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

Climate change and global responsibility - the role of energy consumption, GDP and CO2 emissions

Climate change is one of the biggest challenges faced by this generation. Despite being the single most important environmental challenge facing the planet and despite over two decades of international climate negotiations, global greenhouse gas (GHG) emissions continue to rise. By the middle of this century, GHGs must be reduced by as much as 40-70% if dangerous climate change is to be avoided. In the Kyoto Protocol no quantitative emission limitation and reduction commitments were placed on the developing countries. For the planning of the future commitments period and possible participation of developing countries, information of the functioning of the energy systems, CO2 emissions development in different sectors, energy use and technological development in developing countries is essential. In addition to the per capita emissions, the efficiency of the energy system in relation to GHG emissions is crucial for the decision of future long-term burden sharing between countries. Country’s future development of CO2 emissions can be defined by the estimated CO2 intensity of the future and the estimated GDP growth. The changes in CO2 intensity depend on several factors, but generally developed countries’ intensity has been increasing in the industrialization phase and decreasing when their economy shifts more towards the system dominated by the service sector. The level of the CO2 intensity depends by a large extent on the production structure and the energy sources that are used. Currently one of the most urgent issues regarding global climate change is to decide the future of the Kyoto Protocol. Negotiations on this topic have already been initiated, with the aim of being finalised by the 2015. This thesis provides insights into the various approaches that can be used to characterise the concept of comparable efforts for developing countries in a future international climate agreement. The thesis examines the post-Kyoto burden sharing questions for developing countries using the contraction and convergence model, which is one approach that has been proposed to allocate commitments regarding future GHG emissions mitigation. This new approach is a practical tool for the evaluation of the Kyoto climate policy process and global climate change negotiations from the perspective of the developing countries.

The role of nuclear and other conventional power plants in the flexible energy system

This thesis reviews the role of nuclear and conventional power plants in the future energy system. The review is done by utilizing freely accesible publications in addition to generating load duration and ramping curves for Nordic energy system. As the aim of the future energy system is to reduce GHG-emissions and avoid further global warming, the need for flexible power generation increases with the increased share of intermittent renewables. The goal of this thesis is to offer extensive understanding of possibilities and restrictions that nuclear power and conventional power plants have regarding flexible and sustainable generation. As a conclusion, nuclear power is the only technology that is able to provide large scale GHG-free power output variations with good ramping values. Most of the currently operating plants are able to take part in load following as the requirement to do so is already required to be included in the plant design. Load duration and ramping curves produced prove that nuclear power is able to cover most of the annual generation variation and ramping needs in the Nordic energy system. From the conventional power generation methods, only biomass combustion can be considered GHG-free because biomass is considered carbon neutral. CFB combusted biomass has good load follow capabilities in good ramping and turndown ratios. All the other conventional power generation technologies generate GHG-emissions and therefore the use of these technologies should be reduced.

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.

National energy policies of the Federal Republic of Germany and Canada in the 1970s and 1980s: are economic and/or environmental concerns responsible for change?

The thesis presents a comparison of the national energy policies of the Federal Republic of Germany and Canada from 1973 until the late 1980s. The purpose of this paper is to analyze whether economic and/or environmental concerns were responsible for changes in the· West-German and Canadian national energy policies. Furthermore, the feasibility of implementing a soft energy path in West-Germany and Canada is examined. For better comprehension of the policy-making process and implemented changes in the national energy policies of the two states, the West-German and Canadian parliamentary systems and the political cultures were compared. For the analysis, several events with international impact were taken as guidelines. Furthermore, based on statistical data, the West-German and Canadian energy production and consumption were analyzed. With reference to these results the degree of the de facto changes in the national energy policies were analyzed. In addition, the thesis discusses the possibilities which a soft energy path offers to both national governments to renounce themselves from the dependencies on a few energy resources. The thesis reveals that changes in the West-German and Canadian national energy policies, in their energy production and consumption are correlated to various world events. In particular, governmental reponses security of energy supply by the two international oil crises of 1973 and 1979/1980 demonstrate that changes in the West-German and Canadian national energy policies were implemented in reaction to economic concerns than environmental ones. With the policies "away from oil" and "off oil", the West-German and Canadian government implemented the i i substitution of oil through various diverse energy supply resources. However, energy savings concepts and policies were initiated through the first oil crisis in 1973. The world recessions in 1975 and 1982 had no 'profound impacts on the agenda of West-German and Canadian energy policies. As a consequence of the stagnation or the negative growth of the world economic market, changes in their energy production and consumption can be perceived. However, the West-German and Canadian energy production and consumption intensified with the augmentation of the world economy. During the period of study, environmental concerns were taken into account in the energy policy agendas of the Federal Republic of Germany and Canada but they were not of primary concern. wi thin the decade of. the 1980s notably more environmental considerations were taken into account in the energy policies of the two states. The two nuclear reactor accidents in 1979 and 1986 sharpened to various degrees West-German and Canadian public discourse of present energy supply mix and attitude towards energy production and consumption. The statistical data reflects yet no changes in the energy policies in regard to the position of nuclear power. However, in the next several years possible changes can be observed through statistical data, because the planning, the construction and possible phase out of nuclear power requires several years. Finally, the thesis reveals that the implementation of a soft energy path requires profound changes in the consumer behaviour. As several studies indicate, a soft energy path is technological and economically feasible for the Federal Republic of Germany and Canada, its implementation remains to be a political decision.

On the Ewald method and the quartic Helmholtz free energy of an anharmonic metallic crystal

Thesis (M. Sc.) - Brock University, 1978.

Special report of New York State Survey on the preservation of the scenery of Niagara Falls ; and fourth annual report on the triangulation of State. For the Year 1879 /

Notes by F. L. Olmsted.

Myths of greece and Rome : narrated with special reference to literature and art

UANL

Support for renewable energy and WTO Law : the actionability of Ontario and Québec renewable energy support mechanisms

Le Traité de Marrakech stipule que le commerce et le développement économique devraient être orientés de manière à permettre l’utilisation optimale des ressources mondiales, conformément à l’objectif de développement durable. Combiné aux dispositions du Protocole de Kyoto et du Traité de Copenhague, les gouvernements poursuivent de politiques nationales favorisant les producteurs nationaux au détriment des étrangers. Cette mémoire propose une analyse des règles de l’OMC, dans le but de déterminer les mesures disciplinaires possibles contre le Canada à l'égard de ses mécanismes de support de l’énergie renouvelable. Une analyse des règles énoncées dans le GATT, l’Accord sur les subventions et les mesures compensatoires et divers accords multilatéraux conclus dans le cadre de l’OMC permet de déterminer si elles pourraient s’appliquer aux mécanismes de support de l’énergie renouvelable. Une analyse des programmes du Québec et de l’Ontario permet une prise de position quant à leur conformité aux règles commerciales de l’OMC.

Special functions of Weyl groups and their continuous and discrete orthogonality

Cette thèse s'intéresse à l'étude des propriétés et applications de quatre familles des fonctions spéciales associées aux groupes de Weyl et dénotées $C$, $S$, $S^s$ et $S^l$. Ces fonctions peuvent être vues comme des généralisations des polynômes de Tchebyshev. Elles sont en lien avec des polynômes orthogonaux à plusieurs variables associés aux algèbres de Lie simples, par exemple les polynômes de Jacobi et de Macdonald. Elles ont plusieurs propriétés remarquables, dont l'orthogonalité continue et discrète. En particulier, il est prouvé dans la présente thèse que les fonctions $S^s$ et $S^l$ caractérisées par certains paramètres sont mutuellement orthogonales par rapport à une mesure discrète. Leur orthogonalité discrète permet de déduire deux types de transformées discrètes analogues aux transformées de Fourier pour chaque algèbre de Lie simple avec racines des longueurs différentes. Comme les polynômes de Tchebyshev, ces quatre familles des fonctions ont des applications en analyse numérique. On obtient dans cette thèse quelques formules de <>, pour des fonctions de plusieurs variables, en liaison avec les fonctions $C$, $S^s$ et $S^l$. On fournit également une description complète des transformées en cosinus discrètes de types V--VIII à $n$ dimensions en employant les fonctions spéciales associées aux algèbres de Lie simples $B_n$ et $C_n$, appelées cosinus antisymétriques et symétriques. Enfin, on étudie quatre familles de polynômes orthogonaux à plusieurs variables, analogues aux polynômes de Tchebyshev, introduits en utilisant les cosinus (anti)symétriques.

Metamorphism and Fluid Inclusion Studies of Charnockites and Associated Rocks from the Madurai Granulite Block , Southern India with Special Reference to Graphite Mineralization

The present research is aimed at studying the charnockites and associated rocks of the Madurai Granulite Block (MGB), especially in terms of their field settings, texture, mineralogy, and mineral chemistry analyzing their petrogenesis with the help of thermobarometrical studies and geochronological constraints. The mechanism of charnockitization by the influx of CO2 rich fluids and its relation to the graphite mineralization is actually a matter of discussion and study. The objectives of the present study are, to delineate petrological and structural relationship of charnockites and associated gneissic rocks, to study the field and petrogenetic aspects of graphite mineralization in the MGB, to establish and re-evaluate the P-T conditions of formation of the rocks with the aid of thermbarometric computations and to compare with the earlier studies, characterization of graphite with XRD, Raman spectroscopy and isotope studies together with a search in to its genesis and its relation to the high-grade metamorphism of the terrain, to evaluate the role of CO2 bearing fluids in the processes of charnockitization as well as in the genesis of graphite within the high-grade terrain and to delineate the metamorphic geochronology of selected rocks using ‘monazite dating’ technique with EPMA.