Small area estimation of under-5 mortality in Bangladesh,Cameroon, Chad,Mozambique, Uganda,and Zambia using spatially misaligned data

Background

The under-5 mortality rate (U5MR) is an important metric of child health and survival. Country-level estimates of U5MR are readily available, but efforts to estimate U5MR subnationally have been limited, in part, due to spatial misalignment of available data sources (e.g., use of different administrative levels, or as a result of historical boundary changes).

Methods

We analyzed all available complete and summary birth history data in surveys and censuses in six countries (Bangladesh, Cameroon, Chad, Mozambique, Uganda, and Zambia) at the finest geographic level available in each data source. We then developed small area estimation models capable of incorporating spatially misaligned data. These small area estimation models were applied to the birth history data in order to estimate trends in U5MR from 1980 to 2015 at the second administrative level in Cameroon, Chad, Mozambique, Uganda, and Zambia and at the third administrative level in Bangladesh.

Results

We found substantial variation in U5MR in all six countries: there was more than a two-fold difference in U5MR between the area with the highest rate and the area with the lowest rate in every country. All areas in all countries experienced declines in U5MR between 1980 and 2015, but the degree varied both within and between countries. In Cameroon, Chad, Mozambique, and Zambia we found areas with U5MRs in 2015 that were higher than in other parts of the same country in 1980. Comparing subnational U5MR to country-level targets for the Millennium Development Goals (MDG), we find that 12.8% of areas in Bangladesh did not meet the country-level target, although the country as whole did. A minority of areas in Chad, Mozambique, Uganda, and Zambia met the country-level MDG targets while these countries as a whole did not.

Conclusions

Subnational estimates of U5MR reveal significant within-country variation. These estimates could be used for identifying high-need areas and positive deviants, tracking trends in geographic inequalities, and evaluating progress towards international development targets such as the Sustainable Development Goals.

     

Comparison between a novel nickel-titanium alloy and 508 nitinol on the cyclic fatigue life of ProFile 25/.04 rotary instruments

ProFile 25/.04 instruments manufactured from three variants of Nitinol (1A, 1B & 2AS) were compared with stock production ProFile 25/.04 instruments and fatigue tested to failure. Cyclic fatigue testing was performed by rotating instruments at 300 RPM in a simulated steel root canal with 5 mm radius and 90 degrees curve until instrument separation. Time to failure was recorded. Torsion testing was undertaken by clamping 3 mm of each instrument tip between brass plates and rotating it at 2 RPM until failure. Data were recorded for torque and angle at fracture. Statistical differences were found with nickel-titanium variant 1B (M-Wire NiTi) nearly 400% more resistant to cyclic fatigue than stock ProFile 25/.04 (P < .001). Torsion testing found differences between all 508 Nitinol groups and M-Wire NiTi (P < .001). ProFile 25/.04 files manufactured from M-Wire NiTi have significantly greater resistance to cyclic fatigue while maintaining comparable torsional properties.     

Recurrent cutaneous metaplastic synovial cyst

Orofacial granulomatosis (OFG) is a granulomatous disease of the orofacial region. This clinicopathological entity describes patients with oral lesions characterized by persistent and/or recurrent labial enlargement, ulcers, and a variety of other orofacial features, which on biopsy have lymphedema and noncaseating granulomas. The cause is idiopathic but appears to represent an abnormal immune reaction. This may be a manifestation of Crohn's disease (CD) since some patients with oral lesions develop typical bowel symptoms of CD in ensuing months to years; tooth-associated infections, sarcoidosis, food or contact allergies, and viruses have also been implicated in causing OFG. Clinical features of OFG are highly variable and sometimes so insidious that signs and symptoms are frequently not severe enough to cause alarm. The lips are most commonly involved and demonstrate a nontender, persistent swelling. Because of the relatively nonspecific clinical findings associated with granulomatous diseases, a microscopic diagnosis of granulomatous inflammation often presents a diagnostic dilemma for clinicians. We report a case of OFG of the lower lip and cheek and describe its management to add to the current body of literature on the subject.     

Dietary influences on the formation of dental calculus in rats

Eleven diets were evaluated for their ability to produce dental calculus in albino rats. A diet containing 50 % cornstarch, 32 % nonfat dry milk, 3 % liver powder, 5 % celluflour, 1 % cottonseed oil, 5 % powdered sucrose, 1 % calcium chloride dihydrate, 2.7 % sodium dihydrogen phosphate monohydrate, and 0.3 % magnesium sulfate (Francis and Briner 1969) was remarkably effective. On the basis of a 0–3 calculus scoring system, an average score of 2.36 (S.D. = 0.65) resulted after 4 weeks' exposure to the above diet and, after 8 weeks, the average score was 2.59 (S.D. = 0.56).
While it was found that, in general, high cornstarch and milk powder diets were associated with higher calculus scores, no other diet remotely approached the above diet in calculogenicity.     

TRPM8 Axonal expression is decreased in painful human teeth with irreversible pulpitis and cold hyperalgesia

Pulpitis pain might be triggered by a cold stimulus, yet the cellular mechanisms responsible for this phenomenon are largely unknown. One possible mechanism involves the direct activation of cold-responsive thermoreceptors. The purpose of this study was to evaluate the possible role of the TRPM8 thermoreceptor in cold-mediated noxious pulpal pain mechanisms by comparing expression patterns in pulpal nerves from healthy control molars to cold-sensitive painful molars with irreversible pulpitis. Samples were identically processed with the indirect immunofluorescence method, and images were obtained with confocal microscopy. The immunofluorescence intensity and area occupied by TRPM8 within N52/PGP9.5-identified nerve fibers were quantified. Results showed that relative to normal samples, TRPM8 nerve area expression was significantly less in the cold-sensitive painful samples (34.9% vs 8%, P <0.03), but with no significant difference in immunofluorescence intensity between the 2 groups. These results suggest that TRPM8 is most likely not involved in cold-mediated noxious pulpal pain mechanisms.