The COVID-19 pandemic and dentistry: the clinical, legal and economic consequences - part 1: clinical

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus which causes COVID-19, is highly contagious. Dentistry is a high-risk profession for occupational virus transmission because of the close proximity of the operator to the patient during treatment and the procedural generation of aerosols. The impact on the provision of dental care has been profound, with routine care restricted or paused for a period around the world. There have been adverse consequences for dental education and clinical research. Emergency and urgent care provisions have generally proceeded. However, even when a patient's condition is deemed urgent, access to the appropriate care may not have been possible due to lack of the recommended personal protective equipment. The common dental diseases of caries and periodontitis usually present with signs and symptoms after some advancement, hence the recommended regular dental examination so that these may be diagnosed early by a professional with suitable lighting, instruments and radiography. Conditions such as oral cancer similarly present in their early stages without symptoms. Many countries introduced telephone and video consultations for patients with symptoms but much disease has gone undiagnosed and without management. It is difficult to ascertain the full effect of the disruption to dental services, education and research but it is likely to be substantial. The immediate future will focus on return to routine care provision with likely longer-term permanent changes

Motor neglect associated with loss of action inhibition

Motor neglect, underuse of one side of the body not explained by weakness or sensory impairment, is a common consequence of stroke that is surprisingly little understood. Behavioural and neuroanatomical hallmarks of the disorder are investigated. Using a masked prime task, it was shown that when patients with left motor neglect plan to move their left hand, irrelevant right limb motor programmes intrude, causing delay. Lesion analysis reveals that such asymmetry of motor programming occurs after infarcts of the right putamen and motor association areas. This demonstration of failure to inhibit ipsilesional limb motor plans suggests potential benefit from interventions that might act to restore balance in action planning

In search of ‘lost’ knowledge and outsourced expertise in flood risk management

This paper examines the parallel discourses of ‘lost’ local flood expertise and the growing use of commercial consultancies to outsource aspects of flood risk work. We critically examine the various claims and counter-claims about lost, local and external expertise in flood management, focusing on the aftermath of the 2007 floods in East Yorkshire, England. Drawing on interviews with consultants, drainage engineers and others, we caution against claims that privilege ‘local’ floods knowledge as ‘good’ and expert knowledge as somehow suspect. This paper urges carefulness in interpreting claims about local knowledge, arguing that it is important always to think instead of hybrid knowledge formations. We conclude by arguing that experiments in the co-production of flood risk knowledge need to be seen as part of a spectrum of ways for producing shared knowledge

Sensitivity of estuaries to compound flooding.

Fluvial and surge-tide extremes can occur synchronously resulting in compound flooding in estuaries, greatly intensifying the hazard. This flood risk has the potential to increase in the future as the frequency, phasing and/or intensity of these drivers change. Improved understanding of how extreme fluvial discharge and surge-tides interact will help inform future flood mitigation methodology. In this paper, therefore, we resolve for the first time intra-estuary sensitivities to fluvial and surge-tide extremes, for two contrasting UK estuaries (Humber and Dyfi). Model simulations at hyper-spatial resolution (< 50 m) using a 2D hydrodynamic model predicted compound flooding hazards based on: (1) present-day extreme events (worst on record); (2) present-day extreme events with shifted timings of the drivers to maximise flooding; and (3) modified drivers representing projected climate change. We found that in a small estuary with short-duration, high-intensity fluvial inputs (Dyfi), flood extent is sensitive to the relative timing of the fluvial and surge-tide drivers. In contrast, the relative timing of these drivers did not affect flooding in a larger estuary with a slower fluvial response to rainfall (Humber). In the Humber, extreme fluvial inputs during a compound hazard actually reduced maximum water depths in the outer estuary, compared with a surge-tide-only event. Projected future changes in these drivers by 2100 will increase compound flooding hazards: simulated sea-level rise scenarios predicted substantial and widespread flooding in both estuaries. However, projected increases in surge-tide behaved differently to sea-level rise of the same magnitude, resulting in a greater seawater influx and more flooding. Increased fluvial volumes were the weakest driver of estuarine flooding. In this paper we show how these interactions are complex and how the hydrodynamics vary considerably between different estuaries and sites within estuaries, making it difficult to generalise, use probabilistic or use 1D approaches for assessing compound flooding hazards. Hence, we contribute new knowledge and methods for catchment-to-coast impact modelling used for flood mitigation strategies

Money, use and experience: Identifying the mechanisms through which ecosystem services contribute to wellbeing in coastal Kenya and Mozambique

Despite extensive recent research elucidating the complex relationship between ecosystem services and human wellbeing, little work has sought to understand how ecosystem services contribute to wellbeing and poverty alleviation. This paper adopts concepts from the “Theory of Human Need” and the “Capability Approach” to both identify the multitude of links occurring between ecosystem services and wellbeing domains, and to understand the mechanisms through which ecosystem services contribute to wellbeing. Focus Group Discussions (N = 40) were carried out at 8 sites in Mozambique and Kenya to elicit how, why, and to what extent benefits derived from ecosystem services contribute to different wellbeing domains. Our results highlight three types of mechanisms through which ecosystem services contribute to wellbeing, monetary, use and experience. The consideration of these mechanisms can inform the development of interventions that aim to protect or improve flows of benefits to people. Firstly, interventions that support multiple types of mechanisms will likely support multiple domains of wellbeing. Secondly, overemphasising certain types of mechanism over others could lead to negative social feedbacks, threatening the future flows of ecosystem services. Finally, the three mechanism types are interlinked and can act synergistically to enhance the capacities of individuals to convert ecosystem services to wellbeing

Adenovirus-mediated transfer of a gene encoding acyloxyacyl hydrolase (AOAH) into mice increases tissue and plasma AOAH activity

Although the host response to gram-negative bacterial infection follows largely from the interactions of bacterial lipopolysaccharides (LPS or endotoxin) with host cells, little information is available concerning the mechanisms by which the host eliminates or detoxifies LPS. Acyloxyacyl hydrolase (AOAH) is an enzyme, found in phagocytic cells, that catalyzes the enzymatic deacylation of the lipid A moiety of LPS. Enzymatically deacylated LPS is much less potent than LPS at inducing responses in human cells, and it can antagonize the ability of LPS to activate human macrophages, neutrophils, and endothelial cells. Despite these observations, the physiologic role of LPS deacylation remains undefined. To investigate the ability of AOAH to carry out LPS deacylation in vivo, we produced a recombinant adenovirus carrying a gene encoding AOAH (Ad.CMV-AOAH) and employed this vector to elicit transient overexpression of AOAH in mice. Mice infected with Ad.CMV-AOAH expressed high levels of the enzyme in plasma, liver, spleen, and kidney. Although adenovirus-induced hepatitis reduced hepatic uptake of intravenously injected [H-3]LPS, animals expressing the transgene deacylated a larger fraction of the [3H]LPS taken up by their livers than did mice infected with a control adenovirus. These studies indicate that AOAH can catalyze the deacylation of LPS in vivo, and they provide evidence that the rates of hepatic LPS uptake and deacylation are not closely linked

Visual neglect after right posterior cerebral artery infarction

This article has been made available through the Brunel Open Access Publishing Fund and is available from the specified link - Copyright © 2006 BMJ Publishing Group.Objectives: To investigate the characteristics and neuroanatomical correlates of visual neglect after right-sided posterior cerebral artery (PCA) infarction.Methods: 15 patients with acute PCA strokes were screened for the presence of neglect on a comprehensive battery of cognitive tests. Extra tests of visual perception were also carried out on six patients. To establish which areas were critically associated with neglect, the lesions of patients with and without neglect were compared.Results: Neglect of varying severity was documented in 8 patients. In addition, higher-order visual perception was impaired in 5 of the 6 patients. Neglect was critically associated with damage to an area of white matter in the occipital lobe corresponding to a white matter tract connecting the parahippocampal gyrus with the angular gyrus of the parietal lobe. Lesions of the thalamus or splenium of the corpus callosum did not appear necessary or sufficient to cause neglect, but may mediate its severity in these patients.Conclusions: PCA stroke can result in visual neglect. Interruption of the white matter fibres connecting the parahippocampal gyrus to the angular gyrus may be important in determining whether a patient will manifest neglect

Assessing sedation need and managing referred dentally anxious patients:is there a role for the Index of Sedation Need?

Aim: To conduct an exploratory investigation of public dental service (PDS) practitioners' planned sedation modality using a structural equation modelling approach, in order to identify the explanatory value of using the Index of Sedation Need (IOSN), or its component parts, to predict sedation modality in patients referred with dental anxiety. Methods: A convenience sample of patients referred to the PDS for dental anxiety management was invited to take part. The IOSN was completed for each patient (patient dental anxiety, medical and behavioural indicators and dental treatment complexity) as well as the American Society of Anesthesiologists Physical Status Classification System and the Case Mix Tool. The practitioners completed details of their planned sedation modality and identified normative dental treatment need. The data were entered onto an SPSS v21 database and subjected to frequency distributions, t-tests, correlation analysis and exploratory partial structural equation modelling (SEM). Results: Ninety-five percent of patients were ranked as MDAS 3 or 4, indicating high dental anxiety; 69% had a medical condition, which might impact on dental treatment and 82% had a dental treatment need, which was classified as intermediate/complex according to the IOSN. Eighty-eight percent of the patients in accordance with the IOSN required sedation: 62% of patients were assessed as requiring intravenous sedation. The IOSN discriminated between patients who were assessed as requiring more complex sedation modalities and had a greater normative treatment need. The SEM showed that the patient dental anxiety (P &lt;0.02) and dental treatment complexity (P &lt;0.02) predicted planned sedation modality. Functional morbidity was less strong, as a predictor, and was significant at the ten percent level. Conclusions: The IOSN is a useful and valid assessment of sedation need and predicted sedation modality for patients referred with high dental anxiety states and secondly, that component parts of the IOSN add explanatory value in practitioners' choice of planned sedation modality