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.

Safety and outcome of coronary interventions with special reference to anticoagulation and stent type

University of Turku, Faculty of Medicine, Department of Cardiology and Cardiovascular Medicine, Doctoral Programme of Clinical Investigation, Heart Center, Turku University Hospital, Turku, Finland Division of Internal Medicine, Department of Cardiology, Seinäjoki Central Hospital, Seinäjoki, Finland Heart Center, Satakunta Central Hospital, Pori, Finland Annales Universitatis Turkuensis Painosalama Oy, Turku, Finland 2015 Antithrombotic therapy during and after coronary procedures always entails the challenging establishment of a balance between bleeding and thrombotic complications. It has been generally recommended to patients on long-term warfarin therapy to discontinue warfarin a few days prior to elective coronary angiography or intervention to prevent bleeding complications. Bridging therapy with heparin is recommended for patients at an increased risk of thromboembolism who require the interruption of anticoagulation for elective surgery or an invasive procedure. In study I, consecutive patients on warfarin therapy referred for diagnostic coronary angiography were compared to control patients with a similar disease presentation without warfarin. The strategy of performing coronary angiography during uninterrupted therapeutic warfarin anticoagulation appeared to be a relatively safe alternative to bridging therapy, if the international normalized ratio level was not on a supratherapeutic level. In-stent restenosis remains an important reason for failure of long-term success after a percutaneous coronary intervention (PCI). Drug-eluting stents (DES) reduce the problem of restenosis inherent to bare metal stents (BMS). However, a longer delay in arterial healing may extend the risk of stent thrombosis (ST) far beyond 30 days after the DES implantation. Early discontinuation of antiplatelet therapy has been the most important predisposing factor for ST. In study II, patients on long-term oral anticoagulant (OAC) underwent DES or BMS stenting with a median of 3.5 years’follow-up. The selective use of DESs with a short triple therapy seemed to be safe in OAC patients, since late STs were rare even without long clopidogrel treatment. Major bleeding and cardiac events were common in this patient group irrespective of stent type. In order to help to predict the bleeding risk in patients on OAC, several different bleeding risk scorings have been developed. Risk scoring systems have also been used also in the setting of patients undergoing a PCI. In study III, the predictive value of an outpatient bleeding risk index (OBRI) to identify patients at high risk of bleeding was analysed. The bleeding risk seemed not to modify periprocedural or long-term treatment choices in patients on OAC after a percutaneous coronary intervention. Patients with a high OBRI often had major bleeding episodes, and the OBRI may be suitable for risk evaluation in this patient group. Optical coherence tomography (OCT) is a novel technology for imaging intravascular coronary arteries. OCT is a light-based imaging modality that enables a 12–18 µm tissue axial resolution to visualize plaques in the vessel, possible dissections and thrombi as well as, stent strut appositions and coverage, and to measure the vessel lumen and lesions. In study IV, 30 days after titanium-nitride-oxide (TITANOX)-coated stent implantation, the binary stent strut coverage was satisfactory and the prevalence of malapposed struts was low as evaluated by OCT. Long-term clinical events in patients treated with (TITANOX)-coated bio-active stents (BAS) and paclitaxel-eluting stents (PES) in routine clinical practice were examined in study V. At the 3-year follow-up, BAS resulted in better long-term outcome when compared with PES with an infrequent need for target vessel revascularization. Keywords: anticoagulation, restenosis, thrombosis, bleeding, optical coherence tomography, titanium

Electrical Safety of Island Operated Low Voltage DC Network

Today, renewable energy technologies and modern power electronics have made it feasible to implement low voltage direct current (LVDC) microgrids (MGs) ca-pable to island operation. Such LVDC networks are particularly useful in remote areas. However, there are still pending issues in island operated LVDC MGs like electrical safety and controlled operation, which should be addressed before wide-scale implementation. This thesis is focused on the overall protection of an island operated LVDC network concept, including protection against electrical shocks, mains equipment protection and protection of photovoltaic (PV) power sources and battery energy storage systems (BESSs). The topic is approached through ex-amination of the safety hazards and the appropriate methods to protect against them, comprising considerations for earthing system selection and realisation of the protection system.

Power Electronic Converters in Low-Voltage Direct Current Distribution – Analysis and Implementation

Over the recent years, smart grids have received great public attention. Many proposed functionalities rely on power electronics, which play a key role in the smart grid, together with the communication network. However, “smartness” is not the driver that alone motivates the research towards distribution networks based on power electronics; the network vulnerability to natural hazards has resulted in tightening requirements for the supply security, set both by electricity end-users and authorities. Because of the favorable price development and advancements in the field, direct current (DC) distribution has become an attractive alternative for distribution networks. In this doctoral dissertation, power electronic converters for a low-voltage DC (LVDC) distribution system are investigated. These include the rectifier located at the beginning of the LVDC network and the customer-end inverter (CEI) on the customer premises. Rectifier topologies are introduced, and according to the LVDC system requirements, topologies are chosen for the analysis. Similarly, suitable CEI topologies are addressed and selected for study. Application of power electronics into electricity distribution poses some new challenges. Because the electricity end-user is supplied with the CEI, it is responsible for the end-user voltage quality, but it also has to be able to supply adequate current in all operating conditions, including a short-circuit, to ensure the electrical safety. Supplying short-circuit current with power electronics requires additional measures, and therefore, the short-circuit behavior is described and methods to overcome the high-current supply to the fault are proposed. Power electronic converters also produce common-mode (CM) and radio-frequency (RF) electromagnetic interferences (EMI), which are not present in AC distribution. Hence, their magnitudes are investigated. To enable comprehensive research on the LVDC distribution field, a research site was built into a public low-voltage distribution network. The implementation was a joint task by the LVDC research team of Lappeenranta University of Technology and a power company Suur-Savon S¨ahk¨o Oy. Now, the measurements could be conducted in an actual environment. This is important especially for the EMI studies. The main results of the work concern the short-circuit operation of the CEI and the EMI issues. The applicability of the power electronic converters to electricity distribution is demonstrated, and suggestions for future research are proposed.

Sedentary behaviour and health with special reference to obesity and fatty liver in early midlife. The Cardiovascular risk in Young Finns Study

Background: Physical inactivity and positive energy balance pose a risk to health. They increase the risk of obesity and associated non-communicable diseases. Recently, also sedentary behaviour has been associated with obesity and non-communicable diseases. Nevertheless, it has been unclear which type of sedentary behaviour is the most harmful. It is also unknown whether the relationship of sedentary behaviour with obesity is truly independent of other factors, for example physical activity and diet. Longitudinal data are limited, and the direction of causality and the mechanism of action are still unknown. Aims: The aim of this study was 1) to identify the type of sedentary behaviour having the strongest association with obesity, 2) to explore the causal relationship of sedentary behaviour and weight increase, and 3) to additionally, investigate the relationship of sedentary behaviour with fatty liver. These were studied in cross-sectional and/or longitudinal settings using data from the Cardiovascular Risk in Young Finns Study. Special emphasis was put on the evaluation of a wide range of other lifestyle factors and risks for obesity and fatty liver. Subjects: 2,060 subjects (aged 33-50 years in 2011, of which 55 % were female) from the Cardiovascular Risk in Young Finns Study participating in follow-ups in 2001, 2007, and 2011. Measures: Self-reported time spent in various types of sedentary behaviour (I), or TV viewing time (I-III). Measured body weight, height and waist circumference (I-III), and genetic variants for high BMI (I). Fasting plasma concentrations of gamma-glutamyltransferase enzyme and triglyceride, calculated Fatty Liver Index (based on gamma-glutamyltransferase and triglyceride concentration, BMI and waist circumference), and the amount of intrahepatic fat measured with ultrasound (III). Self-reported leisure-time physical activity and active commuting, occupational physical activity, energy intake, diet, alcohol consumption, smoking, socioeconomic status, and sleep duration as possible confounders were considered (I-III). Results: TV viewing is the sedentary behaviour type that has the strongest association with obesity. Sedentary behaviour (TV viewing) precedes weight increase, and not the other way around. Sedentary behaviour (TV viewing) is associated with increased risk of fatty liver. Conclusions: Sedentary behaviour (especially high TV viewing time) is associated with increased risks of obesity and fatty liver. Intervention studies are needed to assess whether reduction of TV time would prevent obesity and fatty liver.

The role of extracellular matrix macromolecules in cancer and diabetic macroangiopathy – with special reference to decorin and hyaluronan

The central role of extracellular matrix (ECM) macromolecules in diseases such as cancer and atherosclerotic vascular diseases including diabetic macroangiopathy is indisputable. Decorin and hyaluronan (HA) represent vital ECM macromolecules in the microenvironment of cells and are centrally involved in human cancer and cardiovascular biology. In cancer, decorin is considered to play a tumor suppressive role. However, there is some discrepancy whether malignant cells express it. Regarding HA, its contribution to the development of atherosclerotic vascular diseases has been well established. Nevertheless, the precise role of HA in arterial narrowing associated with diabetes is not known. The present study focused on two vital ECM macromolecules, namely decorin and HA. First, decorin expression was studied in human tumorigenesis. Furthermore, the effect of adenovirus-mediated decorin transduction on selected cancer cell lines was investigated. The results invariably showed that cancer cells completely lacked decorin expression. The study also demonstrated that transducing cancer cells with decorin adenoviral vector markedly inhibited their malignant behavior. In line with this, a strong induction of decorin expression in normal human embryonic stem cells (hESCs), but not in abnormal hESCs was observed during their differentiation. Secondly, the significance of HA in the development of diabetic macroangiopathy in response to hyperglycemia was evaluated. Results showed that the synthesis of HA by vascular smooth muscle cells was significantly increased in response to high glucose concentration. This increase was associated with the diminished ability of the cells to contract collagen-rich matrix suggesting that HA participates in the disturbed vascular remodeling of diabetic patients. The results of this study support endeavours to develop novel ECM macromolecule -based therapies targeting cancer and cardiovascular diseases.

Case: Kitaravahvistimen AB-luokan tehovahvistimen päivittäminen D-luokkaan

D-luokan vahvistimien etu perinteisiin A- tai AB-luokan vahvistimiin nähden on niitten korkea hyötysuhde ja pieni koko. Lisäksi ne ovat edullisia ja niihin voidaan asentaa pienemmät jäähdytyslevyt kuin perinteisiin vahvistimiin korkean hyötysuhteen ansiosta. Tässä tutkimuksessa asennetaan Peavey Solo –kitaravahvistimen pääteasteena toimivan AB-luokan päätevahvistimen tilalle tehokkaampi ja uudempaa vahvistinluokkaa edustava D-luokan vahvistin. Tutkimuksessa selvitetään, miten D-luokan vahvistimella toteutettu kytkentä toimii verrattuna alkuperäiseen kytkentään tutkimalla kitaravahvistimelle tyypillisiä sähköisiä ominaisuuksia. Työ toteutetaan mittauksin. Koska työssä olevissa kytkennöissä on jännitteisiä osia, on siinä perehdyttävä sähköturvallisuuteen. D-luokan vahvistin asettaa tietyt sähkötekniset kestävyysvaatimukset kytkennän teholähteelle ja kaiutinelementille, jolloin työssä paneudutaan myös niiden valintaan. D-luokan vahvistimeen päivitetyn kytkennän tuottamat äänenpainetasot olivat valtaosassa mittauksia suuremmat kuin alkuperäisellä kytkennällä. Äänenpainetasojen mittaustilanteissa myös kuormalle syötetyt tehot olivat suuremmat päivitetyllä kytkennällä verrattuna alkuperäiseen. Suurin päivitetyn kytkennän kuorman teho 72,72 W saavutettiin, kun kaiutinelementin yli oli 24,12 V:n jännitteen tehollisarvo ja kuorman teho oli noin 36 kertaa suurempi kuin alkuperäisellä kytkennällä. D-luokan vahvistimen mitatut harmonisen särön arvot ovat huomattavasti pienempiä kuin alkuperäisellä vahvistimella. Muokkaamattoman vahvistimen mitatusta sähköisestä taajuusvasteeesta nähdään, että alkuperäinen vahvistin korostaa tiettyjä taajuuksia, kun D-luokan vahvistimen taajuusvaste on sen sijaan likimain tasainen. Akustinen taajuusvaste ei ole niin tasainen D-luokan vahvistimeen päivitetyllä kytkennällä kuin alkuperäisellä kytkennällä ja sillä on myös kapeampi taajuusalue. Jos päivitetyn kytkennän sointia haluttaisiin parantaa, pitäisi tutkia lisää akustiseen taajuusvasteeseen vaikuttavia asioita.

Model to Build a Service Quality Centric Customer Reference Portfolio in a Software as a Service Company

The goal of the master’s thesis was to develop a model to build a service quality centric customer reference portfolio for a software as a service company. The case company is Meltwater Finland Oy that leverages customer references externally but there is no systematic model to produce good quality customer references that are in line with the company strategy. The project was carried out as a case study, where the primary source of information were seventeen internal interviews with the employees of the case company. The theory part focuses on customer references as assets and service quality in software as a service industry. In the empirical part the research problem is solved. As a result of the case study, the model to build a service quality centric customer reference portfolio was created and further research areas were suggested.

Benefits of a low-cost one-phase current distortion detection device in appliance supply in low-voltage residential networks

In this bachelor’s thesis are examined the benefits of current distortion detection device application in customer premises low voltage networks. The purpose of this study was to find out if there are benefits for measuring current distortion in low-voltage residential networks. Concluding into who can benefit from measuring the power quality. The research focuses on benefits based on the standardization in Europe and United States of America. In this research, were also given examples of appliances in which current distortion detection device could be used. Along with possible illustration of user interface for the device. The research was conducted as an analysis of the benefits of current distortion detection device in residential low voltage networks. The research was based on literature review. The study was divided to three sections. The first explain the reasons for benefitting from usage of the device and the second portrays the low-cost device, which could detect one-phase current distortion, in theory. The last section discuss of the benefits of usage of current distortion detection device while focusing on the beneficiaries. Based on the result of this research, there are benefits from usage to the current distortion detection device. The main benefitting party of the current distortion detection device was found to be manufactures, as they are held responsible of limiting the current distortion on behalf of consumers. Manufactures could adjust equipment to respond better to the distortion by having access to on-going current distortion in network. The other benefitting party are system operators, who would better locate distortion issues in low-voltage residential network to start prevention of long-term problems caused by current distortion early on.

Modelling of faults in low-voltage cables

Power line modelling has become an interesting research area in recent years as a result of advances in the power line distribution network system. Extensive knowledge about the power line cable characteristics can be implemented in a software algorithm in a modern broadband power-line communication modem. In this study, a novel approach for modelling power line cables (AMCMK) based on the broadband impedance spectroscopy (BIS) and transmission line matrix (TLM) techniques is recommended in characterizing a healthy cable and the various faults associated with low-voltage cables for both open and short circuit situation. Models for different cable conditions are developed and tuned, which include six models for both healthy and faulty cables situations. The models are on the basis of impedance response analysis of the cable. The resulting spectra from the simulations are also cross-correlated to determine the degree of similarities between the healthy cable spectra and their respective faulty spectra.

The effectiveness of interpretive methods in informal educational facilities : an experimental study with reference to marine parks

Interpretation has been used in many tourism sectors as a technique in achieving building hannony between resources and human needs. The objectives of this study are to identify the types of the interpretive methods used, and to evaluate their effectiveness, in marine parks. This study reviews the design principles of an effective interpretation for marine wildlife tourism, and adopts Drams' five design principles (1997) into a conceptual framework. Enjoyment increase, knowledge gain, attitude and intention change, and behaviour modification were used as key indicators in the assessment of the interpretive effectiveness of the Vancouver Aquarium (VA) and Marineland Canada (MC). Since on-site research is unavailable, a virtual tour is created to represent the interpretive experiences in the two study sites. Self-administered questionnaires are used to measure responses. Through comparing responses to the questionnaires (pre-, post-virtual tours and follow-up), this study found that interpretation increased enjoyment and added to respondents' knowledge. Although the changes in attitudes and intentions are not significant, the findings indicate that attitude and intention changes did occur as a result of interpretation, but only to a limited extent. Overall results suggest that more techniques should be added to enhance the effectiveness of the interpretation in marine parks or self-guiding tours, and with careful design, virtual tours are the innovative interpretation techniques for marine parks or informal educational facilities.

The surficial geology, sedimentology and geochemistry of the late glacial sediments and Paleozoic bedrock in the Campbellford area, Ontario, with special reference to the Dummer Complex /

The Dummer Complex extends 180 km along the Precambrian - Paleozoic contact from Tamworth to Lake Simcoe. It is composed of coarse, angular Paleozoic clasts in discontinuous, pitted, hummocky deposits. Deposits are usually separated by bare or boulder strewn bedrock, but have been found in the southern drumlinized till sheet. Dummer Complex deposits show rough alignment with ice-flow. Eskers cross-cut many of the deposits. Dummer sediment subfacies are defined on the basis of dominant coarse grain size and lithology, which relate directly to the underlying Paleozoic formation. Three subglacial tills are identified based on the degree of comminution and distance of transport; the immature facies of the Dummer Complex; the mature facies of the drumlinized till sheet and; the submature facies which is transitional. Carbonate geochemistry was used for till-bedrock correlation in various grain sizes. Of the 3 Paleozoic formations underlying the Dummer Complex, the Gull River Fm. is geochemically distinctive from the Bobcaygeon and Verulam Formations using Ca, Mg, Sr, Cu, Mn, Fe and Na. The Bobcaygeon Fm. and Verulam Fm. can be differentiated using Ca and the Sr/Ca ratio. The immature facies from 1.0 phi and finer is dominated by the non-carbonate, long distance transported component which decreases slightly downice. The submature till facies contains more long distance material than the immature facies. Sr and Mn can be used to correlate the Gull River immature till facies to the underlying bedrock the other subfacies could not be distinguished from each other or their respective source formation. This method proved to be ineffective for sediments with greater than 35% non-carbonate component, due to leaching of elements by the dissolving acid.The Dummer Complex is produced subglacially , as the compressional ice encounters the permeable Paleozoic carbonates. The increased shear strength of the ice and pore pressures in the carbonates results in the basal ice zones becoming debris ladden. Cleaner ice overrides the basal debris . laden dead ice which then acts as the glacier bed. During retreat, the Simcoe lobe stagnates as flow is cut-off by the Algonquin Highlands.

A speculative systems model of the dynamic interaction among students, faculty and administration in the community college, with particular reference to intrinsic motivation and the teacher-administrator interface

The challenge the community college faces in helping meet the needs of the living open system of society is examined in this study. It is postulated that internalization student outcomes are required by society to reduce entropy and remain self-renewing. Such behavior is characterized as having an intrinsically motivated energy source and displays the seeking and conquering of challenge, the development of reflective knowledge and skill, full use of all capabilities, internal control, growth orientation, high self-esteem, relativistic thinking and competence. The development of a conceptual systems model that suggests how transactions among students, faculty and administration might occur to best meet the needs of internalization outcomes in students, and intrinsic motivation in faculty is a major purpose of this study. It is a speculative model that is based on a synthesis of a wide variety of variables. Empirical evidence, theoretical considerations, and speculative ideas are gathered together from researchers and theoretici.ans who are working on separate answers to questions of intrinsic motivation, internal control and environments that encourage their development. The model considers the effect administrators·have on faculty anq the corresponding effect faculty may have on students. The major concentration is on the administrator--teacher interface.For administrators the model may serve as a guide in planning effective transactions, and establishing system goals. The teacher is offered a means to coordinate actions toward a specific overall objective, and the administrator, teacher and researcher are invited to use the model to experiment, innovate, verify the assumptions on which the model is based, and raise additional hypotheses. Goals and history of the community colleges in Ontario are examined against current problems, previous progress and open system thinking. The nature of the person as a five part system is explored with emphasis on intrinsic motivation. The nature, operation, conceptualization, and value of this internal energy source is reviewed in detail. The current state of society, education and management theory are considered and the value of intrinsically motivating teaching tasks together with "system four" leadership style are featured. Evidence is reviewed that suggests intrinsically motivated faculty are needed, and "system four" leadership style is the kind of interaction-influence system needed to nurture intrinsic motivation in faculty.