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Having practiced over 54 years the art and science of general dentistry, many changes in philosophy and performance have occurred. Some are minor while others very major. This series of observations will treat some in detail while others very briefly. The physical locations have been in the Dallas, Texas area of the USA. Definitions of terms set the stage for discussion of the basis of dentistry. Support for the scientific as well as evidence-based approaches is laid forth. Filling materials have transitioned from amalgam to composite being most prevalent. Fluoride added to local water supplies has decreased the number of decayed/sensitive teeth, the timing of initial decay, and the prognosis for remediation. pH is a major player in the deterioration of tooth structure. New understandings of tooth brushing and oral hygiene have significantly improved the future for continuing dental health. Absence of fluoride in bottled water has taken a front-center stage for helping/hurting chances of keeping teeth free of decay. Fluoride varnishes have widespread acceptance in America. Failure to seek routine dental care has influenced the outcomes for many younger patients, especially those who have graduated high school, gone off to college or into the workforce. Such lack of routine preventive influence raises the costs of care when it is received, often leading to complaints from patients about the high costs of repair. The alternative is prevention with ongoing consistent 6-month recalls/repairs when problems initiate, rather than allowing problems of long duration. The USA dental insurance industry adverse impact on practicing dentists is a vital monologue. Revealing the dental insurance industry as a number one concern of many surveys of practicing dentists is a way of preparing international countries for learning from the flawed USA models. Recent Congressional law, HR 1418, the Competitive Health Insurance Reform Act, will address some of the most critical wrongs by placing the dental insurance industry into antitrust restraints. Current concerns about digital X-ray’s diagnostic potential are revealed. Conservative dentistry is promoted. Results of conservative practice from nearly 50 years are documented with photos and X-rays. Bonded bridge technology is highlighted for its valued impact.

Newly discovered and previously documented Late Neolithic chalk plaques from the Stonehenge locality have been subjected to new, non-invasive techniques which allow access to previously unseen elements of archaeological evidence. The application of these methods – involving Reflectance Transformation Imaging (RTI) and Polynomial Texture Mapping (PTM) – has revealed detail of the surface preparation and allowed methods and sequence of the compositions to be unpicked, clarifying their complexities. The results reveal a range of approaches to the compositions, some of which demonstrate planning, order, and intention while others include less systematic, rapidly executed sketches. Investigations of lines and surfaces have been made, supplemented by preliminary studies of replicated test pieces, to examine potential implements used in their creation and remark on plaque biographies and surface attrition following manufacture. Furthermore, detail revealed by RTI provides indications of the orientations in which some of the plaques should be viewed and – in one instance – suggests a ‘reflected’ element that may not be entirely abstract. Results from improved radiocarbon determinations place the plaques in the early part of the 3rd millennium bc which, together with identification of individual motifs, allows the plaques and the designs to be reconsidered within the corpus of Neolithic art in the British Isles.

Background: There has been civil strife, spanning more than two decades in some countries and recurrent natural disasters in the Horn of Africa (HoA). This has consistently maintained these countries in chronic humanitarian conditions. More important however is the fact that these crises have also denied populations of these countries access to access to lifesaving health services. Children in the difficult terrains and security compromised areas are not given the required immunization services to build their immunity against infectious diseases like the poliovirus. This was the situation in 2013 when the large outbreaks of poliovirus occurred in the HoA. This article reviews the epidemiology, risk, and programme response to what is now famed as the 2013-204 poliovirus outbreaks in the HoA and highlights the challenges that the programme faced in interrupting poliovirus transmission here. Methods: A case of acute flaccid paralysis (AFP) was defined as a child

In the art of three San Francisco drag queen painters we find their highly personal responses to HIV/AIDS and their own mortality. Doris Fish's commitment to glamour wouldn't allow the disease to intrude on her paintings, though she was able to write about her illness's progress in her weekly newspaper column. Jerome Caja made art from the disease's horror by incorporating the ashes of deceased artist Charles Sexton, who died of AIDS, into her works, her way of mastering the carnage. Miss Kitty confronted the disease in an even more personal way, creating art from her own illness by incorporating her prescription for Prozac into one painting and using her emaciated, AIDS-ravaged body as the subject of a photographic portrait by Daniel Nicoletta in which her physical body fades, white on white, into an angel with wings.

Following the outbreak of poliovirus in the countries in the Horn of Africa, Somalia, Kenya and Ethiopia, in two WHO regions, an outbreak response involving the WHO Africa and WHO East and Mediterranean Regions and partner agencies like the UNICEF in East and Southern African was developed. This paper documents response to polio virus outbreak in the Horn of Africa and the lessons learnt for the interregional and inter-agency collaboration on the response. This collaboration led to speedy interruption of the outbreak and within a period of one year the total virus load of 217 in 2013 was brought down to mere six. This resulted from collaborative planning and implementation of activities to boost the hitherto low immunity in the countries andimprove surveillance among others. A number of lesson were generated from the process. Some of the lessons is critical role such collaboration plays in ensuring simultaneous immunity boosting, information and resources sharing, among other. Some challenges were equally encountered, chiefly in the appropriation of authorities. In conclusion, however, one is safe to note that the collaboration was very fruitful given the timely interruption of transmission.

An 80-year-old patient fell while jogging, hitting his face on the concrete trail and causing a horizontal root fracture of his maxillary right central incisor. The fracture separated the root into 2 halves about 0.60-0.84 mm apart, resulting in extrusion of the incisal half. The patient had severe lip swelling and facial injury but no tooth pain. Various options for care were evaluated, but, other than reducing the extrusion, placing local antibiotics, and prescribing periodontal medication, the dentist did not provide or recommend further treatment. At the most recent recall, 8 years after the accident, the root exhibited good bone repair, there was no evidence of abscess, and the patient reported no discomfort. This report aims to remind clinicians that no or minimal treatment may be the best option in certain cases.

Introduction: Improving chronic disease in Australia’s Indigenous populations is complex and new approaches are urgently required. Under the new Primary Health Networks PHNs, a contemporary commissioning approach in partnership with the Aboriginal Community Controlled Health Organisation ACCHO Sector is directly addressing health disparity in Indigenous chronic disease compared to other non-Indigenous Australians. Transformation: Cultural competence is embedded through an enterprising Alliance and Consortia arrangement that is shifting leadership and design of Indigenous health care delivery in Western NSW and Western Queensland. Aim and Theory of Change: The Marrabinya and Nukal Murra initiatives are health support services that aim to ensure eligible Indigenous clients of general practice have better access to more comprehensive care including medication and medical aids, transport, Specialist and allied health interventions. Using a service brokeragemodel, active chronic disease management is promoted across General Practice and ACCHO settings building health literacy and uptake of Medicare. A place-based commissioning approach, it allows knowledge of local behavioural, social and biomedical factors impacting on patient engagement and participation to be incorporated into culturally informed service delivery. Targeted Population: The Marrabinya consortium agreement Western NSW and Nukal Murra alliance agreement Western QLD targets Indigenous patients with chronic disease living across a combined landmass of 1,400,000km2. Timeline: Marrabinya commenced September 2016 and Nukal Murra July 2017. Both services have been funded through the Commonwealth PHN program till 2020. Highlights: Through direct commissioning with Australia’s ACCHO sector both services have pioneered innovative approaches to achieve program fidelity across vast regions of remote Australia: - supporting care-link workers who provide care coordination assisting patients to better navigate and understand their local healthcare system - Increased enrolments - decreased staffing and administration costs - customised health intelligence and operating procedures Sustainability: Centralised brokerage optimises quality, access and cost drivers of care. Increased active enrolments signify changes in attitudes of providers and patients. A quadruple aim locus is achieved through ‘whole of population’ coverage, leveraging regional ACCHO infrastructure to realise cost efficiency at scale, improving quality through cultural competence, and better differentiating clinical and non-clinical roles in care. Transferability: There is high transferability of this unique co-commissioning approach across the PHN national network. Commencing with the Marrabinya initiative, early sharing assisted the establishment of the Nukal Murra program. Conclusions: Partnering with ACCHOs can strengthen cultural competence in clinical practice resulting in significant innovation, efficiency and demonstrated patient and system benefits. Early indications highlight potential to reduce unwarranted acute presentations. Discussions: Cultural intelligence is an important element in commissioning and extremely difficult to dispense in practice. The cultural and social knowledge of Indigenous patients must be effectively integrated into systems supporting their care. Key Lessons Learned: Integrated approaches that engages Indigenous leadership in primary health care design can dramatically improve commissioning outcomes. Centralised brokerage and active health intelligence supports triage and assessment, as well as guiding greater efficiencies, clinical re-design and consumer and provider engagement. Combining short term commissioning pragmatism with longer term partnerships is an important development and a new feature of engagement with Indigenous people.

The publication in 2005 of a book of found photographs focused attention on a rural cross-dressers' resort in New York's Catskill Mountains named “Casa Susanna.” At the time of publication, the editors knew very little about the people in the photographs, and no one was identified. Interest in these anonymous trans* women intensified when playwright Harvey Fierstein's play, Casa Valentina, based on Casa Susanna, opened on Broadway nine years later. This article discusses how magazines, photographs, newsletters, private correspondence, and personal ads in private and institutional trans* archives can be used to identify these trans* women and other members of the early MtF cross-dressing community. It proposes a research methodology that uses aliases and identification codes, originally intended for protection and anonymity, to connect archival holdings to individuals, deepening our understanding of the lived experience of early community members.

This paper proves that convex Brunnian links exist for every dimension n ≥ 3 by constructing explicit examples. These examples are three-component links which are higher-dimensional generalizations of the Borromean rings.

The pattern of Searle’s later teaching career and continuing development of a child-centred, working-class pedagogy, or critical literacy, proved even more controversial than at Sir John Cass school. He was appointed to the head-ship of the 80 per cent non-white Earl Marshal comprehensive in Sheffield in 1990, a year before the first Gulf war. But his refusal to exclude pupils, his determined attempt to involve the local communities, Yemeni, Pakistani, white working-class, etc., in the life of the school and his encouragement of pupils to confront the issues raised by the war — which affected many of them directly — and his bending of the National Curriculum to these ends earned him the wrath not only of the more conservative elements on the local education authority but of shadow Labour education secretary and Sheffield MP, David Blunkett. Attempts made to close Earl Marshal were successfully resisted; Searle was fired, but not before the publication of a number of collections of pupils’ writings, including Lives of Love and Hope, by female pupils and based on family experiences.

The template for Chris Searle’s teaching career, his development of a working-class pedagogy and his concept of critical literacy, was set in his very first teaching job, at Sir John Cass School in Stepney, East London. Here he engaged with the lives and imaginations of all the children, encouraging them to write out of their own experience and imaginatively extend it to the lives and struggles of others, whether in their immediate neighbourhood, across the UK, or globally. The writings, published as a series of booklets, Stepney Words, became a national cause célèbre, leading to Searle’s dismissal, a student strike and his reinstatement. Searle’s pedagogy — which he terms critical literacy — goes beyond the concept of child-centred radical progressivism in education, to class-conscious, communitarian education. Critical literacy exposes and deals with the issues that shape the world in which the students have to live, helping them to make sense of it in their own terms. It is a genuine, unforced fusion of the personal and the political.

Sixteen groups of chinchillas (N=140) were exposed to various equivalent energy noise paradigms at 100 dB(A) or 103 dB(A) SPL. Eleven groups received an interrupted, intermittent, and time varying (IITV) non-Gaussian exposure quantified by the kurtosis statistic. The IITV exposures, which lasted for 8 hday, 5 daysweek for 3 weeks, were designed to model some of the essential features of an industrial workweek. Five equivalent energy reference groups were exposed to either a Gaussian or non-Gaussian 5 days, 24 hday continuous noise. Evoked potentials were used to estimate hearing thresholds and surface preparations of the organ of Corti quantified the sensory cell population. For IITV exposures at an equivalent energy and kurtosis, the temporal variations in level did not alter trauma and in some cases the IITV exposures produced results similar to those found for the 5 day continuous exposures. Any increase in kurtosis at a fixed energy was accompanied by an increase in noise-induced trauma. These results suggest that the equal energy hypothesis is an acceptable approach to evaluating noise exposures for hearing conservation purposes provided that the kurtosis of the amplitude distribution is taken into consideration. Temporal variations in noise levels seem to have little effect on trauma.

Data from an earlier study [Hamernik et al. (2003). J. Acoust. Soc. Am. 114, 386-395] were consistent in showing that, for equivalent energy [Leq= 100 dB(A)] and spectra, exposure to a continuous, nonGaussian (nonG) noise could produce substantially greater hearing and sensory cell loss in the chinchilla model than a Gaussian (G) noise exposure and that the statistical metric, kurtosis, computed on the amplitude distribution of the noise could order the extent of the trauma. This paper extends these results to Leq= 90 and 110 dB(A), and to nonG noises that are generated using broadband noise bursts, and band limited impacts within a continuous G background noise. Data from nine new experimental groups with 11 or 12 chinchillas/group is presented. Evoked response audiometry established hearing thresholds and surface preparation histology quantified sensory cell loss. At the lowest level [Leq=90 dB(A)] there were no differences in the trauma produced by G and nonG exposures. For Leq >90 dB(A) nonG exposures produced increased trauma relative to equivalent G exposures. Removing energy from the impacts by limiting their bandwidth reduced trauma. The use of noise bursts to produce the nonG noise instead of impacts also reduced the amount of trauma.

Assessing the thermal efficiency of a forced-air distribution system is difficult, in large part because of interactions between energy loss mechanisms and other building characteristics. This paper describes short-term coheating, a method of measuring the thermal efficiency of residential heating and cooling distribution systems in situ, and presents the results of a series of studies that utilized the short-term coheat methodology. Short-term coheat tests were conducted in 53 residential buildings including both site-built and manufactured housing. The magnitude of the distribution efficiency, defined as the ratio of the energy required to heat the building if there were no duct losses to the actual heating energy required, ranged from less than 50% for homes with disconnected ducts to more than 90% for well sealed and insulated systems. Duct retrofits were also performed at 20 of the test sites and, following the retrofits, on average, the homes required 16–17% less heating energy. These results show that residential distribution system losses can be responsible for substantial energy loss and that duct retrofits are a viable energy conservation strategy for homes with distribution systems located outside of the conditioned space.

Seventeen groups of chinchillas with 11 to 16 animals/group (sigmaN = 207) were exposed for 5 days to either a Gaussian (G) noise or 1 of 16 different non-Gaussian (non-G) noises at 100 dB(A) SPL. All exposures had the same total energy and approximately the same flat spectrum but their statistical properties were varied to yield a series of exposure conditions that varied across a continuum from G through various non-G conditions to pure impact noise exposures. The non-G character of the noise was produced by inserting high level transients (impacts or noise bursts) into the otherwise G noise. The peak SPL of the transients, their bandwidth, and the intertransient intervals were varied, as was the rms level of the G noise. The statistical metric, kurtosis (beta), computed on the unfiltered noise beta(t), was varied 3or = beta(t)or = 105. Brainstem auditory evoked responses were used to estimate hearing thresholds and surface preparation histology was used to determine sensory cell loss. Trauma, as measured by asymptotic and permanent threshold shifts (ATS, PTS) and by sensory cell loss, was greater for all of the non-G exposure conditions. Permanent effects of the exposures increased as beta(t) increased and reached an asymptote at beta(t) approximately 40. For beta(t)40 varying the interval or peak histograms did not alter the level of trauma, suggesting that, in the chinchilla model, for beta(t)40 an energy metric may be effective in evaluating the potential of non-G noise environments to produce hearing loss. Reducing the probability of a transient occurring could reduce the permanent effects of the non-G exposures. These results lend support to those standards documents that use an energy metric for gauging the hazard of exposure but only after applying a "correction factor" when high level transients are present. Computing beta on the filtered noise signal [beta(f)] provides a frequency specific metric for the non-G noises that is correlated with the additional frequency specific outer hair cell loss produced by the non-G noise. The data from the abundant and varied exposure conditions show that the kurtosis of the amplitude distribution of a noise environment is an important variable in determining the hazards to hearing posed by non-Gaussian noise environments.

At first glance there appears to be significant cultural differences between South Asia and the West. Jandt has argued that the cognitive processes of various cultures ‘are embedded in different naive metaphysical systems and tacit epistemologies, which in turn are rooted in divergent social systems’ (2013, p. 423). It’s therefore possible that these differing cultures ‘perceive different worlds’ (Jandt, 2013, p. 59). For example, we can see that at the macro-level cultural assumptions in the West tend to emphasise extraordinary individual activity (Howe, 1999) often embedded in Romantic and inspirationist frameworks (Boden, 2004, p. 14), which are partially set in foundational ideas from Judeo-Christian creation myths and the works of Plato, Kant, Lombroso, Galton and Freud (collected in Rothenberg & Hausman, 1976). By comparison the South Asian world-view is strongly committed to the notions of renewability and transformation. According to Misra et al., ‘the Indian way of thinking has been characterized as context sensitive’ with an emphasis on ‘the interplay of continuity and change in one’s existence’ (2006, p. 424). Divinities such as Brahma, Vishnu and Mahesh also regulate through intervention the creation, maintenance and destruction of the world (Misra et al., 2006; Kishore, 2011; Srinivasan, 2007; Pattanaik, 2011).