Socioeconomic disparities in orthodontic treatment outcomes and expenditure on orthodontics in England's state-funded National Health Service:A retrospective observational study

Percentage distribution/means of variables used in the adjusted treatment outcomes analyses, by socioeconomic status (SES). Additional file 1 contains information on the distribution of variables used to adjust for potential confounding: IOTN AC scores, gender, and age. This information is provided by IMD quintile. (DOCX 16 kb

Productive efficiency and its determinants in the Community Dental Service i nthe north-west of England

To assess the efficiency of service provision in the Community Dental Services and its determinants in the North-West of England.40 Community Dental Services sites operating across the North-West of England.A data envelopment analysis was undertaken of inputs (number of surgeries, hours worked by dental officers, therapists, hygienists and others) and outputs (treatments delivered, number of courses of treatment and patients seen) of the Community Dental Services to produce relative efficiency ratings by health authority. These were further analyzed in order to identify which inputs (determined within the Community Dental Services) or external factors outside the control of the Community Dental Services are associated with efficiency.Relative efficiency rankings in Community Dental Services production of dental healthcare.Using the quantity of treatments delivered as the measure of output, on average the Community Dental Services in England is operating at a relative efficiency of 85% (95% confidence interval 77%- 99%) compared to the best performing services. Average efficiency is lower when courses of treatment and unique patients seen are used as output measures, 82% and 68% respectively. Neither the input mix nor the patient case mix explained variations in the efficiency across Community Dental Services.Although large variations in performance exist across Community Dental Services, the data available was not able to explain these variations. A useful next step would be to undertake detailed case studies of several best and under-performing services to explore the factors that influence relative performance levels

Determining the optimal model for role substitution in NHS dental services in the UK: a mixed-methods study.

Background: Maximising health gain for a given level and mix of resources is an ethical imperative for health-service planners. Approximately half of all patients who attend a regular NHS dental check-up do not require any further treatment, whereas many in the population do not regularly attend. Thus, the most expensive resource (the dentist) is seeing healthy patients at a time when many of those with disease do not access care. Role substitution in NHS dentistry, where other members of the dental team undertake the clinical tasks previously provided by dentists, has the potential to increase efficiency and the capacity to care and lower costs. However, no studies have empirically investigated the efficiency of NHS dental provision that makes use of role substitution. Research questions: This programme of research sought to address three research questions: (1) what is the efficiency of NHS dental teams that make use of role substitution?; (2) what are the barriers to, and facilitators of, role substitution in NHS dental practices?; and (3) how do incentives in the remuneration systems influence the organisation of these inputs and production of outputs in the NHS? Design: Data envelopment analysis was used to develop a productive efficiency frontier for participating NHS practices, which were then compared on a relative basis, after controlling for patient and practice characteristics. External validity was tested using stochastic frontier modelling, while semistructured interviews explored the views of participating dental teams and their patients to role substitution. Setting: NHS ‘high-street’ general dental practices. Participants: 121 practices across the north of England. Interventions: No active interventions were undertaken. Main outcome measures: Relative efficiency of participating NHS practices, alongside a detailed narrative of their views about role substitution dentistry. Social acceptability for patients. Results: The utilisation of non-dentist roles in NHS practices was relatively low, the most common role type being the dental hygienist. Increasing the number of non-dentist team members reduced efficiency. However, it was not possible to determine the relative efficiency of individual team members, as the NHS contracts only with dentists. Financial incentives in the NHS dental contract and the views of practice principals (i.e. senior staff members) were equally important. Bespoke payment and referral systems were required to make role substitution economically viable. Many non-dentist team members were not being used to their full scope of practice and constraints on their ability to prescribe reduced efficiency further. Many non-dentist team members experienced a precarious existence, commonly being employed at multiple practices. Patients had a low level of awareness of the different non-dentist roles in a dental team. Many exhibited an inherent trust in the professional ‘system’, but prior experience of role substitution was important for social acceptability. Conclusions: Better alignment between the financial incentives within the NHS dental contract and the use of role substitution is required, although professional acceptability remains critical. Study limitations: Output data collected did not reflect the quality of care provided by the dental team and the input data were self-reported. Future work: Further work is required to improve the evidence base for the use of role substitution in NHS dentistry, exploring the effects and costs of provision. Funding: The National Institute for Health Research Health Services and Delivery Research programme

Perfectionism and stuttering: Findings of an online survey.

Purpose: Using a multi-dimensional measure of perfectionism: the Frost Multidimensional Perfectionism Scale (FMPS: Frost, Marten, Lahart, & Rosenblate, 1990), this study investigates: (a) whether adults who stutter (AWS) display more perfectionistic attitudes and beliefs than those who do not stutter, and (b) whether, in AWS, moreperfectionistic attitudes and beliefs are associated with greater self-reported difficulty communicating verbally and speaking fluently.Method: In the first analysis, FMPS responses from 81 AWS and 81 matched, normally-fluent controls were analyzed using logistic regression to investigate the relative contributions of four FMPS perfectionism-subscale self-ratings to the likelihood of being in the AWS group. In the subsequent analyses, data from the 81 AWS were analyzed using linear multiple regression to determine which FMPS subscale self-ratings best predicted their Communication-Difficulty and Fluency-Difficulty scores.Results: Both the likelihood of being a member of the AWS group, and also the magnitude of the AWS group's Communication-Difficulty and Fluency-Difficulty scores, were positively part-correlated to respondents' Concern over Mistakes-Doubts about Actions (CMD) subscale self-ratings but negatively part-correlated to their Personal Standards (PS) subscale self-ratings.Conclusions: The FMPS profiles of respondents who stutter suggest that, as a group, they are not abnormally perfectionistic overall, but may be (or perceive themselves to be) abnormally error-prone. Also, AWS who are more concerned about their errors and uncertainof their actions experience more difficulty communicating verbally and speaking fluently

Physical Conditions in the Dwarf Local Group Irregular Galaxy IC10. I- Diffuse Ionized Gas

A detailed analysis on the physical conditions of the Interstellar Medium in the main body of the Local Group dwarf irregular galaxy IC 10 is carried out using long-slit spectroscopy. Maps of the excitation, the H$\alpha$ flux, [NII]/H$\alpha$ and [SII]/H$\alpha$ are presented. The Diffuse Ionized Gas inside the galaxy is studied. We found that the spectral characteristics are not similar to those for spiral galaxies: the values of the ratios [NII]/H$\alpha$ and [SII]/H$\alpha$ are not as large as in spiral galaxies but the excitation is much larger. These values, especially the large excitation, can be explained by proposing an extra source of ionization. Different sources are studied but any of the models at hand could be really fitted except a combination of photons leaking from the HII regions in addition to the ionization provided by the WR stars present in this galaxy. Shocks are not needed for explaining the line intensity ratios except in a small part in the west side of the galaxy.Comment: 12 pages, 12 figures, accepted for publication in A&

Emission-line Helium Abundances in Highly Obscured Nebulae

This paper outlines a way to determine the ICF using only infrared data. We identify four line pairs, [NeIII] 36\micron/[NeII] 12.8\micron, [NeIII]~15.6\micron /[NeII] 12.8\micron, [ArIII] 9\micron/[ArII] 6.9\micron, and [ArIII] 21\micron/[ArII] 6.9\micron, that are sensitive to the He ICF. This happens because the ions cover a wide range of ionization, the line pairs are not sensitive to electron temperature, they have similar critical densities, and are formed within the He$^+$/H$^+$ region of the nebula. We compute a very wide range of photoionization models appropriate for galactic HII regions. The models cover a wide range of densities, ionization parameters, stellar temperatures, and use continua from four very different stellar atmospheres. The results show that each line pair has a critical intensity ratio above which the He ICF is always small. Below these values the ICF depends very strongly on details of the models for three of the ratios, and so other information would be needed to determine the helium abundance. The [Ar III] 9\micron/[ArII] 6.9\micron ratio can indicate the ICF directly due to the near exact match in the critical densities of the two lines. Finally, continua predicted by the latest generation of stellar atmospheres are sufficiently hard that they routinely produce significantly negative ICFs.Comment: Accepted by PASP. Scheduled for the October 1999 issue. 11 pages, 5 figure