Validity of environmental audits using GigaPan<Superscript>®</Superscript> and Google Earth Technology

Background

Health behaviors are shaped by the context in which people live. However, documenting environmental context has remained a challenge. More specifically, direct observation techniques require large investments in time and resources and auditing the environment through web-based platforms has limited stability in spatio-temporal imagery. This study examined the validity of a new methodology, using GigaPan^® imagery, where we took photos locally and, stitched them together using GigaPan^® technology, and quantified environmental attributes from the resulting panoramic photo. For comparison, we examined validity using Google Earth imagery.

Methods

A total of 464 street segments were assessed using three methods: GigaPan^® audits, Google Earth audits, and direct observation audits. Thirty-seven different attributes were captured representing three broad constructs: land use, traffic and safety, and amenities. Sensitivity (i.e. the proportion of true positives) and specificity (i.e. the proportion of true negatives) were used to estimate the validity of GigaPan^® and Google Earth audits using direct observation audits as the gold standard.

Results

Using GigaPan^®, sensitivity was 80% or higher for 6 of 37 items and specificity was 80% or higher for 31 of 37 items. Using Google Earth, sensitivity was 80% or higher for 8 of 37 items and specificity was 80% or higher for 30 of 37 items. The validity of GigaPan^® and Google Earth was similar, with significant differences in sensitivity and specificity for 7 items and 2 items, respectively.

Conclusion

GigaPan^® performed well, especially when identifying features absent from the environment. A major strength of the GigaPan^® technology is its ability to be implemented quickly in the field relative to direct observation. GigaPan^® is a method to consider as an alternative to direct observation when temporality is prioritized or Google Earth imagery is unavailable.

     

Cost-effectiveness of vedolizumab compared with infliximab,adalimumab, and golimumab in patients with ulcerative colitis in the United Kingdom

Objective

To examine the clinical and economic impact of vedolizumab compared with infliximab, adalimumab, and golimumab in the treatment of moderately to severely active ulcerative colitis (UC) in the United Kingdom (UK).

Methods

A decision analytic model in Microsoft Excel was used to compare vedolizumab with other biologic treatments (infliximab, adalimumab, and golimumab) for the treatment of biologic-naïve patients with UC in the UK. Efficacy data were obtained from a network meta-analysis using placebo as the common comparator. Other inputs (e.g., unit costs, adverse-event disutilities, probability of surgery, mortality) were obtained from published literature. Costs were presented in 2012/2013 British pounds. Outcomes included quality-adjusted life-years (QALYs). Costs and outcomes were discounted by 3.5% per year. Incremental cost-effectiveness ratios were presented for vedolizumab compared with other biologics. Univariate and multivariate probabilistic sensitivity analyses were conducted to assess model robustness to parameter uncertainty.

Results

The model predicted that anti-tumour necrosis factor-naïve patients on vedolizumab would accrue more QALY than patients on other biologics. The incremental results suggest that vedolizumab is a cost-effective treatment compared with adalimumab (incremental cost-effectiveness ratio of £22,735/QALY) and dominant compared with infliximab and golimumab. Sensitivity analyses suggest that results are most sensitive to treatment response and transition probabilities. However, vedolizumab is cost-effective irrespective of variation in any of the input parameters.

Conclusions

Our model predicted that treatment with vedolizumab improves QALY, increases time in remission and response, and is a cost-effective treatment option compared with all other biologics for biologic-naïve patients with moderately to severely active UC.

     

Associations Between Neighborhood Characteristics,Social Cohesion,and Perceived Sex Partner Risk and Non-Monogamy Among HIV-Seropositive and HIV-Seronegative Women in the Southern U.S.

Neighborhood social and physical factors shape sexual network characteristics in HIV-seronegative adults in the U.S. This multilevel analysis evaluated whether these relationships also exist in a predominantly HIV-seropositive cohort of women. This cross-sectional multilevel analysis included data from 734 women enrolled in the Women’s Interagency HIV Study’s sites in the U.S. South. Census tract-level contextual data captured socioeconomic disadvantage (e.g., tract poverty), number of alcohol outlets, and number of non-profits in the census tracts where women lived; participant-level data, including perceived neighborhood cohesion, were gathered via survey. We used hierarchical generalized linear models to evaluate relationships between tract characteristics and two outcomes: perceived main sex partner risk level (e.g., partner substance use) and perceived main sex partner non-monogamy. We tested whether these relationships varied by women’s HIV status. Greater tract-level socioeconomic disadvantage was associated with greater sex partner risk (OR 1.29, 95% CI 1.06–1.58) among HIV-seropositive women and less partner non-monogamy among HIV-seronegative women (OR 0.69, 95% CI 0.51–0.92). Perceived neighborhood trust and cohesion was associated with lower partner risk (OR 0.83, 95% CI 0.69–1.00) for HIV-seropositive and HIV-seronegative women. The tract-level number of alcohol outlets and non-profits were not associated with partner risk characteristics. Neighborhood characteristics are associated with perceived sex partner risk and non-monogamy among women in the South; these relationships vary by HIV status. Future studies should examine causal relationships and explore the pathways through which neighborhoods influence partner selection and risk characteristics.     

Oral cancer. Practical prevention and early detection for the dental team

Approximately 2,000 patients a year are diagnosed with oral cancer in New York State. In an effort to control this deadly disease, Governor George Pataki has taken a leadership role in the United States by mandating and funding training for dentists in the prevention and early detection of oral cancer. The purpose of this article is to highlight the epidemiology of oral cancer, to show how the dental profession can contribute to the health of the citizens of New York State, and to provide practical guidelines for both tobacco cessation intervention and utilization of existing technology for the early detection of oral cancer and precancerous conditions in the general dental practice setting.     

Periodontal repair in dogs: evaluation of a bioabsorbable space-providing macroporous membrane with recombinant human bone morphogenetic protein-2

BACKGROUND: Recombinant human bone morphogenetic protein-2 (rhBMP-2) technologies have been shown to significantly support alveolar bone formation. Biomaterial limitations, however, have restricted the biologic potential for onlay indications. The objective of this study was to evaluate regeneration of alveolar bone and periodontal attachment, and biomaterials reaction following surgical implantation of a space-providing, bioabsorbable, macroporous, polyglycolic acid-trimethylene carbonate (PGA-TMC) membrane combined with a rhBMP-2 construct in a discriminating onlay defect model. METHODS: Routine supraalveolar periodontal defects were created at the mandibular premolar teeth in 9 beagle dogs. Contralateral jaw quadrants in subsequent animals were randomly assigned to receive the dome-shaped PGA-TMC (100 to 120 microm pores) membrane with rhBMP-2 (0.2 mg/mL) in a bioresorbable hyaluronan (Hy) carrier or the PGA-TMC membrane with Hy alone (control). The gingival flaps were advanced to submerge the membranes and teeth and sutured. Animals were euthanized at 8 and 24 weeks postsurgery for histologic observations. RESULTS: Jaw quadrants receiving the PGA-TMC membrane alone experienced exposures at various time points throughout the study. Jaw quadrants receiving the PGA-TMC/rhBMP-2 combination remained intact, although one site experienced a late minor exposure. Newly formed alveolar bone approached and became incorporated into the macroporous PGA-TMC membrane in sites receiving rhBMP-2. The PGA-TMC biomaterial was occasionally associated with a limited inflammatory reaction. Residual PGA-TMC could not be observed at 24 weeks postsurgery. Residual Hy could not be observed at any time interval. Regeneration of alveolar bone height (means +/- SD) was significantly increased in sites receiving the PGA-TMC/rhBMP 2 combination compared to control (3.8 +/- 1.3 versus 0.7 +/- 0.5 mm at 8 weeks and 4.6 +/- 0.8 versus 2.1 +/- 0.4 mm at 24 weeks; P < 0.05). Limited cementum regeneration was observed for PGA-TMC/rhBMP-2 and PGA-TMC control sites. Ankylosis compromised regeneration in sites receiving PGA-TMC/rhBMP-2. CONCLUSIONS: The bioabsorbable, space-providing, macroporous PGA-TMC membrane appears to be a compatible biomaterial for bone augmentation procedures. rhBMP-2 significantly enhances alveolar bone augmentation and soft tissue healing when combined with the PGA-TMC membrane.     

Transverse craniofacial features and their genetic predisposition in families with nonsyndromic unilateral cleft lip and palate.

OBJECTIVE: The purpose of this study was to evaluate the transverse craniofacial form in families with nonsyndromic cleft lip and palate (NSCLP). It was hypothesized that affected as well as noncleft NSCLP family members are characterized by a common array of craniofacial features that differ from the general population. DESIGN: This was a prospective cross-sectional investigation that included affected children with NSCLP and their noncleft parents and siblings. PATIENTS, PARTICIPANTS: A total of 114 subjects (14 affected girls, 17 affected girls, 15 unaffected male siblings, 10 unaffected female siblings, 29 unaffected biological mothers, and 29 unaffected biological fathers) were included. Subject records comprised of posteroanterior cephalometric radiographs obtained from all 114 subjects. MAIN OUTCOME MEASURES: The width of midfacial structures, including the orbit and nose, was increased in NSCLP families, compared with published norms. Interestingly, the face was disproportionally wider in relation to total facial height. The transverse craniofacial form of children with or without clefts significantly correlated with that of their parents. Mothers displayed strong correlation with their affected and unaffected sons, whereas fathers correlated to their daughters, suggesting a possible sex-linked developmental influence. CONCLUSION: Better understanding of the genetic inheritance of craniofacial features associated with cleft lip and palate may ultimately contribute to the development of cleft risk assessment methods.     

Maxillary growth following LeFort III advancement surgery in Crouzon, Apert, and Pfeiffer syndromes

This was a cephalometric study of maxillary growth following LeFort III osteotomy in children with Crouzon, Apert, and Pfeiffer (CAP) syndromes. Nineteen children who had undergone LeFort III advancement osteotomies were followed postoperatively for an average of 5.3 years. Data for horizontal and vertical maxillary growth increments were obtained and compared with data of a control group of unoperated CAP children and with normal data. The findings indicate that horizontal maxillary growth following surgical treatment is negligible (less than 0.1 mm/yr), and differs from unoperated CAP children (0.7 mm/yr) and normal children (1.3 mm/yr). Vertical maxillary growth following surgery is identical to that in unoperated CAP and normal children, amounting to 1.3 mm/yr. The LeFort III osteotomy during childhood is a justifiable procedure for physiologic and psychologic reasons. Horizontal maxillary growth, for all practical purposes, is eliminated by this procedure and a subsequent maxillary advancement is invariably required at the completion of growth.     

Clinical benefits of oral irrigation for periodontitis are related to reduction of pro-inflammatory cytokine levels and plaque

BACKGROUND: Although a growing body of evidence indicates that oral irrigation with water has therapeutic benefits in periodontitis, the mechanisms of action have not been elucidated. The aims of this study were: (1) to analyze the effects of oral irrigation (Water Pik Oral Irrigator) on the clinical signs of adult periodontitis (AP) and on the levels of interleukin-1 beta (IL-beta), prostaglandin-E2 (PGE2), interleukin-10 (IL-10) and interferon-gamma (IFN-gamma) in GCF, and (2) to analyze the influence of the periodontitis-related IL-1 genotype (IL-1GT) on these variables. METHOD: A single-center, blinded study in otherwise healthy humans (n= 52) with localized mild to moderate AP was carried out, using the following groups: group A (n= 12), no oral hygiene for 14 days; group B (n=20), routine oral hygiene (ROH) for 14 days; group C (n=20), supra-gingival oral irrigation plus ROH for 14 days. Group A patients were crossed-over to group C for 14 days (=day 28) after a professional prophylaxis. Group assignment was randomized by a coin toss, with the exception of group A subjects, who were self-selected as per recommendations of the internal review board for human subjects. GCF was sampled from 3 study teeth per patient and analyzed for IL-1 beta, PGE2, IL-10 and IFN gamma by ELISA on days 0, 7, 14 and 28. Probing pocket depths (PPD), clinical attachment levels (CAL), bleeding on probing (BOP), gingival index (GI) and plaque index (PI) were measured by a calibrated examiner (TWS) on days 0, 14 and 28. Analysis of covariance was performed using SAS 6.12 and Proc Mixed with group and IL-1GT as the factors and the baseline levels as the covariate, with output being least squares means and least significant difference (LSD). Significant differences were declared if the p-value for the F-statistic was < or =0.05. RESULTS: Oral irrigation plus ROH resulted in a significant reduction in PPD, BOP, GI and PI, as well as IL-beta levels by 7 days and PGE2 levels by 14 days, relative to ROH or no oral hygiene. Interestingly, decreased IL-1 beta levels in patients using oral irrigation plus ROH was accompanied by a trend for increased levels of the "anti-inflammatory" cytokine IL-10. ROH reduced GI, BOP and PI, and PGE2 levels by 14 days, but had no effect on IL-1 beta or IL-10 levels relative to no oral hygiene. The effects of no oral hygiene were reversed by a prophy followed by oral irrigation plus ROH for 14 days. No clinical differences were evident between IL-1 GT (+) patients (n= 1) and GT (-) patients (n=40), but the former had significantly elevated levels of GCF IL-10 and borderline increases in IL-1 beta (p=0.07). CONCLUSIONS: Oral irrigation with water for 14 days had an improved therapeutic benefit for AP over that of routine oral hygiene alone and this improvement was accompanied by a down-modulation of the pro-inflammatory cytokine profile in GCF.     

Prevalence of missing posterior teeth and intraarticular temporomandibular disorders.

STATEMENT OF PROBLEM: The association between missing mandibular posterior teeth and the development of intraarticular temporomandibular disorders (TMDs) remains unclear. PURPOSE: The purpose of this study was to evaluate the prevalence of missing mandibular posterior teeth and intraarticular TMDs in a mixed population of asymptomatic subjects and symptomatic TMD patients. MATERIAL AND METHODS: Eighty-two asymptomatic volunteers and 263 symptomatic TMD patients were included in this study. Asymptomatic volunteers completed a subjective questionnaire and underwent clinical examination to document the absence of TMD signs and symptoms. All symptomatic subjects had localized jaw joint pain and pain on movement or when eating. The number of missing mandibular bicuspid and molar teeth (excluding third molars) in each subject was recorded, and magnetic resonance images were made to document the presence or absence of disk displacement in the temporomandibular joints. Subjects were divided into 4 groups: group 1 = asymptomatic, normal magnetic resonance imaging result; group 2 = asymptomatic, disk displacement; group 3 = symptomatic, normal magnetic resonance imaging result; and group 4 = symptomatic, disk displacement. Collected data were analyzed with chi-square tests (P<.05) with no adjustment for multiple comparisons. RESULTS: A positive association between missing mandibular posterior teeth and the presence of disk displacement was found. CONCLUSION: The literature does not suggest that replacement of missing posterior teeth prevents the development of TMDs. However, missing mandibular posterior teeth may accelerate the development of degenerative joint disease.