Evaluating the environmental impact of the Welsh national childhood oral health improvement programme, Designed to Smile.

INTRODUCTION: Designed to Smile (D2S) is a national oral health improvement programme, aimed to reduce the prevalence of dental caries in young children in Wales. D2S has a responsibility to consider the environmental impact of the service it provides and demonstrate adherence to the sustainable development principle legislated within the Wellbeing of Future Generations (Wales) Act. OBJECTIVE: To review the environmental impact of D2S by estimating the carbon footprint of the programme and identify carbon hotspots for future targeted action. RESEARCH DESIGN: Process mapping identified the steps to deliver the supervised toothbrushing and fluoride varnish elements of D2S. Annual estimates of business travel mileage, financial spend on procurement, total number of plastic consumables and waste disposal were made. An online survey enabled calculation of staff commuting behaviour. These contributors were converted to carbon emissions using established carbon conversion factors. RESULTS: The annual carbon footprint of D2S was estimated at 388 tonnes of CO²e (tCO²e) with 31% attributed to staff travel, 23% to business travel and 46% to procurement. An estimated 1 million plastic items were distributed. CONCLUSION: By promoting good oral care and preventing the need for future carbon intensive restorative dental treatments, D2S exemplifies a sustainable model of healthcare. Adopting reduce, reuse, recycle principles for plastic consumables and introducing sustainable procurement procedures could lead to further decarbonisation and reduction in plastic waste.

The deposition of metal nanoparticles on carbon surfaces: the role of specific functional groups.

The enormous complexity of a typical heterogeneous catalyst makes understanding the development and properties of any active nanoparticles present extremely challenging. In the case of carbon based catalysts that difficulty is compounded by the variability of the carbon powders used. We have previously developed a strategy that addresses these problems by mimicking the catalyst preparation conditions very closely but using highly ordered pyrolytic graphite crystals (HOPG) as a model surface. This enables us to examine the effects of specific functional groups on nanoparticle formation. We report here an extension of our work characterising functional groups on the HOPG surface, using XPS and AFM to explore the deposition of gold from aqueous solution onto HOPG surfaces treated in a variety of ways to alter the surface functionality. The structure and oxidation state of the resulting nanoparticles depend critically on the nature of the functional groups present and offers some insight into the development of catalysts based on these materials. Hydroxyls are identified as key functional species, reducing gold ions to their metallic state whilst being oxidised themselves to carbonyls. Carbonyls meanwhile promote the nucleation of Au3+, creating a network of islands at the HOPG surface. The results have relevance not only to catalysts using activated carbons but also the new generation of materials based on graphene and carbon nanotubes.

Hemi-hamate arthroplasty versus transarticular Kirschner wire fixation for unstable dorsal fracture-dislocation of the proximal interphalangeal joint in the hand.

Following the introduction of the hemi-hamate arthroplasty (HHA) technique to our unit, we sought to evaluate the early clinical outcomes achieved with this method of fixation and compare these with simple trans-articular Kirschner wire (K-wire) fixation for dorsal fracture dislocations (DFD) of the proximal interphalangeal joint (PIPJ). Ninteen patients underwent fixation of these injuries with either K-wire fixation (12/19) or hemi-hamate bone grafting (7/19) between 2005 and 2011. At a mean follow-up of 14 weeks median arc of movement at the PIPJ was 65° (range 31° to 108°) following HHA and 56° (range 9° to 85°) (p = 0.82) following temporary transarticular K-wire fixation. Median fixed flexion deformity (FFD) was 20° and 15° for hemi-hamate bone grafting and K-wire fixation respectively. Based upon our findings, transarticular K-wire fixation produced equivalent outcomes to HHA for unstable DFD of the PIPJ in the hand.

A bioactive triterpene from Lantana camara.

Lantana camara afforded a novel triterpene 22 beta-acetoxylantic acid and the known triterpenes, lantic acid, 22 beta-dimethylacryloyloxylantonolic acid, a mixture of 22 beta-dimethylacryloyloxy lantanolic acid and 22 beta-angeloyloxylantanolic acid and lantanolic acid. 22 beta-Acetoxylantic acid showed antimicrobial activity against Staphylococcus aureus and Salmonella typhi. This compound and 22 beta-dimethylacryloyloxy lantanolic acid also showed antimutagenic activity.

Screening marine natural products for selective inhibitors of key kynurenine pathway enzymes.

Kynurenine, a metabolite of tryptophan along the 'kynurenine pathway', is at a branch point of the pathway which can lead to the synthesis of both quinolinic acid (QUIN) and kynurenic acid (KYNA). KYNA is an antagonist of glutamate receptors; however, QUIN is a selective agonist of NMDA receptors, and has been shown to act as an excitotoxic agent. A high QUIN/KYNA ratio has been implicated in a variety of neurological diseases in which excitotoxic neuronal cell death is found, e.g. AIDS-related dementia, stroke, etc. Inhibiting the key enzymes of this pathway (i.e. kynureninase and kynurenine 3-hydroxylase) would lower the QUIN/KYNA ratio, which may potentially have neuroprotective effects. We have developed high through-put assays for kynurenine pathway enzymes which allow us to screen extracts from marine organisms for selective enzyme inhibitors. Active metabolites are purified, isolated and identified by HPLC, high-field NMR and mass spectral techniques. Extracts from a sponge of the Aka species were found to contain a selective inhibitor of kynureninase. We have recently purified and identified the active principal as being serotonin sulfate. Related indoleamines, serotonin and 5-hydroxyindoleacetic acids are inactive. This finding may be suggestive of a novel interaction between the serotoninergic and excitatory amino acid pathways.

Policy implications of the epidemiology of dental diseases for the prevention and control of periodontal disease: the North Carolina studies.

The North Carolina Dental Manpower Study indicated that periodontal disease was widespread and little was being done to control the disease. We have continued to address issues identified by the Dental Manpower Study in order to better understand the high prevalence of periodontal disease. Drawing from the theoretical basis of behavioral science and the clinical and epidemiological knowledge of periodontal disease, we have planned a strategy for testing the feasibility for controlling periodontal disease through dental health services. Only when attention to periodontal disease pervades the thinking and behavior of all segments of the dental care system--professional education, professional certification and regulation, financing mechanisms, consumers, and dental research--will factors be totally conducive to controlling this problem.

Exposure to serious family violence among incarcerated boys: its association with violent offending and potential mediating variables.

A sample of 213 delinquent male adolescents (mean age = 16.1) were compared on interview-based measures concerning exposure to interadult family violence and physical abuse, attitudes toward aggression, self-reported competence, and coping strategies. Using juvenile arrest data and self-reports of violence behaviors, the sample was divided into four groups: "Violent Offenders," "Violent Deniers," and "Controls." Results indicated that violent offenders and undetected violent offenders had higher rates of exposure to serious physical abuse, and weapons violence between adults, than controls and deniers. A serious of 2 x 2 ANOVAs further indicated that exposure to serious violence was associated with lower self-reported competence, attitude more supportive of aggression, and more use of aggressive control as a form of coping. Logistics regression analyses were also consistent with the hypothesis that the effects of exposure to family violence on serious violent offending are mediated by beliefs supporting aggression and by the tendency to cope through aggressive control-seeking. Implications of these results for future research concerning exposure to family violence as a risk factor for serious violent offending are discussed.

Use of psychiatric services by homeless veterans.

Patients treated in a Department of Veterans Affairs (VA) emergency room were evaluated to delineate the differences in use of services between homeless and domiciled veterans who have mental disorders. Data were obtained and compared on DSM-III-R diagnoses, number of hospitalizations, lengths of stay, and outpatient visits in the preceding year. Homeless veterans with mental disorders were significantly more likely to have emergency visits and psychiatric admissions in the preceding 12 months than were the domiciled veterans. However, the average length of stay was shorter for the homeless group. These differences must be accounted for in the design of programs targeting homeless veterans with mental illness.