Tackling socially determined dental inequalities: ethical aspects of Childsmile, the national child oral health demonstration programme in Scotland

Many ethical issues are posed by public health interventions, including whether they ought to be aimed at improving health across society or reducing specific health inequalities, whether they should be targeted or universal and the issue of which targeting criteria ought to be used. Although abstract theorising about these issues can be useful, it is the application of ethical theory to real cases which will ultimately be of benefit in decision-making. To this end, this paper will analyse the ethical issues involved in Childsmile, a national oral health demonstration programme in Scotland that aims to improve the oral health of the nation’s children and reduce dental inequalities through a combination of targeted and universal interventions. With Scotland’s level of dental caries among the worst in the Western world, Childsmile represents perhaps the largest programme of work aimed at combating oral health inequalities in the UK. The areas of ethical interest include several contrasting themes: reducing health inequalities and improving health; universal and targeted interventions; political values and evidence base; prevention and treatment; and underlying all of these, justice and utility

Epidemiology and strain differentiation of Echinoccus granulosus in Kenya

Imperial Users onl

Some aspects of analytical chemistry as applied to water quality assurance techniques for reclaimed water: The potential use of X-ray fluorescence spectrometry for automated on-line fast real-time simultaneous multi-component analysis of inorganic pollutants in reclaimed water

The potential use of isotopically excited energy dispersive X-ray fluorescence (XRF) spectrometry for automated on line fast real time (5 to 15 minutes) simultaneous multicomponent (up to 20) trace (1 to 10 parts per billion) analysis of inorganic pollutants in reclaimed water was examined. Three anionic elements (chromium 6, arsenic and selenium) were studied. The inherent lack of sensitivity of XRF spectrometry for these elements mandates use of a preconcentration technique and various methods were examined, including: several direct and indirect evaporation methods; ion exchange membranes; selective and nonselective precipitation; and complexation processes. It is shown tha XRF spectrometry itself is well suited for automated on line quality assurance, and can provide a nondestructive (and thus sample storage and repeat analysis capabilities) and particularly convenient analytical method. Further, the use of an isotopically excited energy dispersive unit (50 mCi Cd-109 source) coupled with a suitable preconcentration process can provide sufficient sensitivity to achieve the current mandated minimum levels of detection without the need for high power X-ray generating tubes

Digestible Energy Content of Diets of Pine Voles from Different Orchard Habitat Types

In a previous study at VPI & SU, Servello (1981) developed a technique for predicting the digestible dry matter (DDM) and digestible energy (DE) of the diets of pine voles from a nutritive analysis of their stomach contents. In this nutritive analysis, developed by Goering and Van Soest (1970), feeds are divided into two major fractions: cell soluble and cell wall fractions. The cell soluble fraction is highly digestible while the cell wall (fiber) fraction varies in digestibility. It was found that the highly digestible cell soluble values of the stomach contents were the best predictor of the digestibility of the pine vole\u27s diet. The objective of the present study was to use the cell soluble values of pine vole stomach contents to determine if there were seasonal or orchard differences in the diet digestibility of pine voles captured from diverse orchard habitat types

Overview of Mine Awareness Programs in Kosovo & Somaliland

Since September 1999, CARE, working with its mine action partner, MineTech, has been engaged in a mine awareness project in Kosovo

Binary open clusters in the Milky Way: photometric and spectroscopic analysis of NGC 5617 and Trumpler 22

Using photometry and high resolution spectroscopy we investigate for the first time the physical connection between the open clusters NGC 5617 and Trumpler 22. Based on new CCD photometry we report their spatial proximity and common age of ~70 Myr. Based on high resolution spectra collected using the HERMES and UCLES spectrographs on the Anglo-Australian telescope, we present radial velocities and abundances for Fe, Na, Mg, Al, Si, Ca and Ni. The measured radial velocities are -38.63 +/-2.25 km/s for NGC 5617 and -38.46 +/-2.08 km/s for Trumpler 22. The mean metallicity of NGC 5617 was found to be [Fe/H] =-0.18 +/-0.02 and for Trumpler 22 was found to be [Fe/H] = -0.17 +/-0.04. The two clusters share similar abundances across the other elements, indicative of a common chemical enrichment history of these clusters. Together with common motions and ages we confirm that NGC 5617 and Trumpler 22 are a primordial binary cluster pair in the Milky Way.Comment: 7 pages, 3 figure, accepted by MNRA

Scanning electrochemical microscopy as a local probe of oxygen permeability in cartilage

The use of scanning electrochemical microscopy, a high-resolution chemical imaging technique, to probe the distribution and mobility of solutes in articular cartilage is described. In this application, a mobile ultramicroelectrode is positioned close (not, vert, similar1 μm) to the cartilage sample surface, which has been equilibrated in a bathing solution containing the solute of interest. The solute is electrolyzed at a diffusion-limited rate, and the current response measured as the ultramicroelectrode is scanned across the sample surface. The topography of the samples was determined using Ru(CN)64−, a solute to which the cartilage matrix was impermeable. This revealed a number of pit-like depressions corresponding to the distribution of chondrocytes, which were also observed by atomic force and light microscopy. Subsequent imaging of the same area of the cartilage sample for the diffusion-limited reduction of oxygen indicated enhanced, but heterogeneous, permeability of oxygen across the cartilage surface. In particular, areas of high permeability were observed in the cellular and pericellular regions. This is the first time that inhomogeneities in the permeability of cartilage toward simple solutes, such as oxygen, have been observed on a micrometer scale

Effectiveness and reach of a directed-population approach to improving dental health and reducing inequalities: a cross sectional study

Background Childsmile School adopts a directed-population approach to target fluoride varnish applications to 20% of the primary one (P1) population in priority schools selected on the basis of the proportion of enrolled children considered to be at increased-risk of developing dental caries. The study sought to compare the effectiveness of four different methods for identifying individuals most in need when a directed-population approach is taken. <p></p> Methods The 2008 Basic National Dental Inspection Programme (BNDIP) cross-sectional P1 Scottish epidemiological survey dataset was used to model four methods and test three definitions of increased-risk. Effectiveness was determined by the positive predictive value (PPV) and explored in relation to 1-sensitivity and 1-specificity. <p></p> Results Complete data was available on 43470 children (87% of the survey). At the Scotland level, at least half (50%) of the children targeted were at increased-risk irrespective of the method used to target or the definition of increased-risk. There was no one method across all definitions of <i>increased-risk</i> that maximised PPV. Instead, PPV was highest when the targeting method complimented the definition of <i>increased-risk</i>. There was a higher percentage of children at <i>increased-risk</i> who were not targeted (1-sensitivity) when caries experience (rather than deprivation) was used to define <i>increased-risk</i>, irrespective of the method used for targeting. Over all three definitions of <i>increased-risk</i>, there was no one method that minimised (1-sensitivity) although this was lowest when the method and definition of <i>increased-risk</i> were complimentary. The false positive rate (1-specificity) for all methods and all definitions of <i>increased-risk</i> was consistently low (<20%), again being lowest when the method and definition of <i>increased-risk</i> were complimentary. <p></p> Conclusion Developing a method to reach all (or even the vast majority) of individuals at <i>increased-risk</i> defined by either caries experience or deprivation is difficult using a directed-population approach at a group level. There is a need for a wider debate between politicians and public health experts to decide how best to reach those most at need of intervention to improve health and reduce inequalities. <p></p&gt