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ABSTRACT Objectives: Cone beam computerized tomography use is becoming more common in preparation for surgical planning and treatment diagnosis by clinicians. The scanning result gives clinicians a more accurate understanding of each patients’ anatomy, which aids in designing better treatment plan, avoidance of vital anatomy, etc. Modern treatments involving extraction of teeth has become more sophisticated due to advent of dental implant treatment. Along with the procedure, more sophisticated treatment techniques involving manipulation of sinus has flourished. Traditional periapical and panoramic radiograph are not as adapt at identifying sinus pathologies. As patients age, proximity of sinus floor and apex of teeth may become closely related where possibility of one affecting another is observed. This study aims to study the prevalence of odontogenic related pathologies in relation to maxillary sinus in the population who had CBCT images taken at Temple University Kornberg School of Dentistry. The study also looks in detail the relationship of such pathology in relation to teeth status, age, gender, and ethnicity. Methods: 821 CBCT scans completed at Temple University Kornberg School of Dentistry Department of Oral Maxillofacial Radiology from January 1st, 2009 to July 31, 2013 were evaluated with iCAT computer imaging software. Patients under 18, no posterior dentition, or complete edentulous were excluded from the study. A total of four hundred fourty four (444) CBCT scans were included in the study. Patients with odontogenic related maxillary sinus pathology were selected and teeth status, age, gender and ethnicity recorded. Individual scans had sinus pathology identified and examined for proximity and relationship to respective tooth/teeth. Each individual tooth’s status were also recorded. Chi-square test was conducted to verify validity Results: After reviewing 680 scans, only 444 were included in the study due to exclusions. Scans were subdivided by age (18-35: 77, 36-53: 113, 54-71: 188, 72> : 46), gender (280 male and 164 female), ethnicity (African American 86, Asian 45, Caucasian 291, Hispanic 22), tooth status (caries, 26, crown 87, healthy 31, impacted 11, root canal 88, restoration 58), tooth position ( 3rd molar 9, 2nd molar 86, 1st molar 138, 2nd premolar 20, 1st premolar 6, canine 3). Overall 63.06% of scans were classified as healthy, and 36.04% were classified as presenting odontogenic related maxillary sinus pathology. None of the parameters showed significant predilection to odontogenic related pathology, however, 1st molar has the highest risk of exhibiting pathology in the maxillary sinus with 2nd molar second. The pathology incidence rates are slightly higher in male patients 41% vs 34%. Age is not a significant factor as all age groups demonstrates similar incidence rate except 72> group. Dentition status showed root canal and crown being the most commonly associated with pathology at 29% each. In Caucasian population, crown and root canal was most commonly related. African American was restoration and healthy teeth. Asian population had the most link with large restorations. Conclusions: Maxillary 1st molar is the most commonly involved tooth with maxillary sinus pathologies with 2nd molar as second most common. Caucasian individuals had the most odontogenic related pathologies. In general, crown and root canal are associated with a significant number of pathologies found in the sinus and should be evaluated prior to any surgical evaluation prior to any sinus manipulative surgery or odontogenic treatment. / Oral Biology

Objectives: To describe the profile of Canadian adults with type 2 diabetes mellitus (T2DM), examine the prevalence of diabetes-related complications and investigate the factors associated with having common diabetes-related complications. Methods: Self-reported data from Statistics Canada’s 2011 Survey on Living with Chronic Diseases in Canada (SLCDC) – Diabetes component were available to describe the prevalence of T2DM, related complications and co-morbidities. Associations with diabetes-related complications were evaluated using logistic regression models. Survey weights and bootstrapping resampling method were applied to account for the complex survey design. Results: 2,341 T2DM respondents (weighted Canadian population estimate n=1,365,165) had a mean age of 62.9 years and diabetes duration of 10.6 years. The prevalence of diabetes-related complications and comorbidities were high: eye (34.0%), foot or leg (24.4%), cardiovascular (22.6%), renal (15.7%), neuropathy (10.8%), hypertension (68.4%) and high cholesterol (67.2%). Factors associated with diabetes-related complications were: Eye: > 65 years of age (odds ratio [OR] 3.7, 95% CI 2.4 – 5.5, p=<0.0001); household income < $29,999 (OR 1.9, 95% CI 1.1 – 3.2, p=0.01), diabetes duration > 10 years (OR 2.3, 95% CI 1.6 – 3.5, p<0.001), cardiovascular complications (OR 1.8, 95% CI 1.1 – 2.9, p=0.01). Renal: duration of diabetes 6 – 9 years (OR 3.0, 95% CI 1.4 – 6.3, p=0.02), duration of diabetes > 10 years (OR 2.1, 95% CI 1.1 – 3.9, p=0.04) Cardiovascular: male sex (OR 1.9, 95% CI 1.3 – 2.7, p=0.0006), eye complication (OR 1.9, 95% CI 1.2 – 3.0, p=0.007), foot or leg complication (OR 2.0, 95% CI 1.3 – 3.0, p=0.002). Foot or leg: cardiovascular complication (OR 2.0, 95% CI 1.4 – 3.1, p=0.0006). Neuropathy: household income $30,000 - $59,999 (OR 2.1, 95% CI 1.2 – 3.9, p=0.03); duration of diabetes >10 years (OR 1.9, 95% CI 1.1 – 3.8, p=0.01), foot or leg complication (OR 7.0, 95% CI 4.1 – 11.8, p<0.0001), eye complication (OR 2.0, 95% CI 1.1 – 3.7, p=0.006). Conclusions: The presence of diabetes-related complications among Canadians with T2DM is multifactorial. / Thesis / Master of Science (MSc)

This dissertation comprises three main chapters, book-ended by an introduction and a concluding chapter. Chapters 2 and 3 examine the impacts of health insurance programs in the Philippines and Indonesia on healthcare utilization, healthcare expenditures, and health outcomes. Chapter 4 then examines the age-related trajectories of health-related quality of life of Canadians with diabetes. In Chapter 2, we examine the impact of the national health insurance program of The Philippines on maternal and health outcomes among poor mothers. We find that the program is associated with greater likelihood of prenatal care visits, facility-based birth delivery, and post-natal care, and the impact is most pronounced among the poorest women, but we do not observe improvements in birthweight. In Chapter 3, we evaluate the impact of Jamkesmas, the largest subsidized health insurance in Indonesia, on healthcare utilization, health outcomes, and healthcare expenditures. We find that Jamkesmas is associated with higher probability of using outpatient care and inpatient care and lower out-of-pocket healthcare expenditures, but no significant impact on catastrophic healthcare expenditures and health outcomes. In Chapter 4, we characterize the age-related-trajectories of health-related quality of life of Canadians with diabetes. We find that women and low-income individuals with diabetes experience a lower health-related quality of life trajectories, but there is no evidence that the rate of deterioration of their health-related quality of life is faster than their counterparts without diabetes. / Dissertation / Doctor of Philosophy (PhD)

Work-related musculoskeletal disorders (WMSDs) continue to present a substantial personal and economic burden. Biomarkers, in providing objective measures of physiological changes, may offer advantages over current tools for WMSD risk assessment. Existing work has identified biomarkers of cartilage and muscle damage, and demonstrated responsiveness to various forms of physical activity and biomechanical loading. Here, three studies were complete to further assess the occupational relevance/utility of three selected biomarkers: Cartilage Oligomeric Matrix Protein (COMP), Interleukin-6 (IL6), and Creatine Kinase (CK). First, the effects of age, obesity, gender, and diurnal variation was investigated. Significant effects of time, age, and gender were evident, as well as some interactive effects, for COMP and CK, but not IL6. Second, biomarker levels were compared between individuals in occupations having relatively high and low WMSD risk. IL6 levels were greater in the high-risk group, while COMP levels demonstrated an oscillatory pattern, and CK levels did not vary between groups. Third, physical demands were imposed on the lumbar spine during a repetitive flexion/extension task, under conditions with different loading and frequency. IL6 levels varied significantly over time and between added load levels, while CK levels varied over time and was influenced by load and frequency. These studies demonstrate important features of biomarkers; that personal confounding factors need to be considered, that select biomarkers may be sensitive to occupational risk factor exposure, and particularly to task parameters in lifting activities involving the lower back. Further, these studies reveal important information concerning the relevance of the selected biomarkers, favorable time points for biomarker collection, and approximate biomarker levels expected between occupations and exposure to common risk factors. These results support the use of biomarkers in occupational settings for assessing exposure and WMSD risk imposed by common risk factors. Sensitivity to exposure levels is an important precursor to risk prediction, however prospective work is needed to verify predictive validity. / Ph. D.

Cleaning of PFAS and metals from the leachate at Degermyran's landfill, Skellefteå The purpose of this study was to evaluate the concentration of PFAS in the leachate water from Degermyrans landfill in Skellefteå and find and compare various techniques for remediation. Additionally some metals were examined but they were not the main focus. PFAS is a collection of synthetic chemicals that can be detrimental to health and environment. Degermyran has high concentrations of these chemicals and since Degermyran is in the process of expanding PFAS will most likely have to be reduced to attain permission. A literature study was conducted to identify goal concentrations for different PFAS and metals. Calculations of leachate water amount and substance concentrations were made and compared to the literature to identify which substances needed to be reduced and by how much.  The techniques surveyed for reduction of PFAS were compared through the factors: short-chain removal, technology readiness level, general deficiencies, leachate water amount compatibility and costs. The conclusions drawn were that granulated active carbon (GAK) and ion exchange combined or foam fractionation and ion exchange combined would give the highest reduction of PFAS with the least amount of complications. Phytoremediation could be an alternative if combined with GAK but its cost and reduction-level can be unpredictable. Ozonation is not a good option due to high costs, varying effectiveness and operational complications. Membrane filtration is incredibly effective for reduction, but it has many operational difficulties and can be very expensive. Two possible techniques were identified for metal reduction, both were relevant options for Degermyran.

No / This paper aims to evaluate the aims and methods of appraisal, and the difficulties encountered in the appraisal process. The paper uses a review of the literature to evaluate the development of appraisals and argues that the critical area of line management development that was identified as a critical success factor in appraisals has been ignored in the later literature evaluating the effectiveness of performance appraisals. The review identifies the lack of theoretical development in appraisal and argues the psychological approach of analysis and a more critical realisation of appraisal, re‐evaluating the challenge to remove subjectivity and bias in judgement of appraisal. Further evaluation of key interpersonal skills is required for appraisal systems to develop performance. The use and design of performance pay in public and private services linked to appraisal have not always improved organisational performance and can contribute to reduced motivation. Little research has evaluated the current increases in using appraisals and the changes in focus from appraisal to performance management. The paper adds value to the existing body of knowledge and offers insights for practitioners and researchers.

Adverse childhood experiences (ACEs) are associated with substance use problems, however, few studies have examined the mechanisms underlying this relationship. Research has found that cannabis use motives may mediate the association between ACEs and cannabis-related problems among young adults. However, research has not identified the affective components driving coping motives. Further, higher instances of ACEs predict an increased tendency to experience internalized shame. Coping with shame may be the mechanism linking ACEs to cannabis-related problems. Data were collected using Prolific, an online crowdsourcing platform. Participants were young adults (n = 155, 61.9% Female, 56.8% White) ages 18-29 years (M =22.8, SD = 3.01), who used cannabis in the past year. A serial mediation model examined whether cannabis use coping motives and shame mediate the association between ACEs and cannabis-related problems 6-months later. The overall model showed good fit to the data (χ2(8) =14.30, p=.07, CFI=.96, SRMR=.04, RSMEA=.07). There was a significant indirect effect from ACEs to cannabis-related problems (IND=0.06; 95% CI=0.01 to 0.16) through internalized shame and cannabis-use coping motives. The model accounted for 41% of the variance in cannabis-related problems. Findings suggest that individuals who reported greater ACEs were more likely to endorse cannabis-use coping motives, and this association was fully mediated by internalized shame. Coping motives in turn were associated with greater cannabis-related problems, and coping motives fully mediated the link between shame and problems. Interventions that target reduction in maladaptive affective responses to ACEs, such as shame may be a promising avenue for cannabis use disorder treatment.