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Introduction The new world classification of periodontal diseases and conditions was developed in 2017. The British Society of Periodontology and Implant Dentistry (BSP) implemented the classification in a series of papers published in the British Dental Journal in January 2019.Aims and objectives This study aimed to investigate if the BSP implementation was workable in general dental practice and to reveal if any lessons were learnt from its regular use two years following its release.Materials and methods This was a cross-sectional, retrospective, non-intervention analysis of a patient population (n = 891) drawn from a complete list of a private dental surgeon. Diagnostic and demographic data were drawn from the patient records, collated and analysed using SPSS Statistics v26.Results Diagnoses derived from the new classification were identified for 92% of subjects, indicating a high level of implementation. In total, 20.9% of subjects were diagnosed with periodontitis, and of these, 57% were unstable, 39% stable and 4% in remission. The mean bleeding on probing score across the cohort was 7.7%. Moreover, 76% of the non-periodontitis patients were diagnosed with 'clinical gingival health', 23% with localised gingivitis and 1% with generalised gingivitis.Conclusion The new classification has been found to be readily implemented in a general practice setting. Use of the new classification allows for close monitoring of periodontal status, and as a result, close monitoring of the effectiveness of pathways of care.

Alliance contracts are consummated before the subsurface investigation to support the final geotechnical design is complete, forcing clients and their industry partners to operate with high levels of geotechnical uncertainty during the negotiation of the alliance agreement. Research has shown that perceptions of each stakeholder of this key area of uncertainty are very different, making it challenging to achieve alignment. The purpose of this paper is to propose an objective methodology for alliance members to prioritize geotechnical risk factors during the agreement negotiation process to determine those factors that should be clarified before determining a target outturn cost. This paper proposes an objective methodology based on importance index theory computed from each geotechnical factor’s frequency and impact. Survey data collected from 46 public transportation agency and industry experts provided the input. The paper proposes that a prioritized list of project-specific geotechnical risks be used to guide the negotiations and potentially identify the need for preliminary subsurface investigations to support the development of the target outturn cost. The framework is applied to a typical alliance project to demonstrate its efficacy. The paper’s primary contribution is the importance index-based methodology for ranking geotechnical risk factors, which may be utilized as a checklist to guide negotiations of geotechnical risk distribution in the alliance agreement.

The value of infrastructure activity in New Zealand is expected to increase to $11.2 billion per year by 2026. However, there is a question concerning the capability and capacity of the construction sector to deliver this quantity of work. This study provides an analysis of award notice data, specifically for transportation physical works contracts published on the Government Electronic Tender Service. Data was reviewed from 1197 transportation projects awarded by Waka Kotahi, the New Zealand Transport Agency, and by 37 local councils across New Zealand. Estimations were then used to assess project resource requirements and later verified by industry professionals. Findings suggest an average of approximately $218 million New Zealand dollars per year was awarded to contractors for transportation physical works contracts from July 2015 to June 2021. However, analysis of contract award dates and award amounts shows the level of resources required to deliver transportation contracts is not consistent throughout the years. Inconsistent workloads may cause contracting companies to experience gaps in resource allocation. Conversely, government agencies may be unnecessarily competing for construction resources due to the timing of project award dates. A strategic, coordinated release of transportation projects could level out demand for construction resources across each financial year. This approach would level out resource requirements, create continuity, and minimize uncertainty for contracting companies, which may allow more effective use of available resources and hence more work to be delivered.

Household air pollution (HAP) from cooking with solid fuels has been associated with adverse respiratory effects, but most studies use surveys of fuel use to define HAP exposure, rather than on actual air pollution exposure measurements.To examine associations between household and personal fine particulate matter (PMAs part of the Prospective Urban and Rural Epidemiology Air Pollution study, we analyzed 48-h household and personal PMThe median (interquartile range) of household and personal PMWe used measurements of household and personal air pollution for individuals using different cooking fuels and documented strong associations with respiratory symptoms.

Black Carbon (BC) is an important component of household air pollution (HAP) in low- and middle-income countries (LMICs), but levels and drivers of exposure are poorly understood. As part of the Prospective Urban and Rural Epidemiological (PURE) study, we analyzed 48-hour BC measurements for 1187 individual and 2242 household samples from 88 communities in 8 LMICs (Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania, and Zimbabwe). Light absorbance (10−5 m−1) of collected PM2.5 filters, a proxy for BC concentrations, was calculated via an image-based reflectance method. Surveys of household/personal characteristics and behaviors were collected after monitoring. The geometric mean (GM) of personal and household BC measures was 2.4 (3.3) and 3.5 (3.9)·10−5 m−1, respectively. The correlation between BC and PM2.5 was r = 0.76 for personal and r = 0.82 for household measures. A gradient of increasing BC concentrations was observed for cooking fuels: BC increased 53% (95%CI: 30, 79) for coal, 142% (95%CI: 117, 169) for wood, and 190% (95%CI: 149, 238) for other biomass, compared to gas. Each hour of cooking was associated with an increase in household (5%, 95%CI: 3, 7) and personal (5%, 95%CI: 2, 8) BC; having a window in the kitchen was associated with a decrease in household (−38%, 95%CI: −45, −30) and personal (−31%, 95%CI: −44, −15) BC; and cooking on a mud stove, compared to a clean stove, was associated with an increase in household (125%, 95%CI: 96, 160) and personal (117%, 95%CI: 71, 117) BC. Male participants only had slightly lower personal BC (−0.6%, 95%CI: −1, 0.0) compared to females. In multivariate models, we were able to explain 46–60% of household BC variation and 33–54% of personal BC variation. These data and models provide new information on exposure to BC in LMICs, which can be incorporated into future exposure assessments, health research, and policy surrounding HAP and BC.

Use of polluting cooking fuels generates household air pollution (HAP) containing health-damaging levels of fine particulate matter (PMThe Prospective Urban and Rural Epidemiology (PURE)-AIR study included 48-hour monitoring of PMThe final models explained half (RUsing survey data to estimate PM

Summary Background Approximately 2·8 billion people are exposed to household air pollution from cooking with polluting fuels. Few monitoring studies have systematically measured health-damaging air pollutant (ie, fine particulate matter [PM2·5] and black carbon) concentrations from a wide range of cooking fuels across diverse populations. This multinational study aimed to assess the magnitude of kitchen concentrations and personal exposures to PM2·5 and black carbon in rural communities with a wide range of cooking environments. Methods As part of the Prospective Urban and Rural Epidemiological (PURE) cohort, the PURE-AIR study was done in 120 rural communities in eight countries (Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania, and Zimbabwe). Data were collected from 2541 households and from 998 individuals (442 men and 556 women). Gravimetric (or filter-based) 48 h kitchen and personal PM2·5 measurements were collected. Light absorbance (10−5m−1) of the PM2·5 filters, a proxy for black carbon concentrations, was calculated via an image-based reflectance method. Surveys of household characteristics and cooking patterns were collected before and after the 48 h monitoring period. Findings Monitoring of household air pollution for the PURE-AIR study was done from June, 2017, to September, 2019. A mean PM2·5 kitchen concentration gradient emerged across primary cooking fuels: gas (45 μg/m3 [95% CI 43–48]), electricity (53 μg/m3 [47–60]), coal (68 μg/m3 [61–77]), charcoal (92 μg/m3 [58–146]), agricultural or crop waste (106 μg/m3 [91–125]), wood (109 μg/m3 [102–118]), animal dung (224 μg/m3 [197–254]), and shrubs or grass (276 μg/m3 [223–342]). Among households cooking primarily with wood, average PM2·5 concentrations varied ten-fold (range: 40–380 μg/m3). Fuel stacking was prevalent (981 [39%] of 2541 households); using wood as a primary cooking fuel with clean secondary cooking fuels (eg, gas) was associated with 50% lower PM2·5 and black carbon concentrations than using only wood as a primary cooking fuel. Similar average PM2·5 personal exposures between women (67 μg/m3 [95% CI 62–72]) and men (62 [58–67]) were observed. Nearly equivalent average personal exposure to kitchen exposure ratios were observed for PM2·5 (0·79 [95% 0·71–0·88] for men and 0·82 [0·74–0·91] for women) and black carbon (0·64 [0·45–0·92] for men and 0·68 [0·46–1·02] for women). Interpretation Using clean primary fuels substantially lowers kitchen PM2·5 concentrations. Importantly, average kitchen and personal PM2·5 measurements for all primary fuel types exceeded WHO's Interim Target-1 (35 μg/m3 annual average), highlighting the need for comprehensive pollution mitigation strategies. Funding Canadian Institutes for Health Research, National Institutes of Health.

PURPOSE Until human papillomavirus (HPV)–based cervical screening is more affordable and widely available, visual inspection with acetic acid (VIA) is recommended by the WHO for screening in lower-resource settings. Visual inspection will still be required to assess the cervix for women whose screening is positive for high-risk HPV. However, the quality of VIA can vary widely, and it is difficult to maintain a well-trained cadre of providers. We developed a smartphone-enhanced VIA platform (SEVIA) for real-time secure sharing of cervical images for remote supportive supervision, data monitoring, and evaluation. METHODS We assessed programmatic outcomes so that findings could be translated into routine care in the Tanzania National Cervical Cancer Prevention Program. We compared VIA positivity rates (for HIV-positive and HIV-negative women) before and after implementation. We collected demographic, diagnostic, treatment, and loss-to-follow-up data. RESULTS From July 2016 to June 2017, 10,545 women were screened using SEVIA at 24 health facilities across 5 regions of Tanzania. In the first 6 months of implementation, screening quality increased significantly from the baseline rate in the prior year, with a well-trained cadre of more than 50 health providers who “graduated” from the supportive-supervision training model. However, losses to follow-up for women referred for further evaluation or to a higher level of care were considerable. CONCLUSION The SEVIA platform is a feasible, quality improvement, mobile health intervention that can be integrated into a national cervical screening program. Our model demonstrates potential for scalability. As HPV screening becomes more affordable, the platform can be used for visual assessment of the cervix to determine amenability for same-day ablative therapy and/or as a secondary triage step, if needed.

Overwhelming evidence shows that overconsumption of meat is bad for human and environmental health and that moving towards a more plant-based diet is more sustainable. For instance, replacing beef with beans in the US could free up 42% of US cropland and reduce greenhouse gas emissions by 334 mmt, accomplishing 75% of the 2020 carbon reduction target. We summarise the evidence on how overconsumption of meat affects social, environmental and economic sustainability. We highlight the social, environmental and economic effectiveness of a range of dietary interventions that have been tested to date. Because meat eating is embedded within complex cultural, economic, and political systems, dietary shifts to reduce overconsumption are unlikely to happen quickly and a suite of sustained, context-specific interventions is likely to work better than brief, one-dimensional approaches. We conclude with key actions needed by global leaders in politics, industry and the health sector that could help aide this dietary transformation to benefit people and the planet., Graphical abstract Unlabelled Image, Highlights • Overconsumption of meat must decline to meet Sustainable Development Goals • We review the range and effectiveness of interventions to reduce meat overconsumption • Government and food supply chain buy-in are needed to transition to more sustainable diets

BackgroundCervical cancer, although almost entirely preventable through cervical cancer screening (CCS) and human papillomavirus vaccination, is the leading cause of cancer deaths among women in Tanzania. Barriers to attending CCS include lack of awareness of CCS, affordability concerns regarding screening and travel cost. We aimed to compare the effectiveness of SMS (short message service) behaviour change communication (BCC) messages and of SMS BCC messages delivered with a transportation electronic voucher (eVoucher) on increasing uptake of CCS versus the control group.MethodsDoor-to-door recruitment was conducted between 1 February and 13 March 2016 in randomly selected enumeration areas in the catchment areas of two hospitals, one urban and one rural, in Northern Tanzania. Women aged 25–49 able to access a mobile phone were randomised using a computer-generated 1:1:1 sequence stratified by urban/rural to receive either (1) 15 SMS, (2) an eVoucher for return transportation to CCS plus the same SMS, or (3) one SMS informing about the nearest CCS clinic. Fieldworkers and participants were masked to allocation. All areas received standard sensitisation including posters, community announcements and sensitisation similar to community health worker (CHW) sensitisation. The primary outcome was attendance at CCS within 60 days of randomisation.FindingsParticipants (n=866) were randomly allocated to the BCC SMS group (n=272), SMS + eVoucher group (n=313), or control group (n=281), with 851 included in the analysis (BCC SMS n=272, SMS + eVoucher n=298, control group n=281). By day 60 of follow-up, 101 women (11.9%) attended CCS. Intervention group participants were more likely to attend than control group participants (SMS + eVoucher OR: 4.7, 95% CI 2.9 to 7.4; SMS OR: 3.0, 95% CI 1.5 to 6.2).Trial registration numberNCT02680613.

Dentine hypersensitivity is a common oral pain condition affecting many individuals. The aetiology is multifactorial; however, over recent years the importance of erosion has become more evident. For dentine hypersensitivity to occur, the lesion must first be localised on the tooth surface and then initiated to exposed dentine tubules which are patent to the pulp. The short, sharp pain symptom is thought to be derived from the hydrodynamic pain theory and, although transient, is arresting, affecting quality of life. This episodic pain condition is likely to become a more frequent dental complaint in the future due to the increase in longevity of the dentition and the rise in tooth wear, particularly amongst young adults. Many efficacious treatment regimens are now available, in particular a number of over-the-counter home use products. The basic principles of treatment are altering fluid flow in the dentinal tubules with tubule occlusion or modifying or chemically blocking the pulpal nerve.

Contaminated blood cultures cause a diagnostic and therapeutic challenge for microbiologists and physicians. There is potential risk to patients and expense to hospital trusts from inappropriate antibiotic administration and further tests. Data collection by the director of infection prevention and

The aim of these clinical studies was to evaluate an in situ dentine tubule occlusion model, and to determine the occluding effect from novel occluding agents on patent dentine tubules compared to a positive control (8% strontium acetate--Sensodyne Mint) and negative control (a non-occluding agent) after four days of brushing treatment.These two in situ clinical studies were of single-center, randomized, crossover, single-blind design. Healthy participants wore two lower intra-oral appliances retaining four dentine samples for four treatment days for each period of the study. Samples were power-brushed each day with the test product. Assessment utilized surface topological analysis with a replica-based methodology under scanning electron microscopy (SEM).Both clinical trials demonstrated that the positive control (8% strontium acetate) occluded dentine tubules significantly better (p = 0.0007; p0.0009) than the negative controls in the two studies, respectively. The experimental occluding agents demonstrated varying degrees of success for occluding effect compared to the controls.The methodology clearly demonstrates that this in situ clinical model can robustly and reproducibly detect the dentine tubular occlusive effects of positive and negative controls in the treatment of dentine hypersensitivity brushed on the dentine surface. Using this methodology, new occlusion agents for the relief of dentine hypersensitivity can be assessed for occlusive effects on dentine.

Background If emerging "trail-blazers", such as the consultant nurse, are to be successful in developing and sustaining new ways of working then factors that support or inhibit new role developments need identification. There is a growing body of evaluative and anecdotal evidence about the experience of consultant nurses since the introduction of the role in the UK thirteen years ago. Objective To synthesise the evidence on the experiences of UK consultant nurses in implementing a new role in order to identify inhibitors and facilitators of role development. Inclusion criteria This review sought qualitative and mixed methodology studies that yielded qualitative data about the phenomenon of interest, together with narrative opinion papers i.e. consultant nurses‟ experiences of role development. Search strategy The search in 14 databases considered studies and opinion papers published between January 1999 and April 2010 in English. Methodological quality All retrieved studies and opinion papers were assessed by two independent reviewers using the standardised Joanna Briggs Institute critical appraisal tools. Data collection Data were extracted from included papers using the standardised Joanna Briggs Institute data extraction tool. Data synthesis Data synthesis used the Joanna Briggs Institute approach for meta-synthesis by meta-aggregation. Findings were synthesised into categories and categories were aggregated into synthesised findings. Results On the basis of critical appraisal, no opinion papers were included in the review. A total of 11 qualitative studies were included, yielding a total of 313 findings. These were synthesised into 64 categories which were further synthesised into 11 synthesised findings about factors that facilitate and inhibit the role‟s implementation and development. Conclusion Drawing directly on consultant nurses‟ experiences, these findings add evidence to what is already known about what does and does not work in developing a consultant role. They indicate that an understanding about the role‟s core functions is needed, as is a supportive environment in which the consultant can fully operate. Implications for practice The implications for practice are derived from the results of the synthesised findings. An organisation, through its policies, practices, procedures and individuals, must support the consultant‟s leadership and collaborative goal directed approach to care delivery and service development. This can be achieved by allowing the consultant both autonomy and authority. The synthesised findings reinforce the need to optimise the facilitators and minimise the inhibitors of role development. They can also make a contribution to the conceptual understanding of the consultant role. Implications for research Further research into the experiences of consultant nurses is necessary – in particular, how nurse consultants interpret their relationships with others, negotiate resources and demonstrate the impact of their role in each of the core functions, notably the leadership function.