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Dental caries are the most common chronic disease of childhood. Untreated caries can result in severe pain and infection; and in some cases, difficulties in eating, speech, and education. Hospitalization and general anesthesia are often necessary for treating extensive disease in young children, which adds significant risk and expense. Interventions, such as community-based preventative care, utilization of pre-authorizations for treatment, and at-risk contracts, have been deployed as innovative strategies to reduce the incidence of caries and the cost of treatment. Value-based payment structures give payors flexibility to design a multipronged system to impact the health of consumers. This practice brief will identify interventions at a systems level that reduced the utilization of general anesthesia treating dental caries in children under the age of six. Dental claims data from the period of Q1 2011 to Q2 2020 were utilized to analyze the trends in utilization of the operating room (OR) to treat dental conditions among children under 6 years. Fixed effects analysis was utilized to identify key over time changes in the reduction of children's OR utilization. A reduction in utilization of general anesthesia and hospitalization for treating dental caries in young children was seen. The expansion of the community care team, metrics to reinforce the systems of provider education and training, and the use of incentive payments were all associated with reductions in the rate of OR utilization. Between 2012 and 2017, multiple initiatives were implemented without a systematic approach to quality improvement to evaluate. [ABSTRACT FROM AUTHOR]

This case describes an unusual intraoperative transesophageal echocardiogram ( TEE) finding of an unknown sinus of Valsalva mass in a patient undergoing an off-pump coronary artery bypass procedure. The intraoperative TEE finding not only revealed a protruding right coronary ostial stent but also changed the surgical procedure to include an aortotomy that allowed successful removal of the stent. As interventional cardiologists begin exploring more techniques to manage difficult ostial lesions, this finding may be seen more commonly in the future. This case highlights how the use of routine TEE even in off-pump coronary artery bypass procedures may be very beneficial. [ABSTRACT FROM AUTHOR]

Participants maneuvered a rat image through a circular region on the computer screen to find a hidden target platform, blending aspects of two well-known spatial tasks. Like the Morris water maze task, participants first experienced a series of learning trials before having to navigate to the hidden target platform from different locations and orientations. Like the dot-location task, they determined the location of a position within a two-dimensional circular region. This procedure provided a way to examine how the number of surrounding cues (1, 2, or 3) affects the memory for spatial location in navigation. Memory performance was better when there were more cues and when targets were close to cues, consistent with the idea that cues bolster fine-grain memory, especially in proximal regions. Early and late measures of bias in memory reflected biases in a direction toward the nearest cue, implicating a cue-based category structure of the navigational space. Collectively, results suggest cue-based spatial memory representations that have been inferred from the dot-location task generalize to a navigation task within a simple, computer-based environment, as demonstrated by the good fits of the spatial model developed for the dot-location task ( Fitting, Wedell, & Allen, 2005, 2007 ). [ABSTRACT FROM AUTHOR]

Training metric accuracy in distance estimation skill for distances up to 300 m was done using three different feedback methods: Direct verbal feedback in the field, indirect visual feedback consisting of presentation of labelled markers in the field, and indirect visual feedback consisting of presentation of labelled markers in pictorial depictions of the field. Results from Experiment 1 showed that all three feedback methods resulted in rapid acquisition of skill in estimating perceived distance from a stationary viewpoint and that the skill transferred to a new field setting. Results from Experiment 2 replicated these results for the estimation of traversed distance along routes. These findings have important implications for the use of pictorial presentations, including virtual reality technology, to train generalizable spatial skills. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

A series of experiments was conducted to examine the effect of several principle-based practices hypothesized as being important in communicating route knowledge. Results indicated that remembering and following route directions were facilitated by the practice of (a) presenting the directions in correct temporal–spatial order, consistent with the principle of natural order, (b) concentrating information in statements concerned with choice points, consistent with the principle of referential determinacy, and, to some extent, (c) using spatial designations with which most listeners are facile, consistent with the principle of mutual knowledge. In all studies, women had more difficulty than men in following the route from verbal directions. Possible avenues for explaining this sex-related difference are suggested. Copyright © 2000 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The major objective of this study was to identify predictors of the duration of homeless spells among persons with severe mental illness (SMI). This was the first study to incorporate time-varying covariates into the survival analysis model predicting the length of homeless spells. The sample consisted of 215 individuals who had participated in two experiments evaluating the effectiveness of various treatment programs for homeless individuals. Persons who received assertive community treatment exited homelessness sooner than individuals who received brokered case management, outpatient treatment, or services from a drop-in center. More assistance in finding and maintaining housing were especially predictive of shorter homeless spells. Inclusion of variables which varied over time in the model (e.g., income and frequency of service contacts) reduced the impact of many of the demographic variables in the model. This survival analysis demonstrated that the efforts of human service agencies to assist homeless mentally ill individuals do make a difference. In general, persons who received more services exited homelessness sooner. © 1998 John Wiley & Sons, Inc. [ABSTRACT FROM AUTHOR]

To investigate developmental changes in recognition-in-context memory, kindergartners, fourth graders, and adults initially studied photographs of real-world scenes. Subsequently, subjects' recognition memory in the landmark-in-context condition was tested on the original scenes paired with 3 types of foils: different landmark/different context, different 1 context, and original landmark/different context. Subjects in the landmark-out-of-context condition were tested on landmarks extracted from original scenes paired with foils that were different isolated landmarks. Results indicated that (a) older children and adults were more accurate than kindergartners, (b) young children's difficulty in recognizing landmarks in context was not due solely to centering on landmarks exclusively, and (c) the visual encoding of landmark/context relations improves in efficiency over the course of childhood. [ABSTRACT FROM AUTHOR]

Examines developmental differences in the ability to select and use environmental landmarks for cognitively organizing distance information. Subjects' viewing of a simulated walk and selected scenes that were high in potential landmark value; Comparison of adults and children's judgment; Cognitive mapping.

Kindergartners, second, and fifth graders made repeated trips through a large- or small-scale model town, and then constructed from memory the layout of buildings in either a large- or small-scale space. Accuracy of construction increased as a function of developmental level and repeated trips through the town. Children's constructions were most accurate when they were tested in the same-scale environment as that in which they developed their spatial knowledge; accuracy was impaired significantly only when children were exposed to a small space and then reconstructed in a large space. Results were interpreted in terms of a "competence-load trade-off." [ABSTRACT FROM AUTHOR]