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During the coronavirus pandemic, there have been significant challenges in the remote teaching and demonstration of experiments, especially those that require laboratory testing equipment. With a desire to give students a feel for our materials laboratory on open days and allow them to gain a deeper understanding of what materials science and engineering is about, we have designed an experiment focused on composite materials that can be performed remotely and without specialist equipment. This enabled students to experience a bend test sensorily through seeing, hearing and feeling it, creating a strong link to then being able to relate it to the pre-prepared experimental data taken in the laboratory. This fun, easy-to-run and engaging experiment allowed a shared experience and encouraged a discussion about students' observations, differences in results and implications of the bend strength of sandwich composites. We have found it not only works well universally by all ages but can be used with younger children to think about words such as 'stronger', 'stiffer' and 'flexible' and how materials can be different in different directions.

Objective: To pragmatically assess the clinical and cost‐effectiveness of water fluoridation for preventing dental treatment and improving oral health in a contemporary population of adults and adolescents, using a natural experiment design. Methods: A 10‐year retrospective cohort study (2010–2020) using routinely collected NHS dental treatment claims data. Participants were patients aged 12 years and over, attending NHS primary dental care services in England (17.8 million patients). Using recorded residential locations, individuals exposed to drinking water with an optimal fluoride concentration (≥0.7 mg F/L) were matched to non‐exposed individuals using propensity scores. Number of NHS invasive dental treatments, DMFT and missing teeth were compared between groups using negative binomial regression. Total NHS dental treatment costs and cost per invasive dental treatment avoided were calculated. Results: Matching resulted in an analytical sample of 6.4 million patients. Predicted mean number of invasive NHS dental treatments (restorations 'fillings'/extractions) was 3% lower in the optimally fluoridated group (5.4) than the non‐optimally fluoridated group (5.6) (IRR 0.969, 95% CI 0.967, 0.971). Predicted mean DMFT was 2% lower in the optimally fluoridated group (IRR 0.984, 95% CI 0.983, 0.985). There was no difference in the predicted mean number of missing teeth per person (IRR 1.001, 95% CI 0.999, 1.003) and no compelling evidence that water fluoridation reduced social inequalities in dental health. Optimal water fluoridation in England 2010–2020 was estimated to cost £10.30 per person (excludes initial set‐up costs). NHS dental treatment costs for optimally fluoridated patients 2010–2020 were 5.5% lower, by £22.26 per person (95% CI ‐£21.43, −£23.09). Conclusions: Receipt of optimal water fluoridation 2010–2020 resulted in very small positive health effects which may not be meaningful for individuals. Existing fluoridation programmes in England produced a positive return on investment between 2010 and 2020 due to slightly lower NHS dental care utilization. This return should be evaluated against the projected costs and lifespan of any proposed capital investment in water fluoridation, including new programmes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Methods of remuneration have been linked with the professional behaviour of primary care physicians. In dentistry, this can be exacerbated as clinicians operate their practices as businesses and take the full financial risk of the provision of services. The main methods for remunerating primary care dentists include fee-for-service, fixed salary and capitation payments. The aim of this review was to determine the impact that these remuneration mechanisms have upon primary care dentists behaviour. OBJECTIVES: To evaluate the effects of different methods of remuneration on the level and mix of activities provided by primary care dentists and the impact this has on patient outcomes. SEARCH METHODS: We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 7, 2013); MEDLINE (Ovid) (1947 to 11 June 2013); EMBASE (Ovid) (1947 to 11 June 2013); EconLit (1969 to 11 June 2013); the NHS Economic Evaluation Database (EED) (11 June 2013); and the Health Economic Evaluations Database (HEED) (11 June 2013). We conducted cited reference searches for the included studies in ISI Web of Knowledge; searched grey literature sources; handsearched selected journals; and contacted authors of relevant studies. SELECTION CRITERIA: Primary care dentists were defined as clinicians that deliver routine or mainstream dental care in a primary care environment. We included randomised controlled trials (RCTs), non-randomised controlled clinical trials (NRCTs), controlled before-after (CBA) studies and interrupted time series (ITS) studies. The methods of remuneration that we considered were: fee-for-service, fixed salary and capitation payments. Primary outcome measures were: measures of clinical activity; volume of clinical activity undertaken; time taken and clinical session length, or both; clinician type utilised; measures of health service utilisation; access and attendance as a proportion of the population; re-attendance rates; recall frequency; levels of oral health inequalities; non-attendance rates; healthcare costs; measures of patient outcomes; disease reduction; health maintenance; and patient satisfaction. We also considered measures of practice profitability/income and any reported unintended effects of the included methods of remuneration. DATA COLLECTION AND ANALYSIS: Three of the review authors (PRB, JP, AMG) independently reviewed titles and abstracts and resolved disagreements by discussion. The same three review authors undertook data extraction and assessed the quality of the evidence from all the studies that met the selection criteria, according to Cochrane Collaboration procedures. MAIN RESULTS: Two cluster-RCTs, with data from 503 dental practices, representing 821 dentists and 4771 patients, met the selection criteria. We judged the risk of bias to be high for both studies and the overall quality of the evidence was low/very low for all outcomes, as assessed using the GRADE approach.One study used a factorial design to investigate the impact of fee-for-service and an educational intervention on the placement of fissure sealants in permanent molar teeth. The authors reported a statistically significant increase in clinical activity in the arm that was incentivised with a fee-for-service payment. However, the study was conducted in the four most deprived areas of Scotland, so the applicability of the findings to other settings may be limited. The study did not report data on measures of health service utilisation or measures of patient outcomes.The second study used a parallel group design undertaken over a three-year period to compare the impact of capitation payments with fee-for-service payments on primary care dentists clinical activity. The study reported on measures of clinical activity (mean percentage of children receiving active preventive advice, health service utilisation (mean number of visits), patient outcomes (mean number of filled teeth, mean percentage of children having one or more teeth extracted and the mean number of decayed teeth) and healthcare costs (mean expenditure). Teeth were restored at a later stage in the disease process in the capitation system and the clinicians tended to see their patients less frequently and tended to carry out fewer fillings and extractions, but also tended to give more preventive advice.There was insufficient information regarding the cost-effectiveness of the different remuneration methods. AUTHORS CONCLUSIONS: Financial incentives within remuneration systems may produce changes to clinical activity undertaken by primary care dentists. However, the number of included studies is limited and the quality of the evidence from the two included studies was low/very low for all outcomes. Further experimental research in this area is highly recommended given the potential impact of financial incentives on clinical activity, and particular attention should be paid to the impact this has on patient outcomes.

The letter discusses concerns about a specific acupuncture trial on shoulder pain. The authors argue that the trial did not effectively control for placebo effects and did not compare acupuncture to a placebo treatment. They suggest that the trial unintentionally included active components in the sham treatments, potentially underestimating the effects of acupuncture. The authors also highlight the need for better descriptions of sham acupuncture techniques and pre-clinical studies to assess their lack of specific effects. Overall, the letter raises important considerations for interpreting the results of acupuncture trials that use sham acupuncture as a control treatment. [Extracted from the article]

In most countries, the demand for integrated care for people with chronic diseases is increasing as the population ages. This demand requires a fundamental shift of health-care systems towards more integrated service delivery models. To achieve this shift in China, the World Health Organization, the World Bank and the Chinese government proposed a tiered health-care delivery system in accordance with a people-centred integrated care model. The approach was pioneered in Luohu district of Shenzhen city from 2015 to 2017 as a template for practice. In September 2017, China's health ministry introduced this approach to people-centred integrated care to the entire country. We describe the features of the Luohu model in relation to the core action areas and implementation strategies proposed and we summarize data from an evaluation of the first two years of the programme. We discuss the challenges faced during implementation and the lessons learnt from it for other health-care systems. We consider how to improve collaboration between institutions, how to change the population's behaviour about using community health services as the first point of contact and how to manage resources effectively to avoid budget deficits. Finally, we outline next steps of the Luohu model and its potential application to strengthen health care in other urban health-care systems.Dans la plupart des pays, la demande de soins integres pour les personnes atteintes de maladies chroniques augmente a mesure que la population vieillit. Cette demande necessite une reorientation majeure des systemes de soins de sante vers des dispositifs de prestation de services plus integres. Pour effectuer cette reorientation en Chine, l'Organisation mondiale de la Sante, la Banque mondlale et le gouvernement chlnois ont propose un systeme de soins de sante a plusieurs niveaux selon un dlspositif de soins integres axes sur 1'etre humain. Cette approche a ete utilisee pour Ia premiere fois dans le distria de Luohu de la ville de Shenzhen de 2015 a 2017 en tant que modele de pratique. En septembre 2017, le ministere chinois de la Sante a applique a l'ensemble du pays ce dispositif de soins integres axes sur l'etre humain. Nous decrivons les caracteristiques du modele de Luohu par rapport aux principaux domaines d'action et aux strategies de mise en ceuvre proposees et nous resumons les donnees extraites d'une evaluation des deux premieres annees du programme. Nous examinons les difficultes rencontrees lors de la mise en ceuvre et les lecons tirees de ees difficultes pour d'autres systemes de soins de sante. Nous reflechissons aux moyens d'ameliorer la collaboration entre les institutions, de changer le comportement de la population concernant l'utilisation des services de sante des collectives comme premier point de contact et de gerer efncacement les ressources pour eviter les deficits budgetaires. Enfin, nous decrivons les prochaines etapes a suivre dans le cadre du modele de Luohu et son application potentielle pour renforcer les soins de sante dans d'autres systemes urbains de soins de sante.En la mayoria de los paises, la demanda de atencion integrada para las personas con enfermedades cronicas aumenta a medida que la poblacion envejece. Esta demanda requiere un cambio fundamental de los sistemas de atencion sanitaria hacia modelos de prestacion de servicios mas integrados. Para lograr este cambio en China, la Organizacion Mundial de la Salud, el Banco Mundial y el gobierno chino propusieron un sistema escalonado de prestacion de servicios sanitarios de acuerdo con un modelo de atencion integrada centrada en las personas. El enfoque se introdujo en el distrito de Luohu de la ciudad de Shenzhen de 2015 a 2017 como modelo para la practica. En septiembre de 2017, el Ministerio de Salud de China introdujo este enfoque de atencion integrada centrada en las personas en todo el pais. Se describen las caracteristicas del modelo de Luohu en relacion con las areas centrales de accion y las estrategias de implementation propuestas y se resumen los datos de una evaluacion de los dos primeros anos del programa. Se exponen los desafios enfrentados durante la implementacion y las lecciones aprendidas de la misma para otros sistemas de atencion sanitaria. Se considera como mejorar la colaboracion entre las instituciones, como cambiar el comportamiento de la poblacion sobre el uso de los servicios sanitarios comunitarios como primer punto de contacto y como gestionar eficazmente los recursos para evitar deficits de presupuesto. Por ultimo, se esbozaron los proximos pasos del modelo de Luohu y su posible aplicacion para fortalecer la atencion sanitaria en otros sistemas urbanos de atencion sanitaria., IntroductionOn 1 September 2017, China's health ministry introduced a new approach to people-centred integrated care to the entire country. (1) Called the Luohu model, the approach was pioneered in Luohu [...]