Additional experimental evidence for a solar influence on nuclear decay rates

Additional experimental evidence is presented in support of the recent hypothesis that a possible solar influence could explain fluctuations observed in the measured decay rates of some isotopes. These data were obtained during routine weekly calibrations of an instrument used for radiological safety at The Ohio State University Research Reactor using Cl-36. The detector system used was based on a Geiger-Mueller gas detector, which is a robust detector system with very low susceptibility to environmental changes. A clear annual variation is evident in the data, with a maximum relative count rate observed in January/February, and a minimum relative count rate observed in July/August, for seven successive years from July 2005 to June 2011. This annual variation is not likely to have arisen from changes in the detector surroundings, as we show here.Comment: 8 pages, 6 figure

Quantifying physiological influences on otolith microchemistry

Trace element concentrations in fish earstones (‘otoliths’) are widely used to discriminate spatially discrete populations or individuals of marine fish, based on a commonly held assumption that physiological influences on otolith composition are minor, and thus variations in otolith elemental chemistry primarily reflect changes in ambient water chemistry. We carried out a long-term (1-year) experiment, serially sampling seawater, blood plasma and otoliths of mature and immature European plaice (Pleuronectes platessa L.) to test relationships between otolith chemistry and environmental and physiological variables. Seasonal variations in otolith elemental composition did not track seawater concentrations, but instead reflected physiological controls on metal transport and biokinetics, which are likely moderated by ambient temperature. The influence of physiological factors on otolith composition was particularly evident in Sr/Ca ratios, the most widely used elemental marker in applied otolith microchemistry studies. Reproduction also triggered specific variations in otolith and blood plasma metal chemistry, especially Zn/Ca ratios in female fish, which could potentially serve as retrospective spawning indicators. The influence of physiology on the trace metal composition of otoliths may explain the success of microchemical stock discrimination in relatively homogenous marine environments, but could complicate alternative uses for trace element compositions in biominerals of higher organism

General dental practitioners' perceptions of, and attitudes towards, improving patient safety through a multidisciplinary approach to the prevention of medication-related osteonecrosis of the jaw (MRONJ):A qualitative study in the North East of England

Objective To explore general dental practitioners’ (GDPs’) perceptions of, and attitudes towards, the risks of medication-related osteonecrosis of the jaw (MRONJ) and the current/potential multidisciplinary approach(es) to prevention of the condition. Design Interpretivist methodology using a grounded theory approach and constant comparative analysis to undertake an iterative series of semistructured interviews. Ritchie and Spencer’s framework analysis facilitated the identification and prioritisation of salient themes. Setting Primary care general dental practices in the North East of England. Participants 15 GDPs. Results GDPs are aware of the risk of MRONJ with commonly implicated medicines; however, they report limited collaboration between professional groups in person-centred avoidance of complications, which is a key requirement of the preventive advice recommended in extant literature. Four salient and inter-related themes emerged: (1) perception of knowledge; indicating the awareness of the risk, limited knowledge of implicated medications and experience of managing the condition; (2) risk; indicating the importance of accurate medication histories, the treatment of low risk patients in primary dental care, counselling of poorly informed patients, the fear of litigation and perceived low priority of oral health in the context of general health and well-being; (3) access and isolation; referring to access to general medical records, professional isolation and somewhat limited and challenging professional collaborative relationships; (4) interprofessional working; indicating oral health education of other professional groups, collaboration and communication, and a focus on preventive care. Conclusions Patients continue to be at risk of developing MRONJ due to limited preventive interventions and relatively disparate contexts of multidisciplinary team healthcare. Effective collaboration, education and access to shared medical records could potentially improve patient safety and reduce the potential risk of developing MRONJ

'We do not seem to engage with dentists':A qualitative study of primary healthcare staff and patients in the North East of England on the role of pharmacists in oral healthcare

Objective: To explore the attitudes towards, and perceptions of, primary care healthcare staff and patients, regarding the role of clinical pharmacists in the provision of oral health advice and collaboration with dentists in general practice. Design: Interpretivist methodology using qualitative semi-structured interviews and focus groups. Participants 22 participants; 10 pharmacists; 3 general practitioners; 2 nurses; 1 practice manager; 6 patients. Setting Primary care general medical practices in the North East of England and the University of Sunderland Patient Carer and Public Involvement group. Methods: One-to-one semi-structured interviews were performed with primary care healthcare staff. An iterative approach using constant comparative analysis facilitated the ongoing enrichment of data; salient themes were identified using Framework Analysis and related back to extant literature. A focus group was held with patients to further explore key themes. Results: Four salient and inter-related themes emerged: enhanced clinical roles; indicating rapidly changing roles of pharmacists working in general practice, increased responsibility and accountability of pharmacist prescribers and the delivery of advanced clinical services; limited knowledge; indicating basic understanding of appropriate oral health advice, but limited insight and provision of advice to patients with regards to links with systemic diseases and medication; geographical/situational isolation of the dental team; indicating the disparate contexts and challenges of multidisciplinary working in oral health, and patients’ attitudes towards dental care; integration of oral health advice; indicating the potential of pharmacists to integrate oral health advice into current roles and to target specific patient groups in practice. Conclusions: The lack of integration between oral and general healthcare services potentially impacts negatively on patient care, requiring further interprofessional oral health education. The developing role of the pharmacist in general practice represents an opportunity to integrate oral health advice and/or interventions into the management of patients in this setting

Multidisciplinary prevention of medication related osteonecrosis of the jaw

Background: Medication related osteonecrosis of the jaw (MRONJ), is a rare adverse effect of anti-resorptive or anti-angiogenic drug therapy that can cause significant morbidity; commonly prescribed drugs, such as bisphosphonates, used to treat a variety of cancers and osteoporosis have been associated with MRONJ (1). A multidisciplinary approach to the promotion and prioritisation of preventative strategies to ensure patients are dentally fit prior to the prescription of implicated medications is recommended; current evidence suggests that patients have limited knowledge relating to MRONJ and that preventative strategies are rarely implemented (2,3,4). Objective: To explore the impact of MRONJ on quality of life and to explore the attitudes and perceptions of patients towards the multidisciplinary approach to the prevention of the condition. Method: Using a Grounded Theory approach and integrating a process of constant comparison in the iterative enrichment of data sets, semi-structured interviews were undertaken, transcribed and analysed using Ritchie and Spencer’s (2002) Framework Analysis(7). 23 patients; 6 patients with MRONJ, 13 patients prescribed a bisphosphonate and 4 patients with osteoporosis not currently prescribed any medication were recruited from primary care general medical practices and secondary care dental services in England. Salient themes were identified and related back to extant literature in the field. Results: Five salient and inter-related themes emerged: (1) quality of life, indicating the physical, psychological and social impact of MRONJ; (2) limited knowledge, indicating limited awareness of the condition, risk factors and preventative strategies; (3) patient specific, referring to the complexity of patients, polypharmacy, prioritising aspects of care and personal responsibility; (4) inter-professional management, indicating a perceived organisational hierarchy, professional roles and responsibilities, articulation of risk and communication; (5) wider context, indicating potential demands on NHS resources, and barriers to dental care. Conclusions: MRONJ has a significant impact on quality of life yet appropriate preventative education is not apparent. Effective inter-professional patient education and prevention to mitigate against the risk of developing MRONJ is required

An audit of antimicrobial prescribing by dental practitioners in the north east of England and Cumbria

Background Inappropriate prescribing of antimicrobials is a significant threat to global public health. In England, approximately 5% of all antimicrobial items are prescribed by dentists, despite the limited indications for their use in the treatment of oral infections in published clinical guidelines. The objective of this study was to survey antimicrobial prescribing by dental practitioners in North East England and Cumbria, identify educational and training needs and develop a self-assessment tool that can be used for Continued Professional Development by individual practitioners. Methods During October 2016, 275 dental practitioners used a standardised form to record anonymous information about patients who had been prescribed antimicrobials. Clinical information and prescribing details were compared against clinical guidelines published by the Faculty of General Dental Practitioners UK. Results Dental practitioners provided data on 1893 antimicrobial prescriptions. There was documented evidence of systemic spread, such as pyrexia in 18% of patients. Dentists recorded patients’ pain (91.1% of patients), local lymph gland involvement (41.5%) gross diffuse swelling (55.5%) dysphagia (7.2%) and trismus (13.6%). Reasons for prescribing antimicrobials included patient expectations (25.8%), patient preference (24.8%), time pressures (10.9%), and patients uncooperative with other treatments (10.4%). The most commonly prescribed antimicrobials were amoxicillin, accounting for 61.2% of prescriptions, followed by metronidazole (29.9%). Most prescriptions for amoxicillin were for either 5 days (66.8%) or 7 days (29.6%) and most prescriptions for metronidazole were for a 5-day course (65.2%) or 7-day (18.6%) course. Conclusion In most cases, when an antimicrobial was prescribed, practitioners used the correct choice of agents and usually prescribed these at the correct dose. However, some evidence of suboptimal prescribing practices when compared to the Faculty of General Dental Practitioner guidelines were identified. The audit has identified training needs across the region and aided the development of Continued Professional Development sessions. Further work to identify barriers and facilitators for improving antimicrobial prescribing and determining appropriate methods to improve clinical practice are required

Dense and accurate motion and strain estimation in high resolution speckle images using an image-adaptive approach

Digital image processing methods represent a viable and well acknowledged alternative to strain gauges and interferometric techniques for determining full-field displacements and strains in materials under stress. This paper presents an image adaptive technique for dense motion and strain estimation using high-resolution speckle images that show the analyzed material in its original and deformed states. The algorithm starts by dividing the speckle image showing the original state into irregular cells taking into consideration both spatial and gradient image information present. Subsequently the Newton-Raphson digital image correlation technique is applied to calculate the corresponding motion for each cell. Adaptive spatial regularization in the form of the Geman-McClure robust spatial estimator is employed to increase the spatial consistency of the motion components of a cell with respect to the components of neighbouring cells. To obtain the final strain information, local least-squares fitting using a linear displacement model is performed on the horizontal and vertical displacement fields. To evaluate the presented image partitioning and strain estimation techniques two numerical and two real experiments are employed. The numerical experiments simulate the deformation of a specimen with constant strain across the surface as well as small rigid-body rotations present while real experiments consist specimens that undergo uniaxial stress. The results indicate very good accuracy of the recovered strains as well as better rotation insensitivity compared to classical techniques

Prevention of medication-related osteonecrosis of the jaw

Medication-related osteonecrosis of the jaw (MRONJ) is a rare adverse effect of several anti-resorptive and anti-angiogenic drugs that typically presents following a dental extraction. MRONJ is difficult to treat and can have a significant negative effect on quality of life; therefore, the implementation of preventative measures is recommended. The multidisciplinary healthcare team should work collectively to educate patients on the need for good oral hygiene and ensure that patients undergo remedial dental work prior to the initiation of implicated medicines. As medicine experts, a major aspect of the pharmacist’s role is to educate both patients and other healthcare professionals on the safe and effective use of medicines. Consequently, there is an opportunity for pharmacists working in all settings to contribute to the prevention of MRONJ. This article provides a summary of the most important background information in relation to the prevention of MRONJ, and outlines the potential opportunities for pharmacists working in community pharmacy, secondary care and general practice