Dental hygiene and direct access to care: Past and present Gadbury‐Amyot, Cynthia C.; Simmer‐Beck, Melanie L.; Lynch, Ann ...
International journal of dental hygiene,
November 2023, 2023-11-00, 20231101, Volume:
21, Issue:
4
Journal Article
Peer reviewed
The American Dental Hygienists' Association (ADHA) defines direct access as the ability of a dental hygienist to initiate treatment based on their assessment of patient's needs without the specific ...authorization of a dentist, treat the patient without the physical presence of a dentist and maintain a provider–patient relationship. In 2000, there were nine direct access states; currently, there are 42 states that have authorized some form of direct access. The ADHA has been instrumental in these legislative initiatives through strong advocacy efforts. While research and data support the benefits of direct preventive/therapeutic care provided by dental hygienists, many barriers remain. This paper chronicles key partnerships that have influenced and advocated for direct access and the recognition of dental hygienists as primary healthcare providers. The National Governors Association released a report in 2014 suggesting that dental hygienists be ‘deployed’ outside of dental offices as one strategy to increase access to oral health care along with reducing restrictive dental practice acts and increasing the scope of practice for dental hygienists. The December 2021 release of the National Institutes of Health report, Oral Health in America, further supports greater access to dental hygiene preventive/therapeutic care. This paper also reflects on opportunities and barriers as they relate to workforce policy, provides examples of effective state policies and illustrates an educational curriculum specifically created to prepare dental hygienists to provide oral health services in settings outside of the dental office. Dental hygiene education must ensure that graduates are future‐ready as essential healthcare providers, prepared to deliver direct access to dental hygiene care.
ABSTRACT To date, no direct detection of Lyman continuum emission has been measured for intermediate-redshift ( ) star-forming galaxies. We combine Hubble Space Telescope grism spectroscopy with ...GALEX UV and ground-based optical imaging to extend the search for escaping Lyman continuum to a large (∼600) sample of low-mass ( 9.3 ), moderately star-forming ( 10 yr−1) galaxies selected initially on H emission. The characteristic escape fraction of LyC from star-forming galaxies (SFGs) that populate this parameter space remains weakly constrained by previous surveys, but these faint (sub-L ) SFGs are assumed to play a significant role in the reionization of neutral hydrogen in the intergalactic medium (IGM) at high redshift . We do not make an unambiguous detection of escaping LyC radiation from this sample, individual non-detections to constrain the absolute Lyman continuum escape fraction, (3 ). We measure an upper limit of from a sample of SFGs selected on high H equivalent width (EW ), which are thought to be close analogs of high redshift sources of reionization. For reference, we also present an emissivity-weighted escape fraction that is useful for measuring the general contribution SFGs to the ionizing UV background. In the discussion, we consider the implications of these intermediate redshift constraints for the reionization of hydrogen in the IGM at high ( ) redshift. If we assume our SFGs, for which we measure this emissivity-weighted , are analogs to the high redshift sources of reionization, we find it is difficult to reconcile reionization by faint ( ) SFGs with a low escape fraction ( ), with constraints from independent high redshift observations. If evolves with redshift, reionization by SFGs may be consistent with observations from Planck.
Aims: The objective was to investigate if gender differences exist in the associations between periodontitis and type 2 diabetes. Disproportionate disparities by gender were found to exist in rates ...of both periodontitis and diabetes with respect to demographics and behavioural predictors that cannot be explained solely by the well‐established association between these two diseases. Materials and methods: Multiple datasets were extracted from the National Health and Nutrition Examination Survey (NHANES) 2009–2014, which used a stratified multistage probability sampling to obtain samples from all civilian non‐institutionalised people in the USA. Bivariate relationships between each explanatory variable and periodontitis level were assessed with odds ratios (OR) and their 95% confidence intervals (CI). A set of weighted logistic regression models was used to investigate the association differentiations between periodontitis and diabetes by gender. C‐statistics measured the goodness‐of‐fit of weighted logistic regression models. Results: The prevalence of moderate–severe periodontitis was 36.39% and 22.71% among participants with type 2 diabetes and without diabetes, respectively. Type 2 diabetes was significantly associated with moderate–severe periodontitis OR (OR = 1.47, 95% CI: 1.18–1.82) among males even after adjusting for demographics, socioeconomic status and oral health behaviours. The aforementioned relationship was not found in females. Furthermore, different relationships of moderate–severe periodontitis with body mass index and the use of mouthwash were found between the males and females. Conclusions: The current findings suggest that important improvements in the development of gender‐specific strategies in prevention, such as oral home‐care, to reduce the high prevalence of periodontal disease and maintain good oral health are vital, and are especially important for male diabetic patients and those who are at high risk of developing diabetes, such as those who are obese.
Purpose
To evaluate the outcomes of a dental pipeline program at strengthening dental school applications, growing the diversity of dental students, and increasing access to care
Methods
This program ...evaluation used a descriptive and quasi‐experimental retrospective study design. Researchers analyzed secondary data, from a dental pipeline program, for the years 2011–2018. Descriptive statistics were used to describe short‐term and intermediate outcomes and impact. Associations were tested using paired t‐test, 2‐sample t‐test, analysis of variance, and chi‐squared test
Results
Ninety‐eight scholars completed the 10‐week program. The majority of scholars were female (70%), non‐Hispanic or Latino (76%), non‐White (72%), and pursuing baccalaureate degrees (94%). After completing the program, the mean Dental Admission Test (DAT) Academic Average Score (AAS) increased (16.0 vs. 17.5, P < 0.01). Significant associations were revealed between post‐program DAT AAS and being accepted into dental school (P = 0.02). Associations remained when stratified by gender (male P = 0.01) and ethnicity (P = 0.03). The majority of scholars (71%) applied to the host school. Over half of the scholars matriculated to dental school (55%). Twenty‐nine scholars (30%) graduated from the host school. Graduates report choosing careers in private practice (38%), public health (24%), corporate dentistry (17%), and the military (3%)
Conclusion
Dental pipeline programs are effective at strengthening dental school applications, increasing DAT AAS, growing the diversity of dental students, and increasing access to care. Dental education needs to examine barriers dental pipeline programs do not typically address, such as the high cost of applying to dental school, and identify additional ways to support underrepresented minority students entering into dentistry.
Modern large-scale cosmological simulations model the universe with increasing sophistication and at higher spatial and temporal resolutions. These ongoing enhancements permit increasingly detailed ...comparisons between the simulation outputs and real observational data. Recent projects such as Illustris are capable of producing simulated images that are designed to be comparable to those obtained from local surveys. This paper tests the degree to which Illustris achieves this goal across a diverse population of galaxies using visual morphologies derived from Galaxy Zoo citizen scientists. Morphological classifications provided by these volunteers for simulated galaxies are compared with similar data for a compatible sample of images drawn from the Sloan Digital Sky Survey (SDSS) Legacy Survey. This paper investigates how simple morphological characterization by human volunteers asked to distinguish smooth from featured systems differs between simulated and real galaxy images. Significant differences are identified, which are most likely due to the limited resolution of the simulation, but which could be revealing real differences in the dynamical evolution of populations of galaxies in the real and model universes. Specifically, for stellar masses , a substantially larger proportion of Illustris galaxies that exhibit disk-like morphology or visible substructure, relative to their SDSS counterparts. Toward higher masses, the visual morphologies for simulated and observed galaxies converge and exhibit similar distributions. The stellar mass threshold indicated by this divergent behavior confirms recent works using parametric measures of morphology from Illustris simulated images. When , the Illustris data set contains substantially fewer galaxies that classifiers regard as unambiguously featured. In combination, these results suggest that comparison between the detailed properties of observed and simulated galaxies, even when limited to reasonably massive systems, may be misleading.
Subterranean estuaries (STEs) are important biogeochemical land–sea interfaces, where fresh groundwater mixes with seawater in coastal aquifers. However, the sources of dissolved organic matter (DOM) ...and the connection of its molecular-level processing to pore water chemistry and redox conditions in these ecosystems are still not well understood. We studied the cycling of DOM in the STE of an intertidal sandy beach of the North Sea on spatial and seasonal scales. Ultrahigh-resolution mass spectrometry was used to identify thousands of DOM molecular formulae. These data were interpreted in the context of inorganic pore water chemistry, stable carbon isotope composition of solid-phase extracted (SPE) DOM and chemical tracers for bioavailable (dissolved carbohydrates, DCHOs) as well as biorefractory DOM (dissolved black carbon, DBC). Numerical modelling was used to estimate pore water residence times indicating relatively young pore water in the upper saline plume (USP, <4 years) and decades-old groundwater in the freshwater discharge tube. The detected levels of dissolved Fe and ammonium in the USP at sediment depths exceeding 50cm demonstrated suboxic conditions. Statistical analyses revealed complex biotic and abiotic DOM processing apart from conservative mixing of marine and terrestrial endmembers. We propose that the input of bioavailable marine and terrestrial DOM, such as DCHOs, by percolating seawater and meteoric groundwater and its degradation by microbes caused oxygen depletion favoring Fe oxide/hydroxide reduction. In the freshwater discharge tube, the presence of highly aromatic compounds, DBC, and 13C-depleted SPE-DOM indicated the intrusion of meteoric groundwater containing terrestrial DOM. The discharge of this groundwater appears to be a significant source of nutrients (e.g., ammonium) and biorefractory, e.g. combustion-derived, DOM to the adjacent water column.
•Seasonal study of nutrients and molecular composition of dissolved organic matter (DOM) in a sandy beach•Modelled pore water residence times were <4 years in upper saline plume (USP) and several decades close to the low water line•The subterranean estuary received DOM from terrestrial and marine sources•Dissolved Fe and ammonium in USP pore water indicated oxygen depletion at sediment depths >50cm•Marine DOM appears to be degraded in the USP while less reactive terrestrial DOM may be transported to the adjacent water column by submarine groundwater discharge
This study addresses key processes in high-energy beach systems using an interdisciplinary approach. We assess spatial variations in subsurface pore water residence times, salinity, organic matter ...(OM) availability, and redox conditions and their effects on nutrient cycles as well as on microbial community patterns and microphytobenthos growth. At the study site on Spiekeroog Island, southern North Sea, beach hydrology is characterized by the classical zonation with an upper saline plume (USP), a saltwater wedge, and a freshwater discharge tube in between. Sediment and pore water samples were taken along a cross-shore transect from the dunes to the low-water line reaching sediment depths down to 5m below sediment surface. Spatial variations in pore water residence time, salinity, and organic matter availability lead to steep redox and nutrient gradients. Vertical and horizontal differences in the microbial community indicate the influence of these gradients and salinity on the community structure. Modeled seawater flux through the USP and freshwater flux through the tube are on average 2.8 and 0.75m3 per day and meter of shoreline, respectively. Furthermore, ridge sediments at the lower beach discharge seawater at rates of 0.5 and 1.0m3 per day and meter of shoreline towards the runnel and seaside, respectively. Applying seawater and freshwater fluxes and representative nutrient concentrations for the discharge zones, nutrient fluxes to adjacent nearshore waters are 117mmol NH4+, 55mmol PO43− and 575mmol Si(OH)4 per day and meter of shoreline. We propose that this nutrient efflux triggers growth of microphytobenthos on sediment surfaces of the discharge zone. A first comparison of nutrient discharge rates of the beach site with a nearby sandy backbarrier tidal flat margin indicates that the beach system might be of less importance in supplying recycled nutrients to nearshore waters than the backbarrier tidal flat area.
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•Interdisciplinary study of a high-energy beach system•Pore water origin (land/sea) and redox state affect nutrient and metal cycling.•Pore water salinity and redox gradients influence microbial community patterns.•Nutrient discharge triggers microphytobenthos growth.•The beach system discharges less nutrients than the backbarrier tidal flat area.
Sandy beaches have received increasing attention due to their global ubiquity and ecological services they provide. Previous investigations on their microbial diversity mostly targeted low energy ...beaches, lacked seasonality or geochemical information. We now have used a multidisciplinary approach to study the microbial diversity within sediments of a sandy, high energy beach that additionally exhibits submarine groundwater discharge (SGD) in the intertidal. We sampled two transects at three seasons down to a depth of one meter for 16S rRNA gene amplicon sequencing and subsequent correlation of microbial diversity to physico-chemical parameters. We found that advection driven transport of porewater constituents and constant physical reworking of the sediments prevented a distinct formation of vertically stratified redox zones. Consequently, a uniform microbial core community of generalists established independently of sampling site and depth. During spring, the community structure was disturbed by a “subsurface bloom” of Bacteroidetes and Firmicutes, probably due to deeper oxygen and nitrate penetration depths. In summer, the community returned to its equilibrium state with imprints of the subsurface bloom still visible. In our study, we did not detect a clear impact of SGD on microbial diversity, but found an unexpected homogeneous composition and resilience of the microbial community structure.
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