Estimates of time and propensity for dental treatment among institutionalised elders

The oral health and concerns of elderly residents were surveyed in a stratified random selection of 41 long-term care facilities in Vancouver. The residents who could participate were examined and interviewed to determine their oral health and concerns about dental treatment. The need and time required for treatment were estimated in six groups to reflect the propensity for treatment in dentate and edentate subjects. The propensity for treatment was high in about one-third of the participants whereas it was unlikely that one-tenth of those examined would ever use a dental service. In general, there was a widespread need for a diagnostic service because so few had been examined by a dentist in the previous year. Prosthodontics accounted for most of the treatment in all of the propensity groups, with substantially more time required by the dentate residents. There was also a substantial need for management of mucosal pathoses and oral hygiene and, to a lesser extent, for dental restorations and endodontics. Overall, our estimates indicate a substantial need for dental treatment among residents of long-term care facilities, although the need is reduced by half if the propensity for treatment is considered.     

Gaps in knowledge and data driving uncertainty in models of photosynthesis

Regional and global models of the terrestrial biosphere depend critically on models of photosynthesis when predicting impacts of global change. This paper focuses on identifying the primary data needs of these models, what scales drive uncertainty, and how to improve measurements. Overall, there is a need for an open, cross-discipline database on leaf-level photosynthesis in general, and response curves in particular. The parameters in photosynthetic models are not constant through time, space, or canopy position but there is a need for a better understanding of whether relationships with drivers, such as leaf nitrogen, are themselves scale dependent. Across time scales, as ecosystem models become more sophisticated in their representations of succession they needs to be able to approximate sunfleck responses to capture understory growth and survival. At both high and low latitudes, photosynthetic data are inadequate in general and there is a particular need to better understand thermal acclimation. Simple models of acclimation suggest that shifts in optimal temperature are important. However, there is little advantage to synoptic-scale responses and circadian rhythms may be more beneficial than acclimation over shorter timescales. At high latitudes, there is a need for a better understanding of low-temperature photosynthetic limits, while at low latitudes the need is for a better understanding of phosphorus limitations on photosynthesis. In terms of sampling, measuring multivariate photosynthetic response surfaces are potentially more efficient and more accurate than traditional univariate response curves. Finally, there is a need for greater community involvement in model validation and model-data synthesis.     

The prosthetic need WHO index: a comparison between self‐perception and professional assessment in an elderly population

The purpose of this study was to consider the criteria for establishing the need for prosthesis, by comparing the need perceived subjectively by a patient (self‐perception) with that assessed by an examiner according to the WHO diagnosis criteria. The proposed domiciliary sample comprised 270 elderly (aged 60 years or older) residents in a municipality in southern Brazil. The interviews and oral examinations were conducted by two dentists following a period of training and calibration. The criteria used conformed to the WHO and FDI standards. Statistical treatment of data included bivariate and multivariate analysis using SPSS 10.0. Only five patients identified the need for a prosthesis when not identified by the examiner. In the case of 172 elderly subjects, there was agreement in the self‐perceived and observed treatment needs. The need for prosthesis was found in 93 elderly subjects who did not perceive any need for prosthetic treatment. The multivariate analysis showed that the variables age, gender, residential area and form of service most sought after during their lives were significantly associated with a better self‐perception of oral health. The professional criteria based on WHO guidelines differed from the self‐perceived need. Elderly male subjects who lived in a rural area and were 70 years of age or more, who did not participate in third age groups, and who had not sought dental services for most of their lives were the least likely to perceive the need for prosthetic treatment, thereby underestimating their oral health needs.     

Regional variations in need for and provision and use of child health services in England and Wales.

An analysis of indicators of the need for and provision and use of child health services in the 15 pre- 1974 hospital board regions in England and Wales showed that need and provisions were badly matched. There was a high degree of correlation between the indices within each of the three groups, indicating that a region with a small provision in one area of child health services would tend to have few resources in other areas also. Statistics on the use of services relate more to the provision of those services than to the need for them. Regions with large resources will justify these resources by claiming that their use statistics indicate needs, whereas they really indicate met demands. It is more important to identify demands and needs that are not being met.     

Some professional and scientific problems and opportunities for biofeedback

This paper will deal with a variety of topics such as dangers and opportunities from the developing crisis in health care costs, a cooperative study of the cost-effectiveness of treatments for headaches, the need for a federation of related societies, exploiting remarkable electronic advances, the wide range of adaptive functions of visceral learning (including its role in homeostasis), why maladjustments occur and their implications for biofeedback, and the need for analytic experiments involving adequate amounts of training.Presidential address presented at the meetings of the Biofeedback Society of America, April 14, 1985, New Orleans.     

The impact on production and mechanisms of pathogenesis of trematode infections in cattle and sheep

Trematodes can have marked effects on several components of individual animal productivity—particularly growth and wool production, but there is a need for better definition of their effects upon overall flock and herd productivity and of the economic benefits to be derived from their control by chemical, immunological and/or genetic approaches. The reasons for reduced productivity are complex and include reduced appetite coupled with a protein/energy drain arising from increased protein turnover, and in some cases derangements in gastrointestinal function and mineral metabolism are to be anticipated. Knowledge of the effects of trematodes on animal productivity and metabolism lags far behind that of gastrointestinal nematodes and while there is certainly a need for more study of the effects of trematodes per se, there is perhaps an even more pressing need for experimental and field work on mixed infections.     

Acoustic signalling of hunger and thermal state by nestling tree swallows

The begging displays used by altricial nestling birds to solicit care from parents include vigorous movements and loud calling. These begging signals have attracted considerable interest, mainly because their intensity seems excessive for the function of transmitting information about nestling need to parents. However, how information on need is encoded in the various components of the signal, especially its acoustic components, is poorly understood. We examined how begging calls of large and small nestling tree swallows, Tachycineta bicolor, changed during a short period of food deprivation and cooling, as a first step in determining the role that various call characteristics played in advertising nestling need. In contrast to previous studies, we examined several call variables, and related them not only to need for food but also need for warmth. When nestlings were deprived of food, their calls increased in rate and length. Large nestlings also increased the amplitude of their calls. When nestlings were cooled during food deprivation, they decreased the frequency of their calls and their call rate. The latter trend was especially evident in small nestlings. Our results suggest that begging calls carry information not only on the overall hunger level of broods, as emphasized in previous studies, but also on the size, hunger and thermal need of individual nestlings. Further tests are needed to determine whether parents use this information and whether begging calls are optimally designed to convey it. Copyright 2001 The Association for the Study of Animal Behaviour.     

Guidelines for screening,diagnosis and management of hemoglobinopathies

The β-thalassemias and sickle cell disorders are a major health burden in India. Diagnosis and management of these disorders both in adults and in newborns using appropriate approaches and uniform technology are important in different regions of a vast and diverse country as India. In view of a National Thalassemia Control Program to be launched soon, a need was felt for guidelines on whom to screen, cost-effective technologies that are to be used as well as for establishing prenatal diagnosis programs in regional centers. Newborn screening for sickle cell disorders is in its infancy in India and uniform approaches need to be followed. Also, included are guidelines for monitoring and managing patients who are now growing older and need comprehensive care as well as management of complications of the disease.     

Transnationalism and the state: recurring themes and new directions

Transnationalism is central to our understanding of the impact and experiences of global migration. The paper by Levitt and de la Dehesa (2003) explores the policies and strategies of the sending state in relation to their emigrants and investigates the reasons for policy convergences and divergences. While the issues examined in the paper continue to be relevant there are other areas and methodological approaches that need to be developed and/or included in contemporary studies of sending state led transnationalism explored in this piece. These include the need for research to take a multi-level approach to include the different actors involved and their interactions; longitudinal analysis that examines the heterogeneous and complex nature of contemporary migration flows, the changing situations in sending and destination countries and among migrants and the need to incorporate the second and subsequent generations into research.     

Medical Need,Equality, and Uncertainty

Many hold that distributing healthcare according to medical need is a requirement of equality. Most egalitarians believe, however, that people ought to be equal on the whole, by some overall measure of well‐being or life‐prospects; it would be a massive coincidence if distributing healthcare according to medical need turned out to be an effective way of promoting equality overall. I argue that distributing healthcare according to medical need is important for reducing individuals' uncertainty surrounding their future medical needs. In other words, distributing healthcare according to medical need is a natural feature of healthcare insurance; it is about indemnity, not equality.     

The Executive and Neurosis

Executives are prone to overwork, to need to achieve and to need to compete. The dynamics responsible for this pattern were also the dynamics of the breakdown in 16 executives with neurosis. Overcompensation for inferiority feelings, often originating in low socioeconomic childhood background, and ambivalence to the father with repression of hostility were prominent, the main ego mechanisms of defence being repression and denial. The patients often attempted to turn psychotherapy into discussions and had difficulty in accepting a non-directive approach.     

Unmet need for contraception among HIV-positive women in Lesotho and implications for mother-to-child transmission

In Lesotho, the risk of mother-to-child-transmission (MTCT) of HIV is substantial; women of childbearing age have a high HIV prevalence rate (26.4%), low knowledge of HIV status and a total fertility rate of 3.5 births per woman. An effective means of preventing MTCT is to reduce unwanted fertility. This paper examines the unmet need for contraception to limit and space births among HIV-positive women in Lesotho aged 15-49 years, using the 2004 Lesotho Demographic and Health Survey. HIV-positive women have their need for contraception unmet in almost one-third of cases, and multivariate analysis reveals this unmet need is most likely amongst the poor and amongst those not approving of family planning. Urgent action is needed to lower the level of unmet need and reduce MTCT. A constructive strategy is to improve access to family planning for all women in Lesotho, irrespective of HIV status, and, more specifically, integrate family planning with MTCT prevention and voluntary counselling and testing services.     

Reasons for Unmet Need for Child and Family Health Services among Children with Special Health Care Needs with and without Medical Homes

Objectives

Medical homes, an important component of U.S. health reform, were first developed to help families of children with special health care needs (CSHCN) find and coordinate services, and reduce their children’s unmet need for health services. We hypothesize that CSHCN lacking medical homes are more likely than those with medical homes to report health system delivery or coverage problems as the specific reasons for unmet need.

Methods

Data are from the 2005-2006 National Survey of Children with Special Health Care Needs (NS-CSHCN), a national, population-based survey of 40,723 CSHCN. We studied whether lacking a medical home was associated with 9 specific reasons for unmet need for 11 types of medical services, controlling for health insurance, child’s health, and sociodemographic characteristics.

Results

Weighted to the national population, 17% of CSHCN reported at least one unmet health service need in the previous year. CSHCN without medical homes were 2 to 3 times as likely to report unmet need for child or family health services, and more likely to report no referral (OR= 3.3), dissatisfaction with provider (OR=2.5), service not available in area (OR= 2.1), can’t find provider who accepts insurance (OR=1.8), and health plan problems (OR=1.4) as reasons for unmet need (all p<0.05).

Conclusions

CSHCN without medical homes were more likely than those with medical homes to report health system delivery or coverage reasons for unmet child health service needs. Attributable risk estimates suggest that if the 50% of CSHCN who lacked medical homes had one, overall unmet need for child health services could be reduced by as much as 35% and unmet need for family health services by 40%.     

Setting Effective and Realistic Restoration Goals: Key Directions for Research

Restoration ecology has made significant advances in the past few decades and stands to make significant contributions both to the practical repair of damaged ecosystems and the development of broader ecological ideas. I highlighted four main areas where progress in research can assist with this. First, we need to enhance the translation of recent advances in our understanding of ecosystem and landscape dynamics into the conceptual and practical frameworks for restoration. Second, we need to promote the development of an ability to correctly diagnose ecosystem damage, identify restoration thresholds, and develop corrective methodologies that aim to overcome such thresholds. This involves understanding which system characteristics are important in determining ecosystem recovery in a range of ecosystem types, and to what extent restoration measures need to overcome threshold and hysteresis effects. A third key requirement is to determine what realistic goals for restoration are based on the ecological realities of today and how these will change in the future, given ongoing changes in climate and land use. Finally, there is a need for a synthetic approach which draws together the ecological and social aspects of the issues surrounding restoration and the setting of restoration goals.     

Using patient and physician perspectives to develop a shared decision-making framework for colorectal cancer

The Quality Enhancement Research Initiative (QUERI) program and implementation research have both come of age in the 10 years since QUERI was established. Looking forward, if QUERI and the field of implementation science are to mature successfully, we will need to address a series of challenges. First, we need to more clearly demonstrate how applying principles of implementation science leads to more effective implementation and communicate those lessons to our partners and funders. Second, we will need to engage in the ongoing debate over methodological standards in quality improvement and implementation research. Third, a program like QUERI needs to become more relevant to the daily decisions of key stakeholders. Fourth, if we hope to sustain interest in implementation science, we will need to demonstrate the business case for more effective implementation. Fifth, we need to think creatively about how to nurture the next generations of implementation researchers and front-line "connectors," who are critical for accelerating implementation. Finally, we need to strengthen the connections between implementation research and the other operational and research activities that influence change in healthcare systems. The excitement of entering adulthood is tempered by the challenge of new responsibilities and expectations. What is essential is that we continue to learn and move forward. For implementation science and for QUERI, the next decade looks to be one filled with exciting possibilities, new partnerships, increasing relevance, and real accomplishment.     

The psychophysiology of the emotions and personality

According to the need-informational approach the need is specific (essential) force of living organisms, procuring their connections with external environment for self-preservation and self-development, a source of living systems' activity in the surrounding world. Emotion-reflection in human and higher animals' brain of an urgent need and of probability (possibility) of its satisfaction. Emotion in its neurophysiological sense is an active state of a system of specialized brain structures, prompting the subject to change his behaviour so that to maximize or to minimize this state which determines the role of emotions in organization of goal-directed behaviour. Personality is individual unique composition and internal hierarchy of basic (vital, social, ideal) needs of a given human being, including their varieties of preservation and development, "for me" and "for others". The most important personality characteristic is which of those needs and for how long are dominant in the hierarchy of coexisting motives, which need is "supplied" by creative intuition (superconsciousness, according to K. S. Stanislavski?'s terminology).     

Reserpine and chlorpromazine,their use in alcoholic and geriatric patients

Although reserpine and chlorpromazine had tranquilizing effect on a number of geriatric and alcoholic patients in a state hospital, several complicating results were noted, some with a bearing on the patients' health and others that might affect the assignment of personnel. Lipoprotein studies carried out on patients receiving reserpine seemed to indicate that a reduction in the blood levels of the denser lipoprotein molecules took place during therapy. Several elderly patients receiving chlorpromazine died of diseases that were not as sharply manifest by symptoms as they might be expected to be. Hence the need for closer observation than a limited staff could afford seemed a matter for consideration. Another consideration of the same order was the possible need for increased personnel for psychotherapy in light of the more receptive condition of the patients.     

Rapid and reliable extraction of genomic DNA from various wild-type and transgenic plants

Background  

DNA extraction methods for PCR-quality DNA from calluses and plants are not time efficient, since they require that the tissues be ground in liquid nitrogen, followed by precipitation of the DNA pellet in ethanol, washing and drying the pellet, etc. The need for a rapid and simple procedure is urgent, especially when hundreds of samples need to be analyzed. Here, we describe a simple and efficient method of isolating high-quality genomic DNA for PCR amplification and enzyme digestion from calluses, various wild-type and transgenic plants.