The perceptions of undertaking a higher degree alongside orthodontic speciality training: a cross-sectional survey of British Orthodontic Society members

Introduction: In the UK, orthodontic speciality training takes place over three years full-time. In addition to the clinical training, there is an expectation that trainees undertake a higher degree. Currently, there is little evidence regarding the impact of undertaking a higher degree on specialist orthodontists. Aims: Investigate UK orthodontists' perceptions of undertaking a higher degree alongside speciality training. Materials and methods: A cross-sectional research study involving the distribution of an anonymous, descriptive, online, questionnaire-based survey between May and June 2021 via the British Orthodontic Society. Data were obtained in relation to the impact of undertaking a higher degree on the completion of speciality training, research skills, delivery of patient care and career opportunities. Results: In total, 166 questionnaires were completed (approximately 13.3% response rate). Most respondents 'agreed' or 'strongly agreed' that undertaking a higher degree had improved their scientific (77.1%) and critical appraisal skills (80.7%), job prospects (60.2%) and career opportunities (63.9%). Most respondents felt the benefits of the higher degree outweighed the associated costs (65.1%) and was a worthwhile component of training (69.3%). Conclusions: Specialist orthodontists place a high value on undertaking a higher degree. The results of this questionnaire should be of importance to stakeholders involved in the development of the orthodontic curriculum

Later Age at Onset of Independent Walking Is Associated with Lower Bone Strength at Fracture-Prone Sites in Older Men

Later age at onset of independent walking is associated with lower leg bone strength in childhood and adolescence. However it is unknown whether these associations persist into older age, or whether they are evident at axial (central) or upper limb sites. Therefore we examined walking age obtained at 2y and bone outcomes obtained by dual-energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT) scans at 60-64y in a nationally-representative cohort study of British people, the MRC National Survey of Health and Development. It was hypothesised that later walking age would be associated with lower bone strength at all sites. Later independent walking age was associated with lower height-adjusted hip (standardised regression coefficients with 95%CI) [-0.179(-0.251,-0.107)], spine [-0.157(-0.232,-0.082)] and distal radius [-0.159(-0.245,-0.073)] bone mineral content (BMC, indicating bone compressive strength) in men (all P < 0.001). Adjustment for covariates partially attenuated these associations, primarily due to lower lean mass and adolescent sporting ability in later walkers. These associations were also evident for a number of hip geometric parameters (including cross-sectional moment of inertia (CSMI), indicating bone bending/torsional strength) assessed by Hip Structural Analysis (HSA) from DXA scans. Similar height-adjusted associations were also observed in women for several hip, spine and upper limb outcomes, although adjustment for fat or lean mass led to complete attenuation for most outcomes, with the exception of femoral shaft CSMI and spine bone area (BA). In conclusion, later independent walking age appears to have a lifelong association with bone strength across multiple skeletal sites in men. These effects may result from direct effects of early life loading on bone growth, and mediation by adult body composition. Results suggest that late walking age may represent a novel risk factor for subsequent low bone strength. Existing interventions effective in hastening walking age may have positive effects on bone across life

A pragmatic harm reduction approach to manage a large outbreak of wound botulism in people who inject drugs, Scotland 2015

Abstract Background People who inject drugs (PWID) are at an increased risk of wound botulism, a potentially fatal acute paralytic illness. During the first 6 months of 2015, a large outbreak of wound botulism was confirmed among PWID in Scotland, which resulted in the largest outbreak in Europe to date. Methods A multidisciplinary Incident Management Team (IMT) was convened to conduct an outbreak investigation, which consisted of enhanced surveillance of cases in order to characterise risk factors and identify potential sources of infection. Results Between the 24th of December 2014 and the 30th of May 2015, a total of 40 cases were reported across six regions in Scotland. The majority of the cases were male, over 30 and residents in Glasgow. All epidemiological evidence suggested a contaminated batch of heroin or cutting agent as the source of the outbreak. There are significant challenges associated with managing an outbreak among PWID, given their vulnerability and complex addiction needs. Thus, a pragmatic harm reduction approach was adopted which focused on reducing the risk of infection for those who continued to inject and limited consequences for those who got infected. Conclusions The management of this outbreak highlighted the importance and need for pragmatic harm reduction interventions which support the addiction needs of PWID during an outbreak of spore-forming bacteria. Given the scale of this outbreak, the experimental learning gained during this and similar outbreaks involving spore-forming bacteria in the UK was collated into national guidance to improve the management and investigation of future outbreaks among PWID

Current Welfare Problems Facing Horses in Great Britain as Identified by Equine Stakeholders

Despite growing concerns about the welfare of horses in Great Britain (GB) there has been little surveillance of the welfare status of the horse population. Consequently we have limited knowledge of the range of welfare problems experienced by horses in GB and the situations in which poor welfare occurs. Thirty-one in-depth interviews were conducted with a cross -section of equine stakeholders, in order to explore their perceptions of the welfare problems faced by horses in GB. Welfare problems relating to health, management and riding and training were identified, including horses being under or over weight, stabling 24 hours a day and the inappropriate use of training aids. The interviewees also discussed broader contexts in which they perceived that welfare was compromised. The most commonly discussed context was where horses are kept in unsuitable environments, for example environments with poor grazing. The racing industry and travellers horses were identified as areas of the industry where horse welfare was particularly vulnerable to compromise. Lack of knowledge and financial constraints were perceived to be the root cause of poor welfare by many interviewees. The findings give insight into the range of welfare problems that may be faced by horses in GB, the contexts in which these may occur and their possible causes. Many of the problems identified by the interviewees have undergone limited scientific investigation pointing to areas where further research is likely to be necessary for welfare improvement. The large number of issues identified suggests that some form of prioritisation may be necessary to target research and resources effectively

Barriers to transformative adaptation: Responses to flood risk in Ireland

Barriers to climate change adaptation have received increased attention in recent years as researchers and policymakers attempt to understand their complex and interdependent nature and identify strategies for overcoming them. To date however, there is a paucity of research on barriers to transformative adaptation. Using two case studies of flood risk management from Ireland we identify and characterize barriers to transformative adaptation. Qualitative semi-structured interviews were conducted with key stakeholders connected to proposed transformative strategies in Skibbereen, County Cork and Clontarf, County Dublin. Across both case studies, where transformative strategies failed to materialize, we highlight three significant barriers that impede transformation including: (i) social and cultural values, particularly place attachment and identity; (ii) institutional reliance on technical expertise which fails to look beyond traditional technocratic approaches and; (iii) institutional regulatory practices. Findings illustrate that where social or institutional barriers emerge, transformation may more likely succeed through a series of incremental changes. This research has practical implications for future adaptation planning as facilitating transformation through incrementalism requires flexible adaptation strategies that are responsive to changing social values over time. While focused on flood risk management, our findings have applicability for other sectors adapting to climate change

"It's a can of worms": understanding primary care practitioners' behaviours in relation to HPV using the Theoretical Domains Framework

Background: The relationship between infection with high-risk human papillomavirus (HPV) and cervical cancer is transforming cervical cancer prevention. HPV tests and vaccinations have recently become available. In Ireland, as elsewhere, primary care practitioners play a key role in prevention. ATHENS (A Trial of HPV Education and Support) aims to develop a theorybased intervention to support primary care practitioners in their HPV-related practice. This study, the first step in the intervention development process, aimed to: identify HPV-related clinical behaviours that the intervention will target; clarify general practitioners’ (GPs’) and practice nurses’ roles and responsibilities; and determine factors that potentially influence clinical behaviour. A secondary objective was to informally assess the utility of the Theoretical Domains Framework (TDF) in understanding clinical behaviours in an area with an evolving evidence-base. Methods: In-depth semi-structured telephone interviews were conducted with GPs and practice nurses. The topic guide, which contained open questions and HPV-related clinical scenarios, was developed through literature review and clinical experience. Interview transcripts were content-analysed using the TDF as the coding framework. Results: 19 GPs and 14 practice nurses were interviewed. The major HPV-related clinical behaviours were: initiating a discussion about HPV infection with female patients; offering/recommending HPV vaccination to appropriate patients; and answering patients’ questions about HPV testing. While the responsibility for taking smears was considered a female role, both male and female practitioners dealt with HPV-related issues. All 12 theoretical domains arose in relation to HPV infection; the domains judged to be most important were: knowledge, emotion, social influences, beliefs about capabilities and beliefs about consequences. Eleven domains emerged in relation to HPV vaccination, with beliefs about consequences, social influences, knowledge and environmental context and resources judged to be the most important. Nine domains were relevant to HPV testing, with knowledge and beliefs about capabilities judged to be the most important. Conclusions: The findings confirm the need for an intervention to support primary care practitioners around HPV and suggest it should target a range of theoretical domains. The TDF proved valuable in analysing qualitative data collected using a topic guide not specifically designed to capture TDF domains and understanding clinical behaviours in an area with an evolving evidence-base

Accreting Protoplanets in the LkCa 15 Transition Disk

Exoplanet detections have revolutionized astronomy, offering new insights into solar system architecture and planet demographics. While nearly 1900 exoplanets have now been discovered and confirmed, none are still in the process of formation. Transition discs, protoplanetary disks with inner clearings best explained by the influence of accreting planets, are natural laboratories for the study of planet formation. Some transition discs show evidence for the presence of young planets in the form of disc asymmetries or infrared sources detected within their clearings, as in the case of LkCa 15. Attempts to observe directly signatures of accretion onto protoplanets have hitherto proven unsuccessful. Here we report adaptive optics observations of LkCa 15 that probe within the disc clearing. With accurate source positions over multiple epochs spanning 2009 - 2015, we infer the presence of multiple companions on Keplerian orbits. We directly detect H{\alpha} emission from the innermost companion, LkCa 15 b, evincing hot (~10,000 K) gas falling deep into the potential well of an accreting protoplanet.Comment: 35 pages, 3 figures, 1 table, 9 extended data item

Prediction of preterm birth with and without preeclampsia using mid-pregnancy immune and growth-related molecular factors and maternal characteristics.

OBJECTIVE:To evaluate if mid-pregnancy immune and growth-related molecular factors predict preterm birth (PTB) with and without (±) preeclampsia. STUDY DESIGN:Included were 400 women with singleton deliveries in California in 2009-2010 (200 PTB and 200 term) divided into training and testing samples at a 2:1 ratio. Sixty-three markers were tested in 15-20 serum samples using multiplex technology. Linear discriminate analysis was used to create a discriminate function. Model performance was assessed using area under the receiver operating characteristic curve (AUC). RESULTS:Twenty-five serum biomarkers along with maternal age &lt;34 years and poverty status identified &gt;80% of women with PTB ± preeclampsia with best performance in women with preterm preeclampsia (AUC = 0.889, 95% confidence interval (0.822-0.959) training; 0.883 (0.804-0.963) testing). CONCLUSION:Together with maternal age and poverty status, mid-pregnancy immune and growth factors reliably identified most women who went on to have a PTB ± preeclampsia

Gene expression and matrix turnover in overused and damaged tendons

Chronic, painful conditions affecting tendons, frequently known as tendinopathy, are very common types of sporting injury. The tendon extracellular matrix is substantially altered in tendinopathy, and these changes are thought to precede and underlie the clinical condition. The tendon cell response to repeated minor injuries or “overuse” is thought to be a major factor in the development of tendinopathy. Changes in matrix turnover may also be effected by the cellular response to physical load, altering the balance of matrix turnover and changing the structure and composition of the tendon. Matrix turnover is relatively high in tendons exposed to high mechanical demands, such as the supraspinatus and Achilles, and this is thought to represent either a repair or tissue maintenance function. Metalloproteinases are a large family of enzymes capable of degrading all of the tendon matrix components, and these are thought to play a major role in the degradation of matrix during development, adaptation and repair. It is proposed that some metalloproteinase enzymes are required for the health of the tendon, and others may be damaging, leading to degeneration of the tissue. Further research is required to investigate how these enzyme activities are regulated in tendon and altered in tendinopathy. A profile of all the metalloproteinases expressed and active in healthy and degenerate tendon is required and may lead to the development of new drug therapies for these common and debilitating sports injuries