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A regeneration-based, nonobturation root-canal treatment for fully-mature teeth: Six years' experience with "SealBio"
Department of Dentistry, Hindu Rao Hospital, North Delhi Municipal Corporation Medical College, New Delhi, India
Date of Web Publication 17-Aug-2016
Department of Dentistry, Hindu Rao Hospital, North Delhi Municipal Corporation Medical College, New Delhi - 110 007
Objectives: To provide scientific evidence on the outcome of a large number of cases treated by SealBio over the longer follow-up period. Materials and Methods: One hundred and thirty-four teeth in 116 patients presenting with pulp and periapical disease were randomly recruited between 2009 and 2014. SealBio was performed, and cases were followed up at regular intervals up to 6-year. Results: Of the total 134 teeth treated, 16 teeth could not be followed up and 9 cases failed (7.62% of cases). In only 4 cases (approximately 3.38% of cases), the failure could be directly attributed to endodontic causes. In the remaining 5 cases, coronal leakage from under the crown margins or dislodged restoration was found after 3-5 years of treatment. Conclusions: SealBio was found to be a successful, nonobturation, regeneration-based endodontic treatment protocol. By cell homing of endogenous stem cells, a biological seal rather than an artificial seal with gutta-percha and sealer cement is possible to achieve. It is highly cost saving and easier to perform, in addition to other advantages, such as retreatment is much simpler, and postcore restoration is possible after SealBio treatment.
Keywords: Endogenous stem cells, homing of stem cells, nonobturation root canal treatment, periapical healing, regenerative endodontic treatment, SealBio
Shah N. A regeneration-based, nonobturation root-canal treatment for fully-mature teeth: Six years' experience with "SealBio". Contemp Clin Dent 2016;7:296-301
Shah N. A regeneration-based, nonobturation root-canal treatment for fully-mature teeth: Six years' experience with "SealBio". Contemp Clin Dent [serial online] 2016 [cited 2020 Jan 22];7:296-301. Available from: http://www.contempclindent.org/text.asp?2016/7/3/296/188541
Interest in "regenerative endodontics" has revived since 2001 when Iwaya et al. [1] introduced "revascularization" (later termed as "revitalization") as a treatment modality for immature, non-vital teeth. Enormous research is being undertaken all over the world on how best to improve the treatment outcome. In this direction, use of platelet-rich plasma and platelet-rich fibrin, preparation of effective scaffold utilizing nano technology, various growth factors, injectable scaffold, etc., are being tested. Now, the scientists are also debating if using regeneration-based procedures, "biological obturation" of root canals in fully mature teeth can be achieved, instead of using external artificial materials such as gutta-percha and sealer cement. [2] Another novel approach could be to achieve apical seal with biological tissues rather than plug the canal space with root canal obturating materials. This novel regeneration-based, non-obturation endodontic treatment protocol "SealBio" was reported in 2012. [3] .
Root canal obturation requires multiple dental materials comprising solid core and sealer cement. Over the past 1½ century, all possible materials have been used to obturate root canal space; from wood sticks, silver cones, silver amalgam, gutta-percha, Resilon, etc. Grossman [4] as early as in 1958 had stated, "I doubt very much whether there is any hollow cavity in the body that has been plugged with as many different materials as the root canal of a tooth."
Toward achieving a biological obturation, research is under way to regenerate vital pulp in the root canal space after debridement and disinfection. Various attempts are being made to search for the best method to deliver stem cells, scaffold, and growth factors in the canal lumen so that it can regenerate the vital pulp as existed before pulp infection had occurred. However, the total pulp volume in permanent teeth is 0.38 cc with the mean being 0.02cc. [5] The functions of pulp listed are nutrition, defense, and repair. In a mature tooth with fully developed root, both laterally and apically, the function of dentin deposition is not required. Therefore, regeneration of pulp in a fully mature tooth is not likely to be of much benefit. Mao stated that attempt to regenerate tissues and high cost may be justified for potentially life-threatening diseases such as Parkinson's disease, diabetes, and spinal cord injuries, but likely not for tooth regeneration. [6] Applying the same analogy, attempt to revitalize a fully mature tooth after endodontic treatment with extraneous stem cells, growth factors, scaffold, etc., and the cost involved is similarly neither required nor justified.
If a canal after cleaning, shaping, and disinfection, can be maintained in a disinfected state, without recurrence of infection, the apical pathology can be healed, and a biological barrier, composed of fibrous or cementum tissue over the root apex can be achieved (which is considered the most desirable outcome of conventional endodontic treatment) without obturation of root canals, will be highly advantageous and cost saving.
The novel, non-obturation, "regeneration-based" treatment protocol "SealBio" was conceived and developed in 2009. The patent application was filed in 2010 and Australian and US patents were granted in 2014 and 2015 respectively (Australian patent no. 2010355508 and US patent no. US 9,180,072B2). The technique has been tested over the past 6 years on 134 teeth in 116 patients. This paper reports on the philosophy of treatment, its application in varied clinical cases, outcome, failures, and retreatment considerations in the light of treated cases and explains the scientific basis of all the procedures employed with evidence from the existing endodontic literature.
The study was conducted at the Centre for Dental Education and Research at the All India Institute of Medical Sciences, New Delhi. Ethical clearance was taken from the Institute Ethics Committee (P-06/January 21, 2009 dated February 12, 2009), and the study was registered with Clinical Trial Registry of India (CTRI) and Universal Trail Registry Number (UTRN) of WHO (CTRI/2010/091/001030, June 28, 2010, and UTRN WHO TEMP UTRN 093019259-2306201023293507). The patients who presented with either irreversible pulpitis or acute and chronic apical periodontitis, in reasonably good health, were randomly recruited, irrespective of age and gender during 2009-2014. The procedure was explained in detail, and a written informed consent was obtained from all the patients. The treatment was initiated in the tooth/teeth requiring endodontic therapy. Access cavity was prepared, and chemo-mechanical preparation was performed under aseptic conditions using instrumentation with crown-down technique and copious irrigation with 2.5% sodium hypochlorite. Apical patency was maintained throughout the cleaning and shaping procedure. As recommended in conventional root canal treatment, the canal was enlarged 3 sizes larger than the initial apical file size. Intracanal dressing of either triple antibiotic paste of ciprofloxacin, metronidazole, and tetracycline (in cases treated during 2009-2011) or calcium hydroxide (later since 2011) was given, and the cavity was sealed with intermediate restorative material. In the next visit after 5-7 days, if the clinical signs and symptoms were resolved and on opening, the canals were found dry and clean, the following steps were done to perform SealBio:
The apical third of the canal was further enlarged to 2-4 sizes larger than the master apical file, which is termed as "apical clearing." [7] It is the dry reaming of the apical third without transportation of apical foramen or the canal. It helps in removing the loose debris from the apical third and the recesses, deltas, and accessory canals, which are the areas where bacteria hide and escape disinfection process
After copious irrigation, "apical foramen widening" was done with gradually increasing size of K-file till size #25. This helps to clean the cemental part of the canal [8] as well as ensures smooth passage of instrument for overinstrumentation to be performed as the next step
After "apical clearing" and "apical foramen widening," a final wash with Betadine was done and the canals were dried with sterile paper points. This was done to ensure that the final over-instrumentation was done by passage of an instrument through a clean, disinfected canal and to eliminate the possibility of pushing any traces of contaminant from the root canal to the periapical tissues. Intentional over-instrumentation into the periapical region was done with #20 K-file by giving gentle 2-3 clockwise turns and then withdrawn by giving counter-clockwise rotation, to induce bleeding and subsequent clot formation near the apical foramen.
A calcium sulfate-based cement (Cavit, 3M ESPE USA) was introduced into the access cavity and with a hand plugger, condensed into the cervical third of the root canals. Access cavity was then appropriately restored with either silver amalgam/composite/cermet cement and full coverage coronal restoration was given, where indicated, at subsequent appointment. The patient was recalled every 6-months for clinical and radiographic evaluation.
A total of 134 teeth in 116 patients were recruited; 76 men and 40 women. The age range was 12-80 years, mean age being 46.84 years. The cases were followed up for up to 6-year, which is shown in [Table 1].
Table 1: Follow - up of treated cases
Criteria for success and failures
The cases were evaluated by clinical and radiographic evaluation. Clinical criteria included - tooth asymptomatic and functional, intraoral swelling, and sinus, if present pre-operatively, had healed. On radiographic evaluation, complete healing or decrease in the size of radiolucency. If the periapical area was normal at the start of treatment (as in the cases where only pulpitis was the presenting complaint), no lesion should develop subsequently after the treatment.
Of all the cases treated, 16 cases were lost to follow-up. Only 9 cases (7.62 % of cases) failed. However, in only 4 cases, the cause of failure could be directly correlated to endodontic cause (approximately 3.38% of cases). In the remaining 5 cases, coronal leakage from under the crown margins or dislodged restoration was found, leading to periapical lesion with or without clinical symptoms, after 3-5 years of treatment. In these cases, retreatment was performed, in some cases, of only the exposed canal. Hence, the novel technique was successful in approximately 97% of the cases.
Rationale for non-obturation
The concept of obturating root canals was based on the hollow tube theory given by Rickert and Dixon. [9] Their theory was based on observation in experimental animals that when hollow plastic tubes were implanted, inflammatory response was seen at both the open ends of the tube. It was inferred that the open ends encourage fluid movement in and out of the tube and hence evoke inflammation. Therefore, to prevent inflammation, both the ends of the tube must be sealed. The tube was likened to an unobturated root canal and hence the root canal obturation was considered mandatory. However, Goldman and Pearson [10] refuted the hollow tube theory. Their results showed no inflammation at the open ends of the implanted tubes when they were sterile and clean. The majority of the implants showed the presence of fluids inside the lumens of the tubes. This fluid was compatible with normal cellular function in adjacent tissues even after a long period of placement. From the results, it was concluded that the presence of space, even if fluid-filled, is not sufficient to initiate and perpetuate an inflammatory reaction. Klevant and Eggink [11] showed that stagnant tissue fluid and sterile necrotic pulp tissue do not sustain inflammation at the periapex.
Although the hollow tube theory no longer holds, the concept of root canal obturation has stuck. It is believed that it is impossible to completely clean all the canal space, and the remaining bacteria will cause reinfection of the canal and periapical tissues at a later date. Therefore, root canal obturation in three-dimension is mandatory to entomb the remaining bacteria and to prevent future reinfection. [12]
However, it has now been recognized that root canal system can be adequately disinfected, and microbial density can be lowered below the threshold level, required to initiate or perpetuate periapical infection. Grossman [13] had stated that an optimum concentration was necessary to initiate or sustain periapical inflammation. Body's defense mechanism can take care of residual infection. Sequera in 2011 [14] stated that for any microbial species to cause disease, they have to reach a population density (load), conducive to cause tissue damage. It was demonstrated that reducing the microbial count to <10 3 -10 4 colony-forming units, which is not detected on culture, would suffice to resolve the infection.
"Apical clearing" and "apical foramen widening" are intended to maximize debridement and results in reduced number of apical ramifications and bacterial load in the apical third. [15] Apical foramen widening removes the bulk of contaminated cementum. [16]
Sabeti et al. [17] had documented that there was no difference in periapical healing in teeth with and without obturation following complete disinfection, if the coronal seal of the sterile canal was maintained.
Healing following "SealBio"
The healing of periapical lesion is seen as a result of body's response to disinfected root canal space and decreased bacterial burden. Ostby demonstrated that healing response with deposition of cellular cementum and fibrous connective tissue in the apical third of the root canal had better resistance to infection and is advantageous over inert root filling materials. [18]
In "SealBio" technique, bleeding is induced by intentional over-instrumentation. The novelty of the present treatment protocol is that over-instrumentation is performed in fully formed, mature teeth after minimal apical foramen widening. The traditional text of endodontic literature contraindicates violating the apical foramen for fear of pushing necrotic debris and microorganisms from root canals into the periapical tissues and inducing inflammation in the periapical region. [19]
In the periapical region, periodontal ligament (PDL) stem cells, PDL progenitor cells (PDLPs), stem cells from the apical papilla, and bone marrow mesenchymal stem cells are commonly present, [20] which can be recruited by over-instrumentation into the scaffold provided by the blood clot, close to the apex of the root. The reason regenerative procedure succeeded in adults and in the presence of large periapical lesions could be explained by the fact that: a) the MSCs recruited in the regenerative endodontic procedure are either less prone to aging ("persisting MSCs") or elude aging indefinitely ("perennial MSCs") [21]],[ b) the quiescent, non-proliferative adult MSCs can be stimulated by the signals triggered either by tissue damage or by different growth factors released [22] and c) the presence of inflamed periapical progenitor cells (iPAPCs) [23] and infection survived stem cells from apical papilla (SCAP) [24] in teeth with large periapical pathology, helped the regenerative procedures in adults.
Organization of blood clot results in the release of various growth factors, which regulate multiple events involved in wound healing such as chemotaxis, cell adhesion, proliferation, and differentiation. [25] Of the many growth factors, platelet-derived growth factor, vascular endothelial growth factor, transforming growth factor α and β, fibroblast growth factor, and bone morphogenetic proteins 2, 3, and 7 are important for regeneration of apical tissues. [26],[27] The stem cells then differentiate into various forming cells such as fibroblast, cementoblasts, and osteoblasts which lay down fibrous/mineralized tissue over the apex; hence, the term "SealBio" - sealing with biological tissues.
There are two methods of tissue engineering; stem cells can putatively be isolated and expanded in vitro or can be stimulated in situ. Since the former is highly technically demanding and cost-intensive and as mentioned earlier, not justified for pulp-dentin regeneration in fully mature tooth, bioactivation of adult stem cells in the organ and the neighboring tissues is more practical for clinical implementation. [9] "SealBio" confirms to this philosophy of regeneration-based treatment protocol.
Coronal seal
If coronal seal is broken, bacteria or their endotoxin can reach the apex of the tooth within 20 days, and it is recommended to per form retreatment in such cases. [28],[29] In SealBio technique, calcium-sulfate-based cement was placed on the floor of the access cavity and pushed into the cervical third of the canals with hand pluggers. It has the property to expand on setting in the presence of moisture, which provides an effective seal and in case retreatment was required, it is easy to gain access to the canals.
All the limitations/drawbacks associated with root canal obturation, as listed below, are eliminated in the non-obturation protocol of "SealBio:"
The obturating materials act as foreign materials; if extruded beyond the confines of the root canal, have the potential to impair periapical healing or to cause a foreign body reaction [30]
The effectiveness of root fillings to attain a fluid-tight seal has been questioned as experimental studies have shown microleakage at various interfaces of obturating materials [31]
Obturation is demanding on operator's skill; if not performed well, it can result in under or over-filling, poor lateral condensation and can have voids, which would result in microleakage and reinfection at a later date [32]
Iatrogenic mishaps during obturation such as excessive extrusion of sealer cement into the periapical space, invading the maxillary sinus or the inferior alveolar canal, causing severe pain or paresthesia have been reported [33],[34]
It requires obturation materials such as gutta-percha and sealer cement and various delivery systems, which adds to the total cost of treatment
If retreatment is required, removal of the old root canal obturation materials from the root canals requires several instruments and retreatment kits, solvents, additional time, and can cause iatrogenic complications such as strip perforation.
Retreatment considerations
The failure cases could be categorized as reinfection (2), cystic lesion expanding (1), and periodontal cause (1).
In all the cases of retreatment, re-entry into the canal was found to be very easy. With a probe, the calcium sulfate-based cement could easily be felt and removed with files and irrigation to clean and retreat the canal.
Thus, the novel protocol of "SealBio" can be considered as a simple, easy to perform, cost saving, regeneration-based endodontic treatment protocol [Figure 1] and [Figure 2]. The other major advantages are: (i) posts can be used in cases treated by SealBio, as the canals are left empty and only an apical barrier is expected to form at the apical end [Figure 3], unlike in cases of revascularization/revitalization (another regeneration-based protocol for immature, nonvital teeth), where the canal is filled with vital tissues. (ii) As the cleaning and disinfection are augmented with "apical clearing" and "apical foramina widening," better healing response was observed, even in cases of large cyst-like lesions [Figure 4] and [Figure 5]. (iii) In case retreatment is required, it is easy to re-enter, as the canal is empty unlike removal of all the obturating materials, as required in conventional endodontic treatment. [Figure 6].
Figure 1: (a) Tooth #16 in a 58-year-old male periapical lesion at both mesial and distal root. (b) At 3-year follow-up, complete healing and normal bony architecture are evident (compare with Figure 2a). (c) At 6-year follow-up, the periapical area has remained normal
Figure 2: (a) Large periapical lesion associated with teeth #21 and 22 in a 45-year-old male. Significant apical root resorption of both the teeth is evident. (b) Follow-up radiograph at 6-month, showing significant healing (compare with Figure 3a). (c) At 2-year, bony trabeculae seen filling-in the apical radiolucency
Figure 3: (a) X-ray showing large periapical lesions associated with teeth #36 and 37 in a 17-year-old girl. (b) SealBio was performed in both the teeth. The second molar required post and core restoration due to severe coronal destruction. Follow-up radiograph at 2-year showing significant healing (compare with Figure 4a). (c) Follow-up at 3-year shows normal bony architecture around both the root apices
Figure 4: (a) Tooth #36 in an 18-year-old boy, showing a very large cyst-like radiolucency associated with distal root and also a smaller lesion on the mesial root. (b) At 6-month after SealBio, significant healing of both the lesions can be seen (compare with Figure 3a). (c) Radiograph at 3-year follow-up shows almost complete healing
Figure 5: (a) Large, fluctuant swelling on left side of palate associated with carious tooth # 26. (b) Periapical X ray immediately after "SealBio. Note large cyst-like periapical radiolucency. (c) At 2-years follow-up, complete healing of the lesion is seen
Figure 6: (a) Tooth #36 in a 32-year-old male, immediately after SealBio. Note the wide root canal space, periapical lesions on both roots and root resorption, more marked on mesial root. (b) Patient reported 1½ years after SealBio, with diffuse bone expansion. Intraoral X-ray showed a large radiolucency around the mesial root. It was decided to perform retreatment only in the mesial root. (c) At 2½ years postretreatment, the apical lesion shows healing at the mesial root
Although the efficacy of this procedure is established in clinical endodontics by the large number of cases treated and long-term follow-up, further evidence may be established by histologic examination of the apical root end, to evaluate the type of tissue deposited to seal the apical end. Furthermore, the treatment outcome with SealBio needs to be compared with conventional endodontic treatment with obturation of root canals, for which the study is under way.
Long-term follow-up of treated cases has proved the efficacy of "SealBio" as non-obturation of root canals does not cause re-infection, if proper coronal seal is provided. The technique is highly effective, simple to perform and cost and time saving, as obturation is not required. Additional benefits are that retreatment is much easy and allows the use of post and core restorations, as no vital tissue is in the canal space.
The author wishes to acknowledge Dr. Vijay Kumar, Assistant Professor for the assistance during preparation of the first draft of the manuscript and Dr. Ajay Logani, Additional Professor, Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, for initial reviewing the manuscript. The assistance of all the postgraduates, senior residents, and research officers is acknowledged for their very valuable help in radiographic evaluation of pre- and post-treatment cases. I would also like to acknowledge Ms. Kiran for her secretarial assistance in record keeping and patients' recall during the entire study period.
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Klevant FJ, Eggink CO. The effect of canal preparation on periapical disease. Int Endod J 1983;16:68-75.
Pinheiro ET, Gomes BP, Ferraz CC, Sousa EL, Teixeira FB, Souza-Filho FJ. Microorganisms from canals of root-filled teeth with periapical lesions. Int Endod J 2003;36:1-11.
Grossman LI. Antibiotics vs. instrumentation. A reply. N Y State Dent J 1953;19:409.
Siqueira JF Jr., Rôças IN. Clinical implications and microbiology of bacterial persistence after treatment procedures. J Endod 2008;34:1291-301.e3.
Yadav SS, Shah N, Logani A. Effect of "apical clearing" and "apical foramen widening" on apical ramifications and bacterial load in root canals - An ex-vivo stereomicroscopic study. Bull Tokyo Dent Coll 2014;55:67-75.
Borlina SC, de Souza V, Holland R, Murata SS, Gomes-Filho JE, Dezan Junior E, et al. Influence of apical foramen widening and sealer on the healing of chronic periapical lesions induced in dogs' teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:932-40.
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Kim SG, Zhou J, Solomon C, Zheng Y, Suzuki T, Chen M, et al. Effects of growth factors on dental stem/progenitor cells. Dent Clin North Am 2012;56:563-75.
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Silva-Herzog D, Ramírez T, Mora J, Pozos AJ, Silva LA, Silva RA, et al. Preliminary study of the inflammatory response to subcutaneous implantation of three root canal sealers. Int Endod J 2011;44:440-6.
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Kierklo A, Tabor Z, Pawinska M, Jaworska M. A microcomputed tomography-based comparison of root canal filling quality following different instrumentation and obturation techniques. Med Princ Pract 2015;24:84-91.
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González-Martín M, Torres-Lagares D, Gutiérrez-Pérez JL, Segura-Egea JJ. Inferior alveolar nerve paresthesia after overfilling of endodontic sealer into the mandibular canal. J Endod 2010;36:1419-21.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
Shah N
Endogenous stem cells
homing of stem cells
nonobturation root canal treatment
periapical healing
regenerative endodontic treatment
SealBio


#5: Scarface "Money & The Power"
It might be stating the obvious, but one of the things that makes Scarface one of rap's greatest storytellers is his constant attention to the traditional rules of storytelling. His narratives have things like arcs and conflicts, all of which is storytelling 101, but are often lost on lazier lyricists. Even something as simple as setting a place, be it a four-corner room or deep in the heart of South Park, has always set him apart. "Money & The Power" is a classic dope game rise and fall account, owing more than a little bit to his namesake.


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PACER announce new album 'Mechanical' and stream title track
PACER announce new album 'Mechanical'
Set for release through Everything Sucks Music (UK) / Shield Records (EUR) on 17th November, 2014
Listen to the title track now
PACER have announced the release of their second album will be on 17th November through Everything Sucks Music in the UK. The title track 'Mechanical' can be heard now here. Vocalist Mark Pavey explains that it's "about how an intense focus can sometimes leave you without a wider perspective; how when you suddenly have no plans, you can feel broken."
The band's punk rock pedigree is undeniable with their first EP getting a release on The Bouncing Souls' Chunksaah Records, the line-up featuring former members of The Steal and Twofold, and a Split 7" with Iron Chic, acclaimed debut album 'Making Plans' and appearance at The Fest in Florida under their collective belt.
'Mechanical' is an album exemplary in its energetic bounce. As vocalist Mark Pavey says – "Whilst (last album) Making Plans was written in a few periods of intense writing, Mechanical took shape at a slower pace being both more complex musically and more introspective in its subject matter. As it reached its completion, we booked some time to record the album in a similar manner to how we recorded Making Plans – over two days, playing mostly live together as a group in order to give the album the frenetic energy we wanted."
"Making Plans was about a focus, about deciding on a goal and moving towards it at a great speed to achieve it." Continues Pavey. "Mechanical is a counter to that. It's about what happens after you reach a goal that you have focused on so strongly and working out what to do when you are suddenly left feeling aimless and adrift."
With the album mixed by guitarist/vocalist Dave House at home and in coffee shops all over the south-east, House and Pavey found the two day deadline key to the energy of the record (and many others they've been involved with) – "We find it's just enough time to track things without hideous mistakes while retaining the sense of urgency and authenticity of a band just playing together in a room," says House.
Despite focusing on the problematic hurdles in life, 'Mechanical' as an album has a strong focus on the realisation that, as long as you can keep the problems that happen around you in perspective, you can move past them without letting them bog you down.
PACER ARE: Mark Pavey – Vocals # Dave House – Guitar / Vocals # John Hayler – Guitar / Vocals # Mike Turner – Bass # Chris Pellatt – Drums
https://www.facebook.com/wearepacer # https://twitter.com/wearepacer http://wearepacer.com
EMMA RUTH RUNDLE RELEASES THE MUSIC VIDEO FOR "LIGHT SONG"
Sweden's Normandie Release Another Track Off Upcoming InVogue Records Debut 'Inguz' out March 11
Scottish rock outfit Vukovi unveil 'Boy George'- new track released 3rd August
LYDIA AINSWORTH shares new track 'Hologram' – 'Right From Real' album out September 29th on Arbutus Records
Demob Happy share new music video 'Suffer You' + Announce October UK Tour


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How Satya Nadella Sounds a Lot Like My Brother, And Why That Is Not A Good Thing - The Aerogram
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How Satya Nadella Sounds a Lot Like My Brother, And Why That Is Not A Good Thing
by Sonora Jha
I had just emerged from teaching a class in media studies at Seattle University last Thursday when I saw numerous posts on social media about remarks made by Satya Nadella. The recently installed Microsoft CEO was acting as the keynote speaker at a female-focused technology event when he was asked if he had any advice for women who are uncomfortable asking for promotions.
"It's not really about asking for the raise, but knowing and having faith that the system will actually give you the right raises as you go along," he said. "That might actually be one of the superpowers that women who don't ask for raises have, because that's good karma."
I felt like someone had reached out across continents, punched me in the gut, and stripped me of all sense of accomplishment in my chosen home. Yet my next response was to protect Nadella, to shield him from any orientalist backlash over his South Asian roots.
In the next few hours, as apologists came out of the woodwork in his defense, and even as his own "apology" had me searching in vain for the word "sorry," I grew increasingly uneasy. I could no longer hide my head in the sand over the fact that his remarks — and his almost-instant recovery — was a naked spectacle of the CEO's upper-caste Hindu Brahmin male privilege reaching out across continents to high-five his American capitalist male supremacy.
Watching the video of Nadella's remarks, I couldn't help but feel that I had heard his message before. I had heard it overI hear him asking women to be Lakshmi, to be content with his reverence, as she waits, with deific patience, this Goddess of Wealth, for a raise in her own paycheck. and over in the lessons I was taught growing up in India: be a good girl, be undemanding and uncomplaining, and trust that as a female, my special karma had my back. As my brother was allowed to go out and be just another boy, I was told by society that I could be a deity, a goddess, superior on account of my sacrifices. When I hear Nadella talk about these "superpowers" that women have, I cannot help but hear, despite his hip Americanized accent, that same call to rise above it all, like a Durga in waiting, a Draupadi for whom Krishna would one day arrive with yards of sari. "That's the kind of person I wanna trust," Nadella said. "That's the kind of person I really wanna give more responsibility to." I hear him asking women to be Lakshmi, to be content with his reverence, as she waits, with deific patience, this Goddess of Wealth, for a raise in her own paycheck.
The remarks were not, as he later said — in what one suspects was a scripted message swiftly crafted by the crisis-communication experts of Microsoft — "inarticulate." They were not unfortunate or uninformed or clueless. They were, in fact, a clue hinting at the unchecked baggage of privilege that some of us immigrants brought with us to a country that holds special rewards for exactly this privilege, nursed as it is on the perfect milk of karma's confluence with free-market economics.
Was inarticulate re how women should ask for raise. Our industry must close gender pay gap so a raise is not needed because of a bias #GHC14
— Satya Nadella (@satyanadella) October 9, 2014
Far from being inarticulate, the remarks provide an uncorrupted view of the Indian-American dream that played out at the U.N. General Assembly on September 28, when thousands of elite Indian Americans in New York City's Madison Square Garden roared in a spectacular song-and-dance welcome for India's free-market-focused Prime Minister Narendra Modi — a leader who was until recently banned from entering the country by the United States government for his reported role in a Hindu-supremacist pogrom against Muslims in his home state of Gujarat.
Like Modi in NYC, we have "arrived," the Indian community said at Madison Square Garden. And Nadella is the poster boy for what it means to introduce Indian privilege to American privilege. As he himself stated in that interview on Thursday, who would have believed that a South Asian could have made it to the position of CEO of a corporation like Microsoft?
I would. And so would Indra Nooyi, the Indian-American CEO of PepsiCo, another Indian of Brahmin caste. The difference between the two is that Nooyi was asked — by her mother — to check her privilege by "removing her damned crown" before she entered her home, to be mother and wife. Nadella's privilege, of crown and coronation, goes unchecked. While Nooyi must know when to play woman, Nadella gets to tell women to keep playing woman.
Let's move on, said one Indian-American woman after another on my Facebook page — feminists, Klawe attributed Nadella's remarks to "a cultural belief which, you know, fits in well with where he comes from, South India, that you shouldn't ask for things, you shouldn't demand things."all of them, before this episode. But we all knew what we were doing: covering up for our South Asian brother, playing nice, the way we had done back home. Even Kavita Krishnan, secretary of the All India Progressive Women's Association, delivered a tempered Facebook update: "Microsoft CEO @satyanadella miso-gyny isn't a case of 'Indians' anti-women bias', it's capitalism, mansplaining itself to women! Capitalism always tells women & workers to trust to karma/the system, not fight for a raise!" Maria Klawe — president of Harvey Mudd College, mathematician, computer scientist, and the woman who interviewed Nadella on Thursday — told NPR the day after that she felt "guilty" for the way the whole episode played out. She, a Microsoft director, swept aside notions that Nadella's remarks were aimed at women at all. She attributed it to "a cultural belief which, you know, fits in well with where he comes from, South India, that you shouldn't ask for things, you shouldn't demand things." And then she said she was sorry that he said what he did.
The trouble is, we don't want to hear Klawe say she's sorry. As NPR reporter Melissa Block reminded her, Nadella himself hadn't said "sorry." Klawe, Krishnan, the feminists on my Facebook wall — all of us are lining up in a merry dance we have been taught to do, to tell ourselves that it will all be OK if we just learn to forgive. But, in the Bhagavad Gita, when the God Krishna introduces the notion of karma to the warrior Arjuna, it is to exhort him to go to war and not question the consequences. Nadella is asking women not to go to war. And look how we're falling in line.
Karma's consequence now demands that Nadella sign up for a training program in gender discrimination. And, on his next trip to India, ask a few questions of a sister or two.
Shared here by permission, this article originally appeared in Seattle Weekly.
Sonora Jha is a journalism professor at Seattle University and the author of Foreign, a novel about farmers' suicides in India. She is currently writing a memoir about raising her son outside the influences of patriarchy.
Tags: GenderIndra NooyikarmaMaria KlaweMicrosoftSatya NadellaTechnology
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What is a GPA of 7?
Asked by: Mina Ferry | Last update: May 2, 2022
Your grade point average (GPA) is the average result of all your grades and is calculated on a 7-point grading scale. 7 being the highest (HD), and 0 is the lowest (fail). The GPA calculator can help you determine if you are eligible for scholarships, programs such as Honours or admission to other universities.
What Is a Good GPA in High School? The average high school GPA is around 3.0, or a B average. This also happens to be the minimum requirement for many college scholarships, though a 3.5 or higher is generally preferable.
What is a good GPA for 7?
GPA of 6 and 7 are considered as an excellent score in Australian universities and among Australian employers. GPA of 6 or 7 means Distinction or Higher Distinction.
Is a GPA out of 7?
What is the highest GPA in Australia? The grade point average (GPA) is the average outcome of your all grades and is based on a 7-point grading scale. The number 7 is the highest (HD) GPA, and 0 is the lowest (fail).
What's a perfect GPA?
If your school uses this one, the perfect GPA is a 4.0, which means that you have straightAs. If you have a 3.0, you have straight Bs, and so on and so forth. The unweighted GPA scale also means that each class is scored the same, regardless of its difficulty.
What is a GPA?
Is GPA and GWA the same?
Are GWA and GPA the Same? GWA and GPA both represent academic performance for a certain period. However, Grade Point Average (GPA) is based on the "letter-grade" system where each letter has corresponding points (e.g., A = 4 points, B+ = 3 points, and so on) while GWA works with the numerical grades.
Is 3.0 A good GPA?
Is a 3.0 GPA good? A 3.0 unweighted GPA means that you've earned a B average across all of your classes. This is the national average GPA for high school students, but it may be slightly lower than the average GPA of high school students who plan on attending college. 16.1% of schools have an average GPA below a 3.0.
What is a 6.00 GPA?
Those course grades are typically weighted and are usually graded on a five-point scale instead of four points, so if you get a "B, it equates to a 4.0, and an "A" would give you a grade of 5.0. At some schools, honors classes and advanced placement courses would be figured on a 6.0 GPA format.
How do you calculate 7 point grading?
1) For 7 point Grading System (CBGS), the percentage shall be calculated on the percentage of actual marks obtained by the candidates. 2) For the 10 Point Grading System (CBCS), the formula for calculating the percentage is given by:- Percentage. (%) = 7.1 * CGPA +11.
Why do some schools use a 7 point grading scale?
For the college-bound student, the 7-point scale demonstrates that extra push academically that is reflected in the transcript. "Each student that applies to a college has a school profile sent with respect to the grading system of each high school.
GPA of 6 and 7 are considered as an excellent score in Australian universities and among Australian employers. GPA of 6 or 7 means Distinction or Higher Distinction. At most high schools, this means that the highest GPA you can get is a 5.0.
If your school uses a 5- or 6-point GPA scale, you want to be closer to those values instead. The average grade for high school students in the United States is around a B, which means the average high school GPA is a 3.0. So, if your GPA is higher than that, you're off to a good start!
On the weighted scale, a strong GPA could range from a 4.0 to a 5.3 – indicating to colleges that you're taking challenging courses (Advanced Placement, Dual Enrolled, etc.) and keeping up A's and B's. On the unweighted scale, a good GPA could range from a 3.0 to a 4.3, which spans the A/B average values.
Can I bring up a 1.7 GPA?
A 1.7 is a GPA that will put you in jeopardy of not getting into college. Luckily, you still have your junior year to raise your grades. If you work very hard and earn B+s or higher in your classes, you may be able to get your GPA to a 2.5 or higher before you have to apply to college.
What's the average GPA for a 8th grader?
Here are the high school GPA averages, according to NCES: Overall GPA average: 3.0. Average in core academic courses (math, science, English, and social studies): 2.79. Average in other academic courses (foreign language and other academic courses not in the core curriculum): 3.14.
A 3.0 GPA, or Grade Point Average, is equivalent to a B letter grade on a 4.0 GPA scale. This means is equivalent to an 83-86%.
What is a 3.8 average?
A 3.8 GPA, or Grade Point Average, is equivalent to an A- letter grade on a 4.0 GPA scale. This means is equivalent to a 90-92%.
Is 70 good in university?
Getting over 60% is excellent because it means you have demonstrated a deep knowledge of your subject to the marker. You may be used to getting marks of 90–100%, but this is very unlikely to happen at university. Remember that marks in the 50–70% range are perfectly normal.
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Israel | Rabbi Molly G.
After 2,000 years and 5 weeks of longing for Jerusalem, I have arrived! Thanks to an amazing playlist from Michelle featuring only songs about Jerusalem, my friend Sonya and I danced our way up the trail to Tzur Hadassah right outside Jerusalem where we then took a bus to the city. We've walked 506 kilometers (314 miles) from Eilat to Jlem!
The arrival was a bit overwhelming as Jerusalem is an intense and busy place particularly right before Shabbat, but once I got out of the center of the city and my taxi pulled up to my favorite address in Jerusalem where my friends Nancy and Ron live I felt completely in awe that just five weeks ago this is where my journey began.
I was reunited with my belongings that I had brought here for before and after the trail. It was strange and yet wonderful to put on jeans, use face wash, put on perfume, etc. I sat across from Nancy at her kitchen table in disbelief at how far I had come also while I wolfed down the most amazing tasting bread, cheese, and grapes.
This was like no other time I had ever arrived to Jerusalem. First, it was by foot and second it was the day after Yom HaShoah (Holocaust Remembrance Day).
As a group we observed Yom HaShoah when the sunset on Wednesday evening. We had a minute of silence and then a talking circle where everyone shared what was alive for them at this moment of remembrance. Several of the Israelis in the group spoke about their families survival stories. Others shared about the power of remembering, experiences at Yad Vashem, and the impact the loss of 6 million of our ancestors has on their lives. Towards the end a heated discussion erupted about whether one could compare the holocaust with other genocides. Though it was challenging in that moment to hear the tense discussion it was certainly a reminder how important it is to engage in these types of discussions.
The following morning I was standing on the trail by myself with yellow flowers waving in the wind as the siren went off throughout the country to remember the Shoah. I stood there thinking about Jews who passed away in fields and had to run through fields fearing for their life and had to live in fields and forests for years during the war in order to survive. In some ways the flowers and the grass waving in the wind felt like their memories were being lifted and honored as the siren blared. I also felt sad that so many never got to see such beauty here in our home land, a safe haven for the Jewish people.
So, arrival to this holy city of Jerusalem took on extra meaning as I was so aware of how many before me dreamed of and longed to be in this place.
This past week as we walked up to Jerusalem I was giddy as we passed through places where the prophet Micah preached, where Goliath lived, where Israelites took refuge after the destruction of the second temple, we saw ancient wells, an old Ottoman bridge, vineyards, wheat fields, and the most breathtaking storks flying in the sky.
What an unforgettable week…I sat under a fig tree and near vineyards this past week ( as the prophet Micah envisioned) and I rejoiced in Jerusalem (just as the prophet Isaiah preached) with the words…sisu et Yerushalayim… I am truly humbled by it all.
I've been enthusiastically lounging over the past two days. I envision that this really is how Chag (last day of Pesach) and Shabbat should always be spent…reading, resting, singing, chatting, and enjoying the outdoors.
Some of my favorite things over the past few days have been singing Shabbat songs around the camp fire last night with drumming, searching for the chametz that had been hidden away for the week, chilling out under the big green tarp that Walk About Love puts up on Shabbat, and getting to know my fellow walkers even better. Oh and also getting a lot of practice with my Hebrew!
Over the past 48 hours, Maggie from our group often exclaimed "What a time to be alive!" every time someone would come to visit our group over Chag and Shabbat with food and drink! While we did have food in the truck, which we made good use of including the American classic Matza Brei (which I supervised), we were a bit sick of matza and tehina, matza and chocolate spread, matza and matza. So…it really was pretty exciting (great to be alive) when a bottle of tequila was brought to us, ice cream and ice cream cones, pita, hummus, labaneh, cheese, pastries, kanafe, and baklava!
We are camped at Har (Mt.) Amasa in the edge of the Yatir Forest about a 20 minute drive by car to the north of Arad. Amasa is named for King David's nephew who ultimately heads his army at the end of Second Samuel. Right near us is a small village also called, "Har Amasa." They have a room that they leave open for hikers and back packers and have been very welcoming to us who didn't go back to civilization for the weekend.
Tomorrow we start walking and (Gd willing) by the end of next week we will reach Jerusalem. I can't believe it! Shavua tov!


text:
Source: Population and Development Review
Resulting in 4 citations.
1. Geronimus, Arline T.
Korenman, Sanders D.
Hillemeier, Marianne M.
Does Young Maternal Age Adversely Affect Child Development? Evidence from Cousin Comparisons in the United States
Population and Development Review 20,3 (September 1994): 585-609
Cohort(s): Children of the NLSY79, NLSY79
Publisher: Population Council
Keyword(s): Adolescent Fertility; Behavior Problems Index (BPI); Child Development; Childbearing, Adolescent; Disadvantaged, Economically; General Assessment; Home Observation for Measurement of Environment (HOME); Mothers, Adolescent; Peabody Individual Achievement Test (PIAT- Math); Peabody Picture Vocabulary Test (PPVT); Siblings; Socioeconomic Factors; Test Scores/Test theory/IRT; Verbal Memory (McCarthy Scale)
The construction of teenage childbearing as a public problem, and the degree to which it should be a source of social or policy concern, have been the subject of numerous empirical investigations, theoretical analyses, commentaries, and controversy. While we do not review this literature in detail here, we highlight what we believe to be the most important theoretical tension and social scientific question to emerge from it. The theoretical tension is between whether teenage mothers are best understood as teenagers or as socioeconomically disadvantaged women, given the overrepresentation of socioeconomically disadvantaged teenagers among the ranks of teenage mothers. The social scientific question is the extent to which teen childbearing contributes causally to the social problems with which it is associated. One important area of social concern is the potential consequences of teen childbearing for offspring. In this article, we focus on early childhood development. The literature on child development in the United States has documented that, on average, children of young mothers score more poorly on cognitive and socioemotional measures and are at higher risk of poor school achievement than children of older mothers. While some investigators do not control for socioeconomic status when comparing child outcomes across maternal ages, many do take socioeconomic differences into account.
Geronimus, Arline T., Sanders D. Korenman and Marianne M. Hillemeier. "Does Young Maternal Age Adversely Affect Child Development? Evidence from Cousin Comparisons in the United States." Population and Development Review 20,3 (September 1994): 585-609.
2. Morgan, S. Philip
Rackin, Heather
The Correspondence Between Fertility Intentions and Behavior in the United States
Population and Development Review 36,1 (March 2010): 91-118.
Also: http://onlinelibrary.wiley.com/doi/10.1111/j.1728-4457.2010.00319.x/abstract
Cohort(s): NLSY79
Keyword(s): Birth Rate; Expectations/Intentions; Family Size; Fertility; Life Course; Marital Status
Using data from the 1979 National Longitudinal Survey of Youth, we describe the correspondence between intended family size and observed fertility for US men and women in the 1957-64 birth cohorts. Mean fertility intentions calculated from reports given in the mid-20s modestly overstate completed fertility. But discrepancies between stated intent and actual fertility are common--the stated intent at age 24 (for both women and men) is more likely to miss than to match completed fertility. We focus on factors that predict which women and men will have fewer or more children than intended. Consistent with life-course arguments, those unmarried, childless, or (for women) still in school at approximately age 24 were most likely to underachieve their intended parity (i.e., had fewer children than intended at age 24). We discuss how such discrepancies between intentions and behavior may cumulate to produce sizable cross-group fertility differences. [ABSTRACT FROM AUTHOR]
Copyright of Population & Development Review is the property of Blackwell Publishing Limited and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Morgan, S. Philip and Heather Rackin. "The Correspondence Between Fertility Intentions and Behavior in the United States." Population and Development Review 36,1 (March 2010): 91-118.
3. Scott, Mindy E.
Steward-Streng, Nicole R.
Barry, Megan C.
Neighborhood, Family and School Environments: Associations with the Timing of Adolescent First Sex
Presented: Washington, DC, Population Association of America Annual Meetings, March 31-April 2, 2011
Keyword(s): Adolescent Sexual Activity; Age at First Marriage; Family Environment; Geocoded Data; Neighborhood Effects; School Quality
A major focus of policy and research is on delaying the timing of first sex to help reduce high rates of teenage pregnancy and STDs in the U.S. This study uses data from Rounds 1-8 of the National Longitudinal Survey of Youth (NLSY97) to examine whether and how different adolescent environments including neighborhood, family, school, and the surrounding physical environment are associated with an earlier timing of first sex. We also examine whether micro-level factors (e.g., parent involvement) are more or less protective against early sexual experience in more disadvantaged neighborhoods. County-level indicators of neighborhood disadvantage (e.g., poverty, unemployment, single motherhood, educational attainment) are used. Preliminary results suggest that many contexts matter for the timing of adolescent sex (e.g., neighborhood, parent involvement, family structure, youth's perceptions of their school and physical environments, parent background) and that these contexts vary depending on the level of neighborhood disadvantage.
Scott, Mindy E., Nicole R. Steward-Streng and Megan C. Barry. "Neighborhood, Family and School Environments: Associations with the Timing of Adolescent First Sex." Presented: Washington, DC, Population Association of America Annual Meetings, March 31-April 2, 2011.
4. Sironi, Maria
Furstenberg, Frank
Trends in the Economic Independence of Young Adults in the United States: 1973–2007
Population and Development Review 38,4 (December 2012): 609-630.
Cohort(s): NLSY79, NLSY97, Young Men, Young Women
Keyword(s): Economic Independence; Economic Well-Being; Employment; Transition, Adulthood
One of the major milestones of adulthood is achieving economic independence. Without sufficient income, young people have difficulty leaving their childhood home, establishing a union, or having children—or they do so at great peril. Using the National Longitudinal Survey, this article compares the employment and economic circumstances of young adults aged 22–30 in 1973, 1987, and 2007, and their possible determinants. The results show that achieving economic independence is more difficult now than it was in the late 1980s and especially in the 1970s, even for the older age groups (age 27–28). The deterioration is more evident among men. From the 1970s there has been convergence in the trajectories for the achievement of economic self-sufficiency between men and women, suggesting that the increase in gender parity, especially in education and labor market outcomes, is making their opportunities to be employed and to earn good wages more similar. This convergence also suggests that union formation increasingly may depend on a capacity to combine men's and women's wages.
Sironi, Maria and Frank Furstenberg. "Trends in the Economic Independence of Young Adults in the United States: 1973–2007." Population and Development Review 38,4 (December 2012): 609-630.