"Over-reviewing" of research? An analysis of orthodontic reviews

INTRODUCTION

Research overviews may be undertaken to identify gaps in the literature, evaluate existing systematic reviews (SRs), and summarize evidence. This paper aims to profile overviews that have been conducted in orthodontics and related interventions since 2012 and to evaluate the degree of overlap among these overviews.

METHODS

Overviews published between January 1, 2012 and June 20, 2023 were identified using an electronic search involving Google Scholar and PubMed. A descriptive summary was produced, and citation matrices were used to evaluate the percentage of overlap between overviews using corrected covered area and covered area. This was classified as slight, moderate, high, or very high.

RESULTS

A total of 35 overviews were identified across a wide range of topics. Eight overviews included <10 SRs; 21 had 10-20 SRs; and 6 included >20 SRs (median no. of SRs per overview, 15; range, 3-62). Meta-analysis was conducted in only 5 overviews. Overlap between overviews on the same topic ranged from slight (2.7%) to very high (53.8%).

CONCLUSIONS

Almost all overview topics address treatments and their effects, with a wide variation in the number and quality of SRs included. There is considerable overlap in some orthodontic overviews, suggesting unnecessary duplication and research waste. Researchers should be encouraged to focus on primary data collection to add more high-quality data to SRs, which will ultimately enhance the yield from secondary and tertiary orthodontic research.

A Cross-Sectional Study of Factors Influencing Pre-Operative Anxiety in Orthognathic Patients

Orthognathic treatment is an important treatment modality to manage severe dentofacial discrepancies. Patients awaiting orthognathic surgery often experience increased anxiety, which may adversely affect post-operative recovery and treatment satisfaction. This study investigated the effects of a number of factors on pre-operative anxiety in orthognathic patients. Seventy patients prospectively recruited from three orthognathic centres in the UK completed a pre-operative questionnaire that included validated scales for measuring anxiety, social support, resilience, and coping styles. Sociodemographic data and satisfaction with the information provided by the clinical team were also elicited from the questionnaire. Univariable analysis showed that social support from a significant other (p = 0.026), resilience (p < 0.001), and satisfaction with the information provided by the clinical team (p = 0.002) were significantly associated with reduced anxiety, whilst avoidance coping (p < 0.001) and coping through seeking social support (p = 0.006) were significantly related to increased anxiety. With the exception of coping by seeking social support, these relationships retained significance in a multivariable regression analysis. Neither gender nor ethnicity moderated the effects of social support on pre-operative anxiety. These findings suggest potential avenues for clinicians to address with future interventions to reduce pre-operative anxiety. Further qualitative research may provide greater clarity on the relationship between these variables and anxiety.

An evaluation of a biophysical model for predicting avian thermoregulation in the heat

Survival and reproduction of endotherms depend on their ability to balance energy and water exchange with their environment, avoiding lethal deficits and maximising gains for growth and reproduction. At high environmental temperatures, diurnal endotherms maintain body temperature (Tb) below lethal limits via physiological and behavioural adjustments. Accurate models of these processes are crucial for predicting effects of climate variability on avifauna. We evaluated a biophysical models' performance (NicheMapR) for predicting evaporative water loss (EWL), resting metabolic rate (RMR) and Tb at environmental temperatures approaching or exceeding normothermic Tb for three arid-zone birds: Southern Yellow-billed Hornbill (Tockus leucomelas), Southern Pied Babbler (Turdoides bicolor) and Southern Fiscal (Lanius collaris). We simulated metabolic chamber conditions and compared model outputs to thermal physiology data collected at air temperatures (Tair) between 10 °C and 50 °C. Additionally, we determined the minimum data needed to accurately model diurnal birds' thermoregulatory responses to Tair using sensitivity analyses. Predicted evaporative water loss, metabolic rate and Tb corresponded tightly with observed values across Tair, with only minor discrepancies for EWL in two species at Tair=∼ 35 °C. Importantly, the model captured responses at Tair=30 - 40 °C, a range spanning threshold values for sublethal fitness costs associated with sustained hot weather in arid-zone birds. Our findings confirm how taxon-specific parameters together with biologically relevant morphological data can accurately model avian thermoregulatory responses to heat. Biophysical models can be used as a non-invasive way to predict species sensitivity to climate, accounting for organismal (e.g., physiology) and environmental factors (e.g., microclimates).

Helpers don't help when it's hot in a cooperatively breeding bird, the Southern Pied Babbler

Cooperative breeding, where more than two individuals invest in rearing a single brood, occurs in many bird species globally and often contributes to improved breeding outcomes. However, high temperatures are associated with poor breeding outcomes in many species, including cooperative species. We used data collected over three austral summer breeding seasons to investigate the contribution that helpers make to daytime incubation in a cooperatively breeding species, the Southern Pied Babbler Turdoides bicolor, and the ways in which their contribution is influenced by temperature. Helpers spent a significantly higher percentage of their time foraging (41.8 ± 13.7%) and a significantly lower percentage of their time incubating (18.5 ± 18.8%) than members of the breeding pair (31.3 ± 11% foraging and 37.4 ± 15.7% incubating). In groups with only one helper, the helper's contribution to incubation was similar to that of breeders. However, helpers in larger groups contributed less to incubation, individually, with some individuals investing no time in incubation on a given observation day. Helpers significantly decrease their investment in incubation on hot days (>35.5°C), while breeders tend to maintain incubation effort as temperatures increase. Our results demonstrate that pied babblers share the workload of incubation unequally between breeders and helpers, and this inequity is more pronounced during hot weather. These results may help to explain why recent studies have found that larger group size does not buffer against the impacts of high temperatures in this and other cooperatively breeding species.

Interactive effects of rising temperatures and urbanisation on birds across different climate zones: A mechanistic perspective

Climate change and urbanisation are among the most pervasive and rapidly growing threats to biodiversity worldwide. However, their impacts are usually considered in isolation, and interactions are rarely examined. Predicting species' responses to the combined effects of climate change and urbanisation, therefore, represents a pressing challenge in global change biology. Birds are important model taxa for exploring the impacts of both climate change and urbanisation, and their behaviour and physiology have been well studied in urban and non-urban systems. This understanding should allow interactive effects of rising temperatures and urbanisation to be inferred, yet considerations of these interactions are almost entirely lacking from empirical research. Here, we synthesise our current understanding of the potential mechanisms that could affect how species respond to the combined effects of rising temperatures and urbanisation, with a focus on avian taxa. We discuss potential interactive effects to motivate future in-depth research on this critically important, yet overlooked, aspect of global change biology. Increased temperatures are a pronounced consequence of both urbanisation (through the urban heat island effect) and climate change. The biological impact of this warming in urban and non-urban systems will likely differ in magnitude and direction when interacting with other factors that typically vary between these habitats, such as resource availability (e.g. water, food and microsites) and pollution levels. Furthermore, the nature of such interactions may differ for cities situated in different climate types, for example, tropical, arid, temperate, continental and polar. Within this article, we highlight the potential for interactive effects of climate and urban drivers on the mechanistic responses of birds, identify knowledge gaps and propose promising future research avenues. A deeper understanding of the behavioural and physiological mechanisms mediating species' responses to urbanisation and rising temperatures will provide novel insights into ecology and evolution under global change and may help better predict future population responses.

Bird tolerance to humans in open tropical ecosystems

Animal tolerance towards humans can be a key factor facilitating wildlife-human coexistence, yet traits predicting its direction and magnitude across tropical animals are poorly known. Using 10,249 observations for 842 bird species inhabiting open tropical ecosystems in Africa, South America, and Australia, we find that avian tolerance towards humans was lower (i.e., escape distance was longer) in rural rather than urban populations and in populations exposed to lower human disturbance (measured as human footprint index). In addition, larger species and species with larger clutches and enhanced flight ability are less tolerant to human approaches and escape distances increase when birds were approached during the wet season compared to the dry season and from longer starting distances. Identification of key factors affecting animal tolerance towards humans across large spatial and taxonomic scales may help us to better understand and predict the patterns of species distributions in the Anthropocene.

A qualitative exploration of the experiences of young people and their parents regarding the impact of missing school to attend hospital-based orthodontic appointments

OBJECTIVE

To explore the experiences of young people and their parents regarding the impact on school performance due to time away from school for orthodontic appointments and to explore their views about a possible extension to the current service.

DESIGN

A qualitative study using semi-structured interviews.

SETTING

UK district hospitals.

PARTICIPANTS

A total of 11 pairs of interviewees: young people undergoing fixed appliances and their parents.

METHODS

Semi-structured interviews were conducted with young people and their parents. The interviews were audio recorded and transcribed verbatim. A framework approach was used to analyse the data.

RESULTS

A thematic analysis of the data identified five main themes which were as follows: (1) expectations of the treatment process and appointments; (2) impact of school absences and treatment; (3) appointments; (4) implications for young people, parents and others; and (5) satisfaction with treatment. These themes were then further subdivided and analysed.

CONCLUSION

Young people and their parents felt that attending appointments for orthodontic treatment had minimal impact on a young person's school performance. However, some young people did engage in coping mechanisms in order to ensure this was the case. Young people and their parents advised they were satisfied with the process of the treatment despite the time missed at school/work. Some young people and their parents saw a real benefit to appointments that could be fitted into a 'NHS seven-day' service model, but this did not apply to all interviewees.

Social support and pre-operative anxiety in patients undergoing elective surgical procedures: A systematic review and meta-analysis

Pre-operative anxiety may adversely affect post-operative recovery and treatment satisfaction. This systematic review assessed the impact of social support on pre-operative anxiety in elective surgery patients. MEDLINE via Ovid, Embase, PsycINFO, Web of Science, CINAHL Plus, Emcare and LILACS were searched for publications (1950-2021). Fourteen studies were included for descriptive analysis and five for meta-analysis. The pooled estimate in the meta-analysis was r = -0.372 (95% CI: -0.578 to -0.122). Stronger social support was weakly associated with reduced pre-operative anxiety, but the quality of available evidence was low. The findings suggest potential benefit in enhancing utilisation of support networks before elective surgery.

A qualitative evaluation of attitudes toward extractions among primary care orthodontists in Great Britain

INTRODUCTION

The need to extract permanent teeth as part of orthodontic treatment has been keenly debated over many decades. Changes in the frequency of extraction have been well documented; however, we continue to lack an understanding of what influences clinicians' decisions regarding extracting permanent teeth.

METHODS

Purposive sampling was undertaken to obtain representative views from primary care practitioners across Great Britain with a range of experience representing genders and wide geographic distribution. Twenty participants (9 female, 11 male) took part in in-depth, qualitative, 1-to-1 interviews based on a piloted topic guide. Interviews were conducted via video conferencing software with audio recording and verbatim transcription. Thematic analysis was performed with discussion and agreement to identify the main themes.

RESULTS

Five main themes were identified: (1) patient-related factors, such as age and features of the malocclusion, (2) operator factors, including the level of experience, (3) setting, with regard to geographic location and method of remuneration, (4) mechanical approaches, including variations in appliance systems; and (5) self-directed ongoing education, including both formal continuing professional development and informal learning from peers. These factors acted as barriers, enablers, or both in relation to nonextraction treatment.

CONCLUSIONS

Five key influences on extraction decisions among orthodontists in Great Britain were identified. Extraction choices appear to be influenced by various interrelated factors, evolving over time and with increased experience.

Is self always prioritised? Attenuating the ownership self-reference effect in memory

The current study demonstrates the abolishment of the Ownership Self Reference Effect (OSRE) when elaborate details of a distant other-referent are provided. In a 2 (High versus Low information) × 2 (Self versus Other) experimental design, we tested the capacity for the SRE to be modulated with social saliency. Using a well-established ownership paradigm (Collard et al., 2020; Cunningham et al., 2008; Sparks et al., 2016), when the other was made socially salient (i.e. details and characteristics about the other were provided to the participant prior to encoding), no SRE emerged, such that self-owned and other-owned items were recalled with comparable accuracy. In contrast, when the other was not salient (i.e., no details about them were provided), participants accurately recalled a higher proportion of self-owned items, demonstrating a typical SRE in source memory. The degree of self- or other- referencing was not related to measured variables of closeness, similarity or shared traits with the other. Although the SRE is an established and robust effect, the findings of the current study illustrate critical circumstances in which the self is no longer prioritised above the other. In line with our predictions, we suggest that the self has automatic attributed social salience (e.g. through ownership) and that enhancing social salience by elaborating details of the other, prioritisation can expand to encapsulate an other beyond the self and influence incidental memory.

The spatial and temporal exploitation of anthropogenic food sources by common ravens (Corvus corax) in the Alps

BACKGROUND

Anthropogenic food sources (AFSs) are widespread in human-transformed landscapes and the current scale at which they occur drives ecological change at the individual, population, and community levels. AFSs are exploited extensively by common ravens, Corvus corax. Understanding how raven populations use AFSs can provide insight into their ecological responses to AFSs.

METHODS

We equipped 81 ravens in the Austrian Alps with GPS-transmitters over a period of 2.75 years. Using these tracking data, we investigated how cohort differences (i.e., age, sex, and origin) and seasonal changes influence raven movement patterns (i.e., occurrence distribution and maximum daily displacement) and AFS-use (i.e., number of AFSs visited and probability of being present at any AFS) at 45 extensively exploited sites.

RESULTS

We found that proxies for experience and dominance, inferred by age (i.e., juvenile versus adult) and origin (i.e., wild-caught versus captive-bred-released) cohorts, influenced movement patterns and the number of AFSs visited. However, all individuals were equally likely to be present at AFSs, highlighting the importance of AFSs for non-breeders in the study population. Seasonal changes in environmental conditions that affect energetic demands, the availability of natural and anthropogenic food, and foraging competition,  influenced individuals' occurrence distributions and AFS-use. We found that under harsher conditions in autumn and winter, individuals ranged wider and depended on AFSs to a larger degree. However, contrary to expectation, they were less likely to be present at AFSs in these seasons compared to spring and summer, suggesting a trade-off between time spent moving and exploiting resources. We attribute the small ranging movements exhibited by non-breeders in spring and summer to the presence of highly territorial and socially dominant breeders. As breeders mostly stay and forage within their territories during these seasons, competition at AFSs decrease, thereby increasing the likelihood of individuals being present at any AFS.

CONCLUSIONS

We emphasize that movement and AFS-use differ according to cohort differences and the seasonality of the environment. Our results highlight that predictable AFSs affect foraging strategies among non-breeding ravens. The extent of AFS-exploitation among non-breeding ravens in our study emphasize the potential of AFSs in shaping raven movement and resource-use.

Comparative morphology and soft tissue histology of the remote-touch bill-tip organ in three ibis species of differing foraging ecology

Ibises (order: Pelecaniformes, family: Threskiornithidae) are probe-foraging birds that use 'remote-touch' to locate prey items hidden in opaque substrates. This sensory capability allows them to locate their prey using high-frequency vibrations in the substrate in the absence of other sensory cues. Remote-touch is facilitated by a specialised bill-tip organ, comprising high densities of mechanoreceptors (Herbst corpuscles) embedded in numerous foramina in the beak bones. Each foramen and its associated Herbst corpuscles make up a sensory unit, called a 'sensory pit'. These sensory pits are densely clustered in the distal portion of the beak. Previous research has indicated that interspecific differences in the extent of sensory pitting in the beak bones correlate with aquatic habitat use of ibises, and have been suggested to reflect different levels of remote-touch sensitivity. Our study investigates the interspecific differences in the bone and soft tissue histology of the bill-tip organs of three species of southern African ibises from different habitats (mainly terrestrial to mainly aquatic). We analysed the external pitting pattern on the bones, as well as internal structure of the beak using micro-CT scans and soft tissue histological sections of each species' bill-tip organs. The beaks of all three species contain remote-touch bill-tip organs and are described here in detail. Clear interspecific differences are evident between the species' bill-tip organs, both in terms of bone morphology and soft tissue histology. Glossy Ibises, which forage exclusively in wetter substrates, have a greater extent of pitting but lower numbers of Herbst corpuscles in each pit, while species foraging in drier substrates (Hadeda and Sacred Ibises) have more robust beaks, fewer pits and higher densities of Herbst corpuscles. Our data, together with previously published histological descriptions of the bill-tip organs of other remote-touch foraging bird species, indicate that species foraging in drier habitats have more sensitive bill-tip organs (based on their anatomy). The vibrations produced by prey (e.g., burrowing invertebrates) travel poorly in dry substrates compared with wetter ones (i.e., dry soil vs. mud or water), and thus we hypothesise that a more sensitive bill-tip organ may be required to successfully locate prey in dry substrates. Furthermore, our results indicate that the differences in bill-tip organ anatomy between the species reflect complex trade-offs between morphological constraints of beak shape and remote-touch sensitivity requirements, both of which are likely related to each species' foraging behaviour and substrate usage. Our study suggests that structures in the bone of the bill-tip organ could provide valuable osteological correlates for the associated soft tissues, and consequently may provide information on the sensory ecology and habitat usage of the birds in the absence of soft tissues.

Collapse of Breeding Success in Desert-Dwelling Hornbills Evident Within a Single Decade

Rapid anthropogenic climate change potentially severely reduces avian breeding success. While the consequences of high temperatures and drought are reasonably well-studied within single breeding seasons, their impacts over decadal time scales are less clear. We assessed the effects of air temperature (Tair) and drought on the breeding output of southern yellow-billed hornbills (Tockus leucomelas; hornbills) in the Kalahari Desert over a decade (2008–2019). We aimed to document trends in breeding performance in an arid-zone bird during a time of rapid global warming and identify potential drivers of variation in breeding performance. The breeding output of our study population collapsed during the monitoring period. Comparing the first three seasons (2008–2011) of monitoring to the last three seasons (2016–2019), the mean percentage of nest boxes that were occupied declined from 52% to 12%, nest success from 58% to 17%, and mean fledglings produced per breeding attempt from 1.1 to 0.4. Breeding output was negatively correlated with increasing days on which Tmax (mean maximum daily Tair) exceeded the threshold Tair at which male hornbills show a 50% likelihood of engaging in heat dissipation behavior [i.e., panting (Tthresh; Tair = 34.5°C)] and the occurrence of drought within the breeding season, as well as later dates for entry into the nest cavity (i.e., nest initiation) and fewer days post-hatch, spent incarcerated in the nest by the female parent. The apparent effects of high Tair were present even in non-drought years; of the 115 breeding attempts that were recorded, all 18 attempts that had ≥ 72% days during the attempt on which Tmax &gt; Tthresh failed (equivalent to Tmax during the attempt ≥ 35.7°C). This suggests that global warming was likely the primary driver of the recent, rapid breeding success collapse. Based on current warming trends, the Tmax threshold of 35.7°C, above which no successful breeding attempts were recorded, will be exceeded during the entire hornbill breeding season by approximately 2027 at our study site. Therefore, our findings support the prediction that climate change may drive rapid declines and cause local extinctions despite the absence of direct lethal effects of extreme heat events.

The perceptions of undertaking a higher degree alongside orthodontic speciality training: a cross-sectional survey of British Orthodontic Society members

Introduction In the UK, orthodontic speciality training takes place over three years full-time. In addition to the clinical training, there is an expectation that trainees undertake a higher degree. Currently, there is little evidence regarding the impact of undertaking a higher degree on specialist orthodontists.Aims Investigate UK orthodontists' perceptions of undertaking a higher degree alongside speciality training.Materials and methods A cross-sectional research study involving the distribution of an anonymous, descriptive, online, questionnaire-based survey between May and June 2021 via the British Orthodontic Society. Data were obtained in relation to the impact of undertaking a higher degree on the completion of speciality training, research skills, delivery of patient care and career opportunities.Results In total, 166 questionnaires were completed (approximately 13.3% response rate). Most respondents 'agreed' or 'strongly agreed' that undertaking a higher degree had improved their scientific (77.1%) and critical appraisal skills (80.7%), job prospects (60.2%) and career opportunities (63.9%). Most respondents felt the benefits of the higher degree outweighed the associated costs (65.1%) and was a worthwhile component of training (69.3%).Conclusions Specialist orthodontists place a high value on undertaking a higher degree. The results of this questionnaire should be of importance to stakeholders involved in the development of the orthodontic curriculum.

Global COVID-19 lockdown highlights humans as both threats and custodians of the environment

The global lockdown to mitigate COVID-19 pandemic health risks has altered human interactions with nature. Here, we report immediate impacts of changes in human activities on wildlife and environmental threats during the early lockdown months of 2020, based on 877 qualitative reports and 332 quantitative assessments from 89 different studies. Hundreds of reports of unusual species observations from around the world suggest that animals quickly responded to the reductions in human presence. However, negative effects of lockdown on conservation also emerged, as confinement resulted in some park officials being unable to perform conservation, restoration and enforcement tasks, resulting in local increases in illegal activities such as hunting. Overall, there is a complex mixture of positive and negative effects of the pandemic lockdown on nature, all of which have the potential to lead to cascading responses which in turn impact wildlife and nature conservation. While the net effect of the lockdown will need to be assessed over years as data becomes available and persistent effects emerge, immediate responses were detected across the world. Thus, initial qualitative and quantitative data arising from this serendipitous global quasi-experimental perturbation highlights the dual role that humans play in threatening and protecting species and ecosystems. Pathways to favorably tilt this delicate balance include reducing impacts and increasing conservation effectiveness.

Pulses of anthropogenic food availability appear to benefit parents, but compromise nestling growth in urban red-winged starlings

The provision of anthropogenic food undoubtedly influences urban bird fitness. However, the nature of the impact is unclear, with both benefits and costs of urban diets documented. Moreover, the influence of short-term fluctuations in food availability, linked to urban weekday/weekend cycles of human presence, is largely unknown. We explored whether breeding red-winged starlings Onychognathus morio in Cape Town, South Africa, altered foraging and provisioning behaviour between days with high human presence (HHP) and days with low human presence (LHP)—i.e. weekdays versus weekends and vacation days. We investigated the relationship between starling diet, adult body mass and nestling development. Breeding adults consumed and provisioned the same quantity of food, but a significantly greater proportion of anthropogenic food on HHP compared to LHP days. Adults apparently benefited from the anthropogenic diet, experiencing significantly greater mass gain on HHP days. However, nestlings experienced a cost, with the number of HHP days during the nestling period associated negatively with nestling size. Adults may, therefore, benefit from the high calorie content of anthropogenic food, while nestlings may be negatively affected by nutrient limitation. The quantity of food available in urban environments may, therefore, benefit adult survival, while its quality imposes a cost to nestling growth.

Decision making regarding management of compromised first permanent molars in patients with molar incisor hypomineralisation: A comparison of orthodontists and paediatric dentists

OBJECTIVES

To obtain the views and opinions of specialist members of the British Orthodontic Society (BOS) and British Society of Paediatric Dentistry (BSPD) in relation to (1) the multidisciplinary management of patients affected by molar incisor hypomineralisation (MIH) and (2) the diagnosis and management of MIH-affected first permanent molars (FPMs) in four clinical scenarios, and compare the responses to those of an expert panel consensus.

DESIGN

A prospective cross-sectional study.

SETTING

Part 1: Eastman Dental Institute and part 2: online questionnaire.

METHODS

Four clinical scenarios showing patients with differing severities of MIH affected FPMs were considered by a panel of orthodontists and paediatric dentists to agree on the severity of MIH and management. A 21-item online questionnaire sent to both specialist groups, after pilot study. The questionnaire covered demographics, access to multidisciplinary clinics, clinicians' opinions on various management aspects, and questions relating to the management of the same 4 clinical scenarios.

RESULTS

The overall response was 21.9% (20% of the orthodontists and 45% of the paediatric dentists). Approximately half of the respondents from both groups felt that these patients should be managed through a multidisciplinary treatment type clinic (49.0% of the orthodontists and 47.2% of the paediatric dentists). Only 40.3% of the orthodontists and 35.0% of the paediatric dentists agreed completely with the panel consensus on all management options. When assessing overall agreement on all four FPMs for all scenarios, agreement was predicted by severity of MIH (P<0.001) and complexity of malocclusion (P<0.001) where more complex malocclusions and more severe MIH resulted in poorer agreement, but specialty was not a significant predictor (P=0.21).

CONCLUSION

The majority of the respondents from both groups, felt that managing patients with MIH affected FPMs is challenging. Approximately half of the orthodontists and the paediatric dentists, felt that MIH affected patients should be managed through a multidisciplinary type clinic. Managing more severe cases on multidisciplinary clinics is indicated, to incorporate specialist input into decision making.

Direct and indirect effects of high temperatures on fledging in a cooperatively breeding bird

High temperatures and low rainfall consistently constrain reproduction in arid-zone bird species. Understanding the mechanisms underlying this pattern is critical for predicting how climate change will influence population persistence and to inform conservation and management. In this study, we analyzed Southern Pied Babbler Turdoides bicolor nestling survival, daily growth rate and adult investment behavior during the nestling period over three austral summer breeding seasons. High temperatures were associated with lower body mass, shorter tarsi, and reduced daily growth rates of nestlings. Our piecewise structural equation models suggested that direct impacts of temperature had the strongest influence on nestling size and daily growth rates for both 5-day-old and 11-day-old nestlings, followed by temperature-related adjustments to provisioning rates by adults. Rainfall and group size influenced the behavior of provisioning adults but did not influence nestling growth or survival. Adjustments to adult provisioning strategies did not compensate for direct negative effects of high air temperatures on nestling size or daily growth rates. Detailed mechanistic data like these allow us to model the pathways by which high temperature causes nest failure. In turn, this could allow us to design targeted conservation action to effectively mitigate climate effects.

Hot days are associated with short-term adrenocortical responses in a southern African arid-zone passerine bird

Relatively little effort has been directed towards elucidating the role of physiological stress pathways in mediating avian responses to global heating. For free-ranging southern pied babblers, Turdoides bicolor, daily maximum air temperatures (Tmax) between ∼35 and ∼40°C result in reduced foraging efficiency, loss of body mass and compromised breeding success. We tested the hypothesis that very hot days are experienced as stressors by quantifying relationships between Tmax and faecal glucocorticoid metabolite (fGCM) levels in naturally excreted droppings. On days when Tmax<38°C, fGCM levels were independent of Tmax (mean±s.d. 140.25±56.92 ng g-1 dry mass). At Tmax>38°C, however, fGCM levels increased linearly with Tmax and averaged 190.79±70.13 ng g-1 dry mass. The effects of Tmax on fGCM levels did not carry over to the following morning, suggesting that very hot days are experienced as acute stressors.

Patient, clinician and independent observer perspectives of shared decision making in adult orthodontics

OBJECTIVES

To investigate and compare the extent of shared decision making (SDM) in orthodontics from the perspective of patients, clinicians and independent observers.

DESIGN

A cross-sectional, observational study.

SETTING

NHS teaching hospital.

PARTICIPANTS

A total of 31 adult patients and their treating clinicians were included in the study.

METHODS

The extent of SDM in new patient orthodontic consultations was measured using three versions of a validated instrument: the self-administered patient dyadic-OPTION scale; the self-administered clinician dyadic-OPTION scale; and an independent observer-rated OPTION¹² scale. Patients and clinicians completed the 12-item dyadic-OPTION questionnaire independently at the end of the consultation to rate their perceived levels of SDM. The consultations were also audio-recorded and two calibrated raters independently rated the extent of SDM in these consultations using the OPTION¹² scale.

RESULTS

There was excellent inter-rater reliability between the two independent raters using the OPTION¹² scale (intraclass correlation coefficient (ICC) = 0.909). The mean patient, clinician and independent observer OPTION scores for SDM were 90.4% (SD 9.1%, range 70.8% to 100%), 76.2% (SD 8.95%, range 62.5% to 95.8%) and 42.6% (SD 17.4%, range 13.5% to 68.8%), respectively. There was no significant correlation between the OPTION scores for the three groups (ICC = -0.323).

CONCLUSIONS

The results showed that generally high levels of SDM were perceived by patients and clinicians but lower levels of SDM were scored by the independent observers. However, it could be argued that the patient's perception of SDM is the most important measure as it is their care that is affected by their involvement.

How hornbills handle heat: sex-specific thermoregulation in the southern yellow-billed hornbill

At a global scale, thermal physiology is correlated with climatic variables such as temperature and aridity. There is also evidence that thermoregulatory traits vary with fine-scale microclimate, but this has received less attention in endotherms. Here, we test the hypothesis that avian thermoregulation varies with microclimate and behavioural constraints in a non-passerine bird. Male and female southern yellow-billed hornbills (Tockus leucomelas) experience markedly different microclimates while breeding, with the female sealing herself into a tree cavity and moulting all her flight feathers during the breeding attempt, becoming entirely reliant on the male for provisioning. We examined interactions between resting metabolic rate (RMR), evaporative water loss (EWL) and core body temperature (T _b) at air temperatures (T _a) between 30°C and 52°C in male and female hornbills, and quantified evaporative cooling efficiencies and heat tolerance limits. At thermoneutral T _a, neither RMR, EWL nor T _b differed between sexes. At T _a >40°C, however, RMR and EWL of females were significantly lower than those of males, by ∼13% and ∼17%, respectively, despite similar relationships between T _b and T _a, maximum ratio of evaporative heat loss to metabolic heat production and heat tolerance limits (∼50°C). These sex-specific differences in hornbill thermoregulation support the hypothesis that avian thermal physiology can vary within species in response to fine-scale microclimatic factors. In addition, Q ₁₀ for RMR varied substantially, with Q ₁₀ ≤2 in some individuals, supporting recent arguments that active metabolic suppression may be an underappreciated aspect of endotherm thermoregulation in the heat.

How hornbills handle heat: sex-specific thermoregulation in the southern yellow-billed hornbill

At a global scale, thermal physiology is correlated with climatic variables such as temperature and aridity. There is also evidence that thermoregulatory traits vary with fine-scale microclimate, but this has received less attention in endotherms. Here, we test the hypothesis that avian thermoregulation varies with microclimate and behavioural constraints in a non-passerine bird. Male and female southern yellow-billed hornbills (Tockus leucomelas) experience markedly different microclimates while breeding, with the female sealing herself into a tree cavity and moulting all her flight feathers during the breeding attempt, becoming entirely reliant on the male for provisioning. We examined interactions between resting metabolic rate (RMR), evaporative water loss (EWL) and core body temperature (T _b) at air temperatures (T _a) between 30°C and 52°C in male and female hornbills, and quantified evaporative cooling efficiencies and heat tolerance limits. At thermoneutral T _a, neither RMR, EWL nor T _b differed between sexes. At T _a >40°C, however, RMR and EWL of females were significantly lower than those of males, by ∼13% and ∼17%, respectively, despite similar relationships between T _b and T _a, maximum ratio of evaporative heat loss to metabolic heat production and heat tolerance limits (∼50°C). These sex-specific differences in hornbill thermoregulation support the hypothesis that avian thermal physiology can vary within species in response to fine-scale microclimatic factors. In addition, Q ₁₀ for RMR varied substantially, with Q ₁₀ ≤2 in some individuals, supporting recent arguments that active metabolic suppression may be an underappreciated aspect of endotherm thermoregulation in the heat.

Assessing the Effectiveness and Acceptability of a Personalized Mobile Phone App in Improving Adherence to Oral Hygiene Advice in Orthodontic Patients: Protocol for a Feasibility Study and a Randomized Controlled Trial

Background

Orthodontic treatment is a common health care intervention; treatment duration can be lengthy (2-3 years on average), and adherence to treatment advice is therefore essential for successful outcomes. It has been reported that up to 43% of patients fail to complete treatment, and there are currently no useful predictors of noncompletion. Given that the National Health Service England annual expenditure on primary-care orthodontic treatment is in excess of £200 million (US $267 million), noncompletion of treatment represents a significant inefficient use of public resources. Improving adherence to treatment is therefore essential. This necessitates behavior change, and interventions that improve adherence and are designed to elicit behavioral change must address an individual’s capability, opportunity, and motivation. Mobile phones are potentially an invaluable tool in this regard, as they are readily available and can be used in a number of ways to address an individual’s capability, opportunity, and motivation.

Objective

This study will assess the effectiveness and acceptability of a personalized mobile phone app in improving adherence to orthodontic treatment advice by way of a randomized controlled trial.

Methods

This study will be conducted in 2 phases at the Eastman Dental Hospital, University College London Hospitals Foundation Trust. Phase 1 is feasibility testing of the My Braces app. Participants will be asked to complete the user version of the Mobile Application Rating Scale. The app will be amended following analysis of the responses, if appropriate. Phase 2 is a randomized controlled trial to test the effectiveness and acceptability of the My Braces app.

Results

This study was approved by the London – Bloomsbury Research Ethics Committee on November 5, 2019 (reference 19/LO/1555). No patients have been recruited to date. The anticipated start date for recruitment to phase 1 is October 2020.

Conclusions

Given the availability, affordability, and versatility of mobile phones, it is proposed that they will aid in improving adherence to treatment advice and hence improve treatment completion rates. If effective, the applicability of this methodology to developing behavior change/modification interventions and improving adherence to treatment across health care provides an exciting opportunity.

Trial Registration

ClinicalTrials.gov NCT04184739; https://clinicaltrials.gov/ct2/show/NCT04184739

International Registered Report Identifier (IRRID)

PRR1-10.2196/18021

Dehydration risk is associated with reduced nest attendance and hatching success in a cooperatively breeding bird, the southern pied babbler Turdoides bicolor

High air temperatures have measurable negative impacts on reproduction in wild animal populations, including during incubation in birds. Understanding the mechanisms driving these impacts requires comprehensive knowledge of animal physiology and behaviour under natural conditions. We used a novel combination of a non-invasive doubly labelled water (DLW) technique, nest temperature data and field-based behaviour observations to test effects of temperature, rainfall and group size on physiology and behaviour during incubation in southern pied babblers Turdoides bicolor, a cooperatively breeding passerine endemic to the arid savanna regions of southern Africa. The proportion of time that clutches were incubated declined as air temperatures increased, a behavioural pattern traditionally interpreted as a benefit of ambient incubation. However, we show that (i) clutches had a <50% chance of hatching when exposed to daily maximum air temperatures of >35.3°C; (ii) pied babbler groups incubated their nests almost constantly (99% of daylight hours) except on hot days; (iii) operative temperatures in unattended nests frequently exceeded 40.5°C, above which bird embryos are at risk of death; (iv) pied babblers incubating for long periods of time failed to maintain water balance on hot days; and (v) pied babblers from incubating groups lost mass on hot days. These results suggest that pied babblers might leave their nests during hot periods to lower the risk of dehydration associated with prolonged incubation at high operative temperatures. As mean air temperatures increase and extreme heat events become more frequent under climate change, birds will likely incur ever greater thermoregulatory costs of incubation, leading to compromised nest attendance and increased potential for eggs to overheat, with implications for nest success and, ultimately, population persistence.

Cretaceous origins of the vibrotactile bill-tip organ in birds

Some probe-foraging birds locate their buried prey by detecting mechanical vibrations in the substrate using a specialized tactile bill-tip organ comprising mechanoreceptors embedded in densely clustered pits in the bone at the tip of their beak. This remarkable sensory modality is known as 'remote touch', and the associated bill-tip organ is found in probe-foraging taxa belonging to both the palaeognathous (in kiwi) and neognathous (in ibises and shorebirds) clades of modern birds. Intriguingly, a structurally similar bill-tip organ is also present in the beaks of extant, non-probing palaeognathous birds (e.g. emu and ostriches) that do not use remote touch. By comparison with our comprehensive sample representing all orders of extant modern birds (Neornithes), we provide evidence that the lithornithids (the most basal known palaeognathous birds which evolved in the Cretaceous period) had the ability to use remote touch. This finding suggests that the occurrence of the vestigial bony bill-tip organ in all modern non-probing palaeognathous birds represents a plesiomorphic condition. Furthermore, our results show that remote-touch probe foraging evolved very early among the Neornithes and it may even have predated the palaeognathous-neognathous divergence. We postulate that the tactile bony bill-tip organ in Neornithes may have originated from other snout tactile specializations of their non-avian theropod ancestors.

Investigating perceptions of patient-centred care in orthodontics

Objectives:

To assess and compare patient and clinician perceptions of patient-centredness for adults about to commence active orthodontic treatment, and to assess whether the following variables affected perceptions of patient-centredness: patient gender and age; clinician gender and grade; and stage of treatment.

Design:

A prospective, cross-sectional questionnaire study.

Setting:

Eastman Dental Hospital, UCLH NHS Foundation Trust.

Participants:

A total of 112 adult patients and 30 clinicians completed 224 questionnaires (112 patient and 112 clinician questionnaires).

Methods:

A validated, dyadic questionnaire, the ‘9-Item Patient Perception of Patient-Centredness’ (PPPC), was used to collect data from both patients and their corresponding clinicians after initial assessment or records/treatment planning consultations. Total PPPC scores (possible score range = 9–36) were calculated for each patient and clinician to ascertain the extent to which they perceived they were engaging in patient-centredness, where higher scores corresponded with better performance.

Results:

Patients and clinicians perceived high engagement in patient-centredness with median scores of 32/36 and 29/36, respectively. There was a statistically significant difference between total scores with patients perceiving consultations to be more patient-centred than clinicians ( P < 0.001). None of the variables (patient gender and age, clinician gender and grade, stage of treatment) were statistically significant.

Conclusion:

Patients and clinicians both perceived high engagement in patient-centredness. Patients perceived consultations to be significantly more patient-centred than clinicians ( P < 0.001).

The Sheldon Friel Memorial Lecture 2020 It's not just about the teeth: Patient-centred Orthodontics

The provision of high-quality health care involves many different aspects, including safety, effectiveness, efficiency, and patient centredness. In order for care to be truly patient centred requires patients' views being sought and considered, and this may be achieved through patient-centred research. Patient-centred research is fundamentally important in contemporary health care and has many benefits; for example, it ensures that research is relevant, identifies those aspects of care that are important to patients, provides information that is important to current and future patients, and allows the integration of patients' views regarding how services may be enhanced in the future. This paper provides an overview of how we currently involve patients in orthodontic research, what this means to the specialty and how we can enhance patient involvement in the future.

Hot droughts compromise interannual survival across all group sizes in a cooperatively breeding bird

Climate change is affecting animal populations around the world and one relatively unexplored aspect of species vulnerability is whether and to what extent responses to environmental stressors might be mitigated by variation in group size in social species. We used a 15-year data set for a cooperatively breeding bird, the southern pied babbler Turdoides bicolor, to determine the impact of temperature, rainfall and group size on body mass change and interannual survival in both juveniles and adults. Hot and dry conditions were associated with reduced juvenile growth, mass loss in adults and compromised survival between years in both juveniles (86% reduction in interannual survival) and adults (60% reduction in interannual survival). Individuals across all group sizes experienced similar effects of climatic conditions. Larger group sizes may not buffer individual group members against the impacts of hot and dry conditions, which are expected to increase in frequency and severity in future.

High temperatures drive offspring mortality in a cooperatively breeding bird

An improved understanding of life-history responses to current environmental variability is required to predict species-specific responses to anthopogenic climate change. Previous research has suggested that cooperation in social groups may buffer individuals against some of the negative effects of unpredictable climates. We use a 15-year dataset on a cooperative breeding arid zone bird, the southern pied babbler Turdoides bicolor, to test (i) whether environmental conditions and group size correlate with survival of young during three development stages (egg, nestling, fledgling) and (ii) whether group size mitigates the impacts of adverse environmental conditions on survival of young. Exposure to high mean daily maximum temperatures (mean T_max) during early development was associated with reduced survival probabilities of young in all three development stages. No young survived when mean T_max > 38°C, across all group sizes. Low survival of young at high temperatures has broad implications for recruitment and population persistence in avian communities given the rapid pace of advancing climate change. Impacts of high temperatures on survival of young were not moderated by group size, suggesting that the availability of more helpers in a group is unlikely to buffer against compromised offspring survival as average and maximum temperatures increase with rapid anthropogenic climate change.

High temperatures drive offspring mortality in a cooperatively breeding bird

An improved understanding of life-history responses to current environmental variability is required to predict species-specific responses to anthopogenic climate change. Previous research has suggested that cooperation in social groups may buffer individuals against some of the negative effects of unpredictable climates. We use a 15-year dataset on a cooperative breeding arid zone bird, the southern pied babbler Turdoides bicolor, to test (i) whether environmental conditions and group size correlate with survival of young during three development stages (egg, nestling, fledgling) and (ii) whether group size mitigates the impacts of adverse environmental conditions on survival of young. Exposure to high mean daily maximum temperatures (mean T_max) during early development was associated with reduced survival probabilities of young in all three development stages. No young survived when mean T_max > 38°C, across all group sizes. Low survival of young at high temperatures has broad implications for recruitment and population persistence in avian communities given the rapid pace of advancing climate change. Impacts of high temperatures on survival of young were not moderated by group size, suggesting that the availability of more helpers in a group is unlikely to buffer against compromised offspring survival as average and maximum temperatures increase with rapid anthropogenic climate change.

Knowledge of, and attitudes to, shared decision-making in orthodontics in the UK

OBJECTIVE

To establish UK orthodontic treatment providers' knowledge of, and attitudes to, shared decision-making (SDM). SDM involves patients as equal partners in decisions about treatment.

DESIGN

Cross-sectional survey.

SETTING

Online survey across the UK.

POPULATION

Dentists and orthodontists providing orthodontic treatment in the UK.

METHODS

Potential participants were contacted through the British Orthodontic Society mailing lists. An online survey was developed to examine knowledge of, and attitudes to, SDM using a combination of evidence-based statements and free text boxes. Questions regarding previous training in SDM and preferences for further training were also included.

RESULTS

The survey was completed by 210 respondents, yielding an approximate response rate of 15%. Respondents were mainly consultants (34%) and specialist orthodontists (42%). SDM was well described in terms of the people involved in this process, how it is approached, the components and topics of discussion, and the overall purpose of SDM. Generally, there was consistency in attitudinal responses, with the largest variance in responses to questions about the professional-patient partnership, the interface between SDM and clinical guidelines, and accepting a decision that is discordant with the professional's opinion. Fifty-one respondents reported having some previous teaching/training in SDM, with the majority (87%) indicating that they would like more training.

CONCLUSION

Clinicians providing orthodontic treatment in the UK have a good understanding of the meaning of shared decision-making. Concerns raised about using SDM and knowledge gaps suggest there is value in providing SDM training for the orthodontic team and that orthodontic providers would welcome it.

How do you identify the patient with 'high expectations' of orthodontic treatment: An empirical approach

OBJECTIVES

To identify an empirical method for identifying patients with 'high expectations' of orthodontic treatment with fixed appliances using a questionnaire-based approach.

DESIGN

Secondary analysis of data from four studies which collected data on patients' expectations of orthodontic treatment using the same questionnaire.

SETTING

Secondary care orthodontic services.

PARTICIPANTS

All four datasets comprised new patients aged 12-15 years, with no history of orthodontic treatment, who fulfilled the criteria for NHS treatment using the Index of Orthodontic Treatment Need (IOTN). Unpublished dataset 1 comprised 100 participants, while dataset 2 had 70 participants, dataset 3 had 67 participants and dataset 4 comprised 40 participants.

METHODS

The questionnaire utilised in all studies had a question which asked respondents to rate seven different expectations of outcome relating to straight teeth, better smile, ease of eating, speaking, cleaning teeth, improved career prospects and social confidence. Dataset 1 was analysed to determine the proportion of patients who had rated all seven outcome expectation items at a maximum score. Similar analyses were performed for the other three datasets to explore the trend in the proportion of patients with high expectations over time.

RESULTS

For dataset 1, 2.0% of participants had high expectations, as defined by their scores on the questionnaire. The proportions for the datasets 2, 3 and 4 were 4.0%, 4.5% and 2.5%, respectively.

CONCLUSION

The method outlined provides an empirical basis for identifying patients with statistically infrequent high expectations. This can potentially help clinicians in the management of such patients.

Information seeking behaviour of dental trauma patients and their parents

BACKGROUND AND AIM

Dental trauma is a common public health issue that can be associated with high costs and lifelong treatment. Children and parents should have the correct information regarding its management to reduce the potential long-term sequelae. Understanding their information seeking behaviour is therefore important to ensure that they are able to access, understand and retain the relevant information. The aim of this study was to investigate (a) the different ways that patients undertaking treatment for dental trauma, and their parents, look for relevant information, (b) their information needs, and (c) their preferred format of information.

MATERIAL AND METHODS

This was a two-phase study: Phase I involved in-depth interviews with 10 patients who were currently undergoing treatment for dental trauma, and 11 parents. In phase II, the themes and sub-themes identified from the interviews were used to develop patient and parent questionnaires, which were distributed to all trauma patients and parents who fulfilled the inclusion criteria and who were attending the dental clinics from March to May 2014.

RESULTS

Patients and parents had different concerns immediately following the trauma, during treatment and in the long term, and they wanted different forms of information to answer their concerns. Reliability was the main issue about trusting the information available in the Internet, social media and other online sources. Therefore, patients preferred to obtain information verbally from their dentist, while parents preferred written information.

CONCLUSION

Patients and parents have different information needs, and these also vary at different stages of treatment. It is therefore important to customize the way information is provided for each group accordingly.

Patients' expectations: is there a typical patient?

OBJECTIVES

To qualitatively explore, and analyse, patients' expectations before the start of fixed appliance orthodontic treatment and determine whether typologies exist.

DESIGN

A prospective cross-sectional qualitative study, which involved 13 patients (aged 12-15 years).

SETTING

NHS Hospital Orthodontic Department (UK).

MATERIALS AND METHODS

In-depth interviews were conducted with patients who consented to participate before the start of fixed appliance orthodontic treatment. The in-depth interview data were transcribed and then managed using a framework approach, followed by associative analysis.

RESULTS

The in-depth interviews revealed two major themes and associated subthemes which were: first, patients' expectations about the treatment process and outcome; and second, patients' expectations of themselves during and after treatment. Three typologies related to patients' expectations of the orthodontic treatment process were also identified. The first group of participants had minimal expectations of the treatment process, did not anticipate discomfort or pain and did not anticipate that treatment would cause disruption to their daily life. The second group of participants had expectations that treatment would involve arch wire changes, dental extractions and result in some discomfort/pain, which would cause some limited disruption to their daily life (moderate expectations). The third type of participant had expectations of the treatment process involving arch wire changes and dental extractions, and anticipated that the discomfort and pain experienced would significantly affect their daily life (marked expectations).

CONCLUSIONS

These results provide the clinician with information about patient typologies and provide the clinician with some direction when communicating with their patients and managing their expectations before the start of treatment.

National British Orthodontic Society (BOS) Orthognathic Audit 2017–2018

Objective:

To carry out a UK national clinical audit of orthognathic acceptance criteria and information provided to orthognathic patients before treatment.

Design:

National clinical audit.

Setting:

Data collected using Bristol Online Surveys.

Participants:

Sixty-nine UK hospital orthodontic departments submitted data.

Methods:

Data were collected at two time points using Bristol Online Surveys over a period of 12 months. These were before treatment at the first multidisciplinary clinic (MDT) and immediately after surgery. The data collected included: Index of Orthognathic Functional Treatment Need (IOFTN); Index of Orthodontic Treatment Need (IOTN); age; previous orthodontic treatment; attendance at an MDT; treatment times; and information provision.

Results:

Eighty-five units agreed to take part in the audit with 69 submitting data, giving a response rate of 81%. The data from 3404 patients were uploaded, 2263 before treatment and 1141 immediately after surgery. Of patients, 91.07% had an IOFTN score of 4 or 5 and 88.73% had an IOTN score of 4 or 5. The mean age at the first MDT was 22 years in the first cohort and 21 years and 4 months in the second immediate post-surgery cohort. Of patients, 37.93% had undergone some form of previous orthodontic treatment, but only 0.28% had undergone previous orthognathic treatment; 96.93% had an MDT confirm that orthodontic treatment by itself was insufficient to adequately correct their functional symptoms. The average treatment time from bond up to surgery was 2 years and 6 months. With respect to information provision, patients received information from a number of sources, principally the British Orthodontic Society (BOS) patient information leaflets and the BOS website Your Jaw Surgery.

Conclusions:

In the UK, the majority of orthognathic cases fulfil the criteria for acceptance for NHS-funded orthognathic treatment, as outlined by the Chief Dental Officer’s interim guidance on orthognathic treatment. This suggests any prior approval process would not be a good use of NHS resources in the commissioning of orthognathic treatment.

The costs of keeping cool: behavioural trade-offs between foraging and thermoregulation are associated with significant mass losses in an arid-zone bird

Avian responses to high environmental temperatures include retreating to cooler microsites and/or increasing rates of evaporative heat dissipation via panting, both of which may affect foraging success. We hypothesized that behavioural trade-offs constrain the maintenance of avian body condition in hot environments, and tested predictions arising from this hypothesis for male Southern Yellow-billed Hornbills (Tockus leucomelas) breeding in the Kalahari Desert. Operative temperatures experienced by the hornbills varied by up to 13 °C among four microsite categories used by foraging males. Lower prey capture rates while panting and reductions associated with the occupancy of off-ground microsites, resulted in sharp declines in foraging efficiency during hot weather. Consequently, male body mass (M_b) gain between sunrise and sunset decreased with increasing daily maximum air temperature (T_max), from ~ 5% when T_max < 25 °C to zero when T_max = 38.4 °C. Overnight M_b loss averaged ~ 4.5% irrespective of T_max, creating a situation where nett 24-h M_b loss approached 5% on extremely hot days. These findings support the notion that temperature is a major determinant of body condition for arid-zone birds. Moreover, the strong temperature dependence of foraging success and body condition among male hornbills provisioning nests raises the possibility that male behavioural trade-offs translate into equally strong effects of hot weather on female condition and nest success. Our results also reveal how rapid anthropogenic climate change is likely to substantially decrease the probability of arid-zone birds like hornbills being able to successfully provision nests while maintaining their own condition.

Extraction of premolars for orthodontic reasons on the decline? A cross-sectional survey of BOS members

OBJECTIVE

To obtain the opinion of British Orthodontic Society (BOS) members in relation to possible patterns of prescription of orthodontic extractions over the past 5-10 years and to relate any changes identified to treatment objectives, facial and smile aesthetics, and treatment strategies and adjuncts.

DESIGN

Cross-sectional questionnaire.

SETTING

On-line survey of BOS members.

METHODS

A 14-item on-line questionnaire was sent to orthodontic practitioners for completion. The questionnaire covered demographics, possible changes in frequency of prescribed extractions with specific information concerning the effect of patient age, and the influence of other factors including alternative approaches to space creation, evolving treatment mechanics, smile and facial aesthetics, and retention protocols.

RESULTS

Two hundred and eight responses were obtained with 95.6% (n = 199) reporting reduced extraction prescription over the last 5-10 years. Overall, 29.9% and 35.5% felt that their threshold for extractions had increased by more than 2 mm in adolescents and adults, respectively. Facial (n = 145; 69.7%) and smile (n = 127; 61.1%) aesthetics, and increased use of inter-proximal reduction (n =  102; 49%) were the factors most frequently reported as having either a moderate or major influence on this trend. Based on ordinal logistical regression analyses, no significant relationship was found between threshold for extractions and work setting (P =  0.675; O.R. 0.51; 95% CI: 0.39, 1.85) or level of orthodontic experience (P =  0.15; O.R. 1.02; 95% CI: 0.15, 1.05), although a higher threshold for extractions was more likely among users of conventional than self-ligating brackets (P =  0.001; O.R. 4.74; 95% CI: 1.95, 11.5).

CONCLUSIONS

A reduced tendency to prescribe orthodontic extractions over the past 5-10 years among British Orthodontic Society members was identified. Comparative clinical research exploring the relative merits of extraction and non-extraction approaches could be timely.

Career satisfaction and work-life balance of specialist orthodontists within the UK/ROI

Objectives To investigate factors affecting career satisfaction and work-life balance in specialist orthodontists in the UK/ROI.Design and setting Prospective questionnaire-based study.Subjects and methods The questionnaire was sent to specialist orthodontists who were members of the British Orthodontic Society.Results Orthodontists reported high levels of career satisfaction (median score 90/100). Career satisfaction was significantly higher in those who exhibited: i) satisfaction with working hours; ii) satisfaction with the level of control over their working day; iii) ability to manage unexpected home events; and iv) confidence in how readily they managed patient expectations. The work-life balance score was lower than the career satisfaction score but the median score was 75/100. Work-life balance scores were significantly affected by the same four factors, but additionally were higher in those who worked part-time.Conclusions Orthodontists in this study were highly satisfied with their career and the majority responded that they would choose orthodontics again. Work-life balance scores were lower than career satisfaction scores but still relatively high. It is important for the profession to consider ways of maintaining, or improving, career satisfaction and work-life balance; including maintaining flexibility of working hours and ensuring that all clinicians have ready access to appropriate training courses throughout their careers (for example, management of patient expectations).