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A simple valuation model with time-varying investment opportunities is developed and estimated. The model assumes that the investment opportunity set is completely described by the real interest rate and the maximum Sharpe ratio, which follow correlated Ornstein–Uhlenbeck processes. The model parameters and time series of the state variables are estimated using U.S. Treasury bond yields and expected inflation from January 1952 to December 2000, and as predicted, the estimated maximum Sharpe ratio is related to the equity premium. In cross-sectional asset-pricing tests, both state variables have significant risk premia, which is consistent with Merton's ICAPM. [ABSTRACT FROM AUTHOR]

Objective: A novel Oral Lichen Planus Symptom Severity Measure was developed as a clinical outcome assessment of the daily symptom experience of patients with oral lichen planus. Methods: A literature review and expert input were followed by open‐ended concept elicitation interviews with 17 adults with oral lichen planus in the United States and Ireland. Item content was generated, and the interviews continued until input saturation was reached. The final electronic version of the measure was cognitively debriefed in 6 US patients and subsequently translated and linguistically validated in Germany and Denmark. Results: Concept elicitation interviews demonstrated content validity and saturation in identifying symptoms and daily activities that generate symptoms in patients with oral lichen planus. The content and electronic daily diary format demonstrated content validity during cognitive debriefing interviews. Linguistic validation of the 7‐item Oral Lichen Planus Symptom Severity Measure in Germany and Denmark confirmed the content validity of the German and Danish versions. Conclusions: Qualitative research methods generated evidence that the 7‐item Oral Lichen Planus Symptom Severity Measure version 1.0 is a well‐defined assessment tool to characterize the severity, specificity and variations of symptoms in patients with oral lichen planus. [ABSTRACT FROM AUTHOR]

The article presents the results of an equilibrium model created to analyze the pricing of U.S. government bonds for the period of 1958-1979. The bond pricing model relies on the assumption that there are only two independent stochastic factors which are two interest rates; the short rate and the consol rate. These determine bond prices and the shape and position of the yield curve at any point of time. The model also considers Arbitrage Pricing theory, the term structure of interest rates, and the relative rates of return on bonds with different coupons and maturities.

This article develops a model of international equity portfolio investment flows based on differences in informational endowments between foreign and domestic investors. It is shown that when domestic investors possess a cumulative information advantage over foreign investors about their domestic market, investors tend to purchase foreign assets in periods when the return on foreign assets is high and to sell when the return is low. The implications of the model are tested using data on United States (U.S.) equity portfolio flows. [ABSTRACT FROM AUTHOR]

This article discusses assets and investment practices in corporate accounting. In corporate management practices, it is common for corporate insiders to possess an informational advantage over investors at large. Imperfect observability of corporate management's actions and of corporate investment opportunities has given rise to problems of agency and adverse selection. There is also interest in the possibility of signaling resolution to problems arising from the superior information of management about corporate prospects. The article deals with the implications of investor costs in determining the value of assets held by corporations. It considers the implications of latent assets from both investors and corporate policy perspectives.

Opioid abuse is a healthcare and societal problem that burdens individuals, their families and the healthcare professionals who care for them. Restricting access to opioid analgesics is one option to deter abuse, but this may prevent pain patients in need from obtaining effective analgesics. Therefore, strategies that mitigate the risk of opioid abuse while maintaining access are being pursued by several stakeholders including federal agencies, state governments, payors, researchers, the pharmaceutical industry and clinicians. Federal agency efforts have included required licensure and documentation for prescribing opioids, implementation of risk evaluation and mitigation strategies, and guidance on assessment and labeling of opioid abuse-deterrent formulations. In addition, state governments and payors have enacted monitoring programs, and pharmaceutical companies continue to develop abuse-deterrent opioid formulations. Strategies for clinicians to mitigate opioid abuse include comprehensive patient assessment and universal precautions (e.g. use of multimodal analgesia and abuse-deterrent opioid formulations, urine toxicology screening, participation in prescription drug monitoring and risk evaluation and mitigation strategy programs). [ABSTRACT FROM AUTHOR]

The current standard applied by the US National Labor Relations Board (NLRB) to determine joint-employer status is that the putative joint-employer's control over employment matters should be direct, immediate and substantial. Recently some have argued that a broader 'potential control' test should apply, which is sufficiently vague to turn many franchisors into joint employers with their franchisees contradicting the fundamental principle that franchisors and franchisees are independent contractors. This article analyses these developments in detail and concludes that it will always be imperative for franchisors to strike the right balance with respect to control over franchisees and their businesses. [ABSTRACT FROM AUTHOR]

Because of the threat that Hurricane Irene (2011) posed to the United States, supplemental observations were collected for assimilation into operational numerical models in the hope of improving forecasts of the storm. Synoptic surveillance aircraft equipped with dropwindsondes were deployed twice daily over a 5-day period, and supplemental rawinsondes were launched from all upper-air sites in the continental United States east of the Rocky Mountains at 0600 and 1800 UTC, marking an unprecedented magnitude of coverage of special rawinsondes at the time. The impact of assimilating the supplemental observations on National Centers for Environmental Prediction (NCEP) Global Forecast System (GFS) model track forecasts of Irene was evaluated over the period that these observations were collected. The GFS track forecasts possessed small errors even in the absence of the supplemental observations, providing little room for improvement on average. The assimilation of the combined dropwindsonde and supplemental rawinsonde data provided small but statistically significant improvements in the 42-60-h range for GFS forecasts initialized at 0600 and 1800 UTC. The primary improvement from the dropwindsonde data was also within this time range, with an average improvement of 20% for 48-h forecasts. The rawinsonde data mostly improved the forecasts beyond 3 days by modest amounts. Both sets of observations provided small, additive improvements to the average cross-track errors. Investigations of individual forecasts identified corrections to the model analyses of the Atlantic subtropical ridge and an upstream midlatitude short-wave trough over the contiguous United States due to the assimilation of the extra data. [ABSTRACT FROM AUTHOR]

This chapter describes how the American higher education system is about to witness unprecedented growth in the number of foreign students studying on U.S. campuses. Presidents and governing board members are challenged to leverage this threshold moment to achieve comprehensive internationalization. [ABSTRACT FROM AUTHOR]

Amiodarone therapy in adults with congenital heart disease (CHD) is associated with a significant risk of amiodarone-induced thyrotoxicosis (AIT). We developed a risk index to identify those patients being considered for amiodarone treatment who are at high risk for AIT. We reviewed the health records of adults with CHD and assessed the association between potential clinical predictors and AIT. Significant predictors were included in multivariate analyses. The parameter estimates from multivariate analysis were subsequently used to develop a risk index. 169 adults met eligibility criteria and 23 developed AIT. The final model included age, cyanotic heart disease and BMI. The risk index developed identified 3 categories of risk. Their AIT likelihood ratios were: 0.37 for low risk (95% CI 0.15-0.92); 1.12 for medium risk (95% CI 0.65-1.91); and 3.47 for high risk (95% CI 1.7-7.11). The AIT predicted risk in our population was 5% for the low risk group, 15% for the medium risk group and 47% for the high risk group. Conclusions. We derived the first model to quantify the risk for developing AIT among adults with CHD. Before using it clinically to help selecting among alternative antiarrhythmic options, it needs validation in an independent population. [ABSTRACT FROM AUTHOR]

More than 75 million Americans have chronic or recurring pain []. Such pain negatively impacts emotional and mental health, quality of life, and productivity and increases the use of health care resources []. Prescription opioids are widely used and may be effective analgesics for chronic, moderate-to-severe pain in appropriately selected patients, particularly when used as part of comprehensive pain management plans []. The increased use of prescription opioids over the last decade has been mirrored in an increase in the reported misuse, abuse, and diversion of these agents. Physician reluctance to initiate opioid therapy may lead to undertreatment of pain []. Clinicians can implement procedures such as careful patient screening and ongoing monitoring to ensure that risk of opioid abuse is minimized without interfering with the appropriate use for patients with legitimate chronic noncancer pain. Efforts are being made nationally, statewide, and locally to inform and educate medical professionals, policymakers, the public health community, and patients concerning the benefits and risks of opioid therapy for chronic pain. Monitoring programs are currently being adopted to document and discourage misuse, abuse, and diversion of prescription opioids. The US Food and Drug Administration recently initiated hearings to examine a potential change in the government''s risk management plan, Risk Evaluation and Mitigation Strategies [], which could dramatically change the development, release, marketing, and prescription of extended-release opioids. Pharmaceutical companies have remained active in developing products that are potentially less attractive for abuse. The challenge of balancing the availability of prescription opioids to treat patients who have pain while discouraging illicit use is complex, requiring effective efforts on many levels. [Copyright &y& Elsevier]

The article focuses on a study that assessed rare precipitation events with standardized anomalies. The study was carried out at the U.S. Hydrometeorological Prediction Center (HPC). Standardized anomalies were used operationally at HPC to evaluate both deterministic and ensemble NWP model forecasts. The SREF mean 850-hPa MF anomaly forecasts were even more impressive. HPC forecasters have access to model forecasts of standardized anomaly fields of various degrees. The study also analyzed relationship between precipitation and rain.

As air traffic in the United States has grown over the last several years, traffic demand has begun to outstrip capacity. As of 2005, the Federal Aviation Administration (FAA) had no effective approach for strategically managing a weather event that has been very disruptive to the national aviation system--large-scale thunderstorms that block the major flight routes in the northeastern United States. The operations research team that supports the FAA's efforts to provide innovations in air traffic management, led by researchers at Metron Aviation, Inc. and the Volpe Transportation Center, recognized the consequence of this operational deficiency and set out to resolve it. In this paper, we show how this team (1) developed and applied system-simulation models to quantify the extent of the traffic flow management problem and convey its magnitude to the FAA and to the aviation industry; (2) designed the Airspace Flow Program (AFP), a new approach to managing air traffic that could correct the problem within the limitations of a short development cycle and a change-resistant culture; (3) designed and developed an interactive simulation system that could be and was used to refine and perfect this concept prior to deployment by developing policies on the use of a decision support system; (4) engaged FAA and airline traffic management experts in a series of interactive exercises using the simulation system to develop the final software design, operational procedures, and decision rules for deployment and use; and (5) provided a clear and convincing postdeployment benefits assessment for the new traffic management approach. The deployment of this new capability was an enormous success that both the FAA and the airline community heralded widely. The postdeployment impact assessment showed benefits to the aircraft operators and the flying public of almost $190 million in 2006 and 2007, the first two years of use, compared to less than $5 million in design and development costs. Broader usage of AFPs and new applications for them show a projected 10-year benefit of approximately $2.8 billion. [ABSTRACT FROM AUTHOR]

Key results of a comprehensive survey of U.S. National Weather Service operational forecast managers concerning the assessment and communication of forecast uncertainty are presented and discussed. The survey results revealed that forecasters are using uncertainty guidance to assess uncertainty, but that limited data access and ensemble underdispersion and biases are barriers to more effective use. Some respondents expressed skepticism as to the added value of formal ensemble guidance relative to simpler approaches of estimating uncertainty, and related the desire for feature-specific ensemble verification to address this skepticism. Respondents reported receiving requests for uncertainty information primarily from sophisticated users such as emergency managers, and most often during high-impact events. The largest request for additional training material called for simulator-based case studies that demonstrate how uncertainty information should be interpreted and communicated. Respondents were in consensus that forecasters should be significantly involved in the communication of uncertainty forecasts; however, there was disagreement regarding if and how forecasters should adjust objective ensemble guidance. It is contended that whether forecasters directly modify objective ensemble guidance will ultimately depend on how the weather enterprise views ensemble output (as the final forecast or as a guidance supporting conceptual understanding), the enterprise’s commitment to provide the necessary supporting forecast infrastructure, and how rapidly ensemble weaknesses such as underdispersion, biases, and resolution are addressed. The survey results illustrate that forecasters’ operational uncertainty needs are intimately tied to the end products and services they produce. Thus, it is critical that the process to develop uncertainty information in existing or new products or services be a sustained collaborative effort between ensemble developers, forecasters, academic partners, and users. As the weather enterprise strives to provide uncertainty information to users, it is asserted that addressing the forecaster needs identified in this survey will be a prerequisite to achieve this goal. [ABSTRACT FROM AUTHOR]

The article summarizes the changes to the Federal Trade Commission's rule on franchising in the U.S. It explains the procedural disclosure changes, substantive disclosure changes, updating of the disclosure document, exemptions to the disclosure requirements of the revised rule, other exclusions which will not be covered under the revised rule, and impact of the revised rule on foreign franchisors or foreign companies entering the U.S.

The article presents various court cases concerning franchising agreement. It includes the case between an Internet retailer, WHC, and kitchen and bathroom products manufacturer Thermasol and gasoline station franchisee, Karimi, and franchisor, BP Products North America. WHC and Thermasol concerns the "Minimum Advertised Price" (MAP) policy while the Karimi and BP Products concerns the Petroleum Marketing Practices Act (PMPA).

There is debate concerning use of antibiotic prophylaxis before invasive dental procedures for patients at risk of acquiring distant site infection (DSI). We determined the opinions and practices of infectious disease consultants (IDCs) regarding antimicrobial prophylaxis to prevent DSIs that result from invasive dental procedures by conducting a survey of the 797 members of the Infectious Diseases Society of America Emerging Infections Network (477 members [60%] responded). Ninety percent of respondents closely follow the American Heart Association guidelines for antibiotic prophylaxis for patients with valvular heart disease who undergo invasive dental procedures. In contrast, few IDCs recommend prophylaxis for patients with lupus erythematosus, poorly controlled diabetes mellitus, dialysis catheters or shunts, cardiac pacemakers, or ventriculoperitoneal shunts. Twenty-five percent to forty percent of respondents recommended prophylaxis for prosthetic vascular grafts, orthopedic implants, or chemotherapy-induced neutropenia. We conclude that IDCs differ considerably in their assessment of the need for prophylaxis for patients who have noncardiac risk factors for DSI. These differences underscore the need for definitive studies to delineate appropriate candidates for antimicrobial prophylaxis in dental practice. [ABSTRACT FROM AUTHOR]

This article analyses and quantifies the costs of suboptimal decision making for an investor with a multi-period horizon. In light of the empirical evidence that investors are too conservative and hold portfolios that are insufficiently diversified, we evaluate the costs of suboptimal equity participation both analytically and using simulation, and also estimate the costs of suboptimal diversification using simulation. We find that suboptimal leverage imposes only modest costs on the investor for reasonable parameter values. While the costs of inadequate diversification can be very high, we find that, because of the higher returns on small firms, an equally weighted portfolio of as few as five randomly chosen firms can provide the same level of expected utility as the value weighted market portfolio. (J.E.L.: G11, G18, G23). [ABSTRACT FROM AUTHOR]

Oral medicine is a specialized area of study within the scope of dental medicine. This discipline is often viewed as the crossroads between medicine and dentistry and has become integral in both pre- and postdoctoral dental education. Oral medicine is recognized as a dental specialty throughout most of the world and currently represents an emerging specialty in the United States. Historically, oral medicine has been loosely defined in the United States without a clear consensus definition. Recent published studies regarding international oral medicine postdoctoral programs and clinical practice have helped to provide more specific information regarding oral medicine from many perspectives. This article will review the literature relevant to defining oral medicine in the United States and present a new definition of this important discipline based on recent studies. [ABSTRACT FROM AUTHOR]

In this article, the author discusses issues and aspects of medical professionalism. The author mentions the efforts of medical societies to improve medical professionalism, such as the Charter on Professionalism, a project which identified professionalism commitments and principles. Moreover, it discusses the goals of professionalism training and education, as well as ways in which the profession can help address issues relative to healthcare costs in the U.S.

The article discusses the role of the U.S. Food and Drug Administration in providing guidance documents which facilitate the development of new vaccines against global infectious diseases. It states that the guidance is driven by the identification of gaps or needs in manufacturing, product characterization, and clinical review. It adds that the guidance documents are issued as drafts that are open for public comment through the U.S. Federal Register.

Presents issues addressed by United States regulatory agencies to ensure the safety and effectiveness of vaccines for tuberculosis. Identification of potency assays for antituberculosis vaccines; Effectiveness of the use of animal models of human tuberculosis to provide a scientific basis for studying vaccines in human subjects; Clinical evaluation of tuberculosis vaccines.

The article discusses on a court ruling on the dealership contract between American dealer Brio Corp. and French supplier Meccano S.N. in Wisconsin, United States. The court ruled in favor of Brio Corp. citing the provisions of the Wisconsin Fair Dealership Law (WFDL) declaring unenforceable a forum selection in their dealership agreement. The two companies signed a dealership agreement in May 2001 stating that Brio Corp. is the exclusive dealer of toys manufactured by Meccano S.N.

Highlights the activities and topics discussed at the meeting of the American Meteorological Society Central North Carolina chapter held last February 5, 2001 at the North Carolina Supercomputing Center. Guest speakers; Solicitation for scholarship nominations for North Carolina State University students; Presentation from prominent meteorologists.

Provides updates of local chapter meetings of the American Meteorological Society. Venue of the final meeting of the 2000 to 2001 chapter year in central North Carolina; Participants of the meeting in Kansas City; Speaker of the final meeting for the chapter in Sacramento.

Xerostomia, or subjective oral dryness, is a serious complaint after hematopoietic cell transplantation (HCT). Xerostomia is rated as one of the most bothersome symptoms by HCT recipients, negatively affecting quality of life. This substudy of the Orastem study, a prospective longitudinal, international, observational, multicenter study, aimed to describe the prevalence and severity of xerostomia following HCT. Furthermore, the effect of the conditioning regimen, type of transplantation, and oral mucosal changes related to chronic graft-versus-host disease (cGVHD) in the development of xerostomia were studied. All HCT recipients rated xerostomia on a scale of 0 to 10 before the conditioning regimen, several times early post-HCT, and at 3 months post-HCT, and only allogeneic HCT recipients also rated xerostomia at 6 and 12 months post-HCT. In addition, stimulated whole mouth saliva was collected several times. Linear regression models and longitudinal mixed-effects models were created to investigate the influence of risk indicators on xerostomia. A total of 99 autologous and 163 allogeneic HCT recipients were included from 6 study sites in Sweden, Canada, the Netherlands, and the United States. The prevalence of xerostomia was 40% before the conditioning regimen, 87% early post-HCT, and 64% at 3 months post-HCT. Complaints after autologous HCT were transient in nature, while the severity of xerostomia in allogeneic HCT recipients remained elevated at 12 months post-HCT. Compared to autologous HCT recipients, allogeneic HCT recipients experienced 1.0 point more xerostomia (95% confidence interval [CI], .1 to 2.0) early post-HCT and 1.7 points more (95% CI, .4 to 3.0) at 3 months post-HCT. Allogeneic HCT recipients receiving a high-intensity conditioning regimen experienced more xerostomia compared to those receiving a nonmyeloablative or reduced-intensity conditioning regimen. The difference was 2.0 points (95% CI, 1.1 to 2.9) early post-HCT, 1.8 points (95% CI, .3 to 3.3) after 3 months, and 1.7 points (95% CI, .0 to 3.3) after 12 months. Total body irradiation as part of the conditioning regimen and oral mucosal changes related to cGVHD did not significantly influence the severity of xerostomia. Conditioning regimen intensity was a significant risk indicator in the development of xerostomia, whereas total body irradiation was not. Allogeneic HCT recipients experienced more xerostomia than autologous HCT recipients, a difference that cannot be explained by a reduction in stimulated salivary flow rate or the development of oral mucosal changes related to cGVHD., (Copyright © 2024 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of the present study was to detail the patient flow and establish the feasibility of a brief 3-week intensive treatment program (ITP) for veterans with posttraumatic stress disorder (PTSD)., Method: The present study examined data from 648 veterans referred to a non-Veterans Affairs ITP for PTSD from January 2016 to February 2018 to determine the flow of patients into and through the ITP and evaluate individuals' satisfaction with treatment., Results: On average, 25.9 individuals contacted the ITP each month expressing interest in the program. A large proportion of individuals who completed an intake evaluation were accepted (72.2%) into the ITP. Of those accepted, 70.6% ultimately attended the ITP, and the vast majority of veterans who attended the ITP completed treatment (91.6%). Logistic regression results suggested that among veterans who were accepted to the program, those who were legally separated or divorced had significantly greater odds of attending the program compared to single veterans. Veterans were highly satisfied with the 3-week ITP and rated cognitive processing therapy components as the most helpful part of the program., Conclusions: The present study demonstrates that ITP formats for PTSD are of interest and acceptable to veterans, and this format allows individuals to receive high doses of evidence-based treatments in a short amount of time. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Background: No evidence-based guidelines exist for preventive dental care before radiation therapy (RT) in patients with head and neck cancer (HNC). An ongoing multicenter, prospective cohort study, Clinical Registry of Dental Outcomes in Head and Neck Cancer Patients (OraRad), is addressing this knowledge gap. The authors evaluated the level of dental disease before RT in the OraRad cohort, factors associated with dental disease, and dental treatment recommendations made before RT., Methods: As part of OraRad, the authors assessed caries, periodontal disease, dental recommendations, and dental interventions performed before RT., Results: Baseline measures were reported for 356 participants (77% men) with mean (standard deviation) age of 59.9 (11.0) years. Measures included mean number of teeth (22.9), participants with at least 1 tooth with caries (37.2%), and participants with at least 1 tooth with probing depth 5 millimeters or greater (47.4%). Factors associated with less extensive dental disease before RT included having at least a high school diploma, having dental insurance, history of routine dental care, and a smaller tumor size (T1 or T2). Based on the dental examination before RT, 163 (49.5%) participants had dental treatment recommended before RT, with extractions recommended most frequently., Conclusion: Many patients with HCN require dental treatment before RT; more than one-third require extractions., Practical Implications: Most patients have some level of dental disease at the start of RT, indicating the importance of dental evaluation before RT. By observing dental outcomes after RT, OraRad has the potential to determine the best dental treatment recommendations for patients with HCN., (Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Oral Medicine is primarily a nonsurgical dental discipline that includes management of (1) oral mucosal and salivary gland diseases; (2) temporomandibular disorders and orofacial pain; (3) oral complications of systemic disease; and (4) dental management of medically complex patients within its scope of practice. In the United States, the American Academy of Oral Medicine (AAOM) is the professional organization that primarily supports Oral Medicine education, research, and patient care. This document informs the knowledge, skills, and behaviors of beginning Oral Medicine graduates in the United States in three domains: Diagnosis and primarily nonsurgical management of oral mucosal and salivary gland disorders. Diagnosis and primarily nonsurgical management of temporomandibular, orofacial pain, and neurosensory disorders. Management of the medically complex patient. Each domain is subsequently expanded with major competencies and supporting competencies., (Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.)

Classification criteria provide a formalized approach to studying course and management of rheumatic disease, as well as a measure of improvement in care. Understanding the purposes of classification criteria sets and the differences between different classification criteria is crucial for understanding rheumatic disease and for the design and conduct of clinical and epidemiologic investigations. In this article, the similarities and differences between the American-European Consensus Group Criteria (AECG) and the newly proposed American College of Rheumatology (ACR) classification criteria for Sjögren's syndrome and the clinical implications of switching to the ACR classification criteria from the AECG are described., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: To determine the potential economic impact from the practice of antibiotic prophylaxis for dental procedures., Study Design: We estimated the prevalence of patients in the United States with 15 medical conditions and devices. We multiplied the prevalence for each patient population by the percentage of specialists recommending prophylaxis, then by the estimated number of dental office visits per year, and then by an average pharmacy cost to arrive at a total estimated range of annual cost for this practice., Results: The 15 medical conditions and devices included in the present study involve upward of 20 million people and an estimated annual cost between $19,880,279 and $143,685,823. The actual cost may be far greater because of an underestimation of these prevalence figures and the use of antibiotic prophylaxis for additional patient populations., Conclusions: Our data suggest a significant cost for antibiotic prophylaxis in the dental practice setting and the need for evidence-based recommendations concerning this practice., (Copyright © 2013 Elsevier Inc. All rights reserved.)

In the summer of 1910, William James Mayo, M.D., delivered the commencement address at Rush Medical College in Chicago. In his speech, he uttered words that have become the cornerstone of Mayo Clinic's model of care: "The best interest of the patient is the only interest to be considered, and in order that the sick may have the benefit of advancing knowledge, a union of forces is necessary." In this article, we reflect on issues raised by Mayo's speech that strike at the very heart of our professional identity and ask two questions: Is medicine's foremost concern the best interest of the patient? And has medicine really united over the last century in the service of patients?

A study was conducted to describe the receipt of dental care by patients with disabilities and to understand their perspective with regard to barriers to dental care. Subjects for this study were recruited among patients with disabilities seen at Carolinas Rehabilitation's outpatient clinic. A questionnaire consisting of 66 questions was completed by 344 subjects; with the topics related to both medical and dental care. Among the study population, 57.2% of subjects reported being seen by a dentist within the last 12 months, versus 67.3% before they became disabled. The last dental appointment was a routine examination for 59.5% of the respondents. Since becoming disabled, 16.6% of subjects reported problems receiving dental care. Financial challenges were the primary problem followed by physical accessibility issues. Further research is required to discover how barriers to care can be overcome to assure that those with disabilities receive adequate dental care., (©2011 Special Care Dentistry Association and Wiley Periodicals, Inc.)

Background: Infective endocarditis (IE) often is caused by bacteria that colonize teeth. The authors conducted a study to determine if poor oral hygiene or dental disease are risk factors for developing bacteremia after toothbrushing or single-tooth extraction., Methods: One hundred ninety-four participants in a study were in either a toothbrushing group or a single-tooth extraction with placebo group. The authors assessed the participants' oral hygiene, gingivitis and periodontitis statuses. They assayed blood samples obtained before, during and after the toothbrushing or extraction interventions for IE-associated bacteria., Results: The authors found that oral hygiene and gingival disease indexes were associated significantly with IE-related bacteremia after toothbrushing. Participants with mean plaque and calculus scores of 2 or greater were at a 3.78- and 4.43-fold increased risk of developing bacteremia, respectively. The presence of generalized bleeding after toothbrushing was associated with an almost eightfold increase in risk of developing bacteremia. There was no significant association between any of the measures of periodontal disease and the incidence of bacteremia after toothbrushing. The oral hygiene or disease status of a tooth was not significantly associated with bacteremia after its extraction., Conclusion: Bacteremia after toothbrushing is associated with poor oral hygiene and gingival bleeding after toothbrushing., Clinical Implications: Improvements in oral hygiene may reduce the risk of developing IE.

Clinical research centers that support hypothesis-driven investigation have long been a feature of academic medical centers but facilities in which clinical care delivery can be systematically assessed and evaluated have heretofore been nonexistent. The Institute of Medicine report "Crossing the Quality Chasm" identified six core attributes of an ideal care delivery system that in turn relied heavily on system redesign. Although manufacturing and service industries have leveraged modern design principles in new product development, healthcare has lagged behind. In this article, we describe a methodology utilized by our facility to study the clinical care delivery system that incorporates modern design principles.

Objective: We sought to assess the prevalence and characteristics of breakthrough pain (BTP) in patients with chronic back pain., Design: Researchers utilized a telephone survey using a pain assessment algorithm. This report represents a subset of patients from a larger survey of 228 patients with chronic pain unrelated to cancer., Participants: This study employed 117 subjects taking opioids for a primary diagnosis of back pain and receiving care at geographically dispersed pain treatment centers. Subjects had pain lasting at least six months and had "controlled" baseline pain., Results: Eighty-seven subjects (74 percent) experienced 93 types of BTP. The median number of BTP episodes per day was two; median time to maximum intensity was 10 minutes, and median duration was 55 minutes. Onset could not be predicted for 46 percent of pains. Eighty-three percent of subjects used shorter-acting opioids for BTP. Other medications used for pain included NSAIDs, antidepressants, anticonvulsants, skeletal muscle relaxants, intrathecal local anesthetics, and transdermal local anesthetics., Conclusions: These patients with opioid-treated chronic back pain commonly experienced BTP, which often had a rapid onset and a relatively short duration and was difficult to predict. Opioids were the mainstay of pharmacologic therapy, but nonopioid analgesics and adjuvant analgesics were commonly used.