bluuebunny/crossref_metadata_2025 huggingface dataset:
Dental Enamel Hypoplasias in Prehistoric Populations
Authors: Goodman A.H.
Published: January 2017

Recent years have witnessed an impressive increase in research on enamel hypoplasias in archaeological populations. By reviewing a series of studies of enamel hypoplasias at Dickson Mounds, Illinois, North America (950-1300 A.D.), a prehistoric site involved in the transition from gathering-hunting to agriculture, this paper provides an illustration of this type of research.

The location of linear hypoplasias on labial tooth surfaces of 111 adults was studied with a thin-tipped caliper, and this location was converted to an age at development. Most defects developed between two and four years of developmental age. Hypoplasias increased in prevalence from 45% in the pre-agriculture group to 80% in the agricultural group (p < 0.01). The transition to agriculture occurred at a cost to infant and childhood health. Defects are associated with decreased longevity. Individuals with defects have a life expectancy of nearly ten years fewer than those without defects, suggesting that the development of a defect marks a significant and lasting health event. Enamel hypoplasias occur most frequently on anterior teeth, polar teeth in developmental fields, and the middle developmental thirds of teeth. Analysis of these data suggests that enamel may be differentially susceptible to growth disruption and that susceptibility varies both within and among teeth.

The study of enamel defects at Dickson provides insights into the health and nutritional consequences of the economic change from hunting and gathering to agriculture. More generally, with the availability of teeth from genetically homogeneous populations, studies of enamel hypoplasias in prehistory should provide a useful complement to research on this condition in contemporary peoples.
Preventive Dental Materials: Sustained Delivery of Fluoride and Other Therapeutic Agents
Authors: Rawls H. Ralph
Published: January 2017

In the 1940's, it was observed that silicate restorative cements were seldom associated with secondary caries. Fissure sealants, designed to protect caries-prone surfaces, appeared in the 1960's. The 1970's and 1980's have seen an increasing emphasis on the use of dental materials for preventive purposes. Glass ionomers, the modern version of silicates, release fluoride and have been available for some time. Polymeric materials that release various therapeutic agents are currently under development for use in topical anesthetic, endodontic, prosthodontic, and periodontal applications. An attachable membrane-reservoir device for oral fluoride delivery will soon be available for general clinical use. Several fluoride-releasing filling and adhesive resins have recently been marketed. These materials are the leading edge of a new class of preventive materials that serve as controlled-release and/or site-specific sources of therapeutic agents. This trend is expected to continue, and the near future should see the introduction of additional oral sustained-delivery systems for use in periodontal and other applications.
Dental Materials Related to Prevention— Fluoride Incorporation Into Dental Materials: Reaction Paper
Authors: Ripa L.W.
Published: January 2017

Rather than a specific commentary to Dr. Rawls' presentation, this reaction paper discusses the general concept of fluoride addition to dental materials. The genesis of the concept is reviewed, but more important is a critique of the rationale for the deliberate addition of fluoride to dental materials. Researchers and practicing dentists should realize that if the principal reason for the addition of fluoride is to prevent dental caries, the ultimate test of that rationale is a controlled clinical trial. Thus, although a number of questions need to be answered when fluoride is introduced into dental materials, the most important is: Does it inhibit dental caries?
Etiologic Theory and the Prevention of Temporomandibular Disorders
Authors: Clark G.T.
Published: January 2017

Over the last 75 years, a variety of etiologic factors has been suggested as the cause of pain and dysfunction in the temporomandibular system. The earliest and still-popular etiologic theory proposed that temporomandibular disorders are induced by abnormal structure, usually described as a malocclusion of the teeth or jaws. The fact that this theory was based on mechanical concepts, ignored biologic diversity, and had limited factual experimental evidence to support it as well as extensive evidence in opposition did not seem to matter to its proponents. In the late 1960'sand early 1970' s, the structural occlusal model for TM Disorders was challenged and has yielded ground to a more multifactorial model of TMD causation. Other etiologic factors for TM disorders-such as anatomical susceptibility of TM tissues to trauma, polyarthritic diseases, joint laxity, repetitive parafunctional behaviors, and stress-related muscle dysfunction-need to be recognized and quantified. Unfortunately, many practicing dentists demonstrate a very poor understanding of and often fail to recognize these etiologic factors as agents that produce TM disorders. This failure is largely due to the fact that the dental profession has spent the last 90 years dealing with a variety of misconceptions about the etiology of temporomandibular disorders. In the 1990's, one of the more formidable challenges we face is acquiring the ability to segregate and define validly the specific TM Disorder of concern and then correctly identify and measure the specific etiologic factors that produce it. Until these problems are solved, it is unlikely that we will be able to prevent disease of the TM apparatus.
Geriatric Dentistry and Prevention: Research and Public Policy (Reaction Paper)
Authors: Meyerowitz C.
Published: January 2017

The population of older adults is heterogeneous and can be divided into many subgroups: the young-old, the old-old, the healthy, the sick, the frail, the mentally and physically handicapped, the ambulatory, the chair-bound, house-bound or institution-bound, and the economically advantaged and disadvantaged. This diversity is extremely important to the discussion of the oral health needs, preventive health strategies, and research agenda for the elderly. As life expectancy increases, more attention is being paid to disease prevention so that the quality of life in old age can be improved. However, the link among oral health, systemic disease, and quality of life in the elderly needs to be better-defined. There is some evidence in the literature that indicates that coronal and root caries appear to be major health problems for the elderly. This needs to be corroborated in longitudinal studies. Although periodontal disease prevalence and severity are high in some subgroups of the elderly, these appear to be in decline in the general population. Dental health-care workers must be cognizant of the oral conditions associated with systemic disease and the use of medication, a major concern in older adults. Prevention of oral disease in the elderly requires early intervention, education of the dental health team, and innovative uses of well-established preventive agents such as fluoride. An extensive research effort is needed to answer basic and applied questions regarding the oral health needs of the elderly. Federal and private funding will be necessary. The dental profession will have to demonstrate and be persuasive that money spent on research and care for the elderly is money well spent.
Prevention Revisited— Summary of Scientific Symposium
Authors: Kennedy J.E. , Geddes D.A.M.
Published: January 2017

A symposium, "Prevention Revisited", was held in September of 1990 in Rochester, New York, as part of the 75th Anniversary celebration of the Eastman Dental Center. The symposium covered a broad range of topics, including risk assessment for oral diseases, the diagnosis and classification of periodontal diseases, caries prevention, fluorides, dental materials, TMJ disorders, and the geriatric patient. Each topic was approached from the perspective of prevention: past accomplishments, present status, and future directions. A format of major presentations, reactor papers, and discussion was used.
Biodegradation of Restorative Metallic Systems
Authors: Lucas Linda C. , Lemons Jack E.
Published: January 2017

Metallic materials utilized for the construction of intra-oral and implant dental restorations include a wide range of relatively pure metals and multicomponent alloys. Basic corrosion and biodegradation properties of these alloys have been studied by both in vitro and in vivo techniques. These property characteristics have been shown to be dependent on composition and metallurgical state, combinations within a construct, surface conditions, mechanical aspects of function, and the local and systemic host environment. The susceptibility of these metallic materials to various forms of biodegradation will be presented, with emphasis on corrosion.
Future Needs for Dental Restorative Materials
Authors: Douglass C.W.
Published: January 2017

While the population of the United States increases from 250 to 310 million people, the number in older age groups will increase dramatically from 28 million to about 64 million. Tooth retention has improved remarkably in the 65-74 age groups, from 7.4 in 1962 to 17.9 in 1986. While younger age groups will require less treatment due to decline in dental caries, older age groups appear to require more treatment than did similar age cohorts in previous generations. Hence, the need for restorative procedures by the United States population will be on an upward trend for the next decade or two.
Degradability of Dental Ceramics
Authors: Anusavice K.J.
Published: January 2017

The degradation of dental ceramics generally occurs because of mechanical forces or chemical attack. The possible physiological side-effects of ceramics are their tendency to abrade opposing dental structures, the emission of radiation from radioactive components, the roughening of their surfaces by chemical attack with a corresponding increase in plaque retention, and the release of potentially unsafe concentrations of elements as a result of abrasion and dissolution.

The chemical durability of dental ceramics is excellent. With the exception of the excessive exposure to acidulated fluoride, ammonium bifluoride, or hydrofluoric acid, there is little risk of surface degradation of virtually all current dental ceramics. Extensive exposure to acidulated fluoride is a possible problem for individuals with head and/or neck cancer who have received large doses of radiation. Such fluoride treatment is necessary to minimize tooth demineralization when saliva flow rates have been reduced because of radiation exposure to salivary glands. Porcelain surface stains are also lost occasionally when abraded by prophylaxis pastes and/or acidulated fluoride. In each case, the solutes are usually not ingested.

Further research that uses standardized testing procedures is needed on the chemical durability of dental ceramics. Accelerated durability tests are desirable to minimize the time required for such measurements. The influence of chemical durability on surface roughness and the subsequent effect of roughness on wear of the ceramic restorations as well as of opposing structures should also be explored on a standardized basis.
Non-Dental Tissue Effects of Fluoride
Authors: Kleerekoper M.
Published: January 2017

The anti-caries effects of water fluoridation are well-established. The non-dental tissue effects of fluoride in drinking water, either naturally occurring or as an additive, have been too poorly studied to permit definitive conclusions to be drawn. Claims have been made that fluoride results in an increased occurrence of malignancies, particularly osteogenic sarcoma. Experimental rat data have not resolved this issue, and epidemiologic studies are equally unclear. Initial claims that fluoride offers protection against atherosclerosis remain viable, but here too, much more directed research is needed. Early studies suggested that a water fluoride content greater than 1 ppm resulted in a lower prevalence of osteoporotic fractures. Recent epidemiologic data seriously question this conclusion and raise the possibility that even this relatively low level may increase the prevalence of osteoporotic hip fractures. Other elements, including calcium and magnesium, also vary in amount as water fluoride content varies, and it has proved difficult to distinguish the independent effects of the various nutrients in water from each other. Therapeutic use of fluoride has been largely restricted to studies of its effect on the osteoporotic vertebral fracture rate. After more than 30 years of detailed study, this important issue remains unresolved. This review provides an overview of these issues, focusing on the uncertainties alluded to, and attempting to develop strategies for future research.
Determination of Fluorine in Biological Materials: Reaction Paper
Authors: Ophaug R.
Published: January 2017

Although the fluorine in human tissues may exist in both inorganic and organic (covalently bound) forms, the inorganic fraction is clearly the most relevant for assessing human exposure to, and utilization of, environmental fluoride. There is now general agreement that the inorganic fraction of total tissue fluorine can be accurately determined by a variety of analytical techniques. One of the basic questions considered at this workshop is whether the analysis of a specific tissue or body fluid can provide an estimate of how much of the fluoride to which an individual is exposed actually enters and accumulates in the body. The analysis of hair and nails has been used as an indicator of exposure and utilization for several trace elements, including fluoride. Due to methodological uncertainties regarding sampling and pre-analysis treatment, however, it is presently not possible clearly to distinguish fluoride which is incorporated into hair and nails during formation (endogenous) from that which becomes associated with the tissues following exposure to the environment (exogenous). Consequently, although the fluoride content of hair and nails is clearly increased by environmental exposure to fluoride, the conclusion that these tissues are suitable indicators of fluoride utilization and accumulation in the body is premature.
Manufacturing cell formation with flexible processing capabilities and worker assignment: Comparison of constraint programming and integer programming approaches
Authors: Baykasoğlu Adil , Topaloğlu Şeyda , Şenyüzlüler Filiz
Published: January 2017

Cell formation deals with grouping of machines and parts in manufacturing systems according to their compatibility. Manufacturing processes are surrounded with an abundance of complex constraints which should be considered carefully and represented clearly for obtaining high efficiency and productivity. Constraint programming is a new approach to combinatorial optimization and provides a rich language to represent complex constraints easily. However, the cell formation problems are well suited to be solved by constraint programming approach since the problem has many constraints such as part-machine requirements, availabilities in the system in terms of capacity, machine and worker abilities. In this study, the cell formation problem is modeled using machine, part processing and worker flexibilities via resource element–based representation. Resource elements define the processing requirements of parts and processing capabilities of machines and workers, which are resource-independent capability units. A total of 12 case problems are generated, and different search phases of constraint programming are defined for the solution procedure. The cell formation problem is modeled in both constraint programming and integer programming, and a comparative analysis of constraint programming and integer programming model solutions is done. The results indicate that both the models are effective and efficient in the solution of the cell formation problem.
Investigation of two pipe diffuser configurations for a compact centrifugal compressor
Authors: Han Ge , Lu Xingen , Zhang Yanfeng , Zhao Shengfeng , Yang Chengwu , Zhu Junqiang
Published: January 2017

Diffusers are one of the most important factors determining the centrifugal compressor performance. The present work is aimed at providing a detailed understanding of the underlying flow and loss mechanisms in three different diffusers in a compact centrifugal compressor stage. Experimental and computational studies were conducted for various diffuser configurations, e.g. two pipe diffusers and one wedge diffuser, while keeping the throat in all the three geometries. It was found that both the pipe diffuser configurations had better aerodynamic performance than the original wedge diffuser. Furthermore, the pipe diffuser with a fishtail arrangement exhibited greater performance improvement, but had more distortion outflow than the wedge diffuser and the radial pipe diffuser because of the strong jet and wake structure caused by the fishtail turn. Nevertheless, the fishtail configuration has a smaller discharge swirl angle, which would have a positive impact on the performance of the combustor. As a result, the fishtail pipe diffuser configuration was recommended in compact centrifugal compressors.
Knowledge and preferences concerning acute HIV testing programs among both Peruvian men who have sex with men and transgender women
Authors: Wandell Grace M , Molina Yamile , Sánchez Hugo , Greer Anna C , Ríos Jessica , Bain Carolyn , Segura Patricia , Lama Javier R , Sánchez Jorge , Duerr Ann
Published: January 2017

Immediate antiretroviral therapy (ART) for acute HIV infection (AHI) may decrease HIV transmission in high-risk populations. This study evaluated knowledge of AHI and AHI testing program preferences in Lima, Peru through four semi-structured focus groups with high-risk men who have sex with men (MSM) ( n = 20) and transgender women (TW) ( n = 16). Using content analysis, emergent themes included knowledge of AHI symptoms, AHI transmission potential, and the HIV testing window period, and preferences concerning point of care results. Participants demonstrated low familiarity with the term AHI, but many correctly identified AHI symptoms. However, these symptoms may not motivate testing because they overlap with common viral illnesses and AIDS. Some were aware that infectiousness is highest during AHI, and believe this knowledge would facilitate HIV testing. The shortened window period with AHI testing would encourage testing following high-risk sex. Delayed result notification would not decrease AHI testing demand among MSM, although it might for some TW.
The theoretical modeling and experimental validation for distributed defect on inner race of ball bearing under radial load
Authors: Kulkarni SS , Bewoor AK , Ingle RB
Published: January 2017

This article presents the theoretical model to study the vibration characteristics of ball bearing. The vibration analysis is accounted for peripheral motions of rolling elements as well as inner and outer races using the Lagrangian approach. In this mathematical model, the contact between the balls and the bearing races is considered as nonlinear springs, whose stiffness is obtained using the Hertzian elastic contact deformation theory. The nonlinear equations of motions are solved by the Runge–Kutta method iteratively. The effects of extended defect on the inner race of the bearing at different speeds and defect sizes have been studied for predicting the vibration response of the bearing. The fast Fourier transformation shows that the vibration characteristic of the ball bearing changes when the ball interacts with the defect as a result of nonlinear load–deflection relation. The analysis implied that defect size and speed of ball bearing are the influencing parameters affecting the dynamic behavior of the ball bearing.
Evaluation of noise when a disturbing sound source cannot be off
Authors: Trematerra Amelia
Published: January 2017

This article shows the results of a method of acoustic measurements performed when a disturbing sound source cannot be turned off. This case happens when it is not possible accessing to disturbing sound source that we want to characterize, or when it cannot be switched off for reasons linked to production cycle. It is possible to carry out acoustic measurement of residual noise (noise present when disturbing source is off) with the technique of acoustically similar place. The residual noise in a certain area is a result of noise level emitted from various sound sources operating with a certain typicality in a considered area. This noise is going to be combined with noise of disturbing sound source, in place where complaints show up. If it is not possible to control disturbing sound source, residual noise surveys may be carried out in a similar place, or in a place where an environmental noise is equal and the influence of disturbing sound source is negligible.
Down by Science: Context and commitment in the lay response to incriminating scientific evidence during a murder trial
Authors: Edmond Gary
Published: January 2017

This paper explores responses to scientific evidence from a lay person accused of murder. These responses are examined with reference to the specific (here legal) contexts in which they were offered. This paper will provide some analysis of the motivations or goals behind some particular lay understandings of scientific evidence, and the function which representations of these understandings were designed to fulfill as the accused attempted to prove her innocence. The specific contexts will be seen to influence the shaping and configuring of scientific knowledge as well as the manner in which various audiences attend to that knowledge and its perceived implications. The discussion will also raise the appropriateness of maintaining a rigid dichotomy between lay and expert knowledges. In conclusion I will emphasize the importance of a more symmetrical and sociologically informed analysis of both expert and lay approaches to scientific knowledge.
Drawing the line: an analysis of lay people's discussions about the new genetics
Authors: Kerr Anne , Cunningham-Burley Sarah , Amos Amanda
Published: January 2017

“Where do we draw the line?” is a question that is frequently asked in discussions about the new genetics. In this paper we explore a range of lay people's accounts of drawing the line. We show that, beyond its rhetorical function, answering this question involves important discussions about genetic research, testing, regulation, and social provision for people who are sick or disabled. It raises difficult questions about clients' and service providers' autonomy and responsibility and about which human illnesses, conditions, and characteristics ought to be the subject of research and testing. In particular, we show how differences in the amount and type of information and advice available to clients of genetic testing, the level of social support to people with particular conditions, and people's perception of stigma, suffering, and quality of life, make drawing the line highly problematic. We end by discussing the implications of our analysis for policy making, considering how the ambiguities and tensions in lay accounts might enable, as opposed to stifle, greater democratization of the new genetics.
The scientist as artist: a study of The Man in the White Suit and some related British film comedies of the postwar period (1945-1970)
Authors: Jones Robert A.
Published: January 2017

The Man in the White Suit is perhaps the major representation of a scientist in mainstream British films of the postwar period. The film was immensely popular at the time of its release in 1951 and continues to be influential today. This paper, which is part of an ongoing study of the image of scientists presented by the cinema during this period, analyzes The Man in the White Suit by comparing it with another film of the period, The Horse's Mouth, which presents an image of an artist, and two related film comedies. Many similarities can be seen between the characters of the scientists and the artists presented in these films. The reason for this, and the origin of the artist stereotype in the Romantic period of the early nineteenth century, are discussed. It is concluded that the stereotype of the artist is used as a model for the scientist because of the lack of familiarity with the nature of scientific creativity; artists and scientists may be treated similarly because both are seen as existing outside of the British class system. The question of whether the apparent innocence of the scientist in these films is seen as admirable or reprehensible is also discussed.
Ordinary women and shapes of knowledge: perspectives on the context of STD and AIDS
Authors: Wallman Sandra
Published: January 2017

In Europe, as well as in Africa, HIV-related studies of women tend to focus on narrowly-defined professional, behavioral, or reproductive categories. The research population for this study of symptom definition and treatment-seeking among women in Kampala, Uganda, was defined only by residence in one low-income “parish” of that city. Its practical justification is the association of STD and HIV: effective treatment of (curable) STD can reduce the risk of HIV infection.

STD and AIDS, however prevalent, are never the only things ordinary people have to worry about; their capacity for preventing, managing, or explaining infection is dependent on the range of other things that may be happening in their lives. An analyst-observer's view is by contrast narrower, and the context of scientific understanding is different. This paper sets out an approach that stresses the differences between “real people” knowledge and scientific or professional knowledge about the problem, and between practical and symbolic levels of context. In the light of this approach the seeming chaos of what these women do—or do not do—about getting treatment for STD becomes intelligible.

I conclude that the contingency of context and the gap between “real” and “scientific” understanding combine to account for the normal inconsistency of social data, and that the proper use of a context perspective renders these data intelligible.
Healthcare Norms under Universal Healthcare (UHC) for Maharashtra
Authors: George Mathew
Published: January 2017

Healthcare norms of a nation also reflect the extent of preventive, promotive, curative and rehabilitative services that is expected to be delivered by a nation’s health services system. It is a reflection of the model of healthcare delivery proposed, whether it is a physician-intensive model where the doctor requirement for a population is much higher than a community-health-worker-based model. Healthcare norms need to be differentiated from human resource requirement for health as the latter largely revolves around the professional to population ratio, which not only fail to consider inequities in the regional distribution of health personnel but also undermine the institutional level strengthening required for effective delivery of services. Thus, the present article is an attempt to propose a healthcare norm for the state of Maharashtra. This article will have two parts, first is the curative component, which is proposed based on the projected morbidity prevalence of the population, and the second part is the norm for a public health system competent enough to address the essential public health functions.
Health Management/Leadership of Small Island Developing States of the English-speaking Caribbean
Authors: Greaves Damian E.
Published: January 2017

Over the last decade, small island states of the English-speaking Caribbean have been embarking on health sector reform initiatives in order to strengthen the quality of the delivery of health services. The wave of health sector reform measures has not placed emphasis on the management/leadership of health care delivery systems which tend to be generally weak. This in turn affects the improved delivery of quality services and superior quality health care. Management and leadership are understood as the capacity to guide the health sector’s institutions and to mobilize stakeholders, organizations and social groups. The general idea is that there are a number of challenges that affect health management of the small island developing states (SIDS) and the efficient organization of these dynamic, complex health systems. These challenges are tied to the unique cultural, organizational and political characteristics of island states. In all of this, the competencies and unique roles required of senior managers/leaders in a SIDS setting are called to question.

Objective

This article provides an overview of the management/leadership of health systems in SIDS of the English- speaking Caribbean region. It highlights the weaknesses and challenges of management and organization of these systems which in turn impact the desired outcome of promotion of quality delivery of health care. It also examines roles of senior health managers/leaders in the economic, social, political and cultural context of SIDS. The article strongly advocates the need for in-depth study of the challenges that bedevil efficient and effective management of health systems in the region as well as the processes that constrain or facilitate the activities of senior health managers. It also highlights the need for an investigation into competencies that health managers/leaders demonstrate and perceive that they need in effectively managing these health care delivery systems.

Method

I wrote this article based on literature review, experience as minister for health of the Ministry of Health of Saint Lucia—one of the island states of the English-speaking Caribbean—and in-depth, semistructured interviews with senior health managers/leaders across the region.
The Predictors of Employee Engagement: A Study in a Ferro Alloys Company of India
Authors: Mishra Sasmita , Mohanty Jitendra Kumar
Published: January 2017

Employee engagement is now the buzzword for any organization. Although it was initially believed that a satisfied employee is the most engaged employee, contradictory findings have compelled researchers to identify alternate models of engagement. In the same line of thought, this study aims at identifying the triggers of employee engagement. Employees in the payroll of a reputed ferro alloys company of India were surveyed to obtain relevant information on employee engagement. Data analysis on 250 responses reveals that factors such as age, senior leadership, manager, colleagues, customers, work, resources, processes, career opportunities, learning and development, work–life balance, physical work environment, policies, people practices, performance assessment, diversity, company reputation, pay, benefits and recognition significantly correlated with employee engagement. However, on account of multicollinearity, when stepwise regression was conducted, following factors were found to be significantly predicting employee engagement: senior leadership, work, company reputation, manager, process, colleague and physical work environment. Results were discussed in relations to recent findings in other industries.
Does Citizen Participation Improve Local Planning? An Empirical Analysis of Stakeholders’ Perceptions in Nepal
Authors: Pandeya Ganesh Prasad , Shrestha Shree Krishna
Published: January 2017

Using a qualitative approach, based on extensive fieldwork and surveys, this article examines how participatory institutions in Nepal perform and affect local planning. The evidence points to mixed outcomes: citizen participation can improve local planning, especially with regard to achieving planning efficacy and equity; and at the same time, it sometimes yields no such effects or may produce negative effects including raising expectations, skewing priorities and producing faulty compartmentalization, besides adding to administrative complexities. This is because the anticipated benefits of citizen participation are strongly embedded in local, socio-political realities such as the degree of power exercised by the local elites, mainly politicians, a collusive nexus among them, prior history of citizen mobilization and empowerment and the degree to which citizens and civil society organizations are able to exercise their agency to countervail those forces.
Book review: Harsh Singh, Vinayak Damle, Devilal Vyas, Ramila Vyas and Vishnu Khedkar, Towards a Local Livelihood Security Framework: Evidence from Small and Marginal Farmers in Dungarpur
Authors: Bedamatta Rajshree
Published: January 2017

Harsh Singh, Vinayak Damle, Devilal Vyas, Ramila Vyas and Vishnu Khedkar, Towards a Local Livelihood Security Framework: Evidence from Small and Marginal Farmers in Dungarpur. New Delhi: Academic Foundation, 2013, ₹695 (Hardbound), 132 pp.
Sex Steroid Hormones and Cell Dynamics in the Periodontium
Authors: Mariotti Angelo
Published: January 2017

The biological changes that occur in tissues of the periodontium during puberty, the menstrual cycle, pregnancy, menopause, and oral contraceptive use have heightened interest in the relationship between sex steroid hormones and periodontal health. These clinical observations coupled with tissue specificity of hormone localization, identification of hormone receptors, as well as the metabolism of hormones have strongly suggested that periodontal tissues are targets for androgens, estrogens, and progestins. The etiologies of periodontal endocrinopathies are diverse; nonetheless, periodontal pathologies may be a consequence of the actions and interactions of sex steroid hormones on specific cells found in the periodontium.
Using Problem-Solving Therapy to Reduce Depressive Symptom Severity Among Older Adult Methadone Clients
Authors: Rosen Daniel , Engel Rafael , McCall Janice , Greenhouse Joel
Published: January 2017

Objective:

Treatment of older adults in methadone maintenance treatment (MMT) with comorbid mood disorders presents many challenges. The goal of this randomized controlled trial was to assess the combined effect of problem-solving therapy (PST) with treatment as usual (TAU) compared to TAU alone on decreasing depressive symptoms in opioid-addicted older adults in MMT.

Methods:

Sixty-four methadone clinic attendees, at least 50 years old, with moderate depressive symptom were randomized to PST + TAU ( n = 29) or TAU ( n = 35). PST is an intervention for depressed older adults with a focus on teaching problem-solving skills.

Results:

There was not a statistically significant difference in depression scores between the two treatment groups. However, there is evidence for a clinically meaningful decrease in symptoms in the PST + TAU group 7 months post treatment (Cohen’s d = .57)

Conclusion:

Clinical implications of PST + TAU in comparison to TAU on depressive symptom seemed to have lasting benefits at 6-month post treatment.
Developing Knowledge Connections to Promote an Integrated Learning Experience for Students in a First Year Management Course
Authors: Connolly Heather , Spiller Dorothy
Published: January 2017

A key challenge for lecturers of many first year Management courses is how to help students create meaningful knowledge connections while at the same time introducing considerable foundational material. This article reports on an instructional innovation that explores how we can better design and teach a first year Management course that provide strategies which assist students to engage with course ideas and recognize relationships between concepts. In addition to deliberate and systematic alignment of design, teaching and learning strategies, and assessment tasks, we use concept mapping to support learners in the construction of their own meaning of course material; to connect, and integrate key concepts. Our approach demonstrates that when students are provided with the space and tools to support the development of meaningful knowledge connections, their learning can improve.
Pharmacy-Based Intervention to Reduce Antibiotic Use for Acute Bronchitis
Authors: Hickman David E , Stebbins Marilyn R , Hanak John R , Guglielmo B Joseph
Published: January 2017

BACKGROUND:

Intervention programs can reduce inappropriate antibiotic use for the treatment of acute bronchitis in a closed health maintenance organization model.

OBJECTIVE:

To evaluate the impact of a pharmacy-based intervention program intended to reduce antibiotic use in the treatment of acute bronchitis in a community-based physician group model.

SUBJECTS:

Adult and pediatric patients with an office or urgent care visit for acute bronchitis during the baseline and study periods were included in the study. The clinicians were primary care physicians, nurse practitioners, and physician assistants in a suburban community-based physician group setting.

METHODS:

All patients treated for acute bronchitis from January 1 through June 30, 1998, were evaluated for initial receipt of antibiotics and use of clinic resources (office visits, additional antibiotics). From September through December of 1998, physicians were provided literature from the Centers for Disease Control and Prevention (CDC), cough and cold package inserts, and newsletters intended to educate the providers regarding the inappropriateness of antibiotics in the treatment of acute bronchitis. Patient-directed literature from the CDC was placed in the examination rooms and clinic waiting areas beginning September 1998. From January 1 through June 30, 1999, all patients treated for acute bronchitis were assessed for receipt of antibiotics and use of clinic resources. A separate geographic clinic site served as a control during both study periods.

RESULTS:

During 1998, 888 of 1840 patients (48.3%) received antibiotics for treatment of acute bronchitis; this total decreased to 924 of 2392 (38.6%; p ≤ 0.001) in 1999, a reduction of 20%. The rate of antibiotic prescribing in control patients was unchanged during the concomitant time periods (142/446, 31.8% vs. 102/321, 31.8%). The rate of subsequent physician visits was similar (8% vs. 9%) between patients receiving antibiotics and those who did not. However, significantly more patients initially receiving antibiotics required a subsequent antibiotic prescription (45/1812, 2.5% vs. 24/2420, 1.0%; p ≤ 0.001).

CONCLUSIONS:

A pharmacy-based intervention program reduces the incidence of inappropriate antibiotic use in the treatment of acute bronchitis. Reduced antibiotic prescribing does not increase consumption of healthcare resources; patients who receive antibiotics for acute bronchitis are more likely to subsequently require additional antibiotic prescriptions. While a significant decrease in antibiotic use was realized, other interventions are required to further reduce the prevalence of antibiotic use in acute bronchitis.
Serotonin Syndrome Induced by Low-Dose Venlafaxine
Authors: Pan Jan-Jhy , Shen Winston W
Published: January 2017

OBJECTIVE:

To report the case of a patient with serotonin syndrome induced by low-dose venlafaxine.

CASE SUMMARY:

A 29-year-old Taiwanese woman with major depressive disorder abruptly developed serotonin syndrome during low-dose (37.5 mg/d) venlafaxine monotherapy, with symptoms of restlessness, tremor, shivering, diarrhea, vomiting, ataxia, tachycardia, and myoclonus. The patient recovered in 2 hours after receiving prochlorperazine and lorazepam in the emergency department. Venlafaxine was discontinued, and she was discharged home. Two weeks later, the patient started to receive fluoxetine 20 mg/d and reported no adverse adverse effects during follow-up clinic visits.

DISCUSSION:

The clinical manifestations of this case meet Sternbach's criteria of serotonin syndrome. Its possible etiologic factors include panic attack, adverse drug reaction, pharmacodynamic interaction, and congenital absence of CYP2D6 enzyme activity. The Naranjo probability scale suggested a probable causality of venlafaxine treatment and serotonin syndrome.

CONCLUSIONS:

Clinicians should be aware of the risk of serotonin syndrome when the patient receives not only a combination of 2 antidepressants, but also the single potent serotonergic agent venlafaxine.
Fenofibrate Potentiates Warfarin Effects
Authors: Kim Karissa Y , Mancano Michael A
Published: January 2017

OBJECTIVE:

To describe 2 patients in whom the initiation of fenofibrate potentiated warfarin's anticoagulant effects.

CASE SUMMARY:

A 71-year-old white woman and an 80-year-old white woman with multiple medical conditions were both stabilized on long-term warfarin therapy. During the course of anticoagulation, both patients were prescribed fenofibrate and experienced threefold and twofold increases in international normalized ratio (INR), respectively, requiring total weekly warfarin dosage reductions of 30–40%. Before starting fenofibrate therapy, both patients' coagulation values were within the therapeutic range. When interviewed, patients and caregivers denied bleeding, bruising, changes in diet, alcohol ingestion, nonadherence with therapy, or changes in drug regimen except for the addition of fenofibrate. Upon chart review, evaluation of potentially contributory parameters, such as other changes in drug therapy, thyroid function, liver function, and drug–disease interactions, showed that these parameters remained stable and were ruled noncontributory.

DISCUSSION:

The addition of fenofibrate in 2 patients on stable and therapeutic doses of warfarin increased the anticoagulant response to warfarin. A clear temporal relationship with the addition of fenofibrate and the appearance of the interaction was seen. Fenofibrate is highly protein bound, with the potential to displace warfarin from its binding protein, leading to an enhanced hypoprothrombinemic effect. Fenofibrate is also a mild to moderate inhibitor of CYP2C9, the enzyme responsible for warfarin metabolism. The combination of these effects — displacement of warfarin by fenofibrate coupled with decreased metabolism of warfarin — may increase the anticoagulant response to warfarin. Using the Naranjo probability scale, these interactions were designated as probable.

CONCLUSIONS:

We suggest serial monitoring of INR and consider an empiric 20% reduction in warfarin dosage when fenofibrate is initiated, with the possibility for a greater warfarin dosage reduction based on INR results.
Lepirudin Use in a Neonate with Heparin-Induced Thrombocytopenia
Authors: Nguyen Thuy N , Gal Peter , Ransom J Laurence , Carlos Rita
Published: January 2017

OBJECTIVE:

To describe a case of heparin-induced thrombocytopenia (HIT) in a premature infant and the doses of danaparoid and lepirudin needed to achieve appropriate therapeutic endpoints.

CASE SUMMARY:

A 30-week gestational age infant was diagnosed with HIT with heparin antibodies. Danaparoid 2.0–2.4 units/kg/h achieved anti-Xa levels of 0.2–0.4 U/mL, but thrombocytopenia failed to resolve. Lepirudin was started in place of danaparoid. Lepirudin doses of 0.03–0.05 mg/kg/h achieved target activated partial thromboplastin time values of 1.5–2.0 times baseline.

DISCUSSION:

Dosing information for danaparoid in neonates is limited, and information for lepirudin appears only in German literature at this time. HIT is well documented in newborns, and lepirudin use in these situations is likely to increase. This report provides some guidance for optimal dosing. It also provides some guidance for HIT evaluation in preterm infants, in whom blood volume for laboratory tests is a major issue.

CONCLUSIONS:

HIT is an important and potentially fatal problem in neonates. Lepirudin may be the drug of choice, especially since danaparoid is now unavailable. Initial lepirudin dosing should not exceed 0.05 mg/kg/h.
Tamoxifen for Prevention of Breast Cancer
Authors: Cersosimo Robert J
Published: January 2017

OBJECTIVE:

To review data on the use of tamoxifen for primary prevention of breast cancer.

DATA SOURCES:

A literature search was performed through MEDLINE (1992–May 2002) using the key words tamoxifen, breast cancer, and prevention.

DATA SYNTHESIS:

Breast cancer is the most common malignancy detected in American women. Attempts to reduce morbidity and mortality include early detection programs and chemoprevention. Clinical trials of tamoxifen for reduction of breast cancer risk are reviewed.

CONCLUSIONS:

Tamoxifen may reduce the risk of primary breast cancer in women at increased risk. The benefit of tamoxifen in women who are not at risk is uncertain. The risks of developing thromboembolic disorders or endometrial cancer must be considered before tamoxifen is prescribed. Women should be given all of the information about the benefits and risks of tamoxifen use so that they can make an informed decision based on the best data available.
Association of HMG-CoA Reductase Inhibitors with Neuropathy
Authors: Backes James M , Howard Patricia A
Published: January 2017

OBJECTIVE:

To review the possible association between statins and peripheral neuropathy.

DATA SOURCES:

Literature was obtained from MEDLINE (1984–September 2002) and International Pharmaceutical Abstracts (1970–June 2002). Key search terms included statin, neuropathy, and HMG-CoA reductase inhibitor.

DATA SYNTHESIS:

Epidemiologic studies and case reports suggest an increased risk of peripheral neuropathy with statin drugs. Most patients were receiving long-term therapy, although the onset was highly variable. The majority of cases were at least partially reversible with drug cessation. Specific risk factors or mechanisms have not been identified.

CONCLUSIONS:

Observational data suggest a link between chronic statin use and increased risk of peripheral neuropathy. However, the risk appears to be small relative to the significant cardioprotective benefits.
Ivermectin for the Treatment of Resistant Scabies
Authors: Cook Aaron M , Romanelli Frank
Published: January 2017

OBJECTIVE:

To assess the clinical literature describing the use of ivermectin in cases of treatment-resistant scabies infestations.

DATA SOURCES:

Clinical literature accessed through a MEDLINE search (1966–July 2001) and the Cochrane Database.

DATA SYNTHESIS:

A limited number of case reports and case series describes successful intervention with ivermectin use in patients who have failed prior therapy. Ivermectin may serve as a viable alternative therapy as the incidence of resistant scabitic infestations increases.

CONCLUSIONS:

Ivermectin appears to be a safe and effective alternative for patients with treatment-resistant scabies. Larger, controlled clinical trials are required before this therapy can be recommended in the general population or as primary therapy.
Personal Digital Assistant Applications for the Healthcare Provider
Authors: Keplar Kristine E , Urbanski Christopher J
Published: January 2017

OBJECTIVE:

To review some common medical applications available for personal digital assistants (PDAs), with brief discussion of the different PDA operating systems and memory requirements. Key search terms included handheld, PDA, personal digital assistants, and medical applications.

DATA SOURCES:

The literature was accessed through MEDLINE (1999–August 2002). Other information was obtained through secondary sources such as Web sites describing common PDAs.

DATA SYNTHESIS:

Medical applications available on PDAs are numerous and include general drug references, specialized drug references (e.g., pediatrics, geriatrics, cardiology, infectious disease), diagnostic guides, medical calculators, herbal medication references, nursing references, toxicology references, and patient tracking databases. Costs and memory requirements for these programs can vary; consequently, the healthcare provider must limit the medication applications that are placed on the handheld computer.

CONCLUSIONS:

This article attempts to systematically describe the common medical applications available for the handheld computer along with cost, memory and download requirements, and Web site information. This review found many excellent PDA drug information applications offering many features which will aid the healthcare provider. Very likely, after using these PDA applications, the healthcare provider will find them indispensable, as their multifunctional capabilities can save time, improve accuracy, and allow for general business procedures as well as being a quick reference tool. To avoid the benefits of this technology might be a step backward.