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There is a remarkable phenomenon occurring among health professionals: the development of ongoing, routine collaboration, both in educating the next generation of providers and in delivering care. These new approaches, commonly referred to as interprofessional education and interprofessional collaborative practice, have been introduced into academic health settings and delivery systems throughout the U.S. and the rest of the world; however, the full integration of dentistry in health care teams remains unrealized. In academic settings, dentistry has found ways to collaborate with the other health professions, but most practicing dentists still find themselves on the margins of new models of care delivery. This article provides a perspective on the history and context of the evolution of collaborative approaches to health care and proposes ways in which dentistry can participate more fully in the future.

This Point/Counterpoint article discusses the transformation of dental practice from the traditional solo/small-group (partnership) model of the 1900s to large Dental Support Organizations (DSO) that support affiliated dental practices by providing nonclinical functions such as, but not limited to, accounting, human resources, marketing, and legal and practice management. Many feel that DSO-managed group practices (DMGPs) with employed providers will become the setting in which the majority of oral health care will be delivered in the future. Viewpoint 1 asserts that the traditional dental practice patterns of the past are shifting as many younger dentists gravitate toward employed positions in large group practices or the public sector. Although educational debt is relevant in predicting graduates' practice choices, other variables such as gender, race, and work-life balance play critical roles as well. Societal characteristics demonstrated by aging Gen Xers and those in the Millennial generation blend seamlessly with the opportunities DMGPs offer their employees. Viewpoint 2 contends the traditional model of dental care delivery-allowing entrepreneurial practitioners to make decisions in an autonomous setting-is changing but not to the degree nor as rapidly as Viewpoint 1 professes. Millennials entering the dental profession, with characteristics universally attributed to their generation, see value in the independence and flexibility that a traditional practice allows. Although DMGPs provide dentists one option for practice, several alternative delivery models offer current dentists and future dental school graduates many of the advantages of DMGPs while allowing them to maintain the independence and freedom a traditional practice provides.

This article describes a quality improvement (QI) initiative that is in process at the University of Texas Health Science Center at San Antonio (UTHSCSA) Dental School and the website that grew out of this effort. The process of screening and assignment of patients was selected for improvement in 2006. QI methods were used to develop a website that improves access to care for patients and assists in the matching of patients and students. The website (www.dentalscreening.com) has received more than 15,000 screening applications in the period from May 2007 to January 2010 and has provided unprecedented insight into the needs of our patients. This article outlines the process by which the website was created, the rationale for the design, and the benefits of establishing a screening website for any dental school. The program was developed entirely at UTHSCSA, but it addresses a problem that may affect many dental schools.

Dental school clinics, originally envisioned as closely similar to private practice, evolved instead as teaching clinics. In the former, graduate and licensed dentists perform the treatment while undergraduate dental students are assigned treatment within their capabilities. In the latter, dental students provide the treatment under faculty supervision. It is generally recognized that the care provided by the teaching clinics is inefficient. However, in the last quarter of the twentieth century, dental school clinics began to pay much more attention to how treatment is rendered. The comprehensive care movement and quality assurance systems are leading towards more efficient patient-centered care. Case studies at the University of Maryland, Columbia University, and University of Louisville describe activities to make their clinic programs more efficient and patient-friendly. This article explores whether the potential exists for faculty to take a direct patient care delivery role in dental clinics in order for those clinics to become efficient patient care delivery systems as originally envisioned in the early part of the twentieth century.

Cornstarch powder on latex examination gloves acts as an airborne carrier of natural latex allergens resulting in cutaneous, conjunctival, and/or respiratory responses to latex, a particular concern in a dental school environment where concentrated use of latex examination gloves occurs. This study measured airborne powder levels associated with a trial substitution of powder-free latex examination gloves for powdered latex examination gloves in a dental school clinic. Secondary aims of the study were to assess user acceptance of powder-free gloves during the trial and to assess the financial impact of converting the entire dental school to a powder-free environment. Air was sampled from two areas (dispensary and treatment room) of a student clinic fifteen to thirty minutes before the beginning of normal clinic sessions and again about 1.5 hours into the clinic session. The samples were microscopically analyzed for particulate counts of cornstarch powder. A written survey instrument assessed user acceptance of the two types of gloves. Historical financial data were used to estimate the cost of converting the entire dental school to a powder-free environment. Both the dispensary and the treatment room showed significant reductions in airborne powder counts during use of powder-free latex gloves and a return to high powder counts with resumption of powdered glove use. During the weeks of powdered glove use, the powder counts were also significantly lower before the beginning of the clinic session and higher during the clinic session. User acceptance of the powder-free latex gloves was high. The increased cost per year to convert the entire dental school to a powder-free environment was estimated to be $13,943.

This study determined the effect of a clinical program driven by patient needs upon students' productivity, attitudes, and academic performance. A group of eight senior students, whose academic and clinical performance profile replicated that of the rest of the class, were chosen to participate in a year-long non-requirement clinic. The students were expected to attend all clinic sessions, and treat their assigned patients. Their performance was compared to that of classmates in the regular requirement-driven curriculum. The non-requirement group had significantly higher academic achievement and significantly outproduced their classmates. Non-requirement students had no state board failures, versus 17 percent in the regular curriculum, and reported significantly lower stress. This study suggests that predoctoral clinical programs can maintain quality and productivity in the absence of unit requirements.

Objective. —To study the clinical characteristics of respiratory tract illness caused by Chlamydia pneumoniae . Design. —Prospective clinical, bacteriologic, and serologic study. Secondarily, a matched comparison of patients with and without evidence of C pneumoniae infection (serologic titers ≥1:64 and Setting. —Four primary care (family practice) clinics in Madison, Wis, and nearby towns. Patients. —The study included 365 white males and females (mean age, 34.2 years). Main Outcome Measures. —Association of acute C pneumoniae infection with signs and symptoms of respiratory illness and the relationship of C pneumoniae antibody titer with wheezing at the time of enrollment in the study, and with the diagnosis of asthmatic bronchitis. Results. —Nine (47%) of 19 patients with acute C pneumoniae infection had bronchospasm during respiratory illness, and there was a strong quantitative association of C pneumoniae titer with wheezing at the time of enrollment in the study ( P =.01). In the matched study, C pneumoniae antibody was significantly associated with asthmatic bronchitis after, but not before, respiratory illness (odds ratio, 7.2; 95% confidence interval, 2.2 to 23.4). Four infected patients had newly diagnosed asthma after illness, and four others had exacerbation of previously diagnosed asthma. There was no serologic evidence of coexisting Mycoplasma pneumoniae, Chlamydia trachomatis , or respiratory viral infection in 96% of patients with asthmatic bronchitis and asthma. Conclusions. —Some Cpneumoniae antibody titers, although not diagnostic of chlamydial infection by present criteria, probably represent acute reinfection or ongoing chronic infection. Repeated or prolonged exposure to C pneumoniae may have a causal association with wheezing, asthmatic bronchitis, and asthma. ( JAMA . 1991;266:225-230)

Abbott-29590, an antiinflammatory compound with antipyretic and analgesic activity in test animals, did not produce any gastric lesions in the rat after oral doses up to 256 mg/kg. In contrast, gastric lesions were produced by oral doses of aspirin, indomethacin, and phenylbutazone; the ED95 values were 88, 13, and 260 mg/kg, respectively. Pretreatment with Abbott-29590 blocked the gastric damage produced by aspirin and indomethacin but not the ulceration produced by phenylbutazone. The ED50 values of Abbott-29590 for preventing the gastric lesions produced by aspirin, Abbott-29590, and exogenous 0.1 N HCl suggest that Abbott-29590 was additive with aspirin in its antiinflammatory activity while simultaneously blocking the gastric lesions produced by aspirin. The antiinflammatory activity of indomethacin in the carrageenin rat paw edema test was not altered by 30 minutes pretreatment with Abbott-29590, while phenylbutazone and Abbott-29590 were additive in antiinflammattory activity. Studies of gastric lesions produced by a combination of aspirin, Abbott-29590, and exogenous 0.1N HCl suggest that Abbott-29590 may tighten the gastric mucosal barrier.

TENDERNESS measurement is a relative evaluation of one of the most important quality factors in meat. Two methods are commonly employed. The first is the organoleptic panel where each member is given a sample to evaluate—either by the number of chews required to masticate the meat or by ranking judgment on some sort of decanoic scale. With even a small panel of conscientious members a good relative evaluation can be obtained. This is considered to be the most accurate evaluation of tenderness. Tenderness is also measured by machine. Several mechanical devices are available for just such a purpose. However, none of these machines appear to be able to simulate the true action of a chewing mouth, and consequently each approximates that action with only a certain degree of success. Of the mechanical devices used the Warner Bratzler shear machine has been most widely reported, but the best relationships between…

Sarcinomyces Inkin Oho (1919) was first isolated and described from a scrotal lesion somewhat resembling eczema marginatum of Hebra in Formosa and the lesion was reproduced experimentally on a human volunteer by rubbing the organism into excoriations on the scrotum. A search of the literature has not revealed other cases; apparently the two cases reported here are the second and third cases known. Since Sarcinomyces infections respond to treatment similar to that used in eczema marginatum caused by Epidermophyton floccosum (Harz) Langeron & Milochevitch, perhaps cases have been diagnosed and treated by physicians without isolating the etiologic agent and hence other cases of Sarcin0omt?vces infection hlave inot been recognlize(l.

DURING a study of factors affecting tenderness in poultry meat, an investigation was made of pH and temperature changes in the breast muscles of birds during and after slaughter. pH has been investigated in beef and pork by Bate-Smith and Bendall (1949), and Scaife (1955). However, little or no work has been done on poultry. pH should give an indication of rates and extensiveness of glycolysis in the tissue and would therefore be a consideration in a study of postmortem tenderization (de Fremery and Pool, 1958). In studies of contraction on rabbit and human muscle Marson et al. (1938) found a slight increase in pH after contraction. This is in apparent conflict with Bate-Smith and Bendall as well as Scaife. A preliminary note on this work was published b y Peters and Dodge, (1959). APPARATUS EMPLOYED A copper—constantan thermocouple was used to determine the temperature within the muscle. The …

INTRODUCTION THE downgrading of eggs with tremulous air cells, which occurs during farm-to-store processing, has for some time been an economic problem to the poultry industry. Depending on the ultimate marketing location, tolerance in tremulosity varies; that is, the economic consequence of downgrading varies by states according to the magnitude in tremulosity which their shell egg marketing laws permit. Up to twenty-five percent downgrading of eggs with tremulous air cells occurs in some Northeastern States which permit no movement of the air cell in some grades. It is a generally accepted fact that transportation is the cause of tremulosity in air cells. A review of the literature provided no evidence of any reported work on the effects of various factors on air cell tremulosity. In this study, differing storage or holding conditions in temperature and percent relative humidity, and oiling, were examined to determine what effect, if any, these may…

IN MANY experiments conducted on tenderness of poultry meat it has been noticed that this factor varies from bird to bird during post-mortem aging, even after seemingly identical slaughter treatments. Marion and Stadelman (1958) showed this effect with turkeys, and Dodge and Stadelman (1959), Klose et al. (1959), and Pool et al. (1959) observed the effect with both turkeys and chickens of different ages. Koonz and Robinson (1946) and Koonz, Darrow and Essary (1954) showed also that considerable variation exists between the tenderness of the principal muscles of the poultry carcass as well as between individual birds. Since in most cases the groups of birds tested were raised under identical management conditions and treated the same during slaughter, it would seem that some presently uncontrolled factor—possibly physiological—causes the variation. Assuming that glycolysis play an important part in post-mortem tenderization of beef (Bate-Smith, 1948, Bendall, 1951) the activity of …

Various basic esters of nitrogen (2) and carbocyclic (3 and 4) analogs of cannabinoids were synthesized using dicyclohexylcarbodiimide in methylene chloride. The compounds in the three series werw studied in selected pharmacological tests in mice, rats, dogs, and cats. It was shown that making the basic ester from the phenol retains biological activity and can lead to a greater selectivity of action, particularly the antinociceptive activity. The most interesting esters were 5, 6, 10, and 14 in the nitrogen analogs series and 19 and 20 in the carbocyclic series. Compound 5 was more potent than codeine in the writhing, hot-plate, and tail-flick tests and is at present undergoing clinical testing. Compound 20 was very potent in the mouse audiogenic seizure test and is of interest as an anticovulsant agent.

The incidence of complications following supine phlebography was studied in 109 patients (142 legs) retrospectively and 89 patients (106 legs) prospectively. Virtually all patients had some discomfort during the procedure, while three patients had delayed pain for up to 4 days following examination. Three patients developed hives, one of whom also had bronchospasm. There were two cases with subcutaneous extravasation. The shorter endothelial contact time of supine phlebography compared to the semiupright technique might explain the reduced incidence of pain.

Aus den cyclischen β-Ketoestern (I), z.B. von S-haltigen Ringsystemen, und dem Resorcin (II) entstehen nach Pechmann die Kondensate (III), die uber eine Grignardreaktion zu den Diolen (IV) die Cyclen (V) sowie ihre Ester (VI) geben.

A number of standard bacteriological media with supplements were tested for their ability to support in vitro growth of Ethiopian strains of Borrelia recurrentis . Propagation of 18 out of 21 strains occurred in Trypticase soy yeast broth to which bovine albumin (fraction V), N -acetyl glucosamine, and sodium pyruvate had been added. This medium supported a population of 10 7 organisms per ml and yielded a harvest of four to five times the original inoculum during the logarithmic phase of growth. Maximal yield varied from 1.4 × 10 7 to 3.4 × 10 7 organisms per ml. Generation time in optimal media was 11.3 h. Lesser multiplication of organisms occurred in other media tested. Strains from primary cultures were infective for the green monkey. Recovery of viable organisms from subculture has not been successful.

Pituitary insufficiency indicates disease in the region of the sella turcica and hypothalamus. Tumors of this region may cause pituitary insufficiency.A finding such as diabetes insipidus, or even amenorrhea, should alert the physician to the possibility of a pituitary tumor. Diagnosis may require such additional evidence as visual-field or x-ray changes.

Intracranial electrography is an extension of scalp and surface electro-encephalography in which electric impulses are obtained from the depths of the human brain. The surgical technic required for the placement of deep electrodes is simple, and the multi-contact electrodes are well tolerated. Pertinent information may be obtained by means of electric recording from or stimulation of the subcortex. This method portends to become a valuable diagnostic and investigative aid.

THIS REPORT was prompted by the circumstance that both the patients reported had unusual clinical histories and that in both communicating hydrocephalus developed as a result of meningeal meningiomatosis. In addition, attempts were made to control the increased intracranial pressure in each instance by the use of drainage through a polyethylene tube. The character of the lesions was not revealed until necropsy. Necropsy also afforded an opportunity to study the effects of the various operative procedures which had been employed in the hope of controlling increased intracranial pressure and the communicating hydrocephalus. It is not within the scope of this presentation to discuss the cause of hydrocephalus 1 or the merits or demerits of procedures employed in attempting to control hydrocephalus of the obstructive 2 or communicating type. 3 Russell 4 discussed the pathologic changes in this condition, and Davidoff 5 reviewed the literature concerning various operative methods of treatment.