Medicine and Health Sciences Commons^™

Comparison Of Automated Ribotyping, Spa Typing, And Mlst In 108 Clinical Isolates Of Staphylococcus Aureus From Orthopedic Infections, Stefano Ravaioli, Davide Campoccia, Werner Ruppitsch, Franz Allerberger, Alessandro Poggi, Emanuele Chisari, Lucio Montanaro, Carla Renata Arciola

Rothman Institute Papers

108 isolates of Staphylococcus aureus, belonging to six large ribogroups according to the automated Ribo-Printer® system, were studied with two highly used molecular methods for epidemiological studies, namely multi-locus sequence typing (MLST) and spa typing, followed by BURP and eBURST v3 analysis for clustering spa types and sequence (ST) types. The aim was to evaluate whether automated ribotyping could be considered a useful screening tool for identifying S. aureus genetic lineages with respect to spa typing and MLST. Clarifying the relationship of riboprinting with these typing methods and establishing whether ribogroups fit single clonal complexes were two main objectives. …

Intouch January 31, 2022, New York Medical College

InTouch

• 26th Annual MSRF to Take Place Virtually February 3
• NYMC and TCUS Host 17th COVID-19 Symposium
• Sima Vazquez, SOM Class of 2024, Faces Adversity with Positivity
• Meghan Work, M.P.H., Ph.D., Brings Years of Epidemiology Experience to the SHSP
• The Office of Public Safety Is Committed to Keeping NYMC Safe and Secure

The Impact Of Three-Dimensional Visualisation On Midwifery Student Learning, Compared With Traditional Education For Teaching The Third Stage Of Labour: A Pilot Randomised Controlled Trial, Michelle Gray, Terri Downer, Donna Hartz, Patrea Andersen, Julie Hanson, Yu Gao

Research outputs 2022 to 2026

Background: Complex physiological processes are often difficult for midwifery students to comprehend when using traditional teaching and learning approaches. Face to face instructional workshops using simulation have had some impact on improving understanding. However, in the 21st century new technologies offer the opportunity to provide alternative learning approaches.

Aim: To investigate the impact of using three-dimensional (3D) visualisation in midwifery education on student's experience of learning, and retention of knowledge at three points in time.

Design: A pilot study involving a two-armed parallel Randomised Controlled Trial (RCT) comparing the retention of knowledge scores between the control and intervention groups.

Setting: …

Repurposing Metformin And Antifolates For The Treatment Of Hepatocellular Carcinoma, Sherouk Mohamed Tawfik

Theses and Dissertations

Hepatocellular carcinoma (HCC), one of the most prevalent types of cancers worldwide, continues to maintain high levels of resistance to standard therapy. As clinical data revealed poor response rates, the need for developing new methods has increased to improve the overall wellbeing of patients with HCC. Due to its safety, wide availability and previously reported anti-cancer effects, metformin (MET) serves to be a possible therapeutic agent when combined with other well-known anti-cancer agents. The aim of this study was to investigate the potential anti-cancer effects of MET, an anti-diabetic agent, when combined with two antifolate drugs: trimethoprim (TMP) or methotrexate …

A Predictive Model For Geographical Location Using Microbiome Composition And Covid-19 Based Analysis, Ahmed Adel Aboushanab

Theses and Dissertations

The human microbiome is a main contributor for the health and welfare of the human body. It is affected by many factors like diet and hygiene. These factors differ between different populations. Testing the population-microbiome differences using healthy samples from different countries is the first objective of this study. This data was then used in training and testing machine learning models (Random Forest and L2-logistic Regression Classifiers) for the prediction of the geographical location based on the microbiome data. Random Forest Classifier had the highest accuracy. Feature importance analysis showed that the data for Proteobacteria, Actinobacteria, and Bacteroidetes improved the …

Selective Gsk3Β Inhibition Mediates An Nrf2-Independent Anti-Inflammatory Microglial Response, Mohamed H. Yousef

Theses and Dissertations

Glycogen Synthase Kinase 3 (GSK3) is associated with the proinflammatory phenotype of microglia and has been shown to act in concert with Nuclear factor kappa B (NF-κB). . GSK3 is also a suppressor of Nuclear factor erythroid 2-related factor 2 (Nrf2), the principal regulator of redox homeostasis. Agreeing with the oxidative paradigm of aging, Nrf2 is often deregulated in parainflammatory and neurodegenerative diseases. In this study, we aimed to explore a multimodal disease-modifying utility of GSK3 inhibition, beyond neuronal proteopathologies, Furthermore, we aimed to underscore the difference in therapeutic value between the two GSK3 paralogs by isoform-selective chemical inhibition.

The …

It’S About Lyme: Why Congress Must Enact Medical Insurance Coverage Laws For Lyme Disease Patients Now, Jennifer Barrett

Seattle University Law Review Online

The Centers for Disease Control and Prevention (CDC) estimates approximately 476,000 people are diagnosed with Lyme disease in the United States each year. While many will recover with a short course of antibiotics, up to 35% will suffer from persistent symptoms after initial treatment. Despite scientific evidence showing the infection can persist long after initial treatment, most insurance companies restrict access to treatment beyond twenty-eight days, leaving patients to bear much of the financial burden. To limit crippling out-of-pocket expenses, Congress must enact legislation mandating coverage for the treatment of clinically diagnosed Lyme disease and co-infections based on the International …

Gene-Gene Interaction Of Ahrwith And Within The Wntcascade Affects Susceptibility To Lung Cancer, Albert Rosenberger, Nils Muttray, Rayjean J Hung, David C Christiani, Neil E Caporaso, Geoffrey Liu, Stig E Bojesen, Loic Le Marchand, Demetrios Albanes, Melinda C Aldrich, Adonina Tardon, Guillermo Fernández-Tardón, Gad Rennert, John K Field, Michael P A Davies, Triantafillos Liloglou, Lambertus A Kiemeney, Philip Lazarus, Bernadette Wendel, Aage Haugen, Shanbeh Zienolddiny, Stephen Lam, Matthew B Schabath, Angeline S Andrew, Eric J Duell, Susanne M Arnold, Gary E Goodman, Chu Chen, Jennifer A Doherty, Fiona Taylor, Angela Cox, Penella J Woll, Angela Risch, Thomas R Muley, Mikael Johansson, Paul Brennan, Maria Teresa Landi, Sanjay S Shete, Christopher I Amos, Heike Bickeböller, Integral-Ilcco Consortium

Faculty, Staff and Student Publications

Background: Aberrant Wnt signalling, regulating cell development and stemness, influences the development of many cancer types. The Aryl hydrocarbon receptor (AhR) mediates tumorigenesis of environmental pollutants. Complex interaction patterns of genes assigned to AhR/Wnt-signalling were recently associated with lung cancer susceptibility.

Aim: To assess the association and predictive ability of AhR/Wnt-genes with lung cancer in cases and controls of European descent.

Methods: Odds ratios (OR) were estimated for genomic variants assigned to the Wnt agonist and the antagonistic genes DKK2, DKK3, DKK4, FRZB, SFRP4 and Axin2. Logistic regression models with variable selection were trained, validated and tested to predict lung …

Determining The Role Of Dendritic Cells During Response To Treatment With Paclitaxel/Anti-Tim-3, Alycia Gardner

USF Tampa Graduate Theses and Dissertations

Intratumoral CD103+ dendritic cells (cDC1) are required for anti-tumor immune responses. In tumors that are poorly responsive to immunotherapeutic approaches targeting T cells, targeting cDC1 represents an alternative approach that may be useful in improving patient response rates. As such, it is critical to understand cDC1 function within tumors, and what may be preventing optimal function of cDC1. TIM-3 is a receptor that is highly expressed by cDC1 in murine and human mammary tumors, and TIM-3 blocking antibodies are currently being evaluated in clinical trials for a number of solid and hematological malignancies. In order to best design combinatorial therapeutic …

Identifying The Metabolic Signatures Of Ppard-Overexpressing Gastric Tumors, Shivanand Pudakalakatti, Mark Titus, José S Enriquez, Sumankalai Ramachandran, Niki M Zacharias, Imad Shureiqi, Yi Liu, James C Yao, Xiangsheng Zuo, Pratip K Bhattacharya

Faculty, Staff and Student Publications

Peroxisome proliferator-activated receptor delta (PPARD) is a nuclear receptor known to play an essential role in regulation of cell metabolism, cell proliferation, inflammation, and tumorigenesis in normal and cancer cells. Recently, we found that a newly generated villin-PPARD mouse model, in which PPARD is overexpressed in villin-positive gastric progenitor cells, demonstrated spontaneous development of large, invasive gastric tumors as the mice aged. However, the role of PPARD in regulation of downstream metabolism in normal gastric and tumor cells is elusive. The aim of the present study was to find PPARD-regulated downstream metabolic changes and to determine the potential significance of …

Increases In Integrin-Ilk-Rictor-Akt Proteins, Muscle Mass, And Strength After Eccentric Cycling Training, Georgios Mavropalias, Yu-Fu Wu, Marni D. Boppart, Anthony J. Blazevich, Kazunori Nosaka

Research outputs 2022 to 2026

Purpose: Recently, it has been suggested that a cellular pathway composed of integrin, integrin-linked kinase (ILK), rapamycin-insensitive companion of mTOR (RICTOR), and Akt may facilitate long-term structural and functional adaptations associated with exercise, independent of the mTORC1 pathway. Therefore, we examined changes in integrin-ILK-RICTOR-Akt protein in vastus lateralis (VL) before and after 8 wk of eccentric cycling training (ECC), which was expected to increase muscle function and VL cross-sectional area (CSA).

Methods: Eleven men (23 ± 4 yr) completed 24 sessions of ECC with progressive increases in intensity and duration, resulting in a twofold increase in work from the first …

The Use Of Theory In Qualitative Research: Challenges, Development Of A Framework And Exemplar, Thi Ngoc Minh Nguyen, Lisa Whitehead, Gordana Dermody, Rosemary Saunders

Research outputs 2022 to 2026

Background: Whilst theoretical grounding is considered important for sound research methodology, consensus on the application of theory in qualitative research remains elusive. Novice researchers may experience challenges in applying theory in qualitative research and these may contribute to the under-use, over-reliance or inappropriate application of theory. Practical guidance on how theory can inform and guide the conduct of qualitative research is needed.

Purpose: The purpose of this paper was to propose a framework for the application of theory in qualitative research and provide an exemplar.

Methods: The Theoretical Application Framework for Qualitative Studies (TAF-QS) was developed from the synthesis of …

2022-01-30_Michiganoverview_Covidsymptoms, Michigan Department Of Health & Human Services

Michigan COVID-19 Syndromic Surveillance System Data

The Syndromic Surveillance System Data report was obtained from Michigan's COVID-19 dashboard, from under the link "​Coronavirus Symptoms": https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated three times a week on Mondays, Wednesdays and Fridays.

Syndromic Surveillance System data is obtained from approximately 216 facilities participating in syndromic surveillance (139 Emergency Departments (ED), 77 Urgent Cares) across the State of Michigan. The reporting is based on individuals who present at EDs and may not be representative of the overall population. The coronavirus-like symptoms query searches visit free-text (chief complaint, …

Genetic Interaction Between Mfrp And Adipor1 Mutations Affect Retinal Disease Phenotypes, Navdeep Gogna, Sonia Weatherly, Fuxin Zhao, Gayle B. Collin, Jai Pinkney, Lisa Stone, Juergen K. Naggert, Gregory W. Carter, Patsy M. Nishina

Faculty Research 2022

Adipor1^tm1Dgen and Mfrp^rd6 mutant mice share similar eye disease characteristics. Previously, studies established a functional relationship of ADIPOR1 and MFRP proteins in maintaining retinal lipidome homeostasis and visual function. However, the independent and/or interactive contribution of both genes to similar disease phenotypes, including fundus spots, decreased axial length, and photoreceptor degeneration has yet to be examined. We performed a gene-interaction study where homozygous Adipor1^tm1Dgen and Mfrp^rd6 mice were bred together and the resulting doubly heterozygous F1 offspring were intercrossed to produce 210 F2 progeny. Four-month-old mice from all nine genotypic combinations obtained in the F2 generation …

Aducanumab, A Novel Anti-Amyloid Monoclonal Antibody, For The Treatment Of Alzheimer’S Disease: A Comprehensive Review, Hannah W. Haddad, Garett W. Malone, Nicholas J. Comardelle, Arielle E. Degueure, Adam M. Kaye, Alan David Kaye

School of Pharmacy Faculty Articles

Alzheimer’s disease (AD) is the most common form of dementia affecting millions of individuals, including family members who often take on the role as caregiver. This debilitating disease reportedly consumes 8% of the total United States healthcare expenditure, with medical and nursing outlays accounting for an estimated $290 billion. Cholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists have historically been the most widely used pharmacologic therapies for patients with AD, however, these drugs are not curative. This review discusses the epidemiology, pathophysiology, risk factors, presentation, and current treatment of AD followed by the role of the novel monoclonal antibody, aducanumab, in treatment …

Oxytocin, A Novel Treatment For Methamphetamine Use Disorder, Amber N. Edinoff, Elliot Thompson, Chandler E. Merriman, Mark R. Alvarez, E. Saunders Alpaugh, Elyse M. Cornett, Kevin S. Murnane, Rachel L. Kozinn, Mila Shah-Bruce, Adam M. Kaye, Alan David Kaye

School of Pharmacy Faculty Articles

The treatment of substance abuse with oxytocin is a novel approach to a challenging public health issue that continues to contribute to a growing economic cost for societies worldwide. Methamphetamine addiction is one of the leading causes of mortality worldwide, and despite advances in understanding the neurobiology of methamphetamine addiction, treatment options are limited. There are no medications that the Food and Drug Administration currently approves for stimulant use disorder. Off-label use of therapies for stimulant misuse include antidepressants, anxiolytics, and milder stimulants as replacement agents. Due to the shortcomings of these attempts to treat a complicated psychiatric disorder, recent …

Evaluation Of Step-Down Oral Antibiotic Therapy For Uncomplicated Streptococcal Bloodstream Infections On Clinical Outcomes, Amy Y. Kang, Richard Beuttler, Emi Minejima

Pharmacy Faculty Articles and Research

Background: Despite the severity and frequency of streptococcal bloodstream infections (BSIs), the effectiveness of oral definitive therapy remains unknown. The objective of this study was to evaluate the clinical outcomes of step-down oral antibiotics for the treatment of uncomplicated streptococcal BSIs.

Methods: In this retrospective cohort study, adult patients admitted with uncomplicated streptococcal BSI between June 2015 and June 2017 were included. Patients were excluded if they received <48 h of antibiotic therapy; therapy was started >48 h after first positive culture; had complicated infections of endocarditis, bone and joint infections, or central nervous system infections; Pitt bacteremia score (PBS) ⩾ 4; or failed to respond …

The Impact Of Physical Distancing Health Policy In Reducing Covid-19 Incidence In The World In 2020: Literature Review Study, Nunik Nurbaiti, Dumilah Ayuningtyas

Journal of Indonesian Health Policy and Administration

To reduce and slow the spread of COVID-19, many countries in the world have adopted physical distancing health policy, which have never happened before. This study aims to get an overview of the impact of physical distancing health policy to reduce of COVID-19 incidence in the world at 2020. The research design used was a descriptive qualitative with a narrative literature review method, while the research source came from international journal channels Google Scholar, ProQuest, PubMed, Science Direct, and Scopus with search data for the past five years. The approach used is the input, process, and output (IPO). From the …

Role Of Accreditation To The Performance Of Non Communicable Diseases (Ncd’S) Control Program And Control In Accredited And Non Accredited Primary Health Care In Cimahi District, Nurkarti Azni, Ede Surya Darmawan

Journal of Indonesian Health Policy and Administration

The Non-Communicable Disease (NCD’s) Prevention and Control Program is one of the essential Community Health Efforts implemented by the Puskesmas. Puskesmas accreditation is a form of program to maintain the quality and form of standardization to Puskesmas services in order to provide quality services. This research uses qualitative method, conducted in April-May 2018, aim to see improvement of performance at puskesmas especially at NCD’s Prevention and Control Program. Result of research, in general Output of program of implementation of NCD’s at Puskesmas accredited better than Puskesmas not yet accredited. Community-based partnership and funding activities have not been implemented, Iva test …

Supervision Of Traditional Medicines Containing Undeclared Substance: Analysis Of Indonesian Fda Monitoring Data For 2012 - 2021, Widha Dianasari, Mardiati Nadjib

Journal of Indonesian Health Policy and Administration

Background: At a time when people believe in the efficacy and minimal risk of traditional medicines, government agencies that oversee traditional medicines often find chemicals that are intentionally added to traditional medicines. The purpose of this study is to present the findings of Undeclared Substance that have been added to traditional medicines for ten years, to analyze their relevance to the real situation related to diseases or health problems in Indonesia, and to examine the violations of related policies. Methods: This study used an observational design based on quantitative and qualitative data and analyzed descriptively. Quantitative data based on Traditional …

Policy On The Use Of Social Media In Hospitals In Building Communication During The Covid-19 Pandemic: Literature Review, Rita Kumalasari, Wahyu Sulistiadi

Journal of Indonesian Health Policy and Administration

Social media is necessary for almost everyone, including in health services. During the COVID-19 pandemic, social media was widely used to build hospital communications. However, the benefits come with risks, as communication spreads so quickly. A proper policy is needed. This study aims to determine the benefits of social media in building communication in hospitals and the policies that govern it. The method used is a literature study. A literature search, through Science Direct, ProQuest, Google Scholar, and other databases (Google scholar, NIH/NLM, JMIH), with the keywords "social media" AND "communication" AND “policy” AND "hospital" AND "COVID-19 Pandemic", obtained 520 …

Extreme Longevity: Analysis Of The Direct Or Indirect Influence Of Environmental Factors On Old, Nonagenarians, And Centenarians In Cilento, Italy, Silvana Mirella Aliberti, Francesco De Caro, Richard H W Funk, Luigi Schiavo, Joseph S. Gonnella, Giovanni Boccia, Mario Capunzo

Department of Medicine Faculty Papers

Longevity is rightly considered one of the greatest achievements of modern society, an achievement understood as the possibility of increasing the healthy part of life and not only its full duration. This study investigated the phenomenon of regional longevity in Cilento by analyzing the association between longevity indicators and some environmental factors, in order to understand if factors such as altitude, climate, UNESCO protected areas, and hinterland can directly or indirectly influence the measure of healthy living and lead to longevity. Demographic and environmental data were collected through the Archives of the Cilento municipalities, the National Institute of Statistics, the …

The Effect Of Silver Versus Titanium Dioxide Nanoparticles On Poly Methylmethacrylate Denture Base Material, Dina Mohamed Moustafa, Yasmine Galaleldin Thabet, Sara Fikry El-Shafei

Dentistry

Three groups of heat cured acrylic resin specimens were prepared; the first was Group C made of conventional heat cured acrylic resin, the second group was Group Ag where the acrylic resin specimens were incorporated with 5% Silver nanoparticles, and the third group Ti had its specimens incorporated with 5% Titanium oxide nanoparticles. The specimens were tested for microbial colonization using direct culture and serial dilution methods. The specimens were then further tested for surface roughness.

(#Womeninddw) Persistent Speaker Gender Gap At The Premier Digestive Disease Event, Zubair Khan, Rabia Rukhshan, Asmeen Bhatt, Sushovan Guha, Srinivas Ramireddy, Prithvi Patil, Ricardo Badillo, Roy Tomas Davee, Nirav Thosani

Faculty, Staff and Student Publications

BACKGROUND: Over the last few decades, advances have been made regarding gender equality starting from medical students to trainees, to leadership in academics. The female representation in specialty academic conferences not only reflects the existing gender disparities in that specialty but also can influence young female trainees to join that field. Digestive Disease Week (DDW) is the premier digestive disease event. We aimed to calculate the proportion of female representation among speakers and moderators at the DDW meetings held from 2018 to 2020.

METHODS: The data for DDW 2018-2020 were collected via the online web-based planner. The gender of speakers …

Social Distancing Policy As A Means Of Improving Public Awareness During Covid-19 Pandemic: A Literature Review, Ulfa Oktaviani, Helen Andriani

Journal of Indonesian Health Policy and Administration

To reduce COVID-19 transmission during the epidemic, most countries implemented a social distancing policy. However, without the people's compliance, this implementation will be useless. The combination of individual and environmental variables is critical to the success of initiating and maintaining health behaviors. The purpose of this study is to assess public participation toward obedience social distancing policy as a means of improving public awareness during COVID-19 pandemic. A literature review was used in this research. PubMed, Google Scholar, and ProQuest, with a cut-off date of 29 June 2021, were used to do an electronic search with no language constraints. There …

Physical Activity Level And Stroke Risk In Us Population: A Matched Case-Control Study Of 102,578 Individuals, Sherief Ghozy, Ahmad Helmy Zayan, Amr Ehab El-Qushayri, Kate Elizabeth Parker, Joseph Varney, Kevin M. Kallmes, Sara Morsy, Alzhraa Salah Abbas, Jose Danilo B Diestro, Ameer E. Hassan

School of Medicine Publications

Background: Stroke has been linked to a lack of physical activity; however, the extent of the association between inactive lifestyles and stroke risk has yet to be characterized across large populations.

Purpose: This study aimed to explore the association between activity-related behaviors and stroke incidence.

Methods: Data from 1999 to 2018 waves of the concurrent cross-sectional National Health and Nutrition Examination Survey (NHANES) were extracted. We analyzed participants characteristics and outcomes for all participants with data on whether they had a stroke or not and assessed how different forms of physical activity affect the incidence of disease.

Results: Of the …

Quality Of Care Assessment For Small And Sick Newborns And Young Infants In Pakistan: Findings From A Cross-Sectional Study, Nousheen Pradhan, Sumera Aziz Ali, Sana Roujani, Ammarah Ali, Syed Shujaat Hussain, Samia Rizwan, Shabina Ariff, Sarah Saleem, Sameen Siddiqi

Community Health Sciences

Introduction: Pakistan is facing a challenging situation in terms of high newborn mortality rate. Securing pregnancy and delivery care may not bring a substantial reduction in neonatal mortality, unless coupled with the provision of quality inpatient care for small and sick newborns and young infants (NYIs). We undertook this study to assess the availability and quality of newborn care services provided and the readiness of inpatient care for NYIs in Pakistan.
Methods: We conducted a cross-sectional study across Pakistan from February to June 2019, using a purposive sample of 61% (23) of the 38 sick newborn care units at public …

Antiplatelet Use In Ischemic Stroke, Marharyta Kamarova, Sheharyar Baig, Hamish Patel, Kimberley Monks, Mohammad Wasay, Ali Ali, Jessica Redgrave, Arshad Majid, Simon M. Bell

Section of Neurology

Objective: A literature review of antiplatelet agents for primary and secondary stroke prevention, including mechanism of action, cost, and reasons for lack of benefit.
Data sources: Articles were gathered from MEDLINE, Cochrane Reviews, and PubMed databases (1980-2021). Abstracts from scientific meetings were considered. Search terms included ischemic stroke, aspirin, clopidogrel, dipyridamole, ticagrelor, cilostazol, prasugrel, glycoprotein IIb/IIIa inhibitors.
Study selection and data extraction: English-language original and review articles were evaluated. Guidelines from multiple countries were reviewed. Articles were evaluated independently by 2 authors.
Data synthesis: An abundance of evidence supports aspirin and clopidogrel use for secondary stroke prevention. In the acute …

Burnout: Exploring The Differences Between U.S. And International Medical Graduates., Joan E St Onge, Heidi Allespach, Yvonne Diaz, Alexandria Poitier, Leonardo Tamariz, Charles Paidas, Ana Palacio

Department of Surgery Faculty Papers

Background: International medical graduates (IMGs) have less burnout than U. S. medical school graduates (USMGs) during residency training. This study evaluates possible correlates of differences in burnout rates between USMGs and IMGs.

Methods: We surveyed 375 first-year residents at orientation in June/July 2017. We assessed burnout using the Copenhagen Burnout Inventory (CBI) and used validated scales to measure stress, quality of life (QoL), mastery, and spirituality. We collected data on gender, place of graduation, language fluency, and specialty. We compared CBI scores between USMGs and IMGs, performed a multivariate linear regression analysis of relationships between covariates and CBI subscales, and …

Perspectives Of Orthodontists Of The Diagnosis, Prevention, And Management Of White Spot Lesions: A Qualitative Study, Salwa Taibah, Neamat Hassan Abubakr Hassan, Hassan Ziada

Dental Medicine Faculty Research

Aims: Several factors influence the development of white spot lesions (WSLs), and one of these is fixed orthodontic appliances. This study aims to evaluate the awareness, preventive strategies, and management of WSLs among a group of Orthodontists. Materials and Methods: A qualitative methodology was applied; four focus groups made up a purposive sample from Orthodontists with various training backgrounds while working within the same healthcare services. Results: Three main themes emerged: awareness and ability to diagnose WSLs, perceived influences on the development of WSLs, and prevention and management strategies and barriers to care delivery. All focus groups agreed that there …