Purpose: The purposes of this study were four-fold: 1) to determine the types and effectiveness of various topical anesthetics being used among dentists currently treating children, 2) to determine the types of procedures for which topical anesthetics are being used among children, 3) to understand the awareness and use of a relatively newer compounded topical gel Oraqix (Dentsply Caulk) among children, 4) to understand the adverse reactions to topical anesthesia that are seen among children. Methods: A cross sectional survey was designed, regarding the type, procedural use, effectiveness, and adverse reactions noted among children to various topical anesthetics. The survey sampled n=4933 actively practicing member dentists from a database of willing survey participants obtained from the American Academy of Pediatric Dentistry. The survey consisted of 14-items in multiple choice/answer format. The survey was pilot tested by a committee of faculty, and attached via e-mail with a cover letter containing a direct survey link for the study participants. Surveys were collected, posted, and managed through www.surveymonkey.com. Results: The study received 1255 responses from practitioners who are actively treating children giving an effective response rate of 25%. Of those that participated 94% are Pediatric dentists, 6% General dentists or “Other” specialists who treat children. The majority of respondents (95%) routinely use topical anesthetic, rating it as effective or very effective clinically. The most commonly used topical was 20%-Benzocaine gel with a reported 96% effective rate. The most common procedures topical anesthetics are being used for are pre-injection of local anesthetic and extraction of exfoliating deciduous teeth. Very few of the responding practitioners have ever heard of or used Oraqix gel prior to this survey. Many though, would consider using Oraqix if proven effective. Only 10% of respondents reported an adverse reaction to topical anesthetics, the most common being contact dermatitis or tissue sloughing from prolonged contact, followed by an allergic or aversive reaction to the dyes or flavoring in the topical anesthetic. Conclusions: The overwhelming majority of dentists treating children routinely use topical anesthetics to reduce pain response among children. 20%-Benzocaine gel is the most widely used topical anesthetic being used for dental procedures on children. Adverse reactions to topical anesthetic noted among practitioners treating children are very low but must still be strongly considered as potential life threatening risks if not used appropriately. Many practitioners treating children are still looking for the “ideal” topical anesthetic with improvements in taste, the ability to stay localized, the method of delivery, and improved effectiveness being key areas for future research.

Endodontic residents must keep current with clinical information to practice evidence- based dentistry. To do so, endodontic residents must access research papers and interpret results. This requires a knowledge of biostatistics. However, the biostatistical knowledge of endodontic residents is relatively unknown. The purpose of the study was to assess the biostatistical knowledge of endodontic residents using a survey instrument to prove or reject the hypothesis that there exists a lack of understanding of biostatistic principles among endodontic residents. A survey consisting of 29 questions querying attitudes and biostatistical knowledge was distributed to 230 endodontic residents and returned with a 32% response rate. The overall mean resident knowledge score was 42.3% (SD, 17.5%; range, 10% to 90%). Only 39% stated they understood all of the statistical terms encountered in journal articles. This data supports the hypothesis that there exists a lack of understanding of biostatistical principles and would suggest that more effective training in biostatistics in residency education is desirable.

A survey was conducted to assess the current state of predoctoral endodontic education in the United States. Fifty-one schools received surveys and 73% responded. Seventy-six percent were from public schools with most having a graduate endodontic program (84%). Preclinical training most often began in the spring of second year and clinical training started in the fall of third year (each 54%). All programs that responded stated that endodontists routinely instruct students in the clinic. Sodium hypochlorite 2.5% was the irrigation of choice. Calcium hydroxide was the most common intracanal medicament. Cold lateral condensation with gutta-percha was the most frequently indicated obturation technique. Sixty-two percent of programs had microscopes, with 1-2 cases treated with microscope per week. Findings suggest that endodontists are still an integral part of teaching predoctoral dental students in the United States.

Head and neck squamous cell carcinoma (HNSCC) is a type of cancer that begins in the epithelial cells that line the mucosal surfaces of the head and neck, including the oral cavity, pharynx, larynx, paranasal sinuses, nasal cavity, and salivary glands. Head and neck cancer is the sixth most common type of cancer with a 5-year survival rate of 60% for all cases. Over the past few years, a subset of cells with stem-like properties, called cancer stem cells, are believed to have tumor-initiation capabilities and are responsible for maintaining on-going tumor growth. Previous data from our lab suggested that cells grown in suspension, called spheroids, may have stem cell like properties. We employed a model system where a primary HNSCC cell line, HN4, was used to set up spheroids. We found that expression of EPS8 and its downstream targets, FOXM1 and CXCL5, was increased in HN4 spheroids. In addition, we measured the expression of Nanog, as it is a transcription factor involved in the self-renewal of human embryonic stem cells. We also used a metastatic HNSCC cell line, HN12, to see how it compared to spheroids. We wanted to investigate the hypothesis that activation of Src potentiates EPS8 function to deregulate downstream signaling pathways. We used a small molecule tyrosine kinase inhibitor, Dasatinib, on HN4 spheroids and HN12 cells. We found that when Src is inhibited, EPS8 expression is decreased in HN4 spheroids and it also interferes with spheroid formation. The results of the current study were also able to show that the proliferation capability of HN12 cells is greatly diminished when treated with Dasatinib, due to G1 arrest in the cell cycle. When we measured for FOXM1, which is a cell cycle regulator, we found the levels were reduced in Dasatinib treated cells, preventing the cells from completing mitosis. With all of the data taken together, it suggests that Src does in fact play a role in regulating the downstream signaling pathways of EPS8, and its inhibition leads to the loss of cell proliferation. Additional studies need to be performed to discover whether Src inhibition will stop the proliferation of cancer stem cells, which are believed to be more resistant to cytotoxic therapies.

Patient ventilator dyssynchrony (PVD) occurs frequently, but little is known about the types, frequency and patterns of PVD for longer than 30 minutes. Deeper levels of sedation are associated with PVD. Evaluation of ventilator graphics and the ability to identify PVD should assist clinicians to optimize patient ventilator interactions and promote earlier interventions. The purpose of this study was to identify the different types, frequency and patterns of PVD in critically ill adults and determine the effect of sedation level on PVD. Thirty medical and surgical ICU adult patients were enrolled; 27 were used for analysis. Pressure/time and flow/ time waveform data were collected using the Noninvasive Cardiac Output monitor for up to 90 minutes per subject. Blinded waveform analysis was performed. Sedation level was measured every 20 minutes. A Dyssynchrony Index (DI) and PVD Type Indices were used to describe PVD frequency. Lag analysis was used to detect associated patterns of PVD. PVD occurred during all phases of ventilated breaths and during each of the ventilatory modes used. Heretofore undocumented dyssynchrony in the form of patient gasp PVD, active triggers and combined PVDs were found. The most common type of PVD was Ineffective Trigger (63%), followed by Premature Termination-Flow (17%), Premature Termination (9%), Multiple Trigger (1%), Flow (0.87%) and Delayed Termination (0.09%). The overall frequency of dyssynchronous breaths in the sample was 23% of total breaths analyzed, however 93% of subjects experienced at least one incident of PVD. The overall median DI (Interquartile Range [IQR]) was 4% (1% - 9%) with Ineffective Trigger Index having the highest median index (1.78%). The high DI group (6 subjects, 22%) had a DI (IQR) of 61% (42% - 85%). Seventy seven percent of subjects experienced multiple types of PVD. Premature Termination was followed by Multiple Triggers starting at 3 seconds, but Delayed Termination was followed by Ineffective Triggers, starting at 30 seconds. Clinicians need to recognize PVD, since this is a critical step in evaluating patient ventilator interaction and providing subsequent intervention. PVD interpretation is complex requiring clinicians to clearly understand the operational function of ventilator modes and waveform alterations that occur.

The aim of this study was to evaluate how Asians, non-Asians, and orthodontists in America view esthetic soft tissue Asian lip profiles. The null hypothesis was that there was no difference in the perception of lip profile esthetics of Asian patients between Asian laypersons, non-Asians laypersons, and orthodontists. A survey was constructed using the profile photographs of one adult male and one adult female Asian American patient taken from the VCU Orthodontics Clinic records. Using Dolphin Imaging 3D, the original photographs were digitally altered. The lips in each photograph were moved in increments forward and backwards to produce 5 images (-4mm, -2mm, 0mm, 4mm, 8mm). Only the lips were modified. Each evaluator was asked to rank, from 1 to 5, each collection of photographs where 1 was most preferable and 5 was least preferable. There were a total of 10 survey questions. The survey was administered to 111 Asian Americans, 115 Caucasians, and 389 Orthodontists. Results suggested that all three groups were similar in their assessment. A retrusive lip profile for the Asian male was preferred, and a slightly protrusive lip profile for the Asian female was preferred across all groups. Generally, orthodontists preferred slightly more retrusive lips compared to the other two groups. The groups of evaluators that showed statistical differences were Chinese and Filipino laypersons. Cluster analysis also revealed tremendous variation in the results, giving credence to the belief that individual patient preference should be assessed in addition to understanding social norms.

Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that occurs when people are exposed to stressful, life-threatening experiences. Consequently, after exposure to such an event, many people may experience fear, guilt, or anger and may believe the trauma is reoccurring. According to the National Institute of Mental Health, approximately 5.2 million U.S. adults age 18-54 have PTSD in any given year. The prevalence of PTSD is even more problematic within the military where an estimated 30% of those who have spent time in war zones experiences PTSD. Researchers have been examining the impact of veterans’ PTSD symptoms on family relationships, and on children in particular yet there is little understanding of the residual impact of PTSD or its secondary effects on children. This study aims to begin to understand how the health care providers’ experiences and acumen may assist patients with addressing PTSD. Additionally, by exploring the treatments and experiences of physicians, further insight and a deeper understanding may be gained on how PTSD impacts family relationships, specifically, hardiness and parental skills. A secondary aim of this study is identify those factors that promote resiliency in hopes of creating new interventions to lessen the residual effects of PTSD and prevent intergenerational trauma. This study begins to explore the residual impact of PTSD and will contribute to inform future research to design new methods and tools which may assist physicians to address intergenerational PTSD. This study was approved by Virginia Commonwealth University (VCU) Institutional Review Board (IRB).

The obesity epidemic is a major public health concern, where the prevalence rates amongst the American children population have more than doubled since the 1980s. Among overweight children, the risk of becoming an overweight or obese adult is 70% higher than children of normal weight, and obese children are more likely to remain obese into adulthood and face a number of morbidities associated with it, including lower quality of life and increased financial burden. In this research, we examined the relationship between household food security and obesity among children and adolescents between the ages of 2-18 years old. We used data from the NHANES 2005-2006 (n= 3,432). Amongst the children aged 2-18 years, 31.21% were determined to be obese or at-risk for obesity. Children aged 2-18 years were 1.27 times more likely to be obese or at-risk when living in a food insecure household after adjusting for race/ethnicity. Adolescents aged 12-18 years were 1.47 times more likely to be obese or at-risk when living in a food insecure household. No significant association was found for young children aged 2-11 years. After adjusting for race/ethnicity and poverty level status, however, the association between food insecurity and obesity was not significant for either age group. Further investigation of other potential confounders could explain the association for both young children and adolescents. There are other factors, like social and societal, that influence the trends of obesity. Future programming could work to ameliorate the conditions of food insecurity and other infrastructure factors.

Background: Food allergy, an abnormal immunologic response to food protein, has an estimated prevalence of 6% in young children and 3.7% in adults in the U.S. The only proven therapy for food allergy is strict elimination of the offending allergens. As a result, caregivers and patients could experience constant anxiety and stress that affects their quality of life. Additionally, food allergy can lead to significant economic impact on the health care system, since severe reactions often lead to ED visits and hospitalizations. Objectives: The first major objective was to determine the economic burden of Food Allergy and Anaphylaxis (FAA) patients in the U.S. by estimating the direct medical and indirect costs. The second principal objective involved assessing the Health Related Quality of Life (HRQL) of food allergic patients by measuring their health utilities and disease specific quality of life. Methods: Economic burden was estimated by measuring certain direct medical and indirect costs from a societal perspective. Costs were estimated using a bottom-up approach -- calculating the average cost of illness per patient and multiplying it by reported prevalence estimates. FAA patients with an emergency department (ED) visit, office based physician visit, outpatient department visit, and hospital admission were identified from a list of federally administered databases using ICD-9 codes. Sensitivity analyses were conducted to measure the robustness of the estimates. The cross-sectional HRQL study measured health utilities in food allergic adults and children, and quality of life in allergic adults using EQ-5D and FAQL-AF questionnaires respectively. These questionnaires were administered in an online survey format. Regression models were specified to explore the deviations in HRQL scores between patients with different disease related characteristics. Results: The findings reveal that for a given year (2007), direct medical costs worth $225 million and indirect costs worth $115 million were incurred. Owing to the irregularities in the reporting and diagnosis of food allergy, these values might be an underestimation. Simulations from probabilistic sensitivity analysis generated mean direct medical costs of $307 million and indirect costs of $203 million. Survey responses were collected online for eight months, during which 45 adults and 94 parents (acting as proxy for their food allergic child) responded. Adults reported a mean utility of 0.874 compared to 0.918 for children. Gender, number of food allergies and frequency of carrying epinephrine device had significant impacts on HRQL scores. An effect size of 0.003 was estimated comparing health utilities of food allergic adults with the general U.S. population. Conclusions: This was the first research to examine economic burden of FAA, and elucidate health utilities for food allergic patients. A large proportion of costs were incurred due to ambulatory visits. Effect size calculation revealed that health utilities of food allergic patients were very similar to the general U.S. population.

Healthcare costs are escalating in the U.S., with a projected 48 trillion dollars by 2021. More than ever medical researches are obligated to ensure that costly treatment modalities are safe and effective. Chronic obstructive pulmonary disease (COPD) is a costly and debilitating disease, ranked as the third leading cause of death in America. Currently, treatment for COPD consists of anti-inflammatory agents, bronchodilators, antibiotics and supplemental oxygen when hypoxemia or clinical manifestations ensue. Oxidative stress is central to the pathology of COPD. Supplemental oxygen has been substantiated as an instigator of oxidative stress; however, LFDO has not been evaluated as a mechanism of ongoing oxidative stress in individuals with COPD. Isofuran (IsoF), a biosynthetic relative of the validated oxidative stress biomarker 8-isoprostane, is preferentially synthesized during periods of increased tissue oxygen tension. This sort of specificity allows for refinement in the assessment of supplemental oxygen as a source of oxidative stress. To address this potential this study evaluated individuals diagnosed with COPD utilizing LFDO. The study also aimed to determine if IsoF possessed clinical application in predicting the standard pulmonary function test (PFT) parameters of FEV1, FVC, FEV1/FVC and FEF25-75. The exhaled breath condensate (EBC) of 52 individuals with COPD was evaluated for the presence of IsoF. An active control group not receiving LFDO (n=26) was compared to an active treatment group receiving LFDO for a minimum of 6 hrs/day (n=26). The groups showed no statistically significant demographic differences in age, gender, height, weight, ethnicity or smoking history or in the pulmonary function test parameters of FEV1, FVC, and FEV1/FVC, with the exception of the FEF25-75 (P=0.03). The active control group generated a mean EBC IsoF level of 35.81 ± 4.91 pg/ml (± SEM) compared to the active treatment group mean EBC IsoF level of 51.37 ± 8.27 pg/ml (P=0.057). Currently, no research has been conducted that defines baseline EBC IsoF levels in healthy or diseased lungs. No statistically significant differences in mean EBC IsoF levels were noted between the control and treatment groups; however, the results, in conjunction with the only two studies available utilizing EBC IsoF as an oxidative stress biomarker, may serve to provide benchmark information for future research regarding individuals with diseased lungs, specifically COPD.