Improving the quality of caries prevention

Introduction: Dental caries has long been a significant child health issue in Scotland. Significant advances have been made in recent years in tackling this issue. However, as dental caries has become less endemic to the population as a whole, it is now increasingly concentrated within a high risk segment. There are a number of effective preventive interventions that can be targeted to those at higher risk. Clinical guidelines recommend the practice of assessing an individual’s caries risk and implementing an appropriate prevention plan. Unfortunately, the translation of clinical guidelines to routine clinical practice is inconsistent throughout healthcare; including dentistry. This inconsistency results in patient receiving suboptimal care and in some cases irreversible harm. This inconsistency of practice is increasingly being identified as an unnecessary cost to the healthcare services, potentially causing patients to receiving suboptimal care and potentially irreversible harm. Therefore, efforts are being targeted at interventions that improve the consistent translation of best evidence to routine practice. Aims and Objectives Primary Aim – To improve the documentation of a caries risk assessment (CRA) for all patients attending the department of paediatric dentistry by application of a systems based approach to quality improvement methods. Secondary Aim – To investigate the impact of these quality improvement efforts on the subsequent delivery of preventive care. Materials and Methods This work was carried out with the department of Paediatric dentistry at Glasgow Dental Hospital and School over a 25 month period. Improvement of CRA was driven by the Plan-Do-Study-Act improvement method and was termed the Caries Assessment Risk Evaluation (CARE) project. This was monitored and guided by the use of a run chart, with data provided by random sampling of 5 case notes on a weekly basis. The impact that this improvement was having on preventive care delivery was monitored during the project by undertaking two retrospective surveys. These compared preventive care received by patients who did have a completed CARE tool with those who did not. At the end of the study a retrospective survey was carried out comparing the preventive care received by a random sample of patients prior to any improvement work (2007) with a random sample once the improvement work was well established (2010). Results Over the 25 months of the study there was a significant variability in the monitoring of CRA completion. In the first months of the project performance shifted to around 40%, whilst by the end of this project a shift in performance to around 80% was detected. A notable difference in the consistency of performance of completion of a CRA by the different staff groups (p &#60; 0.001) and clinics (p = 0.04) within the department was detected. A clear impact on performance was seen when systems of working were disrupted by environmental constraints. The two surveys of preventive care received by the patients who did have a completed CARE tool in comparison to those who did not, consistently found that those patients with a completed CARE tool had more documented preventive care delivered. The 2007 versus 2010 audit found that CRA (p < 0.001), radiographs (p = 0.004), oral hygiene instruction (p < 0.001), fluoride varnish (p < 0.001), toothpaste strength (p < 0.001) and diet advice (p < 0.001) had all significantly improved following the implementation of the project. Conclusions This study found that improvement in oral health care is possible by applying a systems based approach to ensure translation of best evidence into routine practice. The greatest consistency in improvement was achieved when new processes could be integrated that complemented current working practice. The challenge remains to develop such complementary systems that are suitable for the wide variety of clinical situations that present in daily practice. The evidence from this study supports the hypothesis that improving CRA compliance leads to an improvement in documented delivery of other preventive interventions

A comparison in a youth population between those with and without a history of concussion using biomechanical reconstruction

OBJECTIVE: Concussion is a common topic of research as a result of the short- and long-term effects it can have on the affected individual. Of particular interest is whether previous concussions can lead to a biomechanical susceptibility, or vulnerability, to incurring further head injuries, particularly for youth populations. The purpose of this research was to compare the impact biomechanics of a concussive event in terms of acceleration and brain strains of 2 groups of youths: those who had incurred a previous concussion and those who had not. It was hypothesized that the youths with a history of concussion would have lower-magnitude biomechanical impact measures than those who had never suffered a previous concussion. METHODS: Youths who had suffered a concussion were recruited from emergency departments across Canada. This pool of patients was then separated into 2 categories based on their history of concussion: those who had incurred 1 or more previous concussions, and those who had never suffered a concussion. The impact event that resulted in the brain injury was reconstructed biomechanically using computational, physical, and finite element modeling techniques. The output of the events was measured in biomechanical parameters such as energy, force, acceleration, and brain tissue strain to determine if those patients who had a previous concussion sustained a brain injury at lower magnitudes than those who had no previously reported concussion. RESULTS: The results demonstrated that there was no biomechanical variable that could distinguish between the concussion groups with a history of concussion versus no history of concussion. CONCLUSIONS: The results suggest that there is no measureable biomechanical vulnerability to head impact related to a history of concussions in this youth population. This may be a reflection of the long time between the previous concussion and the one reconstructed in the laboratory, where such a long period has been associated with recovery from injury

‘Genome design’ model and multicellular complexity: golden middle

Human tissue-specific genes were reported to be longer than housekeeping genes (both in coding and intronic parts). The competing neutralist and adaptationist models were proposed to explain this observation. Here I show that in human genome the longest are genes with the intermediate expression pattern. From the standpoint of information theory, the regulation of such genes should be most complex. In the genomewide context, they are found here to have the higher informational load on all available levels: from participation in protein interaction networks, pathways and modules reflected in Gene Ontology categories through transcription factor regulatory sets and protein functional domains to amino acid tuples (words) in encoded proteins and nucleotide tuples in introns and promoter regions. Thus, the intermediately expressed genes have the higher functional and regulatory complexity that is reflected in their greater length (which is consistent with the ‘genome design’ model). The dichotomy of housekeeping versus tissue-specific entities is more pronounced on the modular level than on the molecular level. There are much lesser intermediate-specific modules (modules overrepresented in the intermediately expressed genes) than housekeeping or tissue-specific modules (normalized to gene number). The dichotomy of housekeeping versus tissue-specific genes and modules in multicellular organisms is probably caused by the burden of regulatory complexity acted on the intermediately expressed genes

Deciphering the demographic history of allochronic differentiation in the pine processionary moth <i>Thaumetopoea pityocampa</i>

International audienceUnderstanding the processes of adaptive divergence, which may ultimately lead to speciation, is a major question in evolutionary biology. Allochronic differentiation refers to a particular situation where gene flow is primarily impeded by temporal isolation between early and late reproducers. This process has been suggested to occur in a large array of organisms, even though it is still overlooked in the literature. We here focused on a well-documented case of incipient allochronic speciation in the winter pine processionary moth Thaumetopoea pityocampa. This species typically reproduces in summer and larval development occurs throughout autumn and winter. A unique, phenologically shifted population (SP) was discovered in 1997 in Portugal. It was proved to be strongly differentiated from the sympatric "winter population" (WP), but its evolutionary history could only now be explored. We took advantage of the recent assembly of a draft genome and of the development of pan-genomic RAD-seq markers to decipher the demographic history of the differentiating populations and develop genome scans of adaptive differentiation. We showed that the SP diverged relatively recently, that is, few hundred years ago, and went through two successive bottlenecks followed by population size expansions, while the sympatric WP is currently experiencing a population decline. We identified outlier SNPs that were mapped onto the genome, but none were associated with the phenological shift or with subsequent adaptations. The strong genetic drift that occurred along the SP lineage certainly challenged our capacity to reveal functionally important loci

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Signatures of Selection for Environmental Adaptation and Zebu × Taurine Hybrid Fitness in East African Shorthorn Zebu

The East African Shorthorn Zebu (EASZ) cattle are ancient hybrid between Asian zebu × African taurine cattle preferred by local farmers due to their adaptability to the African environment. The genetic controls of these adaptabilities are not clearly understood yet. Here, we genotyped 92 EASZ samples from Kenya (KEASZ) with more than 770,000 SNPs and sequenced the genome of a pool of 10 KEASZ. We observe an even admixed autosomal zebu × taurine genomic structure in the population. A total of 101 and 165 candidate regions of positive selection, based on genome-wide SNP analyses (meta-SS, Rsb, iHS, and ΔAF) and pooled heterozygosity (Hp) full genome sequence analysis, are identified, in which 35 regions are shared between them. A total of 142 functional variants, one novel, have been detected within these regions, in which 30 and 26 were classified as of zebu and African taurine origins, respectively. High density genome-wide SNP analysis of zebu × taurine admixed cattle populations from Uganda and Nigeria show that 25 of these regions are shared between KEASZ and Uganda cattle, and seven regions are shared across the KEASZ, Uganda, and Nigeria cattle. The identification of common candidate regions allows us to fine map 18 regions. These regions intersect with genes and QTL associated with reproduction and environmental stress (e.g., immunity and heat stress) suggesting that the genome of the zebu × taurine admixed cattle has been uniquely selected to maximize hybrid fitness both in terms of reproduction and survivability

Population genomics reveals that an anthropophilic population of Aedes aegypti\textit{Aedes aegypti} mosquitoes in West Africa recently gave rise to American and Asian populations of this major disease vector

$\textbf{BACKGROUND}$: The mosquito $\textit{Aedes aegypti}$ is the main vector of dengue, Zika, chikungunya and yellow fever viruses. This major disease vector is thought to have arisen when the African subspecies $\textit{Ae. aegypti}$ formosus evolved from being zoophilic and living in forest habitats into a form that specialises on humans and resides near human population centres. The resulting domestic subspecies, $\textit{Ae. aegypti aegypti}$, is found throughout the tropics and largely blood-feeds on humans. $\textbf{RESULTS}$: To understand this transition, we have sequenced the exomes of mosquitoes collected from five populations from around the world. We found that $\textit{Ae. aegypti}$ specimens from an urban population in Senegal in West Africa were more closely related to populations in Mexico and Sri Lanka than they were to a nearby forest population. We estimate that the populations in Senegal and Mexico split just a few hundred years ago, and we found no evidence of $\textit{Ae. aegypti aegypti}$ mosquitoes migrating back to Africa from elsewhere in the tropics. The out-of-Africa migration was accompanied by a dramatic reduction in effective population size, resulting in a loss of genetic diversity and rare genetic variants. $\textbf{CONCLUSIONS}$: We conclude that a domestic population of $\textit{Ae. aegypti}$ in Senegal and domestic populations on other continents are more closely related to each other than to other African populations. This suggests that an ancestral population of $\textit{Ae. aegypti }$evolved to become a human specialist in Africa, giving rise to the subspecies $\textit{Ae. aegypti aegypti}$. The descendants of this population are still found in West Africa today, and the rest of the world was colonised when mosquitoes from this population migrated out of Africa. This is the first report of an African population of Ae. aegypti aegypti mosquitoes that is closely related to Asian and American populations. As the two subspecies differ in their ability to vector disease, their existence side by side in West Africa may have important implications for disease transmission.This work was funded by European Research Council grant Drosophila Infection 281668 to FMJ, a KAUST AEA award to FMJ and AP, a Medical Research Council Centenary Award to WJP and a National Institutes of Health Ruth L. Kirschstein National Research Service Award to JC

Technological elites, the meritocracy, and postracial myths in Silicon Valley

Entre as modernas elites tecnológicas digitais, os mitos da meritocracia e da façanha intelectual são usados como marcadores de raça e gênero por uma supremacia branca masculina que consolida recursos de forma desproporcional em relação a pessoas não brancas, principalmente negros, latinos e indígenas. Os investimentos em mitos meritocráticos suprimem os questionamentos de racismo e discriminação, mesmo quando os produtos das elites digitais são infundidos com marcadores de raça, classe e gênero. As lutas históricas por inclusão social, política e econômica de negros, mulheres e outras classes desprotegidas têm implicado no reconhecimento da exclusão sistêmica, do trabalho forçado e da privação de direitos estruturais, além de compromissos com políticas públicas dos EUA, como as ações afirmativas, que foram igualmente fundamentais para reformas políticas voltadas para participação e oportunidades econômicas. A ascensão da tecnocracia digital tem sido, em muitos aspectos, antitética a esses esforços no sentido de reconhecer raça e gênero como fatores cruciais para inclusão e oportunidades tecnocráticas. Este artigo explora algumas das formas pelas quais os discursos das elites tecnocráticas do Vale do Silício reforçam os investimentos no pós racialismo como um pretexto para a re-consolidação do capital em oposição às políticas públicas que prometem acabar com práticas discriminatórias no mundo do trabalho. Por meio de uma análise cuidadosa do surgimento de empresas de tecnologias digitais e de uma discussão sobre como as elites tecnológicas trabalham para mascarar tudo, como inscrições algorítmicas e genéticas de raça incorporadas em seus produtos, mostramos como as elites digitais omitem a sua responsabilidade por suas reinscrições pós raciais de (in)visibilidades raciais. A partir do uso de análise histórica e crítica do discurso, o artigo revela como os mitos de uma meritocracia digital baseados em um “daltonismo racial” tecnocrático emergem como chave para a manutenção de exclusões de gênero e raça.Palavras-chave: Tecnologia. Raça. Gênero.Among modern digital technology elites, myths of meritocracy and intellectual prowess are used as racial and gender markers of white male supremacy that disproportionately consolidate resources away from people of color, particularly African Americans, Latino/as and Native Americans. Investments in meritocratic myths suppress interrogations of racism and discrimination even as the products of digital elites are infused with racial, class, and gender markers. Longstanding struggles for social, political, and economic inclusion for African Americans, women, and other legally protected classes have been predicated upon the recognition of systemic exclusion, forced labor, and structural disenfranchisement, and commitments to US public policies like affirmative action have, likewise, been fundamental to political reforms geared to economic opportunity and participation. The rise of the digital technocracy has, in many ways, been antithetical to these sustained efforts to recognize race and gender as salient factors structuring technocratic opportunity and inclusion. This paper explores some of the ways in which discourses of Silicon Valley technocratic elites bolster investments in post-racialism as a pretext for re-consolidations of capital, in opposition to public policy commitments to end discriminatory labor practices. Through a careful analysis of the rise of digital technology companies, and a discussion of how technology elites work to mask everything from algorithmic to genetic inscriptions of race embedded in their products, we show how digital elites elide responsibility for their post-racial re-inscriptions of racial visibilities (and invisibilities). Using historical and critical discourse analysis, the paper reveals how myths of a digital meritocracy premised on a technocratic colorblindness emerge key to perpetuating gender and racial exclusions.Keywords: Technology. Race. Gender