How do dentists understand evidence and adopt it in practice?

Although there is now a large evidence-based dentistry literature, previous investigators have shown that dentists often consider research evidence irrelevant to their practice. To understand why this is the case, we conducted a qualitative study. Objective: Our aim was to identify how dentists define evidence and how they adopt it in practice. Methods: A qualitative study using grounded theory methodology was conducted. Ten dentists working in eight dental practices were interviewed about their experience and work processes while adopting evidence-based preventive care. Analysis involved transcript coding, detailed memo writing, and data interpretation. Results: Findings revealed that dentists’ direct observations – referred to as clinical evidence – provided the most tangible and trusted evidence in practice and during discussions with colleagues. Dentists described a detailed process used to gather, compare and implement clinical evidence. This process began when they were exposed to novelty in daily practice and proceeded through self-driven testing, producing clinical or tangible evidence that clinicians could use in practice. Conclusion: Based on these findings, we propose an alternative to the linear form of knowledge transfer commonly represented in the literature.National Health and Medical Research Council Project Grant 63271

Glucose transporter Glut-1 is detectable in pen-necrotic regions in many human tumor types but not normal tissues: Study using tissue microarrays

The hypoxic tumor microenvironment is associated with malignant progression and poor treatment response. The glucose transporter Glut-1 is a prognostic factor and putative hypoxia marker. So far, studies of Glut-1 in cancer have utilised conventional immunohistochemical analysis in a series of individual biopsy or surgical specimens. Tissue microarrays, however, provide a rapid, inexpensive means of profiling biomarker expression. To evaluate hypoxia markers, tissue cores must show architectural features of hypoxia, i.e. viable tissue surrounding necrotic regions. Glut-1 may be a useful biomarker to validate tissue microarrays for use in studies of hypoxia-regulated genes in cancer. In this study, we carried out immunohistochemical detection of Glut-1 protein in many tumor and normal tissue types in a range of tissue microarrays. Glut-1 was frequently found in peri-necrotic regions, occurring in 9/34 lymphomas, 6/12 melanomas, and 5/16 glioblastomas; and in 43/54 lung, 22/84 colon, and 23/60 ovarian tumors. Expression was rare in breast (6/40) and prostate (1/57) tumors, and in normal tissue, was restricted to spleen, tongue and CNS endothelium. In conclusion, tissue microarrays enable the observation of Glut-1 expression in peri-necrotic regions, which may be linked to hypoxia, and reflect previous studies showing differential Glut-1 expression across tumor types and non malignant tissue

Experiences of dental care: what do patients value?

Background Dentistry in Australia combines business and health care service, that is, the majority of patients pay money for tangible dental procedures such as fluoride applications, dental radiographs, dental fillings, crowns, and dentures among others. There is evidence that patients question dentists’ behaviours and attitudes during a dental visit when those highly technical procedures are performed. However, little is known about how patients’ experience dental care as a whole. This paper illustrates the findings from a qualitative study recently undertaken in general dental practice in Australia. It focuses on patients’ experiences of dental care, particularly on the relationship between patients and dentists during the provision of preventive care and advice in general dental practices. Methods Seventeen patients were interviewed. Data analysis consisted of transcript coding, detailed memo writing, and data interpretation. Results Patients described their experiences when visiting dental practices with and without a structured preventive approach in place, together with the historical, biological, financial, psychosocial and habitual dimensions of their experience. Potential barriers that could hinder preventive activities as well as facilitators for prevention were also described. The offer of preventive dental care and advice was an amazing revelation for this group of patients as they realized that dentists could practice dentistry without having to “drill and fill” their teeth. All patients, regardless of the practice they came from or their level of clinical risk of developing dental caries, valued having a caring dentist who respected them and listened to their concerns without “blaming” them for their oral health status. These patients complied with and supported the preventive care options because they were being “treated as a person not as a patient” by their dentists. Patients valued dentists who made them aware of existing preventive options, educated them about how to maintain a healthy mouth and teeth, and supported and reassured them frequently during visits. Conclusions Patients valued having a supportive and caring dentist and a dedicated dental team. The experience of having a dedicated, supportive and caring dentist helped patients to take control of their own oral health. These dentists and dental teams produced profound changes in not just the oral health care routines of patients, but in the way patients thought about their own oral health and the role of dental professionals. Keywords: Qualitative research; Dentist-patient relationship; Preventio

How do dentists and their teams incorporate evidence about preventive care? An empirical study

Objectives: To identify how dentists and their teams adopt evidence-based preventive care. Methods: A qualitative study using grounded theory methodology was conducted. We interviewed 23 participants working in eight dental practices about their experience and work processes, while adopting evidence-based preventive care. During the study, Charmaz’s grounded theory methodology was employed to examine the social process of adopting preventive dental care in dental practices. Charmaz’s iteration of the constant comparative method was used during the data analysis. This involved coding of interview transcripts, detailed memo-writing and drawing diagrams. The transcripts were analysed as soon as possible after each round of interviews in each dental practice. Coding was conducted primarily by AS, supported by team meetings and discussions when researchers compared their interpretations. Results: Participants engaged in a slow process of adapting evidence-based protocols and guidelines to the existing logistics of the practices. This process was influenced by practical, philosophical, and historical aspects of dental care, and a range of barriers and facilitators. In particular, dentists spoke spontaneously about two deeply held ‘rules’ underpinning continued restorative treatment, which acted as barriers to provide preventive care: (i) dentists believed that some patients were too ‘unreliable’ to benefit from prevention; and (ii) dentists believed that patients thought that only tangible restorative treatment offered ‘value for money’. During the adaptation process, some dentists and teams transitioned from their initial state – selling restorative care – through an intermediary stage – learning by doing and educating patients about the importance of preventive care – and finally to a stage where they were offering patients more than just restorative care. Resources were needed for the adaptation process to occur, including: the ability to maintain the financial viability of the practice, appropriate technology, time, and supportive dental team relationships. Conclusions: The findings from this study show that with considerable effort, motivation and coordination, it is possible for dental practices to work against the dental ‘mainstream’ and implement prevention as their clinical norm. This study has shown that dental practice is not purely scientific, but it includes cultural, social, and economic resources that interfere with the provision of preventive care.NHMRC Project Grant 63271

Southern North Sea storm surge event of 5 December 2013: Water levels, waves and coastal impacts

The storm surge event that affected the coastal margins of the southern North Sea on 5–6 December 2013 produced the highest still water levels on record at several tide gauges on the UK east coast. On east-facing coasts south of the Humber estuary and north-facing Norfolk, water levels were higher than in the twentieth century benchmark surge event of 31 January–1 February 1953. Maximum significant wave heights were highest off the North Norfolk coast (peak Hs = 3.8 m offshore, 2.9 m inshore) and lowest off the Suffolk coast (Hs = 1.5–1.8 m inshore); comparable offshore wave heights in 1953 were 7–8 m and ca. 3 m. The lower wave heights, and their short duration, in 2013 explain both localised breaching, overtopping, and back-barrier flooding associated with gravel ridges and relatively low earthen banks as well as the lack of failure in more highly-engineered coastal defences. On barrier coasts and within estuaries, the signal of maximum runup was highly variable, reflecting the modification of the tide–surge–wave signal by inshore bathymetry and the presence of a range of coastal ecosystems. The landscape impacts of the December 2013 surge included the notching of soft rock cliffs and cliffline retreat; erosion of coastal dunes; and the augmentation or re-activation of barrier island washover deposits. Whilst surge event-related cliff retreat on the rapidly eroding cliffs of the Suffolk coast lay within the natural variability in inter-annual rates of retreat, the impact of the surge on upper beach/sand dune margins produced a pulse of shoreline translation landwards equivalent to about 10 years of ‘normal’ shoreline retreat. The study of east coast surges over the last 60 years, and the identification of significant phases of landscape change — such as periods of rapid soft rock cliff retreat and the formation of new gravel washovers on barrier islands — points to the importance of high water levels being accompanied by high wave activity. Future developments in early warning systems and evacuation planning require information on the variable impacts of such extreme events.This paper is a contribution to NERC BESS Consortium grant A hierarchical approach to the examination of the relationship between biodiversity and ecosystem service flows across coastal margins (grant reference NE/J015423/1). Table 5 incorporates information gathered as part of an EU FP7 Collaborative Project Resilience-Increasing Strategies for Coasts — toolkit (RISC_KIT).This is the final published version. It first appeared at http://www.sciencedirect.com/science/article/pii/S0012825215000628#

Same-sex sexual behaviour as a dominance display

Same-sex sexual behaviour (SSB) is widespread across taxa. One adaptive hypothesis to explain the occurrence and maintenance of SSB is that it acts to intensify or diminish aggression by providing males with a means to reinforce or resolve dominance. However, evidence for this hypothesis is very limited across taxa and the possibility that SSB acts as an extension of intrasexual competition remains contentious. We investigated the role of SSB in intensifying or diminishing aggression in the broad-horned flour beetle, Gnatocerus cornutus. We tested the hypothesis that SSB is an extension of male-male competition by observing how the occurrence of SSB and the stability of SSB courtship roles (i.e. whether males switched between mounting and being mounted) influenced levels of aggression within pairs. We found that, typically, males rapidly establish fixed SSB roles and moreover that the occurrence of SSB and the stability of SSB roles had a highly significant effect on levels of aggression observed within pairs. Pairs in which one male consistently mounted the other showed significantly lower levels of aggression than pairs in which neither male exhibited SSB or in which males continuously switched SSB roles and attempted to mount each other. Furthermore, males that were consistently on the receiving end of SSB demonstrated lower propensity to court females and had a lower mating success than active males. This pattern was analogous to that found in loser males as a result of fighting. Males that lost fights also courted less and had lower mating success than males that won fights. Our findings provide the first empirical support for the hypothesis that SSB is an extension of male-male competition. Furthermore, our results suggest that SSB may act as a display, allowing males to resolve dominance hierarchies without escalating into an injurious fight

The impact of COVID‐19 in Dravet syndrome: A UK survey

OBJECTIVES: To understand the risks, impact and outcome of COVID-19 in people affected by Dravet Syndrome (DS). MATERIALS AND METHODS: An anonymous cross-sectional online survey was conducted between June 17 and July 13, 2020, addressed to families of people with DS. RESULTS: A total of 116 responses were collected, from families of children (n = 86; 74%) and adults (30; 26%) with DS. The majority (106; 91%) were shielded at the family home during lockdown. Symptoms compatible with COVID-19 were reported in 22 (19%) individuals. Only four individuals with symptoms had a PCR swab test, none of which was positive. Only one symptomatic person had antibody testing (but not swab testing), which was positive. One person had repeatedly positive swab tests whilst in hospital for renal failure, but had no typical symptoms of COVID-19. In 50% of people with DS who developed possible or probable COVID-19 symptoms, seizure worsening was reported, in terms of increased seizure frequency or duration or both. Medical attention was required in 9/22 (41%), all of whom were children. CONCLUSIONS: In this cohort of people with DS, we observed an infection rate, determined by compatible symptoms, of 19%, with no deaths and benign outcome in most cases despite the underlying complex epilepsy although children often required medical attention. Early adoption of preventative measures, including testing of symptomatic individuals, regular surveillance for people living in residential care facilities, and shielding of individuals with comorbidities increasing the risk of severe outcome, may limit the impact of COVID-19

Effects of an Active Lifestyle on Water Balance

Water is the most abundant chemical constituent of the human body, typically making up approximately two thirds of body mass, but body water content is maintained within relatively narrow limits by a number of regulatory mechanisms. Both a reduction (hypohydration) and increase (hyperhydration) in body water may, if sufficiently severe, lead to adverse health and performance consequences. Active lifestyles, warm climates, and high altitude, as well as some infectious illnesses, increase the likelihood of becoming hypohydrated due to an increase in water loss. Moderate reductions in body water result in changes in cardiovascular system function as well as altering cognitive function and mood. A significant number of elite athletes, recreational exercisers and those with active occupations begin their daily activities in a hypohydrated state and incur large sweat losses during periods of activity, and thus risk negative effects on physiological function. Sweat rate and fluid intake during physical exertion are highly variable between individuals suggesting that an individual hydration strategy may be necessary to avoid significant levels of hypohydration. Rehydration after the completion of physical activity may also be necessary to avoid starting further bouts of activity in a hypohydrated state. Undertaking physical activity in a hypohydrated state appears to increase an individual’s perceived exertion which may negatively influence exercise performance and self-selected exercise intensity, and may decrease the likelihood of further participation in physical activity. This is, therefore, an important consideration for public health as well as competitive sportspeople, be they elite or otherwise. Certain populations, such as the elderly, are more likely to become hypohydrated which may lead to other illnesses and contribute to morbidity and mortality