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This paper analyses how teacher identity is shaped by professional standardisation and regulatory apparatuses in the context of English Further Education from a specifically spatial perspective. We focus on how these apparatuses erode teachers' sense of identity and, paradoxically, quality by establishing what anthropologist Marc Augé (1935-2023) calls 'non-places'. Drawing on interview data and Augé's spatial anthropology, we discuss how places can define, foster and erode identity and, thus, practice. Our data shows how teachers' accounts of their changing spatial experiences reflects the transient nature of their own interpretations of how identities are shaped in these shifting contexts of 'dis/placement' wherein the process of identity construction frequently places individuals in contact with another side of themselves.

This paper develops the pedagogical implications of xenolexia, a concept introduced as a phenomenon in the learning and teaching of academic writing (Beighton, C. 2020. "Beyond Alienation: Spatial Implications of Teaching and Learning Academic Writing." "Teaching in Higher Education" 25 (2): 205-222.). Complementing this theoretical base, this paper examines xenolexia's positivity and its ability to both analyse and propose specific academic writing pedagogies in today's challenging HE context(s). Drawing on data from students/teachers of academic writing (n = 33), this paper uses xenolexia aetiologically and practically. Aetiologically, I identify and categorise different sets of practices in terms of the way they respond to this positivity as two pedagogical tropes: the material and its affective counterpart. Practically, I discuss pedagogical practices associated with these tropes in the light of the data. My conclusions about the extent to which each contributes to the development of academic writing link the latter to the current context of teaching and learning in higher education, challenging approaches based on identity with more productive material, affective alternatives.

This paper examines emerging discourses and practices of quality assurance in English Further Education (FE), a sector currently undergoing significant change. Using a broadly ethnographic approach and Foucauldian theories of power, we discuss how 'documentisation' contributes to governance techniques in a specific institutional context. Documentisation, the transformation of concrete practice into discourse, reverses a common-sense view of the role of policy documentation and exemplifies a wide range of practices in both FE and the wider post-16 sector and includes the gamification of quality systems. Our analysis of the conditions and practices out of which the phenomenon appears identifies processes that are shaping present-day experiences and redefining the discourse of quality itself. Moreover, rather than situating compliance and/or resistance in practice "per se," we argue that it is within the conditions of possibility expressed by such processes that the intertwining of compliance and resistance can best be appreciated.

This paper critiques recent developments in educational discourse through an analysis of two UK Government White Papers and three specific problems. We argue that the latter herald forms of 'biocreep'. Echoing the analysis of such phenomena in the work of Michel Foucault, this gradual extension of 'biopolitics' into the field of education is a tendency which has accelerated with the Coronavirus pandemic and raises many questions for policy analysis. First, we show how the White Papers' approach to life and its related assumptions embody an attempt to further entrench the techniques of biopolitical population management in secondary and further education settings. Second, our analysis of the two Papers shows not just a deepening discursive shift towards ways of instrumentalising educational processes, but also identifies a triple problem of political assemblage: primo, this shift relies on the assemblage of a 'problematic subject'; secondo, it simultaneously assembles the problem of value extraction; and tertio, it obscures the problem of desire or unruliness of the assemblages created. Just as discursive practices of instrumentation, administration and evacuation try to manage these assemblages, they remain unable to contain the three problems they enshrine.

French philosopher Gilles Deleuze (1925-95) was something of a cult figure among his university students in the 1970s and 1980s, "telling ghost stories with the voice of an ogre" (Jaeglé, 2005:10). More recently, academic interest in the educational possibilities of his work has grown considerably in Anglophone countries. Perhaps texts such as "A Thousand Plateaus" (Deleuze & Guattari, 2004b3), which discuss "things which, at the time, didn't fully exist, and which just seemed science fiction," have become more readable since 21st-century shifts in geo-politics, notably the events associated with 9/11 and their echoes in current affairs (Antonioli in Dosse, 2007, p. 583). Questions remain as to whether Deleuze's well-known suggestion in 1968 that his empiricism necessarily has affiliations with science fiction (Deleuze, 1994) can really shift attention from the current focus on outcomes to the "actual ontology" of practice (Strom, 2015, p. 10), thus informing more socially just teacher education and research. In this article, the author addresses this question by examining the potential of Deleuze's "science fiction" ontology, where being is expressed in the reciprocal determination of virtual and actual (Deleuze, 1996, 179-185), to enhance social justice.

Following a damning report into racism in United Kingdom Higher Education (EHRC, 2019), this paper discusses students' experiences of racism in HE. Focusing on the connections between lived experience and wider goals and trends in the Internationalisation of the university sector, we discuss accounts of racist practices on campus through the concept of xeno-racism highlighted in data from a small-scale, in-depth qualitative study. Three main findings are highlighted. First, we suggest that racism is a predictable -- even integral - feature of Internationalisation as it is currently pursued by UKHE. Second, we argue that our data provides evidence that the traditional forms of racism highlighted by the EHRC are part of a wider, deeper problem of xeno-racist treatment and troubling narrative practices. Finally, our analysis connects these practices to a degree of angelism in the Internationalised institution's self-image, portraying Internationalised HE in an idealistic but disingenuous way for financial gain. Together, these three phenomena undermine UKHE's altruistic claims by subordinating the issue of discrimination to questions of process, brand management, and reputational damage limitation. Tackling the problem of racism on campus cannot be successful without also tackling these issues.

This paper argues that a shift in discourse about the nature and purpose of Further Education is under way in England. A recent White Paper, 'Skills for jobs: lifelong learning for opportunity and growth', issued by the UK government, is couched in terms which suggest that a prior reliance on the ideology of neoliberalism is now moving towards the objectives and instruments of what Michel Foucault termed biopolitics or the exploitation of life itself. I analyse the White Paper and related recent texts to show how a form of vitalist discourse accompanies attempts to accelerate potentially problematic processes of value-extraction. While these developments respond partly to the societal changes resulting from the threats to life of the Coronavirus pandemic and other existential crises, their likely impact suggests a shift in the discourses of lifelong learning: an existing apparatus of normalisation and control is now turning to biopolitical exploitation.

This paper critically examines Equality and Human Rights Commission's (EHRC) 2019 report into racism in United Kingdom Higher Education. After outlining the context of the report, the paper is situated within discourses of internationalization in higher education (HE) and those of investment, excellence and social mobility. Using transversality, an analytical tool developed by Gilles Deleuze, as a means of critiquing these connections, two groups of findings are presented. First, the report misrepresents the role of racism in HE as an isolated phenomenon rather than as an integral part of the discourse, logic and practices of internationalized HE. Specifically, it masks the discourses of investment, mobility and excellence that underpin it. Second, the report evidences, but fails to identify, the negative consequences of internationalization in higher education discourse. Specifically, discourses of investment, excellence and mobility are linked to the threat of decomplexification, securitization and, ultimately, ethical vacuity in HE.

Despite existing work on the situated and sometimes alienating nature of academic writing practices, the implications of the specifically spatial nature of these practices continue to pose questions for teaching and learning in higher education. This paper addresses these questions through a study of the views and experiences of students and teachers of academic writing in postgraduate teacher education (n = 33). Specifically, it introduces a concept, xenolexia, which complements that of alienation by recognizing the dynamic nature of academic writing, texts and practices without reifying them. Discussing the fundamentally spatial nature of this dynamism, the concept of xenolexia is used to analyse perceptions of academic writing practices as 'foreign'. The features of this 'foreignness' are examined from the point of view of both teaching and learning, and lessons about identity and dynamism in academic writing are drawn for writing pedagogies in postgraduate teacher education contexts.

This paper examines the implementation of the "Prevent Duty" to actively promote fundamental British values in English Further Education (FE). After critically reviewing the history of "Prevent" and the 2015 "Duty" to identify evidence of radicalisation in FE, data from interviews of strategic decision-makers in two distinct cases is analysed. The identification, interpretation and recirculation of verbal, graphic and behavioural signs of radicalisation is highlighted. Pinpointing a 'semiotisation' of the "Prevent" agenda, practical and conceptual implications are discussed. First, we identify a practical preoccupation with signs, specific beliefs about how they work, and how decision-makers deal with them. Second, we divide these beliefs conceptually into univocal and polyvocal semiotisation, referring to the degree to which signs are understood as unequivocal indicators of meaning. We underline significant variations in practice in this context and implications which, we argue, link practice and research to inform the fields of (edu)semiotics and policy enactment.

Abstract Taurodontism is a dental anomaly defined by enlargement of the pulp chamber of multirooted teeth with apical displacement of the pulp floor and bifurcation of the roots. Taurodontism can be an isolated trait or part of a syndrome. A study was conducted to document the dental and craniofacial aspects of genetic thin bone disorders in South Africa. Sixty-four individuals with Osteogenesis imperfecta (OI), one individual with Pyle disease and one with Torg-Winchester syndrome respectively, were assessed clinically, radiographically and at a molecular level. Ten patients with OI XI and those with Pyle disease and Torg-Winchester syndrome had taurodontism. Taurodontism has been identified in several genetic disorders necessitating cognizance of the possible existence and implications of this characteristic when managing patients in the dental environment. Further studies should be directed toward identifying the incidence, etiology, and molecular pathways leading to taurodontism and its relationship to genetic syndromes.

Background: Identifying what parents describe to be positive about parenting their child who has intellectual disabilities is important for professional practice and how parents can be supported over a lifespan. Methods: Studies in which parents describe the positive aspects of parenting their child with intellectual disabilities were identified via electronic databases searches and analysed in a narrative synthesis. Results: Twenty-two studies were included. Consistent themes emerged relating to positive change, increased personal strength, growth and development largely related to parental intrapersonal orientation. Several studies emphasized that the presence of growth or positive change does not imply the absence of distress. Conclusions: Positive aspects are not consistently defined and measured differently across studies. Consistent themes are described variously attributed to theories relating to coping, adaptation or growth following adversity; however, no single theoretical framework emerged. Factors likely to predict a parent's ability to identify positive aspects are inconclusive.

Patient and public involvement is considered integral to health research in the United Kingdom; however, studies documenting the involvement of adults with intellectual disabilities and parent carers in health research studies are scarce. Through group interviews, this study explored the perspectives and experiences of a group of adults with intellectual disabilities and a group of parent carers about their collaborative/participatory involvement in a 3-year study which explored the effectiveness of annual health checks for adults with intellectual disabilities. Thematic analysis identified five key themes consistent across both groups; authenticity of participation, working together, generating new outcome measures, dissemination of findings and involvement in future research. Although reported anecdotally rather than originating from the analysis, increased self-confidence is also discussed. The groups' unique perspectives led to insights not previously considered by the research team which led to important recommendations to inform healthcare practice.

The aim of this study was to investigate and clarify the ambiguous taxonomy of Actinomyces naeslundii and its closely related species using state-of-the-art high-throughput sequencing techniques, and, furthermore, to determine whether sub-clusters identified within Actinomyces oris and Actinomyces naeslundii in a previous study by multi locus sequence typing (MLST) using concatenation of seven housekeeping genes should either be classified as subspecies or distinct species. The strains in this study were broadly classified under Actinomyces naeslundii group as A. naeslundii genospecies I and genospecies II. Based on MLST data analysis, these were further classified as A. oris and A. naeslundii. The whole genome sequencing of selected strains of A. oris (n = 17) and A. naeslundii (n = 19) was carried out using Illumina Genome Analyzer IIxe and Roche 454 allowing paired-end and single-reads sequencing, respectively. The sequences obtained were aligned using CLC Genomic workbench version 5.1 and annotated using RAST (Rapid Annotation using Subsystem Technology) release version 59 accessible online. Additionally, genomes of seven publicly available strains of Actinomyces (k20, MG1, c505, OT175, OT171, OT170, and A. johnsonii) were also included. Comparative genomic analysis (CGA) using Mauve, Progressive Mauve, gene-by-gene, Core, and Pan Genome, and finally Digital DNA-DNA homology (DDH) analysis was carried out. DDH values were obtained using in silico genome–genome comparison. Evolutionary analysis using ClonalFrame was also undertaken. The mutation and recombination events were compared using chi-square test among A. oris and A. naeslundii isolates (analysis methods are not included in the study). CGA results were consistent with previous traditional classification using MLST. It was found that strains of Actinomyces k20, MG1, c505, and OT175 clustered in A. oris group of isolates, while OT171, OT170, and A. johnsonii appeared as separate branches. Similar clustering to MLST was observed for other isolates. The mutation and recombination events were significantly higher in A. oris than A. naeslundii, highlighting the diversity of A. oris strains in the oral cavity. These findings suggest that A. oris forms six distinct groups, whereas A. naeslundii forms three. The correct designation of isolates will help in the identification of clinical Actinomyces isolates found in dental plaque. Easily accessible online genomic sequence data will also accelerate the investigation of the biochemical characterisation and pathogenesis of this important group of micro-organisms.

Although acknowledging the stress of raising their child with intellectual disabilities, parents also report that their child has brought about many positive changes in themselves and family. This study reports what parents perceive to be a positive aspect of parenting their child, as currently what constitutes a "positive" is unclear. Seven key themes were identified; an increased sense of personal strength and confidence, changed priorities, greater appreciation of life, pleasure in the child's accomplishments, increased faith/spirituality, more meaningful relationships and the positive effect that the child has on the wider community. Interpretive examination of the themes reveals that the positive aspects identified consist mostly of meaning-focused coping strategies. These enable parents to adapt successfully to the stressful experiences of raising their child and therefore could be amenable to meaning-focused therapeutic interventions for parents with newly diagnosed children or for those unable to identify any positive aspects of parenting their child.

A new discourse is being deployed by the English learning and skills sector's new professional body, the Education and Training Foundation (ETF). This discourse repositions learning within a specific vision of corporate expectations. With a focus on deregulation in the sector and employer engagement, this repositioning deploys the terminology and mindset of a particular type of industrial process. This repositioning involves an important change, replacing a culture of micro-management with more decentralised techniques of control following changes at the national level of policy and beyond. Here, learning is analogous to the management of liquid, a move which is naturalised in texts which present education as an unavoidable and unassailable process or closed circuit of flow. Paul Virilio's work on the effects of speed is used to pinpoint ambivalence and incipient nihilism as central to this shift, critiquing the ETF's claims to represent the sector.

This paper analyses recent policy and discourse in the UK lifelong learning sector to identify a tension in discourse which positions teacher educators as essential to the knowledge economy while simultaneously insisting on the deficits they represent. Drawing on critical analyses from Friedrich Nietzsche, Maurizio Lazzarato and Gilles Deleuze, I challenge altruistic views of professional motivation and situate individual professionalism under a construction of an indebted subject. Examining recent attempts to redefine professional standards in the sector, I argue that teachers are positioned as subject to homogenisation and ethically indebted to a higher ideal. Ethical commitments to adult learning, I suggest, are a cost-effective instrument of social control because of their imbrication in this discourse of irredeemable moral debt to the sector. Responses to this situation, I argue, are likely to include forms of professional mobility which undermine it.

Abstract Background Nurses leaving their jobs and the profession are an issue of international concern, with supply-demand gaps for nurses reported to be widening. There is a large body of existing literature, much of which is already in review form. In order to advance the usefulness of the literature for nurse and human resource managers, we undertook an overview (review of systematic reviews). The aim of the overview was to identify high quality evidence of the determinants and consequences of turnover in adult nursing. Methods Reviews were identified which were published between 1990 and January 2015 in English using electronic databases (the Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, Applied Social Sciences Index and Abstracts, CINAHL plus and SCOPUS) and forward searching. All stages of the review were conducted in parallel by two reviewers. Reviews were quality appraised using the Assessment of Multiple Systematic Reviews and their findings narratively synthesised. Results Nine reviews were included. We found that the current evidence is incomplete and has a number of important limitations. However, a body of moderate quality review evidence does exist giving a picture of multiple determinants of turnover in adult nursing, with - at the individual level - nurse stress and dissatisfaction being important factors and -at the organisational level - managerial style and supervisory support factors holding most weight. The consequences of turnover are only described in economic terms, but are considered significant. Conclusions In making a quality assessment of the review as well as considering the quality of the included primary studies and specificity in the outcomes they measure, the overview found that the evidence is not as definitive as previously presented from individual reviews. Further research is required, of rigorous research design, whether quantitative or qualitative, particularly against the outcome of actual turnover as opposed to intention to leave. Trial registration PROSPERO Registration 17 March 2015: CRD42015017613 .

This paper examines the developing relationship between higher education (HE) practices and professional training for UK firearms officers. In particular, this paper's analysis challenges some common assumptions about the role of HE and the drive to professionalization in the context of police firearms training. The potential for effective partnership in this setting is examined, focusing on how these partnerships might work better and how theories of expansive learning might support them. Its impact is explored through interviews with officers from three UK forces, focusing on the relations between academic and more professionally oriented learning. Semi-structured interviews were used to gauge the views of seven trainees, whose responses were analysed to inform a discussion of workplace learning environments and conclusions about enhanced training and professional practices. The findings suggest that expansive learning environments are one way of developing training provision to meet the needs of increasingly complex firearms roles in the UK, especially the demand for greater responsibility and effectiveness. We suggest that both HE and professional training organizations can and should play a part in developing such environments.

Background: Guidelines recommend walking to increase moderate to vigorous physical activity (MVPA) for health benefits. Objectives: To assess the effectiveness, cost-effectiveness and acceptability of a pedometer-based walking intervention in inactive adults, delivered postally or through dedicated practice nurse physical activity (PA) consultations. Design: Parallel three-arm trial, cluster randomised by household. Setting: Seven London-based general practices. Participants: A total of 11,015 people without PA contraindications, aged 45–75 years, randomly selected from practices, were invited. A total of 6399 people were non-responders, and 548 people self-reporting achieving PA guidelines were excluded. A total of 1023 people from 922 households were randomised to usual care (n = 338), postal intervention (n = 339) or nurse support (n = 346). The recruitment rate was 10% (1023/10,467). A total of 956 participants (93%) provided outcome data. Interventions: Intervention groups received pedometers, 12-week walking programmes advising participants to gradually add ‘3000 steps in 30 minutes’ most days weekly and PA diaries. The nurse group was offered three dedicated PA consultations. Main outcome measures: The primary and main secondary outcomes were changes from baseline to 12 months in average daily step counts and time in MVPA (in ≥ 10-minute bouts), respectively, from 7-day accelerometry. Individual resource-use data informed the within-trial economic evaluation and the Markov model for simulating long-term cost-effectiveness. Qualitative evaluations assessed nurse and participant views. A 3-year follow-up was conducted. Results: Baseline average daily step count was 7479 [standard deviation (SD) 2671], average minutes per week in MVPA bouts was 94 minutes (SD 102 minutes) for those randomised. PA increased significantly at 12 months in both intervention groups compared with the control group, with no difference between interventions; additional steps per day were 642 steps [95% confidence interval (CI) 329 to 955 steps] for the postal group and 677 steps (95% CI 365 to 989 steps) for nurse support, and additional MVPA in bouts (minutes per week) was 33 minutes per week (95% CI 17 to 49 minutes per week) for the postal group and 35 minutes per week (95% CI 19 to 51 minutes per week) for nurse support. Intervention groups showed no increase in adverse events. Incremental cost per step was 19p and £3.61 per minute in a ≥ 10-minute MVPA bout for nurse support, whereas the postal group took more steps and cost less than the control group. The postal group had a 50% chance of being cost-effective at a £20,000 per quality-adjusted life-year (QALY) threshold within 1 year and had both lower costs [–£11M (95% CI –£12M to –£10M) per 100,000 population] and more QALYs [759 QALYs gained (95% CI 400 to 1247 QALYs)] than the nurse support and control groups in the long term. Participants and nurses found the interventions acceptable and enjoyable. Three-year follow-up data showed persistent intervention effects (nurse support plus postal vs. control) on steps per day [648 steps (95% CI 272 to 1024 steps)] and MVPA bouts [26 minutes per week (95% CI 8 to 44 minutes per week)]. Limitations: The 10% recruitment level, with lower levels in Asian and socioeconomically deprived participants, limits the generalisability of the findings. Assessors were unmasked to the group. Conclusions: A primary care pedometer-based walking intervention in 45- to 75-year-olds increased 12-month step counts by around one-tenth, and time in MVPA bouts by around one-third, with similar effects for the nurse support and postal groups, and persistent 3-year effects. The postal intervention provides cost-effective, long-term quality-of-life benefits. A primary care pedometer intervention delivered by post could help address the public health physical inactivity challenge. Future work: Exploring different recruitment strategies to increase uptake. Integrating the Pedometer And Consultation Evaluation-UP (PACE-UP) trial with evolving PA monitoring technologies. Trial registration: Current Controlled Trials ISRCTN98538934. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 37. See the NIHR Journals Library website for further project information.

This article examines the Deleuzian concept of "assemblage" in educational research in the context of Teacher Education (TE) for the "continuing education" or "Lifelong Learning" sector. Drawing on Deleuze's creative approach to analysis, it draws a portrait of practice which identifies problems and successes in specific cases of TE with wider applicability. I argue that the concept of assemblage recognises developmental practices in distinctive ways and that it challenges the centripetal views implied by other models' elision of more specific types of convergence, each of which is analysed. This is followed by suggestions which could help provide scope for creativity in research and practice in TE, if a set of challenges can be met. I argue that a situated and dynamic epistemological model is offered by assemblage theory which recognises not just the spatial but also the temporal and political complexities of actual practice.

Background: People with intellectual disability (ID) have poorer health than the general population; however, there is a lack of comprehensive national data describing their health-care needs and utilisation. Annual health checks for adults with ID have been incentivised through primary care since 2009, but only half of those eligible for such a health check receive one. It is unclear what impact health checks have had on important health outcomes, such as emergency hospitalisation. Objectives: To evaluate whether or not annual health checks for adults with ID have reduced emergency hospitalisation, and to describe health, health care and mortality for adults with ID. Design: A retrospective matched cohort study using primary care data linked to national hospital admissions and mortality data sets. Setting: A total of 451 English general practices contributing data to Clinical Practice Research Datalink (CPRD). Participants: A total of 21,859 adults with ID compared with 152,846 age-, gender- and practice-matched controls without ID registered during 2009–13. Interventions: None. Main outcome measures: Emergency hospital admissions. Other outcomes – preventable admissions for ambulatory care sensitive conditions, and mortality. Data sources: CPRD, Hospital Episodes Statistics and Office for National Statistics. Results: Compared with the general population, adults with ID had higher levels of recorded comorbidity and were more likely to consult in primary care. However, they were less likely to have long doctor consultations, and had lower continuity of care. They had higher mortality rates [hazard ratio (HR) 3.6, 95% confidence interval (CI) 3.3 to 3.9], with 37.0% of deaths classified as being amenable to health-care intervention (HR 5.9, 95% CI 5.1 to 6.8). They were more likely to have emergency hospital admissions [incidence rate ratio (IRR) 2.82, 95% CI 2.66 to 2.98], with 33.7% deemed preventable compared with 17.3% in controls (IRR 5.62, 95% CI 5.14 to 6.13). Health checks for adults with ID had no effect on overall emergency admissions compared with controls (IRR 0.96, 95% CI 0.87 to 1.07), although there was a relative reduction in emergency admissions for ambulatory care-sensitive conditions (IRR 0.82, 95% CI 0.69 to 0.99). Practices with high health check participation also showed a relative fall in preventable emergency admissions for their patients with ID, compared with practices with minimal participation (IRR 0.73, 95% CI 0.57 to 0.95). There were large variations in the health check-related content that was recorded on electronic records. Limitations: Patients with milder ID not known to health services were not identified. We could not comment on the quality of health checks. Conclusions: Compared with the general population, adults with ID have more chronic diseases and greater primary and secondary care utilisation. With more than one-third of deaths potentially amenable to health-care interventions, improvements in access to, and quality of, health care are required. In primary care, better continuity of care and longer appointment times are important examples that we identified. Although annual health checks can also improve access, not every eligible adult with ID receives one, and health check content varies by practice. Health checks had no impact on overall emergency admissions, but they appeared influential in reducing preventable emergency admissions. Future work: No formal cost-effectiveness analysis of annual health checks was performed, but this could be attempted in relation to our estimates of a reduction in preventable emergency admissions. Funding: The National Institute for Health Research Health Services and Delivery Research programme.

BackgroundBrisk walking in older people can increase step-counts and moderate to vigorous intensity physical activity (MVPA) in ≥10-minute bouts, as advised in World Health Organization guidelines. Previous interventions have reported step-count increases, but not change in objectively measured MVPA in older people. We assessed whether a primary care nurse-delivered complex intervention increased objectively measured step-counts and MVPA.Methods and findingsA total of 988 60-75 year olds, able to increase walking and randomly selected from three UK family practices, were invited to participate in a parallel two-arm cluster randomised trial; randomisation was by household. Two-hundred-ninety-eight people from 250 households were randomised between 2011 and 2012; 150 individuals to the intervention group, 148 to the usual care control group. Intervention participants received four primary care nurse physical activity (PA) consultations over 3 months, incorporating behaviour change techniques, pedometer step-count and accelerometer PA intensity feedback, and an individual PA diary and plan. Assessors were not blinded to group status, but statistical analyses were conducted blind. The primary outcome was change in accelerometry assessed average daily step-counts between baseline and 3 months, with change at 12 months a secondary outcome. Other secondary outcomes were change from baseline in time in MVPA weekly in ≥10-minute bouts, accelerometer counts, and counts/minute at 3 months and 12 months. Other outcomes were adverse events, anthropometric measures, mood, and pain. Qualitative evaluations of intervention participants and practice nurses assessed the intervention's acceptability. At 3 months, eight participants had withdrawn or were lost to follow-up, 280 (94%) individuals provided primary outcome data. At 3 months changes in both average daily step-counts and weekly MVPA in ≥10-minute bouts were significantly higher in the intervention than control group: by 1,037 (95% CI 513-1,560) steps/day and 63 (95% CI 40-87) minutes/week, respectively. At 12 months corresponding differences were 609 (95% CI 104-1,115) steps/day and 40 (95% CI 17-63) minutes/week. Counts and counts/minute showed similar effects to steps and MVPA. Adverse events, anthropometry, mood, and pain were similar in the two groups. Participants and practice nurses found the intervention acceptable and enjoyable.ConclusionsThe PACE-Lift trial increased both step-counts and objectively measured MVPA in ≥10-minute bouts in 60-75 year olds at 3 and 12 months, with no effect on adverse events. To our knowledge, this is the first trial in this age group to demonstrate objective MVPA increases and highlights the value of individualised support incorporating objective PA assessment in a primary care setting.Trial registrationControlled-Trials.com ISRCTN42122561.

Actinomyces naeslundii and Actinomyces oris are members of the oral biofilm. Their identification using 16S rRNA sequencing is problematic and better achieved by comparison of metG partial sequences. A. oris is more abundant and more frequently isolated than A. naeslundii. We used a multi-locus sequence typing approach to investigate the genotypic diversity of these species and assigned A. naeslundii (n = 37) and A. oris (n = 68) isolates to 32 and 68 sequence types (ST), respectively. Neighbor-joining and ClonalFrame dendrograms derived from the concatenated partial sequences of 7 house-keeping genes identified at least 4 significant subclusters within A. oris and 3 within A. naeslundii. The strain collection we had investigated was an under-representation of the total population since at least 3 STs composed of single strains may represent discrete clusters of strains not well represented in the collection. The integrity of these sub-clusters was supported by the sequence analysis of fimP and fimA, genes coding for the type 1 and 2 fimbriae, respectively. An A. naeslundii subcluster was identified with both fimA and fimP genes and these strains were able to bind to MUC7 and statherin while all other A. naeslundii strains possessed only fimA and did not bind to statherin. An A. oris subcluster harboured a fimA gene similar to that of Actinomyces odontolyticus but no detectable fimP failed to bind significantly to either MUC7 or statherin. These data are evidence of extensive genotypic and phenotypic diversity within the species A. oris and A. naeslundii but the status of the subclusters identified here will require genome comparisons before their phylogenic position can be unequivocally established.

Streptococcus mutans, consisting of serotypes c, e, f and k, is an oral aciduric organism associated with the initiation and progression of dental caries. A total of 135 independent Streptococcus mutans strains from caries-free and caries-active subjects isolated from various geographical locations were examined in two versions of an MLST scheme consisting of either 6 housekeeping genes [accC (acetyl-CoA carboxylase biotin carboxylase subunit), gki (glucokinase), lepA (GTP-binding protein), recP (transketolase), sodA (superoxide dismutase), and tyrS (tyrosyl-tRNA synthetase)] or the housekeeping genes supplemented with 2 extracellular putative virulence genes [gtfB (glucosyltransferase B) and spaP (surface protein antigen I/II)] to increase sequence type diversity. The number of alleles found varied between 20 (lepA) and 37 (spaP). Overall, 121 sequence types (STs) were defined using the housekeeping genes alone and 122 with all genes. However pi, nucleotide diversity per site, was low for all loci being in the range 0.019-0.007. The virulence genes exhibited the greatest nucleotide diversity and the recombination/mutation ratio was 0.67 [95% confidence interval 0.3-1.15] compared to 8.3 [95% confidence interval 5.0-14.5] for the 6 concatenated housekeeping genes alone. The ML trees generated for individual MLST loci were significantly incongruent and not significantly different from random trees. Analysis using ClonalFrame indicated that the majority of isolates were singletons and no evidence for a clonal structure or evidence to support serotype c strains as the ancestral S. mutans strain was apparent. There was also no evidence of a geographical distribution of individual isolates or that particular isolate clusters were associated with caries. The overall low sequence diversity suggests that S. mutans is a newly emerged species which has not accumulated large numbers of mutations but those that have occurred have been shuffled as a consequence of intra-species recombination generating genotypes which can be readily distinguished by sequence analysis.

Bifidobacteria, one of the relatively dominant components of the human intestinal microbiota, are considered one of the key groups of beneficial intestinal bacteria (probiotic bacteria). However, in addition to health-promoting taxa, the genus Bifidobacterium also includes Bifidobacterium dentium, an opportunistic cariogenic pathogen. The genetic basis for the ability of B. dentium to survive in the oral cavity and contribute to caries development is not understood. The genome of B. dentium Bd1, a strain isolated from dental caries, was sequenced to completion to uncover a single circular 2,636,368 base pair chromosome with 2,143 predicted open reading frames. Annotation of the genome sequence revealed multiple ways in which B. dentium has adapted to the oral environment through specialized nutrient acquisition, defences against antimicrobials, and gene products that increase fitness and competitiveness within the oral niche. B. dentium Bd1 was shown to metabolize a wide variety of carbohydrates, consistent with genome-based predictions, while colonization and persistence factors implicated in tissue adhesion, acid tolerance, and the metabolism of human saliva-derived compounds were also identified. Global transcriptome analysis demonstrated that many of the genes encoding these predicted traits are highly expressed under relevant physiological conditions. This is the first report to identify, through various genomic approaches, specific genetic adaptations of a Bifidobacterium taxon, Bifidobacterium dentium Bd1, to a lifestyle as a cariogenic microorganism in the oral cavity. In silico analysis and comparative genomic hybridization experiments clearly reveal a high level of genome conservation among various B. dentium strains. The data indicate that the genome of this opportunistic cariogen has evolved through a very limited number of horizontal gene acquisition events, highlighting the narrow boundaries that separate commensals from opportunistic pathogens.

BackgroundWhile ethnic disparities in health and health care are increasing, evidence on how to enhance quality of care and reduce inequalities remains limited. Despite growth in the scope and application of guidelines on "cultural competence," remarkably little is known about how practising health professionals experience and perceive their work with patients from diverse ethnic communities. Using cancer care as a clinical context, we aimed to explore this with a range of health professionals to inform interventions to enhance quality of care.Methods and findingsWe conducted a qualitative study involving 18 focus groups with a purposeful sample of 106 health professionals of differing disciplines, in primary and secondary care settings, working with patient populations of varying ethnic diversity in the Midlands of the UK. Data were analysed by constant comparison and we undertook processes for validation of analysis. We found that, as they sought to offer appropriate care, health professionals wrestled with considerable uncertainty and apprehension in responding to the needs of patients of ethnicities different from their own. They emphasised their perceived ignorance about cultural difference and were anxious about being culturally inappropriate, causing affront, or appearing discriminatory or racist. Professionals' ability to think and act flexibly or creatively faltered. Although trying to do their best, professionals' uncertainty was disempowering, creating a disabling hesitancy and inertia in their practice. Most professionals sought and applied a knowledge-based cultural expertise approach to patients, though some identified the risk of engendering stereotypical expectations of patients. Professionals' uncertainty and disempowerment had the potential to perpetuate each other, to the detriment of patient care.ConclusionsThis study suggests potential mechanisms by which health professionals may inadvertently contribute to ethnic disparities in health care. It identifies critical opportunities to empower health professionals to respond more effectively. Interventions should help professionals acknowledge their uncertainty and its potential to create inertia in their practice. A shift away from a cultural expertise model toward a greater focus on each patient as an individual may help.