Challenges associated with implementation of a school-based tooth-brushing and fluoride varnish programme in a diverse and transient urban population.

Public health competencies being illustrated; Planning, delivery and evaluation of health improvement programmes, addressing health inequalities, awareness of cultural impacts on health and wellbeing. Smile4Life, a schools-based, evidence informed oral health promotion programme, was designed to address high levels of oral health need and inequality within a UK City. The aims of the pilot described were to test the feasibility of delivering the programme (supervised tooth-brushing, take home kits, educational resources and application of fluoride varnish) in six culturally diverse schools in disadvantaged neighbourhoods, and evaluate its impact on caries prevalence. High levels of participation were achieved (98% positive consent) however only 44% received more than one application of fluoride varnish. A reduction in decay prevalence and improved oral hygiene was observed. This paper examines the challenges faced in working with transient and culturally diverse population groups, working effectively with schools to deliver an effective intervention for this population, and in responding effectively across agencies to address safeguarding concerns.

Nurse-Led Phone Call Follow-Up Clinics Are Effective for Patients With Prostate Cancer.

INTRODUCTION: The rising cost of healthcare requires rethinking in terms of resource utilisation care delivery. Nurse-led PSA phone follow-up clinics may provide a suitable option. MATERIALS AND METHODS: 815 patients were recruited for the nurse-led stable prostate cancer telephone follow-up service. A convenience sample was selected for postal questionnaire assessment of their satisfaction. RESULTS: 815 patients had 3683 phone-call follow ups over 10 years. Patients' own understanding of condition varied from average (76.3%) and good (9.2%) in the majority. 87.2% found the service convenient and 75.6% informative. 95.3% found the telephone assessment preferable to attending the outpatient department. 87.2% were keen on savings on transport/travel. 53.5% found it more reassuring. 91.9% of patients felt that everything they wanted to talk about was covered. DISCUSSION: This service can be delivered in a high volume nurse-led service, with high levels of patient satisfaction, as an innovative service development.

Patients' expectations and experiences of rehabilitation following lung transplantation.

INTRODUCTION: Exercise rehabilitation is a key element of care following lung transplantation; however, little is known about the patients' experience of rehabilitation, or whether it meets the needs of this complex patient group. This qualitative study explored patients' expectations of a supervised exercise rehabilitation program following lung transplantation. METHODS: Participants undertook two semi-structured interviews, one before and one after the rehabilitation program. Interviews were digitally recorded, and themes were developed using line-by-line iterative thematic analysis and grounded theory. RESULTS: Eighteen adults (11 females) with mean age of 52 participated in a mean of 26 sessions of exercise training. Themes were (i) desire for normalcy including resuming family roles and performing everyday activities; (ii) the importance of rehabilitation as the mechanism for how this transformation occurred; (iii) the benefits of exercising in a group setting; and (iv) the limitations on rehabilitation that were imposed by comorbidities, either existing pre-transplant or occurring as a postoperative sequelae. CONCLUSION: Post-transplant exercise rehabilitation was perceived as a highly valuable tool that assisted recipients to return to "normal life." Group exercise was motivational, offered peer support, and therefore was advantageous to assist patients to achieve their desired physical performance level following transplantation.

Vitamin D therapy and related metabolomics: is the calciferol dose and form the only requirements for successful clinical therapeutics?

A nutraceutical that has exploded onto the prescription pad in recent years is the fat soluble vitamin, vitamin D. This is due to an increasing medical interest in the utility of the vitamin in the treatment and prevention of an array of diseases and ailments. Despite the continued debate over the correct dose, form and serum levels, many clinicians fail to achieve intended therapeutic responses with their patients and deficiencies still exist. This may be due to medical professionals being less aware of the multitude of factors that can influence treatment when dosing a product. In this paper we explore the magnitude of interactions that exist between the host physiology and the vitamin and cite such points as a reason for confounding treatment end points. Aspects that are proposed to influence treatment success more critically than dose and molecular form prescribed are: organ pathology, intracellular states, the endocrine system, concomitant products, genetics, lifestyle, quality of product, and modern delivery systems.

Tools for appraisal and revalidation--evaluation of regionally delivered workshops.

BACKGROUND: The advent of revalidation has created a need for occupational physicians to be provided with further advice on the preparation of their supporting information. A road show was delivered to the Society of Occupational Medicine (SOM) regional groups to meet the need. The objective of the road show was to improve delegates' confidence in the selection and development of supporting information for appraisal and revalidation by assembling a collection of tools. AIMS: To provide internal evaluation of the effectiveness of the road show. METHODS: The audience voting software Turning Point(®) was used to gather delegates' responses to various questions on their opinion and confidence self-rating. Data were then collated from all iterations. RESULTS: Eighty per cent of delegates became more confident in the selection and development of supporting information for appraisal and revalidation, with the improvement in rating scores being highly significant (P < 0.001). The importance of audit and the use of self-reflective were emphasized. CONCLUSIONS: Internal validation using Turning Point(®) was most useful. This was the first time that the SOM had used a road show format to deliver an educational topic. The road show format was successful, and other similar topics would benefit from a similar delivery.

Adverse events arising from a palliative care survey.

Development of evidence-based practice requires investigation of the attitudes and needs of patients, families and healthcare professionals, particularly for sensitive subject areas. Cystic fibrosis (CF) is a recessively inherited life-limiting disorder resulting in early death. Patients with this condition generally expect that lung transplantation will be an available treatment option; however, this is uncertain. A dual approach to care that involves both preparing patients for transplant assessment, while simultaneously exploring acceptable palliative care options is needed. A survey amongst patients with CF, their families and health carers was conducted to understand their attitudes and needs in relation to end-of-life care. The survey encompassed five separate domains, with a total of 60 questions requiring approximately 20 min to complete. Of the 200 surveys sent to patients, 82 (41%) completed responses were received. The Institutional Ethics Committee received six complaints from families of seven patients (3.5% of those surveyed). This article explores the nature of the adverse responses to the survey. The majority of complaints were received from family members rather than from patients. Complaints described dissatisfaction with the topic, little warning about the study and felt it to be inappropriate for their family member's level of health. Survey instruments used to determine attitudes and needs in relation to end-of-life patient care are likely to elicit adverse responses that should be reported in a similar way to other investigational studies. Also arising from adverse responses and the complaint process, is the impact of criticism on study researchers.

Validation of smoke inhalation therapy to treat microbial infections.

AIM OF THE STUDY: In traditional healing, the burning of selected indigenous medicinal plants and the inhalation of the liberated smoke are widely accepted and a practiced route of administration. This study elucidated the rationale behind this commonly practiced treatment by examining the antimicrobial activity for five indigenous South African medicinal plants commonly administered through inhalation (Artemisia afra, Heteropyxis natalensis, Myrothamnus flabellifolius, Pellaea calomelanos and Tarchonanthus camphoratus). MATERIAL AND METHODS: An apparatus was designed to simulate the burning process that occurs in a traditional setting and the smoke fraction was captured for analysis and bioassay. Methanol and acetone extracts as well as the essential oil (for the aromatic species) were prepared and assayed in parallel with the smoke fraction. RESULTS: Antimicrobial data revealed that in most cases, the 'smoke-extract' obtained after burning had lower minimum inhibitory concentration (MIC) values than the corresponding solvent extracts and essential oils. The combustion, acetone and methanol extracts produced different chromatographic profiles as demonstrated for Pellaea calomelanos where several compounds noted in the smoke fraction were not present in the other extracts. CONCLUSION: These results suggest that the combustion process produces an 'extract' with superior antimicrobial activity and provides in vitro evidence for inhalation of medicinal smoke as an efficient mode of administration in traditional healing.

Evaluation of a psycho-educational group programme for family caregivers in home-based palliative care.

BACKGROUND: Family caregivers are often responsible for providing significant support to relatives who require palliative care at home. However, evidence suggests that family caregivers have limited information, resources or support to prepare them for such a role. Furthermore, family caregiving can be associated with negative physical, financial and psychosocial outcomes. PURPOSE: This project sought to examine the utility of a group family caregiver psycho-educational programme focused on preparing primary family caregivers for the role of supporting a relative with advanced cancer at home. METHOD: The education programme consisted of three consecutive weekly sessions presented in a group format, conducted at six home-based palliative care services across metropolitan and regional Victoria (Australia). Participating caregivers were required to complete a set of self-report questionnaires measuring caregiver competence, preparedness, optimism, rewards, social support, burden and information needs, at three time points: commencement of the programme (T1), upon completion (T2) and 2 weeks later (T3). Caregivers were also asked to report on the relevance, acceptability and content of the programme, as well as any barriers to access. RESULTS: Sixteen education programmes were conducted, with 74 caregivers attending the first session. Forty-four caregivers completed all three data collection sets. Following the intervention, a significant positive effect was found for the following outcomes: preparedness for the caring role, caregiving competence, caregiving rewards and having information needs met from T1 to T2. These improvements were maintained at follow-up (T3). Feedback on the individual sessions and entire programme was favourable and the overwhelming majority of participants reported that the programme had a positive impact on their lives. CONCLUSIONS: This study demonstrated that a group education programme to prepare family caregivers for the role of supporting a dying relative at home was accessible, applicable and effective.

Angiolymphoid hyperplasia with eosinophilia (epithelioid haemangioma) occurring within multiple deep lymph nodes and presenting with weight loss and raised CA-125 levels.

We report a case of angiolymphoid hyperplasia with eosinophilia (epithelioid haemangioma) involving multiple deep mediastinal, abdominal and intramammary lymph nodes in a 52-year-old woman with weight loss and raised CA-125 levels. The unusual clinical presentation with raised CA-125 levels and its occurrence within multiple deep visceral lymph nodes has never been reported in literature.

Explosive decomposition of ethylene oxide at elevated condition: effect of ignition energy, nitrogen dilution, and turbulence.

Experimental and theoretical investigation of explosive decomposition of ethylene oxide (EO) at fixed initial experimental parameters (T=100 degrees C, P=4 bar) in a 20-l sphere was conducted. Safety-related parameters, namely the maximum explosion pressure, the maximum rate of pressure rise, and the Kd values, were experimentally determined for pure ethylene oxide and ethylene oxide diluted with nitrogen. The influence of the ignition energy on the explosion parameters was also studied. All these dependencies are quantified in empirical formulas. Additionally, the effect of turbulence on explosive decomposition of ethylene oxide was investigated. In contrast to previous studies, it is found that turbulence significantly influences the explosion severity parameters, mostly the rate of pressure rise. Thermodynamic models are used to calculate the maximum explosion pressure of pure and of nitrogen-diluted ethylene oxide, at different initial temperatures. Soot formation was experimentally observed. Relation between the amounts of soot formed and the explosion pressure was experimentally observed and was calculated.

The in vitro life-span of human periodontal ligament fibroblasts.

The in vitro life-span of human periodontal ligament fibroblasts (PDLF) was studied on clones from periodontium of teeth extracted due to periodontitis and dental caries (69 clones/192 individuals, aged 20-80 years) and from periodontium of teeth extracted for orthodontic reasons (23 clones/26 individuals, aged 15-19 years). In the primary cultures the ratio of the number of cells expressing senescence-associated beta-galactosidase (SA-beta-Gal) to the total number of cells is significantly larger in PDLF (92 clones; 11.1+/-4.9%) than in human gingival fibroblasts (GF) (10 clones; 0.5+/-0.1 %). The finite population doubling numbers (PD) of PDLF are not age-matched and the mean PD of PDLF (7.1+/-2.9) is significantly smaller than GF (28.5+/-3.2), IMR-90 (human lung fibroblasts, 5 clones; 44.3 +/- 2.2), and human osteoblasts (5 clones; 19.7+/-1.4). Comparing the ratio of the number of SA-beta-Gal positive cells to the total number of cells in primary culture, and the finite PD in PDLF cultures: 1) the ratio of 15-19 years old donor group is significantly smaller than in the other donor groups (20-29, 30-39, 40-49, 50-59 and 60-80 years old), and 2) there were no statistically significant differences among the 20-29, 30-39, 40-49 and 50-59 year old donor groups, and the 30-39, 40-49, 50-59 and 60-80 year old donor groups. These findings suggest that the in vitro life-span of PDLF is shorter than other fibroblasts in the connective tissues and that PDLF may undergo senescence in adult clones without relation to donor's age. There may be more aged fibroblasts in periodontium than in other tissues, such as gingiva and lung.

Impairment of osteocalcin production in senescent periodontal ligament fibroblasts.

Osteocalcin production of senescent periodontal ligament fibroblasts (PDLF) with the expression of senescence-associated beta-galactosidase (SA-beta-Gal) was investigated on clones from 50-80 years old donors (n=20) with teeth extracted due to periodontitis and dental caries, and from 15-19 year old donors (n=20) with normal teeth extracted for orthodontic reasons. Immunohistochemically, the nonsenescent PDLF in all cultures in passage 2 showed strong reactivity with anti-osteocalcin. The reactive intensity of PDLF (passage 2, PD 3.0) was significantly stronger in 50-80 year old donor group than in 15-19 year old donor group, suggesting that osteocalcin production of PDLF cultured in early passage is larger in cells from adult population than in cells from adolescent population. In PDLF cultures in passage 2 from 50-80 year old donor, two types of senescent cells were found: one with strong reactivity to anti-osteocalcin and the other with little detectable reactivity. The culture consisted of senescent PDLF (passage 8, PD 14.8) did not include cells which have a detectable reactivity with anti-osteocalcin immunohistochemically and the reactive intensity was significantly weaker in the senescent culture than in the culture in passage 2 by ELISA. This suggests that the production potential of osteocalcin is impaired in PDLF with aging in culture. Further, the reactive intensity with anti-osteocalcin of PDLF in passage 2 deprived of serum for 48 h was 6% of that of cells cultured with serum and the reaction increased after serum stimulation, suggesting that the osteocalcin production in PDLF in early passage is implicated in mitogenic stimulation.

Effects of Social versus Musical Antecedents on Communication Responsiveness in Five Children with Developmental Disabilities.

The present study involved a comparison of social versus musical antecedents on communication responsiveness in five children with developmental disabilities. During the social antecedent condition, the teacher presented opportunities for the children to greet, name objects, and request materials. In the musical antecedent condition, these same opportunities were embedded within a music/singing activity. A reversal design was used to compare the percentage of opportunities with appropriate communication responses across the two conditions. For three of the five children, the musical antecedent condition was associated with higher percentages of appropriate communication responses. For the other two children, the two conditions were associated with approximately equal rates of appropriate communication. Across both conditions, appropriate responses were more likely during opportunities for greeting and requesting than during opportunities to name objects. The results suggest that embedding communication opportunities within a musical activity may lead to increased appropriate communication responses for some children with developmental disabilities.

Expression of immunoglobulin superfamily members on the lymphatic endothelium of inflamed human small intestine.

Previously, lymphatic endothelium of human tissue has been shown to express only platelet-endothelial cell adhesion molecule-1 (PECAM-1). In this study we examined the expression of immunoglobulin superfamily members on the lymphatic endothelium of human small intestine while in the presence of inflammatory cytokines. Lymphatic vessels were identified by using a cocktail of IgGs for desmoplakin I and II while the presence of inflammatory cytokines was determined by the expression of major histocompatibility complex (MHC) class II in the venules. As a result, lymphatic vessels in the tissue with venules expressing MHC class II expressed PECAM-1, intercellular adhesion molecule (ICAM)-1, ICAM-3, and vascular cell adhesion molecule-1 (VCAM-1). The expression of ICAM-3 and VCAM-1 was significantly stronger in lymphatic vessels than in blood vessels. The results suggest that inflamed lymphatic endothelium may allow more lymphocyte subpopulations to adhere to the endothelium than non-inflamed lymphatic endothelium, due to the expression of multiple adhesion molecules playing a role.

The optokinetic cervico reflex during simulated helicopter flight.

INTRODUCTION: The optokinetic cervico reflex (OKCR) is a recently hypothesized, visually driven reflex that serves to stabilize the image of the external horizon on the retina during roll maneuvers in high-performance aircraft. Although reported anecdotally, head tilt during helicopter flight has not been studied formally. Such research is required to determine the full impact and significance that it may have on the flying performance of a rotary-wing aviator. OBJECTIVE: The aim of this study was to investigate the relationship between horizon position and the perception of orientation and, thus, to generate vital information to assess whether OKCR plays an important role in spatial disorientation. HYPOTHESIS: Pilots of rotary-wing aircraft will exhibit the OKCR. METHODS: A UH-60 flight simulator study, with 20 volunteer pilots participating, was performed to examine the effects of this reflex during day flight and during flight with night vision goggles (NVGs). RESULTS: The results confirm that the OKCR occurs during simulated helicopter flight, both with and without NVGs. As with previous studies, head roll increased during flight under visual meteorological conditions in relation to an increasing aircraft roll angle up to a maximum sustainable level and then remained constant. Head roll did not occur during flight under instrument meteorological conditions. CONCLUSION: The presence of the OKCR will impact rotary-wing operations. Various aspects are discussed, and recommendations are made for future research.

Spatial disorientation in U.S. Army rotary-wing operations.

This paper describes two surveys concerning spatial disorientation (SD) in U.S. Army rotary-wing operations that sought to assess the hazard and to identify recommendations to control it. One survey was of accident records, and the other was of aircrew experiences. Both surveys highlighted the magnitude of the problem. The accident survey showed that 30% of class A to C accidents involved SD as a significant factor, while the aircrew survey showed that 78% of aircrews have been disoriented (8% to the extent that flight safety was threatened). Both surveys showed a significant increase in SD associated with combat operations. Several differences between the two surveys were noted: 90% of the reviewed accidents were thought to involve type I (unrecognized) SD compared with only 43% of the reported incidents; both pilots in a particular aircraft were considered to have been disoriented in at least 59% of accidents compared with 23% of incidents; sudden loss of visual cues ("brownout," "whiteout," or inadvertent entry to instrument meteorological conditions) accounted for 25% of SD accidents compared with 13% of incidents; and 62% of the accidents occurred at night compared with only 36% of incidents. Neither survey showed any association between SD and fatigue or other human factors. The results of both surveys suggested that crew coordination, alerting devices (e.g., audio warnings on the radar altimeter), flight information displays, and autopilot functions would be good targets for improvement.

The hazard of spatial disorientation during helicopter flight using night vision devices.

INTRODUCTION: Night Vision Devices (NVDs) provide an enormous advantage to the operational effectiveness of military helicopter flying by permitting flight throughout the night. However, compared with daytime flight, many of the depth perception and orientational cues are severely degraded. These degraded cues predispose aviators to spatial disorientation (SD), which is a serious drawback of these devices. METHODS: As part of an overall analysis of Army helicopter accidents to assess the impact of SD on military flying, we scrutinized the class A-C mishap reports involving night-aided flight from 1987 to 1995. The accidents were classified according to the role of SD by three independent assessors, with the SD group further analyzed to determine associated factors and possible countermeasures. RESULTS: Almost 43% of all SD-related accidents in this series occurred during flight using NVDs, whereas only 13% of non-SD accidents involved NVDs. An examination of the SD accident rates per 100,000 flying hours revealed a significant difference between the rate for day flying and the rate for flight using NVDs (mean rate for daytime flight = 1.66, mean rate for NVD flight = 9.00, p < 0.001). The most important factors associated with these accidents were related to equipment limitations, distraction from the task, and training or procedural inadequacies. CONCLUSIONS: SD remains an important source of attrition of Army aircraft. The more than fivefold increase in risk associated with NVD flight is of serious concern. The associated factors and suggested countermeasures should be urgently addressed.

An evaluation of the British Army spatial disorientation sortie in U.S. Army aviation.

BACKGROUND: Following didactic instruction, most aircrew are able to experience some of the disorienting illusions and limitations of the orientation senses in a variety of ground-based devices. In order to reinforce instruction in spatial disorientation (SD) within the environment in which they operate, British Army Air Corps helicopter pilots also receive an airborne demonstration of the limitations of their orientation senses prior to rotary-wing instrument flight training. The objective of this assessment was to determine whether the SD demonstration sortie would be an effective adjunct in training aircrew in SD in the U.S. Army. METHODS: There were 45 aviators and training personnel who experienced the sortie and gave their opinion in questionnaires. RESULTS: The following conclusions were made: the maneuvers performed in the SD demonstration sortie, and the sortie overall, were extremely effective at demonstrating the limitations of the orientation senses; the SD sortie attracted a significantly higher rating in its effectiveness to train aviators in SD than all the currently available methods; the introduction of the sortie into the initial flight training syllabus would be a distinct enhancement to the SD training of aviators and associated personnel; and the introduction of the sortie into refresher training in field units would also be an advantage. CONCLUSION: Other services are encouraged to consider this enhancement to the SD training of aviators.