Biologically Based Restorative Management of Tooth Wear

The prevalence and severity of tooth wear is increasing in industrialised nations. Yet, there is no high-level evidence to support or refute any therapeutic intervention. In the absence of such evidence, many currently prevailing management strategies for tooth wear may be failing in their duty of care to first and foremost improve the oral health of patients with this disease. This paper promotes biologically sound approaches to the management of tooth wear on the basis of current best evidence of the aetiology and clinical features of this disease. The relative risks and benefits of the varying approaches to managing tooth wear are discussed with reference to long-term follow-up studies. Using reference to ethical standards such as “The Daughter Test”, this paper presents case reports of patients with moderate-to-severe levels of tooth wear managed in line with these biologically sound principles

Coarse Woody Debris and Carbon Stocks in Pine Forests after 50 Years of Recovery from Harvesting in Northeastern California

The long-term effects of harvesting on stand carbon (C) pools were assessed in a dry, interior pine-dominated forest at the Blacks Mountain Experimental Forest in northeastern California. Six 8-hectacre plots, established in 1938–1943, were treated as either an uncut control or a heavy-cut harvest (three-quarters of the stand volume removed). Response variables included C pools in overstory tree and shrub, coarse woody debris (CWD), forest floor, mineral soil (to 30 cm depth), cubicle brown root fragments of wood, fine roots, and ectomycorrhizal root tips. CWD was further classified as intact wood or more highly decayed brown rot or white rot types. CWD nutrient stocks (N, P, K, Ca, and Mg) and soil N content were also measured. In 1992, 50 years after harvest, total ecosystem C was 188 and 204 Mg C ha−1 in the harvest and control treatments or 8% lower (p = 0.02) in the harvest stands. There were changes in the distributions of C pools between the treatments. After 50 years of recovery, most C pools showed statistically non-significant and essentially no change in C pool size from harvests. Notable reductions in C with harvests were declines of 43% in CWD including standing snags (p = 0.09) and a decline of 9% of live tree C (p = 0.35). Increases in C pools after harvest were in a 3-fold build-up of fragmented brown cubicle rot (p = 0.26) and an 11% increase in soil C (p = 0.19). We observed strong evidence of C transfers from CWD to soil C pools with two- to three-fold higher soil C and N concentrations beneath CWD compared to other cover types, and lower CWD pools associated with elevated cubicle brown rot are elevated soil C in the harvests. Our results showed that while harvest effects were subtle after 50 years of regrowth, CWD may play an important role in storing and transferring ecosystem C to soils during recovery from harvesting in these dry, eastside pine forests of California. This poses a tradeoff for managers to choose between keeping CWD for its contribution to C sequestration and its removal as the hazardous fuels

Heterogeneity in Residential Yard Care: Evidence from Boston, Miami, and Phoenix

The management of residential landscapes occurs within a complex socio-ecological system linking household decision-making with ecological properties, multi-scalar human drivers, and the legacy effects of past management. Conventional wisdom suggests that resource-intensive turf grass yards are the most common landscaping outcome, resulting in a presumed homogeneous set of residential landscaping practices throughout North America. We examine this homogenization thesis through an interview-based, cross-site study of residential landscape management in Boston, Phoenix, and Miami. Counter to the homogeneity thesis, we find that yard management practices often exhibit heterogeneity, for example, in groundcover choice or use of chemical inputs. The degree of heterogeneity in management practices varies according to the scale of analysis, and is the outcome of a range of constraints and opportunities to which households respond differently depending on their existing yard and landscaping preferences. This study highlights the importance of multi-scalar and cross-site analyses of decision-making in socio-ecological systems, and presents opportunities for longitudinal and cross-site research to examine the extent to which homogeneity is actually present in the management of residential landscapes over time and in diverse places

The role of the purinergic P2X(7 )receptor in inflammation

The inflammatory process, orchestrated against a variety of injurious stimuli, is composed of three inter-related phases; initiation, propagation and resolution. Understanding the interplay between these three phases and harnessing the beneficial properties of inflammation whilst preventing its damaging effects, will undoubtedly lead to the advent of much needed therapies, particularly in chronic disease states. The P2X(7 )receptor (P2X(7)R) is increasingly recognised as an important cell surface regulator of several key inflammatory molecules including IL-1β, IL-18, TNF-α and IL-6. Moreover, as P2X(7)R-dependent cytokine production is driven by activating the inflammasome, antagonists of this receptor are likely to have therapeutic potential as novel anti-inflammatory therapies. The function of the P2X(7)R in inflammation, immunity and its potential role in disease will be reviewed and discussed

The role of the purinergic P2X(7 )receptor in inflammation

The inflammatory process, orchestrated against a variety of injurious stimuli, is composed of three inter-related phases; initiation, propagation and resolution. Understanding the interplay between these three phases and harnessing the beneficial properties of inflammation whilst preventing its damaging effects, will undoubtedly lead to the advent of much needed therapies, particularly in chronic disease states. The P2X(7 )receptor (P2X(7)R) is increasingly recognised as an important cell surface regulator of several key inflammatory molecules including IL-1β, IL-18, TNF-α and IL-6. Moreover, as P2X(7)R-dependent cytokine production is driven by activating the inflammasome, antagonists of this receptor are likely to have therapeutic potential as novel anti-inflammatory therapies. The function of the P2X(7)R in inflammation, immunity and its potential role in disease will be reviewed and discussed

Masked hypertension and submaximal exercise blood pressure among adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC)

Purpose: Masked hypertension is associated with increased cardiovascular risk but is undetectable by clinic blood pressure (BP). Elevated systolic BP responses to submaximal exercise reveal the presence of masked hypertension in adults, but it is unknown whether this is the case during adolescence. We aimed to determine if exercise BP was raised in adolescents with masked hypertension, and its association with cardiovascular risk markers.Methods: A total of 657 adolescents (aged 17.7 ± 0.3 years; 41.9% male) from the Avon longitudinal study of parents and children (ALSPAC) completed a step-exercise test with pre-, post-, and recovery-exercise BP, clinic BP and 24-hour ambulatory BP. Masked hypertension was defined as clinic BP Results: Fifty participants (7.8%) were classified with masked hypertension. Clinic, pre-, post-, and recovery-exercise systolic BP were associated with masked hypertension (AUC ≥ 0.69 for all, respectively), with the clinic systolic BP threshold of 115 mm Hg having high sensitivity and specificity and exercise BP thresholds of 126, 150, and 130 mm Hg, respectively, having high specificity and negative predictive value (individually or when combined) for ruling out the presence of masked hypertension. Additionally, this exercise systolic BP above the thresholds was associated with greater left-ventricular mass index and aortic PWV.Conclusions: Submaximal exercise systolic BP is associated with masked hypertension and adverse cardiovascular structure in adolescents. Exercise BP may be useful in addition to clinic BP for screening of high BP and cardiovascular risk in adolescents

Developing and enhancing biodiversity monitoring programmes: a collaborative assessment of priorities

1.Biodiversity is changing at unprecedented rates, and it is increasingly important that these changes are quantified through monitoring programmes. Previous recommendations for developing or enhancing these programmes focus either on the end goals, that is the intended use of the data, or on how these goals are achieved, for example through volunteer involvement in citizen science, but not both. These recommendations are rarely prioritized. 2.We used a collaborative approach, involving 52 experts in biodiversity monitoring in the UK, to develop a list of attributes of relevance to any biodiversity monitoring programme and to order these attributes by their priority. We also ranked the attributes according to their importance in monitoring biodiversity in the UK. Experts involved included data users, funders, programme organizers and participants in data collection. They covered expertise in a wide range of taxa. 3.We developed a final list of 25 attributes of biodiversity monitoring schemes, ordered from the most elemental (those essential for monitoring schemes; e.g. articulate the objectives and gain sufficient participants) to the most aspirational (e.g. electronic data capture in the field, reporting change annually). This ordered list is a practical framework which can be used to support the development of monitoring programmes. 4.People's ranking of attributes revealed a difference between those who considered attributes with benefits to end users to be most important (e.g. people from governmental organizations) and those who considered attributes with greatest benefit to participants to be most important (e.g. people involved with volunteer biological recording schemes). This reveals a distinction between focussing on aims and the pragmatism in achieving those aims. 5.Synthesis and applications. The ordered list of attributes developed in this study will assist in prioritizing resources to develop biodiversity monitoring programmes (including citizen science). The potential conflict between end users of data and participants in data collection that we discovered should be addressed by involving the diversity of stakeholders at all stages of programme development. This will maximize the chance of successfully achieving the goals of biodiversity monitoring programmes

Managing Injuries of the Neck Trial (MINT) : design of a randomised controlled trial of treatments for whiplash associated disorders

Background: A substantial proportion of patients with whiplash injuries develop chronic symptoms. However, the best treatment of acute injuries to prevent long-term problems is uncertain. A stepped care treatment pathway has been proposed, in which patients are given advice and education at their initial visit to the emergency department (ED), followed by review at three weeks and physiotherapy for those with persisting symptoms. MINT is a two-stage randomised controlled trial to evaluate two components of such a pathway: 1. use of The Whiplash Book versus usual advice when patients first attend the emergency department; 2. referral to physiotherapy versus reinforcement of advice for patients with continuing symptoms at three weeks. Methods: Evaluation of the Whiplash Book versus usual advice uses a cluster randomised design in emergency departments of eight NHS Trusts. Eligible patients are identified by clinicians in participating emergency departments and are sent a study questionnaire within a week of their ED attendance. Three thousand participants will be included. Patients with persisting symptoms three weeks after their ED attendance are eligible to join an individually randomised study of physiotherapy versus reinforcement of the advice given in ED. Six hundred participants will be randomised. Follow-up is at 4, 8 and 12 months after their ED attendance. Primary outcome is the Neck Disability Index (NDI), and secondary outcomes include quality of life and time to return to work and normal activities. An economic evaluation is being carried out. Conclusion: This paper describes the protocol and operational aspects of a complex intervention trial based in NHS emergency and physiotherapy departments, evaluating two components of a stepped-care approach to the treatment of whiplash injuries. The trial uses two randomisations, with the first stage being cluster randomised and the second individually randomised