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OBJECTIVES: To compare the effectiveness of deproteinized bovine bone mineral with 10% collagen alone (DBBMC) or with enamel matrix derivative (DBBMC-EMD) in ridge preservation. METHODS: 42 maxillary anterior teeth were extracted and received either a DBBMC (control) or DBBMC-EMD (test) treatment protocol. CBCT taken before and 4 months after the extraction procedure was used to measure changes in alveolar ridge width (RW), buccal bone height (BH) and palatal bone height (PH). Bone cores were harvested during implant osteotomy preparation and the samples processed histomorphometrically to assess the fraction of new bone (%NB), residual graft (%RG), and soft tissue matrix (%STM). RESULTS: Overall, both treatment groups showed significant reductions in mean RW from baseline to 4 months after extraction, but no significant change in either mean BH or PH over this time. When CBCT measurements were analysed according to the initial thickness of the buccal wall (BT

We describe our experiences with organizing pro bono medical genetics and neurology outreach programs on several different resource-limited islands in the West Indies. Due to geographic isolation, small population sizes, and socioeconomic disparities, most Caribbean islands lack medical services for managing, diagnosing, and counseling individuals with genetic disorders. From 2015 to 2019, we organized 2-3 clinics per year on various islands in the Caribbean. We also organized a week-long clinic to provide evaluations for children suspected of having autism spectrum disorder. Consultations for over 100 different individuals with suspected genetic disorders were performed in clinics or during home visits following referral by locally registered physicians. When possible, follow-up visits were attempted. When available and appropriate, clinical samples were shipped to collaborating laboratories for molecular analysis. Laboratory tests included karyotyping, cytogenomic microarray analysis, exome sequencing, triplet repeat expansion testing, blood amino acid level determination, biochemical assaying, and metabolomic profiling. We believe that significant contributions to healthcare by genetics professionals can be made even if availability is limited. Visiting geneticists may help by providing continuing medical education seminars. Clinical teaching rounds help to inform local physicians regarding the management of genetic disorders with the aim of generating awareness of genetic conditions. Even when only periodically available, a visiting geneticist may benefit affected individuals, their families, their local physicians, and the community at large.

Purpose Facial palsy is a condition which can lead to significant changes in facial function and appearance. People with facial palsy often report psychosocial difficulties, including withdrawal from social activities, anxiety, negative body image, and low mood. This paper aimed to review all published research investigating the psychosocial impact of facial palsy on adults. Methods A systematic search of MEDLINE, CINAHL, EMBASE, PsycINFO, and AMED databases was performed. The quality of included studies was assessed, and data were extracted with regard to characteristics of participants; study methodology and design; outcome measures used; and psychosocial outcomes. Results Twenty‐seven studies met inclusion criteria. A high proportion of people with facial palsy reported clinically significant levels of anxiety and depression, with greater difficulties typically reported by females, compared to males. Other difficulties consistently reported include low quality of life, poor social function, and high levels of appearance‐related distress. Objective severity of facial palsy was consistently shown to not be associated with anxiety or depression, with psychological factors instead likely mediating the relationship between the severity of facial palsy and psychosocial well‐being. Conclusions Irrespective of objective symptom severity, facial palsy has the potential to have a significant impact on psychosocial well‐being and quality of life. The various methodological limitations of the included studies are discussed, along with clinical implications, including the need for greater access to psychological screening and interventions for people with facial palsy.

Objectives: As biomaterial‐induced modulation of mediators of the immune response may be a potential therapeutic approach to enhance wound healing events, the aim of this study was to delineate the effects of titanium surface modification on macrophage phenotype and function. Material and methods: Rodent bone marrow‐derived macrophages were polarized into M1 and M2 phenotypes and cultured on micro‐rough (SLA) and hydrophilic modified SLA (modSLA) titanium discs. Macrophage phenotype and cytokine secretion were subsequently assessed by immunostaining and ELISA, respectively. Osteoblast gene expression in response to culture in the M1 and M2 macrophage conditioned media was also evaluated over 7 days by RT‐PCR. Results: M1 macrophage culture on the modSLA surface promoted an M2‐like phenotype as demonstrated by marked CD163 protein expression, Arg1 gene expression and the secretion of cytokines that significantly upregulated in osteoblasts the expression of genes associated with the TGF‐s/BMP signalling pathway and osteogenesis. In comparison, M2 macrophage culture on SLA surface promoted an inflammatory phenotype and cytokine profile that was not conducive for osteogenic gene expression. Conclusions: Macrophages are able to alter or switch their phenotype according to the signals received from the biomaterial surface. A hydrophilic micro‐rough titanium surface topography elicits a macrophage phenotype associated with reduced inflammation and enhanced pro‐osteogenic signalling.

Aim To evaluate the influence of systemic zoledronate administration on the osseointegration of titanium implants with different surface topography in rat maxillae. Methods Twenty Sprague‐Dawley rats were divided into two groups—test (bisphosphonate) and control (healthy). Bisphosphonate administration began three weeks prior to implant placement, and the animals received zoledronate (66 μg/kg) three times per week. Forty endosseous implants with a moderately rough (20 implants) or a turned surface (20 implants) were immediately placed bilaterally into extraction sockets of maxillary first molars. Animals were sacrificed after 14 and 28 days of healing, and en bloc specimens were harvested for histological and histomorphometric analysis. Osseointegration was quantified by measuring the percentage of bone‐to‐implant contact. Results Bone‐to‐implant contact (BIC) (mean ± SD) values of moderately rough and turned implants at day 14 in test group were 17.62 ± 6.68 and 10.69 ± 1.48, respectively, while in the control group, they were 46.36 ± 5.08 and 33.29 ± 8.89, respectively. At day 28, BIC values of moderately rough and turned implants in the test group were 25.94 ± 7.87 and 7.83 ± 4.30, respectively, while in the control group, they were 72.99 ± 6.60 and 47.62 ± 18.19, respectively. Statistically significant higher BIC values were measured on moderately rough implants compared to turned implants at 28 days, and the control group compared to the test group for both implant surfaces. Histological observations for the control and the test groups demonstrated initial bone formation around moderately rough implants not only on the surface of the parent bone, as was the case with the turned surfaced implants, but also along the implant surface itself. Conclusions Systemic zoledronate administration negatively influences osseointegration. Osseointegration was enhanced adjacent to moderately rough compared to turned implants in both the presence and absence of systemic zoledronate administration. Therefore, topographical surface modification may partially offset the negative impact of zoledronate administration.

Recent literature suggests that suppressed bone healing and angiogenesis contributes significantly to the pathogenesis of Medication induced osteonecrosis of jaws (MRONJ), a complex condition commonly associated with anti-resorptive agents. This in vitro study evaluated the effect of locally delivered angiogenic growth factor (VEGF165) with or without osteogenic growth factor (BMP-7) to enhance bone healing, thereby preventing the occurrence of MRONJ. A chemically defined hydrogel (HyStem-HP, Glycosan Biosciences) containing a combination of thiolmodified hyaluronan, heparin and denatured collagen was crosslinked with thiol-reactive, PEGDA. To establish the in vitro release kinetics, 100 and 200 ng of rat VEGF165 (Biovision) or BMP-7 (250 and 500 ng/mL) was loaded into a 500 lL hydrogel prior to crosslinking (Hystem-HP).

BRONJ was considered to be due to direct suppression of bone remodelling and cytotoxic effects of zoledronic acid (ZA) on bone and oral mucosal cells. However, recent literature suggests that suppressed angiogenesis contributes significantly to the pathogenesis of this condition. This in vitro and in vivo study examined the effect of locally delivered VEGF-hydrogel and local gene expression in rat BRONJ model. In vitro release study with 200 ng of rat VEGF-165 (Biovision) loaded into 500 lL hydrogel (Hystem-HP) prior to cross-linking and incubated in release media that was sampled and quantified using ELISA, over 28-days. In vivo, a BRONJ model using Sprague-Dawley rats was established by weekly intraperitoneal injection of ZA (three weeks), followed by extraction of maxillary first two molars and creation of a 5 mm defect which received either VEGF-containing hydrogel, HA gel alone or no gel. ZA was continued for four weeks post-surgery, prior to sacrifice. Gross examination, micro-CT evaluation and histological assessment was conducted to evaluate the effect of VEGF local delivery. Histological assessment involved quantification of osteonecrotic areas, total vascularity (von Willebrand Factor, vWF immunostaining) and specifically, the microvessel density (CD105 immunostaining). Furthermore, to assess molecular level changes during bone and soft tissue healing, gene expression analysis was conducted on the bone and gingival tissue samples from defect area.

The ability of species to shift their distributions in response to climate change may be impeded by lack of suitable climate or habitat between species’ current and future ranges. We examined the potential for climate and forest cover to limit the movement of bird species among sites of biodiversity importance in the Albertine Rift, East Africa, a biodiversity hotspot. We forecasted future distributions of suitable climate for 12 Albertine Rift endemic bird species using species distribution models based on current climate data and projections of future climate. We used these forecasts alongside contemporary forest cover and natal dispersal estimates to project potential movement of species over time. We identified potentially important pathways for the bird species to move among 30 Important Bird and Biodiversity Areas (IBAs) that are both currently forested and projected to provide suitable climate over intervening time periods. We examined the relative constraints imposed by availability of suitable climate and forest cover on future movements. The analyses highlighted important pathways of potential dispersal lying along a north-south axis through high elevation areas of the Albertine Rift. Both forest availability and climate suitability were projected to influence bird movement through these landscapes as they are affected by future climate change. Importantly, forest cover and areas projected to contain suitable climate in future were often dissociated in space, which could limit species’ responses to climate change. A lack of climatically suitable areas was a far greater impediment to projected movement among IBAs than insufficient forest cover. Although current forest cover appears sufficient to facilitate movement of bird species in this region, protecting the remaining forests in areas also projected to be climatically suitable for species to move through in the future should be a priority for adaptation management. This article is protected by copyright. All rights reserved.

[Extract] Recent literature suggests that suppressed angiogenesis contributes significantly to the pathogenesis of bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) by effecting local vasculature. This in vitro and in vivo study examined the mechanisms by which the anti-angiogenic properties of BP's could lead to the occurrence of BRONJ lesions.

Uganda is one of the most species rich countries in Africa because of the presence of several major biomes. However, it is also a country that has lost much of its natural habitat to agriculture. Uganda is a country that has been better surveyed for its biodiversity than many African countries, but despite this, there has not been a comprehensive analysis of the critical sites that contribute to biodiversity conservation at a global, as well as at a national level. We here present such an assessment using mammals, birds, reptiles, amphibians, and plants as surrogate taxa. We identified 36 terrestrial sites that are of sufficient global importance to qualify as Key Biodiversity Areas (KBAs), using the Global Standard for the Identification of KBAs, which complement an additional nine freshwater sites. National red listing of species and ecosystems was used to identify sites of national importance for conservation. We employ a conservation planning approach using Marxan to identify the minimum set of sites needed to conserve all the globally and nationally threatened species and nationally threatened habitats in Uganda. The findings show that most of the remaining natural habitat in Uganda is important for the conservation of globally and nationally threatened species and threatened habitat. Large areas of irreplaceable habitat occur outside protected areas, although more extensive surveys of these areas would likely reduce the area that is irreplaceable.

This study assessed the effect of titanium surface modification on macrophage phenotype polarization and osseous healing under diabetic conditions.Critical-sized calvarial defects were created in healthy and streptozotocin-induced type I diabetic Sprague-Dawley rats. Titanium (Ti) discs with either large-grit sandblasted and acid-etched micro-rough (SLA) or hydrophilic-modified SLA (modSLA) surfaces were used to cover the healing defect for a period of up to 28 days. Samples of the exudate within the calvarial defect and beneath the titanium discs were collected 1, 4 and 7 days post-surgery for inflammatory cytokine analysis using an ELISA. The macrophage phenotype(s) on the Ti disc surfaces were determined by CD11c+ (M1) and CD163+ (M2) immunofluorescent staining. Samples of the healing defects at days 14 and 28 were also prepared for histomorphometric analysis.Cytokine levels in the diabetic animals were higher than those of the healthy group throughout the observation period. The modSLA surface significantly reduced MIP-2 levels at day 1 in both diabetic and healthy animals, and MCP-1 levels at day 4 in the diabetic animals. Immuno-fluorescent staining showed that an M2-like macrophage phenotype was more frequently found on the modSLA surface at day 1 in healthy and day 4 in both healthy and diabetic animals. Histomorphometric analysis showed more new bone formation on the modSLA surface at days 14 and 28 in both groups, although statistically significant differences were only found in the healthy group.Diabetic conditions greatly increased the expression of proinflammatory cytokines during osseous healing. The modSLA surface was shown to promote an M2-like macrophage phenotypic response in titanium adherent macrophages despite the significantly elevated inflammatory environment induced by uncontrolled type I diabetes. Modulation of the macrophage phenotype by the modSLA surface in the early healing period was associated with osseous healing under both healthy and uncontrolled diabetic conditions.

We developed Columbia River streamflow reconstructions using a network of existing, new, and updated tree-ring records sensitive to the main climatic factors governing discharge. Reconstruction quality is enhanced by incorporating tree-ring chronologies where high snowpack limits growth, which better represent the contribution of cool-season precipitation to flow than chronologies from trees positively sensitive to hydroclimate alone. The best performing reconstruction (back to 1609 CE) explains 59% of the historical variability and the longest reconstruction (back to 1502 CE) explains 52% of the variability. Droughts similar to the high-intensity, long-duration low flows observed during the 1920s and 1940s are rare, but occurred in the early 1500s and 1630s-1640s. The lowest Columbia flow events appear to be reflected in chronologies both positively and negatively related to streamflow, implying low snowpack and possibly low warm-season precipitation. High flows of magnitudes observed in the instrumental record appear to have been relatively common, and high flows from the 1680s to 1740s exceeded the magnitude and duration of observed wet periods in the late-19th and 20th Century. Comparisons between the Columbia River reconstructions and future projections of streamflow derived from global climate and hydrologic models show the potential for increased hydrologic variability, which could present challenges for managing water in the face of competing demands.

PURPOSE To determine the optimal respiratory navigator gating configuration for the quantification of left ventricular strain using spiral cine displacement encoding with stimulated echoes (DENSE) MRI. MATERIALS AND METHODS Two-dimensional spiral cine DENSE was performed on a 3 Tesla MRI using two single-navigator configurations (retrospective, prospective) and a combined "dual-navigator" configuration in 10 healthy adults and 20 healthy children. The adults also underwent breathhold DENSE as a reference standard for comparisons. Peak left ventricular strains, signal-to-noise ratio (SNR), and navigator efficiency were compared. Subjects also underwent dual-navigator gating with and without visual feedback to determine the effect on navigator efficiency. RESULTS There were no differences in circumferential, radial, and longitudinal strains between navigator-gated and breathhold DENSE (P = 0.09-0.95) (as confidence intervals, retrospective: [-1.0%-1.1%], [-7.4%-2.0%], [-1.0%-1.2%]; prospective: [-0.6%-2.7%], [-2.8%-8.3%], [-0.3%-2.9%]; dual: [-1.6%-0.5%], [-8.3%-3.2%], [-0.8%-1.9%], respectively). The dual configuration maintained SNR compared with breathhold acquisitions (16 versus 18, P = 0.06). SNR for the prospective configuration was lower than for the dual navigator in adults (P = 0.004) and children (P

This study explores the sensitivity of high-resolution mesoscale simulations of urban heat island (UHI) in the Chicago metropolitan area (CMA) and its environs to urban physical parameterizations, with emphasis on the role of lake breeze. A series of climate downscaling experiments were conducted using the urban-Weather Research and Forecasting (uWRF) model at 1-km horizontal resolution for a relatively warm period with a strong lake breeze. The study employed best available morphological data sets, selection of appropriate urban parameters, and estimates of anthropogenic heating sources for the CMA. Several urban parameterization schemes were then evaluated using these parameter values. The study also examined (1) the impacts of land data assimilation for initialization of the mesoscale model, (2) the role of urbanization on UHI and lake breeze, and (3) the effects of sub-grid scale land-cover variability on urban meteorological predictions. Comparisons of temperature and wind simulations with station observations and Moderate Resolution Imaging Spectroradiometer satellite data in the CMA showed that uWRF, with appropriate selection of urban parameter values, was able to reproduce the measured near-surface temperature and wind speeds reasonably well. In particular, the model was able to capture the observed spatial variation of 2-m near-surface temperatures at night, when the UHI effect was pronounced. Results showed that inclusion of sub-grid scale variability of land-use and initializing models with more accurate land surface data can yield improved simulations of near-surface temperatures and wind speeds, particularly in the context of simulating the extent and spatial heterogeneity of UHI effects.

BackgroundOsteocytes, the most abundant cells in bone, have multiple functions, including acting as mechanosensors and regulating mineralization. It is clear that osteocytes influence bone remodeling by controlling the differentiation and activity of osteoblasts and osteoclasts. Determining the relationship between titanium implants and osteocytes may therefore benefit our understanding of the process of osseointegration.

Background and Purpose: Platelets are one of the earliest cell types to interact with surgically inserted titanium implants. This in vitro study investigated the effect of titanium surface-induced platelet releasate on macrophage cytokine gene expression.

Climate change projections for the Pacific Northwest (PNW) region of North America include warmer temperatures (T), reduced precipitation (P) in summer months, and increased P during all other seasons. Using a physically based hydrologic model and an ensemble of statistically downscaled global climate model scenarios produced by the Columbia Basin Climate Change Scenarios Project, we examine the nature of changing hydrologic extremes (floods and low flows) under natural conditions for about 300 river locations in the PNW. The combination of warming, and shifts in seasonal P regimes, results in increased flooding and more intense low flows for most of the basins in the PNW. Flood responses depend on average midwinter T and basin type. Mixed rain and snow basins, with average winter temperatures near freezing, typically show the largest increases in flood risk because of the combined effects of warming (increasing contributing basin area) and more winter P. Decreases in low flows are driven by loss of snowpack, drier summers, and increasing evapotranspiration in the simulations. Energy-limited basins on the west side of the Cascades show the strongest declines in low flows, whereas more arid, water-limited basins on the east side of the Cascades show smaller reductions in low flows. A fine-scale analysis of hydrologic extremes over the Olympic Peninsula echoes the results for the larger rivers discussed above, but provides additional detail about topographic gradients.

Increased titanium surface hydrophilicity has been shown to accelerate dental implant osseointegration. Macrophages are important in the early inflammatory response to surgical implant placement and influence the subsequent healing response. This study investigated the modulatory effect of a hydrophilic titanium surface on the inflammatory cytokine expression profile in a human macrophage cell line (THP-1). Genes for 84 cytokines, chemokines, and their receptors were analyzed following exposure to (1) polished (SMO), (2) micro-rough sand blasted, acid etched (SLA), and (3) hydrophilic-modified SLA (modSLA) titanium surfaces for 1 and 3 days. By day 3, the SLA surface elicited a pro-inflammatory response compared to the SMO surface with statistically significant up-regulation of 16 genes [Tumor necrosis factor (TNF) Interleukin (IL)-1β, Chemokine (C-C motif) ligand (CCL)-1, 2, 3, 4, 18, 19, and 20, Chemokine (C-X-C motif) ligand (CXCL)-1, 5, 8 and 12, Chemokine (C-C motif) receptor (CCR)-7, Lymphotoxin-beta (LTB), and Leukotriene B4 receptor (LTB4R)]. This effect was countered by the modSLA surface, which down-regulated the expression of 10 genes (TNF, IL-1α and β, CCL-1, 3, 19 and 20, CXCL-1 and 8, and IL-1 receptor type 1), while two were up-regulated (osteopontin and CCR5) compared to the SLA surface. These cytokine gene expression changes were confirmed by decreased levels of corresponding protein secretion in response to modSLA compared to SLA. These results show that a hydrophilic titanium surface can modulate human macrophage pro-inflammatory cytokine gene expression and protein secretion. An attenuated pro-inflammatory response may be an important molecular mechanism for faster and/or improved wound healing.

Although it has been widely acknowledged that people living in poverty are underserved by mental health professionals, little is known about the experiences of psychotherapists who are currently working with poor clients. What can we learn from these clinicians that may help us more effectively prepare trainees for work in the context of poverty? This qualitative investigation analyzed narrative data from 10 therapists regarding their work with poor clients. Participants revealed perceptions of the challenging (and rewarding) nature of this work, the inadequacies of their training to meet these demands, and the damaging influence of social stigma within their clients' lives and presenting problems, as well as on clinicians' own occupational status.