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Parental Perception of Children Affected by Amelogenesis Imperfecta (AI) and Dentinogenesis Imperfecta (DI): A Qualitative Study
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Hasmun, N.
Lawson, J.
Vettore, M. V.
Elcock, C.
Zaitoun, H.
Rodd, H.
Noren Hasmun
1,*,
Jennifer Lawson
Mario V. Vettore
Claire Elcock
Halla Zaitoun
Helen Rodd
School of Clinical Dentistry, University of Sheffield, Sheffield S10 2TA, UK
Department of Paediatric Dentistry, Charles Clifford Dental Hospital, Sheffield S10 2SZ, UK
Received: 18 September 2018 / Revised: 11 October 2018 / Accepted: 19 October 2018 / Published: 1 November 2018
(This article belongs to the Special Issue Psychosocial Impacts of Dental Conditions in Childhood)
Molar incisor hypomineralisation (MIH) is a common enamel condition, presenting with incisor opacities, which may be of psychosocial concern to children. This clinical study sought to determine whether minimally invasive treatment, aiming to improve incisor aesthetics, would also improve children's oral health-related quality of life (OHRQoL). 111 MIH patients, aged 7–16 years, referred to a UK Dental Hospital, were invited to complete the Child Oral Health Impact Profile (C-OHIP-SF19) prior to any intervention (T0) and again at one-month following the intervention (T1) for MIH. Treatment regimens included one or more of the following: Microabrasion; resin infiltration; tooth whitening; resin composite restoration. Data were obtained for 93 children with a mean age of 11 years. Mean total C-OHIP-SF19 score at T0 was 47.00 (SD = 9.29; range = 0–76) and this increased significantly at T1 to 58.24 (SD = 9.42; range = 0–76; p < 0.001, paired t-test), indicating a marked improvement in self-reported OHRQoL. There were no statistically significant differences according to gender. This is the first study to show that simple, minimally invasive dental treatment, to reduce the visibility of enamel opacities, in MIH, can have a positive impact on children's wellbeing.
oral health-related quality of life; children; molar incisor hypomineralisation; incisor opacities; minimally invasive treatment
It is well recognised that children with developmental enamel defects may experience a range of psychosocial impacts [1]. For young people with visible defects, poor dental appearance and a sense of feeling different may have a particularly negative effect on social interactions and self-esteem [2,3]. However, the reported severity and nature of these impacts can be hugely variable, depending on the child's sense of self and the social context at different time points in their life, such as moving to a new school [4,5]. It has also been suggested that children with highly visible incisor opacities may be exposed to negative social judgements from their peers, with the common misconception that affected individuals do not care about their appearance or are lazy about brushing their teeth [6].
The first studies to consider the potential impact of abnormal dental development, in terms of poor dental aesthetics, focused on dental fluorosis. Children, living in a number of African countries with endemic dental fluorosis, frequently reported a reluctance to smile, as they did not like to show their discoloured teeth [7]. Investigators have also explored the psychosocial impact of amelogenesis imperfecta in children and young adults using both quantitative and qualitative approaches [2,3,8]. This genetic condition presents both aesthetic and functional problems for individuals, as well as a lifelong treatment burden. For some, the negative impacts of having poor dental appearance are overwhelming, to the detriment of many facets of normal social interaction, such as meeting new people or forming relationships. Recently, attention has turned to a more common enamel disorder, molar incisor hypomineralisation (MIH), which may also severely compromise dental appearance and function. An estimated 13–14% of children are thought to have MIH, creating immense challenges for oral health providers across the world [9,10]. In addition to poorly mineralised and sensitive first permanent molars, MIH typically presents with one or more affected permanent incisors in a reported third of cases, which may have a variety of discrete yellow/white/cream/brown opacities involving the incisal third of labial surfaces [11]. However, in contrast to affected permanent molars, the incisors tend not to be as sensitive or suffer from post-eruptive tissue breakdown. The first studies to explore the psychosocial impacts of MIH were conducted with Brazilian children, using the Child Perception Questionnaire (CPQ11-14ISF) [12] and a questionnaire on tooth appearance, which had originally been validated for use with children with fluorosis [13]. Findings from both these studies suggested that children with severe MIH were dissatisfied with tooth colour, avoided smiling, and experienced poorer social well-being.
Anecdotal reports from paediatric dentists suggest that they are seeing increasing numbers of children with MIH, sometimes as young as six or seven years of age, who report being upset by 'marks' on their teeth and who request 'corrective' treatment. In these situations, clinicians should discuss the risks/benefits of any dental intervention whilst being empathetic to the child's treatment expectations and concerns. It is also imperative that minimally invasive approaches are adopted to preserve tooth structure and maintain tooth vitality, whilst reducing the visibility of any opacity as much as possible. A variety of treatment regimens have been described for the management of children with hypomineralised permanent anterior teeth, including: Tooth whitening (using hydrogen peroxide-containing products); microabrasion; resin infiltration; and resin composite restoration [14,15,16]. Although guidance has been published by the European Academy of Paediatric Dentistry for improving incisor aesthetics in children with MIH [17], the evidence-base for the effectiveness of any single or combined treatment regimen is completely lacking, leaving clinicians to take a pragmatic and experience-led approach.
Although there is persuasive evidence that children with enamel defects experience a variety of psychosocial impacts, surprisingly few studies have attempted to determine the value of dental treatment in addressing these negative impacts in young patients. To date, only two studies, using non-validated questionnaires, have sought children's perspectives of aesthetic interventions to manage their visible incisor opacities [18,19]. There is thus great scope to undertake this line of enquiry, given the prevalence of enamel defects, the negative impacts they may have, and the recognition that seeking patient-reported outcomes and experiences is integral to high quality service provision and development [20].
The aim of this study, therefore, was to compare OHRQoL in children with MIH before and after minimally invasive dental treatment to reduce the visibility of their incisor opacities. An additional objective was to consider whether there was any difference in reported OHRQoL before and after dental treatment according to gender and age.
2.1. Overall Study Design
This was a prospective clinical intervention study conducted in a public-funded dental hospital in Sheffield, UK. It formed part of a more comprehensive three-year PhD study, undertaken by the lead author (N.H.). Children with MIH, requesting cosmetic improvement of one or more permanent anterior teeth, were offered a range of minimally invasive treatment regimens. Prior to treatment they completed a validated OHRQoL measure, and this was repeated at their one-month 'post treatment' review. Children were recalled at six months following treatment; data collection is ongoing and will be published in a future communication.
2.2. Recruitment of Participants
Ethical approval was granted for this study by the UK National Research Ethics Committee (Ref. 17/WA/0096). Participants were sought from the paediatric dentistry clinic of a British dental hospital, following referral from their general dental practitioner for specialist management of their MIH. Recruitment and subsequent treatment took place between June 2017 and July 2018, and was undertaken by two of the named authors (N.H. and J.L.). Inclusion and exclusion criteria were as follows.
Children diagnosed with MIH, according to well established clinical criteria [21] and confirmed by a consultant in paediatric dentistry (H.R.);
children with MIH and who had a visible enamel opacity involving at least one permanent incisor;
children who requested improvement in their incisor aesthetics; and
children aged between 7 and 16 years.
Children who presented with an acute dental symptom and required urgent treatment;
children who were planned to undergo active treatment for their hypomineralised molars during the proposed study period (e.g., extractions) or orthodontic treatment;
children with any dental or facial anomaly other than MIH (e.g., hypodontia, cleft lip, and palate);
children with compromised incisor aesthetics due to a traumatic dental injury, tooth surface loss, or caries;
children with severe learning disabilities who were unable to understand and take part in the research, even with support from the research team; and
children or parents who did not speak English.
Following initial attendance those who met the inclusion criteria were given an age-appropriate information sheet, as were their parents/carers. At their subsequent treatment appointment, having had time to reflect, they were invited to sign a written consent form, if they wished to participate in the study.
2.3. Sample Size Calculation
The primary outcome measure was the score derived from the Child Oral Health Impact Profile Short Form 19 questionnaire (C-OHIP-SF19), which is described below [22]. A sample size calculation was carried out with a view to testing for any statistically significant difference between mean C-OHIP-SF19 scores pre- and post-treatment intervention, assuming a mean change (reduction) in C-OHIP score of 2.5 and a standard deviation of 8.0 [23]. It was calculated that a sample size of 85 children would result in a study with 81% power and a 5% level of significance. Furthermore, assuming a dropout rate of 10% between baseline and follow-up data collection and applying the following formula, N1 = n/(1 − d); n (participant required) = 85 and d (dropout rate) = 0.1, a total of 95 participants was sought.
2.4. Data Collection and Measures
Prior to any dental treatment participants were invited to complete the C-OHIP-SF19. This is a self-report oral health-related quality of life questionnaire, which measures both positive and negative impacts of oral conditions in children on their overall lives and has been used extensively in children's oral health research [24]. The short form has 19 items encompassing three domains: Oral health, functional well-being, and socio-emotional well-being, and has been validated for use in 8–15 year olds [22]. Participants are asked to report on the frequency of any impact over the past three months on a 5-point Likert scale, which is scored from 0–4 (never, almost never, sometimes, fairly often, almost all the time) with negative items having their score reversed. In addition, this instrument also has one general question concerning the participant's perception of their overall oral health. The total score can range from 0–76, with the higher score reflecting better OHRQoL.
The following demographic and clinical data were obtained for each participant from their clinical records:
gender;
postcode address: To allow categorisation of the participant's socioeconomic status according to quintile, where 5 represents the greatest level of deprivation and 1 the least [25]; and
ethnic group (self-reported by the parent/carer).
Standard clinical photographs were acquired of children's anterior teeth before any treatment at baseline (T0) and at one-month review (T1) using a digital SLR camera (Nikon D3400, Nikon UK Ltd., Kingston upon Thames, UK) equipped with a Sigma EM 140DG macro ring flash (Sigma Imaging (UK) Ltd., Welwyn Garden City, UK) and Tamron 90 mm macro lens (TAMRON Europe GmbH, Berkshire, UK). These clinical images were taken at standardised settings (ISO 100, 1/160 speed and F/22 aperture), distance (about 20 cm between operator and the patient), and natural and room illumination conditions. Some examples of these are shown in Figure 1. Images were stored electronically as part of the patients' dental records.
Data were entered using the Statistical Package for Social Sciences (SPSS) v24.0 (IBM Corp., Chicago, IL, USA). Age, gender, ethnicity, deprivation (quintile) score, and MHSI were subject to simple descriptive analysis for means (standard deviations, range) and proportions. C-OHIP-SF19 data distribution were assessed for normality (Shapiro test) and a Wilcoxon Signed Rank test was used to determine any significant difference between pre- and post-treatment scores with a significance level set at 5% (p ≤ 0.05). Differences in C-OHIP-SF19 scores according to gender and age groups were determined using a Mann-Whitney U test. It was planned that for any missing data in the C-OHIP-SF19 questionnaires, the median score for each item would be imputed. Questionnaires with more than 50% of missing responses would be excluded from analysis.
2.6. Clinical Intervention
Children presented with a variety of white, cream, yellow, and brown opacities involving any of their maxillary and/or mandibular permanent incisors, and occasionally also involving their canines. These areas of hypomineralisation were generally discrete and well defined, affecting the incisal third of labial/buccal surfaces. Post-eruptive tooth tissue loss/hypoplasia was uncommon. Due to the diversity of lesion presentation, treatment regimens were tailored for individual patients on discussion with the lead consultant (H.R.), together with the child and their parent/carers. However, the most common approach was for an initial two to three cycles of microabrasion (OpalustreTM, Optident Ltd., Ilkley, UK), immediately followed by resin infiltration (ICONTM, DMG, Hamburg, Germany). Some children had microabrasion alone, and others had ICON alone. For children with multiple affected teeth, a tooth whitening gel (OpalescenceTM 16% carbamide peroxide, Optident Ltd., Ilkley, UK) was advocated for up to four hours a day in custom made trays, for two to four weeks prior to any further treatment. Children (with parental input) who were not satisfied with the aesthetic outcome at their one-month review were given the option of repeating the resin infiltration procedure or having a direct resin composite restoration (FiltekTM, 3M ESPE, Bracknell, UK) to further mask the enamel opacity (Figure 2). All children were treated using rubber dam and appropriate protection of soft tissues. They were advised not to have any highly coloured food or drinks for four days following their treatment.
3.1. Participants
A total of 111 children who met the inclusion criteria were initially approached to participate in the study. Of these, 103 (92.8% response rate) agreed to take part and signed their consent forms. However, there was a drop out of 10 patients, with a final 93 children (90.3% completion rate) completing their treatment and pre- and post-treatment questionnaires. The characteristics of these 93 participants are summarised in Table 1. The mean age was 10.95 years (SD = 2.54; range = 7–16), with a higher proportion of girls (59.1%, n = 55) than boys. There was representation from ethnic minority groups as well as from children from the most socially deprived quintiles. Indeed, around 40% of participants were from the two most deprived quintiles. For completeness, Table 1 also provides details of the treatment regimens employed for these participants, where it can be seen that the majority underwent microabrasion immediately followed by resin infiltration (n = 66.71%). Only two children/parents requested resin composite restorations to achieve optimum aesthetics following one or more of the other treatment options.
3.2. Oral Health-Related Quality of Life
Data from the 93 child-completed C-OHIP-SF19 questionnaires are presented in Table 2, at both baseline and one-month review. No questionnaire had any missing data as clinicians (N.H. and J.L.) were able to check that they had been fully completed at the time of issue.
The mean C-OHIP-SF19 score at baseline (before treatment) was 47.00 (SD = 9.29; range = 0–76), and this increased significantly following treatment at the one-month review to 58.24 (SD = 9.42; range = 0–76) (p < 0.001). This was a large effect size of 11.24 points (14.7% of the total possible score), which suggested that children perceived themselves as having a marked improvement in their overall OHRQoL. In terms of floor and ceiling effects, no children gave the lowest possible score (zero) at T0 and T1 and one child gave the highest possible score (76) at T0 and none at T1. C-OHIP-SF19 reliability was assessed through a Cronbach's alpha coefficient of the items of the scale. The Cronbach's alpha coefficient of C-OHIP-SF19 at T0 and T1 were 0.748 and 0.810, respectively, indicating very good internal consistency [26].
Furthermore, mean scores for each dimension within the measure were also significantly increased following the intervention, with the greatest change seen for socio-emotional wellbeing: Oral health T0 = 11.25 and T1 = 14.15 (p < 0.001); functional wellbeing T0 = 13.28 and T1 = 14.16 (p < 0.001); and socio-emotional wellbeing T0 = 22.46 and T1 = 29.92 (p < 0.001). Further analysis showed that the total mean scores for C-OHIP-SF-19 and all its dimensions were significantly increased at one-month follow-up for both age groups (7–10 years and 11–16 years).
There were no significant differences in total C-OHIP-SF19 or domain scores according to gender either at baseline or one-month review (p > 0.05, Mann-Whitney U test). Data are shown separately for male and female participants and according to age groups (7–10 years and 11–16 years) for information (Table 2).
3.3. Attendance and Treatment
The purpose of this research was to evaluate patient-reported outcomes rather than to evaluate the outcomes of the different interventions from a clinical (objective) perspective. However, for completeness, Table 1 provides the details of the different treatment regimens employed. It can be noted that almost a third of children (31.2%, n = 29) (data not tabulated) had a second course of treatment, suggesting they were not completely satisfied with the initial clinical outcome. There were no adverse outcomes, such as loss of tooth vitality or receipt of a patient complaint, throughout the programme of research.
To the authors' knowledge, this is the first study to show a change (improvement) in children's self-reported OHRQoL following a clinical intervention to reduce the visibility of incisor opacities associated with MIH. Previous data, highlighting the negative impacts of MIH on OHRQoL, have largely been derived from cross-sectional school-based populations [12,27]. Clinical-based investigations in young children, with any type of enamel defect, are sparse [2,18,19]. However, a recent randomised clinical trial did demonstrate improved OHRQoL following microabrasion/tooth whitening for young Brazilian adults with dental fluorosis [28]. Although not a universal finding, some OHRQoL studies have shown gender differences, with girls reporting lower OHRQoL than boys, in relation to a variety of dental conditions [29,30]. On first inspection, therefore, it was surprising that the current investigation did not reveal any significant gender differences in reported OHRQoL, either before or after aesthetic treatment. However, it must be noted that there was a greater proportion of females (59.1%) than males in this study group, suggesting that girls (and their parents) may have been more likely to seek specialist treatment (hospital referral) in the first place, potentially masking any true gender differences.
4.1. Study Strengths
The ease of participant recruitment was a key facilitator in the success of this study, ensuring that the required sample size was readily met. Indeed, response and completion rates of 92.8% and 90.3%, respectively, are considered exceptional in the authors' experience as a response rate of 50–60% is more the norm in their unit [29,31]. It can only be assumed that children with MIH, together with their families, are highly motivated to seek 'aesthetic' dental treatment, demonstrated by their excellent attendance rates and willingness to partake in research. It should be noted, however, that children were offered the same treatment, irrespective of whether or not they wished to take part in the study, thus there was no incentive for study participation. It was encouraging that there was representation from ethnic minority children as well as those from areas of high deprivation, allowing the findings to be widely generalisable. However, it is acknowledged that the proportion of participants from an ethnic minority group (8.6%) was slightly lower than the UK's ethnic minority group as a whole (14%) [32].
It was important to select the most appropriate OHRQoL measure for the purposes of this study, having reviewed the acknowledged advantages and disadvantaged of the most widely used and validated instruments [24]. One factor, prompting the choice of C-OHIP-SF19, was its inclusion of a specific item referring to 'marks' on teeth, making it highly relevant to the proposed research. However, the response format, which asks children to state how often in the past three months they have been affected by the marks or discolouration, may not actually reflect how children describe the impact. The authors' impression is that children are much more likely to quantify the impact of their dental condition in terms of its severity (how much or little) rather than the frequency of that impact [33]. However, in the absence of an alternative instrument, C-OHIP-SF19 was considered fit for purpose. The fact that it was sensitive to change, following a dental intervention, with limited ceiling and floor effects, further supported its application in this study.
In addition to their affected incisors, participants in this study also had a variable number of hypomineralised first permanent molars. Although these were unlikely to be of cosmetic concern, they undoubtedly presented other impacts for children, in terms of treatment burden and dental sensitivity [34]. One of the inclusion criteria for participants was that their first permanent molars were considered 'asymptomatic', having been previously extracted or restored. However, it cannot be assumed that the status of the child's first permanent molars did not influence their overall OHRQoL. The potential confounding effect of the severity of the child's MIH as a whole will therefore need to be considered in future analysis. It is also noted that this study did not include a control group. Withholding 'cosmetic' treatment for children with MIH would be unethical, however, the study could have included a control group where treatment provision was 'delayed' for two months. It would also be interesting to compare self-report OHRQoL in children with incisor opacities, but who do not express a wish for any aesthetic intervention. This would have allowed the investigators to verify that OHRQoL remained stable in the control group over this time period and change in the experimental group was due to the dental intervention itself.
An acknowledged limitation of quantitative research, such as this, is that it fails to capture novel or deeper insights. A numerical change in mean reported C-OHIP-SF19 score, or indeed individual domains following the dental intervention, does not fully explain how and why children feel better about themselves. To gain a greater understanding of how children perceive their oral health following masking of their incisor opacities, a qualitative approach would be warranted. This type of enquiry could also illuminate patient and parent treatment expectations and experiences, thereby helping providers to evaluate and improve their overall quality of care. A previous study in the authors' unit, which sought children's satisfaction following aesthetic treatment for a variety of enamel defects, revealed that expectations were not always met, with some young patients reportedly disappointed that the treatment outcome was not 'perfect' [19].
4.3. Clinical Implications
This research focused on the patient's perspective of treatment, by looking at change in self-reported OHRQoL following a simple intervention. Although children's involvement in oral health research is strongly advocated [35], this study will undoubtedly raise questions about clinical outcomes. There is a paucity of evidence to support the use of one clinical regimen over another in the management of incisor opacities. Indeed, a recent systematic review on treatment modalities for children with MIH concluded that 'no recommendations can be given for MIH-incisors' [34]. As such, the predictability and overall success of minimally invasive techniques in reducing the visibility of incisor opacities remains uncertain. Clinicians are therefore likely to adopt a variety of techniques, drawing on their own experiences and preferences. However, with the advent of newer techniques, such as resin infiltration, there is a clear need for clinical trials to better inform decision-making.
4.4. Future Research
As indicated above, future MIH research needs to consider both patient-reported outcomes as well as clinical outcomes. Although it should be borne in mind that there is rarely a direct correlation between biomedical measures and patient-reported measures [1]. The present study is, however, ongoing and will determine patient-reported and clinical outcomes at six-months, providing valuable and unprecedented longitudinal data. Other factors that may theoretically predict OHRQoL, as a primary outcome measure, could include a variety of patient characteristics (ethnicity, deprivation, age, sense-of-self) and clinical characteristics (caries experience, MIH severity, orthodontic status), and these could be considered within an appropriate theoretical model and more complex statistical analysis. It is also vital that future laboratory and clinical research attempts to relate clinical outcomes (change in opacity colour, visibility, and size) with both initial lesion characteristics and the treatment regimen undertaken. This is a challenging and exciting area of research, which offers great scope to improve children's oral health and treatment experiences.
Accepting the limitations of an uncontrolled study design, this clinical research has provided persuasive and novel evidence for improvement in self-reported OHRQoL following minimally invasive aesthetic treatment for masking the visibility of incisor opacities in children with MIH.
N.H. undertook the majority of treatments, data entry and analysis. Statistical supervision was provided by M.V.V. and imaging expertise was provided by C.E. The concept and clinical supervision of the study is attributed to H.R. All authors were involved in the study design, interpretation of data and preparation of this manuscript.
Thanks are given to the Malaysian Government and Universiti Teknologi MARA for funding this PhD project. Thanks are also given to all the patients and their parents for their willingness to engage in this research study. Staff in the department of paediatric dentistry, Sheffield are also acknowledged for their continued support, especially Joanne Ellis and Katy D'Aprice. Finally, the authors are indebted to Dental Milestones Guaranteed (DMG), Hamburg, Germany for providing the ICON material that was used for many of these patients.
The authors declare no conflict of interest. Dental Milestones Guaranteed (DMG) had no involvement in the study design or conduct and provided no financial incentives.
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Marshman, Z.; Gibson, B.J.; Benson, P.E. Is the short-form Child Perceptions Questionnaire meaningful and relevant to children with malocclusion in the UK? J. Orthod. 2010, 37, 29–36. [Google Scholar] [CrossRef] [PubMed]
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Figure 1. Clinical images to show the appearance of a 'typical' participant's permanent central maxillary incisors before (T0) and one-month after (T1) treatment (microabrasion followed by resin infiltration).
Figure 2. Clinical images to demonstrate both a successful clinical outcome and unacceptable aesthetic result. (a) Maxillary central incisors showing cream/white opacity (right) and white and brown opacities (left) pre-treatment. (b) Microabrasion followed by resin infiltration achieved good aesthetic results on the right central incisor, but brown opacity was still visible on the left central incisor, necessitating further resin composite restoration.
Table 1. Sociodemographic and clinical characteristics of study participants (n = 93).
Patient Variable
n (%) Mean (SD, Range)
Age (years) All Participants 10.95 (2.54, 7–16)
7–10 50 (53.8)
11–16 43 (46.2)
Gender Male 38 (40.9)
Ethnic background White British/Northern European 85 (91.4)
Any other group 8 (8.6)
Deprivation score 1st Quintile (least deprived) 18 (19.4)
2nd Quintile 24 (25.8)
3rd Quintile 14 (15.1)
4th Quintile 14 (15.1)
5th Quintile (most deprived) 23 (24.7)
Number of treated teeth 3.1 (2.65, 1–12)
Treatment regimen Microabrasion alone 6 (6.5)
ICON alone 4 (4.3)
Microabrasion followed by ICON 66 (71.0)
Microabrasion followed by tooth whitening 8 (8.6)
Microbrasion and/or ICON followed by resin composite restoration 2 (2.2)
Tooth whitening followed by microabrasion and/or ICON 7 (7.5)
Table 2. Mean (SD) Child Oral Health Impact Profile (C-OHIP-SF19) scores before treatment (baseline) and one-month following treatment and according to gender.
C-OHIP-SF19 Participants
Pre-Treatment C-OHIP-SF19 Mean (SD, Range)
Post-Treatment C-OHIP-SF19 Mean (SD, Range)
Change in C-OHIP-SF19 Score
Significance (p) Wilcoxon Signed Rank Test
Overall score All participants (n = 93) 47.00 (9.29, 0–76) 58.24 (9.42, 0–76) 11.24 p < 0.001
Female (n = 55) 46.15 (9.48, 0–76) 58.51 (9.77, 0–76) 12.36 p < 0.001
Male (n = 38) 48.24 (8.99, 0–76) 57.84 (9.01, 0–76) 9.60 p < 0.001
Age 7–10 (n = 50) 47.06 (8.89, 0–76) 59.66 (9.38, 0–76) 12.60 p < 0.001
Age 11–16 (n = 43) 46.93 (9.85, 0–76) 56.58 (9.30, 0–76) 9.65 p < 0.001
Oral health domain All participants (n = 93) 11.26 (2.78, 0–20) 14.15 (3.34, 0–20) 2.89 p < 0.001
Female (n = 55) 11.13 (2.93, 0–20) 14.55 (3.42, 0–20) 3.42 p < 0.001
Age 7–10 (n = 50) 10.58 (2.85, 0–20) 14.06 (3.34, 0–20) 3.48 p < 0.001
Functional wellbeing domain All participants (n = 93) 13.28 (2.59, 0–16) 14.16 (1.87, 0–16) 0.88 p < 0.001
Socio-emotional wellbeing domain All participants (n = 93) 22.46 (7.67, 0–40) 29.92 (6.42, 0–40) 7.46 p < 0.001
Hasmun, N.; Lawson, J.; Vettore, M.V.; Elcock, C.; Zaitoun, H.; Rodd, H. Change in Oral Health-Related Quality of Life Following Minimally Invasive Aesthetic Treatment for Children with Molar Incisor Hypomineralisation: A Prospective Study. Dent. J. 2018, 6, 61. https://doi.org/10.3390/dj6040061
Hasmun N, Lawson J, Vettore MV, Elcock C, Zaitoun H, Rodd H. Change in Oral Health-Related Quality of Life Following Minimally Invasive Aesthetic Treatment for Children with Molar Incisor Hypomineralisation: A Prospective Study. Dentistry Journal. 2018; 6(4):61. https://doi.org/10.3390/dj6040061
Hasmun, Noren, Jennifer Lawson, Mario V. Vettore, Claire Elcock, Halla Zaitoun, and Helen Rodd. 2018. "Change in Oral Health-Related Quality of Life Following Minimally Invasive Aesthetic Treatment for Children with Molar Incisor Hypomineralisation: A Prospective Study" Dentistry Journal 6, no. 4: 61. https://doi.org/10.3390/dj6040061


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Physics Education at Radcliffe and Harvard
Joanna Behrman '13
Joanna Behrman '13. Photo by Tony Rinaldo
Schlesinger Library Newsletter
Joanna Behrman considered Bryn Mawr when she was looking at colleges. "I immediately felt a strong sense of community there, but Harvard could offer so many more resources," she says. "And Harvard does have the best physics department in the world."
Now in her senior year, Behrman is obviously proud of her soon-to-be alma mater. She plans to become a physics professor and is considering graduate programs. An ardent student, she's writing a thesis, even though the Harvard physics department doesn't require one. Her topic—a comparison of undergraduate physics teaching at Harvard and Radcliffe from 1895 to 1953—led her to the Schlesinger Library, where she applied for and won a Carol K. Pforzheimer Student Fellowship to begin her research during the summer of 2012.
Behrman is concerned about the lack of gender diversity in her field. "Physics has a problem with cultural diversity, and it lags behind all the other sciences in terms of gender parity," she says. "Only mechanical engineering is worse."
She's aware of existing research that finds undergraduate education to be the leakiest part of the pipeline to careers in physics. It's also known that women's colleges tend to produce proportionally more physicists than coed colleges. So Behrman decided to conduct a scientific experiment with Radcliffe and Harvard. "Here we have a women's college and a men's college with the same faculty and at least nominally the same education," she says. "I wanted to see what the undergraduate physics experience was like at both colleges."
A physics class at Radcliffe, 1912, from the Radcliffe College Archives, Schlesinger Library
Behrman spent months going through archival material stored at the Schlesinger Library. "They have amazing digital collections," she says. "I looked at everything they have online: yearbooks, enrollment records, annual reports. I was able to do very nitty-gritty data collection that feels very solid, that I can track very easily."
She also looked at manuscript records that gave her a feel for the time period. For those, she went online in the catalog and searched "women, physics." Or "Schlesinger Library, physics." "I literally went through every single entry trying to determine if there was anything that could possibly be of use," she says.
Although Radcliffe told prospective students that they would get the same education as Harvard students because the faculty and resources were the same, Behrman says she found that the education was not equal at all. "It tended to be doctoral students and junior faculty who taught at Radcliffe," she says. "Sometimes the teachers didn't even have their PhDs and might be only two or three years older than the Radcliffe women."
In 1943, because of World War II, there weren't enough men at Harvard to justify teaching the classes separately, so some classes became coed. Behrman discovered that there was even a woman teaching physics that year. But she can find nothing about her in the physics archive. "There's just a blank," she says. She found the woman's name in the Radcliffe course catalog, but nowhere else. "I suspect she was someone's wife who had maybe taken a degree in physics," Behrman says. "I know by her name that she was married, but I'm still trying to track her down."
She found only two women who went on from Radcliffe to pursue careers in physics. Marian Butler '50 earned a master's and went into industry, where she conducted research, and Margaret Kivelson, also Class of 1950, earned her PhD at Harvard in 1957 and went into academia, where she conducted research in plasma and space physics. Kivelson is now a professor emerita of space physics at the University of California at Los Angeles.
"Radcliffe was very good at producing astronomers, because the Harvard College Observatory and its director, Harlow Shapley, provided employment," Behrman says. "It became very normal to have female astronomers, but it was still abnormal to have a female physicist."
Behrman is heartened by how far women have come since the time she's researching and writing about. She says her thesis advisor, Howard Georgi, a Harvard College Professor and a Mallinckrodt Professor of Physics, is very supportive of women in physics and has actively recruited them into the field. Although she hasn't taken any classes with Melissa Franklin, also a Mallinckrodt Professor of Physics—who held a Radcliffe Institute fellowship in 2004–2005 and subsequently became chair of the department—Behrman is well aware that Franklin was the first woman to receive tenure in physics at Harvard, in 1992. Franklin gave her access to Harvard's physics archives for her thesis research.
Behrman's own story at Harvard is cautionary. "It turns out that the best high school in math and science in Wichita, Kansas, is nowhere near as good as some of the high schools other Harvard students attended," she says. "I came here very bright-eyed and happy, saying 'I can do this, I love math and science.' Then my first couple of semesters were very difficult."
Behrman's mother, a professor of physics and math at Wichita State University, gave her a lot of support, and Behrman joined study groups, which she says tend to form along gender lines. Plus, no surprise, she worked hard. Later, as copresident of the Society of Physics Students, she helped other students understand that after about two years, everyone's preparation evens out.
Dava Sobel | A Woman's Place at the Harvard Observatory
Detail from photograph of Harvard College Observatory staff, 1918. Courtesy of Harvard University Archives
Dava Sobel / A Woman's Place at the Harvard Observatory
Thursday 4/13/17
From 4-H to Judy Chicago
William Simmons '14. Photo by Tony Rinaldo
William Simmons '14 applied for and won a Carol K. Pforzheimer Student Fellowship from the Schlesinger Library. Now he's writing an article about Eloise Saunders's passion for agriculture and community and curating a show of artist Judy Chicago's work.
Writing in Code
Florence Julie Lillibridge, high-school graduation photograph, 1937, Vermillion, South Dakota. Lillibridge collection at the Schlesinger Library
One woman's diaries, covering more than 30 years, offer an unexpected riddle.
History Comes Alive through the Archives
Laurel Thatcher Ulrich, center, talks to her class. At left, first-year student Talia Weisberg. The class takes place in the Radcliffe College Room, which was established by the Class of 1954 on the occasion of its 50th reunion.
Professor Laurel Thatcher Ulrich's class, Well-Behaved Women Seldom Make History, is "a hands-on introduction to history making in its many forms," and the Schlesinger's manuscripts and artifacts are the means.
New Research Grants to Use the Schlesinger's Collections
Photo by Kevin Grady, Radcliffe Staff Photographer
The Schlesinger Library's 2015 grant recipients include researchers investigating women's activism in STEM fields, the American labor movement, immigration reform, women oyster shuckers, the suffragist Alice Paul, and the environmental and occupational health doctor Harriet Hardy.
A Life Devoted to Inquiry: Cecily Cannan Selby '46
Cecily Cannan Selby. Photo courtesy of the Woods Hole Oceanographic Institution
Cecily Cannan Selby '46 says of her remarkable and varied career, "I had the confidence and competence in problem solving that science can give you."
Toward a Path Less Riddled
Photo by Rose Lincoln
Anthony Jack's findings on economic diversity at elite colleges have brought him national recognition and the understanding that his research could improve lives. It's a mission he plans to continue as a Shutzer Assistant Professor at Radcliffe.
The Site of My Favorite Classes
Magdalene Zier_photo by Kevin Grady, Radcliffe Staff Photographer
I am so grateful for the Schlesinger's rich collections and indebted to its generous staff for making the library the site of my favorite classes and a launching pad for individual research.
Related Collection
The Radcliffe College Archives
This collection chronicles Radcliffe College from its beginning as the Harvard Annex in 1879 through 1999, the year the Radcliffe Institute for Advanced Study was founded.
It's Complicated: 375 Years of Women at Harvard
The Radcliffe Archives at the Schlesinger Library chronicle Radcliffe College from its beginning as the Harvard Annex in 1879 through its transition to the Radcliffe Institute for Advanced Study in 1999. The Library's resources about Radcliffe College were used to create this exploration of the complicated story of women at Harvard University, and an evolution toward equality.
Schlesinger Library Newsletter, Spring 2013
Carol K. Pforzheimer Student Fellowships

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Posted on August 31, 2013 by GameCry
Warner Bros. Interactive Entertainment Launches Guardians of Middle-earthTM for PC
Warner Bros. Interactive Entertainment announces the launch of Guardians of Middle-earth for Windows PC, a multiplayer online battle arena (MOBA) game developed by Monolith Productions and brought to PC by Zombie Studios, available today through Steam and other digital retailers.
Guardians of Middle-earth for Windows PC allows gamers to team up and battle as powerful and iconic heroes from Middle-earth. Gamers will have access to 36 original Guardians, earnable through gameplay and in-game currency, to take into 10 player competitive and five player cooperative multiplayer battle arenas. Players also have access to three modes, including the Survival gameplay mode previously introduced as downloadable content (DLC), and six maps including The Shire, Goblin-town and Mirkwood. Exclusive to the PC version of the game, there are 36 alternate Guardian skins available for purchase through the Steam store. Offering a true MOBA experience, Guardians of Middle-earth for PC supports full Steamworks integration, Steam Trading Cards, Big Picture full controller compatibility and Raptr integration for live streaming matches.
In Guardians of Middle-earth for PC, player versus player (PvP) matches range from 15 to 30 minutes and gamers can decide to play against friends, other live opponents or artificial intelligence combatants in PvP, Co-Op vs. AI, Survival or Training modes. Gamers will have access to a detailed online system to track friends' victories and defeats any time through integrated stats and leaderboard systems, to connect with other players via in-game voice communication and more.
Players who have previously purchased* Guardians of Middle-earth for PlayStation®Network** or on the Xbox Live online entertainment network for the Xbox 360 games and entertainment system from Microsoft will be eligible to receive a PC download key for the base game.
No related Games.
CategoriesConsole Games, Windows PC
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University of Phoenix-Georgia is a small, private, four-year university enrolling 1,721 students and offering 28 degrees in Sandy Springs, GA.
Check out the most popular majors and specific degrees students have earned at University of Phoenix-Georgia.
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Do you have questions about furthering your education with University of Phoenix-Georgia? People are listening and are ready to help. Plus, we're pretty sure others have the same question you do!


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Praecipio Consulting joins the Aha! Partner Program
Praecipio Consulting has been selected to join the Aha! Partner Program as an inaugural partner. Recognized as the world's #1 roadmap software, Aha! serves over 5,000 companies and 400,000 users.
We are honored to join the Aha! Partner Program as an inaugural member. Our diverse clients have varying sets of requirements, but common to them all is the need for a world-class product management solution.
AUSTIN, Texas (PRWEB) November 11, 2020
The Aha! Partner Program provides customers with access to a small and highly specialized group of certified partners that includes Praecipio Consulting. As a partner, Praecipio Consulting offers a wide range of product management and development services to extend the power of Aha! products.
Partnering with an innovation thought leader and one of the most respected SaaS companies will enable Praecipio Consulting to expand its reach and build on its current portfolio of cutting-edge technology solutions. The partnership with Aha! will enable Praecipio Consulting to better serve clients and advance their businesses. As one of the first partners, the Praecipio Consulting team will benefit from the opportunity to deliver new services with close support and collaboration from the Aha! team.
"We are honored to join the Aha! Partner Program as an inaugural member. Our diverse clients have varying sets of requirements, but common to them all is the need for a world-class product management solution. Aha! is a leader in this space and is a welcome addition to our portfolio of technology solutions," says Praecipio Consulting Founder & CEO, Christian Lane.
"We are thrilled that Praecipio Consulting has joined our partner program to help customers innovate even faster and build products that customers really love. They are recognized experts in helping organizations achieve their digital transformation — by leveraging robust technologies and process frameworks like Agile, ITSM, DevOps, and ESM. We look forward to working closely together." — Brian de Haaff, Aha! co-founder and CEO.
About Praecipio Consulting
Praecipio Consulting is a leading business process and technology consulting firm based in Austin, Texas that helps organizations successfully achieve their digital transformation goals. Specializing in process frameworks, including Agile, IT Service Management (ITSM), DevOps, and Enterprise Service Management, Praecipio Consulting serves as a strategic partner to industry leaders and organizations of all sizes across various industries to optimize business processes by leveraging Atlassian's robust product suite along with other technologies. As an Atlassian Platinum Enterprise Solution Partner, Praecipio Consulting offers integrated business and technology solutions that help clients deliver a delightful customer experience, increase costs savings, and improve business performance. Since establishing an official partnership with Atlassian in 2008, Atlassian has recognized Praecipio Consulting as their Partner of the Year for five consecutive years, in addition to naming them as ITSM Partner of the Year. To learn more, visit http://www.praecipio.com.
About Aha!
Aha! is the world's #1 roadmap software. We help more than 5,000 companies and 400,000 users create strategic plans. The company was founded in 2013 by Silicon Valley veterans and product management experts Brian de Haaff and Dr. Chris Waters. Aha! is recognized as one of the fastest-growing private software companies in the U.S., an Inc. Best Workplace, and one of the top 25 most sought-after emerging companies for job seekers. The company is self-funded and profitable, with an entirely remote team. The Aha! founders codified their approach to building successful companies and pioneered a new framework for personal and business success called The Responsive Method (TRM). It is the engine that powers Aha! and is grounded in the belief that sustainable, lasting success and happiness originate in respect for and service to others. TRM and the unique history of Aha! are chronicled in the bestselling book Lovability. Learn more and start a free Aha! trial at http://www.aha.io.
Christian I. Lane
Praecipio Consulting
+1 (512) 266-8271 Ext: 100


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The Subway's the Star in BAM's Transporting Retro
by Melissa Anderson
The Incident BAMcinématek
The people ride in a hole in the ground," sing the three horny, hopped-up sailors as they ecstatically catalog the city's many marvels in "New York, New York," the opening number of Stanley Donen and Gene Kelly's On the Town (1949).
That hole, now 110 years old, receives a more expansive, warts-and-all tribute in BAMcinématek's "Retro Metro" series, a program of 13 features and three shorts that highlight the joys and terrors of subterranean travel. Spanning 1928 through 1992, these movies reveal wildly vacillating feelings about the sprawling transit system — what Randy Kennedy calls "an object of pride and fascination, fear and loathing" in the introduction to his excellent 2004 book, Subwayland, a collection of his New York Times columns recounting his adventures underground.
Sometimes mass transit is imagined as the frothiest of fantasies, re-created on Hollywood soundstages. During the lavish "I Only Have Eyes for You" musical number in Ray Enright's Dames (1934), a 1-line train is both an art deco beauty and the portal to one of choreographer Busby Berkeley's more chimerical set pieces: The face of Ruby Keeler, who's being serenaded by Dick Powell, replaces all of those in the subway ads inside their car, soon multiplying into a bazillion dancing Keeler heads. When the lovers reach the northern terminus, Powell carries his sleeping lady down the tracks, magically sidestepping the third rail. Though On the Town's "New York, New York" was famously filmed on location throughout the boroughs — shots include the trio of gobs, first-timers in the city, walking under elevated tracks and arriving on a subway platform just as a real train pulls in — the musical's most elaborate paean to public transportation occurs during the "Miss Turnstiles Ballet," pure MGM reverie.
Other titles in "Retro Metro" emphasize the subway's most practical feature — conveyance — but focus on the outsize, near-mythic gulf between point A and point B. That's especially the case when Brooklyn and Manhattan are concerned, as in Leslie Harris's Just Another Girl on the I.R.T. (1992). The titular straphanger, smart and smart-mouthed Chantel (Ariyan A. Johnson), keeps up her GPA at a Crown Heights high school and dreams of escaping the projects. She hops the 2 train to get to her job at a Zabar's-like gourmet emporium on the Upper West Side — whose residents seem to face no graver crisis than being unable to find brie with caraway seeds.
In the very first shot of John Badham's Saturday Night Fever (1977), Manhattan looms like Emerald City across the East River, the camera soon traversing part of the Verrazano–Narrows Bridge and then cutting to a B train roaring past. Below the elevated tracks, Bay Ridge's Tony Manero (John Travolta) peacocks down the street, the rumble of the subway overhead adding to the percussion of "Stayin' Alive." The entire life of the 19-year-old prince of the 2001 Odyssey disco is limited to deepest southwest Kings County, where Tony and his buddies get around solely by Cadillac Seville. Yet when he wants to abandon the parochial ways of the old neighborhood for good, Tony's initiated into manhood — or the aspirational class — by riding the rails all night: The RR (as it was known then) train transports him to the Manhattan brownstone apartment of his dance partner and fellow Brooklyn emigrant Stephanie (Karen Lynn Gorney). Making an even longer trek are the leather-vested toughs in Walter Hill's The Warriors (1979): The Coney Island gang must make a round trip from their beachfront turf in Brooklyn to the Bronx via the IND and the IRT, the progress of their below-ground voyage tracked by the frequent close-ups of Massimo Vignelli's modernist, streamlined subway map, retired the same year that Hill's movie was released.
Like nearly all those in service from the '70s through the late '80s, the subway cars in which Tony and the Warriors spend their respective wee-hour commutes are festooned with tags and other graffiti. This elaborate system of signs and symbols is admiringly explored in Tony Silver's documentary Style Wars (1983). Occasionally interspersed with some square voiceover narration — "They call themselves writers, because that's what they do" — this Koch-era chronicle features Hizzoner himself, railing against "quality-of-life offenses," and the even more indignant Detective Bernie Jacobs. Although the film gives ample time to others who see the spray-painted letters and drawings as nothing but an urban scourge — particularly the formidable mother of then-teenage graffiti artist Skeme ("You have destroyed your room!") — Style Wars clearly roots for the taggers and their cohort.
By the time Kennedy began writing, in 2000, his weekly "Tunnel Vision" column for the Times, the trains had long been scrubbed of all their florid markings. Another astute observation he makes about NYC mass transit in Subwayland, however, holds true for any year since 1904: "But like schoolchildren in detention, riders form a kind of unspoken bond while forced into each other's company — call it the kinship of the mildly oppressed." It's precisely this element, beyond its commitment to exacting technical and location detail, that makes Joseph Sargent's The Taking of Pelham One Two Three (1974) one of the best films about New York. In this masterful heist movie, a group of disparate Gotham cranks, weirdos, and hotheads, both below ground and above it, come together in the face of disaster: the inconceivable hijacking of a southbound 6 train. Made during the "Ford to City: Drop Dead" era, Pelham salutes the toughness and irascibility of not just the 17 passengers being held for $1 million in ransom money, but also the team of negotiators led by Walter Matthau's grumpy transit cop. The qualities those fictional characters exhibited 40 years ago are still the trademark of nearly anyone with a MetroCard today.
More:BAM Rose CinemasBrooklyn (New York City)Film and TVFilm ReviewsManhattanNew York CityThe Warriors
Archive Highlights
"I've never seen so much hostility in a demonstration before," King said. "And I've been all over the South."
"I'm a good novelist and I'll get better. I've found my calling and if I have my way I'll be turning out books for the next half-century, books that will blow people away. But right now all I want is to be read."
Republican Nation: The Rise
The pods that were so diligently planted are beginning to sprout.
From 'Sweet Sweetback's Baadasssss Song' in 1971 to Spike Lee's 'Malcom X' in 1992.
The White Noise Supremacists
"You don't have to try at all to be a racist. It's a little coiled clot of venom lurking there in all of us, white and black, goy and Jew, ready to strike out when we feel embattled, belittled, brutalized."
by Lester Bangs
"Jewish children in years to come may live much like my parents, with a subtle but consuming sense of dread. America could yet turn out to be not so different from the Old World my grandparents fled."


WSP has a long history of working on projects for BART, beginning in 1953 when the firm was engaged to study the need for rapid transit in the Bay Area.
The Santa Clara Valley Transportation Authority (VTA), has awarded WSP USA a contract to manage phase II of the extension of the BART (Bay Area Rapid Transit) rail system to Silicon Valley.
The 16-mile, six-station BART extension from Fremont to Santa Clara is being managed by VTA and implemented in phases.
Phase I is a 10-mile, two-station extension from Fremont to Milpitas and the Berryessa District in San Jose, for which WSP provided conceptual and preliminary engineering. Passenger service is expected to begin in 2018.
Phase II is a 6-mile, four-station extension with a 5-mile tunnel through downtown San Jose. Planning is under way with a review of project plans and an update to the state and federal environmental documents.
As the program manager for phase II of the project, WSP, in joint venture, will be responsible for conceptual design, engineering management, project controls, contracting strategies, utilities coordination, constructability reviews, value engineering, and development of procurement documents.
WSP has a long history of working on projects for BART, beginning in 1953 when the firm was engaged to study the need for rapid transit in the Bay Area. The firm in joint venture served as general engineering consultant for the original system, completed in 1974 with the opening of the BART tunnel under San Francisco Bay.
The firm has also supported most of the expansions of BART during the last three decades, including an extension of the system to San Francisco International Airport that opened in 2003. The firm recently completed an assignment as BART's owner representative for the Warm Springs extension, which brought BART to Fremont in Alameda County, near the border with Santa Clara County.


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Adoration remains reality for most churches, despite Eucharistic fast
Do you want many graces? Go and visit the Blessed Sacrament often. Do you want few graces? Visit the Blessed Sacrament rarely. Do you want none at all? Then never pay a visit to the Blessed Sacrament.
— St. John Bosco
Fr. Billy Kosco, pastor of St. Henry Parish in Buckeye, blesses a parishioner as she opens the door to her home with the Eucharist as he processes through nearby neighborhoods with a monstrance containing the Blessed Sacrament, March 22. (John Bering/CATHOLIC SUN)
With the suspension of public Masses throughout the Diocese of Phoenix, the Church has more "adoring" fans now than ever. While the faithful are unable to receive Holy Communion, one pastor brought Jesus in the Blessed Sacrament to their homes.
Fr. Billy Kosco and Fr. Ryan Lee brought the Eucharistic Lord through three neighborhoods — about a mile each — of St. Henry Parish in Buckeye March 22 via a small procession. The priests knew Catholic families lived there and told an approximate time they would be by.
"They spread the word through the grapevine and point out the homes of other parishioners who are expecting us," Fr. Kosco said. "Some people did not know we were coming but came out of their homes when they heard the bells or our singing."
If residents made the sign of the cross or kneeled, the priests stopped in front of their home and gave a benediction. At the home of a cancer-stricken parishioner, Fr. Kosco brought the Eucharist in the monstrance to the screen door and blessed the ailing wife and the husband who wasn't feeling well. A text from him later read, "Thank you for bringing Jesus to me. It lifted my spirits." He died unexpectedly the next morning.
EN ESPAÑOL: La Adoración es una realidad, a pesar del ayuno de la Eucaristía
A woman, joined by a young girl, kneels in reverence, as Fr. Billy Kosco, pastor of St. Henry Parish in Buckeye, processes through nearby neighborhoods with a monstrance containing the Blessed Sacrament, March 22. (John Bering/CATHOLIC SUN)
Fr. Billy Kosco, pastor of St. Henry Parish in Buckeye, blesses parishioners kneeling in the street with the Eucharist as he processes through nearby neighborhoods with a monstrance containing the Blessed Sacrament, March 22. (John Bering/CATHOLIC SUN)
Fr. Ryan Lee, parochial vicar of St. Henry Parish in Buckeye, blesses parishioners standing outside their house with the Eucharist as he processes through nearby neighborhoods with a monstrance containing the Blessed Sacrament, March 22, while pastor Fr. Billy Kosco incenses the monstrance. (John Bering/CATHOLIC SUN)
Fr. Ryan Lee, parochial vicar of St. Henry Parish in Buckeye, processes through nearby neighborhoods with a monstrance containing the Blessed Sacrament, March 22, accompanied by pastor Fr. Billy Kosco (front) and parishioners. The two priests led the Eucharistic Procession to bring the Presence of Christ to his flock after public Masses were suspended in the Diocese of Phoenix because of concerns related to the coronavirus. (John Bering/CATHOLIC SUN)
Fr. Billy Kosco, pastor of St. Henry Parish in Buckeye, blesses parishioners standing outside their house with the Eucharist as he processes through nearby neighborhoods with a monstrance containing the Blessed Sacrament, March 22, while parochial vicar Fr. Ryan Lee incenses the monstrance. (John Bering/CATHOLIC SUN)
Fr. Kosco knows there's a Eucharistic love embedded in the Latino culture but was still impressed with how much the procession meant to people. It was "very touching and affirming of my role in their lives and of the desire they have to be near Jesus," he said.
The concept isn't completely foreign. Several parishes hold a Corpus Christi procession around its feast day each May or June — it's a moveable feast. The faithful then walk behind the monstrance praying and singing and stop at several designated points where the Lord is briefly adored on a makeshift altar. There weren't any altars this time though, only worshippers.
"Many people came out of their homes, stopped what they were doing, and some spontaneously began to follow us and sing 'Bendito, Bendito.' It was amazing. The Church in Buckeye is strong," Fr. Kosco posted to the parish website.
A Facebook post highlighting pictures from the event garnered 384 likes, 60 comments praising the effort and 104 shares. The Phoenix Diocese shared the same pictures eliciting another 651 shares.
Fr. Billy Kosco, pastor of St. Henry Parish in Buckeye, blesses a man kneeling at a stop sign with the Eucharist as he processes through nearby neighborhoods with a monstrance containing the Blessed Sacrament, March 22. (John Bering/CATHOLIC SUN)
Of the 40 Eucharistic Adoration slots Prince of Peace Church offered in its March 15 bulletin, seven had only one or two committed adorers. Another 15 slots had three adorers committed at the Sun City West Church. Only two slots had more than five.
Days later, upwards of 20 people sought Eucharistic Adoration or private prayer at any given time. The spike, at any other time in history would be heaven-sent, but this one closed that church and its parish partner, Our Lady of Lourdes.
Temporary rules issued by the Diocese of Phoenix in response to a nationwide effort to curb the spread of the coronavirus limited gatherings to 10 people — and suspended public Masses altogether.
Even then, those 10 in private prayer were to observe "social distancing" to minimize infecting others. Creating a system of who was next in line, enforcing how long someone could pray or turning people away were not viable options. Parish leaders closed the churches instead.
A couple of parishes avoided that dilemma altogether with its Adoration approach in these days of social distancing. St. Anne in Gilbert launched a livestream of Eucharistic Adoration at stanneaz.org/adoration.
A parish in Maryland created a way for dozens to safely adore the Blessed Sacrament via a drive-in experience. Nearly 150 cars participated March 19. Parishioners remained in their vehicles but were able to adore the Lord in a monstrance outside the church.
"There's a very beautiful paradox taking place," Fr. Dan Leary told the Catholic Standard, newspaper of the Archdiocese of Washington. "There's a contradiction in people's lives in the fact that they're starting to realize what they don't have. The absence is creating a longing for presence. What God is allowing is this divine encounter of love. He's turning the hearts and eyes of the people back to Him."
Fr. Dan Leary of St. Andrew Apostle Parish in Silver Spring, Md., leads prayers for Eucharistic Adoration March 21 as parishioners remain in their cars. (Andrew Biraj/CNS, via Catholic Standard)
Meanwhile, in the Diocese of Green Bay, Bishop David L. Ricken ordered that all perpetual Adoration chapels be closed, and all public Eucharistic Adoration be suspended, effective March 20. Adoration chapels are usually small, area priests said. The bishop did ask that churches remain open for private prayer before the Blessed Sacrament in the tabernacle.
Fr. John Girotti, vicar for canonical services and associate moderator of the Curia, acknowledged that people will express concern that "at the very time we need our Eucharistic Lord the most, we're keeping people from Him. The answer to that is we are keeping the churches open."
Back in Arizona at Our Lady of Perpetual Help in Scottsdale, the first diocesan parish to offer perpetual Adoration — 33 years and counting — temporarily reduced Adoration from 6 a.m. to 6 p.m. daily. The committed adorers are still signing in, and there have been a few more drop-ins than normal the first couple of days after the suspension of public Masses.
"We're hoping we can keep it open because without the Eucharist, at least we can still have Adoration," said Cathy Giedraitis, Adoration coordinator at OLPH. She herself likens Adoration to vital relationship maintenance. "You spend time with someone you love," she said.
Catholic News Service contributed to this article.
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The Principal, Alan Clarke is a former auditor and investigator of the Revenue Commissioners and is best placed to advise on tax issues, maximise tax compliance and minimise audit risk. Alan holds a business studies degree from the Institute of Public Administration, a diploma in applied taxation from the University of Limerick and is a member of the Institute of Incorporated Public Accountants.
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text:
import django
import os
import sys

from django.conf import global_settings

abspath = lambda *p: os.path.abspath(os.path.join(*p))

DEBUG = True
TEMPLATE_DEBUG = DEBUG
SECRET_KEY = 'CHANGE_THIS_TO_SOMETHING_UNIQUE_AND_SECURE'

TEST_SOUTH = 'GUARDIAN_TEST_SOUTH' in os.environ

PROJECT_ROOT = abspath(os.path.dirname(__file__))
GUARDIAN_MODULE_PATH = abspath(PROJECT_ROOT, '..')
sys.path.insert(0, GUARDIAN_MODULE_PATH)
sys.path.insert(0, PROJECT_ROOT)

DATABASES = {
    'default': {
        'ENGINE': 'django.db.backends.sqlite3',
        'NAME': abspath(PROJECT_ROOT, '.hidden.db'),
        'TEST_NAME': ':memory:',
    },
}

INSTALLED_APPS = (
    'django.contrib.auth',
    'django.contrib.contenttypes',
    'django.contrib.sessions',
    'django.contrib.sites',
    'django.contrib.admin',
    'django.contrib.messages',
    'django.contrib.staticfiles',
    'guardian',
    'guardian.testapp',
    'posts',
    'core',
    'integration_tests',
)
if django.VERSION < (1, 3):
    INSTALLED_APPS += ('staticfiles',)
else:
    INSTALLED_APPS += ('django.contrib.staticfiles',)

if 'GUARDIAN_NO_TESTS_APP' in os.environ:
    _apps = list(INSTALLED_APPS)
    _apps.remove('guardian.testapp')
    INSTALLED_APPS = tuple(_apps)

if TEST_SOUTH:
    INSTALLED_APPS += ('south',)
if 'GRAPPELLI' in os.environ:
    try:
        __import__('grappelli')
        INSTALLED_APPS = ('grappelli',) + INSTALLED_APPS
    except ImportError:
        print("django-grappelli not installed")

try:
    import rosetta
    INSTALLED_APPS += ('rosetta',)
except ImportError:
    pass

#MIDDLEWARE_CLASSES = (
    #'django.middleware.common.CommonMiddleware',
    #'django.contrib.sessions.middleware.SessionMiddleware',
    #'django.middleware.csrf.CsrfViewMiddleware',
    #'django.contrib.auth.middleware.AuthenticationMiddleware',
    #'django.contrib.messages.middleware.MessageMiddleware',
    #'django.middleware.transaction.TransactionMiddleware',
#)

STATIC_ROOT = abspath(PROJECT_ROOT, '..', 'public', 'static')
STATIC_URL = '/static/'
STATICFILES_DIRS = [abspath(PROJECT_ROOT, 'static')]
MEDIA_ROOT = abspath(PROJECT_ROOT, 'media')
MEDIA_URL = '/media/'
ADMIN_MEDIA_PREFIX = STATIC_URL + 'grappelli/'

ROOT_URLCONF = 'example_project.urls'

TEMPLATE_CONTEXT_PROCESSORS = global_settings.TEMPLATE_CONTEXT_PROCESSORS + (
    'django.core.context_processors.request',
    'example_project.context_processors.version',
    'django.core.context_processors.static',
)
TEMPLATE_LOADERS = (
    'django.template.loaders.filesystem.Loader',
    'django.template.loaders.app_directories.Loader',
)

TEMPLATE_DIRS = (
    os.path.join(os.path.dirname(__file__), 'templates'),
)

SITE_ID = 1

USE_I18N = True
USE_L10N = True

LOGIN_REDIRECT_URL = '/'

TEST_RUNNER = 'django.test.simple.DjangoTestSuiteRunner'

AUTHENTICATION_BACKENDS = (
    'django.contrib.auth.backends.ModelBackend',
    'guardian.backends.ObjectPermissionBackend',
)

ANONYMOUS_USER_ID = -1

PASSWORD_HASHERS = (
    'django.contrib.auth.hashers.MD5PasswordHasher',
    'django.contrib.auth.hashers.SHA1PasswordHasher',
)

# Neede as some models (located at guardian/tests/models.py)
# are not migrated for tests
SOUTH_TESTS_MIGRATE = TEST_SOUTH

AUTH_USER_MODEL = 'core.CustomUser'

try:
    from conf.localsettings import *
except ImportError:
    pass

redpajama_set_name: RedPajamaGithub


Dr. Carl Stahmer holds office hours in the DSI in Davis on Tuesdays and Thursdays from 9-10am, and at the Blaisdell Medical Library in Sacramento on Fridays from 2-4pm. Dr. Stahmer provides expertise on natural language processing (NLP) and other methods of text mining. Dr. Stahmer is the DSI Associate Director for Humanities and the UC Davis Library's Director of Digital Scholarship. To request a meeting outside of office hours, see the Digital Scholars Lab.


text:
Charlotte's Best Books for September 2019
November 24, 2020 Life & Culture Reading
You've finished your stack of beach books, right? Make room on your shelf for the 5 best books of September 2019, including a celebration of fashion as pop culture, Sara and Tegan's high school memoir (their teen years were just as messy as yours) and a Nordic murder mystery that's cold, dark and creepy.
Fashion: The Definitive Visual Guide by DK Publishing.
Fashion: The Definitive Visual Guide
The Math Book: Big Ideas Simply Explained
The Chestnut Man
When you walk out the door, you're making a statement. Even if you claim you're not into fashion, what you wear tells the world who you think you are. Or want to be.
And that's why the new edition of Fashion: The Definitive Guide (DK Publishing, 2019) is a fascinating coffee table classic.
Divided into 10 Chapters, Fashion takes you on a whirlwind tour of how fashion reflects people, places and social norms from ancient Egypt through to the legendary fashion houses like Chanel, Dior and Yves St. Laurent, and contemporary cutting-edge designers like Alexander Wang and Molly Goddard.
Expert commentary puts social context to fashion turning points: when hemlines rose to reveal a shocking glimpse of stocking (1915), when jeans became a fashion statement (the '50s), who invented the pant suit (YSL, '60s) and how the red carpet became the runway (Halle Berry, 2000 Golden Globes).
Illustrated by a stunning combination of original fashion plates, archive images and commissioned photography, Fashion: The Definitive Guide offers a crash course on everything ever worn. Seriously.
The Reference section at the back is your smarty-pants fashion Coles Notes.
Illustrations and photos chronicle 3000 years of womenswear and menswear – an Ancient Greek dress fastened at the shoulders looks surprisingly on trend today, 400 years of women's shoes – Vivienne Westwood's 1993 patent leather platforms shriek Lady Gaga, 200 years of women's hats and bags – I'm not sure Fascinators should be legal, and 300 years of body shapers – the 1895 corset with a low, flat front designed to push the hips back looks very naughty.
Fashion: The Definitive Visual Guide is a stunning celebration of art and design, imagination and innovation, and the role fashion plays in shaping pop culture.
The Math Book: Big Ideas Simply Explained by DK Publishing.
Math has never been my friend. Sure, I have the basics down – add, subtract, multiply, divide, pay my bills and balance my bank account.
But I couldn't even spell Pythagoras, never mind understand his theorem – it's the relationship between the sides of a right-angled triangle, just so you know.
How do I know that? The Math Book: Big Ideas Simply Explained (DK Publishing, 2019).
Using the Big Ideas Simply Explained series' awesome combo of easy-to-understand text and imaginative graphics, The Math Book explores mathematical ideas and inventions from 6000 BCE to today, with snappy explanations, memorable quotes, playful illustrations and timeline sidebars that put context to the big events.
It's the modern math that's the most interesting, though, mostly because you don't think of the outcomes such as the Internet and AI as math based.
In 1929, Hungarian writer Frigyes Karinthy coined the phrase "six degrees of separation" setting in motion a small world experiment in 1967 and a mathematical analysis of social networks in 1979.
You have a range of connections to different people from different parts of your life, right? These connections have links to other groups of people. Further links to people who are three steps removed – a friend of a friend of a friend – and voila, we are all, on average, six steps away from each other. That's math, Facebook.
AI? Starts with something called fuzzy logic, a many-valued (fuzzy) reasoning system that allows for a range of truth values, not just the old school true or false logic. It's the fuzziness of AI that creates the illusion of self-direction when in fact AI is really the product of a pre-programmed set of values.
Have I lost you? Well, here's an example of AI at work. A humanoid robot using AI works at the front desk of a Henn-na hotel in Tokyo, apparently the world's first hotel with robotic staff. Yup – math again.
The Math Book: Big Ideas Simply Explained is a perfect gift for your tech nerdy best friend. Or math obsessed niece. Or anyone curious about the role math plays in the everyday world.
Canadian song twins Tegan & Sara pen High School.
As you already know if you're a fan – and who isn't, really – Tegan and Sara, identical twins, grew up in Calgary in the 90s – grunge, rave culture, drugs, Beverly Hills 90210. And like many of us, they struggled with who they were and who they would become as they skipped school, dropped acid, drank, grappled with their parents' divorce and generally experienced full out teenage angst.
High School, the LGBTQ icons' coming-of-age memoir, chronicles all that, from first loves and sexual awakenings to set-tos with parents to secret song writing and finally musical collaboration.
Written in alternating chapters from Tegan's point of view and then Sara's, High School captures how each of them experienced those tumultuous years. Sometimes their memories jibe and sometimes they don't, as they assert their independence from each other at the same time as they recognize their twin bond.
High School is an intimate and often uncomfortable accounting that reads like a diary – I sometimes felt like a voyeur TBH. But it serves up a rare peek into Sara and Tegan's formative years and the strength and courage they found to follow their own never-easy path to personal freedom and, of course, stardom.
You May Also Enjoy Reading…
Charlotte's Top 5 Must Reads for August
Charlotte's Top 5 Must Reads for July
Charlotte's Top 5 Must Reads for June
The Chestnut Man by Soren Sveistrup.
The debut novel from the writer behind the acclaimed Scandinavian crime series The Killing is Nordic noir at its finest – a murder mystery that's cold, dark, creepy and can't-put-down compelling.
The Chestnut Man opens on October 31, 1989. Marious Larsen, senior cop at a suburban Copenhagen police station whose wife thinks he's retiring in a week but he isn't, drives out to a remote farm to tell the owner his cows have made a break for it and the neighbours aren't happy.
What he discovers is a bloody massacre. Two teenagers and their mom have been hacked to pieces. A boy, dishevelled, and barely breathing. In the basement, a young girl, frightened but alive. And a shelf crammed with chestnut men, tiny dolls made from chestnuts and toothpicks. Then – an axe strikes his jaw.
Fast forward to October 5, present day. Detective Naia Thulin and Mark Hess, an ex-Europol investigator banished to the backwoods (we don't now why) are investigating a string of brutal murders – all women. Beaten. Tortured. Hands amputated. And a chestnut man left at each crime scene, like a calling card.
The unlikely partners suspect the murders are tied to the daughter of the Minister for Social Affairs, who vanished the year before. There's a lot of pushback from the detectives who investigated the disappearance and forced a confession out a nasty man who is doing time for the murders. Thulin and Hess don't think he did it.
The media-seeking, ladder-climbing Chief doesn't want the case reopened. Not good for his brand. But the duo press on – aided and abetted, of course, by the requisite Forensic guy -certain that unless they catch the real murderer, more deaths will follow.
The plot of The Chestnut Man is complicated. There is a huge cast and a bunch of subplots – very streaming series, actually. But because you won't be able to put it down, you'll have no trouble navigating the story till the bitter end. Which you will not see coming.
Emma Donoghue's Akin.
Emma Donoghue, award-winning author of dozens of novels and short stories including the runaway Room, is back with a tender exploration of how an old man and a young boy unpack their backstories and being to write a fresh one together.
Seventy-nine-year-old Noah Selvaggio, widower and retired university prof, has planned a trip to Nice, his first since his mother put the four-year-old on a boat to join his dad in America in 1942. She followed at the end of the war.
His granddad was a famous photographer, and his mom worked as his 24/7 assistant. When Noah's sister dies, he discovers an envelope of unusual pictures, presumably taken by his mom, of people and places in Nice.
Several days before he boards his plane a social worker calls. Could Noah make a temporary home for his 11-year-old great nephew, Michael, who he has never met? Michael's mom, Amber, is in jail for dealing (she claims she's innocent) his dad, Victor, Noah's nephew, is dead from a drug overdose and Michael's grandma, with whom he lives, has just passed.
The social worker is trying to track down Amber's sister but in the meantime, if Noah doesn't step up, Michael will become a ward of the state and be placed in care.
Against his better judgement, Noah agrees and the unlikely pair set off for Nice.
Michael is a tween from the 'hood. He knows gang members, has experienced gun violence, has seen people murdered – f*** is pretty much his favourite word, used indiscriminately as a noun, verb, adjective and adverb.
But he's also an accomplished phone photographer with a penchant for theatrical selfies and a keen eye for lighting, framing and juxtaposition. And he is, of course, a tech know-it-all.
So despite their constant bickering, Michael offers valuable support as Noah sets out to answer the questions raised by the photographs: what role did his mom play during the last years of the war? Collaborator? Or Resistance fighter.
There is a happy ending, of course, and while you see it coming, Noah and Michael are so carefully crafted, totally imperfect and wonderfully real in their rendering that you want to meet them both. And they earn their happy ending.
Written by Charlotte Empey. Illustrations produced on iPad Pro with Apple Pencil by Mark Scheibmayr.
Some of the links in this story use affiliate links. This means that if you make a purchase through our site, dobbernationLOVES will earn a small commission at no extra cost to you. Your support helps us to produce comprehensive content.
Mark Scheibmayr
Mark is a museum curator by day, Toronto based editorial and portrait illustrator by night, and devoted dog dad 24/7. An occasional writer as well, he talks art and tech.
Charlotte Empey
Charlotte's idea of a day well spent is curling up somewhere with a good book. So it's no wonder she decided on a career in magazine journalism, telling compelling stories of strength, courage and the power of the human spirit. Her motto: Every day is an adventure!
Tags: best books 2019
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text:
IWMI's work in Tajikistan featured on BBC Persian News Channel
The International Water Management Institute (IWMI) had a significant presence at the High-Level Conference on the International Decade for Action "Water for Sustainable Development," 2018-2028, which was organized jointly by the United Nations and Government of Tajikistan, and took place in the nation's capital, Dushanbe, on June 20-21. In addition to sharing perspectives through presentations and panel discussions, we placed opinion articles in diverse media, while also engaging with BBC Persian to develop a feature story on water user associations established in Tajikistan with support from the US Agency for International Development (USAID).
Why winning the 'water game' in India requires team effort
Water isn't just a natural resource; it is also a peoples' resource, shared between communities,…
Can remote sensing identify successful agricultural water management interventions in smallholder farms?
Food security in sub-Saharan African (SSA) countries hinges on smallholder farms, most of which are…
The year in review: Reflecting on a busy and productive 2021
A major highlight for IWMI in 2021 was our robust participation in the COP26 climate…


Summary: This ecological system encompasses vegetation of varying physiognomy at upper elevations, near and slightly above treeline, in the northeastern U.S. and adjacent Canada. It may be a zone between montane spruce-fir forest and alpine systems or may cover the ridgelines and summits of lower mountains. In the Appalachians it occurs mostly above 915 m (3000 feet) elevation but can be at much lower elevations near the Atlantic Coast. Trees become progressively stunted as exposure increases, with Picea rubens being replaced by Picea mariana in a stunted form. Vegetation structure ranges from woodland to shrubland to sparsely vegetated dwarf-shrubs and herbs. Woodlands may be locally extensive, and patches of open rock support areas of shrub, dwarf-shrub or sparse vegetation. In the subalpine zone, shrublands may be extensive on the upper slopes, forming krummholz or, in somewhat more protected spots, deciduous shrub thickets. Ericads, including Kalmia angustifolia, Ledum groenlandicum, and Vaccinium uliginosum, are the most characteristic shrubs; Empetrum nigrum and Empetrum eamesii ssp. atropurpureum (= Empetrum atropurpureum) are indicative of the subalpine zone. Vaccinium boreale occurs rarely but is diagnostic where it is present. Subalpine fens are included here: these are heath-dominated and graminoid-dominated fens, often occurring in a mosaic surrounded by other subalpine vegetation. They are on gentle slopes (usually about 10%), usually at 732 to 915 m (2400-3000 feet) elevation. Calamagrostis pickeringii is dominant and characteristic in the graminoid fens, with northern sedges such as Carex michauxiana, Carex wiegandii, Carex exilis, etc. The montane heath fens contain Alnus viridis ssp. crispa (= Alnus crispa), Ilex mucronata (= Nemopanthus mucronatus), and ericads. Peat accumulation is in the range of 10-50 cm. Occurrences are usually about 5 acres in size but range up to about 20 acres.
Classification Comments: This system is distinguished from Acadian-Appalachian Montane Spruce-Fir Forest (CES201.566) by the shift to woodland and patchy barrens from the forested character of the montane forest, including the decreased importance of Picea rubens. They are often contiguous on the ground. It is related to Northern Appalachian-Acadian Rocky Heath Outcrop (CES201.571) but occurs at higher elevations, lacks Pinus spp. (except for occasional stunted individuals) and Quercus rubra, and features Vaccinium uliginosum, Empetrum and other subalpine plant species that are lacking from the lower-elevation analog. Patches of Picea rubens / Vaccinium angustifolium / Sibbaldiopsis tridentata Woodland (CEGL006053) might occur in this system, but only incidentally; that association is more central to the concept of Northern Appalachian-Acadian Rocky Heath Outcrop (CES201.571). At Acadia National Park, this system could be attributed to the highest balds if Empetrum and/or Vaccinium uliginosum are present, representing a low-elevation disjunction; Northern Appalachian-Acadian Rocky Heath Outcrop (CES201.571) is the common system on Acadia's bald hills. Subalpine fens are considered a distinct system by New Hampshire Natural Heritage Program (the only state where they are currently known to occur), but because (1) there is little information currently available on them and (2) they tend to occur below treeline, they are included within this system. This could be reconsidered as more information on their landscape distribution, extent and pattern becomes available.
Global Range: This system is found on the higher summits of the northern Appalachian mountains, from northern New England and the Adirondacks into the Canadian Gaspé, extending south in scattered locations into southern New England.
Edinger, G. J., D. J. Evans, S. Gebauer, T. G. Howard, D. M. Hunt, and A. M. Olivero, editors. 2014a. Ecological communities of New York state. Second edition. A revised and expanded edition of Carol Reschke's ecological communities of New York state. New York Natural Heritage Program, New York State Department of Environmental Conservation, Albany, NY.
Gawler, S. C., and A. Cutko. 2010. Natural landscapes of Maine: A classification of vegetated natural communities and ecosystems. Maine Natural Areas Program, Department of Conservation, Augusta.
Sperduto, D. D., and C. V. Cogbill. 1999. Alpine and subalpine vegetation of the White Mountains, New Hampshire. New Hampshire Natural Heritage Inventory, Concord, NH. 25 pp. plus figures.
Sperduto, D. D., and W. F. Nichols. 2004. Natural communities of New Hampshire: A guide and classification. New Hampshire Natural Heritage Bureau, DRED Division of Forests and Lands, Concord. 242 pp.