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.

Identification of main contamination points by hygiene indicator microorganisms in beef processing plants

The microbiological quality of beef and meat products is strongly influenced by the conditions of hygiene prevailing during their production and handling. Without proper hygienic control, the environment in slaughterhouses and butcher shops can act as an important source of microbiological contamination. To identify the main points of microbiological contamination in the beef processing chain, 443 samples of equipment, installations and products were collected from 11 establishments (1 slaughterhouse and 10 butcher shops) located in the state of Paraná, Brazil. The microbiological quality of all the samples was evaluated using Petri dishes to obtain counts of mesophilic aerobes (AC), total coliforms, Escherichia coli (EC), yeasts and molds (YM). The main contamination points identified in butcher shops, in decreasing order, were stainless steel boxes, beef tenderizers, grinders, knives, mixers, sausage stuffers, plastic boxes, floors and drains. In the slaughterhouse, these points were sausage stuffers, platforms, floors and drains. The most severely contaminated products were fresh sausages and ground beef. This information about the main points of microbiological contamination in the beef processing chain is expected to aid professionals responsible for hygiene in similar establishments to set up proper hygienic procedures to prevent or reduce microbiological contamination of beef and meat products.

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

Heat processing (HTST) of umbu (Spondias tuberosa Arruda Câmara) pulp

Umbu pulp is an important product in the economy of the northeastern region of Brazil, and its preservation can be ensured by heat treatment. A complete factorial design with 2 factors (time and temperature) and 3 central points was used to verify the effect of the HTST process on the physicochemical, chemical, physical, microbiological, and sensory qualities of umbu pulps. The results showed that the heat treatments applied resulted in products without significant alterations on the physicochemical, chemical, and microbiological characteristics. With respect to color, the parameters L and a* were altered by increases in temperature indicating by darkening of color. The sensory evaluation indicated that a treatment of 88 °C for 10 seconds was the best processing condition due to the greater similarity of the resulting product to the reference sample (blanched pulp).

Hepatitis B vaccination in hemodialysis patients: different points of view for conclusion

The present letter to the editor shows the other aspect of Hepatitis B vaccination in hemodialysis patients.

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.

In Search for the European solidarity: The rule of law within the European Union in the framework of constitutional pluralism

The dissertation examines the rule of law within the European Union in the theoretical framework of constitutional pluralism. The leading lines of constitutional pluralism are examined with relation to the traditional and prevailing, monistic and hierarchical conceptions on how to perceive legal orders in Europe. The theoretical part offers also historical perspective by highlighting some of the turning points for the Union constitutional legal order in the framework of European integration. The concept of rule of law is examined in legal terms and its meaning to the Union constitutional constellation as a constitutional principle and a common value is observed. The realization of the rule of law at supranational and national level is explored with a view to discover that recent developments in some of the Member States give rise to concern about the viability of the rule of law within the European Union. It is recognized that the inobservance of the rule of law at national level causes a threat to the supranational constitutional legal order. The relationship between the supranational and national legal orders is significant in this respect and therefore particularly the interaction between the Court of Justice of the European Union (hereinafter the ECJ) and the Member States’ (constitutional/supreme) courts takes focus. It is observed that functioning dialogue between the supranational and national courts based on mutual respect and judicial deference is an important prerequisite for the realization of the rule of law within Europe. In order to afford a concrete example, a recent case C-62/14 Gauweiler v Deutscher Bundestag is introduced and analysed in relation to the notorious relationship between the Federal Constitutional Court of Germany and the ECJ. The implications of the ECJ’s decision in Gauweiler v Deutscher Bundestag is assessed with reference to some of the pressing issues of constitutionalism within Europe and some institutional aspects are also brought forward. Lastly, the feasibility of constitutional pluralism as a theoretical setting is measured against the legal reality of today’s Europe and its many constitutions. The hierarchical idea of one ultimate source of power, stemming from the traditional approaches to legal systems, is then assessed with relation to the requirement of the realization of the rule of law within the European Union from the supranational and national point of view.

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.

Stories from the City, Stories from the Sea - How place brands are perceived differently from the points of view of a local and a tourist

Tämä tutkielma käsittelee paikkamarkkinointia ja paikkabrändäystä. Tutkielmassa tarkastellaan paikallisen ja turistin tapoja muodostaa kaupunkibrändi; mistä palasista brändi muodostuu kirjallisuuden ja haastateltavien mukaan, koetaanko eri palaset vaihtelevissa määrin tärkeiksi riippuen siitä, tarkastellaanko paikkaa paikallisena vai turistina, ja löytyykö jotain yhteisiä retorisia nimittäjiä sille, miten kotikaupungista puhutaan verrattuna lomakaupunkiin. Tutkimuksessa haastateltiin yli kolmeakymmentä henkilöä heidän kotikaupungeistaan ja kaupungeista, joihin he olivat matkustaneet lomalle. Haastateltavat olivat suurinpiirtein samanikäisiä, mutta eri kaupungeista ja matkustaneet eri paikkoihin. Haastateltavia pyydettiin ensin kuvailemaan vapaasti kotikaupunkiaan ja sen jälkeen kaupungista kysyttiin kirjallisuuteen perustuen kysymyksiä. Sama menetelmä toistettiin lomakohteen suhteen. Tutkimuksesta selvisi, että paikkabrändi muodostetaan samoista komponenteista, mutta joidenkin komponenttien merkitys on tärkeämpi kotikaupungissa, kun taas toiset komponentit ovat tärkeitä lomakohteen suhteen. Ihmiset ja kulttuuri yleisesti koettiin tärkeinä komponentteina molemmista paikkabrändeistä puhuttaessa, kun taas kotikaupungin brändinmuodostukseen kuului vahvemmin lait ja muut käytännölliset menettelytavat kuten liikenteen toimivuus. Lomakohteen brändinmuodostuksessa vapaudella tehdä mitä haluaa oli suuri merkitys ja vapautta nähtiin eri muodoissa. Retoriikka kotikaupungista puhuttaessa oli selvästi negatiivista, kun taas lomakohteesta puhuttiin yleisesti ottaen positiiviseen sävyyn. Suhde kotikaupunkiin oli ambivalentti, sillä huonojakin puolia mainittaessa niitä puolusteltiin, tai kotikaupungista mainittiin loppujen lopuksi jotain hyvää. Tutkimusten tuloksiin perustuen toimenpidesuosituksina ehdotetaan olemassaolevan autenttisen kulttuurin ylläpitämäistä, korostamista ja kaupungin orgaanista kehittämistä suuntaan, jossa se on hyvä paikka niin elämiseen kuin lomailuun. Identiteetti, imago ja ihmiset kietoutuvat tiiviisti yhteen, minkä vuoksi kaupunkisuunnittelun- ja kehittämisen tehtävänä on pitää huolta, että kaupunki on onnistunut molempien ryhmien suhteen, ja molemmat ryhmät levittävät kaupungista positiivista sanomaa.

Convenience of scallops in plate structures

In this thesis was performed comprehensive study about the convenience of scallops in plate structures. A literature review was performed and lack of knowledge was fulfilled with fatigue tests performed in the laboratory of Steel Structures at the Lappeenranta University of Technology and with finite element method. The aim of this thesis was to produce design guidance for the use of scallops for different structural details and different loading conditions. An additional aim was to include more precise instructions for scallop design to produce good fatigue resistance and appropriate manufacturing quality. The literature review was performed searching bridge engineering and maritime standards and design guides and studies from scientific databases and reference lists from the literature of this field. Fatigue tests were used to research the effect of using scallops or not using scallops to fatigue strength of bracket specimen. Tests were performed on three specimens with different scallop radii and to five specimens without scallops with different weld penetration depths. Finite element method using solid elements, symmetry and submodels was used to determine stress concentration factors for I-beams with scallops. Stresses were defined with hot spot stress method. Choosing to use a scallop or not in the structure is affected by many factors, such as structural and loading conditions and manufacturability. As a rule of thumb, scallops should be avoided because those cause stress concentration points to the structure and take a lot of time to manufacture. When scallops are not used, good quality welding should be provided and full weld penetration is recommended to be used in load carrying corner weld areas. In some cases, it is advisable to use scallops. In that case, circular scallops are recommended to be used and radius should be chosen from fatigue strength or manufacturing point of view.

شرايط الاسلام. Traité élémentaire sur les cinq points fondamentaux de la jurisprudence musulmane.

Sharaït al-Islam