Comparison of the salivary and dentinal microbiome of children with severe-early childhood caries to the salivary microbiome of caries-free children

peer-reviewedBackground The main objectives of this study were to describe and compare the microbiota of 1) deep dentinal lesions of deciduous teeth of children affected with severe early childhood caries (S-ECC) and 2) the unstimulated saliva of these children and 3) the unstimulated saliva of caries-free children, and to compare microbiota compositional differences and diversity of taxa in these sampled sites. Methods Children with S-ECC and without S-ECC were recruited. The saliva of all children with and without S-ECC was sampled along with the deep dentinal microbiota from children affected by S-ECC. The salivary microbiota of children affected by S-ECC (n = 68) was compared to that of caries-free children (n = 70), by Illumina MiSeq sequencing of 16S rRNA amplicons. Finally, the caries microbiota of deep dentinal lesions of those children with S-ECC was investigated. Results Using two beta diversity metrics (Bray Curtis dissimilarity and UniFrac distance), the caries microbiota was found to be distinct from that of either of the saliva groups (caries-free & caries-active) when bacterial abundance was taken into account. However, when the comparison was made by measuring only presence and absence of bacterial taxa, all three microbiota types separated. While the alpha diversity of the caries microbiota was lowest, the diversity difference between the caries samples and saliva samples was statistically significant (p < 0.001). The major phyla of the caries active dentinal microbiota were Firmicutes (median abundance value 33.5%) and Bacteroidetes (23.2%), with Neisseria (10.3%) being the most abundant genus, followed by Prevotella (10%). The caries-active salivary microbiota was dominated by Proteobacteria (median abundance value 38.2%) and Bacteroidetes (27.8%) with the most abundant genus being Neisseria (16.3%), followed by Porphyromonas (9.5%). Caries microbiota samples were characterized by high relative abundance of Streptococcus mutans, Prevotella spp., Bifidobacterium and Scardovia spp. Conclusions Distinct differences between the caries microbiota and saliva microbiota were identified, with separation of both salivary groups (caries-active and caries-free) whereby rare taxa were highlighted. While the caries microbiota was less diverse than the salivary microbiota, the presence of these rare taxa could be the difference between health and disease in these children

Illusory resizing of the painful knee is analgesic in symptomatic knee osteoarthritis

Background. Experimental and clinical evidence support a link between body represen- tations and pain. This proof-of-concept study in people with painful knee osteoarthritis (OA) aimed to determine if: (i) visuotactile illusions that manipulate perceived knee size are analgesic; (ii) cumulative analgesic effects occur with sustained or repeated illusions. Methods. Participants with knee OA underwent eight conditions (order randomised): stretch and shrink visuotactile (congruent) illusions and corresponding visual, tactile and incongruent control conditions. Knee pain intensity (0-100 numerical rating scale; 0 = no pain at all and 100 D worst pain imaginable) was assessed pre- and post- condition. Condition (visuotactile illusion vs control) × Time (pre-/post-condition) repeated measure ANOVAs evaluated the effect on pain. In each participant, the most beneficial illusion was sustained for 3 min and was repeated 10 times (each during two sessions); paired t -tests compared pain at time 0 and 180s (sustained) and between illusion 1 and illusion 10 (repeated). Results. Visuotactile illusions decreased pain by an average of 7.8 points (95% CI [2.0-13.5]) which corresponds to a 25% reduction in pain, but the tactile only and visual only control conditions did not (Condition × Time interaction: p = 0:028). Visuotactile illusions did not differ from incongruent control conditions where the same visual manipulation occurred, but did differ when only the same tactile input was applied. Sustained illusions prolonged analgesia, but did not increase it. Repeated illusions increased the analgesic effect with an average pain decrease of 20 points (95% CI [6.9-33.1])-corresponding to a 40% pain reduction. Discussion. Visuotactile illusions are analgesic in people with knee OA. Our results suggest that visual input plays a critical role in pain relief, but that analgesia requires multisensory input. That visual and tactile input is needed for analgesia, supports multisensory modulation processes as a possible explanatory mechanism. Further research exploring the neural underpinnings of these visuotactile illusions is needed. For potential clinical applications, future research using a greater dosage in larger samples is warranted

The patient experience of radiotherapy for breast cancer: A qualitative investigation as part of the SuPPORT 4 All study.

Introduction: Breast cancer is a global health problem with 2.09 million cases of breast cancer diagnosed worldwide in 2018. With an increase in breast cancer survival attention has now focussed on the impact treatment side effects can have on the quality of life for women during survivorship. The aim of the SuPPORT 4 All project is to develop a support bra for use during radiotherapy, that can reduce normal tissue toxicity (for women with larger breasts) and provide accuracy, dignity and modesty for all women. The first stage of the project involved a co-design process to understand the current patient experience where no support bra or modesty device is used. Method: A participatory co-design methodology was adopted. Workshops were held with patient representatives (n ¼ 9) to seek understanding of experience during radiotherapy; a total of three workshops over 4 h. The workshops were audio recorded and framework analysis was adopted to identify key patient experiences. Results: Twelve categories and twenty-six sub categories were identified specific to patient experience. Patient concerns focussed on information provision, Healthcare Practitioner (HCP) knowledge of breast lymphoedema, lack of choice, experiences of being naked, and feelings of disempowerment. Conclusions: A number of areas were identified that had negative effects on overall patient experience. Implications for practice: Practitioners should consider patient dignity when configuring services to support patient needs regarding undressing, outside or inside the linear accelerator room. Additionally, practitioners should have an understanding of the impact permanent tattoos may have on some patients’ wellbeing and the impact that breast lymphoedema has on patient quality of life. Practitioners should also consider methods to encourage patient empowerment during radiotherapy; supporting patient selfmonitoring of side-effects may be one way to facilitate this

No more amalgams: Use of amalgam and amalgam alternative materials in primary dental

Objectives The aim of this study was to investigate the use of dental amalgam and amalgam alternate materials in primary dental care in Wales. Methods Following pre-piloting, a questionnaire was distributed to 667 dentists registered as working in primary dental care in Wales. The questionnaire sought to determine the current use of amalgam, and amalgam alternative materials in primary dental care services in Wales. In addition, the questionnaire sought to determine the attitudes and confidence of dentists in respect of placement of resin composites as alternatives to dental amalgam. Results A response rate of 40.4% was achieved (n = 270). High levels of reported confidence were seen in relation to placing resin composites in posterior teeth, but these levels reduced as the complexity of the cavity increased (while 82% of respondents 'strongly agreed' that they felt confident in placing resin composites in occlusal cavities, this reduced to 52.6% for three-surface occlusoproximal cavities). Patterns of care suggested that 73.3% of respondents often, or always, place amalgam restorations for NHS-funded dentistry in adults, where two or more posterior restorations are required. This proportion drops to 27% for the same scenario in children, and 19.4% in privately-funded care for adults. Sixty-seven percent of respondents reported that restoring posterior teeth with resin composite is too expensive for NHS-funded dentistry. A similar proportion of respondents (65.9%) agreed, or strongly agreed, that having to place resin composite routinely in posterior teeth would cause appointment delays. Respondents estimated that it would take them 1.61 times as long on average to place a resin composite, compared to an amalgam, in a moderately deep two-surface proximal-occlusal cavity in a lower first permanent molar. Respondents felt that the NHS fees would have to increase by 55–60% to support the restoration of posterior teeth with resin composite, rather than dental amalgam. Conclusions This study provided insight into current practising arrangements of primary dental care practitioners in relation to the use of dental amalgam and resin composites in the restoration of posterior teeth. Based on a sample of mainly UK-trained dentists, it would seem that amalgam remains the material typically selected for restoring posterior teeth in adults for NHS-funded care. While dentists are knowledgeable and embracing of new techniques for posterior resin composite placement, funding arrangements in NHS dentistry appear to be a barrier to the increasing use of resin composite-based, minimum intervention approaches to the restoration of posterior teeth

Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial

Objective To assess the effect of home based telehealth interventions on the use of secondary healthcare and mortality

Behind the curtain of the "Ultimate Empathy Machine"

Virtual Reality nonfiction (VRNF) is an emerging form of immersive media experience created for consumption using panoramic “Virtual Reality" headsets. VRNF promises nonfiction content producers the potential to create new ways for audiences to experience “the real"; allowing viewers to transition from passive spectators to active participants. Our current project is exploring VRNF through a series of ethnographic and experimental studies. In order to document the content available, we embarked on an analysis of VR documentaries produced to date. In this paper, we present an analysis of a representative sample of 150 VRNF titles released between 2012-2018. We identify and quantify 64 characteristics of the medium over this period, discuss how producers are exploiting the affordances of VR, and shed light on new audience roles. Our findings provide insight into the current state of the art in VRNF and provide a digital resource for other researchers in this area

Developing a whole-school mental health and wellbeing intervention through pragmatic formative process evaluation: A case-study of innovative local practice within the School Health Research Network

The evidence-base for whole school approaches aimed at improving student mental health and wellbeing remains limited. This may be due to a focus on developing and evaluating de-novo, research led interventions, while neglecting the potential of local, contextually-relevant innovation that has demonstrated acceptability and feasibility. This study reports a novel approach to modelling and refining the theory of a whole-school restorative approach, alongside plans to scale up through a national educational infrastructure in order to support robust scientific evaluation. A pragmatic formative process evaluation was conducted of a routinized whole-school restorative approach aimed at improving student mental health and wellbeing in Wales. The study reports seven phases of the pragmatic formative process evaluation that may be undertaken in the development and evaluation of interventions already in routine practice: 1) identification of innovative local practice; 2) scoping review of evidence-base to identify existing intervention programme theory; outcomes; and contextual characteristics that influence programme theory and implementation; 3) establishment of a Transdisciplinary Action Research (TDAR) group; 4) co-production of an initial intervention logic model with stakeholders; 5) confirmation of logic model with stakeholders; 6) planning for intervention refinement; and 7) planning for feasibility and outcome evaluation. The phases of this model may be iterative and not necessarily sequential. Formative, pragmatic process evaluations support researchers, policy-makers and practitioners in developing a robust scientific evidence-base for acceptable and feasible local innovation that does not have a clear evidence base. The case of a whole-school restorative approach provides a case example of how such an evaluation may be undertaken.Wellcome Trust Institutional Strategic Support Fund, Cardiff University, grant no. 510564