Book Review: Working with loss and grief: a theoretical and practical approach

THE UPDATED second edition of this text begins with an overview of theories underpinning loss and grief, followed by a comprehensive outline of the author’s ‘range of response to loss’ (RRL) model, which emerged from her own research and experience. The RRL model provides a framework to explore variability in how people respond to grief, and case studies are used to demonstrate its application in practice. This is followed by an outline of the author’s ‘adult attitude to grief’ scale, which can be used to map a person’s grief and generate a grief profile.

Tooth replacement for partially dentate elders: a randomised controlled trial

Objective: This study aimed to compare two different tooth replacement strategies for partially dentate older patients namely; removable partial dentures (RPDs) and functionally orientated treatment based on the shortened dental arch (SDA) concept. Method: 88 partially dentate older patients (mean age 69.4 years) completed a randomised controlled clinical trial. 43 patients received RPDs and 45 received functionally orientated treatment where resin bonded bridgework was used to provide 10 pairs of occluding contacts. Patients were followed for 1 year after treatment intervention. The impact of treatment on oral health-related quality of life (OHrQOL) and cost effectiveness were used as outcome measures. Each patient completed the short form of the Oral Health Impact Profile (OHIP-14) at baseline, 6 months and 1 year after treatment intervention. All costs involved in providing and maintaining each intervention were recorded including dental laboratory bills, materials and professional time. Result: Both the RPD (p=0.004) and the functionally orientated (p<0.001) treatment groups demonstrated statistically significant improvements in OHrQOL 1 year after treatment intervention. On average 9.4 visits were required to complete and maintain the RPDs over the 1 year period as compared to 5.3 visits for the functionally orientated group. The average laboratory cost for the RPDs was $537.45 per patient versus $367.89 for functionally orientated treatment. The cost of achieving the Minimally Important Difference of 5 scale points in OHIP-14 score with RPDs was $732.17. For the functionally orientated group the cost was $356.88. Therefore, functionally orientated treatment was more than twice as cost effective (1:2.05). Conclusion: For partially dentate older patients, functionally orientated treatment based on the SDA concept resulted in sustained, significant improvements in OHrQOL. Provision of functionally orientated treatment was also more than twice as cost effective compared to conventional treatment using RPDs.

Cost Effectiveness of Tooth Replacement Strategies for Partially Dentate Elders

Objectives: This study aimed to compare the cost effectiveness of conventional treatment using partial dentures with functionally-orientated treatment based on the shortened dental arch concept to replace missing teeth for partially dentate elders.
Methods: 44 partially dentate patients aged 65 years and older were recruited following routine dental assessment at a university dental hospital. Patients consented to and were randomly assigned to the two treatment arms. The conventional treatment group received a removable partial denture to replace all missing natural teeth. The functionally-orientated group were restored to a shortened dental arch of 10 occluding contacts using resin bonded bridgework. The costs associated with each treatment were recorded including laboratory charges, treatment time and opportunity costs. The impact on quality of life (OHRQoL) was measured using the 14-item Oral Health Impact Profile.
Results: Both groups reported improvements in OHRQoL after completion of treatment. For the conventional group, the mean OHIP-14 score decreased from 12.4 pre-operatively to 3.3 post-operatively (p<0.001). In the functionally-orientated group the OHIP-14 score decreased from 11.4 to 1.8 following treatment (p<0.001). On average the conventional treatment group required 8.3 clinic visits as compared to 4.4 visits for the functionally-orientated group. The mean total treatment time was 183 minutes 19 seconds for the conventional group versus 124 minutes 8 seconds for the functionally-orientated group. The conventional treatment group had an average of 6.33 teeth replaced at a laboratory cost of 337.31 Euros. The functionally-orientated group had an average of 2.64 teeth replaced at a laboratory cost of 244.05 Euros.
Conclusions: Restoration to a shortened dental arch using functionally-orientated treatment resulted in a similar improvement in OHRQoL with fewer clinic visits, less operative time and at a lower laboratory cost compared with conventional treatment.

Challenges of minimizing heat loss at birth: A narrative overview of evidence-based thermal care interventions

Evidence-based thermal care recommendations designed to minimize heat loss immediately at birth are readily available however, hypothermia still persists as a global challenge especially when caring for the most immature and smallest preterm infants. In this narrative overview we aim to provide the reader with a succinct summary of the causes and consequences of hypothermia, the extent of the problem (rates of hypothermia), principles of good thermal care, delivery room preventative measures, the research evidence underpinning existing interventions, current issues in practice, and the way forward. Due to the plethora of research literature available in this subject area, our article will focus primarily on evidence derived from systematic reviews and randomized or quasi-randomized controlled trials assessing the effectiveness of interventions to prevent hypothermia in the most vulnerable (preterm/low birth weight) infants where the intervention or combination of interventions is applied immediately at birth. © 2014.

An investigation into the factors influencing tooth brushing behaviour amongst school children living in Northern Ireland: An application of the Theory of Planned Behaviour.

Background: Northern Ireland has the worst oral health in the UK and its children have among the highest levels of tooth decay in Europe (DHSSPS, 2007).
Aim: The aim of this study is to investigate the factors influencing tooth brushing behaviour among Year 6 primary schoolchildren using the Theory of Planned Behaviour (TPB).
Method: Seven semi-structured focus groups involving 56 children were conducted during which children were asked questions about the factors that influence whether or not they brush their teeth. Thematic analysis was used with the purpose of eliciting the belief-based measures for all the TPB constructs.
Results: The findings suggest that children are knowledgeable about their teeth and are aware of the importance of maintaining good oral health; although a number of barriers to consistent tooth brushing exist.
Discussion: The findings will be used to inform stage 2 of the research project; questionnaire development to identify the factors influencing young people’s motivations to improve their tooth brushing behaviour and to assess their relative importance.

Effect of a Web-Based Behavior Change Program on Weight Loss and Cardiovascular Risk Factors in Overweight and Obese Adults at High Risk of Developing Cardiovascular Disease:Randomized Controlled Trial

BACKGROUND: Web-based programs are a potential medium for supporting weight loss because of their accessibility and wide reach. Research is warranted to determine the shorter- and longer-term effects of these programs in relation to weight loss and other health outcomes.

OBJECTIVE: The aim was to evaluate the effects of a Web-based component of a weight loss service (Imperative Health) in an overweight/obese population at risk of cardiovascular disease (CVD) using a randomized controlled design and a true control group.

METHODS: A total of 65 overweight/obese adults at high risk of CVD were randomly allocated to 1 of 2 groups. Group 1 (n=32) was provided with the Web-based program, which supported positive dietary and physical activity changes and assisted in managing weight. Group 2 continued with their usual self-care (n=33). Assessments were conducted face-to-face. The primary outcome was between-group change in weight at 3 months. Secondary outcomes included between-group change in anthropometric measurements, blood pressure, lipid measurements, physical activity, and energy intake at 3, 6, and 12 months. Interviews were conducted to explore participants' views of the Web-based program.

RESULTS: Retention rates for the intervention and control groups at 3 months were 78% (25/32) vs 97% (32/33), at 6 months were 66% (21/32) vs 94% (31/33), and at 12 months were 53% (17/32) vs 88% (29/33). Intention-to-treat analysis, using baseline observation carried forward imputation method, revealed that the intervention group lost more weight relative to the control group at 3 months (mean -3.41, 95% CI -4.70 to -2.13 kg vs mean -0.52, 95% CI -1.55 to 0.52 kg, P<.001), at 6 months (mean -3.47, 95% CI -4.95 to -1.98 kg vs mean -0.81, 95% CI -2.23 to 0.61 kg, P=.02), but not at 12 months (mean -2.38, 95% CI -3.48 to -0.97 kg vs mean -1.80, 95% CI -3.15 to -0.44 kg, P=.77). More intervention group participants lost ≥5% of their baseline body weight at 3 months (34%, 11/32 vs 3%, 1/33, P<.001) and 6 months (41%, 13/32 vs 18%, 6/33, P=.047), but not at 12 months (22%, 7/32 vs 21%, 7/33, P=.95) versus control group. The intervention group showed improvements in total cholesterol, triglycerides, and adopted more positive dietary and physical activity behaviors for up to 3 months verus control; however, these improvements were not sustained.

CONCLUSIONS: Although the intervention group had high attrition levels, this study provides evidence that this Web-based program can be used to initiate clinically relevant weight loss and lower CVD risk up to 3-6 months based on the proportion of intervention group participants losing ≥5% of their body weight versus control group. It also highlights a need for augmenting Web-based programs with further interventions, such as in-person support to enhance engagement and maintain these changes.

Loss-of-Main Monitoring and Detection for Distributed Generations Using Dynamic Principal Component Analysis

In this paper, our previous work on Principal Component Analysis (PCA) based fault detection method is extended to the dynamic monitoring and detection of loss-of-main in power systems using wide-area synchrophasor measurements. In the previous work, a static PCA model was built and verified to be capable of detecting and extracting system faulty events; however the false alarm rate is high. To address this problem, this paper uses a well-known ‘time lag shift’ method to include dynamic behavior of the PCA model based on the synchronized measurements from Phasor Measurement Units (PMU), which is named as the Dynamic Principal Component Analysis (DPCA). Compared with the static PCA approach as well as the traditional passive mechanisms of loss-of-main detection, the proposed DPCA procedure describes how the synchrophasors are linearly
auto- and cross-correlated, based on conducting the singular value decomposition on the augmented time lagged synchrophasor matrix. Similar to the static PCA method, two statistics, namely T2 and Q with confidence limits are calculated to form intuitive charts for engineers or operators to monitor the loss-of-main situation in real time. The effectiveness of the proposed methodology is evaluated on the loss-of-main monitoring of a real system, where the historic data are recorded from PMUs installed in several locations in the UK/Ireland power system.

Loss of exudates from the roots of perennial ryegrass inoculated with a range of micro-organisms

To determine the effect of microbial metabolites on the release of root exudates from perennial ryegrass, seedlings were pulse labelled with [¹⁴C]-CO₂ in the presence of a range of soil micro-organisms. Microbial inoculants were spatially separated from roots by Millipore membranes so that root infection did not occur. Using this technique, only microbial metabolites affected root exudation. The effect of microbial metabolites on carbon assimilation and distribution and root exudation was determined for 15 microbial species. Assimilation of a pulse label varied by over 3.5 fold, dependent on inoculant. Distribution of the label between roots and shoots also varied with inoculant, but the carbon pool that was most sensitive to inoculation was root exudation. In the absence of a microbial inoculant only 1% of assimilated label was exuded. Inoculation of the microcosms always caused an increase in exudation but the percentage exuded varied greatly, within the range of 3-34%. © 1995 Kluwer Academic Publishers.

Assessing 1D Loss Models for the Off-Design Performance Prediction of Automotive Turbocharger Compressors

Single-Zone modelling is used to assess three 1D impeller loss model collections. An automotive turbocharger centrifugal compressor is used for evaluation. The individual 1D losses are presented relative to each other at three tip speeds to provide a visual description of each author’s perception of the relative importance of each loss. The losses are compared with their resulting prediction of pressure ratio and efficiency, which is further compared with test data; upon comparison, a combination of the 1D loss collections is identified as providing the best performance prediction. 3D CFD simulations have also been carried out for the same geometry using a single passage model. A method of extracting 1D losses from CFD is described and utilised to draw further comparisons with the 1D losses. A 1D scroll volute model has been added to the single passage CFD results; good agreement with the test data is achieved. Short-comings in the existing 1D loss models are identified as a result of the comparisons with 3D CFD losses. Further comparisons are drawn between the predicted 1D data, 3D CFD simulation results, and the test data using a nondimensional method to highlight where the current errors exist in the 1D prediction.

An Evaluation of 1D Loss Model Collections for the Off-Design Performance Prediction of an Automotive Turbocharger Compressor

Abstract. Single-zone modelling is used to assess different collections of impeller 1D loss models. Three collections of loss models have been identified in literature, and the background to each of these collections is discussed. Each collection is evaluated using three modern automotive turbocharger style centrifugal compressors; comparisons of performance for each of the collections are made. An empirical data set taken from standard hot gas stand tests for each turbocharger is used as a baseline for comparison. Compressor range is predicted in this study; impeller diffusion ratio is shown to be a useful method of predicting compressor surge in 1D, and choke is predicted using basic compressible flow theory. The compressor designer can use this as a guide to identify the most compatible collection of losses for turbocharger compressor design applications. The analysis indicates the most appropriate collection for the design of automotive turbocharger centrifugal compressors.

Analysis of Transmission Loss with Droop Control in a Multi-Terminal HVDC System

High Voltage Direct Current (HVDC) electric power transmission is a promising technology for integrating offshore wind farms and interconnecting power grids in different regions. In order to maintain the DC voltage, droop control has been widely used. Transmission line loss constitutes an import part of the total power loss in a multi-terminal HVDC scheme. In this paper, the relation between droop controller design and transmission loss has been investigated. Different MTDC layout configurations are compared to examine the effect of droop controller design on the transmission loss.