Habitat phenotyping of two sub-Antarctic flies by metabolic fingerprinting: evidence for a species outside its home?

Metabolic fingerprinting can elucidate rearrangements of metabolic networks in organisms exposed to various environmental conditions. Maintenance of organismal performance occurs by alterations in metabolic fluxes and pathways, resulting in habitat-specific metabolic signatures. Several insects of sub-Antarctic Islands, including the wingless flies Anatalanta aptera and Calycopteryx moseleyi, are exposed to saline organic matter accumulated along littoral margins. However, C. moseleyi has long been considered restricted to a habitat of lower salinity, the Kerguelen cabbage. High C. moseleyi densities identified in saline decaying seaweeds are intriguing, and may involve osmoregulatory adjustments including accumulation of osmoprotectants. In the present work, we examined quantitative metabotypes (metabolic phenotypes) among wild C. moseleyi individuals from seaweeds versus non-saline Kerguelen cabbages. They were compared to metabotypes from wild A. aptera, a common fly on seaweed. Statistical procedures designed to magnify between-class differences failed to clearly separate C. moseleyi metabotypes from cabbage and seaweed, despite contrasted morphotypes, diets, and salinities. A. aptera exhibited higher glycerol, inositol, trehalose, and other osmoprotectants concentrations that may enhance its performance under saline environments. Seaweed may represent a secondary niche in C. moseleyi, promoted by the marked reduction in Kerguelen cabbage frequency subsequent to climate change, and herbivorous pressures caused by rabbit invasion.

Positioning, identity and professionalism: a searching question for dental faculties.

As the new Joint Dental Council appointed by the two Dental Faculties of The Royal College of Surgeons of England begins its work to improve inter-faculty collaboration, this paper suggests some of the issues that will need to be addressed. Drawing on the concepts of 'positioning', 'identity' and 'professionalism', the question is raised as to how the Faculties may seek to engage more meaningfully with dental professionals at large. The need for all Dental Faculties in the British Isles to learn to work together is emphasised. Attention is drawn to the importance, in the rapidly evolving social context in which dental professionals work, of reflecting deeply on the nature of professionalism in contemporary society, and the moral and humanitarian issues that need to be addressed if dentists are to continue to be deemed worthy of the status 'profession'.

Ultraviolet avoidance by embryonic buoyancy control in three species of marine fish.

Pelagic fish embryos are thought to float in or near surface waters for the majority of their development and are presumed to have little to no control over their mobility, rendering these embryos at high risk for damages associated with surface stressors such as ultraviolet radiation (UVR). We recently challenged these long-standing paradigms by characterizing a potential mechanism of stressor avoidance in early-life stage mahi-mahi (Coryphaena hippurus) in which embryos sense external cues, such as UVR, and modify their buoyancy to reduce further exposure. It is unknown whether embryos of other marine fish with pelagic spawning strategies have similar capabilities. To fill this knowledge gap, we investigated buoyancy change in response to UVR in three additional species of marine fish that utilize a pelagic spawning strategy: yellowfin tuna (Thunnus albacares), red snapper (Lutjanus campechanus), and cobia (Rachycentron canadum). Embryos of all three species displayed increased specific gravity and loss of buoyancy after exposures to environmentally relevant doses of UVR, a response that may be ubiquitous to fish with pelagic embryos. To gain further insight into this response, we investigated recovery of buoyancy, oxygen consumption, energy depletion, and photolyase induction in response to UVR exposures in at least one of the three species listed above.

The use of non-prescribed antibiotics; prevalence estimates in low-and-middle-income countries. A systematic review and meta-analysis.

BACKGROUND: The global increase in the utilization of non - prescribed antibiotics (NPA), is concerning, with high persistence within the low and middle-income countries (LMICs). With a negative impact on the health of individuals and communities the use of NPA paves the way to the  propagation of superbugs that potentially predisposes to changes in bacterial resistance patterns, antibiotic resistance (AR) and antimicrobial resistance (AMR). This study aimed at estimating through a systematic review and meta-analysis, the prevalence of NPA utilisation and describe its primary sources in LMICs. METHODS: The study is a systematic review and meta-analysis which study protocol was registered in PROSPERO (CRD42017072954). The review used The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.  The studies searched in databases were deemed eligible if reported evidence of practices of self-medication with antibiotics (SMA) and the prevalence of NPA utilisation within adult participants from LMICs, published between 2007 to 2017. The pooled analyses were carried out using Meta XL statistical software. The pooled prevalence was calculated with a 95% confidence interval (CI). The risk of bias of the included studies was assessed using the Quality in Prognosis Studies (QUIPS) tool. RESULTS: The review included a total of 11 cross-sectional studies, involving 5080 participants and conducted in LMICs from Asia (India, Laos, Nepal, Pakistan, Sri Lanka and Yemen), Latin America (Guatemala), Africa (Nigeria). All studies reported existing  practices of SMA, with reported prevalence ranging from 50% to 93,8%. The pooled prevalence of SMA was 78% (95% CI: 65-89%). The main sources of NPA were; pharmacies, family and friends, old prescriptions, home cabinet and leftover antibiotics. CONCLUSION: This study revealed a high prevalence of utilisation of NPA in the studied LMICs, these were found to be twice as high in women than men and those participants aged between 18 and 40 years old. The review suggests f considering broader qualitative and comprehensive contextuallized research to better understand the nuances of NPA use. These would be benefitial to uncover uncover gray areas, inform decisions, support the (re) design and implementation of multifaceted interventions towards antibiotic stewardship and conservancy in LMICs.

Ageing and thermal performance in the sub-Antarctic wingless fly Anatalanta aptera (Diptera: Sphaeroceridae): older is better.

Senescence is a progressive biological process expressed in behavioural, morphological, physiological, biochemical and cellular age-related changes. Age-associated alterations in activity are regularly found in insects when examining whole-organism senescence over the adult lifespan. In addition, overall stress resistance usually decreases with senescence. In the present study, we measured the critical thermal minimum (CT(min)) and the subsequent recovery period over the lifespan of the sub-Antarctic wingless fly, Anatalanta aptera. Experiments were conducted on males and females in seven age groups: newly emerged, 1.5-, 5-, 7-, 13-, 15- and 18-month-old adults. Surprisingly, CT(min) decreased significantly with ageing in A. aptera, from -3.8 +/- 0.5 degrees C just after the emergence to -5.6 +/- 0.7 degrees C in the 18-month-old flies. The subsequent recovery period remained similar between the seven groups tested. Our unexpected results contradict the previous data collected in other insects. We have demonstrated for the first time that ageing may improve rather than impair locomotor activity during unfavourable thermal conditions. It raises questions and challenges the literature dealing with ageing. These fascinating results also question the underpinning mechanisms involved in the improvement of the thermal performance with ageing in A. aptera.

Do ice nucleating agents limit the supercooling ability of the land snail Cornu aspersum?

The supercooling ability of adults and eggs of the partially freezing tolerant land snail Cornu aspersum remains limited to high subzero temperatures (ca. -5 degree C) whatever the conditions, suggesting the presence of ice nucleating agents (INAs). In this study, we investigated the nucleation activity of the digestive tract of adult snails, eggs and their direct environment: food, faeces and soil. The mucous ribbon always present in the distal intestine of adults exhibited a heat-sensitive (i.e. organic) nucleation activity, close to that of the entire snails during dormant states (aestivation and hibernation). However, a microbial nature of these INAs could not be established in inactive snails. The food provided to active snails contained ice nucleating bacteria, which followed the digestive tract to be found in the intestine and in the faeces, but with a decreasing concentration along the transit. Eggshells also presented a heat-sensitive nucleation activity, which could be related to its structure. Moreover, eggs are laid directly in the soil which contained both organic and mineral INAs. This study is the first to demonstrate the implication of organic INAs in the cold hardiness of a terrestrial gastropod.

Dentistry as a business: in search of the moral high ground.

This paper has been developed from a version originally submitted as an assignment for the Faculty of General Dental Practice (UK) Certificate in Health Services Leadership and Management Course. It has been revised in the light of the independent review led by Professor Jimmy Steele into National Health Service dental services in England (generally referred to as the Steele Report), which has commented on many of the points dealt with here. The paper addresses issues arising from a moral tension often experienced by dentists between the professional desire to serve patients well and the necessity, as practice owners running a business, to survive financially. The need for honest and open recognition of what is truly achievable from the public purse is stressed. Rights and responsibilities are discussed in relation to professional practitioners, their patients, and society in general, in seeking the moral high ground under different funding arrangements. The paper concludes by stressing the need to offer improved health rather than palliation of disease.

Mentoring. A quality assurance tool for dentists. Part 6: Outcomes: patient care, professional development and personal growth. Authentic happiness for dentists.

This paper is the last in a series of six papers that have described different aspects of mentoring. It considers the impact of mentoring when it is used in general dental practice, applying the technique of learning through positive psychology. The first part of the paper considers this approach from a patient's perspective, the second from the perspective of a dentist. Because the impact on the quality of care for the patient is largely mediated through the personality of the dentist, the quality of the dentist's own performance, during his/her professional relationship with the patient, is a critical ingredient. The way that this critical ingredient impacts on quality of care is considered and parallels are drawn between roles assumed in dental practice and those found in industry. The paper also considers the way in which mentoring, as a part of a professional development programme, can enhance dentists' personal skills and performance. It is an opportunity for great personal growth, with increased levels of job and life satisfaction, leading to greater levels of authentic happiness for all those involved, not least for dentists and the dental team.

Developing a mentoring culture in dentistry. Making a difference in a changing world.

This paper follows the recent series published in Primary Dental Care on the subject of mentoring. It is intended to place mentoring in a broader societal, professional, ethical and philosophical context. The introduction of the mentoring approach into human affairs in general, and the workplace in particular, is evidence of a fundamental shift both in the way we work together as individuals and in how we view and value ourselves as human beings. This paper reflects on the changes in thinking and attitudes in society that have led to the emergence of mentoring and coaching as elements in the approach of positive psychology. It then seeks to learn from the experience of the adoption of mentoring and coaching in other areas of work and society. It goes on to consider what impact this might have on underlying beliefs and attitudes within the profession of dentistry, and who might become the mentors and the mentees. Finally, it presents mentoring as an expression of the values and the culture of a caring profession seeking to promote the 'good life' both for its patients and for its practitioners.

Pharmacists' practices for non-prescribed antibiotic dispensing in Mozambique.

BACKGROUND: Antibiotics are the most frequently used medicines worldwide with most of the countries defining these as prescription-only medicines. Though, dispensing non-prescribed antibiotics represent one of the chief causal factors to the irrational use of antibiotics that paves the way to the development of antimicrobial resistance. OBJECTIVE: We aimed at describing the practices and the enablers for non-prescribed antibiotic dispensing in Maputo city, Mozambique. METHODS: A qualitative study was conducted, between October 2018 and March 2019, in nine private pharmacies randomly selected across Maputo city. Eighteen pharmacists were contacted and seventeen enrolled through snowball sampling. In-depth interviews were conducted, audiotaped, and transcribed verbatim. Transcripts were coded and analysed though thematic analysis with guidelines from Braun and Clark. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist by (Tong, 2007) was performed. RESULTS: Out of seventeen, fifteen pharmacists admitted non-prescribed dispensing of antibiotics. Common antibiotic dispensing practices included; dispensing without prescription, without asking for a brief clinical history of patients, without clear explanation of the appropriate way of administering, without advising on the side effects. Reasons for non-prescribed antibiotic dispensing are linked to patients' behaviour of demanding for non-prescribed antibiotics, to the patients expectations and beliefs on the healing power of antibiotics, to the physicians' prescribing practices. Other reasons included the pressure for profits from the pharmacy owners, the fragile law enforcement, and absence of accountability mechanisms. CONCLUSIONS: The practices of non-prescribed antibiotic dispensing characterize the 'daily life' of the pharmacists. On the one hand, the patient's demand for antibiotics without valid prescriptions, and pharmacist's wish to assist based on their role in the pharmacy, the pressure for profits and on the understanding of the larger forces driving the practices of self-medication with antibiotics - rock. On the other hand, pharmacists are aware of the legal status of antibiotics and the public health consequences of their inappropriate dispensing practices and their professional and ethical responsibility for upholding the law - hard place. Highlighting the role of pharmacists and their skills as health promotion professionals is needed to optimizing antibiotic dispensing and better conservancy in Mozambique.

Identifying the commonly used antibiotics for self-medication in urban Mozambique: a qualitative study.

OBJECTIVES: The study aimed at identifying the commonly used non-prescribed antibiotics (NPAs) and the main health conditions leading to the practices of self-medication with antibiotics (SMAs) in Maputo city, Mozambique. DESIGN: Cross-sectional qualitative study based on individual and group interviews. SETTING: The study was conducted in nine pharmacies of three socioeconomic areas of Maputo city, from October 2018 to March 2019. PARTICIPANTS: The study included 32 pharmacy clients and 17 pharmacists. The pharmacy clients included men 10 (31%) and women 22 (69%) ranging from 19 to 67 years while the pharmacists included men 6 (35,3%) and women 11 (64,7%) with ages ranging from 24 to 47 years. FINDINGS: The majority of the pharmacy clients 30 (93.75%) admitted frequent use of NPAs, 15 (88.2%) out of the 17 pharmacists admitted dispensing NPAs. While the majority of the participants (16) mentioned the use of amoxicillin, also known as 'two colours medicine', 14 mentioned the use of cotrimoxazole and seven mentioned amoxicillin with clavulanic acid. Two to five participants also used tetracycline, ciprofloxacin, azithromycin, doxycycline, erythromycin, metronidazole and phenoxymethylpenicillin. The above mentioned NPAs were used to treat self-perceived sore throat, fever, pain, cough, vaginal discharge, eye problems, the common influenza, urinary infections, respiratory tract infections, wounds and toothaches. CONCLUSIONS: Antibiotics are perceived as essential medical resources to manage health and illnesses. While taking an active role in their health-disease process, participants commonly used amoxicillin, 'two colours', cotrimoxazole and amoxicillin with clavulanic acid to manage their health and that of their families. In this sense, the practices of SMAs were perceived as part of the self-care process and not necessarily as misuse of antibiotics. A wideunderstanding of health-seeking beliefs and behaviours regarding the utilisation of antibiotics is needed to inform public health experts, health policymakers and other stake-holders in designing and implementing public health education and health promotion programsat all levels in Mozambique.

Mentoring. A quality assurance tool for dentists. Part 3: Building a successful mentoring relationship.

The contribution that the mentor can make to the mentoring relationship is undoubtedly crucial. It revolves around mentor qualities, including honesty, congruence, self-sufficiency, and patience. Mentor attitudes include unconditional positive regard for the mentee and mentee focus. Mentor behaviours include establishing rapport, demonstrating warmth and empathy, and giving constructive feedback. There are also unhelpful mentor positions, which are to be avoided. However, there are enormous rewards for the mentor. Mentees also make a significant contribution to the successful relationship by being open to the process and ready to engage with their mentor in order to discover their own goals and develop their own resources and career. This will help them to serve their patients better in the years to come and thereby to achieve a greater sense of purpose, satisfaction and reward in their professional lives.

Mentoring. A quality assurance tool for dentists part 5: the roots of the modern approach to mentoring and coaching.

Mentoring and coaching, as they are currently practised, are relatively new techniques for working with people. The roots of the current approach can be traced back to the psychotherapist Carl Rogers, who developed a new 'person-centred approach' to counselling and quickly realised that this approach was also appropriate for many types of relationship, from education to family life. Rogers' thinking was deeply influenced by dialogues with his friend, the existentialist philosopher Martin Buber. Developments in psychology building upon this new person-centred approach include transactional analysis (TA) and neurolingusitic programming (NLP). More recently, solutions-focused approaches have been used and a related approach to leadership in the business environment-strengths-based leadership-has been developed. In recent years, developments in neuroscience have greatly increased understanding not only of how the brain is 'wired up' but also of how it is specifically wired to function as a social organ. The increased understanding in these areas can be considered in the context of emotional and social intelligence. These concepts and knowledge have been drawn together into a more structured discipline with the development of the approach known as positive psychology, the focus of which is on the strengths and virtues that contribute to good performance and authentic happiness.

Mentoring. A quality assurance tool for dentists. Part 2: what are mentoring and coaching?

In this paper, the traditional model of mentoring is briefly explained. A description of the current technique, which has developed from the traditional model, is then presented and a distinction made between mentoring and coaching, followed by a brief explanation of how mentoring, coaching and counselling make up a triad of helping activities. The authors then provide information on the use and impact of mentoring and coaching in some areas of human activity, other than dentistry, before outlining the application potential of these approaches in general dental practice. The paper concludes that the modern approach to mentoring and counselling offers a person-centred approach that is much more likely than traditional approaches to produce personal change, personal growth and personal development. Further aspects of this important and exciting subject will be explored in subsequent papers in this series.

Mentoring. A quality assurance tool for dentists. Part 4: some tools for mentoring and coaching. The mentoring encounter.

This paper reviews a range of tools that a mentor may use to facilitate the mentoring process. In particular, six 'Master Tools' are highlighted and discussed. Some tools represent mentor qualities and attitudes whereas others represent particular strategies, especially asking questions, which may be employed to move the conversation in a helpful direction for a mentee. The use of 'scripts' is described as part of a mentor's preparation for dealing with difficult or unexpected situations or questions. Because it is important for mentors to be able to give feedback effectively, a section of the paper is devoted to this aspect in which some specific tools are described. A brief description of transactional analysis is given and a template for use of the GROW model is illustrated.

Patterns of self-medication with antibiotics in Maputo City: a qualitative study.

Background: Mozambique classifies but does not yet enforce antibiotics as prescription-only-medicine (POM) allowing the public access to a variety of antibiotics that otherwise are provided on prescription. This contributes to the growing practice of self-medication with antibiotics (SMA) which systematically exposes individuals to the risk of developing antibiotic resistance, antibiotic side effects and increases the health service costs and morbidity. This study aimed at describing the patterns of SMA among Maputo city pharmacy customers. Methods: A qualitative study conducted between October 2018 and March 2019 was developed with thirty-two pharmacy customers and seventeen pharmacists. Using convenience sampling, customers were recruited after buying antibiotics without prescription from nine private pharmacies. Of the thirty-two participants, twenty participated in in-depth interviews and twelve in two focus groups discussions (FGD) with six participants each. Purposive sampling and a snowball technique were used to recruit pharmacists. The transcripts were coded and analyzed using latent content analysis. Nvivo 11 was used to store and retrieve the data. The COREQ (Tong, 2007) checklist for interviews and FGD was performed. Results: Customers admitted practices of SMA, pharmacists admitted dispensing a variety of antibiotics without prescription. Non-prescribed antibiotics (NPA) were obtained through five different patterns including; using the generic name, describing the physical appearance and using empty package, describing symptoms or health problem to pharmacists, using old prescriptions and sharing antibiotics with family, friends, and neighbors. Conclusion: Different patterns of SMA are contributing to the indiscriminate use of antibiotics among customers. The NPA utilization is perceived as an expression of self-care where participants experience self-perceived symptoms and indulge in self-treatment as a method of caring for themselves. Moreover, antibiotics are mostly used to treat diseases that do not necessarily need antibiotics. Strong and effective public health education and promotion initiatives should be implemented to discourage inappropriate utilization of antibiotics and SMA practices.

The need for leadership and vision in dentistry. A personal view.

This paper considers how dentistry has developed in the United Kingdom (UK) over the last 60 years and concludes that dentists have failed to be proactive and to shape the systems for the delivery of an optimal level of care to the population. It suggests that there is a need for far better leadership and for dentists, as individuals and as a profession, to rediscover the sense of vision that they once had and to shape their destinies, rather than accepting the current situation. The author goes on to explain how this might be done. Since the inception of the National Health Service (NHS), the dental profession in the UK has, to a large extent, been dominated by the politics of the NHS, by changing fee structures and contracts, by reports from the Review Body on Doctors' and Dentists' Remuneration (DDRB), and by strategies adopted by successive governments, especially during the last two decades. These strategies have resulted in cohorts of disillusioned dental practitioners reducing their commitment to, or opting out of, NHS contracts and committing themselves, to a greater or lesser extent, to private practice. It is now over three years since, for the first time, the proportion of dentistry provided under private contact in the UK, as measured by gross fees, exceeded that provided under NHS contract. The profession has shown a remarkable lack of imagination in organising itself to provide the best kind of care for patients. Instead of being proactive and visionary, it has allowed itself to become a political football. This has led to the progressive deskilling of many practitioners, and a manifest failure to secure the long-term oral health of patients. This paper considers how the situation could be improved and looks at four aspects, which are: 1. 21st century dentistry: state of the art versus reality? The contrast between what is clinically possible and what the profession currently delivers. 2. What are we here for? The need for a new vision for dentistry, the profession and the future, and the need for a new sense of mission. 3. A responsibility for the profession. The responsibility of the profession for providing patients (and funding bodies) with advice. 4. Leading the way: a new-look personal development plan. The personal development needs of dentists, with much more emphasis on interpersonal and leadership skills.

Mentoring. A quality assurance tool for dentists. Part 1: the need for mentoring in dental practice.

This paper introduces the concept of mentoring and its use in dental practice. It explains how there has been a drive for quality in all areas of healthcare in the United Kingdom (UK), and that clinical audit and clinical governance are two of the quality assurance tools that have been developed. It suggests that the most important factor in the provision of quality care is the dentist and that it is therefore essential that dentists are given support and encouragement by their peers, together with recognition of good performance. The next section of the paper considers factors that hinder a dentist's quality of performance. It explains that there are multiple stresses in dental practice and, if they are not managed and controlled, that they can lead to professional burnout, anxiety and depression. One of the most important stressors that can impact on the quality of patient care is the constraint of time, which can frequently result from pressure from third parties such as managers and administrators. Dentists often feel isolated. The final section of the paper describes how dentists may be supported. Techniques include developing special interests within oral healthcare, career development, good human resource management, peer review and study groups, and coaching and mentoring. The nature of these last two techniques is discussed and the authors conclude that the best tool for supporting the quality of performance of dentists is mentoring.

Evidence of factors influencing self-medication with antibiotics in LMICs: a systematic scoping review protocol.

BACKGROUND: The Sustainable Development Goals (SDGs) emphasize the need for strengthening the capacity of all developing countries in the early warning, risk reduction and management of national as well as global health risks. Despite there being a considerable amount of effort in controlling and promoting the rational use of antibiotics, studies show that the practice of self-medication with antibiotics (SMA) systematically exposes individuals to the risk of antibiotic resistance and other antibiotic side effects. The proposed scoping review aims to map literature on the factors influencing self-medication with antibiotics in low- and middle-income countries (LMICs). METHODS AND ANALYSIS: The adopted search strategy for this scoping review study will involve electronic databases including PubMed, Web of Knowledge, Science Direct, EBSCOhost (PubMed, CINAHL, MEDLINE), Google Scholar, BioMed Central and World Health Organization library. A two-stage mapping strategy will be conducted. Stage 1 will screen studies through examining their titles and screening abstracts descriptively by focus and method as stipulated by the inclusion and exclusion criteria. In stage 2, the researchers will extract data from the included studies. A parallel screening and data extraction will be undertaken by two reviewers. In accessing the quality of the included studies, the researchers will utilize the mixed methods appraisal tool (MMAT, version 11). The NVivo computer software (version 11) shall be used to classify, sort, arrange and examine relationships in the data, and to extract the relevant outcomes and for the thematic analysis of the studies. DISCUSSION: The study anticipates finding relevant studies reporting evidence on the factors influencing self-medication with antibiotics in LMICs. The evidence obtained from the included studies will help guide future research. The study findings will be disseminated electronically and in print with presentations being done at relevant platforms, i.e. conferences related to antibiotic use, antimicrobial resistance, health seeking behaviour and the use of medicines. SYSTEMATIC REVIEW REGISTRATION: Prospero Registration Number: CRD42017072954.