Charting the path toward a greener world: A review of facilitating and inhibiting factors for carbon neutrality

The carbon neutrality (CN) literature has witnessed a mushrooming growth but also limited attempts to systematize the mass of evidence running in multiple directions. The consequent accumulation of fragmented insights can confuse concerned stakeholders, causing them to neglect or miss crucial discussions. Our study addresses this concern by undertaking a systematic literature review (SLR) of congruent studies to delineate the facilitating and inhibiting factors that support or impede the efficacious achievement of CN targets. Given the vastness of the extant literature, we limited our review to five sectors: manufacturing, energy, transportation, agriculture, and construction (METAC), since these are known to be among the highest contributors to emissions. Using a rigorous search and filtration protocol, we shortlisted 149 studies for inclusion in the review. Going beyond the curation of insights and identifying research gaps to suggest potential research questions for future investigations, our SLR contributes significantly by synthesizing facilitators and inhibitors from the reported evidence. At the same time, identifying stimulating forces and impeding hurdles helped us highlight areas requiring policy attention and managerial action to support the achievement of CN targets.publishedVersio

Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. METHODS: We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. FINDINGS: Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, an

Esthetic improvement of white spot lesions and non-pitted fluorosis using resin infiltration technique: Series of four clinical cases

White opacities have always been a major concern of esthetics for patients and can have varying etiology. In general, white discolorations of enamel might be due to dental fluorosis, early caries (white spot lesions), developmental defects etc. Conventional treatment options available for such opacities include non-invasive and invasive approaches. Recently, a new "micro-invasive" technique has been introduced as an alternative therapeutic approach that improves such opacities esthetically, in a single sitting, is painless and exhibits no complications. This case series illustrates the use of resin infiltration to treat fluorosis stains and WSLs, exhibiting significant improvement in esthetics

Treponema denticola: A teammate in periodontal progression

There is compelling evidence that treponemes are involved in the etiology of several chronic oral diseases, including chronic periodontitis and other forms of periodontal disease. Treponema denticola suppresses fibroblast proliferation, enhancement of collagen phagocytosis by gingival fibroblasts, and the activation of both the classic and the alternative pathways of human complement. It was further shown to perturb actin regulating pathways in host cells. Recent advances, especially in molecular-based methodologies, have greatly improved our knowledge of this bacterium and its role in disease. An electronic and manual search based on agreed search phrases between the primary investigator and a secondary investigator was performed for the literature review until the year 2014. PubMed/MEDLINE databases were searched for studies to identify appropriate articles in relation to T. denticola and its virulence factors. The articles that were identified by this systematic review (total of 150) were analyzed in detail, which included the study of inference and conclusion. Within the limits of this systematic review, it can be concluded that T. denticola induces immune inflammatory response in periodontitis subjects. Procedures for gene inactivation provide a basis for characterizing the virulence factors of T. denticola, and thereby establishing its role as a teammate with other virulent plaque microorganisms in the process of tissue destruction

Ectopic eruption of maxillary central incisor through abnormally thickened labial frenum: An unusual presentation

Ectopic eruption is a deviation from the normal eruption pattern, making the tooth erupt out of its normal position, and possibly causing resorption of adjacent primary teeth. A wide range of etiological factors may be responsible for ectopic eruption of the teeth, so their management depends on the correction of the established etiological factor. The present case report describes an unusual case of ectopically erupted central incisor encased within an abnormally thickened labial frenum, which was treated by orthodontic repositioning of the ectopically erupting tooth after frenectomy

Virulence factors of Aggregatibacter actinomycetemcomitans - A status update

Periodontitis is a chronic infectious inflammatory disease characterized by the destruction of tooth. The contribution of bacteria to the disease progression is poorly understood probably due to the multifactorial background of this disease. Aggregatibacter actinomycetemcomitans is part of the normal flora in many healthy individuals, but is also a major etiologic agent in some aggressive forms of periodontitis. The genetic diversity among different isolates of Aggregatibacter actinomycetemcomitans is great and its ability to express and release virulence factors varies. Aggregatibacter actinomycetemcomitans, a pathogen not only in periodontal but also in some nonoral infections, possesses several virulence determinants which contribute to its ability to colonize the oral cavity, persist in the periodontal pocket, resist and evade host defenses, cause destruction of soft and hard tooth-supporting tissues, and interfere with host tissue repair after infection. Authors conducted a comprehensive search through PubMed/Medline databases to compile the available literature till June 2014, for the purpose of detailed insight into the bacteria. The search was designed to identify appropriate articles related to virulence factors of Aggregatibacter actinomycetemcomitans, and the articles were independently screened for eligibility

Comparative evaluation of recession coverage with sub-epithelial connective tissue graft using macrosurgical and microsurgical approaches: A randomized split mouth study

Aims: The aim was to compare the recession coverage outcomes when done macrosurgically and microsurgically. Background: Increasing interest in esthetics and the related problems such as hypersensitivity and root caries have favored the development of many root coverage procedures. Recession coverage up to a certain extent has solved these problems, but these procedures need good maintenance after the surgery for long-term benefits. With increasing advances in the field of recession coverage, microscope has added another dimension in undertaking the surgical procedure. Materials and Methods: Thirty Miller′s Class I and II recession were treated using the sub-epithelial connective tissue graft from the palate. In 15 sites, the graft was placed at the recipient site with unaided eye (Group A) and in other 15 sites the graft was placed using surgical microscope (Group B). Clinical evaluation was done at baseline, 12 weeks and 24 weeks postoperatively using plaque index, gingival index, vertical recession (VR), probing depth, clinical attachment level (CAL), width of attached gingiva, papilla height (PH) and width, malalignment index (MI) and esthetic appearance. Statistical Analysis Used: Paired and unpaired Student′s t-test along with Wilcoxon Z-test were used to analyze the results and probability of P < 0.05 were accepted to reject the null hypothesis. Pearson correlation was used to correlate two parameters such as VR and CAL and MI and VR. Results: Both the techniques demonstrated predictable mean root coverage (Group A 61.78% and Group B 67.58%) at 6 months postsurgery. CAL gain was slightly better in Group B patients when compared to Group A patients. A moderate positive correlation for Group A while a mild correlation in Group B was seen between the MI and VR. Conclusion: The use of the microscope enhances the results, but obtaining an expertise in using needs a lot of practice. The periodontal healing by both techniques should be evaluated histologically

Porphyromonas gingivalis : Its virulence and vaccine

Background: The microbial florae in adult periodontitis lesions are comprised of anaerobic rods with Porphyromonas gingivalis as one of the major components (Slots 1976; Slots 1979; and Tanner et al., 1979). P. gingivalis is a black-pigmented gram-negative anaerobic rod and a secondary colonizer of dental plaque requiring antecedent organisms. The presence of this organism either alone or as a mixed infection with other bacteria and with the absence of beneficial species appears to be essential for disease activity. It is a predominant member of the subgingival microbiota in disease. It possesses and "excretes" numerous potentially toxic virulence factors. Aim of this study is to perform a systematic review of studies on P. gingivalis and its virulence factors with a special focus on its vaccine. Materials and Methods: An electronic and manual search based on agreed search phrases between the primary investigator and a secondary investigator was performed for the literature review till January 2014. The articles that were identified by this systematic review (total of 190) were analyzed in detail, which included the study of inference and conclusion. Conclusions: Within the limits of this systematic review, it can be concluded that P. gingivalis induce immune inflammatory response in periodontitis subjects. Therapeutic vaccines need to be developed and studied for their efficacy in controlling periodontitis

The use of nanocrystalline and two other forms of calcium sulfate in the treatment of infrabony defects: A clinical and radiographic study

Background: Calcium sulphate(CS) is one of the oldest alloplastic graft materials used because of its biocompatibility, handling characteristics, porosity, different rates of dissolution, chemico-physical resemblance to bone mineral, ability to induce release of growth factors and potentially unlimited supply at a modest cost. Aim of the study was to evaluate the efficacy of 3 forms of calcium sulphate i.e. Nanogen (nCS)(+), BoneGen(+) and Dentogen(+) in treatment of infrabony defects and to compare their efficacy as bone grafting substitutes. Materials and Methods: A prospective randomized, double blind controlled study was conducted on 45 sites from 16 subjects having Moderate to Advanced Periodontitis who were divided into 3 groups i.e. Group I (Nanogen), Group II (Dentogen) and Group III (BoneGen) clinical along with radiographic measurements were taken at baseline, 6 and 12 months postoperatively. Results: There was no significant inter-group difference in mean clinical attachment level (CAL) values at different time intervals whereas Intra-group changes in CAL at 6 and 12 months as compared to baseline were significant statistically. In Group I, changes in CAL between 6 and 12 months were found to be statistically significant in comparison with Group II and III. Conclusion: Both Nanogen and BoneGen TR can be considered valuable options in the treatment of infra-bony periodontal defects. The faster degradation of Dentogen may negatively affect its bone regeneration potential