Evaluating the environmental impact of the Welsh national childhood oral health improvement programme, Designed to Smile

INTRODUCTION

Designed to Smile (D2S) is a national oral health improvement programme, aimed to reduce the prevalence of dental caries in young children in Wales. D2S has a responsibility to consider the environmental impact of the service it provides and demonstrate adherence to the sustainable development principle legislated within the Wellbeing of Future Generations (Wales) Act.

OBJECTIVE

To review the environmental impact of D2S by estimating the carbon footprint of the programme and identify carbon hotspots for future targeted action.

RESEARCH DESIGN

Process mapping identified the steps to deliver the supervised toothbrushing and fluoride varnish elements of D2S. Annual estimates of business travel mileage, financial spend on procurement, total number of plastic consumables and waste disposal were made. An online survey enabled calculation of staff commuting behaviour. These contributors were converted to carbon emissions using established carbon conversion factors.

RESULTS

The annual carbon footprint of D2S was estimated at 388 tonnes of CO²e (tCO²e) with 31% attributed to staff travel, 23% to business travel and 46% to procurement. An estimated 1 million plastic items were distributed.

CONCLUSION

By promoting good oral care and preventing the need for future carbon intensive restorative dental treatments, D2S exemplifies a sustainable model of healthcare. Adopting reduce, reuse, recycle principles for plastic consumables and introducing sustainable procurement procedures could lead to further decarbonisation and reduction in plastic waste.

The deposition of metal nanoparticles on carbon surfaces: the role of specific functional groups

The influence of hydroxyl and carbonyl groups on the deposition of gold from solution onto graphite surfaces was explored: OH gives Au⁰ whereas CO results in Au³⁺.

Hemi-hamate arthroplasty versus transarticular Kirschner wire fixation for unstable dorsal fracture-dislocation of the proximal interphalangeal joint in the hand

Following the introduction of the hemi-hamate arthroplasty (HHA) technique to our unit, we sought to evaluate the early clinical outcomes achieved with this method of fixation and compare these with simple trans-articular Kirschner wire (K-wire) fixation for dorsal fracture dislocations (DFD) of the proximal interphalangeal joint (PIPJ). Ninteen patients underwent fixation of these injuries with either K-wire fixation (12/19) or hemi-hamate bone grafting (7/19) between 2005 and 2011. At a mean follow-up of 14 weeks median arc of movement at the PIPJ was 65° (range 31° to 108°) following HHA and 56° (range 9° to 85°) (p = 0.82) following temporary transarticular K-wire fixation. Median fixed flexion deformity (FFD) was 20° and 15° for hemi-hamate bone grafting and K-wire fixation respectively. Based upon our findings, transarticular K-wire fixation produced equivalent outcomes to HHA for unstable DFD of the PIPJ in the hand.

Use of psychiatric services by homeless veterans

Patients treated in a Department of Veterans Affairs (VA) emergency room were evaluated to delineate the differences in use of services between homeless and domiciled veterans who have mental disorders. Data were obtained and compared on DSM-III-R diagnoses, number of hospitalizations, lengths of stay, and outpatient visits in the preceding year. Homeless veterans with mental disorders were significantly more likely to have emergency visits and psychiatric admissions in the preceding 12 months than were the domiciled veterans. However, the average length of stay was shorter for the homeless group. These differences must be accounted for in the design of programs targeting homeless veterans with mental illness.

Phenolic acids in the fibre of some tropical grasses, effect on feed quality, and their metabolism by sheep

A feature of the composition of dry-season tropical grasses, which may in part account for their lower digestibility, is the relatively high content of hydroxycinnamic acids covalently bound in the cell wall. The main phenolic acids liberated on mild alkaline hydrolysis in 19 species of native and introduced grasses in North Queensland were p-coumaric and ferulic acids, with the former predominating in 16 species. Caffeic acid was found in three species and sinapic acid in trace amounts. Total acids occurred at approximately 10 g/kg in most species, but were found at 50 g/kg in one species. When five of the species were fed as the sole diet to sheep, intake and digestibility were not clearly related to phenolic acid level in the diet. However, output of hippuric acid in the urine increased with the daily dietary intake of phenolic acids, and nitrogen excreted as hippurate was equivalent to as much as 17% of the total nitrogen in the diet. The effect of free acids on rumen function was tested by adding p-coumaric and ferulic acid directly to the diet. In contrast to the implications of numerous in vitro studies, intake and digestibility were not affected. Dry matter loss from intraruminal nylon bags was also not affected by administration of these compounds. In addition to hippuric acid, cinnamoylglycine was identified as a urinary metabolite. This appeared in animals on most of the grass diets, and was enhanced following administration of ferulic or p-coumaric acid, but not benzoic acid. It seems that phenolic acids liberated from the cell wall are unlikely to have an adverse effect on rumen microbial metabolism, but impose a serious nitrogen loss for animals on diets already deficient in nitrogen.

Central nervous system involvement in congenital visceral fibromatosis

Congenital visceral myofibromatosis is an uncommon disorder characterized by multiple tumors of myofibroblastic origin in the neonatal period. The natural history of the disorder has been well delineated. The myofibroblast is the cell of origin of the tumor. This is a report of a patient in whom multiple mesenchymal tumors occurred in the CNS as well as in other organs. Light and electron microscopic findings of the CNS lesions are similar to those of the somites and viscera.

Constituents of Eupomatia Species. II. Isolation and Structure Determination of Further Eupomatenoid Lignans From the Bark of Eupomatia laurina

A further extraction of the bark of Eupomatia laurina R.Br. has yielded 16 substances: liriodenine (as before), norushinsunine, three new bases, benzoic acid, sitosterol, eupodienone-1 (previously EL2; but not EL3 which is an artefact from EL2), eupomatene (ELl), and seven related substances. ��� The last eight substances, which are closely related, ere named ?eupomatenoids?. The structures of the eupomatenoids -2 to -8 have been established. Like eupomatenoid-1 (eupomatene), they are derivatives of 3-methyl-2-phenyl-5-(E)-propenylbenzofuran and are classified as lignans.