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.

Creating Value for Corporate Sustainability: Stakeholder Engagement

The thesis aims to build a coherent view and understanding of stakeholder engagement’s contribution to corporate sustainability value creation. Theory suggests that corporate sustainability relies on sustainable relationships between the firm and its multiple stakeholders. This study is qualitative and evidence is derived from integrative analysis of literature, secondary data and case study analysis. The findings from the interviews analysis supplement the framework developed as the results of the literature review. The results obtained throughout the thesis research imply that stakeholder engagement helps develop more thorough understandings of issues and alternative perspectives, which in turn facilitates the decision-making processes improvement. The improvement is also achieved through ethical analysis, by weighing the impact of firm’s decisions on all relevant groups. Therefore, clear communication and exchange of information also improve the acceptance of sustainability initiatives amongst stakeholders both in terms of building trust and managing expectations. As practical implications, this thesis presents organizational practices that can be employed by companies to support effective engagement with stakeholders. The described practices could enhance processes such as partnership and co-creation resulting in greater sustainable development.

Sustainable building solutions: a review of lessons from the natural world

The realisation that much of conventional. modern architecture is not sustainable over the long term is not new. Typical approaches are aimed at using energy and materials more efficiently. However, by clearly understanding the natural processes and their interactions with human needs in view, designers can create buildings that are delightful. functional productive and regenerative by design. The paper aims to review the biomimetics literature that is relevant to building materials and design. Biomimetics is the abstraction of good design from Nature, an enabling interdisciplinary science. particularly interested in emerging properties of materials and structures as a result of their hierarchical organisation. Biomimetics provides ideas relevant to: graded functionality of materials (nano-scale), adaptive response (nano-, micro-. and macro-scales): integrated intelligence (sensing and actuation at all scales), architecture and additional functionality. There are many examples in biology where emergent response of plants and animals to temperature, humidity and other changes in their physical environments is based on relatively simple physical principles. However, the implementation of design solutions which exploit these principles is where inspiration for man-made structures should be. We analyse specific examples of sustainability from Nature and the benefits or value that these solutions have brought to different creatures. By doing this, we appreciate how the natural world fits into the world of sustainable buildings and how as building engineers we can value its true application in delivering sustainable building.

A generic model of Exergy Assessment of the Environmental Impact for the Building Lifecycle

A generic model of Exergy Assessment is proposed for the Environmental Impact of the Building Lifecycle, with a special focus on the natural environment. Three environmental impacts: energy consumption, resource consumption and pollutant discharge have been analyzed with reference to energy-embodied exergy, resource chemical exergy and abatement exergy, respectively. The generic model of Exergy Assessment of the Environmental Impact of the Building Lifecycle thus formulated contains two sub-models, one from the aspect of building energy utilization and the other from building materials use. Combined with theories by ecologists such as Odum, the paper evaluates a building's environmental sustainability through its exergy footprint and environmental impacts. A case study from Chongqing, China illustrates the application of this method. From the case study, it was found that energy consumption constitutes 70–80% of the total environmental impact during a 50-year building lifecycle, in which the operation phase accounts for 80% of the total environmental impact, the building material production phase 15% and 5% for the other phases.

Barriers and commitment of facilities management profession to the sustainability agenda

The practice of sustainable facilities management (FM) is rapidly evolving with the increasing interest in the discourse of sustainable development. This paper examines a recent survey of the experiences of facilities managers in the rapidly growing and evolving industry in regard to the barriers and their commitment to the sustainability agenda. The survey results show that time constraints, lack of knowledge and lack of senior management commitment are the main barriers for the implementation of consistent and comprehensive sustainable FM policy and practice. The paper concludes that the diversity of the FM role and the traditional undervaluation of the contribution it makes to the success of organisations are partially responsible for lack of success in achieving sustainable facilities. The overwhelming barrier for sustainable FM practice is the lack of understanding, focus and commitment of senior executives in appreciating the opportunities, threats and need for strategic leadership and direction in driving essential change, and hence further the sustainability agenda.

Normative, systemic and procedural aspects: a review of indicator‐based sustainability assessments in agriculture

Several methods for assessing the sustainability of agricultural systems have been developed. These methods do not fully: (i) take into account the multi‐functionality of agriculture; (ii) include multidimensionality; (iii) utilize and implement the assessment knowledge; and (iv) identify conflicting goals and trade‐offs. This paper reviews seven recently developed multidisciplinary indicator‐based assessment methods with respect to their contribution to these shortcomings. All approaches include (1) normative aspects such as goal setting, (2) systemic aspects such as a specification of scale of analysis, (3) a reproducible structure of the approach. The approaches can be categorized into three typologies. The top‐down farm assessments focus on field or farm assessment. They have a clear procedure for measuring the indicators and assessing the sustainability of the system, which allows for benchmarking across farms. The degree of participation is low, potentially affecting the implementation of the results negatively. The top‐down regional assessment assesses the on‐farm and the regional effects. They include some participation to increase acceptance of the results. However, they miss the analysis of potential trade‐offs. The bottom‐up, integrated participatory or transdisciplinary approaches focus on a regional scale. Stakeholders are included throughout the whole process assuring the acceptance of the results and increasing the probability of implementation of developed measures. As they include the interaction between the indicators in their system representation, they allow for performing a trade‐off analysis. The bottom‐up, integrated participatory or transdisciplinary approaches seem to better overcome the four shortcomings mentioned above.

Office sustainability: occupier perceptions and implementation of policy

Purpose – The purpose of this research was twofold. First, to investigate the views of occupiers in a typical UK city on the importance of various sustainability issues, their perceived impact of different sustainability drivers and willingness to pay. Second, the environmental and social performance of existing buildings in that city was examined. Design/methodology/approach – The research focuses on buildings of 10,000 feet2 or more that have been constructed in the Bristol city-region in the UK over the past 50 years. The buildings in the sample are located in the city centre and in out-of-town business parks. A questionnaire survey investigated the views of occupiers and follow-up interviews looked more closely at the sustainability performance of the existing stock. Findings – The findings indicate that, as far as occupiers are concerned, the strongest drivers are consumer demand and staff demand. Green features of a building appear to rank low in the overall building selection preference structure and a willingness to pay a premium for green features was indicated. The interviews uncovered barriers to progress as well as initiatives to reduce both energy consumption and the environmental impact of office space. Practical implications – The paper identifies progress and issues which could form obstacles to improving the environmental performance of office buildings. It is argued that there is a need to focus on energy efficiency. Originality/value – This paper explores the linkage between the perception and use of office space by occupants and how this affects the environmental performance of this space.

Putting the S-word back into Sustainability: Can we be more social?

In an era dominated by climate change debate and environmentalism there is a real danger that the important ‘social’ pillar of sustainability drops out of our vocabulary. This can happen at a variety of scales from business level through to building and neighbourhood level regeneration and development. Social sustainability should be at the heart of all housing and mixed-use development but for a variety of reasons tends to be frequently underplayed. The recent English city riots have brought this point back sharply into focus. The relationships between people, places and the local economy all matter and this is as true today as it was in the late 19th century when Patrick Geddes, the great pioneering town planner and ecologist, wrote of ‘place-work-folk’. This paper, commissioned from Tim Dixon, explains what is meant by social sustainability (and how it is linked to concepts such as social capital and social cohesion); why the debate matters during a period when ‘localism’ is dominating political debate; and what is inhibiting its growth and its measurement. The paper reviews best practice in post-occupancy social sustainability metric systems, based on recent research undertaken by the author on Dockside Green in Vancouver, and identifi es some of the key operational issues in mainstreaming the concept within major mixed-use projects. The paper concludes by offering a framework for the key challenges faced in setting strategic corporate goals and objectives; prioritising and selecting the most appropriate investments; and measuring social sustainability performance by identifying the required data sources

Normative, systemic and procedural aspects: a review of indicator-based sustainability assessments in agriculture

Methods for assessing the sustainability of agricultural systems do often not fully (i) take into account the multifunctionality of agriculture, (ii) include multidimensionality, (iii) utilize and implement the assessment knowledge and (iv) identify conflicting goals and trade-offs. This chapter reviews seven recently developed multidisciplinary indicator-based assessment methods with respect to their contribution to these shortcomings. All approaches include (1) normative aspects such as goal setting, (2) systemic aspects such as a specification of scale of analysis and (3) a reproducible structure of the approach. The approaches can be categorized into three typologies: first, top-down farm assessments, which focus on field or farm assessment; second, top-down regional assessments, which assess the on-farm and the regional effects; and third, bottom-up, integrated participatory or transdisciplinary approaches, which focus on a regional scale. Our analysis shows that the bottom-up, integrated participatory or transdisciplinary approaches seem to better overcome the four shortcomings mentioned above.

Practicing sustainability in PFI project management

This paper investigates the relationship of the project management in Private Finance Initiative (PFI) and sustainability. A live PFI project is selected as a case study, where contract review and monitoring on project management are carried out to evaluate the sustainability of project management. The PFI procurement shows great advantages in increased contractual responsibilities of the contractor in sustainable construction, and also in practicing sustainability in project management. Six main sustainable attributes of the project management are selected to evaluate the sustainability of project management in the PFI project. The project management process in the case study is closely monitored in order to verify how the PFI project promotes sustainability in practice. The project management in the different stages of the PFI project, including tendering, design, construction and operation, contributes to the six sustainable attributes in different ways. The project management in PFI project paid more attention in sustainable development during its whole process. As the private sector is responsible to the whole life of the building project, the project manager has to consider the long-term benefits during the management process. The government should take advantages of PFI project management in practicing sustainability therefore to promote sustainable development of the national infrastructure services.

Changing building user attitude and organisational policy towards sustainable resource use in healthcare

Health care provision is significantly impacted by the ability of the health providers to engineer a viable healthcare space to support care stakeholders needs. In this paper we discuss and propose use of organisational semiotics as a set of methods to link stakeholders to systems, which allows us to capture clinician activity, information transfer, and building use; which in tern allows us to define the value of specific systems in the care environment to specific stakeholders and the dependence between systems in a care space. We suggest use of a semantically enhanced building information model (BIM) to support the linking of clinician activity to the physical resource objects and space; and facilitate the capture of quantifiable data, over time, concerning resource use by key stakeholders. Finally we argue for the inclusion of appropriate stakeholder feedback and persuasive mechanism, to incentivise building user behaviour to support organisational level sustainability policy.

Wall materials and techniques available for low cost housing in Khartoum from a sustainability point of view

Khartoum like many cities in least developing countries (LDCs) still witnesses huge influx of people. Accommodation of the new comers leads to encroachment on the cultivation land leads to sprawl expansion of Greater Khartoum. The city expanded in diameter from 16.8 km in 1955 to 802.5 km in 1998. Most of this horizontal expansion was residential. In 2008 Khartoum accommodated 29% of the urban population of Sudan. Today Khartoum is considered as one of 43 major cities in Africa that accommodates more than 1 million inhabitants. Most of new comers live in the outskirts of the city e.g. Dar El-Salam and Mayo neighbourhoods. The majority of those new comers built their houses especially the walls from mud, wood, straw and sacks. Selection of building materials usually depends on its price regardless of the environmental impact, quality, thermal performance and life of the material. Most of the time, this results in increasing the cost with variables of impacts over the environment during the life of the building. Therefore, consideration of the environmental impacts, social impacts and economic impacts is crucial in the selection of any building material. Decreasing such impacts could lead to more sustainable housing. Comparing the sustainability of the available wall building materials for low cost housing in Khartoum is carried out through the life cycle assessment (LCA) technique. The purpose of this paper is to compare the most available local building materials for walls for the urban poor of Khartoum from a sustainability point of view by going through the manufacturing of the materials, the use of these materials and then the disposal of the materials after their life comes to an end. Findings reveal that traditional red bricks couldn’t be considered as a sustainable wall building material that will draw the future of the low cost housing in Greater Khartoum. On the other hand, results of the comparison lead to draw attention to the wide range of the soil techniques and to its potentials to be a promising sustainable wall material for urban low cost housing in Khartoum.

Demonstrating the importance of criteria and sub-criteria in building assessment methods

Building assessment methods have become a popular research field since the early 1990s. An international tool which allows the assessment of buildings in all regions, taking into account differences in climates, topographies and cultures does not yet exist. This paper aims to demonstrate the importance of criteria and sub-criteria in developing a new potential building assessment method for Saudi Arabia. Recently, the awareness of sustainability has been increasing in developing countries due to high energy consumption, pollution and high carbon foot print. There is no debate that assessment criteria have an important role to identify the tool’s orientation. However, various aspects influence the criteria and sub-criteria of assessment tools such as environment, economic, social and cultural to mention but a few. The author provides an investigation on the most popular and globally used schemes: BREEAM, LEED, Green Star, CASBEE and Estidama in order to identify the effectiveness of the different aspects of the assessment criteria and the impacts of these criteria on the assessment results; that will provide a solid foundation to develop an effective sustainable assessment method for buildings in Saudi Arabia. Initial results of the investigation suggest that each country needs to develop its own assessment method in order to achieve desired results, while focusing upon the indigenous environmental, economic, social and cultural conditions. Keywords: Assessment methods, BREEAM, LEED, Green Star, CASBEE, Estidama, sustainability, sustainable buildings, Environment, Saudi Arabia.

Building resilience in the face of recurring environmental crisis in African Sahel

The present food shortages in the Horn of Africa and the West African Sahel are affecting 31 million people. Such continuing and future crises require that people in the region adapt to an increasing and potentially irreversible global sustainability challenge. Given this situation and that short-term weather and seasonal climate forecasting have limited skill for West Africa, the Rainwatch project illustrates the value of near real-time monitoring and improved communication for the unfavourable 2011 West African monsoon, the resulting severe drought-induced humanitarian impacts continuing into 2012, and their exacerbation by flooding in 2012. Rainwatch is now coupled with a boundary organization (Africa Climate Exchange, AfClix) with the aim of integrating the expertise and actions of relevant institutions, agencies and stakeholders to broker ground-based dialogue to promote resilience in the face of recurring crisis.