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First dental steps intervention: feasibility study of a health visitor led infant oral health improvement programme
Get PDFBackground
In England, dental caries is common (22.4% of 5-year-olds, 2024) and the primary reason for hospital admission of children. First Dental Steps (FDS), an intervention in South West England, includes training for health visitors, integrating oral health advice into home visits and provision of oral health packs (a free flow cup, toothbrush and 1450ppm fluoride toothpaste) to vulnerable families at the 1-year developmental check. The aim was to conduct a feasibility study of FDS to support parents to increase infant toothbrushing.
Methods
This study explored the feasibility and acceptability of the FDS intervention and research methods in 5 local authority areas in South West England and 4 comparison sites. Data collection (June 2021-February 2022) included baseline and follow-up questionnaires (mean 5 months), semi-structured interviews with parents (n = 16), health visitors (n = 7), and stakeholders (n = 16). Analysis of questionnaires was descriptive, and interviews were analysed using the framework method.
Results
Parents completed baseline (n = 59) and follow-up questionnaires (n = 26), with 10 parents (40%) reporting an increase in brushing frequency and 4 families (15%) reported visiting a dentist. From the interview data, five themes were identified 1) acceptability of the intervention, 2) feasibility of the intervention (delivery and implementation), 3) possible benefits of the intervention, 4) acceptability of study methods, and 5) suggested improvements. The FDS intervention was seen to be acceptable and feasible to those who took part, however, challenges with recruitment and retention demonstrate that obtaining data for a full trial would not be feasible.
Conclusions
Parents, health visitors and stakeholders who took part in our study found FDS to be acceptable and feasible. Recruitment, retention and study methods (completing participant flow table) were challenging, and the progression criteria for the research methods were not met to progress to a full trial. Modifications were recommended to improve the intervention and further co-production approaches could be used to ensure it is culturally appropriate in a diverse population
Dietary protein intake and overall diet quality in adults with cystic fibrosis following elexacaftor/tezacaftor/ivacaftor therapy
Get PDFThe RDA for dietary protein is likely insufficient for individuals with cystic fibrosis (CF). This study sought to characterise protein intake and diet quality in adults with cystic fibrosis (awCF), before and after elexacaftor/tezacaftor/ivacaftor (ETI) therapy, compared with healthy controls. Dietary intake was assessed by diet diary in awCF at baseline (BL, n 40) and at follow-up > 3 months post ETI therapy (follow-up (FUP), n 40) and in age-matched healthy controls (CON, n 80) free from known disease at a single time point. Protein intake dose and daily distribution, protein quality, protein source and overall diet quality were calculated for each participant. Both CON (1·39 (sd 0·47) g·kg–1·day–1) and CF (BL: 1·44 (sd 0·52) g·kg–1·day–1, FUP: 1·12 (sd 0·32) g·kg–1·day–1) had a higher mean daily protein intake than the protein RDA of 0·75g·kg–1·day–1. There was a significant reduction in daily protein intake in the CF group at FUP (P = 0·0003, d = 0·73), with levels below the alternative suggested dietary intake of ≥ 1·2 g·kg–1·day–1. There were no sex differences or noticeable effects on protein quality or source following the commencement of ETI therapy when compared with CON (all P > 0·05), although overall diet quality decreased between time points (P = 0·027, d = 0·57). The observed reduction in daily protein intake in the present cohort emphasises the importance of ensuring appropriate dietary protein intake to promote healthy ageing in adults with CF. More research is needed to evidence base dietary protein requirements in this at-risk population
EPS4.05CF Tummy Tracker: development of a cystic fibrosis-specific patient reported outcome measure for daily gastrointestinal symptom burden
No full textInternational consensus statement on routine blood testing in primary ciliary dyskinesia
Get PDFBackground
Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterised by dysfunction of motile cilia. Symptoms include recurrent and chronic airway infections which can lead to deteriorating lung function and inflammatory destructive lung disease in the form of persistent atelectasis and bronchiectasis. Routine blood testing may be used as a tool for disease monitoring and management. However, currently there are no consensus-based guidelines within the field of PCD. BEAT-PCD together with the ERN-LUNG PCD-Clinical Trial Network aimed to develop an international expert consensus statement on which routine blood tests should be conducted in patients with PCD.
Methods
An international panel of 33 PCD experts from 17 countries was established to generate consensus on routine blood testing in PCD. A modified Delphi technique with three e-survey rounds was used to reach consensus, which was defined as ≥80% agreement for each statement. Two patient representatives were included in the consensus process.
Results
The expert panel reached consensus on 51 out of 101 statements (50%) on routine blood testing in children and adults with PCD to be performed at diagnosis, annually and on exacerbation. The statements include biomarkers for inflammation, haemoglobin, iron status, vitamin D, immune function, inhalant allergies, liver and kidney function, and allergic bronchopulmonary aspergillosis.
Conclusions
This is the first international consensus on routine blood testing in PCD. It highlights blood tests that may be relevant to perform at diagnosis, annually and on exacerbation in people with PCD. Further research on the clinical usefulness of routine blood testing in PCD is needed
Evaluating the effectiveness of the Drink Less smartphone app for reducing alcohol consumption compared with usual digital care: a comprehensive synopsis from a 6-month follow-up RCT
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Digital interventions can be effective for reducing alcohol consumption. However, most digital interventions that have been evaluated are websites and there is little evidence on the effectiveness of smartphone apps, especially in a United Kingdom context. We developed an evidence- and theory-informed app, Drink Less, to help increasing-and-higher-risk drinkers (Alcohol Use Disorders Identification Test score ≥ 8) reduce their alcohol consumption.
Objective
To evaluate the effectiveness of Drink Less for reducing alcohol consumption compared with usual digital care in the United Kingdom.
Design
Two-arm, double-blind, parallel-group, randomised controlled trial with 1 : 1 group allocation and an embedded process evaluation, with 6-month follow-up.
Setting
Remotely conducted among participants living in the United Kingdom, recruited from July 2020 to March 2022.
Participants
Five thousand six hundred and two increasing-and-higher-risk drinkers aged 18+ who had access to an iPhone operating system device and wanted to drink less alcohol.
Interventions
Participants were recommended to use the intervention (Drink Less) or recommended the comparator (National Health Service alcohol advice web page).
Drink Less is an app-based intervention to help increasing-and-higher-risk drinkers reduce their alcohol consumption. It consists of evidence-based modules (e.g. goal setting, self-monitoring) and was systematically and transparently developed and refined.
The National Health Service alcohol advice web page was considered usual digital care and provides tips on cutting down.
Main outcome measures
The primary outcome was self-reported weekly alcohol consumption at 6-month follow-up (derived from the extended Alcohol Use Disorders Identification Test – Consumption), adjusted for baseline alcohol consumption.
Results
The retention rate at 6-month follow-up was 80%. The data were not missing completely at random with differences detected in educational qualifications, occupation and income, indicating that multiple imputation was the most appropriate analytic approach. This found that Drink Less resulted in a 2.00 United Kingdom unit greater weekly reduction (95% confidence interval −3.76 to −0.24) at 6-month follow-up compared with the National Health Service alcohol advice web page. Compared with the National Health Service alcohol advice web page, Drink Less cost an additional £1.28 per user, when including the sunk costs (already incurred and cannot be recovered), but saved £0.04 per user when considering only the annual maintenance costs. Drink Less costs only an extra £0.64 per additional weekly unit of alcohol reduction, and may be cost saving if sufficient people use the app to cover the sunk costs. There was no statistically significant difference in quality-adjusted life-years between the two groups.
Limitations
This trial relied on retrospective self-reported alcohol consumption. Results from the pre-registered sensitivity analysis of multiple imputation were inconsistent with those from the pre-registered primary analysis (a conservative approach to missing data where non-responders were assumed to be drinking at baseline levels), which found a non-significant weekly reduction of 0.98 units (95% confidence interval −2.67 to 0.70) in the intervention compared with comparator group. Multiple imputation was recommended by the independent Data Monitoring Committee based on the pattern of missing data.
Conclusions
Drink Less appears effective for reducing alcohol consumption among increasing-and-higher-risk drinkers compared with the National Health Service alcohol advice web page in the United Kingdom, and may be cost saving if widely used in the population.
Future work
Drink Less is in a strong position to be promoted widely and provide inexpensive support to increasing-and-higher-risk drinkers in the United Kingdom. Future work should investigate different promotion strategies and ways of implementing the app within healthcare settings and adapting it for other countries.
Funding
This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR127651
Haplotype-resolved genome of Agastache rugosa (Huo Xiang) provides insight into monoterpenoid biosynthesis and gene cluster evolution
Get PDFMonoterpenoids are small volatile molecules produced by many plants that have applications in consumer products and healthcare. Plants from the mint family (Lamiaceae) are prodigious producers of monoterpenoids, including a chemotype of Agastache rugosa (Huo Xiang), which produces pulegone and isomenthone. We sequenced, assembled and annotated a haplotype-resolved chromosome-scale genome assembly of A. rugosa with a monoterpene chemotype. This genome assembly revealed that pulegone biosynthesis genes are in a biosynthetic gene cluster, which shares a common origin with the pulegone gene cluster in Schizonepeta tenuifolia. Using phylogenetics and synteny analysis, we describe how the clusters in these two species diverged through inversions and duplications. Using Hi-C analysis, we identified tentative evidence of contact between the pulegone gene cluster and an array of pulegone reductases, with both regions also enriched in retrotransposons. This genome and its analysis add valuable and novel insights to the organization and evolution of terpenoid biosynthesis in Lamiaceae
Quantum superposition of boundary conditions in PAdS2
Get PDFWe explore the quantum superposition of boundary conditions in the context of the Poincaré patch of the two-dimensional anti–de Sitter space. Focusing on Robin (mixed) boundary conditions, we investigate the response function of the Unruh-DeWitt (UDW) detector interacting with two or more scalar fields, each respecting a different boundary condition. The role of this quantum superposition is twofold: (i) it may represent different fields propagating on the same spacetime and interacting with an UDW detector or (ii) it may describe an UDW detector on a superposition of spacetimes, each one with an inequivalent propagating field
Cascading Constraint and Subsidiary Discretion:Perspectives on Police Discretion From Police-Led Drug Diversion and Stop and Search in England
Get PDFThis article explores how discretion is managed and exercised across senior, middle, and street levels of policing. It uses qualitative data from two studies in England. The first, a study across three police force areas, involved interviews and focus groups with 221 people who were designers, deliverers, and recipients of police-led drug diversion. The second study used 354 hours of ethnographic observation and 21 interviews to examine stop-and-search practices in one other police force. Rather than a simply expanding scope of discretion at lower levels of the hierarchy, the findings reveal a multi-level process of cascading constraints and subsidiary discretion. At each level, we observe the exercise of occupational professionalism and autonomous judgement, but higher-level constraints shape how discretion is applied in pursuit of organizational professionalism
Measurement report:Exploring the variations in ambient BTEX in urban Europe and their environmental health implications
Get PDFBTEX (benzene, toluene, ethylbenzene, and m-xylene,p-xylene, and o-xylene) are significant urban air pollutants. This study examines BTEX variability across 7 European countries using data from 22 monitoring sites in different urban settings (urban background, traffic, industry, and suburban background). Results indicate that the relative abundance of BTEX in urban areas follows the order toluene > benzene > m,p-xylene > o-xylene > ethylbenzene, with median mixing ratios of 266 ± 152, 163 ± 74, 129 ± 88, 53 ± 35, and 45 ± 27 ppt during the years 2017-2022, respectively. Seasonal trends show benzene had similar median concentrations across urban background, traffic, and industrial sites, indicating mixed sources. Toluene levels were highest in traffic and industrial areas, highlighting road traffic and industrial emissions. Ethylbenzene and xylenes showed equivalent levels in traffic and industrial areas but were lower in urban backgrounds. Peak BTEX levels occurred during morning and evening rush hours, linked to traffic, heating, and atmospheric stagnation. B/T ratios ranged from 0.29 ± 0.11 to 1.35 ± 0.95, and X/E ratios ranged from 1.75 ± 0.91 to 3.68 ± 0.30, indicating primary pollution from local traffic, followed by solvents, coatings, and biomass burning. Lifetime cancer risk from BTEX exposure was below the definite risk threshold (10-4) but above the permissible risk level (10-6), suggesting moderate risk from benzene and ethylbenzene, particularly in traffic and industrial areas. Additionally, the health index of BTEX at monitoring sites was generally lower than the threshold limit value, suggesting a low non-carcinogenic risk overall. This study offers essential insights into BTEX pollution in urban European environments
An aminostratigraphy of the northern Upper Rhine Graben, Germany
Get PDFThe northern Upper Rhine Graben (Germany) contains a complex, quasi-continuous Quaternary record, but constraining its chronology is challenging. This study presents the first application of amino acid geochronology for this region using Bithynia opercula to establish a relative dating framework. Intra-crystalline protein decomposition (IcPD) results from opercula have allowed their horizons to be statistically grouped into clusters of equivalent age. Independent chronological evidence associated with these clusters was evaluated to refine the sediment chronology. This framework both constrains the ages of key lithostratigraphic units and facilitates cross-correlation of sediments across the graben, therefore providing a reference regional aminostratigraphy, which has also been extended to help constrain the age of various nearby Palaeolithic sites. This approach shows the value of combining the multi-parameter datasets from IcPD with other chronological evidence to cross-correlate boreholes, hence creating a reference dataset for Quaternary deposits for a given region
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