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Importance The United States consumes most of the opioids worldwide despite representing a small portion of the world’s population. Dentists are one of the most frequent US prescribers of opioids despite data suggesting that nonopioid analgesics are similarly effective for oral pain. While oral health and dentist use are generally similar between the United States and England, it is unclear how opioid prescribing by dentists varies between the 2 countries.\ud \ud Objective To compare opioid prescribing by dentists in the United States and England.\ud \ud Design, Setting, and Participants Cross-sectional study of prescriptions for opioids dispensed from outpatient pharmacies and health care settings between January 1 and December 31, 2016, by dentists in the United States and England. Data were analyzed from October 2018 to January 2019.\ud \ud Exposures Opioids prescribed by dentists.\ud \ud Main Outcomes and Measures Proportion and prescribing rates of opioid prescriptions.\ud \ud Results In 2016, the proportion of prescriptions written by US dentists that were for opioids was 37 times greater than the proportion written by English dentists. In all, 22.3% of US dental prescriptions were opioids (11.4 million prescriptions) compared with 0.6% of English dental prescriptions (28 082 prescriptions) (difference, 21.7%; 95% CI, 13.8%-32.1%; P

Background and aims: Management of familial hypercholesterolaemia (FH) may vary across different settings due to factors related to population characteristics, practice, resources and/or policies. We conducted a survey among the worldwide network of EAS FHSC Lead Investigators to provide an overview of FH status in different countries. Methods: Lead Investigators from countries formally involved in the EAS FHSC by mid-May 2018 were invited to provide a brief report on FH status in their countries, including available information, programmes, initiatives, and management. Results: 63 countries provided reports. Data on FH prevalence are lacking in most countries. Where available, data tend to align with recent estimates, suggesting a higher frequency than that traditionally considered. Low rates of FH detection are reported across all regions. National registries and education programmes to improve FH awareness/knowledge are a recognised priority, but funding is often lacking. In most countries, diagnosis primarily relies on the Dutch Lipid Clinics Network criteria. Although available in many countries, genetic testing is not widely implemented (frequent cost issues). There are only a few national official government programmes for FH. Under-treatment is an issue. FH therapy is not universally reimbursed. PCSK9-inhibitors are available in ∼2/3 countries. Lipoprotein-apheresis is offered in ∼60% countries, although access is limited. Conclusions: FH is a recognised public health concern. Management varies widely across countries, with overall suboptimal identification and under-treatment. Efforts and initiatives to improve FH knowledge and management are underway, including development of national registries, but support, particularly from health authorities, and better funding are greatly needed. © 2018 Elsevier B.V.

Background: Individuals working for the emergency services often bear witness to distressing events. This outcome study examines therapeutic interventions for Fire Service Personnel (FSP) experiencing symptoms of trauma, depression, anxiety and low levels of self-compassion.\ud Aims: To investigate the effectiveness of using compassion focused therapy (CFT) as an adjunct to trauma-focused cognitive behavioural therapy (TF-CBT) in reducing symptoms of trauma, anxiety and depression and increasing self-compassion.\ud Method: A convenience sample (n=17) of participants, referred for therapy following a traumatic incident, were allocated to receive twelve sessions of either TF-CBT or TF-CBT coupled with CFT. The study employed a repeated measures design. Data were gathered pre and post-therapy, using three questionnaires (1) Hospital Anxiety and Depression Scale; (2) Impact of Events Scale; (3) Self Compassion Scale-SF. Results: TF-CBT combined with CFT was more effective than TF-CBT alone on measures of self-compassion. Significant reductions in symptoms of depression, anxiety, hyper-arousal, intrusion and avoidance and a significant increase in self-compassion occurred in both groups post-therapy. \ud Conclusion: The study provides some preliminary evidence to suggest that FSP may benefit from therapeutic interventions aimed at cultivating self-compassion. Further research is warranted using a larger sample size and adequately powered randomised controlled trial, to detect statistically significant differences and to negate the risk of confound due to low numbers resulting in significant differences between groups at baseline. Using CFT as an adjunct to TF-CBT may help FSP, who bear witness to the distress of others, cultivate compassion for their own suffering.

Since the discovery of photosensitivity and the ability to change the refractive index in optical fibre with a period comparable to the wavelength of the transmitted light became practical [1,2], the applications of Bragg gratings have near exploded in the number of systems-utilities. The field now have progressed to an extend where nearly all aspects of transmission systems technology either have the potential or indeed already include Bragg grating devices in one form or another. The advantages using Bragg gratings in systems contexts are many, but a major reason for their employment is their relative ease of manufacture and all-fibre nature making them compatible with existing network fibre thus enhancing transparency of the total network. Roughly speaking a transmission system (Fig. 1) can be split up into a number of sections being, a transmitter section (including multiplexing), a transmission section (including amplification), a regeneration section, which can be either a retiming or reshaping or both, this section typically includes dispersion control of some sort as well, and finally a receiver section which in part can be an add-drop section. In each of these sections there are applications of Bragg gratings that can replace existing components and in many cases even enhance overall system-performance. We will in this presentation discuss some of the latest advances in the fields of systems applications of fibre Bragg grating devices and related technologies and discuss some new approaches to increase data-capacity in the existing systems.

We will in this paper discuss how the time-delay performance of chirped Bragg grating dispersion compensators can be improved by paying a close attention to the design, the fabrication conditions and fibre host quality to the Bragg grating.

There are four categories of causes responsible for the majority of injuries in youth 10-19 years of age: 1) motor vehicle traffic; 2) violence (intra-familial, extra-familial, self, pregnancy-related); 3) recreational; and 4) occupational. This article presents data from the National Center for Health Statistics mortality data and the National Pediatric Trauma Registry morbidity data. Nationwide, the pediatric injury death rate is highest among adolescents 15-19 years of age. Motor vehicle-related deaths account for 41% and firearm-related deaths account for 36% of injury deaths in this age group. For youths aged 10-14 years, motor vehicle-related deaths account for 38% and; firearm-related deaths account for 26% of injury deaths. For both age groups, occupant motor vehicle-related deaths account for the majority of deaths and underscore the need for seat belt use. Using theoretical principles based on the Haddon matrix and a knowledge of adolescent development, proposed interventions to decrease injuries and deaths related to motor vehicles and firearms include graduated licensing, occupant restraint, speed limits, conflict resolution, and gun control. Occupational injuries, particularly injury associated with agricultural production, account for an estimated 100,000 injuries per year. Preventive strategies include OSHA regulations imposing standards for protective devices and further study for guidelines for adolescent work in agriculture. Injuries related to recreation include drowning and sports injuries. Preventive strategies may include proper supervision and risk reduction with respect to use of alcohol/drugs. The data presented support the use of primary prevention to achieve the most effective, safe community interventions targeting adolescents.

Transmission of 10Gbit/s per channel WDM over standard fibre using dispersion compensating fibre gratings and dispersion compensation fibre is investigated. The performance of the two techniques in the presence of self- and cross-phase modulation and for RZ and NRZ signal formats is compared.

The main activities and recent developments towards the implementation of meter-long, high-performance fibre grating dispersion compensators in the Optoelectronics Research Centre, Southampton University are reviewed. Performance requirements of fibre-Bragg-gratings dispersion compensators and their impact on transmission systems will be discussed. We will report on the characteristics of continuously chirped FBGs capable of compensating linear and third-order dispersion over ~10nm bandwidth. Finally, system results using chirped FBGs as dispersion compensators will be given

For the first time long broadband chirped fibre Bragg gratings with a dispersion profile designed to compensate 3rd order-dispersion are presented. These results demonstrate how the increased demands for dispersion compensation at very high bit-rates can be met using chirped fibre Bragg gratings

The authors present the realisation of high-quality 1m long continuously-written fibre Bragg gratings designed to compensate both 2nd and 3rd order fibre dispersion. These compact devices are ideal for counteracting the effects of fibre dispersion in high bit-rate transmission systems.

Broadband Chirped fibre gratings allow the upgrade of the existing non-dispersion shifted fibre network to high data rate operation within the 1.55µm low-loss window. The design, fabrication, performance and application of these devices is covered. Summary: Erbium doped fibre amplifiers have effectively eliminated the propagation-loss barrier in modem telecommunication systems, providing high gain and low noise figure operation over a large (30-80nm) bandwidth 1.55µm, and have enabled high-bit-rate data transmission over transoceanic distances. However, to date the majority of the installed fibre shows a zero dispersion at ~1.3µm and exhibits a relatively high dispersion (~+17ps/nm/km with a slope of +0.07ps/nm/km) across the erbium band. This implies that the upgrade of the existing network to make full use of the erbium bandwidth by either TDM or WDM techniques, will be severely limited by the effects of linear and third order dispersion. The dispersion effects become even more adverse when combined with the optical fibre non-linearities.

The use of chirped fibre Bragg gratings (FBGs) in a dispersion compensating role has been shown to be a successful technology with great promise for future network upgrades [1,2]. A natural consequence of using FBGs in a negative dispersion sense is that although the structure is designed to phase-match forward- and backward-propagating LP01 modes, the phase-matching condition for coupling from the forward propagating fundamental mode to a higher order cladding-mode is also met for wavelengths just below that of the fundamental Bragg reflection. Because propagation in cladding-modes is extremely lossy there is a significant out-coupling of this shorter wavelength light. The chirped nature of FBGs designed for broad-band (> 5 nm) dispersion compensation means that this cladding-mode loss is integrated along the length of the grating with the result that the reflection spectrum has a slope extending from the short wavelength edge of the useable bandwidth. In a practical transmission system this in-band variation of reflectivity is unacceptable. In this paper the authors present for the first time a demonstration of spectral equalisation of cladding-mode losses by exercising control over local apodisation along the length of a 8.5 nm 75 cm long continuously-written chirped FBG. No post-processing was used.