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Objective: This article describes the importance of identifying inflammation‐inducing conditions in the dental office that are prevalent in the population and have significant systemic health risks for the patient. The role of the dental biofilm will be presented, as will the clinical protocols for treating an unhealthy biofilm. Methods for testing and maintaining a healthy biofilm are also presented. Clinical Considerations: Periodontal disease, dental caries, and periapical infections are inflammation‐inducing diseases that can be identified in the dental office. Additionally, sleep apnea has been linked to chronic systemic inflammation. Dentists can identify risk factors and provide treatments that lower the risk of serious systemic outcomes, such as atherosclerosis, cardiac arrest, and stroke. Conclusions: A thorough dental examination, including a comprehensive periodontal evaluation, can provide important information that can be used to improve or maintain a patient's systemic health. Treatments provided to improve oral health have been shown to improve systemic indicators of cardiovascular health. This is the basis of integrative oral medicine, a collaboration between the medical and dental providers, which can offer patients the best opportunity for improved health outcomes. Clinical Significance: Periodontal disease, caries, periapical infections, and sleep apnea all have negative systemic health consequences for the patient (DiMatteo, Inside Dent, 2017, 13, 30; Nakano, Oral Microbiol Immunol, 2009, 24, 64; El Ouarti, BMC Oral Health, 2021, 21, 124; Lamberg, Steve). Periodontal disease, caries, and root end infections influence the health of the oral biofilm. If the biofilm becomes pathogenic the host inflammatory response can be stimulated, resulting in a cascade of inflammatory processes that damage the supporting structures of the teeth and harm the patient's overall health. A thorough dental exam that includes a comprehensive periodontal evaluation will identify patients with active inflammation or oral conditions that contribute to chronic inflammation. Dentists can integrate this information into treatment strategies that reduce the inflammatory burden and assist in better overall health outcomes. [ABSTRACT FROM AUTHOR]

Pool-riffle sediment and flow dynamics have been studied for many years, but relatively little work has investigated how variations in flow and sediment regimes might lead to a diversity of pool-riffle morphologies. In this letter we analyze a database of quantitative and qualitative measurements from sites where pool-riffle morphologies have been studied and assess the sites relative to morphologic transitions and mobility thresholds. Results show that pool-riffle sites are stretched over a morphologic gradient of predicted bar types from scrolls to chutes and a modelled mobility gradient from threshold to low transport channels. Flow- and sediment-driven phenomenon that are relevant for pool-riffle mechanics are discussed in this context. [Display omitted] • Pool-riffles presented in the literature have some features in common but show an important diversity • Studied sites are predominantly located in channels with threshold to low mobility and scroll to mixed scroll/chute bars • Regime diagrams systematize diversity and may help to avoid extending site-specific findings to inappropriate environments [ABSTRACT FROM AUTHOR]

Objective: An important question in implementation/dissemination research is whether the efficacy of a given treatment varies in part based on the therapist delivering the treatment. This study sought to provide practical guidance to researchers in the field of eating disorders for building measurement of therapist effects into the design of a typical, relatively small randomized controlled trial (RCT). Method: Using assumptions based on past trials of eating disorder treatments, Monte Carlo simulations were used to examine 12 different scenarios based on crossing the number of therapists (between two and five) and the estimated therapist effect size (small, medium, and large). Patient sample size and study design were held constant. Results: There was reasonable power (≥70%) to detect the therapist effect with three or four therapists and a large effect size. Discussion: Several practical implications for testing therapist effects in RCT are discussed. © 2012 by Wiley Periodicals, Inc. Int J Eat Disord 2012. [ABSTRACT FROM AUTHOR]

An editorial is presented which discusses the future for virtual military amputee support. The authors emphasize that the successful treatment from a traumatic injury resulting in an amputation is dependent on care from clinical providers and peer support. They consider the stages of recovery from amputation. They look at the applications of virtual worlds.

Introduction: In Western Sydney, over 50% of the residents are overweight and at high risk of developing diet-related chronic disease. It is a diabetes 'hotspot' with a rate 1.5 times higher than the Sydney average. At a cost of $14.6 billion per annum and at current population growth rates, by 2019, diabetes will be the most costly disease in Australia and a debilitating burden on the health system. Health cannot solve the problem alone. The solution lies in prevention through a multi-sectoral, transformational, long-term prevention strategy with scaled up investment. Policy context/objective: Western Sydney Local Health District, NSW Health and the NSW Department of Premier and Cabinet have partnered with over 50 organisations including the three levels of government, non-government organisations and the private sector to form the Western Sydney Diabetes Prevention Alliance. The Alliance aims to produce a paradigm shift in the local environment to allow residents to purchase and prepare healthy food, have access to safe areas for physical exercise and reduce dependency on car travel, through local and governmental interventions and improved urban design. Targeted population: The Alliance has consulted with a number of consumers and experts in their field over a 9-month period, and analysed the most effective local and international interventions to produce a prevention strategy. The strategy is supported by 15 individual initiatives. The strategy aims to prevent 10,000 new cases of diabetes by targeting 270,000 people within a population of 870,000. The target populations include 220,000 children, 44,000 people at high risk and 6,000 'healthy' adults. Highlights: An economic case cost-benefit analysis produced by PwC predicts an investment of $124.27m would realise total net benefits of $577.00m to 2030. Ten of the proposed initiatives are included in this model, but the number and content may alter over time. The benefits will be achieved through savings in healthcare costs, government subsidies and lost productivity. The costs and benefits have been modelled on running each initiative over 14 years from 2017 to 2030. The costing model is based on the average annual cost of the treatment of a person with diabetes, includes a decay rate of the efficacy of interventions, as well as the inclusion of the direct costs of setting up and running each program on an annual basis. Costs of the initiatives have been based on data from existing programs and commercial data provided by Alliance members. The establishment of a Prevention Hub has also been included for sustainability. This cost-benefit analysis has been developed to attract financial support from both government and the private sector. Transferability: The objectives are to improve the overall health of western Sydney residents, as well as to become an exemplar that can be adopted by other health districts throughout Australia. Conclusion: The benefits of the Alliance lie in the ongoing collaboration of previously disparate organisations to address a major health and societal issue, the shared vision to reach the majority of residents and the goal to halt a relentless progression toward diabetes within the local community. [ABSTRACT FROM AUTHOR]

The article presents the author's comments to the article "Surviving the War: A College Counselor's Journal," by Philip Clinton. He states that Clinton provides wonderful insights on the challenges encountered by an international counselor and the change at the Cairo American College (CAC) in Egypt on admitting exiled students from schools in Kuwait, Saudi Arabia, and the United Arab Emirates (UAE). He also cites the crucial role of international counselors in international cooperation.

Initial child welfare screening decisions, traditionally made by an individual worker, determine if a family will receive further intervention by child protective services. A multi-disciplinary team (MDT) decision-making approach for child welfare referrals aims to provide a more thorough assessment of needs and strengths and to connect families to appropriate community-based providers. This study examined 159 child welfare referrals handled by MDTs compared to 331 referrals handled via the traditional screening approach. The study used a pseudo randomization procedure to assign referrals to the study conditions: Referrals logged on 2.5 days of the week were assigned to the treatment group; all others were assigned to the comparison group. Referrals handled by an MDT were more than four times as likely as those not handled by an MDT to be referred to community-based organizations (OR = 4.32, p <.001). There were no statistically significant differences in families' engagement with community-based organizations or child welfare outcomes. MDTs are a promising step in the initial process of connecting families to services, although they did not affect this study's longer-term outcomes. [ABSTRACT FROM AUTHOR]

Contemporary clinical trials often have complex logistics: they are run across multiple centers/countries and involve a lot of uncertainties about disease prevalence rates, patient characteristics and regulatory requirements, all of which can vary across countries. As a result, planning and delivering such studies on-time has long been recognized as a challenge in the pharmaceutical industry. One well-known approach to modeling recruitment in complex trials, which we use as a starting point of our work is a Poisson-Gamma stochastic model. COVID-19 pandemic brought additional layer of complexity to recruitment modeling: as many countries went into shutdown, sponsors were forced with the dilemma of replanning study delivery rebalancing their portfolios "on the fly." That translated into the need to adapt the recruitment model to account for effect of COVID-19. In this work we present an approach that blends Poisson–Gamma model, real-time recruitment data updates and epidemiological modeling of COVID-19 spread. At the core of the methodology is sophisticated Bayesian hierarchical model predicting how pandemic intensity affected parameters of Poisson-gamma model. We also build an app conveniently showing many publicly available COVID models in one place. The work is a result of intense collaboration among many statisticians, data scientists and clinical operations professionals. [ABSTRACT FROM AUTHOR]

Our previous study showed that parents with mental health problems or substance abuse are at increased risk of having children removed from the home, primarily due to caregiving deficits, neglect, and prenatal exposure to substances, not physical abuse. Using a larger sample and more rigorous analysis, the present study improves and expand upon the previous study, yielding more robust explanations for why these children are at increased risk of removal. The study uses a sample of 4070 Structured Decision Making® assessments conducted by San Francisco's Child Welfare provider involving parents reported for the first time from 2007 to 2015. Using structural equation modeling, mediation models were constructed to test the indirect effects of thirteen child safety threats on safety decision. Four threats explained 95% of the effect of mental health problems on safety decision, two of which retained significance in the final model: Failure to Meet Immediate Needs (OR = 1.26, p ≤ 0.01) and Previous Maltreatment (OR = 1.24, p ≤ 0.05). Seven safety threats explained 91% of the effect of co-occurring mental health problems and substance abuse, two of which retained significance in the final model: Failure to Meet Immediate Needs (OR = 1.78, p ≤ 0.001) and Physical Harm (Drug-Exposed Infant; OR = 1.57, p ≤ 0.001). As previously shown, parental mental health problems and substance abuse are not ipso facto safety threats. Rather, unmet child needs account for much of the increased risk of child removal in this population, underscoring the importance of timely resource referrals. [ABSTRACT FROM AUTHOR]

Introduction: Pediatricians need community resources for childhood stress. We examined the association of weekly park visits and resilience amongst children receiving a park prescription at a clinic for low-income families.Materials and Methods: A prospective longitudinal clinical trial was conducted amongst children ages 7-17 at a safety-net primary care clinic with measures at zero, one and three months out. Parents reported their child's park visits per week, baseline ACE score, their own stress (PSS10) and coping; children reported resilience (Brief Resiliency Scale) and stress (PSQ8-11 scale).Results: Enrolled children (N = 54; mean (sd) age 10.3 (2.4) years), had a median (IQR) ACE score of 2 (1, 4). Child resilience improved with each one-day increase in weekly park visits (0.04 points, 95% CI 0.01, 0.08) at every level of ACEs. Child stress partially mediated this relationship.Conclusion: Parks are a community resource for pediatric resilience; park prescriptions may be a way to deal with pediatric stress. [ABSTRACT FROM AUTHOR]

Introduction: Exposure to nature may reduce stress in low-income parents. This prospective randomized trial compares the effect of a physician’s counseling about nature with or without facilitated group outings on stress and other outcomes among low-income parents. Materials and methods: Parents of patients aged 4–18 years at a clinic serving low-income families were randomized to a supported park prescription versus independent park prescription in a 2:1 ratio. Parents in both groups received physician counseling about nature, maps of local parks, a journal, and pedometer. The supported group received additional phone and text reminders to attend three weekly family nature outings with free transportation, food, and programming. Outcomes measured in parents at baseline, one month and three months post-enrollment included: stress (using the 40-point Perceived Stress Scale [PSS10]); park visits per week (self-report and journaling); loneliness (modified UCLA-Loneliness Scale); physical activity (self-report, journaling, pedometry); physiologic stress (salivary cortisol); and nature affinity (validated scale). Results: We enrolled 78 parents, 50 in the supported and 28 in the independent group. One-month follow-up was available for 60 (77%) participants and three-month follow up for 65 (83%). Overall stress decreased by 1.71 points (95% CI, -3.15, -0.26). The improvement in stress did not differ significantly by group assignment, although the independent group had more park visits per week (mean difference 1.75; 95% CI [0.46, 3.04], p = 0.0085). In multivariable analysis, each unit increase in park visits per week was associated with a significant and incremental decrease in stress (change in PSS10–0.53; 95% CI [-0.89, -0.16]; p = 0.005) at three months. Conclusion: While we were unable to demonstrate the additional benefit of group park visits, we observed an overall decrease in parental stress both overall and as a function of numbers of park visits per week. Paradoxically the park prescription without group park visits led to a greater increase in weekly park visits than the group visits. To understand the benefits of this intervention, larger trials are needed. Trial registration: ClinicalTrials.gov [ABSTRACT FROM AUTHOR]

Background Contact with nature improves human health; stress reduction is a mediating pathway. Stay Healthy in Nature Everyday (SHINE) is a stress reduction and health promotion intervention for low-income families at an urban Federally Qualified Health Center. We plan to evaluate two service-delivery models for SHINE and present here the intervention design and evaluation protocol. Methods Behavioral change theory and environmental education literature informed the intervention. Outcomes were selected after review of the literature and field tested procedures to determine what was feasible and ethical in a busy clinic serving vulnerable populations. Design We designed a randomized controlled trial to examine two levels of intensity in behavioral counseling about the health benefits of nature. Dyads consisting of a caregiver and a child aged 4 to 18 who access our pediatric primary care center are eligible. All dyads receive a pediatrician's recommendation to visit parks to experience nature and written resources (a “park prescription”). The intervention group receives added case management and an invitation to three group outings into nature with transportation, meals and activities provided. Primary outcomes measured at baseline, one month and three months post-enrollment are caregiver stress measured by PSS-10 score and salivary α-amylase; secondary outcomes are park prescriptions adherence, physical activity recorded by pedometer and journaling, loneliness, family cohesion and affinity to nature as measured by a validated scales. Both groups receive incentives to participation. Discussion Our intervention represents a feasible integration of recent research findings on the health benefits of nature and primary care practice. [ABSTRACT FROM AUTHOR]