Review and action plan for oral health improvement in Sheffield special schools

A description of the process of a review of oral health improvement in special schools in Sheffield and the implementation of an action plan for these activities. Public health competencies encompassed: assessing the evidence on oral health and dental interventions, programmes and services; strategic leadership and collaborative working for health; oral health improvement.

Monitoring of optic nerve function in Neurofibromatosis 2 children with optic nerve sheath meningiomas using multifocal visual evoked potentials

Monitoring optic nerve sheath meningiomas (ONSM) in Neurofibromatosis type 2 (NF2) patients remains difficult. Other ocular manifestations of NF2 may obscure ophthalmic assessment of optic nerve function in these patients. Serial magnetic resonance imaging (MRI) used to assess the optic nerve is not without limitations, being expensive and often requiring general anaesthetic in children, with associated risks. This study was undertaken to describe the use of multifocal visual evoked potentials (multifocal VEP, mfVEP) in the regular monitoring of NF2 patients with ONSM. This study involved three NF2 patients with ONSM who undertook mfVEP testing at an academic ophthalmic centre. Same day mfVEP and routine ophthalmic testing were undertaken. Topographical function of the optic nerve was assessed, utilising tools such as asymmetry deviation and accumap severity index. Results were assessed alongside MRI and visual acuity (VA). From the three patients, five eyes had ONSMs, of which two caused unilateral blindness. The remaining three affected eyes had initial VAs 6/6, 6/24, and 6/18. Over follow up, ranging from 5 to 12 years, all tumours progressed, and VA declined for all patients. Multifocal VEP detected optic nerve functional loss corresponding with visual decline. This case series suggests mfVEP is effective in the objective topographic monitoring of optic nerve function in NF2 patients with ONSM. Due also to its safety in a paediatric population, the test may be considered in the routine monitoring of these patients, to be used to assist regular ophthalmic review and MRI scans.

Psychiatric comorbidities in adult survivors of major trauma: findings from the Midland Trauma Registry

ABSTRACT INTRODUCTION Information for primary care providers about the outcomes of adult survivors of major medical trauma in the first year of recovery is not widely available. In particular, risks of impairment across multiple domains of functioning are poorly understood. AIM To determine the extent to which adults’ experience impaired health-related quality of life (QoL), symptoms of post-traumatic stress disorder, depression, chronic pain and harmful alcohol use during the year following major trauma, and to identify factors associated with outcomes. METHODS Adults (aged ≥16 years) admitted to Waikato Hospital following major trauma sustained in Waikato District between 1 June 2010 and 1 July 2011 were sent a questionnaire in their first year of recovery. They were asked about their QoL, mental health, experiences of pain, post-traumatic stress disorder symptoms and use of alcohol. RESULTS Sixty-five questionnaires were completed (40% response rate). In the year following major trauma, trauma survivors met criteria for post-traumatic stress disorder (45%), harmful alcohol use (26%), moderate to severe chronic pain (23%) and depression (18%). Reports of poor health-related QoL were common, ranging from self-care difficulties (31%) to pain and discomfort (72%). Younger age, previous psychiatric illness, substance use, intensive care unit admission and length of hospitalisation were associated with symptoms. Thirty-seven adults (57%) reported symptoms in at least two domains. DISCUSSION A significant proportion of adults experience adverse psychosocial outcomes in the first year following major trauma. Screening and management of potentially comorbid psychosocial needs could improve care and outcomes for survivors.

Evidence for non-linear metabolism at low benzene exposures? A reanalysis of data

The presence of a high-affinity metabolic pathway for low level benzene exposures of less than one part per million (ppm) has been proposed although a pathway has not been identified. The variation of metabolite molar fractions with increasing air benzene concentrations was suggested as evidence of significantly more efficient benzene metabolism at concentrations <0.1 ppm The evidence for this pathway is predicated on a rich data set from a study of Chinese shoe workers exposed to a wide range of benzene concentrations (not just "low level"). In this work we undertake a further independent re-analysis of this data with a focus on the evidence for an increase in the rate of metabolism of benzene exposures of less than 1 ppm. The analysis dataset consisted of measurements of benzene and toluene from personal air samplers, and measurements of unmetabolised benzene and toluene and five metabolites (phenol hydroquinone, catechol, trans, trans-muconic acid and s-phenylmercapturic acid) from post-shift urine samples for 213 workers with an occupational exposure to benzene (and toluene) and 139 controls. Measurements from control subjects were used to estimate metabolite concentrations resulting from non-occupational sources, including environmental sources of benzene. Data from occupationally exposed subjects were used to estimate metabolite concentrations as a function of benzene exposure. Correction for background (environmental exposure) sources of metabolites was achieved through a comparison of geometric means in occupationally exposed and control populations. The molar fractions of the five metabolites as a function of benzene exposure were computed. A supra-linear relationship between metabolite concentrations and benzene exposure was observed over the range 0.1-10 ppm benzene, however over the range benzene exposures of between 0.1 and 1 ppm only a modest departure from linearity was observed. The molar fractions estimated in this work were near constant over the range 0.1-10 ppm. No evidence of high affinity metabolism at these low level exposures was observed. Our reanalysis brings in to question the appropriateness of the dataset for commenting on low dose exposures and the use of a purely statistical approach to the analysis.

Phylogenetic Variation of Chelonid Alphaherpesvirus 5 (ChHV5) in Populations of Green Turtles Chelonia mydas along the Queensland Coast, Australia

Sea turtle fibropapillomatosis (FP) is a disease marked by the proliferation of benign but debilitating cutaneous and occasional visceral tumors, likely to be caused by chelonid alphaherpesvirus 5 (ChHV5). This study presents a phylogeny of ChHV5 strains found on the east coast of Queensland, Australia, and a validation for previously unused primers. Two different primer sets (gB-1534 and gB-813) were designed to target a region including part of the UL27 glycoprotein B (gB) gene and part of UL28 of ChHV5. Sequences obtained from FP tumors found on juvenile green turtles Chelonia mydas (<65 cm curved carapace length) had substantial homology with published ChHV5 sequences, while a skin biopsy from a turtle without FP failed to react in the PCRs used in this study. The resulting sequences were used to generate a neighbor-joining tree from which three clusters of ChHV5 from Australian waters were identified: north Australian, north Queensland, and Queensland clusters. The clusters reflect the collection sites on the east coast of Queensland with a definitive north-south trend. Received October 22, 2016; accepted May 7, 2017.

Atypical Morphology and Disparate Speciation in a Case of Feline Cryptococcosis

A 6-year-old, spayed female cat was presented with acute respiratory signs and pleural effusion. Computed tomography scan revealed a large, lobulated mass effect in the ventral right hemithorax with concurrent sternal lymphadenopathy. A cytologic sample of the mass contained pyogranulomatous inflammation, necrotic material, and abundant yeast structures that lacked a distinct capsule and demonstrated rare pseudohyphal forms. Fungal culture and biochemical testing identified the yeast as Cryptococcus albidus, with susceptibility to all antifungal agents tested. However, subsequent 18S PCR identified 99% homology with a strain of Cryptococcus neoformans and only 92% homology with C. albidus. The patient responded well to fluconazole therapy unlike the only known previous report of C. albidus in a cat. The unusual cytologic morphology in this case underscores the need for ancillary testing apart from microscopy for fungal identification. Though C. albidus should be considered as a potential feline pathogen, confirmation with PCR is recommended when such rare non-neoformans species are encountered.

Biodegradation of airborne acetone/styrene mixtures in a bubble column reactor

The ability of a bubble column reactor (BCR) to biodegrade a mixture of styrene and acetone vapors was evaluated to determine the factors limiting the process efficiency, with a particular emphasis on the presence of degradation intermediates and oxygen levels. The results obtained under varied loadings and ratios were matched with the dissolved oxygen levels and kinetics of oxygen mass transfer, which was assessed by determination of k_La coefficients. A 1.5-L laboratory-scale BCR was operated under a constant air flow of 1.0 L.min^-1, using a defined mixed microbial population as a biocatalyst. Maximum values of elimination capacities/maximum overall specific degradation rates of 75.5 gC.m^-3.h^-1/0.197 gC.gdw^-1.h^-1, 66.0 gC.m^-3.h^-1/0.059 gC.gdw^-1.h^-1, and 45.8 gC.m^-3.h^-1/0.027 gC.gdw^-1.h^-1 were observed for styrene/acetone 2:1, styrene-rich and acetone-rich mixtures, respectively, indicating significant substrate interactions and rate limitation by biological factors. The BCR removed both acetone and styrene near-quantitatively up to a relatively high organic load of 50 g.m^-3.h^-1. From this point, the removal efficiencies declined under increasing loading rates, accompanied by a significant drop in the dissolved oxygen concentration, showing a process transition to oxygen-limited conditions. However, the relatively efficient pollutant removal from air continued, due to significant oxygen mass transfer, up to a threshold loading rate when the accumulation of acetone and degradation intermediates in the aqueous medium became significant. These observations demonstrate that oxygen availability is the limiting factor for efficient pollutant degradation and that accumulation of intermediates may serve as an indicator of oxygen limitation. Microbial (activated sludge) analyses revealed the presence of amoebae and active nematodes that were not affected by variations in operational conditions.

Integrative modelling for One Health: pattern, process and participation

This paper argues for an integrative modelling approach for understanding zoonoses disease dynamics, combining process, pattern and participatory models. Each type of modelling provides important insights, but all are limited. Combining these in a '3P' approach offers the opportunity for a productive conversation between modelling efforts, contributing to a 'One Health' agenda. The aim is not to come up with a composite model, but seek synergies between perspectives, encouraging cross-disciplinary interactions. We illustrate our argument with cases from Africa, and in particular from our work on Ebola virus and Lassa fever virus. Combining process-based compartmental models with macroecological data offers a spatial perspective on potential disease impacts. However, without insights from the ground, the 'black box' of transmission dynamics, so crucial to model assumptions, may not be fully understood. We show how participatory modelling and ethnographic research of Ebola and Lassa fever can reveal social roles, unsafe practices, mobility and movement and temporal changes in livelihoods. Together with longer-term dynamics of change in societies and ecologies, all can be important in explaining disease transmission, and provide important complementary insights to other modelling efforts. An integrative modelling approach therefore can offer help to improve disease control efforts and public health responses.This article is part of the themed issue 'One Health for a changing world: zoonoses, ecosystems and human well-being'.

The oral health of people with learning disabilities - a user-friendly questionnaire survey

Impetus for action

To conduct a user-friendly questionnaire survey of the oral health and service needs of adults with learning disabilities.

Solution

Researchers collaborated with local self-advocacy services to develop a questionnaire adapted from one used in a regional postal survey. The questionnaire, which covered dental status, oral health and dental services use, was sent to a random sample of people from the learning disability case register.

Outcome

Of 2,000 questionnaires mailed, 117 were returned undelivered and 625 were completed (response rate 31.3%). The self-reported dental status of people with learning disabilities appeared similar to that of the 2008 postal survey of the general population in Sheffield. The major difference in dental status was 11.5% of people with learning disabilities wore upper dentures and 7.2% wore lower dentures, compared to 21.2% and 12.1% of the general population in Sheffield.

Challenges

Using the case register as a recruitment instrument may have excluded people with learning disabilities not registered. Time and finances only permitted one mailing. Analysis on the basis of deprivation could not be conducted.

Future implications and learning points

Contrary to current practice, it is possible to include people with learning disabilities in oral health surveys. A multidisciplinary team was essential for enabling the progression and implementation of inclusive research and for people with learning disabilities and their supporters to engage meaningfully. This level of collaboration appears necessary if we are committed to ensuring that people with learning disabilities and their supporters are made visible to policy and decision-makers.

Case-control study of candidate gene methylation and adenomatous polyp formation

PURPOSE

Colorectal cancer (CRC) is one of the most common and preventable forms of cancer but remains the second leading cause of cancer-related death. Colorectal adenomas are precursor lesions that develop in 70-90 % of CRC cases. Identification of peripheral biomarkers for adenomas would help to enhance screening efforts. This exploratory study examined the methylation status of 20 candidate markers in peripheral blood leukocytes and their association with adenoma formation.

METHODS

Patients recruited from a local endoscopy clinic provided informed consent and completed an interview to ascertain demographic, lifestyle, and adenoma risk factors. Cases were individuals with a histopathologically confirmed adenoma, and controls included patients with a normal colonoscopy or those with histopathological findings not requiring heightened surveillance (normal biopsy, hyperplastic polyp). Methylation-specific polymerase chain reaction was used to characterize candidate gene promoter methylation. Odds ratios (ORs) and 95 % confidence intervals (95% CIs) were calculated using unconditional multivariable logistic regression to test the hypothesis that candidate gene methylation differed between cases and controls, after adjustment for confounders.

RESULTS

Complete data were available for 107 participants; 36 % had adenomas (men 40 %, women 31 %). Hypomethylation of the MINT1 locus (OR 5.3, 95% CI 1.0-28.2) and the PER1 (OR 2.9, 95% CI 1.1-7.7) and PER3 (OR 11.6, 95% CI 1.6-78.5) clock gene promoters was more common among adenoma cases. While specificity was moderate to high for the three markers (71-97 %), sensitivity was relatively low (18-45 %).

CONCLUSION

Follow-up of these epigenetic markers is suggested to further evaluate their utility for adenoma screening or surveillance.