Suppression of Richtmyer-Meshkov Instability via Special Pairs of Shocks and Phase Transitions.

The classical Richtmyer-Meshkov instability (RMI) is a hydrodynamic instability characterizing the evolution of an interface following shock loading. In contrast to other hydrodynamic instabilities such as Rayleigh-Taylor, it is known for being unconditionally unstable: regardless of the direction of shock passage, any deviations from a flat interface will be amplified. In this article, we show that for negative Atwood numbers, there exist special sequences of shocks which result in a nearly perfectly suppressed instability growth. We demonstrate this principle computationally and experimentally with stepped fliers and phase transition materials. A fascinating immediate corollary is that in specific instances, a phase-transitioning material may self-suppress RMI.

Pediatric Cardiology Fellowship Standards for Training in Exercise Medicine and Curriculum Outline.

Over the past 2 decades, fundamentals of exercise medicine, including clinical exercise testing, assessment and promotion of physical activity, exercise prescription, and supervised exercise training/rehabilitation programming have demonstrated considerable clinical value in the management of children and adolescents with congenital and acquired heart disease. Although the principles of exercise medicine have become an integral component in pediatric cardiology, there are no standardized training recommendations for exercise physiology during pediatric cardiology fellowship at this time. Thus, the Pediatric Cardiology Exercise Medicine Curriculum Committee (PCEMCC) was formed to establish core and advanced exercise physiology training recommendations for pediatric cardiology trainees. The PCEMCC includes a diverse group of pediatric cardiologists, exercise physiologists, and fellowship program directors. The expert consensus training recommendations are by no means a mandate and are summarized herein, including suggestions for achieving the minimum knowledge and training needed for general pediatric cardiology practice.

Changes in physical activity across a 6-month weight loss intervention in adolescents with intellectual and developmental disabilities.

BACKGROUND: Adolescents and young adults with intellectual and developmental disabilities (IDD) have high rates of obesity and low levels of physical activity. This analysis examined changes in light, moderate-to-vigorous physical activity (MVPA) and sedentary time, and the association between changes in MVPA and weight loss in adolescents and young adults with IDD and overweight and obesity participating in a 6-month multi-component weight loss intervention. METHODS: Adolescents and young adults with IDD and overweight or obesity (body mass index ≥ 85 percentile, n = 110, age ~16 years, 52.7% female) and a parent were randomised to one of three intervention groups: face-to-face delivery/conventional reduced energy diet (n = 36), remote delivery (RD)/conventional reduced energy diet (n = 39), or RD/reduced energy enhanced stop light diet (eSLD) (n = 35.) Participants were asked to engage in 60 min/day of MVPA on 5 or more days/wk. Participants and a parent attended twice monthly education/behavioural counselling sessions with a health educator to assist participants in complying with dietary and MVPA recommendations. Education/counselling in the RD arms was delivered remotely using video conferencing, and self-monitoring of MVPA and daily steps was completed using a wireless activity tracker. Education/counselling in the face-to-face arm was delivered during home-visits and self-monitoring of MVPA and daily steps was completed by self-report using paper tracking forms designed for individuals with IDD. MVPA, light activity, and sedentary time were assessed over 7 days at baseline and 6 months using a portable accelerometer (ActiGraph wGT3x-BT). RESULTS: Mixed modelling analysis completed using participants with valid accelerometer data (i.e. ≥4-10 h days) at baseline (n = 68) and 6 months (n = 30) revealed no significant changes in light, moderate- MVPA, or sedentary time across the 6-month intervention (all P > 0.05). Participants obtained 15.2 ± 21.5 min/day of MVPA at baseline and 19.7 ± 19.7 min/day at 6 months (P = 0.119). Mixed modelling indicated no significant effects of group (P = 0.79), time (P = 0.10), or group-by-time interaction (P = 0.21) on changes in MVPA from baseline to 6 months. Correlational analysis conducted on participants with valid accelerometer data at both baseline and 6 months (n = 24) revealed no significant associations between baseline sedentary time (r = 0.10, P = 0.40) and baseline MVPA (r = -0.22, P = 0.30) and change in MVPA across the 6-month intervention. Additionally, attendance at education/counselling sessions (r = 0.26, P = 0.22) and frequency of self-monitoring of MVPA were not significantly associated with change in MVPA from baseline to 6 months (r = 0.26, P = 0.44). Baseline MVPA (r = 0.02, P = 0.92) and change in MVPA from baseline to 6 months (r = 0.13, P = 0.30) were not associated with changes in body weight across the 6-month intervention. CONCLUSION: We observed a non-significant increase in MVPA (30%), which was not associated with the magnitude of weight loss in a sample of adolescents and young adults with IDD who participated in a 6-month multi-component weight loss intervention. Additional strategies to increase MVPA in adolescents and young adults with IDD participating in weight loss interventions need to be developed and evaluated.

Intrapersonal, interpersonal and environmental correlates of moderate to vigorous physical activity and sedentary time in adolescents with intellectual and developmental disabilities.

BACKGROUND: Although correlates of physical activity (PA) have been extensively examined in both children and adolescents who are typically developing, little is known about correlates of moderate to vigorous physical activity (MVPA) and sedentary time in adolescents with intellectual and developmental disabilities (IDD). Therefore, we examined intrapersonal, interpersonal and environmental factors and their association with device-based MVPA and sedentary time in adolescents with IDD. METHODS: MVPA and sedentary time was assessed using a hip-worn ActiGraph model wGT3x-BT tri-axial accelerometer across a 7-day period in adolescents with IDD and one of their parents. Pearson and point-biserial correlations were calculated to inspect the associations of PA (MVPA, sedentary time) with intrapersonal factors (demographic characteristic, BMI, waist circumference, motor ability, muscle strength, grip strength, cardiovascular fitness and self-efficacy for PA), interpersonal factors (parent demographics, parent BMI, parent MVPA and sedentary time, family social support for PA, parent barriers and support for PA, parent's beliefs/attitudes towards PA and number of siblings), and environmental factors (meteorologic season and COVID-19). Ordinary least squares regression was used to estimate the unique contributions of key factors to PA after controlling for participants' age, sex, race, waist circumference and total wear time. RESULTS: Ninety-two adolescents (15.5 ± 3.0 years old, 21.7% non-White, 6.5% Hispanic, 56.5% female) provided valid accelerometer data. Average sedentary time was 494.6 ± 136.4 min/day and average MVPA was 19.8 ± 24.2 min/day. Age (r = 0.27, P = 0.01), diagnosis of congenital heart disease (r = -0.26, P = 0.01) and parent sedentary time (r = 0.30, P = 0.01) were correlated with sedentary time. BMI (r = -0.24, P = 0.03), waist circumference (r = -0.28, P = 0.01), identifying as White (r = -0.23, P = 0.03) and parent MVPA (r = 0.56, P < 0.001) were correlated with MVPA. After adjusting for the adolescent's age, sex, race, waist circumference, and total wear time, the association between parent and adolescent MVPA remained significant (b = 0.55, P < 0.01, partial η2  = 0.11). CONCLUSION: The results of this study provide evidence that race, waist circumference and parental MVPA may influence the amount of MVPA in adolescents with IDD. The limited available information and the potential health benefits of increased MVPA highlight the need to evaluate the effectiveness of multi-component interventions targeting both intrapersonal and interpersonal levels to promote increased PA in adolescents with IDD.

Exploring the effectiveness of an 18-month weight management intervention in adults with Down syndrome using propensity score matching.

BACKGROUND: Down syndrome (DS) is one of the most common birth defects in the USA associated with high levels of overweight and obesity. Unique characteristics of adults with DS that may contribute to the high levels of obesity are high rates of hypothyroidism, poor muscle tone, altered gait and lower resting metabolic rate. Due to these factors, it is unknown if the same weight management interventions that are effective in adults with intellectual or developmental disability (IDD) without DS are as effective in those with DS. Therefore, the purpose of this secondary analysis was to compare changes in weight, diet and physical activity between participants with DS-related and non-DS-related IDD participating in an 18-month weight management trial. METHODS: We used propensity score methods to adjust baseline variables of overweight/obese adults with and without DS participating in an 18-month effectiveness trial with 6 months weight loss and 12 months weight maintenance. Participants followed one of two reduced calorie diet plans, obtained 150 min of moderate-vigorous intensity physical activity (MVPA) per week, and logged dietary intake daily. A health educator held monthly at-home visits with participants and a caregiver to give feedback on intervention compliance. RESULTS: Out of the 124 participants that met the criteria for inclusion, 21 were diagnosed with DS and 103 with non-DS-related IDD. Twenty out of 21 participants with DS were successfully matched. Clinically significant weight loss was seen at 18 months in participants with DS (-5.2%) and non-DS-related IDD (-6.8%), with no difference between groups (P = 0.53). Significant reductions in energy intake were seen across the 18-month intervention in both DS and non-DS-related IDD groups with between-group differences at 12 months only (1119 vs. 1492 kcal/day, respectively; P = 0.003). Although MVPA did not increase in either group across the intervention, those with non-DS-related IDD had higher levels of MVPA compared with those with DS across 18 months. CONCLUSION: Participants with DS lost a clinically significant amount of weight across the 18-month intervention. Compared with those with non-DS-related IDD, those with DS lost similar amounts of weight, had similar decreases in energy intake and participated in less MVPA across the 18-month intervention. Although individuals with DS have physiological factors that may contribute to obesity, weight management interventions designed for individuals with IDD may be equally effective in this population.

Who gains clinical benefit from using insulin pump therapy? A qualitative study of the perceptions and views of health professionals involved in the Relative Effectiveness of Pumps over MDI and Structured Education (REPOSE) trial.

AIMS: To explore health professionals' views about insulin pump therapy [continuous subcutaneous insulin infusion (CSII)] and the types of individuals they thought would gain greatest clinical benefit from using this treatment. METHODS: In-depth interviews with staff (n = 18) who delivered the Relative Effectiveness of Pumps Over MDI and Structured Education (REPOSE) trial. Data were analysed thematically. RESULTS: Staff perceived insulin pumps as offering a better self-management tool to some individuals due to the drip feed of insulin, the ability to alter basal rates and other advanced features. However, staff also noted that, because of the diversity of features on offer, CSII is a more technically complex therapy to execute than multiple daily injections. For this reason, staff described how, alongside clinical criteria, they had tended to select individuals for CSII in routine clinical practice based on their perceptions about whether they possessed the personal and psychological attributes needed to make optimal use of pump technology. Staff also described how their assumptions about personal and psychological suitability had been challenged by working on the REPOSE trial and observing individuals make effective use of CSII who they would not have recommended for this type of therapy in routine clinical practice. CONCLUSIONS: Our findings add to those studies that highlight the difficulties of using patient characteristics and variables to predict clinical success using CSII. To promote equitable access to CSII, attitudinal barriers and prejudicial assumptions amongst staff about who is able to make effective use of CSII may need to be addressed.

Systematic review of guidelines for the assessment and management of high-grade anal intraepithelial neoplasia (AIN II/III).

AIM: There is ambiguity with regard to the optimal management of anal intraepithelial neoplasia (AIN) III. The aim of this review was to assess and compare international/national society guidelines currently available in the literature on the management, treatment and surveillance of AIN III. We also aimed to assess the quality of the studies used to compile the guidelines and to clarify the terminology used in histological assessment. METHOD: An electronic search of PubMed and Embase was performed using the search terms 'anal intraepithelial neoplasia', 'AIN', 'anal cancer', 'guidelines', 'surveillance' and 'management'. Literature reviews and guidelines or practice guidelines in peer reviewed journals from 1 January 2000 to 31 December 2014 assessing the treatment, surveillance or management of patients with AIN related to human papilloma virus were included. The guidelines identified by the search were assessed for the quality of evidence behind them using the Oxford Centre for Evidence-based Medicine 2011 Levels of Evidence. RESULTS: The database search identified 5159 articles and two further guidelines were sourced from official body guidelines. After inclusion criteria were applied, 28 full-text papers were reviewed. Twenty-five of these were excluded, leaving three guidelines for inclusion in the systematic review: those published by the Association of Coloproctology of Great Britain and Ireland, the American Society of Colon and Rectal Surgeons and the Italian Society of Colorectal Surgery. No guidelines were identified on the management of AIN III from human papilloma virus associations and societies. All three guidelines agree that a high index of clinical suspicion is essential for diagnosing AIN with a disease-specific history, physical examination, digital rectal examination and anal cytology. There is interchange of terminology from high-grade AIN (HGAIN) (which incorporates AIN II/III) and AIN III in the literature leading to confusion in therapy use. Treatment varies from immunomodulation and photodynamic therapy to targeted destruction of areas of HGAIN/AIN II/III using infrared coagulation, electrocautery, cryotherapy or surgical excision but with little consensus between the guidelines. Recommendations on surveillance strategies are similarly discordant, ranging from 6-monthly physical examination to annual anoscopy ± biopsy. Over 50% of the recommendations are based on Level 3 or Level 4 evidence and many were compiled using studies that were more than 10 years old. CONCLUSION: Despite concordance regarding diagnosis, there is significant variation in the guidelines over recommendations on the treatment and surveillance of patients with HGAIN/AIN II/III. All three sets of guidelines are based on low level, outdated evidence originating from the 1980s and 1990s.

Spatial propagation of protein polymerization.

We consider the spatial dependence of filamentous protein self-assembly. Through studying the cases where the spreading of aggregated material is dominated either by diffusion or by growth, we derive analytical results for the spatial evolution of filamentous protein aggregation, which we validate against Monte Carlo simulations. Moreover, we compare the predictions of our theory with experimental measurements of two systems for which we identify the propagation as either growth or diffusion controlled. Our results connect the macroscopic observables that characterize the spatial propagation of protein self-assembly with the underlying microscopic processes and provide physical limits on spatial propagation and prionlike behavior associated with protein aggregation.

Production and characterization of a trehalolipid biosurfactant produced by the novel marine bacterium Rhodococcus sp., strain PML026.

AIMS: The aim of this study was to evaluate biosurfactant production by a novel marine Rhodococcus sp., strain PML026 and characterize the chemical nature and properties of the biosurfactant. METHODS AND RESULTS: A novel marine bacterium (Rhodococcus species; strain PML026) was shown to produce biosurfactant in the presence of hydrophobic substrate (sunflower oil). Biosurfactant production (identified as a trehalolipid) was monitored in whole-batch cultures (oil layer and aqueous phase), aqueous phase (no oil layer) and filtered (0·2 µm) aqueous phase (no oil or cells; extracellular) and was shown to be closely associated with growth/biomass production. Extracellular trehalolipid levels increased postonset of stationary growth phase. Purified trehalolipid was able to reduce the surface tension of water to 29 mN m(-1) at Critical Micellar Concentration (CMC) of c. 250 mg l(-1) and produced emulsions that were stable to a wide range of conditions (pH 2-10, temperatures of 20-100°C and NaCl concentrations of 5-25% w/v). Separate chemical analyses of the intact trehalolipid and its constituents demonstrated the compound was in fact a mixture of homologues (>1180 MW) consisting of a trehalose moiety esterified to a series of straight chain and hydroxylated fatty acids. CONCLUSIONS: The trehalolipid biosurfactant produced by the novel marine strain Rhodococcus sp. PML026 was characterized and exhibited high surfactant activity under a wide range of conditions. SIGNIFICANCE AND IMPACT OF STUDY: Strain PML026 of Rhodococcus sp. is a potential candidate for bioremediation or biosurfactant production for various applications.

Professional careers of graduates from one UK dental school.

AIM: The aim of this study was to consider reported working patterns of dentists and retention of the dental workforce. METHOD: Three cohorts of dental graduates from the University of Birmingham (n = 505) were tracked using the General Dental Council (GDC) register to assess retention of the workforce. A questionnaire was sent to these graduates to explore changes in working patterns over time and to investigate the factors which had influenced their choice of job location. RESULTS: A high proportion (90.9%) of the dental graduates included in this tracking exercise were found on the GDC register on the census date. A slightly higher proportion of female graduates (10.3%) than male graduates (8.0%) could not be traced on the current register (p = 0.37). A change in working patterns over time was demonstrated, with more general dental practitioners reporting a shorter working week. 'Availability of jobs' was the factor reported by most respondents to be important in determining job location. CONCLUSION: This study provides evidence of changing work patterns over time. Furthermore, although the majority of the study sample remained on the GDC register, there appeared to have been a gradual loss of subjects from the dental workforce over time. Changes such as these may affect the provision of services and the impact of investment in training. Further research in this area is warranted.

Screening for cognitive and social-emotional problems in individuals with PKU: tools for use in the metabolic clinic.

Cognitive deficits, learning difficulties, and emotional problems occur at significantly higher rates in individuals with phenylketonuria (PKU) than in the general population. The relationship between elevated blood phenylalanine (Phe) levels and the severity of these problems often remain unrecognized. Children and adults with PKU require ongoing screening so that referrals to psychologists or psychiatrists familiar with metabolic disorders can be made when necessary for in-depth evaluation and treatment. To identify screening instruments that can be used by non-psychologists as well as psychologists, a group of 10 psychologists and a psychiatrist in the United States with expertise in neuropsychological assessment and PKU proposed a Uniform Assessment Method for PKU. Questionnaires were selected that reliably detect problems in adaptive behavior, executive function, and emotional well-being, representing the most vulnerable areas for individuals with PKU. These questionnaires are appropriate for individuals from infancy through adulthood, may be administered in less than 1h, have computerized scoring accessibility, have no practice effects, and are available in Spanish and English. In addition to assessing function at a single point in time, the screening measures may be administered at each clinic visit to assess changes in function related to metabolic status or treatment (e.g., Phe-restricted diet, food supplements). The following questionnaires comprise the Uniform Assessment Method for PKU: for 0-2 years, Adaptive Behavior Assessment System-Second Edition (ABAS-II); for 2-17 years, Behavior Rating Inventory of Executive Function (BRIEF) and Behavior Assessment System for Children-Second Edition (BASC-II); and for adults, BRIEF, Beck Anxiety Inventory (BAI), and Beck Depression Inventory-Second Edition (BDI-II). In addition to long-term monitoring of outcomes in PKU, this uniform screening approach facilitates PKU research, as data may be pooled across multiple clinics using a consistent battery of assessment measures.

A comparison of Personal Dental Service (PDS) and General Dental Service (GDS) patients in terms of reported interventions, oral health and dentists' perceptions.

AIMS: The aim of the study was to investigate the reported working patterns, dentist perceptions and patient oral health for dentists in a Personal Dental Services (PDS) pilot and compare this with that of matched dentists working in the General Dental Services (GDS) arrangements in the same part of England. METHOD: Ten dentists were recruited, five each from PDS and GDS practices in Warwickshire, UK. The number of interventions carried out for adult patients in the year to April 2003 was obtained from the Dental Practice Board (DPB) for the two groups and compared. An Oral Health Index (OHX) (Burke and Wilson, 1995) was used to determine the oral health of a selection of patients from the two groups of dentists in the study. The final stage of the study involved semi-structured interviews with the dentists. RESULTS: The average age of dentists was similar, in the early to mid 40's (p>0.05). Both groups were, on average, around 20 years post qualification. The GDS dentists made an average of 3,507 activity reports to the Dental Practice Board in the year examined, compared with 3,441 from the PDS dentists. PDS dentists provided fewer simple periodontal treatments than GDS dentists, but otherwise the pattern of reported activity was similar. Both PDS and GDS dentists suggested that GDS dentists carried out more fillings because of a perverse incentive to provide fillings compared with PDS arrangements. PDS dentists believed that their treatment profiles had not changed significantly since changing to PDS, and suggested that their prescribing was based on clinical need only and was not influenced by the remuneration system. A total of 225 OHX scores were obtained for patients attending PDS dentists and a further 214 from patients attending GDS dentists. Overall, the mean OHX score was lower in the GDS patients than for PDS patients. CONCLUSIONS: PDS dentists provided fewer simple periodontal treatments than their GDS counterparts. There was no difference in the oral health of patients treated under either system. Although there was some evidence of a difference in attitude between GDS and PDS dentists towards charging and claiming for simple periodontal treatment, there was no uniformity of opinion within either group. There would appear to be a number of complex factors impacting upon decisions to treat or monitor dental conditions.

A novel application of terrestrial LIDAR to characterize elevation change at human grave surfaces in support of narrowing down possible unmarked grave locations.

Unmarked graves are difficult to locate once the ground surface no longer shows visible evidence of disturbance, posing significant challenges to missing person investigations. This research evaluates the use of terrestrial LIDAR point data for measuring localized elevation change at human grave surfaces. Three differently sized human graves, one control-pit, and surrounding undisturbed ground, were scanned four times between February 2013 and November 2014 using a tripod-mounted terrestrial laser scanner. All the disturbed surfaces exhibited measurable and localized elevation change, allowing for separation of disturbed and undisturbed ground. This study is the first to quantify elevation changes to human graves over time and demonstrates that terrestrial LIDAR may contribute to multi-modal data collection approach to improve unmarked grave detection.

Predicting response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer with serum biomarkers.

Introduction The aim of this study was to identify patient factors including serum biomarkers that may predict response to neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer staged on magnetic resonance imaging. Prediction of response may be helpful when selecting patients for a non-operative programme. Methods A retrospective review was carried out of patients undergoing neoadjuvant CRT for rectal cancer, conducted at the Royal Devon and Exeter Hospital. All patients were managed through the multidisciplinary team. Receiver operating characteristic (ROC) curve analysis was undertaken to assess the ability of biomarkers to predict response to neoadjuvant CRT. The biomarkers assessed included neutrophils, lymphocytes, monocytes, haemoglobin, platelets, C-reactive protein and carcinoembryonic antigen. Results Seventy-three patients underwent neoadjuvant CRT between January 2006 and December 2011. Nine (12.3%) of these experienced a clinical complete response and were managed with a 'watch and wait' approach. An additional ten patients (13.7%) had a pathological complete response following surgery. Using ROC curve analysis, the biomarkers with the largest area under the curve (AUC) were pre-CRT haemoglobin and post-CRT lymphocyte concentrations, producing AUC values of 0.673 and 0.618 respectively for clinical complete response. Pre-CRT haemoglobin and neutrophil concentrations produced the highest AUC values for pathological complete response at 0.591 and 0.614 respectively. Conclusions None of the assessed biomarkers offer the ability to predict response to neoadjuvant CRT in patients with rectal cancer. They cannot therefore assist in identifying complete clinical or pathological responders who could be considered for a non-operative, observational approach.

Histone deacetylases in acute myeloid leukaemia show a distinctive pattern of expression that changes selectively in response to deacetylase inhibitors.

Histone deacetylase inhibitors (HDIs) are a new class of drugs with significant antileukemic activity. To explore mechanisms of disease-specific HDI activity in acute myeloid leukaemia (AML), we have characterised expression of all 18 members of the histone deacetylase family in primary AML blasts and in four control cell types, namely CD34+ progenitors from umbilical cord, either quiescent or cycling (post-culture), cycling CD34+ progenitors from GCSF-stimulated adult donors and peripheral blood mononuclear cells. Only SIRT1 was consistently overexpressed (>2 fold) in AML samples compared with all controls, while HDAC6 was overexpressed relative to adult, but not neo-natal cells. HDAC5 and SIRT4 were consistently underexpressed. AML blasts and cell lines, exposed to HDIs in culture, showed both histone hyperacetylation and, unexpectedly, specific hypermethylation of H3 lysine 4. Such treatment also modulated the pattern of HDAC expression, with strong induction of HDAC11 in all myeloid cells tested and with all inhibitors (valproate, butyrate, TSA, SAHA), and lesser, more selective, induction of HDAC9 and SIRT4. The distinct pattern of HDAC expression in AML and its response to HDIs is of relevance to the development of HDI-based therapeutic strategies and may contribute to observed patterns of clinical response and development of drug resistance.

Non-carious tooth conditions in children in the UK, 2003.

BACKGROUND: The 2003 Children's Dental Health Survey is the fourth of the 10-yearly surveys of children's oral health. AIM: To report the prevalence of three non-carious tooth conditions in children in the UK. METHOD: A representative sample of children five, eight, 12 and 15 years of age were examined by calibrated examiners in schools across the UK. The dental examination included accidental damage to incisors, tooth surface loss (TSL) and enamel opacities (age 12 only). A postal questionnaire sought parental and child views on marks on teeth which could not be removed by brushing. RESULTS: The proportion of children sustaining accidental damage to permanent incisors decreased to 11% of 12 and 13% of 15-year-olds, but the majority of accidental damage remained untreated. TSL was found on 53% of five-year-olds and on approximately a third of 12 and 15-year-olds. There was a statistically significant change for TSL on permanent teeth at age 15 where 27% upper incisors had TSL palatally in 1993 compared to 33% in 2003. Thirty-four per cent of 12-year-old children had enamel opacities on one or more of their teeth compared with 36% in 1993. CONCLUSIONS: Tooth surface loss remains a common finding in children in the UK. A large proportion of accidental damage to teeth remains untreated.

Patterns of care and service use amongst children in the UK 2003.

BACKGROUND: The 2003 Children's Dental Health Survey is the fourth of the 10-yearly surveys of children's oral health in the United Kingdom. AIM: To detail the reported experience of dental services and dental treatment amongst children in the UK. METHOD: A self-completion questionnaire was distributed to a 50% sub-sample of parents or carers of the children who were clinically examined in the 2003 UK Child Dental Health Survey. This included questions relating to parental and child experience of dental services and dental treatment. RESULTS: The proportion of UK five-year-olds reported as not having visited the dentist fell from 14% in 1983 to 6% in 2003 and the proportion reported as having visited the dentist before the age of two rose from 7% in 1983 to 31% in 2003. Over 80% of all children were reported to seek regular dental check-ups. Around 10% were reported to have had some difficulty in accessing NHS dental care while 5% of five-year-olds were reported to have experienced a general anaesthetic for dental procedures in 2003. Dental attendance was associated with social class and mothers' reported attendance patterns. CONCLUSIONS: In line with previously reported trends, the 2003 survey of children in the United Kingdom shows improvements in several areas but some aspects of attendance pattern continue to be associated with social class and mothers' attendance pattern. It is of concern that 10% of five-year-olds reported having experienced extractions and 5% general anaesthesia for dental treatment.

Oral health habits amongst children in the United Kingdom in 2003.

BACKGROUND: The 2003 Children's Dental Health Survey is the fourth in a series of decennial national children's dental health surveys. AIMS: This paper presents data on parental attitudes towards the care of children's teeth and gums, reported oral hygiene behaviours and clinical measures of hygiene and periodontal health in 2003 and highlights trends since previous surveys. METHOD: A total of 10,381 children were examined in schools by trained and calibrated examiners. Four measures of hygiene and periodontal health were recorded as part of the clinical examination. In addition, 3,342 questionnaires were completed by parents of a sub-sample of these children. The questionnaire enabled information to be collected about reported oral health behaviours and parental attitudes. RESULTS: About three quarters of children across all age groups are reported to brush their teeth twice daily. A range of oral health products was reported as being used in addition to toothbrushes and toothpaste. There is a trend in parental preferences towards restoration of teeth rather than extractions and towards a better understanding of dental caries prevention. Although overall a higher proportion of children in this survey appeared to have gingival inflammation, plaque and calculus than 10 and 20 years ago, there was no change in the proportion of older children with gingivitis. CONCLUSIONS: Dental practitioners have a role to play in reinforcing these positive attitudes and encouraging appropriate and effective oral hygiene behaviours in their child patients.

Considerations in the Evaluation of Potential Efficacy of Medications for Alcohol and Drug Use Disorders: An Editorial.

The societal burden created by alcohol and drug use disorders is estimated to be on the order of hundreds of billions of dollars, creating a need for effective medications to reduce use and prevent relapse. While there are FDA-approved medications to facilitate abstinence and prevent relapse for some indications including, alcohol, tobacco, and opiate use disorders, there are no approved treatments for other abused substances, including cocaine, methamphetamine, and cannabis, leaving these critical medical needs unmet. The development of such medications has fallen largely to the government with efforts spearheaded by the National Institute on Drug Abuse and the National Institute on Alcoholism and Alcohol Abuse. Both agencies have medication development programs with preclinical components that include the standardized evaluation of compounds using animal models. This chapter describes the rationale and considerations involved in the use of such models, including reinstatement of drug self-administration.

Patterns of care and service use amongst children in England, Wales and Northern Ireland 2013.

Background The 2013 Children's Dental Health survey is the fifth in a series of national surveys.Aims This paper describes children's reported use of dental services, their experience of receiving dental treatment and parental satisfaction with services.Methodology A representative sample of children (aged 5, 8, 12 and 15 years) in England, Wales and Northern Ireland were invited to participate in dental examinations. Older children and all parents were invited to complete a questionnaire about oral health behaviours and attitudes.Results Over 80% of 12- and 15-year-olds reported attending for a check-up. According to parents, 9 in 10 children of all ages had visited a dentist in the last year and 9 in 10 parents reported they were satisfied with the last dental practice their child had visited. There was some variation by country with respect to children's experiences of fillings and extractions.Conclusions There has been little change in the reported attendance patterns of children since the 2003 survey. Family deprivation (measured by children's eligibility for free school meals) negatively influenced dental attendance for regular check-ups, attendance within the last 12 months and the likelihood of having experienced difficulties accessing NHS dental services for children.