Development and psychometric validation of the gum health experience questionnaire.

AIM: To develop and validate a new health-related quality of life measure to capture a wide range of gum-related impacts. MATERIALS AND METHODS: The measure was developed using a multi-stage approach and a theoretical model. Development involved semi-structured interviews, pilot testing, cross-sectional analysis among a general population (n = 152) to assess psychometric properties and test-retest reliability among a subsample (n = 27). RESULTS: Psychometric analysis supports the validity and reliability of the measure's impact scale. The measure has excellent internal reliability (nearly all item-total correlations above .4; Cronbach's alpha between .84 and .91 for subscales), with test-retest reliability also performing well (Intra-class correlation coefficient [ICC] of .91-.97 for subscales). Good content validity (indicated by large standard deviations for item and total scores) and construct validity (correlations of .54-.73 with global gum health rating for subscales, all p < .05) were also observed. Qualitative and quantitative data indicate that people with gum health-related symptoms experience different degrees of discomfort and impacts caused by their condition. CONCLUSIONS: The gum health experience questionnaire holds substantial promise as a measure of gum-related quality of life in people across the gum health-disease continuum. Further face validity, refining and reducing the number of items and longitudinal studies to test evaluative properties are required before the measure can be used with confidence.

Effects of parity, seasonal heat stress, and colostrum collection time postpartum on colostrum quality of Holstein cattle in an arid region.

The aim of this study was to determine effects of parity (primiparous vs. multiparous), seasonal heat stress at calving (summer vs. winter), and time postpartum on some parameters associated with colostrum quality in Holstein cows reared in the Sonoran Desert ecosystem. Forty-seven cows (11 primiparous and 36 multiparous) expected to calve during summer, and 46 cows during winter (14 primiparous and 32 multiparous) were randomly selected. Management and feeding before and after parturition were similar for cows in both seasons. After parturition, colostrum from all cows was evaluated for volume, weight, temperature, density, and content of fat, protein, solids non-fat (SNF), and immunoglobulins (IGG). Data were analyzed with a model that included effects of parity status, calving season, and time postpartum, as well as all interactions. Colostrum produced in summer was warmer (P < 0.01) by almost 6 °C than winter colostrum, while colostrum from multiparous was warmer (P = 0.02) by 1.2 °C than that produced by primiparous cows. Colostrum volume and weight were not impacted by parity, calving season or time postpartum. Density, protein, and SNF content in colostrum were higher (P < 0.01) in multiparous vs. primiparous cows, as well as at parturition (0 h postpartum) than at 12 h postpartum (P < 0.01). At calving (0 h), spring colostrum had higher fat content (P < 0.01) and lower (P < 0.01) IGG concentration than that collected in summer, and no difference (P > 0.05) between seasons was observed for these components at 12 h postpartum. Multiparous cows produced colostrum with higher (P < 0.01) IGG concentrations than primiparous cows. In conclusion, only 0-h colostrum and that from multiparous cows was categorized as "Excellent," meanwhile the colostrum produced under summer heat stress was characterized as "Good" with reduced fat content. While the lacteal secretion collected at 12 post-partum still classified as colostrum, substantially lower contents of IGG, protein, fat, and SNF decreased its classification to "Poor" from the classification of "Excellent" at 0 h postpartum.

The Learning Curve of Third-Generation Percutaneous Chevron and Akin Osteotomy (PECA) for Hallux Valgus.

The learning curve to reach technical proficiency for third-generation percutaneous or minimally invasive chevron and Akin osteotomies (PECA/MICA) is recognized to be steep however it is poorly defined in the literature. This study is a retrospective review of the first 58 consecutive PECA cases of a single surgeon. The primary outcome was the number of cases required to reach technical proficiency as defined by the operation time. Secondary outcomes included radiation exposure, radiographic deformity correction, and complication rates. Between November 2017 and March 2019, 61 consecutive PECA cases were performed with outcome data available for 58 of these (95%). Technical proficiency was reached after 38 cases. Operation time and radiation exposure significantly decreased after this transition point (p < .05). There was no difference in complication rate or radiographic deformity correction regardless of position along the learning curve (p > .05). In conclusion, the mean number of cases required to reach technical proficiency in third-generation PECA is 38 cases. The complication rate does not correlate to the number of cases performed, therefore surgeons interested in learning minimally invasive surgery can be reassured that there is unlikely to be an additional risk of harm to a patient during the learning curve.

Golfers have greater preoperative and equal postoperative function when undergoing total knee arthroplasty compared to non-golfers.

BACKGROUND: Approximately 10% to 20% of patients with joint arthroplasties are golfers. The aim of this study was to assess if being a golfer is associated with functional outcomes, satisfaction or improvement in quality of life (QoL) compared to non-golfers following total knee arthroplasty. METHODS: All patients undergoing primary total knee arthroplasty (TKA) over a one-year period at a single institution were included with one-year postoperative outcomes. Patients were retrospectively followed up to assess if they had been golfers at the time of their surgery. Multivariate linear regression analysis was performed to assess the independent association of preoperative golfing status on postoperative function and health-related outcomes. RESULTS: The study cohort consisted of a total of 514 patients undergoing TKA. This included 223 (43.3%) male patients and 291 (56.7%) female patients, with an overall mean age of 70 (SD 9.5) years. The preoperative Oxford Knee Score (OKS) was significantly higher in golfers when adjusting for confounders (Diff 3.4 [95% CI 1 to 5.8], p = 0.006). There was no difference in postoperative outcomes between golfers and non-golfers. There was however a trend towards a higher Forgotten Joint Score (FJS) in the golfers (difference 9.3, 95% CI - 0.2 to 18.8, p = 0.056). Of the 48 patients who reported being golfers at the time of their surgery, 43 (89.6%) returned to golf and 88.4% of those were satisfied with their involvement in golf following surgery. CONCLUSIONS: Golfers had better preoperative and equal postoperative knee specific function compared to non-golfers. The majority of golfers returned to golf by one year and were satisfied with their involvement in the game. LEVEL OF EVIDENCE: III.

Ten rules for effective modeling.

Modeling a natural system such as the brain aims to deepen understanding and to help to explain and link multiple phenomena into a coherent picture. In any specific case, this requires a clear view of the aims of each modeling project, followed by coordinated selection of the model's style and components; theoretical, numerical, and statistical analysis methods; distillation and presentation of results; and resulting well supported conclusions. The ten rules presented here apply to modeling of the brain and other systems and are designed to assist in carrying out integrated modeling with valid and well-supported outcomes that effectively achieve the modeling aims; referees can also use them when assessing the validity of modeling in submitted manuscripts.

Generalized neural field theory of cortical plasticity illustrated by an application to the linear phase of ocular dominance column formation in primary visual cortex.

Physiologically based neural field theory (NFT) is extended to encompass cortical plasticity dynamics. An illustrative application is provided which treats the evolution of the connectivity of left- and right-eye visual stimuli to neuronal populations in the primary visual cortex (V1), and the initial, linear phase of formation of approximately one-dimensional (1D) ocular dominance columns (ODCs) that sets their transverse spatial scale. This links V1 activity, structure, and physiology within a single theory that already accounts for a range of other brain activity and connectivity phenomena, thereby enabling ODC formation and many other phenomena to be interrelated and cortical parameters to be constrained across multiple domains. The results accord with experimental ODC widths for realistic cortical parameters and are based directly on a unified description of the neuronal populations involved, their connection strengths, and the neuronal activity they support. Other key results include simple analytic approximations for ODC widths and the parameters of maximum growth rate, constraints on cortical excitatory and inhibitory gains, elucidation of the roles of specific poles of the V1 response function, and the fact that ODCs are not formed when input stimuli are fully correlated between eyes. This work provides a basis for further generalization of NFT to model other plasticity phenomena, thereby linking them to the range multiscale phenomena accounted for by NFT.

Editorial - Community Dental Health opens its archive of papers to all.

Readers will have noticed the ways we have been modernising Community Dental Health this year. In March we dispensed with hard copies of the journal, publishing it only online. This change was in line with our subscribers' reading behaviours and minimised our environmental impact by reducing the carbon footprints of printing, of using paper and of postage. Subscribers can now also access papers as soon as they are accepted, ahead of publication. Our newly commissioned reviews digest key topics in dental public health to help busy readers keep up with emerging knowledge. In addition, our move to prioritise systematic reviews, by accelerating peer review and fast-tracking publication ensures subscribers' confidence that they are reading the most up to date evidence in our discipline.

Editorial - Going forward, not straight.

Welcome to the first issue of Community Dental Health to be published online only. The journal has been marching ahead now for many years and has reached unprecedented levels of recognition in several aspects of quality. Our Impact Factor (a measure of how often our papers are cited) has risen to its highest ever level of 1.349. A record 383 manuscripts were submitted last year, and as we can only publish 11% of this number, peer review and natural selection combine so that only the very best papers reach the readers.

Neural field theory of neural avalanche exponents.

The power-law exponents of observed size and lifetime distributions of near-critical neural avalanches are calculated from neural field theory using diagrammatic methods. This brings neural avalanches within the ambit of neural field theory, which has also previously explained near-critical 1/f spectra and many other observed features of neural activity. This strengthens the case for near-criticality of the brain and opens the way for these other phenomena to be interrelated with avalanches and their dynamics.

Relationships between lognormal distributions of neural properties, activity, criticality, and connectivity.

Relationships between convergence of inputs onto neurons, divergence of outputs from them, synaptic strengths, nonlinear firing response properties, and randomness of axonal ranges are systematically explored by interrelating means and variances of synaptic strengths, firing rates, and soma voltages. When self-consistency is imposed, it is found that broad distributions of synaptic strength are a necessary concomitant of the known massive convergence of inputs to individual neurons, and observed widths of lognormal distributions of synaptic strength and firing rate are explained provided the brain is in a near-critical state, consistent with independent observations. The strongest individual synapses are shown to have an effect on soma voltage comparable to the effect of all others combined, which supports suggestions that they may have a key role in neural communication. Remarkably, inclusion of moderate randomness in characteristic axonal ranges is shown to account for the observed [Formula: see text]-fold variability in two-point connectivity at a given separation and [Formula: see text]-fold overall when the known mean exponential fall-off is included, consistent with observed near-lognormal distributions. Inferred axonal deviations from straight-line paths are also consistent with independent estimates.

Musculoskeletal radiology training in the UK: a national survey by the British Society of Skeletal Radiologists.

AIM: To identify the standard of core and subspecialist musculoskeletal (MSK) training across deaneries in the UK. MATERIALS AND METHODS: An online survey of 46 questions with responses in Likert scale or dichotomous formats was distributed to members of the Society of Radiologists in training, British Society of Skeletal Radiologists (BSSR), Training Programme Directors and the Royal College of Radiologists (RCR) Junior Radiology Forum representatives for national training schemes across the country. Responses were analysed descriptively with narrative analysis of free-text comments. RESULTS: One hundred and seventy-eight participants completed the survey. Forty-six percent (81/178) were core trainees (ST1-3), 47% (84/178) were subspecialist trainees, and 7% (13/178) were newly qualified consultants (<2 years in post). All (178/178) of the participants had a dedicated MSK rotation, with a duration of ≥3 months in 76% (136/178). Only one-third received a dedicated period in MSK ultrasound and only 60% (107/178) had been actively involved in interventional procedures during their training. Overall, 21% (37/178) and 42% (75/178) of participants rated the quality of their MSK training as excellent and good, respectively. The majority (93%, 168/178) thought that MSK training could be improved, especially for ultrasound (62%, 110/178) and interventional computed tomography (CT) or fluoroscopy (57%, 101/178). CONCLUSIONS: There are inconsistencies in MSK training offered in the UK. Although the majority of trainees are satisfied, there were gaps and potential threats to the quality of training. MSK training is witnessing substantial demand from trainees and workforce strategists necessitating tactical investments to standardise and enhance its quality.

Convergence of marine megafauna movement patterns in coastal and open oceans.

The extent of increasing anthropogenic impacts on large marine vertebrates partly depends on the animals' movement patterns. Effective conservation requires identification of the key drivers of movement including intrinsic properties and extrinsic constraints associated with the dynamic nature of the environments the animals inhabit. However, the relative importance of intrinsic versus extrinsic factors remains elusive. We analyze a global dataset of ∼2.8 million locations from >2,600 tracked individuals across 50 marine vertebrates evolutionarily separated by millions of years and using different locomotion modes (fly, swim, walk/paddle). Strikingly, movement patterns show a remarkable convergence, being strongly conserved across species and independent of body length and mass, despite these traits ranging over 10 orders of magnitude among the species studied. This represents a fundamental difference between marine and terrestrial vertebrates not previously identified, likely linked to the reduced costs of locomotion in water. Movement patterns were primarily explained by the interaction between species-specific traits and the habitat(s) they move through, resulting in complex movement patterns when moving close to coasts compared with more predictable patterns when moving in open oceans. This distinct difference may be associated with greater complexity within coastal microhabitats, highlighting a critical role of preferred habitat in shaping marine vertebrate global movements. Efforts to develop understanding of the characteristics of vertebrate movement should consider the habitat(s) through which they move to identify how movement patterns will alter with forecasted severe ocean changes, such as reduced Arctic sea ice cover, sea level rise, and declining oxygen content.

Impacts on two dairy breeds of adding a third (night) cooling event under extreme ambient heat.

Impacts of an additional cooling event during the night on physiological and productive parameters of two breeds (B) of dairy cows under severe heat stress conditions were determined. Fifteen Holstein (H) and 15 Jersey x Holstein (JxH) cows were assigned to one of the two cooling strategies (CS), where the difference was an added 1 h cooling event during the night (i.e., 3X and 4X cooling events) with the 4X group having the added night cooling event. Maximum and minimum average temperature/humidity indices during the study were 86 and 77 units, respectively. There were no CS x B interactions for any response variable. Body condition score (BCS) was similar between CS, but H cows had higher (P<0.05) condition than JxH. There were no differences in rectal temperature due to CS or B. Respiration rate between breeds and cooling strategies were similar throughout the day. However body surface temperatures of head, thurl, right flank, and udder were higher (P<0.05) in 3X versus 4X cows, and H cows maintained a higher (P < 0.05) temperature in thurl and right flank than JxH during PM hours. Metabolites and hormone concentrations were not affected by CS, but H cows had lower (P < 0.05) triiodothyronine and higher (P < 0.05) thyroxine, than JxH. The 4X cows had higher (P<0.05) milk yield and milk energy output than 3X cows. While H cows produced more milk than JxH, the latter had higher (P < 0.05) milk component levels. In general, JxH cows were judged to have to demonstrate a more desirable physiological response and milk composition outcome than H cows. An additional night cooling event was judged to result in more desirable physiological and productive responses than in cows without this extra night cooling event under the extremely hot and dry environmental conditions during the study.

Nonlinear wave-wave interactions in the brain.

Neural field theory of the corticothalamic system is used to analyze nonlinear wave-wave interactions in steady state visual evoked potential responses. The nonlinear power spectrum is analytically calculated by convolving the linear power spectrum with itself and other factors. Periodic sine and square wave stimuli are used to generate steady state visual evoked potential responses and to study stimulus-driven nonlinear corticothalamic dynamic interactions. Moreover, we use dual sine drives to analyze the driven dynamics. Numerical analysis shows that the nonlinear power spectrum embodies key nonlinear features, including harmonic and subharmonic generation, entrainment of the alpha rhythm to periodic stimuli at the drive frequency, sum and difference frequencies due to wave-wave coalescence and decay. Further, the scaling properties of the key phenomena observed in nonlinear interactions are studied, verifying some of the theoretical predictions for these being generated by three-wave processes.

MRI in acute muscle tears in athletes: can quantitative T2 and DTI predict return to play better than visual assessment?

OBJECTIVES: To assess the ability of quantitative T2, diffusion tensor imaging (DTI) and radiologist's scores to detect muscle changes following acute muscle tear in soccer and rugby players. To assess the ability of these parameters to predict return to play times. METHODS: In this prospective, longitudinal study, 13 male athletes (age 19 to 34 years; mean 25 years) underwent MRI within 1 week of suffering acute muscle tear. Imaging included measurements of T2 and DTI parameters. Images were also assessed using modified Peetrons and British athletics muscle injury classification (BAMIC) scores. Participants returned for a second scan within 1 week of being determined fit to return to play. MRI measurements were compared between visits. Pearson's correlation between visit 1 measurements and return to play times was assessed. RESULTS: There were significant differences between visits in BAMIC scores (Z = - 2.088; p = 0.037), modified Peetrons (Z = - 2.530; p = 0.011) and quantitative MRI measurements; T2, 13.12 ms (95% CI, 4.82 ms, 21.42 ms; p = 0.01); mean diffusivity (0.22 (0.04, 0.39); p = 0.02) and fractional anisotropy (0.07 (0.01, 0.14); p = 0.03). BAMIC scores showed a significant correlation with return to play time (Rs = 0.64; p = 0.02), but modified Peetrons scores and quantitative parameters did not. CONCLUSIONS: T2 and DTI measurements in muscle can detect changes due to healing following muscle tear. Although BAMIC scores correlated well with return to play times, in this small study, quantitative MRI values did not, suggesting that T2 and DTI measurements are inferior predictors of return to play time compared with visual scoring. KEY POINTS: • Muscle changes following acute muscle tear can be measured using T2 and diffusion measurements on MRI. • Measurements of T2 and diffusion using MRI are not as good as a radiologist's visual report at predicting return to play time after acute muscle tear.

Importance of self-connections for brain connectivity and spectral connectomics.

Spectral analysis and neural field theory are used to investigate the role of local connections in brain connectivity matrices (CMs) that quantify connectivity between pairs of discretized brain regions. This work investigates how the common procedure of omitting such self-connections (i.e., the diagonal elements of CMs) in published studies of brain connectivity affects the properties of functional CMs (fCMs) and the mutually consistent effective CMs (eCMs) that correspond to them. It is shown that retention of self-connections in the fCM calculated from two-point activity covariances is essential for the fCM to be a true covariance matrix, to enable correct inference of the direct total eCMs from the fCM, and to ensure their compatibility with it; the deCM and teCM represent the strengths of direct connections and all connections between points, respectively. When self-connections are retained, inferred eCMs are found to have net inhibitory self-connections that represent the local inhibition needed to balance excitation via white matter fibers at longer ranges. This inference of spatially unresolved connectivity exemplifies the power of spectral connectivity methods, which also enable transformation of CMs to compact diagonal forms that allow accurate approximation of the fCM and total eCM in terms of just a few modes, rather than the full [Formula: see text] CM entries for connections between N brain regions. It is found that omission of fCM self-connections affects both local and long-range connections in eCMs, so they cannot be omitted even when studying the large-scale. Moreover, retention of local connections enables inference of subgrid short-range inhibitory connectivity. The results are verified and illustrated using the NKI-Rockland dataset from the University of Southern California Multimodal Connectivity Database. Deletion of self-connections is common in the field; this does not affect case-control studies but the present results imply that such fCMs must have self-connections restored before eCMs can be inferred from them.

MRI hip findings in asymptomatic professional rugby players, ballet dancers, and age-matched controls.

AIM: To investigate hip magnetic resonance imaging (MRI) findings in asymptomatic professional male rugby players and male ballet dancers compared to age-matched controls. MATERIALS AND METHODS: After ethics committee approval and consent from participants, 11 professional rugby players, 10 professional ballet dancers, and 10 controls completed activity and symptom questionnaires and underwent 3 T MRI of their self-declared dominant hip. Each scan was independently scored by two musculoskeletal radiologists for multiple features, including: joint morphology, acetabular labrum appearance, cartilage loss, and capsular thickness. Clinical and MRI features were assessed for variance by group using one-way analysis of variance (ANOVA) tests and Tukey post-hoc pairwise comparison of means. RESULTS: Labral tear prevalence was 87% with no significant difference between groups (p>0.05). Rates of paralabral cysts were significantly higher in ballet dancers (50%), compared to rugby players (0%) and controls (10%; p=0.01). Acetabular cartilage loss was present in 54% with no significant differences between groups. Superior capsular thickness was significantly greater in ballet dancers (5.3 mm) compared to rugby players (3.8 mm) and controls (3.8 mm; p=0.03). CONCLUSION: Despite the difference in type of activity between groups, there were equally high rates of labral tears and acetabular cartilage loss, questioning the role that sport plays in the development of these findings and their relationship to symptoms. The focally increased superior capsular thickness in ballet dancers may be an adaptive response to extreme ranges of movement.

Congenital hyperinsulinism: management and outcome, a single tertiary centre experience.

Hyperinsulinemic hypoglycaemia (HH) is the most frequent cause of persistent hypoglycaemia in neonates and infants. The most severe forms of HH are inherited and referred to as congenital hyperinsulinism (CHI). Diazoxide is the mainstay of treatment, with surgery being an option in appropriate cases. To describe the management and outcome of patients with CHI within our service. Children referred to or attending HH clinic between 2009 and 2017 were identified. Clinical course, genetics and interventions were documented. A total of 39 children were identified, and seven patients with secondary and syndromic HH were excluded. Most were born with an appropriate weight for gestational age (62.5%). Diazoxide was started in all patients; however, 7 did not respond and required octreotide/continuous feeding, with 6/7 requiring surgery. Genetic mutations were detected in 12/32 (37.5%). Hyperinsulinism resolved in conservatively treated patients within 12 months in 11/32 (34.3%) compared to 14/32 (43.7%) requiring more than 12 months of medication. A total of 7 patients underwent pancreatectomy.Conclusion: Although LGA and SGA are risk factors, most babies in our cohort are born AGA. A genetic mutation does not exclude medical remission; long-term conservative treatment of CHI is feasible as surgery does not guarantee complete remission.What is Known:•Congenital hyperinsulinism (CHI) is a clinically and genetically heterogeneous disorder that is the most common cause of permanent hypoglycaemia in infants and children.•Identification of genetic mutations and the use of 18F-DOPA PET scan when feasible lead to better outcomes.What is New:•The study describes clinical criteria, management and outcome of large number of patients with CHI in single tertiary centre.•Conservative treatment is feasible without the need for surgery, with HH resolving in over 30% within 12 months, irrespective of genetic mutation.

Cutaneous adverse events: a predictor of tumour response under anti-PD-1 therapy for metastatic melanoma, a cohort analysis of 189 patients.

INTRODUCTION: Cutaneous adverse events (AEs) are the most prevalent toxicity under checkpoint inhibitors in clinical trials. In 'real-life' conditions of use, skin toxicities under anti-PD-1 have not been described to date in a large cohort. The objective of this study was to determine the clinical features of skin toxicities in patients with advanced melanoma receiving anti-PD-1 therapy under 'real-life' conditions of use. Secondary objectives were to evaluate the characteristics of patients with skin toxicities and to analyse associated extra-cutaneous toxicities, progression-free survival (PFS) and overall survival (OS). PATIENTS AND METHODS: Advanced melanoma patients treated with nivolumab or pembrolizumab between August 2014 and October 2017 were included. Patients lost to follow-up or receiving anti-PD-1 as part of a clinical trial were excluded. RESULTS: One hundred and eighty-nine patients with metastatic melanoma (with 109 men (57.7%) were included. Cutaneous AE occurred in 39 patients (20.6%). The three most prevalent cutaneous AEs were skin eruption (macular-papular or eczematous) (n = 18, 9.5%), vitiligo (n = 16; 8.5%) and isolated pruritus (n = 5, 2.6%). Grade 3-4 skin toxicity was diagnosed in five patients (2.6%). Atopy (28.2% vs. 12.0%; P = 0.024), hypereosinophilia (20.5% vs. 8.7%; P = 0.046), thyroiditis (17.9% vs. 4.7%; P = 0.011) and renal toxicity (15.4% vs. 4%; P = 0.019) were significantly associated with cutaneous AE. Patients with skin eruption (log-rank = 0.001), vitiligo (log-rank = 0.001) and any type of cutaneous AE (log-rank < 0.001) had a better overall survival. CONCLUSIONS: Cutaneous AEs are frequent and often manageable toxicity and were a predictor of tumour response in melanoma patients under anti-PD-1 therapy in this cohort.

Nonlinear harmonic generation in the corticothalamic system.

Neural field theory of the corticothalamic system is applied to quantitatively analyze harmonic generation in normal sleep and wake states. The linear power spectrum is derived analytically via the transfer function and is then convolved with itself and other factors to calculate the nonlinear power spectrum analytically via a recent perturbation expansion. Analysis shows that strong spectral peaks generate a harmonic at twice the original frequency with peak power proportional to the square of that of the original peak. Fits to the data enable absolute normalization to be determined, with the conclusion that the experimentally observed spindle harmonic peak is nonlinear. Using this normalization, the same analysis is applied to the wake state and nonlinear contributions to the alpha and beta peaks are quantified.