More than just a seat at the table: the power of youth voice in ending youth homelessness in the United States

ABSTRACT

Each year, over 600 youth under the age of 25 experience literal homelessness in Austin, Texas. Of these youth, 76% have a history of involvement with foster care or the juvenile justice system—far exceeding the rates of system involvement observed among homeless youth in other large communities in the United States (approximately 54%; Voices of Youth Count, 2017). Recently, Austin was selected by the U.S. Department of Housing & Urban Development as one of ten communities nationwide to participate in the Youth Homelessness Demonstration Program (YHDP), a federal initiative designed to effectively end youth homelessness by 2020. Youth with lived experience are central players in the development and implementation of Austin's response to the youth homelessness crisis. A group of twelve of these youth (the “Austin Youth Collective to End Youth Homelessness,” or AYC) serve as key decision-making partners within the Austin YHDP team. Representatives of the AYC are deeply involved at every level of the community planning process, from the development of youth-centric housing options to system redesign efforts to ensure that youth do not exit the foster care or juvenile justice systems to homelessness. The article provides an overview of the development and contributions of the AYC—including their programmatic recommendations and advocacy work—as well as key recommendations for communities looking to leverage youth voice at the systems level.     

Gap measurement and bond strength of five selected adhesive systems bonded to tooth structure

The ability of a restorative material to bond and seal the interface with tooth structure is perhaps the most significant factor in determining resistance to marginal caries. Thus, the quality and durability of marginal seal and bond strength are major considerations in the selection of restorative materials. The purpose of this study was to compare the bond strength and marginal discrepancies of five adhesive systems: All-Bond 2, Clearfil Liner Bond, KB 200, ProBond and AELITE Bond. Twenty-five buccal and 25 lingual cavities were prepared in 25 caries-free extracted molar teeth, giving 10 cavities for each of the 5 adhesive systems. All teeth were restored with the resin composite Pertac Hybrid, or PRISMA Total Performance Hybrid with their appropriate adhesive systems. After restoration, the teeth were thermocycled, were stained with a 1.5% aqueous solution of a procion dye (reactive orange 14) and sectioned coronally with a saw microtome. Three sections of 200 μm thickness were prepared from each restoration which were then examined microscopically to measure marginal gap widths using a confocal tandem microscope. Shear bond strength measurements were carried out on the dentine bond using a universal testing machine. The All-Bond 2 adhesive system was found to have higher shear bond strength and to have the least gap with at the cementodentinal margin.     

Comparison between two Procion dyes and Alizarin Red to assess marginal leakage in resin restorations. A laboratory study

To assess the width of the gaps that may occur in resin restorations bonded to dentine, buccal and lingual cavities were prepared in 18 caries- and restoration-free extracted molar teeth. All teeth were restored with composite resin. Nine of the teeth were then thermocycled for five hours. All teeth were stained with 0.5 per cent, 1.0 per cent or 1.5 per cent solutions of chloro-s-triazinyl dyes (Reactive Red and Reactive Orange 14) or Alizarin Red in order to assess the effectiveness of each stain in detecting marginal leakage. Quantitative assessment indicated that Reactive Orange 14 was superior to the other two stains as it more clearly defined the marginal gaps of the restorations. This superiority was evident for both thermocycled and nonthermocycled teeth.     

Parkinson's disease: an update for dentists

One of the diseases that will afflict the growing number of elderly American dental patients is Parkinson's disease, yet few dental articles and textbooks address the condition. This article reviews the clinical and diagnostic features, pathophysiology, management, and dental concerns in patients with Parkinson's disease who undergo dental care.     

Regional anesthesia does not decrease opioid demand in pelvis and acetabulum fracture surgery

Introduction

Patients with pelvic and acetabular fractures often have considerable pain in the perioperative period. Regional anesthesia (RA) including peripheral nerve blocks and spinal analgesia may reduce pain. However, the real-world impact of these modalities on inpatient opioid consumption and outpatient opioid demand is largely unknown. The purpose of this study was to evaluate the impact of perioperative RA on inpatient opioid consumption and outpatient opioid demand.

Methods

This is a retrospective, observational review of inpatient opioid consumption and outpatient opioid demand in all patients ages 18 and older undergoing operative fixation of pelvic and acetabular fractures at a single Level, I trauma center from 7/1/2013–7/1/2018 (n = 205). Unadjusted and adjusted analyses were constructed to evaluate the impact of RA on inpatient opioid consumption and outpatient opioid demand while controlling for age, sex, race, body mass index (BMI), smoking, chronic opioid use, ASA score, injury mechanism, additional injuries, open injury, and additional inpatient surgery.

Results

Adjusted models demonstrated increases in inpatient opioid consumption in patients with RA (12.6 estimated OE’s without RA vs 16.1 OE’s with RA from 48 to 72 h post-op, p < 0.05) but no significant differences at other timepoints (17.5 estimated OE’s without RA vs 16.8 OE’s with RA from 0 to 24 h post-op, 15.3 vs 17.1 from 24 to 48 h post-op, p > 0.05). Estimated cumulative outpatient opioid demand was significantly higher in patients with RA at discharge to 90 days post-op (and 156.8 vs 207.9 OE’s to 90 days, p < 0.05) but did not differ significantly before that time (121.5 OE’s without RA vs 123.9 with RA from discharge to two weeks, 145.2 vs 177.2 OE’s to 6 weeks, p > 0.05).

Discussion

In pelvis and acetabulum fracture surgery, RA was associated with increased inpatient and outpatient opioid demand after adjusting for baseline patient and treatment characteristics. Regional anesthesia may not be beneficial for these patients.

     

Creatine kinase MB in cases of skeletal muscle trauma

Fifty-eight patients admitted through our emergency room with severe skeletal muscle injury but no obvious cardiac contusions were evaluated for creatine kinase isoenzyme MB (CK-MB). When such patients show an above-normal value for total CK, it is a question of whether or not myocardial injury has been sustained along with skeletal muscle injury when (a) there are no obvious chest contusions or (b) the patient is unconscious and unable to complain of chest pain. Whenever there is doubt concerning the cardiac status of a patient, lactate dehydrogenase (LD) isoenzymes, serial electrocardiograms, and CK isoenzymes are ordered. Our study revealed that serum of 8.6% of the trauma victims had CK-MB values exceeding 5.0 EU/L (reflecting abnormal CK-MB concentrations) as part of their increased total CK. All patients had normal electrocardiographic patterns along with negative results for LD isoenzymes; none had sustained any demonstrable myocardial injury. The CK-MB value must be interpreted together with the total CK value for appropriate diagnosis in patients with skeletal muscle trauma.     

Outpatient treatment of acute venous thromboembolic disease

Once- or twice-daily subcutaneous dosing of LMWHs without laboratory monitoring has facilitated outpatient VTE therapy. Clinical trials have demonstrated at least equivalent efficacy and safety and potential cost savings of outpatient therapy for uncomplicated proximal DVT with LMWH when compared with inpatient therapy. Explicit criteria exist for outpatient DVT therapy. Home therapy for PE requires further evaluation before it can be recommended outside of a trial or other supervised setting.     

Improving the reliability and reporting of genetic association studies

Genetic association studies, in particular candidate gene studies, have a long history of initially promising findings which subsequently produce a confusing mixture of replications, partial replications and non-replications. Drug and Alcohol Dependence is receiving an increasing number of submissions of genetic association studies. Here we discuss the journal's approach to considering such papers, in order to encourage credible and balanced reports which will contribute positively to the field. Recently, the STrengthening the REporting of Genetic Association studies (STREGA) initiative has provided guidelines which serve to enhance transparency. We strongly encourage authors considering submitting a genetic association study to the journal to follow these guidelines.