Are we Getting It Right First Time? An exploration of clinical coding practices within a UK paediatric dental hospital department.

Introduction Issues arising from the current coding system in dentistry have been highlighted. Available codes are considered to lack clarity and fail to reflect all dental specialties. There are no paediatric-specific codes, which means codes from other specialties are used, which may not accurately reflect the work carried out.Aim This paper aims to explore the range of codes and the consistency and accuracy of current coding practices within the paediatric dentistry department at Newcastle Dental Hospital, and explore the potential impact of introducing new speciality-specific codes for the aforementioned procedures.Method Data were retrospectively collected to determine whether the following treatments had been undertaken, and if so, which procedure code had been used for the treatment: inhalation sedation; dietary advice; acclimatisation; preformed metal crowns, silver diamine fluoride application; and apexification. All codes used within the department for a six-month period were also reviewed retrospectively and the frequency in which procedures relating to the potential new codes would be undertaken within the department was estimated to facilitate consideration of potential financial impact of the introduction of new codes.Results Codes utilised for the aforementioned procedures did not accurately reflect work carried out despite being relatively consistent. The potential new codes corresponded to procedures that were commonly undertaken within the department.Discussion This study highlights shortcomings in the coding system relating to a lack of applicable codes for paediatric dentistry procedures. Introduction of new speciality-specific codes should help to address this deficit to ensure a more accurate representation of the needs of the community to help commissioning and workforce planning.

Meat quality of broiler chickens processed using electrical and controlled atmosphere stunning systems.

Increased consumer concern for animal welfare has led some poultry producers to alter their stunning methods from electrical to controlled atmosphere stunning. The potential for different impacts on meat quality between commercially applied controlled atmosphere stunning (CAS) and electrical stunning (ES) using current US parameters needs further evaluation. Three trials were conducted in a commercial broiler processing facility that uses separate processing lines for ES and CAS. Blood glucose concentrations were measured from broilers stunned by either CAS or ES at: 1) lairage, 2) pre-stunning, and 3) post-stunning, using a glucose monitor. Occurrence of visible wing damage was evaluated post-defeathering and breast fillet meat quality was evaluated through measurement of pH, color, and drip loss at deboning and after 24 h. Data were analyzed using GLM or chi-square with a significance at P ≤ 0.05 and means were separated by Tukey's HSD. Blood glucose concentrations (mg/dL) from CAS and ES birds were not different at lairage (284, 272, P = 0.2646) or immediately prior to stunning (274, 283, P = 0.6425). Following stunning and neck cut, circulating blood glucose from birds stunned by CAS was higher than ES (418, 259, P < 0.0001). CAS carcasses had more visible wing damage than ES carcasses (3.6%, 2.2%, P < 0.0001). Breast fillet pH was lower, L* was higher, and a* was lower at debone for CAS fillets (5.81, 54.65, 1.96) compared to ES fillets (5.92, 53.15, 2.31, P < 0.0001, P = 0.0005, P = 0.0303). Drip loss did not differ between breast fillets from CAS or ES broilers (4.83, 4.84; P = 0.0859). The implications of increased blood glucose concentration post-CAS are unknown and require further evaluation. However, the increase in visible wing damage observed post-defeathering from CAS carcasses indicated a need for equipment parameter adjustments during the process from stunning through defeathering when using CAS for broiler stunning. Although differences were observed in breast fillet attributes at deboning, these differences would have minimal practical application and were no longer present at 24 h. Overall, use of CAS in a commercial facility resulted in differences in subsequent product quality when compared to ES.

What is the impact of primary dental avulsion injuries on the permanent dentition?

Design Retrospective cohort study.Cohort selection Records of 2,922 patients, who attended a reference centre between 1998 and 2019 with primary dental trauma and who had radiographs and photographs, were screened to identify primary dental avulsion injuries that were followed-up until complete eruption of the permanent successors. 240 records were eligible and 194 fulfilled the inclusion criteria.Data analysis Exploratory descriptive analysis was carried out to map the occurrence and type of sequelae to the permanent tooth following primary avulsion, comparing this to the control group of permanent anterior teeth from the same children where the predecessor teeth had not suffered any type of dental trauma. Exploratory descriptive analysis was also used to link the age the primary avulsion occurred to the type of sequelae to permanent dentition. Multilevel Poisson regression analysis was performed and relative risk values and respective 95% confidence intervals were calculated to evaluate the association between avulsion and occurrence of sequelae. Confounders were included in the model to calculate their effect.Results Of the 194 patients included, there were 266 avulsed primary teeth and 115 of the permanent successors presenting with sequelae (43.2%), compared to 15.4% in the control group. Demarcated opacities were most common in both groups. Primary tooth avulsions occurring in children under two years old had a higher risk of sequelae to the permanent successor. There was also a higher risk of successor sequelae with avulsions of the lower arch compared to the upper and when three or more teeth were affected by the trauma compared to a single tooth. Avulsions in children over three years old had a lower risk of hypoplasia and those over four years old had a low risk of opacities to the successor.Conclusions Following avulsions of primary teeth, there is a higher risk of sequelae to the permanent successor in children younger than two years, where the lower jaw is involved and when multiple teeth are involved.

Investigation of the potential of aerosolized Salmonella Enteritidis on colonization and persistence in broilers from day 3 to 21.

The presence of Salmonella in air of poultry houses has been previously confirmed. Therefore, it is important to investigate the entry of Salmonella into broilers through air. The present study aimed to evaluate different levels of Salmonella Enteritidis aerosol inoculations in broiler chicks for colonization of ceca, trachea, and liver/spleen and persistence over time. In 3 independent trials, 112 one-day-old birds were randomly divided into 4 groups (n = 28/group). On d 1 of age, one group was exposed to an aerosol of sterile saline and the remaining three groups were exposed to an aerosol generated from one of 3 doses (103, 106, or 109 CFU/mL) of S. Enteritidis inoculum. Aerosol exposure time was 30 min/group and was performed using a nebulizer. On d 3, 7, 14, and 21 of age, ceca, trachea, and liver/spleen were aseptically removed. Ceca were cultured for Salmonella counts (log10 CFU/g) and all tissues were cultured for Salmonella prevalence. All tissues from the control group were Salmonella negative for all sampling days. On sampling d 3 and 7, ceca Salmonella counts were highest (5.14 and 5.11, respectively) when challenged with 109Salmonella (P ≤ 0.0281). Ceca Salmonella counts increased from d 3 (2.43) to d 7 (4.43), then remained constant when challenged at 103Salmonella, and counts decreased over time for all other groups. Tissue Salmonella prevalence increased with increasing challenge levels at all sampling timepoints (P ≤ 0.0213). Salmonella prevalence was low (0/18 to 4/18) and did not change over time following 103Salmonella challenge (P ≥ 0.2394). Prevalence decreased over time in ceca and trachea following 106 and 109Salmonella challenge (P ≤ 0.0483). Liver/spleen Salmonella prevalence increased from d 3 (13/18) to d 14 (18/18) and then decreased at d 21 (10/18) in birds exposed to an aerosol of 109Salmonella but remained constant over time for rest of the Salmonella inoculated groups. Overall, this study demonstrated the Salmonella colonization and persistence in different tissues in broilers following exposure to aerosolized Salmonella.

Are social stories beneficial for oral health promotion in preschool children with special healthcare needs?

Design A 24-month randomised, two-armed, double-blinded, parallel controlled trial.Methods Participants were recruited from educational centres for children with special healthcare needs (SHCN) aged 2-6 years. Out of the 37 special needs schools in Hong Kong, 19 were randomly selected, of which 16 met the inclusion criteria. Further exclusions occurred if the child was absent, no consent was signed or if they did not meet the inclusion criteria. All participants received standardised tooth brushing instructions. The test group were given validated social stories, while the control group utilised standard leaflets issued by the Department of Health. The resources were used both in education centre sessions in three phases and at home by parents. The oral health-related behaviours were assessed before and after interventions as well as dmft index. Caries was assessed via dmft at baseline and phase 3 (at 24 months). The severity of existing caries was assessed using the International Caries Detection and Assessment System. If existing carious lesions progressed from one stage to a more advanced stage, it was defined as progression. At baseline and each of the three follow-up visits, oral hygiene and gingival health were assessed using the modified gingival index and simplified debris index. Oral health behaviours assessed included tooth brushing performance (assessed by number of tooth brushing steps and duration/frequency), between-meal snacking (assessed by frequency) and dental visit experience (assessed as favourable if the child attended at least annual visits). It was then determined if these behaviours had improved. Data analysis utilised generalised estimating equations, negative binomial regression and binary logistic regression. Kappa statistics were used to test intra-examiner reliability on 10% of randomly selected participants.Results There was no significant difference in caries experience between the two groups after 24 months. The results suggest children in the test group displayed improved tooth brushing performance, better oral hygiene and more frequent dentist visits. Children from higher socioeconomic backgrounds also showed better oral hygiene compared to those from lower socioeconomic backgrounds.Conclusions Social stories may be useful resources to improve oral health-related behaviours in children with SHCN.

Do mindfulness interventions improve road safety? A systematic review.

Mindfulness has been identified as a potentially effective intervention for reducing road trauma. In this paper, we report on the results of a systematic review which examined the evidence regarding the relationship between mindfulness and road safety. The review was conducted following PRISMA guidelines (PROSPERO 2017: CRD42017075704). The primary outcomes measured were crash or near-crash rates and the secondary outcomes were driving violations (including speeding and texting while driving) and driving performance (i.e., errors in driving simulator, etc.). This review was registered with PROSPERO 2017: CRD42017075704. A systematic search of databases from the disciplines of public health, psychology and transport safety (Ovid Cochrane Library, Ovid PsycINFO, Ovid EMBASE, CINAHL PLUS, Ovid TRANSPORT and TRID: TRIS and ITRD database) was conducted on February 7th 2018. Seventeen studies (12 cross-sectional and 5 case-control) published between 2011 and 2017 met the inclusion criteria. These all focused on the association between mindfulness or mind-wandering on road safety measures including driving performance (vehicle control, reaction time), compliance with speed zones and traffic signals, near-crash and crash rates, as well as propensity to engage in distracted driving behaviours. The results of the review suggest that mindfulness may be particularly useful for preventing distracted driving. However, a number of limitations in the existing research are noted. It is clear that more research is warranted to specifically investigate the effectiveness of mindfulness as an intervention for reducing road trauma.

Liver-specific cholesteryl ester hydrolase deficiency attenuates sterol elimination in the feces and increases atherosclerosis in ldlr-/- mice.

OBJECTIVE: Liver is the major organ responsible for the final elimination of cholesterol from the body either as biliary cholesterol or as bile acids. Intracellular hydrolysis of lipoprotein-derived cholesteryl esters (CEs) is essential to generate the free cholesterol required for this process. Earlier, we demonstrated that overexpression of human CE hydrolase (Gene symbol CES1) increased bile acid synthesis in human hepatocytes and enhanced reverse cholesterol transport in mice. The objective of the present study was to demonstrate that liver-specific deletion of its murine ortholog, Ces3, would decrease cholesterol elimination from the body and increase atherosclerosis. APPROACH AND RESULTS: Liver-specific Ces3 knockout mice (Ces3-LKO) were generated, and Ces3 deficiency did not affect the expression of genes involved in cholesterol homeostasis and free cholesterol or bile acid transport. The effects of Ces3 deficiency on the development of Western diet-induced atherosclerosis were examined in low density lipoprotein receptor knock out(-/-) mice. Despite similar plasma lipoprotein profiles, there was increased lesion development in low density lipoprotein receptor knock out(-/-)Ces3-LKO mice along with a significant decrease in the bile acid content of bile. Ces3 deficiency significantly reduced the flux of cholesterol from [(3)H]-CE-labeled high-density lipoproteins to feces (as free cholesterol and bile acids) and decreased total fecal sterol elimination. CONCLUSIONS: Our results demonstrate that hepatic Ces3 modulates the hydrolysis of lipoprotein-delivered CEs and thereby regulates free cholesterol and bile acid secretion into the feces. Therefore, its deficiency results in reduced cholesterol elimination from the body, leading to significant increase in atherosclerosis. Collectively, these data establish the antiatherogenic role of hepatic CE hydrolysis.

Discovery of a series of potent and selective human H4 antagonists using ligand efficiency and libraries to explore structure-activity relationship (SAR).

We describe the identification of a potent, selective lead series that shows antagonism against the human histamine H4 receptor from thirteen actives identified in an HTS as part of a hit to lead program. By focusing on ligand efficiency and concurrently using a diversity based approach, compounds based around 2,4-diaminopyrimidine were identified with compound 25 being quickly shown to be a good lead. It also had the highest ligand efficiency in the series.

Efficient conversion of a nonselective norepinephrin reuptake inhibitor into a dual muscarinic antagonist-ß2-agonist for the treatment of chronic obstructive pulmonary disease.

Following interrogation of a wide-ligand profile database, a nonselective norepinephrin reuptake inhibitor was converted into a novel muscarinic antagonist using two medicinal chemistry transformations (M3/NRI selectivity of >1000). Conjugation to a ß(2) agonist motif furnished a molecule with balanced dual pharmacology, as demonstrated in a guinea pig trachea tissue model of bronchoconstriction. This approach provides new starting points for the treatment of chronic obstructive pulmonary disease and illustrates the potential for building selectivity into GPCR modulators that possess intrinsic promiscuity or reverse selectivity.

Inhalation by design: dual pharmacology ß-2 agonists/M3 antagonists for the treatment of COPD.

This paper describes the successful design and development of dual pharmacology ß-2 agonists-M3 antagonists, for the treatment of chronic obstructive pulmonary disorder using the principles of 'inhalation by design'. A key feature of this work is the combination of balanced potency and pharmacodynamic duration with desirable pharmacokinetic and material properties, whilst keeping synthetic complexity to a minimum.

Peptide-based stimuli-responsive biomaterials.

This article explores recent advances in the design and engineering of materials wholly or principally constructed from peptides. We focus on materials that are able to respond to changes in their environment (pH, ionic strength, temperature, light, oxidation/reduction state, presence of small molecules or the catalytic activity of enzymes) by altering their macromolecular structure. Such peptide-based responsive biomaterials have exciting prospects for a variety of biomedical and bionanotechnology applications in drug delivery, bio-sensing and regenerative medicine.

"To protect or not to protect?" Complaining vulnerable adults? That is the challenge.

PURPOSE: Hidden camera television documentaries filmed in care home settings have shown evidence of the abuse of vulnerable adults, been widely discussed in the mass media and have brought the attention of the mass population to the importance of these issues. Governmental documents have also emphasised the need to protect vulnerable adults. It is therefore known that vulnerable adults exist and require protection from abuse in any shape or form. However, this paper aims to argue that protecting vulnerable adults and the current mechanisms for encouraging such individuals to make their views known to services are not mutually compatible. The main technique vulnerable adults may use, the complaints procedure, currently may not be sufficient to enable vulnerable adults to express themselves and their anxieties adequately. DESIGN/METHODOLOGY/APPROACH: The paper provides a case study which clearly demonstrates the nature of the problems, and then recognises and describes a number of levels which could be explored to learn more about these issues. RESEARCH LIMITATIONS/IMPLICATIONS: Potential solutions are explored by the authors, who draw conclusions about the need for further research into this area. ORIGINALITY/VALUE: This paper defines a gap between adult protection and complaints procedures, questioning both their efficacy and abilities to meet their stated aims. The paper also highlights that the nature of these may not sufficiently enable complaining vulnerable adults to express their views of services.