Human disease/clinical medical sciences for dentistry in early-years dental graduates: Transition from undergraduate study to clinical practice

Introduction Dental bodies across Europe have published curricula aiming to guide the development of a graduating dentist who is safe and competent, and which also contain direction on what knowledge and understanding of patient's health, drugs and disease a recent graduate should have. Materials, Methods and Aim A questionnaire to survey Foundation Dentists in Wales regarding their undergraduate teaching and assessment in human disease/clinical medical science for dentistry and how this translates to their knowledge, attitudes and confidence in the dental management of patients who may have chronic disease or disability. Results A 97% response rate to the questionnaire from Foundation Dentists graduating from schools across the UK showed that the large majority felt their teaching and learning in human disease/clinical medical science for dentistry was appropriately delivered and assessed, and that they were well prepared for independent dental practice and to plan and safely manage treatments for all their patients. Discussion This survey of newly qualified dentists representing graduates from different types of dental courses and both newer and long‐established schools across the UK reports the foundation dentists felt that they are competent and safe to care for all patients, including those with complex medical histories. Conclusions The foundation dentists surveyed have completed dental undergraduate courses containing the appropriate education and assessment for human health and disease, such that they are prepared to manage their patient population safely, and are well placed to serve their patients as the population continues to age and the amount of medical morbidity increases

Understanding the Stigma and Feasibility of Opening a Safe Injection Facility in Baltimore City: A Qualitative Case Study

Supervised injection facilities (SIFs) are medically supervised facilities designed to provide a hygienic environment in which drug users can consume illicit drugs intravenously. SIFs can be cost saving, help to reduce transmission of disease, and decrease drug overdoses. There are no SIFs in the United States. In this study we used a multiple case study design to understand the stigma surrounding the use of a SIF and the feasibility of implementing the drug prevention strategy in Baltimore City by comparing experiences with opening a SIF in Sydney, Australia. We interviewed one healthcare worker at the Sydney SIF and ten community stakeholders in Baltimore City. Interviewees were asked about community stigma of SIFs, drug use, and feasibility of opening a SIF in Baltimore City. Six overarching themes were established including lack of trust, lack of public education, fear of police, concern about efficacy of harm reduction programs, drug user stigma, and concerns about implementation. Findings suggest that stigma surrounding drug use and drug users is the most important aspect in shaping the participant\u27s varied perceptions of SIFs. Participants believed that for any change to occur, there must be multi-tiered collaboration at the level of government, healthcare, community, and law enforcement

Evolutionary history of the Nesophontidae, the last unplaced Recent mammal family

The mammalian evolutionary tree has lost several major clades through recent human-caused extinctions. This process of historical biodiversity loss has particularly affected tropical island regions such as the Caribbean, an area of great evolutionary diversification but poor molecular preservation. The most enigmatic of the recently extinct endemic Caribbean mammals are the Nesophontidae, a family of morphologically plesiomorphic lipotyphlan insectivores with no consensus on their evolutionary affinities, and which constitute the only major recent mammal clade to lack any molecular information on their phylogenetic placement. Here, we use a palaeogenomic approach to place Nesophontidae within the phylogeny of recent Lipotyphla. We recovered the near-complete mitochondrial genome and sequences for 17 nuclear genes from a ∼750-year-old Hispaniolan Nesophontes specimen, and identify a divergence from their closest living relatives, the Solenodontidae, more than 40 million years ago. Nesophontidae is thus an older distinct lineage than many extant mammalian orders, highlighting not only the role of island systems as “museums” of diversity that preserve ancient lineages, but also the major human-caused loss of evolutionary history

Performance characteristics of five triage tools for major incidents involving traumatic injuries to children

Context Triage tools are an essential component of the emergency response to a major incident. Although fortunately rare, mass casualty incidents involving children are possible which mandate reliable triage tools to determine the priority of treatment. Objective To determine the performance characteristics of five major incident triage tools amongst paediatric casualties who have sustained traumatic injuries. Design, setting, participants Retrospective observational cohort study using data from 31,292 patients aged less than 16 years who sustained a traumatic injury. Data were obtained from the UK Trauma Audit and Research Network (TARN) database. Interventions Statistical evaluation of five triage tools (JumpSTART, START, CareFlight, Paediatric Triage Tape/Sieve and Triage Sort) to predict death or severe traumatic injury (injury severity score >15). Main outcome measures Performance characteristics of triage tools (sensitivity, specificity and level of agreement between triage tools) to identify patients at high risk of death or severe injury. Results Of the 31,292 cases, 1029 died (3.3%), 6842 (21.9%) had major trauma (defined by an injury severity score >15) and 14,711 (47%) were aged 8 years or younger. There was variation in the performance accuracy of the tools to predict major trauma or death (sensitivities ranging between 36.4 and 96.2%; specificities 66.0–89.8%). Performance characteristics varied with the age of the child. CareFlight had the best overall performance at predicting death, with the following sensitivity and specificity (95% CI) respectively: 95.3% (93.8–96.8) and 80.4% (80.0–80.9). JumpSTART was superior for the triaging of children under 8 years; sensitivity and specificity (95% CI) respectively: 86.3% (83.1–89.5) and 84.8% (84.2–85.5). The triage tools were generally better at identifying patients who would die than those with non-fatal severe injury. Conclusion This statistical evaluation has demonstrated variability in the accuracy of triage tools at predicting outcomes for children who sustain traumatic injuries. No single tool performed consistently well across all evaluated scenarios

Tachyon Condensation on Noncommutative Torus

We discuss noncommutative solitons on a noncommutative torus and their application to tachyon condensation. In the large B limit, they can be exactly described by the Powers-Rieffel projection operators known in the mathematical literature. The resulting soliton spectrum is consistent with T-duality and is surprisingly interesting. It is shown that an instability arises for any D-branes, leading to the decay into many smaller D-branes. This phenomenon is the consequence of the fact that K-homology for type II von Neumann factor is labeled by R.Comment: LaTeX, 17 pages, 1 figur

Rapid size change associated with intra-island evolutionary radiation in extinct Caribbean "island-shrews"

Background: The Caribbean offers a unique opportunity to study evolutionary dynamics in insular mammals. However, the recent extinction of most Caribbean non-volant mammals has obstructed evolutionary studies, and poor DNA preservation associated with tropical environments means that very few ancient DNA sequences are available for extinct vertebrates known from the region’s Holocene subfossil record. The endemic Caribbean eulipotyphlan family Nesophontidae (“island-shrews”) became extinct ~ 500 years ago, and the taxonomic validity of many Nesophontes species and their wider evolutionary dynamics remain unclear. Here we use both morphometric and palaeogenomic methods to clarify the status and evolutionary history of Nesophontes species from Hispaniola, the second-largest Caribbean island. Results: Principal component analysis of 65 Nesophontes mandibles from late Quaternary fossil sites across Hispaniola identified three non-overlapping morphometric clusters, providing statistical support for the existence of three sizedifferentiated Hispaniolan Nesophontes species. We were also able to extract and sequence ancient DNA from a ~ 750-yearold specimen of Nesophontes zamicrus, the smallest non-volant Caribbean mammal, including a whole-mitochondrial genome and partial nuclear genes. Nesophontes paramicrus (39-47 g) and N. zamicrus (~ 10 g) diverged recently during the Middle Pleistocene (mean estimated divergence = 0.699 Ma), comparable to the youngest species splits in Eulipotyphla and other mammal groups. Pairwise genetic distance values for N. paramicrus and N. zamicrus based on mitochondrial and nuclear genes are low, but fall within the range of comparative pairwise data for extant eulipotyphlan species-pairs. Conclusions: Our combined morphometric and palaeogenomic analyses provide evidence for multiple co-occurring species and rapid body size evolution in Hispaniolan Nesophontes, in contrast to patterns of genetic and morphometric differentiation seen in Hispaniola’s extant non-volant land mammals. Different components of Hispaniola’s mammal fauna have therefore exhibited drastically different rates of morphological evolution. Morphological evolution in Nesophontes is also rapid compared to patterns across the Eulipotyphla, and our study provides an important new example of rapid body size change in a small-bodied insular vertebrate lineage. The Caribbean was a hotspot for evolutionary diversification as well as preserving ancient biodiversity, and studying the surviving representatives of its mammal fauna is insufficient to reveal the evolutionary patterns and processes that generated regional diversity

Systems approach to the improvement of engine warm-up behaviour

Modifications to the coolant and oil circuits of a modern production 2.4 l diesel engine have been made in an attempt to promote oil warm-up to reduce fuel consumption. The new system used oil to cool exhaust gas recirculation (EGR) gases and incorporates a number of coolant flow control valves to reduce heat loss during warm-up. The engine was run over cold-start New European Drive Cycles with various flow strategies as a screening exercise to understand the behaviour of the system. Fuel consumption benefits of up to 4 per cent were observed, but these were accompanied by 3 per cent increases in nitrogen oxide (NO x) emissions. Detailed analysis of the coolant flows and temperatures showed that, when throttling the flow, the mass of coolant in the degas bottle and radiator could be isolated from the system during warm-up, essentially reducing the thermal inertia. Heat transfer directly to the oil from the EGR gases rather than via the coolant allowed more heat to be put into the oil, with engine oil supply temperatures up to 6 °C hotter; however, it was not possible to verify that the oil was hotter at the bearings, valve train, and cylinder liner. The engine strategy was seen to react to the faster warm-up and to retard injection timing, reducing NO x but also compromising overall fuel consumption benefits. Further tests were conducted with various injection timings to establish a NO x—fuel consumption trade-off to demonstrate further benefits when the engine strategy is included in the operation of novel thermal management systems. </jats:p

Altered visual processing in a rodent model of Attention-Deficit Hyperactivity Disorder

A central component of Attention-Deficit Hyperactivity Disorder (ADHD) is increased distractibility, which is linked to the superior colliculus (SC) in a range of species, including humans. Furthermore, there is now mounting evidence of altered collicular functioning in ADHD and it is proposed that a hyper-responsive SC could mediate the main symptoms of ADHD, including distractibility. In the present study we have provided a systematic characterization of the SC in the most commonly used and well-validated animal model of ADHD, the spontaneously hypertensive rat (SHR). We examined collicular-dependent orienting behavior, local field potential (LFP) and multiunit responses to visual stimuli in the anesthetized rat and morphological measures in the SHR in comparison to the Wistar Kyoto (WKY) and Wistar (WIS). We found that SHRs remain responsive to a repeated visual stimulus for more presentations than control strains and have a longer response duration. In addition, LFP and multiunit activity within the visually responsive superficial layers of the SC showed the SHR to have a hyper-responsive SC relative to control strains, which could not be explained by altered functioning of the retinocollicular pathway. Finally, examination of collicular volume, neuron and glia densities and glia:neuron ratio revealed that the SHR had a reduced ratio relative to the WKY which could explain the increased responsiveness. In conclusion, this study demonstrates strain-specific changes in the functioning and structure of the SC in the SHR, providing convergent evidence that the SC might be dysfunctional in ADHD