A new primary dental care service compared with standard care for child and family to reduce the re-occurrence of childhood dental caries (Dental RECUR): study protocol for a randomised controlled trial

Background: In England and Scotland, dental extraction is the single highest cause of planned admission to the hospital for children under 11 years. Traditional dental services have had limited success in reducing this disease burden. Interventions based on motivational interviewing have been shown to impact positively dental health behaviours and could facilitate the prevention of re-occurrence of dental caries in this high-risk population. The objective of the study is to evaluate whether a new, dental nurse-led service, delivered using a brief negotiated interview based on motivational interviewing, is a more cost-effective service than treatment as usual, in reducing the re-occurrence of dental decay in young children with previous dental extractions. Methods/Design: This 2-year, two-arm, multicentre, randomised controlled trial will include 224 child participants, initially aged 5 to 7 years, who are scheduled to have one or more primary teeth extracted for dental caries under general anaesthesia (GA), relative analgesia (RA: inhalation sedation) or local anaesthesia (LA). The trial will be conducted in University Dental Hospitals, Secondary Care Centres or other providers of dental extraction services across the United Kingdom. The intervention will include a brief negotiated interview (based on the principles of motivational interviewing) delivered between enrolment and 6 weeks post-extraction, followed by directed prevention in primary dental care. Participants will be followed up for 2 years. The main outcome measure will be the dental caries experienced by 2 years post-enrolment at the level of dentine involvement on any tooth in either dentition, which had been caries-free at the baseline assessment. Discussion: The participants are a hard-to-reach group in which secondary prevention is a challenge. Lack of engagement with dental care makes the children and their families scheduled for extraction particularly difficult to recruit to an RCT. Variations in service delivery between sites have also added to the challenges in implementing the Dental RECUR protocol during the recruitment phase. Trial registration: ISRCTN24958829 (date of registration: 27 September 2013), Current protocol version: 5.0

High-resolution regional gravity field recovery from Poisson wavelets using heterogeneous observational techniques

2016-2017 > Academic research: refereed > Publication in refereed journal201804_a bcmaVersion of RecordPublishe

The effect of EGM2008-based normal, normal-orthometric and Helmert orthometric height systems on the Australian levelling network

This paper investigates the normal-orthometric correction used in the definition of the Australian Height Datum, and also computes and evaluates normal and Helmert orthometric corrections for the Australian National Levelling Network (ANLN). Testing these corrections in Australia is important to establish which height system is most appropriate for any new Australian vertical datum. An approximate approach to assigning gravity values to ANLN benchmarks (BMs) is used, where the EGM2008-modelled gravity field is used to "re-construct" observed gravity at the BMs. Network loop closures (for first- and second-order levelling) indicate reduced misclosures for all height corrections considered, particularly in the mountainous regions of south eastern Australia. Differences between Helmert orthometric and normal-orthometric heights reach 44 cm in the Australian Alps, and differences between Helmert orthometric and normal heights are about 26 cm in the same region. Normal orthometric heights differ from normal heights by up to 18 cm in mountainous regions >2,000 m. This indicates that the quasigeoid is not compatible with normal-orthometric heights in Australia

Variance component estimation uncertainty for unbalanced data: Application to a continent-wide vertical datum

Variance component estimation (VCE) is used to update the stochastic model in least-squares adjustments, but the uncertainty associated with the VCE-derived weights is rarely considered. Unbalanced data is where there is an unequal number of observations in each heterogeneous dataset comprising the variance component groups. As a case study using highly unbalanced data, we redefine a continent-wide vertical datum from a combined least-squares adjustment using iterative VCE and its uncertainties to update weights for each data set. These are: (1) a continent-wide levelling network, (2) a model of the ocean’s mean dynamic topography and mean sea level observations, and (3) GPS-derived ellipsoidal heights minus a gravimetric quasigeoid model. VCE uncertainty differs for each observation group in the highly unbalanced data, being dependent on the number of observations in each group. It also changes within each group after each VCE iteration, depending on the magnitude of change for each observation group’s variances. It is recommended that VCE uncertainty is computed for VCE updates to the weight matrix for unbalanced data so that the quality of the updates for each group can be properly assessed. This is particularly important if some groups contain relatively small numbers of observations. VCE uncertainty can also be used as a threshold for ceasing iterations, as it is shown—for this data set at least—that it is not necessary to continue time-consuming iterations to fully converge to unity

Post-consent assessment of dental subjects' understanding of informed consent in oral health research in Nigeria

Abstract Background Research participants may not adequately understand the research in which they agree to enroll. This could be due to a myriad of factors. Such a missing link in the informed consent process contravenes the requirement for an "informed" consent prior to the commencement of research. This study assessed the post consent understanding of Nigerian study participants of the oral health research they were invited to join. Methods A descriptive cross sectional study with research participants who had just consented to one of three ongoing research studies on oral health. Study sites included two centers, one in the northern and one in the southern part of Nigeria. Data were collected using a combination of quantitative and qualitative methods. Results A total of 113 research participants were interviewed. The southern part of the country had 58 respondents with the north having 55. The age range was 21 – 80 years. Mean age was 46.1 (SD16.3). The sample was predominantly male (69.9%) and married (64.6%). There was poor understanding of some key elements of the informed consent process such as involvement in research, benefits, contacts, confidentiality and voluntariness. Some identified factors potentially compromising understanding were poverty, illiteracy, therapeutic misconception and confusion about the dual roles of the Dentist and the researcher. Conclusion The participants recruited into the oral health research in Nigeria did not adequately understand the studies they were invited to join nor do they understand their rights as research participants. Measures should be taken to include research bioethics into the curricula of Dental schools and to train oral health researchers in the country on research ethics.</p

The Meissl scheme for the geodetic ellipsoid

We present a variant of the Meissl scheme to relate surface spherical harmonic coefficients of the disturbing potential of the Earth's gravity field on the surface of the geodetic ellipsoid to surface spherical harmonic coefficients of its first- and second-order normal derivatives on the same or any other ellipsoid. It extends the original (spherical) Meissl scheme, which only holds for harmonic coefficients computed from geodetic data on a sphere. In our scheme, a vector of solid spherical harmonic coefficients of one quantity is transformed into spherical harmonic coefficients of another quantity by pre-multiplication with a transformation matrix. This matrix is diagonal for transformations between spheres, but block-diagonal for transformations involving the ellipsoid. The computation of the transformation matrix involves an inversion if the original coefficients are defined on the ellipsoid. This inversion can be performed accurately and efficiently (i.e., without regularisation) for transformation among different gravity field quantities on the same ellipsoid, due to diagonal dominance of the matrices. However, transformations from the ellipsoid to another surface can only be performed accurately and efficiently for coefficients up to degree and order 520 due to numerical instabilities in the inversion

Towards an International Height Reference System: insights from the Colorado geoid experiment using AUSGeoid computation methods

We apply the AUSGeoid data processing and computation methodologies to data provided for the International Height Reference System (IHRS) Colorado experiment as part of the International Association of Geodesy Joint Working Groups 0.1.2 and 2.2.2. This experiment is undertaken to test a range of different geoid computation methods from international research groups with a view to standardising these methods to form a set of conventions that can be established as an IHRS. The IHRS can realise an International Height Reference Frame to be used to study physical changes on and within the Earth. The Colorado experiment study site is much more mountainous (maximum height 4401 m) than the mostly flat Australian continent (maximum height 2228 m), and the available data over Colorado are different from Australian data (e.g. much more extensive airborne gravity coverage). Hence, we have tested and applied several modifications to the AUSGeoid approach, which had been tailored to the Australian situation. This includes different methods for the computation of terrain corrections, the gridding of terrestrial gravity data, the treatment of long-wavelength errors in the gravity anomaly grid and the combination of terrestrial and airborne data. A new method that has not previously been tested is the application of a spherical harmonic high-pass filter to residual anomalies. The results indicate that the AUSGeoid methods can successfully be used to compute a high accuracy geoid in challenging mountainous conditions. Modifications to the AUSGeoid approach lead to root-mean-square differences between geoid models up to ~ 0.028 m and agreement with GNSS-levelling data to ~ 0.044 m, but the benefits of these modifications cannot be rigorously assessed due to the limitation of the GNSS-levelling accuracy over the computation area

Influence of preventive dental treatment on mutans streptococci counts in patients undergoing head and neck radiotherapy

The aim of this study was to evaluate the influence of chlorhexidine gluconate, sodium fluoride and sodium iodine on mutans streptococci counts in saliva of irradiated patients. MATERIAL AND METHODS: Forty-five patients were separated into three experimental groups and received chlorhexidine (0.12%), sodium fluoride (0.5%) or sodium iodine (2%), which were used daily during radiotherapy and for 6 months after the conclusion of the treatment. In addition, a fourth group, composed by 15 additional oncologic patients, who did not receive the mouthwash or initial dental treatment, constituted the control group. Clinical evaluations were performed in the first visit to dental clinic, after initial dental treatment, immediately before radiotherapy, after radiotherapy and 30, 60, 90 days and 6 months after the conclusion of radiotherapy. After clinical examinations, samples of saliva were inoculated on SB20 selective agar and incubated under anaerobiosis, at 37ºC for 48 h. Total mutans streptococci counts were also evaluated by using real-time PCR, through TaqMan system, with specific primers and probes for S. mutans and S. sobrinus. RESULTS: All preventive protocols were able to reduce significantly mutans streptococci counts, but chlorhexidine gluconate was the most effective, and induced a significant amelioration of radiotherapy side effects, such as mucositis and candidosis. CONCLUSION: These results highlights the importance of the initial dental treatment for patients who will be subjected to radiotherapy for head and neck cancer treatment

Treatment results for hypopharyngeal cancer by different treatment strategies and its secondary primary- an experience in Taiwan

<p>Abstract</p> <p>Purpose</p> <p>The aim of this study was to evaluate treatment results in our hypopharyngeal cancer patients.</p> <p>Patients and Methods</p> <p>A total of three hundred and ninety five hypopharyngeal cancer patients received radical treatment at our hospital; 96% were male. The majority were habitual smokers (88%), alcohol drinkers (73%) and/or betel quid chewers (51%). All patients received a CT scan or MRI for tumor staging before treatment. The stage distribution was stage I: 2 (0.5%); stage II: 22 (5.6%); stage III: 57 (14.4%) and stage IV: 314 (79.5%). Radical surgery was used first in 81 patients (20.5%), and the remaining patients (79.5%) received organ preservation-intended treatment (OPIT). In the OPIT group, 46 patients received radiotherapy alone, 156 patients received chemotherapy followed by radiotherapy (CT/RT) and 112 patients received concomitant chemo-radiotherapy (CCRT).</p> <p>Results</p> <p>The five-year overall survival rates for stages I/II, III and IV were 49.5%, 47.4% and 18.6%, respectively. There was no significant difference in overall and disease-specific survival rates between patients who received radical surgery first and those who received OPIT. In the OPIT group, CCRT tended to preserve the larynx better (p = 0.088), with three-year larynx preservation rates of 44.8% for CCRT and 27.2% for CT/RT. Thirty-seven patients developed a second malignancy, with an annual incidence of 4.6%.</p> <p>Conclusions</p> <p>There was no survival difference between OPIT and radical surgery in hypopharyngeal cancer patients at our hospital. CCRT may offer better laryngeal preservation than RT alone or CT/RT. However, prospective studies are still needed to confirm this finding. Additionally, second primary cancers are another important issue for hypopharyngeal cancer management.</p