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Numerous compact pepper (Capsicum annuum) cultivars are available for home gardening. However, evaluations under different environmental conditions are limited. This study aimed to characterize growth and productivity of 14 compact pepper cultivars grown indoors under environmental conditions that simulated a residential space (11 mol·m−2·d−1 provided by white of light-emitting diode fixtures, constant 22 °C, and moderate relative humidity of 40% to 60%) and in a greenhouse with sunlight only. Plants in the greenhouse were generally larger in size and produced more fruit [both in number and total fresh weight (FW)] than those grown indoors. For example, growth index, which is a measure of canopy volume that integrates shoot height and width, and fruit FW were up to 250% and 621% higher in the greenhouse than indoors, respectively. ‘Fresh Bites Red Improved’ and ‘Sweet Yellow’ had the highest fruit FW per plant when grown in the greenhouse (695 g) and indoors (483 g), respectively. All cultivars evaluated in this study are recommended for gardening under sunlight, and most for indoor gardening except for Cosmo, Pinata, and Yellow Tomato, which had the lowest fruit FW when grown indoors (61, 59, and 52 g) and thus, should not be recommended to consumers aiming to maximize fruit yield. In addition, ‘Cayennetta’, ‘Cheyenne’, ‘Hot Tomato Red’, ‘Pinata’, ‘Spicy Jane’, and ‘Sweet Yellow’ were affected by intumescence, which could negatively affect indoor gardening experiences until widespread recommendations to mitigate this disorder become available.

Poor eating habits and an increased sedentary lifestyle are responsible for obesity being one of the main public health problems in Ecuador and the world. Several factors can modulate the risk of an infant to be obese, considering genetic, environmental and sociodemographic variables. The aim of this study is to analyze the evidence on the relationship between breastfeeding (BF) and obesity in childhood and thus contribute to the planning of prevention strategies from an early age. A nationally representative sample of children under 5 years of age from the National Health and Nutrition Survey (ENSANUT, 2018) was used. We used heteroscedasticity and autocorrelation tests of the data to rule out possible statistical modeling problems and used multicollinearity tests to avoid redundant information in the models. We also calculated confusion matrices to test the correct specification of the models. In addition, we used a binary logistic linear regression model where the Odds Ratio (OR) with their 95% confidence intervals (95% CI) were estimated for each of the independent variables. Our results show that those children who were breastfed show a greater protective factor against obesity compared to those children who were not breastfed. That is, our results show that exclusive breastfeeding during the first six months of life increased 2 times (OR= 2.01; CI=1.91-2.17) the probability of not suffering from obesity. Other significant protective factors are the mother's age, the mother's educational level and the mother's area of residence. The recommendation derived from this research is that BF should be carried out until the sixth month of life of the infant and complemented with solid (non-milk) food until two years of age and beyond since this could protect against childhood obesity and its associated comorbidities in adulthood, although the benefit that BF can offer against the risk of obesity in the general population is small.

Dietary supplements are a form of complementary and alternative medicine that includes amino acids, biological extracts, herbs, minerals and vitamins. A theoretical review was carried out on the use of nutritional supplements in the pediatric population and their relationship with constipation, which is the second most important adverse effect associated with the consumption of these preparations, after diarrhea. A search for information was carried out, using specialized databases such as Pubmed, Scielo and Biomed Central, describing the main supplements used in pediatrics, constipation as a side effect, and the most important elements on its diagnosis and treatment.

The development of a dental clinic within an existing Rural Health Clinic (RHC) was proposed to improve access to dental care for Medicaid enrollees in Washington. This qualitative study assessed the implementation of a co-located dental clinic in a rural community during the pre-implementation phase. Additionally, we sought to determine the needs and expectations of community members living in this rural Washington county.This study took place in Jefferson County, Washington, a Dental Health Professional Shortage Area. Semi-structured interviews were conducted with 42 participants, consisting of administrators (n = 9), health providers (n = 9) and community members (n = 24). Administrators and health providers were interviewed by phone. Community members were interviewed in-person at Jefferson Healthcare primary care clinics or by phone. Interview data were deductively coded, and thematic analysis with a hybrid inductive-deductive approach was used to analyse coded data.Five themes were identified regarding local needs and expectations: dental care as a major need in the community, persisting barriers to dental care access, expecting more than a 'Medicaid experience', visions for a clinic that serves the community, and solutions outside the clinic to improve community oral health.By improving access to dental care, a co-located dental clinic is helping to address general dental care needs in rural communities. Policy-level solutions that address housing and food insecurity, improve public transportation, and retain and expand low-income adult Medicaid dental benefits may be needed to overcome persisting barriers to oral health.

Objective To explore how pediatric hospitalist attendings can recognize, prevent, and mitigate moral distress among pediatric residents. Methods We conducted a qualitative study, utilizing a deductive approach, from August 2019 to February 2020 at 4 university-affiliated, freestanding children's hospitals in the United States using semistructured, one-on-one interviews with pediatric residents and pediatric hospitalist attendings. All transcripts were coded by pairs of research team members. Using constant comparative analysis, codes were categorized into themes and subsequently grouped into domains. We then conceptualized the relationships between the domains. Results We interviewed 40 physicians (18 residents, 22 attendings) and identified specific strategies for attendings to help residents navigate moral distress, which were categorized into 4 proactive and 4 responsive themes. The proactive themes included strategies employed before morally distressing events to minimize impact: ensuring attendings’ awareness of residency factors influencing residents’ moral distress; knowing available support resources; creating a learning environment that lays the foundation for mitigating distress; and recognizing moral distress in residents. The responsive themes included strategies that help mitigate the impact of morally distressing situations after they occur: partnering with the senior resident to develop a team-specific plan; consideration of who will participate in, the timing of, and content of the debrief. Conclusions We present multiple strategies that attendings can implement to learn to recognize, prevent, and mitigate moral distress among residents. Our findings highlight the need for both proactive and reactive strategies and offer a possible roadmap for attending physicians to help their residents navigate moral distress.

This study aimed to assess the single-dose pharmacokinetics and tolerability of a cannabidiol (CBD) isolate in sunflower oil with escalating oral doses in eight healthy, purpose-bred cats. Eight cats were randomized into six dosing groups of four cats each. Cats were administered a single 2.5, 5, 10, 20, 40, or 80 mg/kg dose orally with at least a two-week washout in between doses. Behavior scoring, complete blood count, serum biochemistry analysis, physical examination, and CBD plasma levels were evaluated before and after dosing. All cats successfully completed the study. CBD was measured in the plasma of all cats dosed with CBD oil. The Cmax and AUC increased in a dose-proportional fashion across all dosing groups. There were no major bloodwork or behavioral changes although the BUN and creatinine values decreased after treatment across all doses. No adverse effects were observed, and behavioral changes were limited to head shaking, lip smacking, and hypersalivation immediately following dose administration. Single orally administered CBD doses up to 80 mg/kg were safe and well tolerated in this cohort of cats and display dose-proportional pharmacokinetics across a broad concentration.

PhenomenonMoral distress, which occurs when someone's moral integrity is seriously compromised because they feel unable to act in accordance with their core values and obligations, is an increasingly important concern for physicians. Due in part to limited understanding of the root causes of moral distress, little is known about which approaches are most beneficial for mitigating physicians' distress. Our objective was to describe system-level factors in United States (U.S.) healthcare that contribute to moral distress among pediatric hospitalist attendings and pediatric residents.ApproachIn this qualitative study, we conducted one-on-one semi-structured interviews with pediatric hospitalist attendings and pediatric residents from 4 university-affiliated, freestanding children's hospitals in the U.S. between August 2019 and February 2020. Data were coded with an iteratively developed codebook, categorized into themes, and then synthesized.FindingsWe interviewed 22 hospitalists and 18 residents. Participants described in detail how the culture of medicine created a context that cultivated moral distress. Norms of medical education and the practice of medicine created conflicts between residents' strong sense of professional responsibility to serve the best interests of their patients and the expectations of a hierarchical system of decision-making. The corporatization of the U.S. healthcare system created administrative and financial pressures that conflicted with the moral responsibility felt by both residents and hospitalists to provide the care that their patients and families needed.InsightsThese findings highlight the critical role of systemic sources of moral distress. These findings suggest that system-level interventions must supplement existing interventions that target individual health care providers. Preventing and managing moral distress will require a broad approach that addresses systemic drivers, such as the corporatization of medicine, which are entrenched in the culture of medicine.

Congenital duodenal obstruction (CDO) occurs due to intrinsic and extrinsic mechanisms but is most often caused by intrinsic duodenal atresia and stenosis. This review will summarize the history, epidemiology, and etiologies associated with the most common causes of CDO. The clinical presentation, complex diagnostic considerations, and current surgical repair options for duodenal atresia and stenosis will also be discussed. Finally, both historical and recent controversies which continue to affect the surgical decision-making in the management of these patients will be highlighted.

A number of treatment options have been explored for peri-implantitis. Seven rough-surfaced implants that failed from peri-implantitis were retrieved. Surfaces were treated by different methods: saline, chlorhexidine, citric acid, 35% phosphoric acid etch gel, hydrogen peroxide, implantoplasty, airborne-particle abrasion, laser, and titanium brush. Implants were observed under scanning electron microscopy. Chemical agents failed to remove any biologic debris. Airborne-particle abrasion, laser, and titanium brush removed part of the biologic debris, and implantoplasty showed complete biologic debris removal. In ex vivo failed implants, implantoplasty showed complete disturbance and removal of bacterial biofilm.

BACKGROUND: Interest is growing in interventions to address social needs in clinical settings. However, little is known about patients’ perceptions and experiences with these interventions. OBJECTIVE: To evaluate patients’ experiences and patient-reported outcomes of a primary care-based intervention to help patients connect with community resources using trained volunteer advocates. DESIGN: Qualitative telephone interviews with patients who had worked with the volunteer advocates. Sample and recruitment targets were equally distributed between patients who had at least one reported success in meeting an identified need and those who had no reported needs met, based on the database used to document patient encounters. PARTICIPANTS: One hundred two patients. INTERVENTIONS: Patients at the study clinic were periodically screened for social needs. If needs were identified, they were referred to a trained volunteer advocate who further assessed their needs, provided them with resource referrals, and followed up with them on whether their need was met. APPROACH: Thematic analysis was used to code the data. KEY RESULTS: Interviewed patients appreciated the services offered, especially the follow-up. Patients’ ability to access the resource to which they were referred was enhanced by assistance with filling out forms, calling community resources, and other types of navigation. Patients also reported that interacting with the advocates made them feel listened to and cared for, which they perceived as noteworthy in their lives. CONCLUSIONS: This patient-reported information provides key insights into a human-centered intervention in a clinical environment. Our findings highlight what works in clinical interventions addressing social needs and provide outcomes that are difficult to measure using existing quantitative metrics. Patients experienced the intervention as a therapeutic relationship/working alliance, a type of care that correlates with positive outcomes such as treatment adherence and quality of life. These insights will help design more patient-centered approaches to providing holistic patient care. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11606-019-05397-6) contains supplementary material, which is available to authorized users.

BackgroundAddressing social risks in the clinical setting can increase patient confidence in the availability of community resources and may contribute to the development of a therapeutic alliance which has been correlated with treatment adherence and improved quality of life in mental health contexts. It is not well understood what barriers patients face when trying to connect to community resources that help address social risks. This paper aims to describe patient-reported barriers to accessing and using social needs-related resources to which they are referred by a program embedded in a safety net primary care clinic.MethodsThis is a qualitative assessment of patient-reported barriers to accessing and using social needs assistance programs. We conducted over 100 in-depth interviews with individuals in Northern California who participated in a navigation and referral program to help address their social needs and describe a unique framework for understanding how policies and systems intersect with an individual’s personal life circumstances.ResultsIndividuals described two distinct domains of barriers: 1) systems-level barriers that were linked to the inequitable distribution of and access to resources, and 2) personal-level barriers that focused on unique limitations experienced by each patient and impacted the way that they accessed services in their communities. While these barriers often overlapped or manifested in similar outcomes, this distinction was key because the systems barriers were not things that individuals could control or overcome through their own initiative or by increasing individual capacity.ConclusionsRespondents describe intersecting systemic and personal barriers that compound patients’ challenges to getting their social needs met; this includes both a picture of the inequitable distribution of and access to social services and a profile of the limitations created by individual life histories. These results speak to the need for structural changes to improve adequacy, availability, and accessibility of social needs resources. These findings highlight the need for advocacy to address systems barriers, especially the stigma that is faced by people who struggle with a variety of health and social issues, and investment in incentives to strengthen relationships between health care settings and social service agencies.

This multicenter study retrospectively evaluated implant survival and bone growth in atrophic ridges that were augmented with titanium mesh and 100% mineralized solvent-dehydrated bone allografts (MSDBA). A secondary objective of this study was to evaluate differences in outcomes by diagnostic model type. Titanium mesh was shaped on a diagnostic wax-up of the patient's jaw: Twenty-three patients (Group 1) had wax-ups on dental stone models, and 16 patients (Group 2) had wax-ups on models fabricated with three-dimensional (3D) printing technology. Clinical and histologic data were analyzed. The average bone gain ranged from 5.94 to 6.91 mm horizontally and 5.76 to 6.99 mm vertically and was not significantly different between the two model groups (P > .05). Implant survival was 100% after 18 to 48 months. Although model type had no significant influence on outcomes, 3D-printed models allowed for faster surgery and served as visual aids for patient education.

Background Alaska Native children, including children of Yup'ik descent, consume large volumes of sugar-sweetened fruit drinks, which contain added sugars that contribute to obesity, diabetes, and dental caries. To date, taste preference evaluations have not been conducted on commercially available sugar-free fruit drinks. Objective The study tested the hypothesis that children would have equal preference for sugar-free and sugar-sweetened fruit drinks. Design This was an experimental two-alternative forced-choice paired preference test. Participants/setting The study focused on a convenience sample of Yup'ik children, aged 7 to 10 years, recruited and enrolled from the Yukon-Kuskokwim Health Corporation dental clinic in Bethel, AK (N=89). Intervention Children evaluated four different commercially available sugar-free fruit drinks paired with the sugar-sweetened versions of each flavor. Order of flavor pair presentation was alternated across children, and order of presentation within each of the four pairs was randomized across pairs. Main outcome measures The outcome was taste preference for the sugar-free versus the sugar-sweetened version of a fruit drink. Statistical analyses performed A test of equivalence was run across all four flavors and separately for each flavor using two one-sided tests. Results The data failed to demonstrate equivalence of the sugar-free and sugar-sweetened fruit drinks across all four flavors (P=0.51) or separately for each flavor. However, this was not because of a preference for sugar-sweetened drinks. The preference for sugar-free drinks overall and for each flavor was >50%. Although the lower bounds of the 90% CIs were within the range of equivalence (40% to 60%), the upper bounds were outside the range of equivalence (>60%). According to post hoc analyses, similar preferences were observed for Yup'ik and non-Yup'ik children, boys and girls, and children of different ages. Conclusions Taste preference findings suggest that sugar-free fruit drinks may be a well-tolerated alternative to sugar-sweetened fruit drinks for Yup'ik children in Alaska Native communities.

The purpose of this case series was to evaluate peri-implant tissues in 10 patients at 1 year after placement of a tapered 3.0-mm laser-microtextured dental implant (Laser-Lok, BioHorizons) using a two-stage approach. Clinical and radiographic measurements were assessed. Keratinized tissue at the facial surfaces of each implant had a slight increase of 0.73 mm (95% confidence interval [CI], P = .058), and marginal bone levels had significant increase of 1.85 mm (95% CI, P = .005) at 1 year compared to baseline. These data suggest that 3.0-mm laser-microtextured implants demonstrate stable or improved soft and hard tissue parameters at 1 year postloading.

Introduction Schwannomas are a benign tumor of peripheral nerve sheath origin. Although most commonly arising in the extremities, head, and neck there have been rare cases of schwannomas presenting within or adjacent to the pancreas reported in the literature. Presentation of case We present an asymptomatic and otherwise healthy 57-year-old male with an incidental peripancreatic mass measuring 3.5 × 3.7 cm found on abdominal computed tomography (CT). The patient underwent complete enucleation of the mass at our hospital. Pathological analysis of the excised specimen showed spindle shaped cells. Immunohistochemical staining was positive for S100 protein expression, confirming the definitive diagnosis of peripancreatic schwannoma. The patient's postoperative course was uneventful. Discussion Schwannoma is a commonly benign, encapsulated, and slowly growing tumor arising from myelin producing cells of peripheral nerves. A schwannoma presenting within or adjacent to solid abdominal viscera, such as the pancreas, may be challenging to diagnose preoperatively as it may mimic other lesions. Radiological appearance of schwannoma may be nonspecific and definitive diagnosis is reliant upon pathological analysis. The use of endoscopic ultrasound (EUS) with fine needle aspiration (FNA) may assist the clinician in preoperative diagnosis, however these interventions are not widely available. Accurate preoperative diagnosis of a peripancreatic schwannoma is of high importance as it may preclude unnecessary pancreatectomy or radical resection. Conclusion Although rare, schwannoma should be part of the differential diagnosis of a cystic or solid appearing mass within or surrounding the pancreas. Total resection carries an excellent prognosis with little to no documented recurrence., Highlights • Peripancreatic schwannoma is rare, but should be considered in the differential diagnosis of an incidentally found mass • Histopathological features of schwannoma • Radiological features of schwannoma • Enucleation of peripancreatic schwannoma carries excellent prognosis

Acinetobacter baumannii is an opportunistic pathogen associated with nosocomial and community infections of great clinical relevance. Its ability to rapidly develop resistance to antimicrobials, especially carbapenems, has re-boosted the prescription and use of polymyxins. However, the emergence of strains resistant to these antimicrobials is becoming a critical issue in several regions of the world because very few of currently available antibiotics are effective in these cases. This review summarizes the most up-to-date knowledge about chromosomally encoded and plasmid-mediated polymyxins resistance in A. baumannii. Different mechanisms are employed by A. baumannii to overcome the antibacterial effects of polymyxins. Modification of the outer membrane through phosphoethanolamine addition, loss of lipopolysaccharide, symmetric rupture, metabolic changes affecting osmoprotective amino acids, and overexpression of efflux pumps are involved in this process. Several genetic elements modulate these mechanisms, but only three of them have been described so far in A. baumannii clinical isolates such as mutations in pmrCAB, lpxACD, and lpsB. Elucidation of genotypic profiles and resistance mechanisms are necessary for control and fight against resistance to polymyxins in A. baumannii, thereby protecting this class for future treatment.

The aim of this case series was to evaluate clinical and patient-centered outcomes when treating multiple recessions (Miller Class I, II, and III) affecting five or more teeth in a single procedure using acellular dermal matrix in 18 eligible participants (mean of 7.4 ± 1.7 recessions/patient). Low mean visual analog scale pain scores (0.7 ± 0.8) and analgesic consumption (2.3 ± 2.5 tablets) were reported from days 0 to 6 postoperatively. Mean baseline recession depth was 2.1 ± 1 mm. At 1 year postsurgery, mean percent root coverage was 87.1% ± 18.3%, and complete root coverage was achieved in 61.7% of recessions with statistically significant differences between smokers and nonsmokers.

Little is known about research evidence use in dental Medicaid class action lawsuits. In this qualitative study, we developed a conceptual model to understand the role of dentists and how research evidence was used. We conducted archival analyses and interviewed 15 key informants. Dentists had key roles requiring scientific expertise or clinical experience serving vulnerable populations. Most evidence was newly generated data rather than based on existing sources. Dentists were involved in all phases of the lawsuit. Future research should identify conditions fostering research evidence use in dental Medicaid lawsuits and whether high-quality research evidence use improves child health outcomes.

The mothSymmetrischema lavernella(Chambers) (Lepidoptera: Gelechiidae) has two feeding strategies on its host plantPhysalisLinnaeus (Solanaceae): a fruitworm that feeds on developing ovules in a fruit and a budworm that consumes a floral bud. The fruitworm strategy occurs when a neonate caterpillar enters the ovary of a flower bud above a size threshold (~4 mm inPhysalis heterophyllaNees), consumes the developing ovules, and pupates in the fruit. InP.heterophylla, occupancy of the ovary byS. lavernellacauses fruit development to occur in the absence of pollination, indicating that the caterpillar initiates developmental pathways associated with pollination. The budworm strategy occurs in buds below ~4 mm, involves consumption of the ovary and immature anthers, and results in pupation inside the uninflated calyx. The two strategies co-occur on plants, determined by the sizes of the available buds at the time of oviposition. The most prominent natural enemy ofS. lavernellausing the fruitworm strategy was the frugivorous caterpillarHeliothis subflexa(Guenée) (Lepidoptera: Noctuidae), also a specialist ofPhysalis. The largerHeliothis subflexafeeds on the fruit externally, consumesS. lavernella, and caused 31.3% of fruitworm mortality in field surveys. Parasitoids included wasps (Hymenoptera) of the families Braconidae, Ichneumonidae, and Chalcididae.

Purpose To identify the types of oral health services offered by community-based organizations to young children with special health care needs (CSHCN) and the barriers and facilitators to the provision of these in a nonfluoridated community. Methods Thirteen key informant interviews with representatives from early intervention agencies, advocacy groups, and oral health programs who provide services to CSHCN in Spokane county, Washington. We used a content analysis to thematically identify oral health services as proactive or incidental and the barriers and facilitators to their provision. Results We identified four types of oral health services: screenings, parent education, preventive dental care, and dental referrals. Barriers to providing all four services included limited agency resources, restrictive administrative and system-level policies, and low demand from parents. A barrier to providing education and preventive dental care was community disagreement regarding fluoride. A barrier to providing dental referrals was the perceived lack of dentists who could treat CSHCN. Facilitators included community partnerships among the organizations and utilization of the statewide oral health program. Conclusions Oral health services for young CSHCN are limited and often delivered in response to oral health problems. Coordinated efforts between community-based organizations, health providers, and advocates are necessary to ensure the provision of comprehensive care, including preventive and restorative services, to all young CSHCN.

Protection from lethality by postchallenge administration of brincidofovir (BCV, CMX001) was studied in normal and immune-deficient (nude, nu/nu) BALB/c mice infected with vaccinia virus (VACV). Whole-body bioluminescence imaging was used to record total fluxes in the nasal cavity, lungs, spleen, and liver and to enumerate pox lesions on tails of mice infected via the intranasal route with 10 5 PFU of recombinant IHD-J-Luc VACV expressing luciferase. Areas under the flux curve (AUCs) were calculated for individual mice to assess viral loads. A three-dose regimen of 20 mg/kg BCV administered every 48 h starting either on day 1 or day 2 postchallenge protected 100% of mice. Initiating BCV treatment earlier was more efficient in reducing viral loads and in providing protection from pox lesion development. All BCV-treated mice that survived challenge were also protected from rechallenge with IHD-J-Luc or WRvFire VACV without additional treatment. In immune-deficient mice, BCV protected animals from lethality and reduced viral loads while animals were on the drug. Viral recrudescence occurred within 4 to 9 days, and mice succumbed ∼10 to 20 days after treatment termination. Nude mice reconstituted with 10 5 T cells prior to challenge with 10 4 PFU of IHD-J-Luc and treated with BCV postchallenge survived the infection, cleared the virus from all organs, and survived rechallenge with 10 5 PFU of IHD-J-Luc VACV without additional BCV treatment. Together, these data suggest that BCV protects immunocompetent and partially T cell-reconstituted immune-deficient mice from lethality, reduces viral dissemination in organs, prevents pox lesion development, and permits generation of VACV-specific memory. IMPORTANCE Mass vaccination is the primary element of the public health response to a smallpox outbreak. In addition to vaccination, however, antiviral drugs are required for individuals with uncertain exposure status to smallpox or for whom vaccination is contraindicated. Whole-body bioluminescence imaging was used to study the effect of brincidofovir (BCV) in normal and immune-deficient (nu/nu) mice infected with vaccinia virus, a model of smallpox. Postchallenge administration of 20 mg/kg BCV rescued normal and immune-deficient mice partially reconstituted with T cells from lethality and significantly reduced viral loads in organs. All BCV-treated mice that survived infection were protected from rechallenge without additional treatment. In immune-deficient mice, BCV extended survival. The data show that BCV controls viral replication at the site of challenge and reduces viral dissemination to internal organs, thus providing a shield for the developing adaptive immunity that clears the host of virus and builds virus-specific immunological memory.

To identify the types of oral health services offered by community-based organizations to young children with special health care needs (CSHCN) and the barriers and facilitators to the provision of these in a nonfluoridated community.Thirteen key informant interviews with representatives from early intervention agencies, advocacy groups, and oral health programs who provide services to CSHCN in Spokane county, Washington. We used a content analysis to thematically identify oral health services as proactive or incidental and the barriers and facilitators to their provision.We identified four types of oral health services: screenings, parent education, preventive dental care, and dental referrals. Barriers to providing all four services included limited agency resources, restrictive administrative and system-level policies, and low demand from parents. A barrier to providing education and preventive dental care was community disagreement regarding fluoride. A barrier to providing dental referrals was the perceived lack of dentists who could treat CSHCN. Facilitators included community partnerships among the organizations and utilization of the statewide oral health program.Oral health services for young CSHCN are limited and often delivered in response to oral health problems. Coordinated efforts between community-based organizations, health providers, and advocates are necessary to ensure the provision of comprehensive care, including preventive and restorative services, to all young CSHCN.

Endometrial polyps are localized intrauterine overgrowths of endometrial glands and stroma covered by a surface epithelium. They occur singularly or in multiples, may be sessile or pedunculated, and range from a few millimeters to several centimeters in size. They are common, present in 7.8%–41% of women. Their detection has increased with the advent of high-resolution transvaginal sonography, saline-infusion ultrasonography, and hysteroscopy. Polyps are encountered in both premenopausal and postmenopausal women. Many women are asymptomatic, while others present with abnormal bleeding patterns. Most polyps are benign, but hyperplastic and malignant polyps also may occur. Appropriate management of endometrial polyps includes observation, medication, and surgery. Treatment of these lesions should be tailored to each patient based on their symptoms, menopausal status, risk of malignancy, and fertility desires.

To systematically review and summarize the medical literature regarding the association of menopausal status, uterine bleeding, and polyp size and risk of malignancy among women undergoing polyp resection.We supplemented a search of entries in electronic databases with references cited in original studies and review articles to identify studies assessing the risk of malignancy for patients undergoing polypectomy. Key word searches were performed using the words "endometrial polyp," "malignancy," "ultrasound," "saline sonohysterography," "hysteroscopy," and "histopathology."We evaluated abstracted data and performed quantitative analyses in observational studies assessing the effects of menopausal status, vaginal bleeding, and polyp size on the risk of malignancy in patients undergoing polyp resection (n=1,552). For each study with binary outcomes, relative risks with 95% confidence intervals (CIs) were calculated. Estimates of relative risk were calculated using fixed and random-effects models. Homogeneity was tested across the studies. Sensitivity analyses were performed to determine the effects of individual studies on the overall effect estimates. Publication bias was assessed using Egger test.Seventeen studies met inclusion criteria for this review. Among women found to have endometrial polyps, the prevalence of premalignant or malignant polyps was 5.42% (214 of 3,946) in postmenopausal women compared with 1.7% (68 of 3,997) in reproductive-aged women (relative risk 3.86; 95% CI 2.92-5.11). The prevalence of endometrial neoplasia within polyps in women with symptomatic bleeding was 4.15% (195 of 4,697) compared with 2.16% (85 of 3,941) for those without bleeding (relative risk 1.97; 95% CI 1.24-3.14). Among symptomatic postmenopausal women with endometrial polyps, 4.47% (88 of 1,968) had a malignant polyp in comparison to 1.51% (25 of 1,654) asymptomatic postmenopausal women (relative risk 3.36; 95% CI 1.45-7.80).Based on data from observational studies, both symptomatic vaginal bleeding and postmenopausal status in women with endometrial polyps are associated with an increased risk of endometrial malignancy.

Teachers who work with students with emotional and behavioral disorders (EBD) play a vital role in public education, but they often experience a wide range of challenges when working with this group of students. To improve the quality of instruction for students with EBD, teachers not only need to equip themselves with a repertoire of up-to-date evidence-based practices, but also know the limitations of these practices. Through a systematic review of empirical studies published in peer-reviewed journals between 2006 and early 2018, this study reviews and discusses practical teaching and research implications on serving and supporting students with EBD in public education.

Objectives: This work aimed to evaluate the antibacterial, antifungal, and anti-Mayaro virus(MAYV) activity of leaf and branch extracts from Tontelea micrantha. Materials and Methods: T. micrantha extracts were prepared through the partition of the leaf and branch samples in different solvents. Then, the antibacterial and antifungal activity was assessed against bacterial pathogens and Candida sp. by the determination of the minimum inhibitory concentration (MIC) by the broth microdilution method. The activity against anti-MAYV was evaluated through the quantification of the extract concentration that promoted the protection of 50% of the cells after the viral infection. Results: The extracts of T. micrantha were inactive (MIC >500 µg/mL) against Gram-positive, Gram-negative and Candida species at the highest concentration tested (500 µg/mL). Anti-MAYV activity was also not detected, with SI

Objectives The objectives of this study were to examine underserved women's acceptability of the forthcoming human papillomavirus (HPV) vaccines and to identify correlates of HPV vaccine acceptability. Study design A sample of primarily low-income minority women (n = 58) recruited from community health clinics completed a semistructured interview assessing health beliefs, vaccination attitudes, health behavior, and HPV vaccination intentions. Results Personal acceptability of the HPV vaccines was generally high. Moreover, 100% of parents were interested in having their children vaccinated. Correlates of vaccination intentions included health beliefs and attitudes (perceived risk of HPV infection, perceived safety and effectiveness of HPV vaccines, perceived physician encouragement for vaccination) and previous health behavior (HIV testing). Independent predictors of vaccine acceptability were also identified. Conclusions The current study highlights key correlates of vaccine acceptability that may inform HPV vaccination campaigns for underserved populations.

The purpose of this study was to understand dental care transitions for adolescents with special health care needs (ASHCNs) from the dentist perspective.We conducted semi-structured interviews with 13 dentists (seven pediatric dentists and six general dentists) to learn about the dental transition process for ASHCNs.Most dentists believed transitions from child-centered to adult-centered dental care were important for ASHCNs. Dentists reported two main barriers to transitions: (1) low dental reimbursements by Medicaid; and (2) a shortage of general dentists qualified or willing to treat ASHCNs. Pediatric and general dentists reported playing complimentary roles in facilitating transitions for ASHCNs and their families.Dentists acknowledged the challenges that adolescents with special health care needs and their families face in transitioning to adult-centered care and believed in the importance of ASHCNs maintaining a dental home. Pediatric dentists and general dentists play a key role in working together to implement dental transition plans for ASHCNs and to ensure successful dental transitions.