The usability of digestate in organic farming.

As organic farming prohibits the use of synthetic fertilisers, animal slurries and manures must be used. Digestate offers an alternative to these and this study reports on three experiments conducted to determine its usability in terms of: (1) the effect on earthworm populations, (2) its fertilising effects on Italian Ryegrass and wild Creeping Thistle, and (3) the suppression effects digestate has on weed emergence. The results for digestate application to field plots were intermediate between slurry and no treatment for earthworm attraction and wild thistle suppression. In glasshouse trials it led to increased ryegrass growth compared with undigested slurry. Analysis showed that the digestate had improved nitrogen availability, leading to increased plant growth, but a reduced organic matter content compared with the slurry, leading to a positive though less beneficial impact on the earthworms. Digestate therefore provides a suitable fertiliser for organic farming. This suitability could be improved by drying or separation to increase the OM content making its properties closer to those of slurry whilst still retaining the higher content of plant available nitrogen.

Measuring the development of insight by dental health professionals in training using workplace-based assessment.

INTRODUCTION: For health professionals, the development of insight into their performance is vital for safe practice, professional development and self-regulation. This study investigates whether the development of dental trainees' insight, when provided with external feedback on performance, can be assessed using a single criterion on a simple global ratings form such as the Longitudinal Evaluation of Performance or Mini Clinical Evaluation Exercise. METHODS: Postgraduate dental trainees (N = 139) were assessed using this tool on a weekly basis for 6 months. Regression analysis of the data was carried out using SPSS, and a short trainer questionnaire was implemented to investigate feasibility. RESULTS: Ratings for insight were shown to increase with time in a similar manner to the growth observed in other essential skills. The gradient of the slope for growth of insight was slightly less than that of the other observed skills. Trainers were mostly positive about the new criterion assessing trainees' insight, although the importance of training for trainers in this process was highlighted. DISCUSSION: Our data suggest that practitioners' insight into their performance can be developed with experience and regular feedback. However, this is most likely a complex skill dependent on a number of intrinsic and external factors. CONCLUSION: The development of trainees' insight into their performance can be assessed using a single criterion on a simple global ratings form. The process involves no additional burden on evaluators in terms of their time or cost, and promotes best practice in the provision of feedback for trainees.

Stevens-Johnson syndrome in a boy with macrolide-resistant Mycoplasma pneumoniae pneumonia.

Mycoplasma pneumoniae is a highly specialized parasitic bacterium that is a significant cause of community-acquired pneumonia in children. Although most such respiratory infections are mild, a minor percentage of patients require hospitalization and, occasionally, intensive treatment for respiratory failure. A variety of extrapulmonary sequelae of M pneumoniae infections have been described, including Stevens-Johnson syndrome. Macrolide resistance in M pneumoniae has developed rapidly in Asia, particularly in China, over the past decade and is now appearing in the United States. Emerging resistance to macrolides creates a therapeutic conundrum, particularly for pediatricians caring for young children in whom absolute or relative contraindications exist for the use of tetracyclines or fluoroquinolones, the 2 other main classes of drugs shown to be efficacious for M pneumoniae. We describe here the case of a child with a prolonged febrile illness associated with Stevens-Johnson-like mucocutaneous involvement who was found to have a respiratory infection with macrolide-resistant M pneumoniae.

An international survey in postgraduate training in Oral Medicine.

OBJECTIVES: The aim of this preliminary study was to investigate postgraduate Oral Medicine training worldwide and to begin to identify minimum requirements and/or core content for an International Oral Medicine curriculum. MATERIALS AND METHODS: Countries where there was believed to be postgraduate training in Oral Medicine were identified by the working group. Standardized emails were sent inviting participants to complete an online survey regarding the scope of postgraduate training in Oral Medicine in their respective countries. RESULTS: We received 69 total responses from 37 countries. Of these, 22 countries self-identified as having postgraduate Oral Medicine as a distinct field of study, and they served as the study group. While there is currently considerable variation among Oral Medicine postgraduate training parameters, there is considerable congruency in clinical content of the Oral Medicine syllabi. For example, all of the training programs responded that they did evaluate competence in diagnosis and management of oral mucosal disease. CONCLUSIONS: This preliminary study provides the first evidence regarding international Oral Medicine postgraduate training, from which recommendations for an international core curriculum could be initiated. It is through such an initiative that a universal clinical core syllabus in postgraduate Oral Medicine training may be more feasible.

The patient assessment questionnaire: a new instrument for evaluating the interpersonal skills of vocational dental practitioners.

This paper describes a pilot study aimed at evaluating a new instrument, the patient assessment questionnaire (PAQ), which uses patient ratings for the assessment of communication skills and professionalism in vocational practitioners (VDPs). The PAQ was developed as part of an assessment system designed to address all round competence. Acohort of 99 VDPs took part in the study. Questionnaires were distributed to consecutive patients in the general dental service at two time points in the training year. Data from the pilot study was analysed to determine whether the PAQ fulfilled the criteria for robust assessment. Results provide evidence of high levels of reliability, validity and feasibility of the PAQ instrument. All indications to date suggest that the PAQ will prove to be a valuable assessment tool. It is currently being evaluated as part of the system used to assess the all round competence of dental graduates undertaking vocational training in Scotland.

The value of performing head CT in screening for cerebral metastases in patients with potentially resectable non-small cell lung cancer: experience from a UK cardiothoracic centre.

AIM: To evaluate the whether screening for cerebral metastases in neurologically intact patients with potentially resectable non-small cell lung cancer patients is both worthwhile and cost-effective. METHODS: We prospectively performed computed tomography (CT) of the head in 105 consecutive patients with potentially resectable lung cancer over an 18-month period. None of these patients had neurological symptoms or signs. RESULTS: Five patients (4.8%) with cerebral metastases were identified using CT. At our institution the financial saving of avoiding five thoracotomies was pound sterling 45,000, whilst the cost of performing 105 head CTs was pound sterling 16,000. This represented a substantial saving for the healthcare provider and preserved the quality of life in five patients. CONCLUSIONS: We conclude that screening for cerebral metastases in neurologically intact patients with potentially resectable non small cell lung cancer patients is both worthwhile and cost effective.

Satisfactory completion of dental vocational training in Scotland: a system of assessment.

Formal assessment of dental vocational training (DVT) has been an issue since 1993 when DVT became mandatory for graduates wishing to practice within the NHS. There have been a number of other drivers for change, including concerns about the capabilities of new graduates, a lack of standardisation of the training experience and accountability for standards of training. All of these factors contributed to the decision, by the Scottish Council for Postgraduate Medical and Dental Education (now part of NHS Education for Scotland--NES), to support a programme of research into the development of a competency-based system of assessment for DVT. During the life of this project the argument for introducing assessment of DVT and General Professional Training (GPT) has become ever stronger.

How does a g993t mutation in the emerin gene cause Emery-Dreifuss muscular dystrophy?

X-linked Emery-Dreifuss muscular dystrophy is usually caused by absence of the nuclear membrane protein, emerin, due to nonsense mutations or deletions, but a few missense mutations also exist. A pathogenic g993t mutation causes a Q133H change in the nuclear targeting region of emerin, but it may also reduce emerin levels by affecting mRNA splicing. We have introduced the g993t mutation by in vitro mutagenesis and studied the effect of Q133H on nuclear targeting by transfection of COS-7 cells. No qualitative or quantitative differences in nuclear targeting were observed between normal and mutant emerin. Quantitative BIAcore analysis showed no significant change in lamin A binding to emerin when the mutation was present. We conclude that Q133 is not essential for nuclear targeting of emerin or its interaction with lamin A. Reduced emerin levels due to altered splicing or defective interaction with an unidentified binding partner remain possible pathogenic mechanisms.

The R482Q lamin A/C mutation that causes lipodystrophy does not prevent nuclear targeting of lamin A in adipocytes or its interaction with emerin.

Most pathogenic missense mutations in the lamin A/C gene identified so far cause autosomal-dominant dilated cardiomyopathy and/or Emery-Dreifuss muscular dystrophy. A few specific mutations, however, cause a disease with remarkably different clinical features: FPLD, or familial partial lipodystrophy (Dunnigan-type), which mainly affects adipose tissue. We have prepared lamin A with a known FPLD mutation (R482Q) by in vitro mutagenesis. Nuclear targeting of lamin A in transfected COS cells, human skeletal muscle cells or mouse adipocyte cell cultures (pre- and post-differentiation) was not detectably affected by the mutation. Quantitative in vitro measurements of lamin A interaction with emerin using a biosensor also showed no effect of the mutation. The results show that the loss of function of R482 in lamin A/C in FPLD does not involve loss of ability to form a nuclear lamina or to interact with the nuclear membrane protein, emerin.

Direct interaction between emerin and lamin A.

Emerin is the protein of the inner nuclear membrane that is affected by mutation in X-linked Emery-Dreifuss muscular dystrophy. The autosomal dominant form of the disease is caused by mutations in the lamin A/C gene. Several lines of circumstantial evidence have suggested an interaction of emerin with lamins in the nuclear lamina but direct interaction between the two proteins has not yet been demonstrated. We now demonstrate direct interaction between recombinant emerin and lamin A molecules using biomolecular interaction analysis (BIA) and monoclonal antibodies. An emerin-lamin A interaction system may be related in function to the LAP2-lamin B system at the inner nuclear rim.

MPOA lesions affect female pacing of copulation in rats.

This study examined the effects of electrolytic and ibotenic acid (IA) lesions of the medial preoptic area (MPOA) on the temporal pattern of female sexual behavior in the laboratory rat. Both electrolytic and IA MPOA lesions significantly increased the female's latency to return to the male after an intromission or an ejaculation, thereby decreasing the percentage of time spent with a male. Both types of MPOA lesions significantly increased the percentage of times the female left the male's chamber following intromissions. These results demonstrate that neurons in the MPOA regulate the female's temporal copulatory behavior, and the authors suggest that they do so by virtue of their response to vaginocervical stimulation. Studies of female pacing draw attention to parallels between male and female sexual behaviors, including the possibility that they are regulated by similar neural substrates in the MPOA.

Achieving additional myopic correction in undercorrected radial keratotomy eyes using the Lexington RK splint design.

PURPOSE: To reshape or flatten the corneas of post-radial keratotomy (RK) patients with residual myopia to improve uncorrected vision. METHODS: Twenty-one eyes (12 patients) with undercorrected RK results were fit with the Lexington RK splint, a multicurve plateau concept RGP contact lens. RESULTS: After wearing the lens an average of 6.1 months, undercorrected visual acuity improved an average 3.4 lines; change in spherical equivalent averaged 0.77 D; and flat K change averaged 0.75 D. Seventeen of 21 eyes (81%) demonstrated improved uncorrected vision. Nine eyes (43%) subsequently had a decrease in vision after discontinuing lens wear. Patients fit within 7 months of their last RK procedure were more likely to achieve optimal results. Sixty-two percent of this group did not require glasses or contact lenses (range: 4 to 21 months). CONCLUSIONS: A well-designed and fit plateau RGP contact lens can manipulate the healing post-RK cornea.

Migration and Helicobacter pylori seroprevalence: Bangladeshi migrants in the U.K.

Helicobacter pylori, an infectious agent of worldwide public health importance, has higher seroprevalence in developing countries than in developed countries. We investigated whether Bangladeshi women, born in Bangladesh, have a greater H. pylori seroprevalence than Bangladeshi women born in the U.K. and, in addition, whether there is an association between H. pylori seropositivity and age of migration to the U.K. amongst Bangladeshi women. Women attending antenatal clinics at the Royal London Hospital were screened using ELISA for anti-H. pylori IgG. In Bangladeshi individuals born in the U.K., 13/16 (81%, 95% confidence interval (CI) 54%-96%) and, in Bangladeshi individuals born in Bangladesh 91/137 (66%, 95% CI 59%-74%) had antibodies to H. pylori. No significant association was found between H. pylori seropositivity and country of birth, or age at migration to the U.K. Public health strategies concerning H. pylori should consider migrant populations with high seroprevalence of H. pylori.

Helicobacter pylori infection in dentists--a case-control study.

To test the null hypothesis that frequent and multiple salivary exposure is not a risk factor for developing H. pylori infection, serum anti-H. pylori IgG from 179 dentists and dental students and 179 age-, sex- and socioeconomic-matched controls were assayed using an ELISA. Seroprevalence in dentists was 16% (11/70); clinical dental students 6% (3/47); and pre-clinical dental students 10% (6/62). There were no differences in H. pylori seropositivity between cases and controls. There was an increase in H. pylori seropositivity with age (chi (trend)2 9.04, p = 0.003). These data provide evidence that adults are not at high risk of developing H. pylori infection as a result of exposures to saliva from multiple sources.

The relationship between voluntary electromyogram, endurance time and intensity of effort in isometric handgrip exercise.

The relationship between relative force, electromyogram (EMG) and time to fatigue was examined in seven male and seven female subjects [mean (SD) age, 21.7 (3.2) years] during isometric handgrip exercise. Subjects performed sustained submaximal contractions of the right handgrip at three different intensities: 30%, 50%, and 75% of the pretrial maximum voluntary contraction (MVC). EMG was sampled in 1-s epochs every 15 s during the contractions, and the integrated EMG (IEMG) values were then normalized to that of the pretrial MVC. As expected, time to fatigue was longest at 30% MVC and shortest at 75% MVC, but women performed consistently longer than men at each of the three intensities [woman vs men; 400.7 (35.8) vs 364.3 (34.4) s, 205.1 (15.6) vs 139.4 (13) s, and 89.9 (11.4) vs 66.4 (6.4) s, for 30%, 50%, and 75% MVC, respectively; P < 0.05)]. IEMG increased in a non-linear fashion over time during each trial, with the magnitude of IEMG being proportional to the intensity of the contraction. At the endurance limit, IEMG was greatest in the 75% MVC trial, however, no IEMG values reached those obtained in the related MVC [30%, 57.2 (6.9)%, 50%, 84.6 (5.7)%; 75%, 92.8 (7.4)%]. In conclusion, endurance time during sustained submaximal isometric handgrip exercise is dependent up on the intensity of the effort, with women having significantly larger endurance times than men. The related increase in IEMG is also proportional to the intensity of effort, however, the factors causing force to fail prior to the final IEMG reaching its predicted maximum remain to be elucidated.