Direct access in the UK: what do dentists really think?

OBJECTIVE

To investigate dentists' views on the likely impact of direct access (DA), the clinical competence of hygienists and therapists to work autonomously and possible predictors of such views.

DESIGN

Random survey of registered dentists.

SETTING

UK, 2014.

SUBJECTS AND METHODS

A random sample of UK-based dentists registered with the General Dental Council (GDC). A unique-access online questionnaire was developed, with a paper alternative. Email and postal reminders were sent.

MAIN OUTCOME MEASURES

Measures of positive/negative views regarding the impact of DA and clinical competence of hygienists and therapists to work without a dentist's prescription.

RESULTS

One hundred and fifty-nine responded (response rate: 27%), 78 (49.1%) of whom were female. No significant sources of response bias were identified. While 122 (77%) had not undergone joint training with dental hygienists or therapists at the undergraduate level, 98 (62.4%) currently worked with a hygienist and 33 (21.0%) with a therapist. Eighty-three (53.2%) disagreed with the GDC decision regarding DA for hygienists, and 94 (59.1%) felt the same regarding therapists. Concern was greatest in respect to diagnosis, treatment planning and restorations. Comments were predominantly negative and reflected concerns over patient safety, what was seen as hygienists' and therapists' inadequate training or expertise, the undermining of the dentist's role, service delivery, the reform being poorly planned, implemented or being a cost-cutting exercise. Experience of teamwork was not predictive of positive/negative views.

CONCLUSIONS

Response was low, thus posing a potential threat to the study's representativeness. Many dentists had concerns and reservations about DA which were unrelated to teamwork experience. The dissemination of information on curricula and scope of practice may help allay such concerns, as may a greater emphasis on joint training at both the undergraduate level and within continuing professional development programmes.

Experimental validation of a novel compact focusing scheme for future energy-frontier linear lepton colliders

A novel scheme for the focusing of high-energy leptons in future linear colliders was proposed in 2001 [P. Raimondi and A. Seryi, Phys. Rev. Lett. 86, 3779 (2001)]. This scheme has many advantageous properties over previously studied focusing schemes, including being significantly shorter for a given energy and having a significantly better energy bandwidth. Experimental results from the ATF2 accelerator at KEK are presented that validate the operating principle of such a scheme by demonstrating the demagnification of a 1.3 GeV electron beam down to below 65 nm in height using an energy-scaled version of the compact focusing optics designed for the ILC collider.

Chemical fingerprinting of naphthenic acids and oil sands process waters-A review of analytical methods for environmental samples

This article provides a review of the routine methods currently utilized for total naphthenic acid analyses. There is a growing need to develop chemical methods that can selectively distinguish compounds found within industrially derived oil sands process affected waters (OSPW) from those derived from the natural weathering of oil sands deposits. Attention is thus given to the characterization of other OSPW components such as oil sands polar organic compounds, PAHs, and heavy metals along with characterization of chemical additives such as polyacrylamide polymers and trace levels of boron species. Environmental samples discussed cover the following matrices: OSPW containments, on-lease interceptor well systems, on- and off-lease groundwater, and river and lake surface waters. There are diverse ranges of methods available for analyses of total naphthenic acids. However, there is a need for inter-laboratory studies to compare their accuracy and precision for routine analyses. Recent advances in high- and medium-resolution mass spectrometry, concomitant with comprehensive mass spectrometry techniques following multi-dimensional chromatography or ion-mobility separations, have allowed for the speciation of monocarboxylic naphthenic acids along with a wide range of other species including humics. The distributions of oil sands polar organic compounds, particularly the sulphur containing species (i.e., OxS and OxS2) may allow for distinguishing sources of OSPW. The ratios of oxygen- (i.e., Ox) and nitrogen-containing species (i.e., NOx, and N2Ox) are useful for differentiating organic components derived from OSPW from natural components found within receiving waters. Synchronous fluorescence spectroscopy also provides a powerful screening technique capable of quickly detecting the presence of aromatic organic acids contained within oil sands naphthenic acid mixtures. Synchronous fluorescence spectroscopy provides diagnostic profiles for OSPW and potentially impacted groundwater that can be compared against reference groundwater and surface water samples. Novel applications of X-ray absorption near edge spectroscopy (XANES) are emerging for speciation of sulphur-containing species (both organic and inorganic components) as well as industrially derived boron-containing species. There is strong potential for an environmental forensics application of XANES for chemical fingerprinting of weathered sulphur-containing species and industrial additives in OSPW.

Cyclooxygenase-2 gene expression in human breast cancer

Expression of the inducible isoform of the cyclooxygenase gene (PGHS-2, COX-2) which codes for the enzyme that catalyzes formation of prostaglandins, was detected in 13/13 human breast tumors of high grade but not in samples of normal breast tissue. There was a statistically significant linear association between COX-2 gene expression and high (>50%) tumor cell density (p<0.01), with COX-2 protein localized to tumor cells. These results indicate that COX-2 gene expression may be useful as a molecular biomarker for human breast tumors and may also predict sensitivity to treatment with nonsteroidal anti-inflammatory drugs.

Inverse expression of neurotrophins and neurotrophin receptors at the invasion front of human-melanoma brain metastases

Neurotrophins (NT), such as nerve growth factor (NGF), stimulate the growth and differentiation of several neuronal subpopulations in a distinct yet overlapping manner. Brain-metastatic human melanoma cells overexpress p75(NTR), the low-affinity neurotrophin receptor, and treatment of brain-metastatic cells with NGF stimulates extracellular matrix invasion and production of degradative enzymes in relation to the cellular expression of p75(NTR) Although human melanoma cells express high affinity neurotrophin receptors, such as TrkC (the putative receptor for NT-3), they do not express TrkA, the high-affinity NGF receptor. Using digoxigenin-labeled sense/antisense riboprobes against human p75(NTR) and NGF for in situ hybridization, we determined whether the expression of p75(NTR) and NGF mRNAs are related to brain metastasis of human melanoma. We detected p75(NTR) mRNA at the invasion front of human melanoma brain metastases, whereas p75(NTR) expression was not found in adjacent tissues. In contrast, human NGF mRNA levels were increased in tissues surrounding the melanoma lesions, supporting the notion that NGF and NT are important in determining melanoma brain-metastatic microenvironment. Using antibodies specific to p75(NTR), TrkC, NGF and related NT we found high but heterogeneous levels of p75(NTR) and TrkC expression in malignant melanomas metastatic to the brain. Lower levels of expression were found in primary melanomas or in metastatic melanomas to sites other than brain. Additionally, we found elevated levels of synthesis of NGF and NT-3 but not brain-derived neurotrophic factor (BDNF) or NT-4/5 in the brain tissues surrounding melanoma lesions. These studies support a role for NT and their receptors in the progression of melanomas to the brain-metastatic phenotype.

Sexual asymmetry in hermaphroditic plants

Populations of hermaphroditic plants show variation in ovule and pollen production, so that the implicit assumption that hermaphrodite individuals function half as male and half as female is not valid. Such variation in gamete production results in sexual asymmetry, defined as nonconstant ratios of pollen to ovule production among plants of a population. This article reviews (1) some of the considerable amount of recent evidence for sexual asymmetry and non-equal malelfemale sex functioning in hermaphroditic seed plants, and (2) some models of asymmetry and sex functioning, with emphasis on their biological and evolutionary relevance.