Improving oral healthcare in Scotland with special reference to sustainability and caries prevention

Brett Duane Improving oral healthcare in Scotland with special reference to sustainability and caries prevention University of Turku, Faculty of Medicine, Institute of Dentistry, Community Dentistry, Finnish Doctoral Program in Oral Sciences (FINDOS-Turku), Turku, Finland Annales Universitatis Turkuensis, Sarja- Ser. D, Medica-Odontologica. Painosalama Oy, Turku, Finland, 2015. Dentistry must provide sustainable, evidence-based, and prevention-focused care. In Scotland oral health prevention is delivered through the Childsmile programme, with an increasing use of high concentration fluoride toothpaste (HCFT). Compared with other countries there is little knowledge of xylitol prevention. The UK government has set strict carbon emission limits with which all national health services (NHS) must comply. The purpose of these studies was firstly to describe the Scottish national oral health prevention programme Childsmile (CS), to determine if the additional maternal use of xylitol (CS+X) was more effective at affecting the early colonisation of mutans streptococci (MS) than this programme alone; secondly to analyse trends in the prescribing and management of HCFT by dentists; and thirdly to analyse data from a dental service in order to improve its sustainability. In all, 182 mother/child pairs were selected on the basis of high maternal MS levels. Motherswere randomly allocated to a CS or CS+X group, with both groups receiving Childsmile. Theintervention group consumed xylitol three times a day, from when the child was 3 months until 24 months. Children were examined at age two to assess MS levels. In order to understand patterns of HCFT prescribing, a retrospective secondary data analysis of routine prescribing data for the years 2006-2012 was performed. To understand the sustainability of dental services, carbon accounting combined a top-down approach and a process analysis approach, followed by the use of Pollard’s decision model (used in other healthcare areas) to analyse and support sustainable service reconfiguration. Of the CS children, 17% were colonised with MS, compared with 5% of the CS+X group. This difference was not statistically significant (P=0.1744). The cost of HCFT prescribing increased fourteen-fold over five years, with 4% of dentists prescribing 70% of the total product. Travel (45%), procurement (36%) and building energy (18%) all contributed to the 1800 tonnes of carbon emissions produced by the service, around 4% of total NHS emissions. Using the analytical model, clinic utilisation rates improved by 56% and patient travel halved significantly reducing carbon emissions. It can be concluded that the Childsmile programme was effective in reducing the risk for MS transmission. HCFT is increasing in Scotland and needs to be managed. Dentistry has similar carbon emissions proportionally as the overall NHS, and the use of an analytic tool can be useful in helping identify these emissions. Key words: Sustainability, carbon emissions, xylitol, mutans streptococci, fluoride toothpaste, caries prevention.

A five factor model of grief : a q-methodological study /

Q-methodology permitted 41 people to communicate their perspective of grief. In an attempt to clarify the research to date and to allow those who have experienced this human journey to direct the scientists, 80 statements were chosen to present to the participants based on the research from academic and counselling sources. Five different perspectives emerged from the Q-sorts and factor analysis. Each perspective was valuable for the understanding of different groups of mourners. They were interpreted using questionnaire data and interview information. They are as follows: Factor 1- Growth Optimism; Factor 2 - Schema Destruction and Negative Affect; Factor 3- Identification with the Deceased Person; Factor 4- Intact World view with High Clarity and High Social Support; Factor 5- Schema Destruction with High Preoccupation and Attention to Emotion. Some people grow in the face of grief, others hold on to essentially the same schemas and others are devastated by their loss. The different perspectives reported herein supply clues to the sources of these differing outcomes. From examination of Factor 1, it appears that a healthy living relationship helps substantially in the event of loss. An orientation toward emotions that encourages clarity, exemplified by Factor 4, without hyper-vigilance to emotion may be helpful as well. Strategies for maintaining schematic representations of the world with little alteration include: identification with the values of the deceased person, as in Factor 3 and reliance on social support and/or God as demonstrated by Factor 4. When the relationship had painful periods, social support may be accessed to benefit some mourners. When the person's frame of reference or higher order schemas are assaulted by the events of loss, the people most at risk for traumatic grief seem to be those with difficult relationships as indicated by Factor 5 individuals. When low social support, high attention to emotion with low clarity and little belief that feelings can be altered for the better are also attributes of the mourner devastating grief can result. In the end, there are groups of people who are forced to endure the entire process of schema destruction and devastation. Some appear to recover in part and others appear to stay in a form of purgatory for many years. The results of this study suggest that, those who experience devastating grief may be in the minority. In the future interventions could be more specifically addressed if these perspectives are replicated in a larger, more detailed study.

The Respect Circle: Ten Teachers, One Classroom Management Model

In this qualitative investigation, the researcher examined the experiences of 10 teachers as they implemented a classroom management model called the Respect Circle. Through interviews and journal entries, the writer sought to understand how the participating teachers developed their classroom management practice, using the Respect Circle as a reference point. Data collection occurred over a 10-week period from October to December. The findings of this study demonstrate the multifaceted and complex nature of classroom management. Participants identified relationships with their students as the premier factor in establishing classroom management. Additionally, pro action, professional reflection, adaptability, and consistency figured prominently in the classroom management approaches taken by the participating teachers. Utilizing the experiences and suggestions of the participants as a springboard, the Respect Circle model was revised. The findings underline areas of concern regarding classroom management and suggest that teachers want a respectful, structured yet flexible model upon which to base their classroom management. Suggestions for teachers, new and experienced; school administrators; and developers of classroom management courses are provided.

Reference Groups and Individual Deprivation

We provide an axiomatization of Yitzhaki’s index of individual deprivation. Our result differs from an earlier characterization due to Ebert and Moyes in the way the reference group of an individual is represented in the model. Ebert and Moyes require the index to be defined for all logically possible reference groups, whereas we employ the standard definition of the reference group as the set of all agents in a society. As a consequence of this modification, some of the axioms used by Ebert and Moyes can no longer be applied and we provide alternative formulations.

Design thinking and the precautionary principle : development of a theoretical model complementing preventive judgment for design for sustainability enriched through a study of architectural competitions adopting LEED

Cette thèse contribue à une théorie générale de la conception du projet. S’inscrivant dans une demande marquée par les enjeux du développement durable, l’objectif principal de cette recherche est la contribution d’un modèle théorique de la conception permettant de mieux situer l’utilisation des outils et des normes d’évaluation de la durabilité d’un projet. Les principes fondamentaux de ces instruments normatifs sont analysés selon quatre dimensions : ontologique, méthodologique, épistémologique et téléologique. Les indicateurs de certains effets contre-productifs reliés, en particulier, à la mise en compte de ces normes confirment la nécessité d’une théorie du jugement qualitatif. Notre hypothèse principale prend appui sur le cadre conceptuel offert par la notion de « principe de précaution » dont les premières formulations remontent du début des années 1970, et qui avaient précisément pour objectif de remédier aux défaillances des outils et méthodes d’évaluation scientifique traditionnelles. La thèse est divisée en cinq parties. Commençant par une revue historique des modèles classiques des théories de la conception (design thinking) elle se concentre sur l’évolution des modalités de prise en compte de la durabilité. Dans cette perspective, on constate que les théories de la « conception verte » (green design) datant du début des années 1960 ou encore, les théories de la « conception écologique » (ecological design) datant des années 1970 et 1980, ont finalement convergé avec les récentes théories de la «conception durable» (sustainable design) à partir du début des années 1990. Les différentes approches du « principe de précaution » sont ensuite examinées sous l’angle de la question de la durabilité du projet. Les standards d’évaluation des risques sont comparés aux approches utilisant le principe de précaution, révélant certaines limites lors de la conception d’un projet. Un premier modèle théorique de la conception intégrant les principales dimensions du principe de précaution est ainsi esquissé. Ce modèle propose une vision globale permettant de juger un projet intégrant des principes de développement durable et se présente comme une alternative aux approches traditionnelles d’évaluation des risques, à la fois déterministes et instrumentales. L’hypothèse du principe de précaution est dès lors proposée et examinée dans le contexte spécifique du projet architectural. Cette exploration débute par une présentation de la notion classique de «prudence» telle qu’elle fut historiquement utilisée pour guider le jugement architectural. Qu’en est-il par conséquent des défis présentés par le jugement des projets d’architecture dans la montée en puissance des méthodes d’évaluation standardisées (ex. Leadership Energy and Environmental Design; LEED) ? La thèse propose une réinterprétation de la théorie de la conception telle que proposée par Donald A. Schön comme une façon de prendre en compte les outils d’évaluation tels que LEED. Cet exercice révèle cependant un obstacle épistémologique qui devra être pris en compte dans une reformulation du modèle. En accord avec l’épistémologie constructiviste, un nouveau modèle théorique est alors confronté à l’étude et l’illustration de trois concours d'architecture canadienne contemporains ayant adopté la méthode d'évaluation de la durabilité normalisée par LEED. Une série préliminaire de «tensions» est identifiée dans le processus de la conception et du jugement des projets. Ces tensions sont ensuite catégorisées dans leurs homologues conceptuels, construits à l’intersection du principe de précaution et des théories de la conception. Ces tensions se divisent en quatre catégories : (1) conceptualisation - analogique/logique; (2) incertitude - épistémologique/méthodologique; (3) comparabilité - interprétation/analytique, et (4) proposition - universalité/ pertinence contextuelle. Ces tensions conceptuelles sont considérées comme autant de vecteurs entrant en corrélation avec le modèle théorique qu’elles contribuent à enrichir sans pour autant constituer des validations au sens positiviste du terme. Ces confrontations au réel permettent de mieux définir l’obstacle épistémologique identifié précédemment. Cette thèse met donc en évidence les impacts généralement sous-estimés, des normalisations environnementales sur le processus de conception et de jugement des projets. Elle prend pour exemple, de façon non restrictive, l’examen de concours d'architecture canadiens pour bâtiments publics. La conclusion souligne la nécessité d'une nouvelle forme de « prudence réflexive » ainsi qu’une utilisation plus critique des outils actuels d’évaluation de la durabilité. Elle appelle une instrumentalisation fondée sur l'intégration globale, plutôt que sur l'opposition des approches environnementales.

A study of sexuality following traumatic brain injury : moving towards the validation of a biopsychosocial model

L’étude de la sexualité dans le contexte des maladies neurologiques est un domaine émergent qui nous permet de mieux comprendre les corrélats cérébraux et neurocomportementaux de divers aspects de la sexualité. Les changements au sujet de la sexualité sont fréquents à la suite de troubles neurologiques tels que les blessures de la moelle épinière, la sclérose en plaques, l’accident vasculaire cérébral, l'épilepsie et les traumatismes craniocérébraux (TCC). Compte tenu de la complexité de la sexualité après un TCC, celle-ci doit être analysée à partir d'une perspective biopsychosociale qui comprend trois facteurs interdépendants : a) les facteurs neuropsychologiques et psychologiques, b) les variables médicales et physiques, et c) les facteurs relationnels. L’objectif de cette thèse était d’étudier certains éléments de la sexualité auprès de personnes ayant subi un TCC afin de fournir des preuves empiriques pour contribuer à la validation d’une perspective biopsychosociale de la sexualité après un TCC. Trois études quantitatives originales ont été effectuées auprès de personnes ayant subi un TCC léger, modéré ou grave et ayant reçu des services de réadaptation post-TCC, et d’un groupe de témoins en bonne santé, tous vivant dans la communauté. Les groupes étaient comparables en ce qui concerne l’âge, le sexe, le nombre d’années de scolarité, le statut d’emploi et relationnel, et le revenu annuel. Les variables ciblant la sexualité, incluses dans cette thèse, étaient la qualité de vie sexuelle, le comportement sexuel à risque, et la sociosexualité (p. ex., les différences individuelles en ce qui concerne la volonté d’une personne à avoir des relations sexuelles sans engagement). Les variables neuropsychologiques et psychologiques incluaient les fonctions exécutives, la dépression et l’anxiété. Les aspects médicaux et physiques englobaient les symptômes postcommotionnels. Les facteurs relationnels comprenaient les attitudes envers l'infidélité. Les résultats démontrent que par rapport aux témoins en santé, les individus avec un TCC ont montré une diminution de la qualité de vie sexuelle, alors que les groupes étaient comparables sur le plan du comportement sexuel à risque, de la sociosexualité et des attitudes envers l'infidélité. Par ailleurs, les résultats ont montré une différence entre les hommes et les femmes sur le plan de la sociosexualité (p. ex., plus restrictive chez la femme). Chez les personnes ayant subi un TCC, une faible qualité de vie sexuelle était significativement associée à un nombre élevé de symptômes postcommotionnels, un comportement sexuel plus à risque corrélait avec une plus grande fréquence de symptômes dysexécutifs, et une plus faible acceptation de l'infidélité était liée à une sociosexualité moins restrictive. Les résultats de ces trois études soutiennent une perspective biopsychosociale de la sexualité après le TCC. Elles apportent des connaissances nouvelles en ce qui a trait aux domaines de la sexualité qui peuvent être touchés après un TCC, ainsi qu’à certaines variables neuropsychologiques et psychologiques, médicales et physiques, et relationnelles qui sont associées à ces changements. Les implications théoriques, ainsi que pour la pratique clinique et la réadaptation sont discutées. Les limitations des études sont présentées et des recommandations pour la recherche sont proposées. Le modèle biopsychosocial peut être utilisé comme une référence pour guider la recherche future dans ce domaine. D’autres études sur la sexualité et le développement d'interventions multidisciplinaires dans ce domaine pour les personnes TCC sont nécessaires.

Geophysical Constraints on Structure and Tectonics of the Eastern Arabian Sea and the Adjoining West Coast of India with Special Reference to the Kerala Basin

The main objective of the present study is to model the gravity fields in terms of lithospheric structure below the western continental margin of India (WCMI) identify zones of crustal mass anomalies and attempt to infer the location of Ocean Continent transition in the Arabian Sea. In this study, the area starting from the western shield margin to the region covering the deep oceanic parts of the Arabian Sea which is bounded by Carlsberg and Cerg and Central Indian ridges in the south, eastern part of the Indus Cone in the west and falling between 630E and 800E longitudes, and 50N - 240N latitudes has been considered. The vast amount of seismic reflection and refraction data in the form of crustal velocities, basement configuration and crustal thicknesses available for the west coast as well as the eastern Arabian Sea has been utilized for this purpose

Response of Eastern Arabian Sea to Extreme climatic Events with Special Reference to Selected Pelagic Fishes

The thesis attempts to study the changes in oceanographic parameters associated with extreme climatic events,the influence of oceanographic as well as meteorological parameters on fishes.The characteristics of major pelagic fishes of southwest coast of India(Oil sardine and Indian mackerel) have been described here.A description on study area and period of study is also described .The impact of extreme climatic events on the oceanographic variability of Eastern Arabian Sea.The extreme climatic event,the Indian Ocean Dipole associated with EI Nino Southern Oscillation is taken into consideration.The variability in oil sardine and mackerel landings of southwest coast of India during the study period.The trend analysis of the landings has been done and also a prediction model is applied for the landings.The influence of environmental parameters on oil sardine as well as mackerel fishery has been explained .With regression analysis ,the significant relation between environmental parameters and fish landings are also been recognized.The prediction of landings is done with these environmental parameters.

Studies on food and feeding of marine demersal finfishes with special reference to trophic interactions

Food and feeding habits of fourteen demersal finfishes exploited off the Karnataka coast were studied to investigate trophic interactions within the marine food web. Index of Relative Importance (lRI),Ontogenetic, seasonal (pre-monsoon, monsoon and post-monsoon) variation in feeding and prey-predator relationship studies were conducted.The results of prey-predator trophic interaction studies identified four major trophic guilds based on the predators feeding similarity.Trophic guild I is 'copepod and detritus fceders'with an average group similarity of 61.4%. The second trophic guild, 'prawn and crab feeders'with an average similarity of 52.7%. 'Acetes feeders', the largest trophic guild with an average group similarity of 62.5%, composed of six demersal finfish species.The guild 'piscivores' is constituted by C. limba/us and P. arsius with an average similarity of 45%.For each predator, ontogenetic diet shift is common and is characterized by prey of low to high trophic level.Strong selection of certain prey types was observed in some predators while most of them avoided abundant prey.In addition to Acetes spp, strong predation impact was observed for penaeid prawns, epibenthic crabs and detritus.This information on trophic guilds and prey-predator interactions can be used to construct trophic model on the benthic ecosystem off Karnataka and to investigate fishery induced changes as well as predation impact of different animals on commercially important demersals

Texture, composition and provinance of innershelf sediments between Narakkal and Purakkad, Kerala with special reference to the formation of Mud Banks

The continental shelf of southwest coast of India (Kerala) is broader and . flatter compared to that of the east coast. The unique characteristic feature of the study area (innershelf between Narakkal and Purakkad) is the intermittent appearance of 'mud banks' at certain locations during southwest monsoon. The strong seasonality manifests significant changes in the wind, waves, currents, rainfall, drainage etc., along this area. Peculiar geomorphological variation with high, mid and lowlands in the narrow strip of the hinterland, the geological formations mainly consisting of rocks of metamorphic origin and the humid tropical weathering conditions play significant role in regulating the shelf sedimentation. A complementary pattern of distri bution is observed for clay that shows an abundance in the nearshore. Silt, to a major extent, depicts semblance with clay distribution . Summation of the total asymmetry of grain size distribution are inferred from the variation of skewness and kurtosis.Factor I implies a low energy regime where the transportation and deposition phases are controlled mostly by pelagic suspension process as the factor loadings are dominant on finer phi sizes. The second Factor is inferred to be the result of a high energy regime which gives higher loadings on coarser size fractions. The third Factor which might be a transition phase (medium energy regime) representing the resultant flux of coastal circulation of the re-suspension/deposition and an onshoreoffshore advection by reworking and co-deposition of relict and modern sediments. The spatial variations of the energy regime based on the three end-member factor model exhibits high energy zone in the seaward portion transcending to a low energy one towards the coast.From the combined analysis of granulometry and SEM studies, it is concluded that the sandy patches beyond 20 m depth are of relict nature. They are the resultant responses of beach activity during the lower stand of sea level in the Holocene. Re-crystallisation features on the quartz grains indicate that they were exposed to subaerial weathering process subsequent to thei r deposition

Studies on air pollution meteorology with special reference to Madras city

The main aim of the study is to give a clear picture of various meteorological factors affecting the dispersal of pollutants. One such important developing metropolis, namely Madras, is chosen for the present study. The study throws light into the occurrence of inversions, isothermals and lapse conditions and the vertical and horizontal extent of mixing of pollutants. The thesis also aims to study the wind climatology and atmospheric stability .The study gives a insight to the spatial distribution of sulphudioxide concentration using the Gaussian plume model, which accounts for various industrial sources. The researcher suggests optimum locations for industries and various steps to reduce air pollution.

Efficacy of Cluster- Based Approach for the revival of Handloom Co-operative Societies in Kerala- with special reference to Thiruvananthapuram and Kannur Districts

one of the key sectors, identified by the Department of Industries Government of Kerala, for the cluster development initiative is Handloom, which gives employment to over over 50,000 people directly. Despite its age old tradition and fame, the performance of the sector vis-à-vis power looms is not very rosy owing to (i) competition from cheap power loom cloth from other states (ii) scarcity of quality yarn (iii) price escalation of yarn, dyes, chemicals and other raw materials (iv) the shrinking market for handlooms in Kerala (v) non-demand based production and inadequacy of new designs and (vi) inefficiencies in the system, particularly in the co-operative sector. Cluster based approach is adopted in the handloom sector with the objective of providing necessary support mechanism to come out of the crisis that the sector faces now. While four cluster schemes are being implemented in Kerala, it is under IHDS-CDP that the State got a sizeable number of clusters benefiting a large number of societies and weavers- 24 handloom clusters, bringing 152 handloom co-operative societies and over 19,800 handloom workers under the Programme. This research attempts to revisit the underlying rationale and context of the new direction and would attempt to broadly analyze the growth trends under the influence of cluster model adopted by the State IHDS-CDP for the revival of handloom sector through a detailed study of the handloom co-operative societies in Kerala. If handloom sector in Kerala can be revived using cluster based approach, it can be easily concluded that cluster is capable of taking the MSME in Kerala to a ‘high growth path.’ The study is aimed at understanding how best clusters emerge as appropriate industrial organization suitable for the current global structure of manufacture

Model-Based Matching by Linear Combinations of Prototypes

We describe a method for modeling object classes (such as faces) using 2D example images and an algorithm for matching a model to a novel image. The object class models are "learned'' from example images that we call prototypes. In addition to the images, the pixelwise correspondences between a reference prototype and each of the other prototypes must also be provided. Thus a model consists of a linear combination of prototypical shapes and textures. A stochastic gradient descent algorithm is used to match a model to a novel image by minimizing the error between the model and the novel image. Example models are shown as well as example matches to novel images. The robustness of the matching algorithm is also evaluated. The technique can be used for a number of applications including the computation of correspondence between novel images of a certain known class, object recognition, image synthesis and image compression.

An alternative method for dating unknown tephras based on a segmented regression model

In CoDaWork’05, we presented an application of discriminant function analysis (DFA) to 4 different compositional datasets and modelled the first canonical variable using a segmented regression model solely based on an observation about the scatter plots. In this paper, multiple linear regressions are applied to different datasets to confirm the validity of our proposed model. In addition to dating the unknown tephras by calibration as discussed previously, another method of mapping the unknown tephras into samples of the reference set or missing samples in between consecutive reference samples is proposed. The application of these methodologies is demonstrated with both simulated and real datasets. This new proposed methodology provides an alternative, more acceptable approach for geologists as their focus is on mapping the unknown tephra with relevant eruptive events rather than estimating the age of unknown tephra. Kew words: Tephrochronology; Segmented regression

Pharmaceutical innovation, reference pricing and therapeutic classes

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