increased burrowing activities of individuals in response to lower food abundance. We found that grassland degradation resulted in lower plant species richness, plant height, and biomass. Furthermore, the overall population size of pika was not significantly affected by location in lightly and severely degraded grassland. However, pika core areas in severely grassland degradation were significantly larger and had significantly higher densities of burrows and latrines. Our study provides convincing evidence that habitat‐induced changes in the behavior of small, burrowing mammals, such as pika, can exacerbate grassland degradation. This finding has significant implications for managing small mammals and restoring degraded grassland ecosystems. [ABSTRACT FROM AUTHOR]

Background: Placenta accreta spectrum (PAS) is a rare but serious complication of pregnancy. Aims: The aim of this study was to determine maternal and neonatal outcomes following a combined surgical and interventional radiology (IR) approach to managing PAS, and the risks associated with this technique. Methods and Materials: Retrospective cohort study of all cases of PAS in a tertiary maternity centre between January 2001 and July 2020. Women who underwent caesarean hysterectomy for histologically confirmed PAS with a staged surgical and IR approach were compared with those who underwent caesarean hysterectomy without IR. Maternal, neonatal outcomes, surgical and radiological complications were assessed. Results: Forty‐six women were included in the study, and 30/46 (65.2%) underwent the staged surgical and IR approach. Women in the staged group had less overall blood loss (1794 mL vs 3713 mL; P < 0.001), less requirement for blood transfusion (40% vs 75%; P < 0.001), and a lower mean volume of packed red cells transfused (2.5 vs 6.1 units). Anaesthetic and operative times were longer for the staged group (468 vs 189 min: 272 vs 141 min P < 0.001), respectively. There were no differences in rates of neonatal or maternal complications between the two groups. Conclusion: This study demonstrates that a staged procedure combining surgery and IR for PAS results in a considerable reduction in blood loss, need for transfusion, and units of packed red cells transfused compared with surgery alone. The staged procedure required significantly longer anaesthetic and operative times; however, there were no differences in maternal and neonatal morbidity. [ABSTRACT FROM AUTHOR]

Yet, few resources have been allocated to the training of novice reviewers or recognition of their contributions to the peer review process. In this insights article, we reflect on our experiences and provide recommendations for future peer review skills training programmes. Yet, few resources have been allocated to the training of novice reviewers or recognition of their contributions to the peer review process. [Extracted from the article]

Objective: There has been limited examination of how community‐level supports may influence oral health metrics among children. The purpose of our study is to examine the association between two types of community‐level positive childhood experiences and oral healthcare and oral health outcomes among children ages 6 to 17 years of age. Methods: This study uses a cross‐sectional data set from the 2018–2019 National Survey of Children's Health. Two oral health metrics were used: preventive dental care, measured as one or more preventive dental visits in the past 12 months, and tooth decay, measured as tooth decay or cavities in the last 12 months. To quantify living in safe, stable, equitable environments, questions on residing in a safe and supportive neighborhood were used. Descriptive statistics and bivariate analyses were used to calculate frequencies, proportions, and unadjusted associations for each variable (n = 40,290). Multivariable logistic regression models were used. Results: In an adjusted analysis, children who lived in a supportive neighborhood had a higher likelihood of receiving a preventive dental visit than children who did not live in a supportive neighborhood (aOR 1.41; 95% CI 1.21–1.65). Children who lived in a safe neighborhood were less likely to have tooth decay than children who did not live in a safe neighborhood (aOR 0.75; 95% CI 0.65–0.86). Conclusions: The findings from this study highlight the role of social structures in tightening the safety net for oral healthcare in children. [ABSTRACT FROM AUTHOR]

Objectives: The Coronavirus Aid, Relief, and Economic Security (CARES) Act appropriated $100 billion to the Provider Relief Fund, allowing for direct payments to health care providers due to COVID‐19. Few studies have evaluated participation in the Provider Relief Fund (PRF), and none have specifically looked at dental providers in the safety net. Methods: We conducted a retrospective, secondary data analysis using a quasi‐experimental cohort design of South Carolina dentists who received PRF payments, comparing those who did and did not participate in the safety net. Safety net practice was operationalized as those participating in Medicaid, and whether they provided care in dental health professional shortage areas, or rural communities. Results: Of the 628 dental providers in South Carolina who received PRF payments, 34% were identified as Medicaid providers while 66% did not participate in Medicaid; we found no statistical difference between payments to Medicaid versus non‐Medicaid dental providers. Of PRF payments to dental providers participating in South Carolina's Medicaid program, we found no difference between payments to rural and urban providers but did find that practices offering services in dental care shortage areas received less than providers practicing in counties not designated as a shortage area. Conclusions: The PRF achieved its goal of distributing financial support to providers affected by the COVID‐19 pandemic. But without policy imperatives linked to need‐based allocations or incentives for PRF recipients to serve safety net populations, we may later learn this was a missed opportunity for PRF. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of our study was to examine the association between rurality and select oral health care metrics: teeth condition, decay, and access measures such as preventive dental care among children in the United States. Methods: We conducted a cross‐sectional study with a sample of 20,842 respondents from the 2017 to 2018 National Survey of Children's Health (NSCH), a nationally representative sample of U.S. children. Socio‐demographic information, residence, and oral health and healthcare utilization information were used to create study variables. Descriptive statistics, bivariate analyses, and a multivariable regression model were performed. Results: Rural children were less likely to have a preventive dental visit than urban children (84.9 percent versus 87.5 percent, P = 0.03). Children residing in rural areas were more likely to have their teeth condition reported as fair or poor than children residing in urban areas (7.3 percent versus 6.6 percent, P = 0.02). Compared to their urban counterparts, rural children were also less likely to have received fluoride treatment (46.6 percent versus 52.5 percent, P = 0.0022) and less likely to have received a dental sealant (19.5 percent versus 22.5 percent, P = 0.0147). In adjusted analysis, there was no significant difference in receiving a preventive dental visit for rural children, compared to their urban counterparts. Conclusions: As preparations are made for the 2020 Surgeon General's report on oral health, the current study provides important evidence to inform future advocacy and legislative priorities. To reduce urban–rural disparities among children, there must be enhanced dental care access, dental workforce expansion, and increased awareness about preventive oral health services. [ABSTRACT FROM AUTHOR]

In species with obligate sexual reproduction, scarcity of males can occasionally limit female reproductive success. It is unclear, however, whether this impacts population‐level persistence. Sexually deceptive orchids attract mate‐searching male insects who lose time, mating opportunities and may even become sperm depleted by mating with flowers. These insects are almost exclusively haplodiploid, and able to reproduce regardless of sperm availability – which might mitigate costs of deception. We model the population dynamics of deceived diploid or haplodiploid pollinators. The model reveals that haplodiploidy can enhance prospects for coexistence. If 'sperm theft' by orchids is severe enough to generate unmated females in the local pollinator pool, this enhances the production of sons, which are subsequently available to act as pollinators. The mechanism relies on female haplodiploids being able to reproduce with or without sperm; this is absent in many diploid insects – where unmated females do not reproduce. We show that this gives haplodiploids an ability to maintain higher population densities, and to persist up to higher orchid densities, than diploids. Our model identifies the enhanced resilience of haplodiploid pollinators against deceptive exploitation as a possible reason why these systems have persisted. [ABSTRACT FROM AUTHOR]

Objectives: Poor oral health has been shown to be associated with selected adverse health outcomes. This study assessed the association between untreated dental caries and mortality and examined whether having dental insurance mitigates the risk of mortality among working‐age US adults with dental caries. Methods: Analysis used the publicly available linked mortality file for NHANES III, an observational study conducted in 1988‐1994, with follow‐up through December 2015. Propensity score matching was conducted to create similar populations of insured and uninsured adults, resulting in a sample of 4420 matched observations. The Cox proportional hazard model was used to investigate the effect of untreated dental caries and that of dental insurance on risk of all‐cause mortality. The descriptive and final outcome statistical analyses were adjusted for complex sampling technique using weights, strata and cluster variables. Results: Adults with untreated dental caries had a higher risk of mortality (HR: 1.33; 95% CI: 1.06‐1.68) than those with no dental caries. Having dental insurance was associated with a lower risk of mortality (HR: 0.73; 95% CI: 0.59‐0.92). An interaction between caries treatment status and dental insurance was not statistically significant. Conclusions: Adults with untreated dental caries have a higher risk of mortality, even in the presence of dental insurance. Untreated caries may be an indicator for multiple risk factors, including personal attitudes regarding health and healthcare‐seeking behaviour. [ABSTRACT FROM AUTHOR]

Plate reconstruction studies show that the Neotethys Ocean was closing due to the convergence of Africa and Eurasia toward the end of the Cretaceous. The period around 75 Ma reflects the onset of continental collision between the two plates as convergence continued to be taken up mostly by subduction of the Neotethys slab beneath Eurasia. The Owen transform plate boundary in the northeast accommodated the fast northward motion of the Indian plate relative to the African plate. The rest of the plate was surrounded by mid‐ocean ridges. Africa was experiencing continent‐wide rifting related to northeast‐southwest extension. We aim to quantify the forces and paleostresses that may have driven this continental extension. We use the latest plate kinematic reconstructions in a grid search to estimate horizontal gravitational stresses (HGSs), plate boundary forces, and the plate's interaction with the asthenosphere. The contribution of dynamic topography to HGSs is based on recent mantle convection studies. We model intraplate stresses and compare them with the strain observations. The fit to observations favors models where dynamic topography amplitudes are smaller than 300 m. The results also indicate that the net pull transmitted from slab to the surface African plate was low. To put this into context, we notice that available tectonic reconstructions show fragmented subduction zones and various colliding micro‐continents along the northern margin of the African plate around this time. We therefore interpret a low net pull as resulting from either a small average slab length or from the micro‐continents' resistance to subduction. Key Points: Deformation of the African plate 75 Ma was mainly driven by horizontal gravitational stress, transform shear and weak slab pullThe weak pull from the Neotethys slab indicates that the slab was short or the pull was reduced by mantle resistance or by slab buoyancyThe complex closure history of the Neotethys Ocean is a likely candidate for the limited pull magnitude [ABSTRACT FROM AUTHOR]

Background: Gene therapy offers an etiologically targeted treatment for genetic disorders. Little is known about the acceptance of mortality risk among patients with progressive, fatal conditions. We assessed patients' and caregivers' maximum acceptable risk (MAR) of mortality for gene therapy when used to treat Duchenne muscular dystrophy (DMD). Methods: The threshold technique was used to assess tolerance for mortality risks using a hypothetical vignette. Gene therapy was described as non‐curative and resulting in a slowing of progression and with a 10‐year benefit duration. MAR was analyzed using interval regression for gene therapy initiated "now"; in the last year of walking well; in the last year of being able to bring arms to mouth; and in newborns (for caregivers only). Results: Two hundred eighty‐five caregivers and 35 patients reported the greatest MAR for gene therapy initiated in last year of being able to lift arms (mean MAR 6.3%), followed by last year of walking well (mean MAR 4.4%), when used "now" (mean MAR 3.5%), and when used in the newborn period (mean MAR 2.1%, caregivers only). About 35% would accept ≥200/2000 risk in the last year of being able to lift arms. Non‐ambulatory status predicted accepting 1.8 additional points in MAR "now" compared with ambulatory status (p = 0.010). Respondent type (caregiver or patient) did not predict MAR. Conclusion: In this first quantitative study to assess MAR associated with first‐generation DMD gene therapy, we find relatively high tolerance for mortality risk in response to a non‐curative treatment scenario. Risk tolerance increased with disease progression. Patients and caregivers did not have significantly different MAR. These results have implications for protocol development and shared decision making. [ABSTRACT FROM AUTHOR]

Aim: To assess the relationship of dental insurance with all‐cause mortality and mortality due to cardiovascular diseases (CVD), diabetes mellitus (DM), and cerebrovascular diseases (CBD) among those with periodontitis. Materials and Methods: NHANES III and its associated mortality data set were used in this study. The outcome variables were "all‐cause mortality" and "combined mortality" due to CVD, DM, and CBD. The independent variable was dental insurance stratified over periodontitis status. Unweighted frequencies with weighted column percentages were used for descriptive statistics, and chi‐square test was applied for significance. Cox proportional hazard models were used for stratified multivariable analyses. All analyses were performed in SAS v9.4 accounting for survey data complexities. Significance level was kept at 5%. Results: The mortality was 14.58% for all‐cause mortality and 4.06% for combined mortality among those with periodontitis in this study. Dental insurance significantly reduced the hazard of all‐cause mortality among those with periodontitis (HR: 0.75; 95% CI: 0.61 – 0.93), adjusted for covariates. However, no association of dental insurance with combined mortality was observed among periodontitis group. Conclusions: Dental insurance reduces hazard of all‐cause mortality among those with periodontitis. Dental insurance ensures access to dentists and improves oral and dental health. Longitudinal study is needed to establish causality. [ABSTRACT FROM AUTHOR]

Objectives: Previously published sealant measures are not useful when applied to Medicaid claims data in states where dental services are carved out of managed care. A novel sealant measure was developed to assess the degree to which dental providers seal eligible teeth during preventive dental visits (PDVs) in an effort to ascertain if such a measure can be used to valuate provider performance, as condition of potential value‐based care model implementation. Methods: A single‐county feasibility study was conducted using Medicaid claims. A study cohort included children aged 8 years and enrolled 12 months during 2018. Prospective analysis was used to determine whether dental sealants were applied by the same dentists during PDVs or up to 9 months thereafter. Eligible teeth included first permanent molars. Teeth previously restored, sealed or missing were excluded. PDV was defined as any encounter with prophylaxis, fluoride treatment, or EPSDT. Claims were compared to public health surveillance for measurement validation. Results: Single‐county results showed 11 percent of eligible teeth were sealed. Only 9 percent of dentists applied sealants to at least 40 percent of eligible teeth. Face validation of sealant rate was 23 percent Medicaid versus 36 percent Public Health. The former measures incidence and the latter prevalence with greater heterogeneity that included partially retained sealants. Conclusions: A sealant measure that assesses provider adherence to sealant standards of care was produced. It has potential application for assessing performance of pediatric preventive services and informing value‐based performance expectations. [ABSTRACT FROM AUTHOR]

For many animals, sperm can be a limiting resource and impact lifetime reproductive success. Sperm limitation can arise from reduced male availability in a population, but may also be a consequence of external influences, such as sperm wastage. If sperm is finite and not always cost‐free to produce, do males vary sperm use strategies in response to sperm limitation? One way to answer this is to examine male sperm allocation in response to sexual deception that elicits sperm wastage.Cryptostylis orchids trick their parasitoid wasp pollinator, male Lissopimpla excelsa, into mating with the flower and ejaculating. For many parasitoids sperm is limited; so this exploitative interaction could impose a high cost to males. Here, we ask whether this duped wasp can become sperm limited, and whether this impacts his ejaculate size following deception. Sperm limitation has implications for his future and lifetime reproductive success, and consequently, the ultimate fitness of the orchid, and the evolutionary maintenance of orchid deception systems in general.We compared sperm use and availability for male L. excelsa wasps from wild populations that either did or did not co‐occur with sexually deceptive Cryptostylis orchids.On average, males had ~50,000 sperm cells in their seminal vesicles and ejaculated ~10% of their existing sperm stock in a single encounter. Pollinators that were permitted to mate with an orchid had significantly less sperm than males that were not, suggesting they may become temporarily sperm limited. Pollinators from sites with orchids ejaculate significantly less sperm on orchids than naïve males.The difference in ejaculate size for pollinators that do and do not co‐occur with orchids may be a consequence of males learning to avoid orchids, or an adaptation to avoid sperm depletion. Alternatively, males may reduce sperm allocation when they perceive more available 'females' (either orchids or real females) in the environment. These costs and responses to exploitation show how plants can influence the population dynamics of their pollinators, and, more broadly, provides an explanation for the maintenance antagonistic co‐evolutionary relationships. We suggest that by interfering with the population dynamics of a duped species, exploiters might improve their own persistence. A free plain language summary can be found within the Supporting Information of this article. [ABSTRACT FROM AUTHOR]

Operationalizing faculty contributions in ways that align with organizational mission can be difficult, particularly when monetizing effort. Conventional compensation methods may result in faculty effort going undefined, resulting in more subjectivity in recognition and compensation. Inequities lead to faculty marginalization, fragmentation, decreased motivation, and attrition. Dental faculty retirements are expected to increase, as 81% of men and 19% of women faculty aged 60 years and older in 2015-2016. We present opposing perspectives on the use of educational value units (EVUs) in academic dentistry. The first viewpoint articulates that such models improve recruitment and retention by objectifying (a) faculty performance measurement, (b) academic productivity improvements, and (c) compensation determination. The counterpoint suggests EVUs are deterrents to faculty retention due to challenges with objectively quantifying performance measures, a potential inherent bias linked to gender, and the undervaluing of teaching quality or collaborative practices. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this article is to examine the association between preventive dental care and adverse childhood experiences (ACEs), and the association between tooth decay and ACEs, controlling for preventive dental care. Methods: A cross‐sectional study was conducted with a sample of 33,395 respondents from the 2016 National Survey of Children's Health, a nationally representative sample of US children. Sociodemographic information, ACE questions, and oral health and health‐care utilization information were used. Descriptive statistics, bivariate analyses, and multivariable regression models were performed. Results: Children with four or more ACEs were less likely to have a preventive dental visit than children with less than four ACEs (79.7 percent versus 88.7 percent, P < 0.0001). Children with four or more ACEs were more likely to have tooth decay (26.7 percent versus 12.5 percent, P < 0.0001) than their counterparts. Children exposed to four or more ACEs had lower odds of receiving preventive dental visits than children exposed to less than four ACEs (aOR 0.67; 95 percent CI 0.50–0.89). Children with four or more ACEs had higher odds of decayed teeth than children exposed to fewer than four ACEs (aOR 2.08; 95 percent CI 1.61–2.70), even after controlling for preventive dental care. Conclusions: Pediatricians, dental hygienists, and dentists need to be aware of how childhood trauma may hinder both caregivers and children from engaging in preventive oral health care or dental treatment. The information provided in our study can inform policies and programs that support children's oral health, through the identification and mitigation of childhood trauma. [ABSTRACT FROM AUTHOR]

Objectives: Early childhood caries (ECC) negatively impacts many child health outcomes and can lead to greater costs for medical and dental care as well as negatively impact future oral health wellness. ECC risk factors are rooted in many social determinants of health. Addressing ECC at the population-level is a national public health priority. The purpose of this study was to identify the South Carolina counties with the greatest risk for ECC. As policy-makers seek to address inequities stemming from early childhood caries, documenting its prevalence is essential.Methods: Since no county level ECC rates were published for South Carolina, we identified an opportunity to strengthen ECC surveillance through public use data, so as to properly equip policy-makers and pediatric providers with an evidence based understanding of the scope of the problem. As a result we sought to develop an overall county level prevalence measure for ECC risk through an ecological analysis of public use data.Results: Ten counties with the greatest overall risk for ECC were all rural as hypothesized. Additionally, seven of the 10 highest risk counties fell into what is often referred to as the "Corridor of Shame."Conclusions: We have found an affordable way of measuring county level risk for ECC that allows pediatric advocates and policy-makers to develop population level interventions to reduce and measure risk with public-use data. [ABSTRACT FROM AUTHOR]

The continental margins of East Africa and West Madagascar are a frontier for hydrocarbon exploration. However, the links between the regional tectonic history of sedimentary basins and margin evolution are relatively poorly understood. We use a plate kinematic model built by joint inversion of seafloor spreading data as a starting point to analyse the evolution of conjugate margin segments and corresponding sedimentary basins. By correlating megasequences in the basins to the plate model we produce a margin‐scale tectono‐stratigraphic framework comprising four phases of tectonic development. During Phase 1 (183–133 Ma) Madagascar/India/Antarctica separated from Africa, first by rifting and later, after breakup (at ca. 170–165 Ma), by seafloor spreading in the West Somali and Mozambique basins and dextral strike‐slip movement on the Davie Fracture Zone. Mixed continental/marine syn‐rift megasequences were deposited in rift basins followed by shallow‐marine early postrift sequences. In Phase 2 (133–89 Ma) spreading ceased in the West Somali basin and Madagascar became fixed to the African plate. However, spreading continued between the African and Antarctic plates and deposition of the early postrift megasequence continued. The onset of spreading on the Mascarene Ridge separated India from Madagascar in Phase 3 (89–60 Ma). Phase 3 was characterized by the onset of deposition of the late postrift megasequence with continued deep marine sedimentation. At the onset of Phase 4 (60 Ma onward) spreading on the Mascarene ridge ceased and the Carlsberg Ridge propagated south to form the Central Indian Ridge, separating India from the Seychelles and the Mascarene Plateau. Late postrift deposition continued until a major unconformity linked to the development of the East African Rift System marked the change to deposition of the modern margin megasequence. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Routine preventive dental care is important to overall child health and well‐being. However, the experience of adversity in childhood may prevent children from getting adequate preventive care. This study seeks to explore how the prevalence of adverse childhood experiences (ACEs) and the role of a protective adult may be associated with dental care utilization in childhood. Methods: Data from the 2016 South Carolina Behavioral Risk Factor Surveillance System (SC BRFSS), which interviews adults eighteen year of age and older, were used in this study. Dental care utilization in childhood was measured as the adult retrospectively reported frequency of dental care in childhood: at least once every 2 years (adequate dental care) or less often than every 2 years (inadequate dental care). ACEs were determined by asking about each of respondent's childhood exposure to eleven childhood experiences, including divorce, parental incarceration, domestic violence, drug and alcohol abuse, mental illness and emotional, physical or sexual abuse. The presence of a protective adult in childhood included respondents who had an adult who made them feel safe and protected during childhood. Descriptive and bivariate statistics explored differences in the adequacy of child dental care by ACE exposure, the presence of a protective adult and selected demographic characteristics. Multivariate regression models were used to examine the impact of counts and types of ACEs and the presence of a protective adult with inadequate childhood dental care. Results: The unweighted study sample included 7079 respondents ageing from 18 to 79 years of age Sampling weights were used for all analyses. Among all respondents, 71.7% reported receiving adequate dental care during childhood; 28.3% responded that they received inadequate dental care. Adjusting for sociodemographic characteristics, respondents who experienced four or more ACEs had a higher likelihood of inadequate dental care than respondents who reported no ACEs (aOR 2.79; 95% CI 2.77‐2.82). The odds of reporting inadequate dental care were lower among those grew up with an adult who made them feel safe and protected (aOR 0.38; 95% CI 0.37‐0.39). Conclusions: The presence of protective factors may mitigate the effects of ACEs on paediatric dental care. This research contributes to the literature through the further identification of the role of dentists in identifying signs of abuse and neglect. [ABSTRACT FROM AUTHOR]

A 70‐year‐old male underwent transthoracic (TTE) and transesophageal (TEE) echocardiography for a stroke. A bicuspid aortic valve was suspected by TTE, but TEE revealed a normally functioning quadricuspid aortic valve. A quadricuspid aortic valve may be more common than generally thought, as it may not be readily diagnosed by TTE, and may remain functionally normal. [ABSTRACT FROM AUTHOR]

Bird plumage and skin colour can be assessed from museum specimens. To determine whether these accurately represent the colours of live birds when viewed by birds themselves, we analysed the spectral reflectances of live and up to 100-year-old museum specimens of five seabird species (White-faced Petrel Pelagodroma marina, Common Diving Petrel Pelecanoides urinatrix, Grey-faced Petrel Pterodroma gouldi, Little Shearwater Puffinus assimilis and Fluttering Shearwater Puffinus gavia). Live birds had brighter colours than museum specimens, but there were no significant differences in the wavelengths reflected. Modelling indicated that seabirds would be able to detect colour changes in the skin, but not the feathers, of museum specimens, but only for species with blue or pink feet ( Pelecanoides urinatrix and Puffinus assimilis). For seabirds, museum specimens are adequate proxies for feather colour but not for skin colour. [ABSTRACT FROM AUTHOR]

Purpose As a means to identify and quantify oral health interprofessional collaborative practice (IPP), we examined participant-described medical-to-dental (M2D) referral networks and how they function across rurality. Methods We conducted a cross-sectional survey on the appraisal of IPP referral systems in 2016. Secondarily, we examined if rural health clinics (RHCs) have different experiences with M2D referrals compared to other practice types. Independent variables included geographic and organizational indicators, referral system attributes, and respondent characteristics. Data were coded by Census region and state Medicaid expansion status. Bivariable and multivariable analyses were conducted using SAS. Findings A convenience cohort (n = 559) from 44 states was examined. Nearly, half (48.7%) reported dependable M2D referral systems. In bivariate analysis, all independent variables were significant except for state Medicaid expansion status. In multivariable analysis, Census region retained significance ( P = .0093). Organization type and practice issues with no shows/missed appointments continued to have significance ( P < .001 and .002, respectively). Accountable care organizations were over 5 times (5.72, P = .001) more likely than RHCs to report dependable M2D referral systems. Federally qualified health clinics were slightly over 3 times more likely than RHCs to report dependable M2D referral (3.04, P < .001). No differences between RHCs and other private practices were observed. Conclusions The importance of IPP continues to be promoted in the current health care environment. Our study demonstrates that, in this motivated study population, M2D referrals can work well, even in rural areas. Organization type, directionality of referral, broken appointment rates, and electronic health information management were all found to significantly impact the respondents' rating on the dependability of an M2D referral process. [ABSTRACT FROM AUTHOR]

Objective: We estimated the effect of South Carolina's (SC) Medicaid fluoride varnish (FV) reimbursement policy on children's receipt of fluoride varnish in medical (MFV) and dental (DFV) settings.Methods: We obtained data from SC Medicaid enrollment and claims files for children ≤ 47 months of age across State Fiscal Years (SFY) 2008-2013 and created a panel dataset of 52,841 children representing 126,464 child-years of observation. Pooled multivariate logistic regression models were estimated to identify factors associated with a higher likelihood of a child receiving one or more MFV or DFV treatments.Results: The FV rates per child-year were 1 percent for physicians and 23 percent for dentists, respectively. The child-year rate for receipt of FV from both a physician and a dentist was less than one-third of one percent.Conclusions: A policy designed to increase access to FV treatments from physicians and dentists for children up to forty-seven months of age was not successful for physicians; however, the positive findings for dentists were promising. [ABSTRACT FROM AUTHOR]

RATIONALE: Stable isotope analysis (SIA) is a powerful tool for examining diet and food-web dynamics. SIA assumes "you are what you eat" relative to carbon (C) and nitrogen (N). However, fractionation of carbon during lipid synthesis violates this assumption; high-lipid tissues do not reflect δ13C values of diet and therefore have the potential to skew mixing model results and diet interpretations, making corrections necessary. METHODS: Brook Trout (Salvelinus fontinalis) white muscle and liver samples from several fish species representing the temperate North American cold- and warm-water fish community were corrected for lipids via chemical lipid extraction and mathematical lipid normalization. To assess the accuracy of model-predicted lipid-free δ13C values calculated from four normalization models, we compared model-predicted values with those measured after lipid extraction. RESULTS: We found that chemical lipid extraction is unnecessary for Brook Trout white muscle tissue with low initial lipid content. However, in tissues with C:N ratios greater than 3.5, lipid extraction increased δ13C values in fish liver by more than 1.0 ?, indicating that liver lipid content is sufficient to bias δ13C values. We also found that lipids were accurately accounted for with mathematical normalization and recommend that tissues with C:N ratios greater than 3.5 be corrected mathematically. CONCLUSIONS: Our findings indicate that mathematical normalization is sufficient to account for bias in δ13C values associated with lipid content in fish tissues when C:N ratios are above 3.5. C:N ratios below 3.5 indicate that tissues have insufficient levels of lipid to bias the δ13C values. Generally, these findings support the use of more timely and cost-effective processing and analysis methods in future aquatic food-web studies utilizing SIA. [ABSTRACT FROM AUTHOR]

Objectives Using nationally representative data, we examined differences in dental care utilization in emergency departments ( EDs) among working age adults associated with rural residence and lack of health insurance. Methods We used data from the 2008 Nationwide Emergency Department Sample, restricted to working age adults (ages 19-64; 16,928,424 observations). The dependent variable was a principal diagnosis of dental caries. The primary independent variable was patient's area of residence, rural versus urban. The control variables were payer, age, gender, median income, region, and admission timing. Logistic regression analysis was performed to determine the association with residence, payer, and other covariates. Multivariate logistic regression models were estimated. Results In 2008, there were an estimated 74 million ED visits among working adults ages 19-64 in the United States. Dental caries accounted for between 0.2 percent and 1.0 percent of all visits, depending on patient characteristics. Rural patients were significantly more likely than urban patients to have dental visits. Dental visits were more prevalent among patient with government insurance or self -pay relative to the privately insured. Conclusions The Affordable Care Act may reduce the proportion of self-pay visits for dental care. Medicaid expansion may not result in improved dental use among Medicaid patients unless dental services are covered and dental practitioners appropriately engaged. [ABSTRACT FROM AUTHOR]

Purpose To determine whether there is an association between clinical decision support system (CDSS) use and quality disparities in pneumonia process indicators between rural and urban hospitals. Methods Data were used from the FY 2009 American Hospital Association electronic health record (EHR) adoption survey (3,616 responding hospitals) to identify hospitals that used CDSS for clinical guidelines and reminders. This was linked to the 2009 Hospital Compare data set from the Centers for Medicare and Medicaid Services (3,805 reporting hospitals). The merged data set contained 2,405 hospitals: 1,330 were noncritical in metropolitan ZIP Code Tabulation Areas (ZCTAs), 692 were noncritical in rural ZCTAs, and there were 383 critical access hospitals (CAHs; 359 in rural ZCTAs, 24 in urban ZCTAs). The dependent variable was a pneumonia composite quality score, composed of 6 pneumonia process indicators calculated for each hospital. Adjusted analysis controlled for a hospital's propensity to use CDSS. Findings While quality was lower in rural institutions, unadjusted pneumonia quality scores varied modestly, from 90.08% in CAHs to 93.38% in urban hospitals. Hospitals that used CDSS had higher unadjusted pneumonia process composite scores than their non-CDSS counterparts. After controlling for CDSS use, the propensity for CDSS use, and hospital and community characteristics, hospitals in rural ZCTAs did not have significantly different process composite scores than their metropolitan counterparts. Conclusions CDSS was positively associated with quality of care for pneumonia. Adoption of EHRs with CDSS functionality in rural hospitals may serve to reduce quality gaps. Costs of EHR implementation may be a barrier to this process. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to estimate the differences in prevalence of metabolic syndrome and its individual components across rural-urban populations, as well as to determine the risk factors associated with metabolic syndrome and examine how they contribute toward rural-urban disparity. Methods: Data came from the 1999-2006 National Health and Nutrition Examination Survey, restricting to 6,896 participants aged 20 years or more with complete information. Metabolic syndrome was defined using the National Cholesterol Education Program's Adult Treatment Panel III criteria. Residence was measured at the census tract level using the Rural-Urban Commuting Area Codes. We estimated the prevalence of metabolic syndrome and its components by residence. Multiple logistic regression models were used to examine urban-rural differences after adjusting for sociodemographic, health, dietary, and lifestyle factors. Results: The prevalence of metabolic syndrome was higher in rural than urban residents (39.9% vs 32.8%), among both men (39.7% vs 33.3%) and women (40.2% vs 32.3%, respectively). The age and sex adjusted OR for metabolic syndrome in rural as compared to urban residents was 1.23 (95% CI, 1.02-1.49), which was attenuated to 1.06 (95% CI, 0.90-1.25) after adjusting for covariates. Older age, lower physical activity, higher screen time, higher meat intake, and skipping breakfast were associated with increased odds of metabolic syndrome. Conclusion: Rural dwelling was associated with higher prevalence of metabolic syndrome among adults in the Unites States, which can be attributed to the differences in demographic composition and obesity-related behavioral factors between urban and rural residents. [ABSTRACT FROM AUTHOR]

Purpose: An unhealthy prepregnancy weight and/or gaining an inappropriate amount of weight during pregnancy increase the risk for poor pregnancy and birth outcomes. To our knowledge, no studies to date have examined differences in prepregnancy body mass index (BMI) and gestational weight gain (GWG) patterns by rurality. Methods: The 2004-2006 South Carolina birth certificate data (n = 132,795) were used. Rurality of residence was determined using Rural-Urban Commuting Area (RUCA) codes. Mothers were categorized as underweight (<18.5 kg/m2), normal weight (18.5-24.9), overweight (25.0-29.9), and obese (≥30.0) using their prepregnancy BMI and as having inadequate, adequate, or excessive GWG according to the Institute of Medicine's 2009 GWG guidelines. Chi-square tests and adjusted multinomial logistic regression were used in analysis. Findings: Rural women had higher odds of being overweight and obese compared to urban women. This relationship was found to be partially explained by the higher proportion of minorities living in rural areas. The relationship between GWG and residence type varied by BMI category. Specifically, among normal weight women, rural women had increased odds of inadequate GWG. Among overweight women, rural women had decreased odds of excessive GWG. In obese women, rural women had decreased odds of both inadequate and excessive GWG. Conclusions: Rural women were more likely to have an unhealthy prepregnancy weight than urban women. However, rural residence was found to be protective against unhealthy GWG in overweight and obese women. Future research exploring reasons for these findings and confirmation of these results in other populations is necessary. [ABSTRACT FROM AUTHOR]

Purpose: To examine the differences in oral health status among residents of high-poverty counties, as compared to residents of other rural or urban counties, specifically on the prevalence of edentulism. Methods: We used the 2005 Behavioral Risk Factor Surveillance System (BRFSS) and the 2006 Area Resource File (ARF). All analyses were conducted with SAS and SAS-callable SUDAAN, in order to account for weighting and the complex sample design. Findings: Characteristics significantly related to edentulism include: geographic location, gender, race, age, health status, employment, insurance, not having a usual source of care, education, marital status, presence of chronic disease, having an English interview, not deferring care due to cost, income, and dentist saturation within the county. Conclusions: Significant associations between high-poverty rural and other rural counties and edentulism were found, and other socioeconomic and health status indicators remain strong predictors of edentulism. [ABSTRACT FROM AUTHOR]

Purpose: Published advantages of and challenges with telemedicine led us to examine the scope of telemedicine adoption, implementation readiness, and barriers in a southern state where adoption has been historically low. We hypothesized that rural hospitals and primary care providers (RPCPs) differ on adoption, readiness, and implementation barriers. We examined the degree to which they differ on (a) telemedicine adoption or readiness; (b) telemedicine training needs; (c) current use of technology for patient care; and (d) environmental concerns in facilities for telemedicine. Methods: Paper surveys were sent to rural hospitals and RPCPs with response rates of 50% (n = 38) and 25.9% (n = 339), respectively. Three of 4 hospitals were represented. Chi-square analyses were used to test for differences between rural hospitals and RPCPs. Findings: Compared to RPCPs, rural hospitals were significantly more likely to report higher rates of telemedicine knowledge ( P= .0007); planning for or implementing telemedicine ( P < .0001); and reporting their disaster recovery data systems ( P= .0002) and availability and location of outlets and connections ( P= .03) as adequate for telemedicine. Rural hospitals were less likely to report having no telemedicine education needs ( P= .04). Conclusions: Telemedicine continues to be a viable solution for bridging geographic access gaps to a variety of specialty care. Users need assistance in understanding legal implications, care coordination, billing for services, and disaster data recovery. In rural areas, hospitals appear to best embody characteristics of facilities that successfully implement telemedicine and have the greatest degree of readiness. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to compare national estimates of drug use and exposure to violence between rural and urban teens. Methods: Twenty-eight dependent variables from the 2003 Youth Risk Behavior Survey were used to compare violent activities, victimization, suicidal behavior, tobacco use, alcohol use, and illegal drug use across rural, urban, and suburban teens across the country. Results: Overall, rural teens were equally or more likely than both suburban and urban teens to report experiencing many measures of violent behavior, victimization, suicide behaviors, and drug use. Among all teens, nonwhites reported equal or higher rates of violent behavior and victimization than whites, but these associations disappeared within the rural-only population. Conclusions: Rural areas do not appear to provide a strongly protective effect against risk behaviors in teens and may be a risk factor in itself. Community prevention efforts should focus on reaching rural areas and segmenting program content based on need. Where white teens might benefit from an emphasis on preventing tobacco and alcohol use, nonwhite teens would benefit from an emphasis on preventing violence and victimization. [ABSTRACT FROM AUTHOR]

We have established that the Arf tumor suppressor gene regulates mural cell biology in the hyaloid vascular system (HVS) of the developing eye. In the absence of Arf, perivascular cells accumulate within the HVS and prevent its involution. We now demonstrate that mural cell accumulation evident at embryonic day (E) 13.5 in Arf−/− mice was driven by excess proliferation at E12.5, when Arf expression was detectable in vitreous pericyte-like cells. Their expression of Arf overlapped with Pdgf receptor β (Pdgfrβ), which is essential for pericyte accumulation in the mouse. In cultured cells, p19Arf decreased Pdgfrβ and blocked Pdgf-B-driven proliferation independently of Mdm2 and p53. The presence of a normal Arf allele correlated with decreased Pdgfrβ in the embryonic vitreous. Pdgfrβ was required for vitreous cell accumulation in the absence of Arf. Our findings demonstrate a novel, p53- and Mdm2-independent function for p19Arf. Instead of solely sensing excessive mitogenic stimuli, developmental cues induce Arf to block Pdgfrβ-dependent signals and prevent the accumulation of perivascular cells selectively in a vascular bed destined to regress. [ABSTRACT FROM AUTHOR]

Deaths involving sensory deprivation tanks are very rare. We describe a unique case in which a previously healthy 50-year-old woman apparently died while floating in a sensory deprivation tank at her residence. Autopsy failed to reveal definitive anatomical abnormalities pointing to the cause of death. A thorough scene investigation, full medicolegal autopsy to include toxicological analyses, and a complete investigation into the equipment at the scene, were conducted. Blood toxicologic studies were significant for the presence of ethanol (0.27%) and a mixture of over-the-counter sedating medications and prescription drugs. The cause of death was ruled as acute mixed drug and ethanol toxicity combined with probable environmental hyperthermia; manner was accident. This case report will help the forensic community understand the intended use of flotation tanks, as well as possible risks associated with improper use. [ABSTRACT FROM AUTHOR]

The article reviews the book "Rural Populations and Health: Determinants, Disparities, and Solutions" by Richard A. Crosby, Monica L. Wendel, Robin C. Vanderpool and Baretta R. Casey.