Developing clinical practice guidelines for caries prevention and management for pre-school children through the ADAPTE process and Delphi consensus

Background This study aims to develop consensus evidence-based clinical guidelines for caries prevention and management by caries risk assessment for pre-school children in Hong Kong. Methods Employing the ADAPTE process, guidelines for caries prevention and management by caries risk assessment for pre-school children with a preliminary list of 91 recommendations was complied. External review of the guidelines was conducted by a panel of 41 reviewers from the Hong Kong Society of Paediatric Dentistry using a two-round web-based Delphi process. The reviewers were invited to contribute any comments on the draft-adapted guidelines and rated their agreement with each recommendation using a 9-point Likert scale. During the second round, 36 participants received anonymous feedback from the first round and assessed a narrowed list of 28 recommendations. Recommendations were retained and classified according to the median score and rating percentages by the reviewers. Results A total of 70 out of 91 recommendations were retained (five reached high consensus, 65 reached consensus), and 21 recommendations were discarded. Recommendations and guidelines were outlined. Conclusions Caries prevention and management guidelines for pre-school children were developed for use in Hong Kong using the ADAPTE process and Delphi consensus to develop evidence-based recommendations. This can facilitate the translation of guidelines into dental practice.published_or_final_versio

Evaluating the impact of caries prevention and management by caries risk assessment guidelines on clinical practice in a dental teaching hospital

Background Clinical practice guidelines on ‘Dental caries prevention and management by caries risk assessment for pre-school children in Hong Kong’ were developed using ADAPTE process and Delphi consensus technique. This study aimed to evaluate the feasibility of disseminating and implementing the guidelines, and to evaluate their effectiveness in changing clinical practice. Methods The study was conducted in two phases, examining clinical records of pre-school aged patients being treated by non-academic clinical staff in the Paediatric Dentistry Clinic of a dental teaching hospital in Hong Kong. The clinical guidelines were introduced to the staff in a departmental seminar at the end of pre-intervention phase. Post-intervention phase began one month after the introduction of guidelines. Clinical records for three consecutive months were reviewed against standards and recommendations derived from the newly developed clinical guidelines in both phases. The results were assessed by Chi-square test, ANOVA and regression analyses. Results A total of 237 and 147 clinical records were reviewed in pre-intervention and post-intervention phases, respectively. Guideline adherence percentage increased significantly on almost all aspects of the guidelines in the post-intervention phase (P < 0.05). There were a significant difference in the mean overall guideline adherence score (pre-intervention phase: x⎯⎯⎯x¯ = 14.86 ± 6.11; post-intervention phase: x⎯⎯⎯x¯ = 28.88 ± 8.75) and sub-domain adherence scores between the two phases (P < 0.001). The training grade of the clinicians was the factor associated with changes in evidence-based practice (P < 0.001). Conclusions The developed guidelines were effective in translating evidence into best practice. The findings have implication for widespread implementation.published_or_final_versio

Design hazard identification and the link to site experience

The training, development and routes to charteredship of building design engineers have undergone a major transformation in recent years. Additionally, the duration and quality of site experience being gained by designers is reducing. While accident causation is often complex, previous research shows a potential link between design and construction accidents. The effectiveness of the UK’s Construction (Design and Management) (CDM) Regulations is being questioned, and designers regularly do not recognise the impact they can make on site safety. A newly developed hazard perception test was used to determine if students and design practitioners are able to identify hazards in designs and to establish if site experience impacts hazard identification. The results of the tests show an association between the ability to identify and mitigate hazards and possession of site experience. The results provide empirical evidence that supports previous anecdotal evidence. The results also question if the design engineers of today are suitably equipped to fulfil the designer’s responsibilities under the CDM Regulations

The Risk of Unexploded Ordnance on Construction Sites in London

Greater London, among many large cities, was subject to bombing by the German military in both the World Wars and was the target of many air raids during the Second World War (WW2). This was particularly the case during the Blitz, September 1940 – May 1941, when over 28,000 high explosive bombs and parachute mines were dropped on London. Post war research conducted in 1949 estimated that approximately 12,750 t of bombs, including V1 and V2 rockets, were dropped on London. The night of 16th – 17th April 1941 was one of the worst bombing raids, when 446 t of bombs were dropped on London and over 58 t did not detonate. Unexploded bombs remain buried underground today, as they were unidentified at the time or abandoned owing to difficulties in recovering them. Uncharted bombs continue to pose a potentially significant hazard for developments around London. This paper considers the probability of discovering unexploded ordnance (UXO), particularly WW2 ordnance, during intrusive groundworks in London. The prevalence of unexploded ordnance has been assessed using data obtained from governmental organisations to estimate the likelihood of discovery in London

Oral health of Hong Kong children: a historical and epidemiological perspective

published_or_final_versio

Disruptive low-carbon innovations

This perspective article considers the potential for disruptive innovations to transform the market for energy-related goods and services in line with emission reductions required for stringent mitigation. Its rationale is that consumers are a neglected constituency in societal efforts to meet climate policy objectives. First, I review Christensen’s canonical definition of disruptive innovation as low-end products offering novel sources of value to users marginalised or over-supplied by mainstream markets. Second, I apply disruptive innovation concepts to the challenge of climate change mitigation and the necessary contribution of low-carbon innovation. There are both potentials for disruptive low-carbon innovations but also problems in achieving social benefits through the consumption of private goods. Third, I set out a series of criteria for disruptive low-carbon innovations and apply these to identify sets of potential innovations relating to mobility, buildings & cities, food, and energy supply. A wide range of consumer-facing innovations offer goods or services with novel attributes currently valued only in small market niches. Fourth, I report on the findings of two workshops on disruptive low-carbon innovation involving innovators, market intermediaries, policymakers and researchers. Different stakeholders hold sharply contrasting understandings of disruptive low-carbon innovation and its distinctive relevance for energy transformation

Cubosomes: the next generation of smart lipid nanoparticles?

Cubosomes are highly stable nanoparticles formed from the lipid cubic phase and stabilized by a polymer based outer corona. Lipid cubic phases consist of a single lipid bilayer which forms a continuous periodic membrane lattice structure with pores formed by two interwoven water channels. Cubosome composition can be tuned to engineer pore sizes or include bioactive lipids, the polymer outer corona can be used for targeting and they are highly stable under physiological conditions. The structure provides a significantly higher membrane surface area for loading of membrane proteins and small drug molecules than liposomes. Due to recent advances, they can be engineered in vitro in both bulk and nanoparticle formats with applications including drug delivery, membrane bioreactors, artificial cells and biosensors. This review outlines recent advances in cubosome technology enabling their application and provides guidelines for the rational design of new systems for biomedical applications