bluuebunny/crossref_metadata_2025 huggingface dataset:
Improvising in the vulnerable encounter: Using improvised participatory theatre in change for healthcare practice
Authors: Larsen Henry , Friis Preben , Heape Chris
Published: April 2018

Healthcare practitioners are often presented with vulnerable encounters where their professional experience is insufficient when dealing with patients who suffer from illnesses such as chronic pain. How can one otherwise understand chronic pain and develop practices whereby medical healthcare practitioners can experience alternative ways of doing their practice? This essay describes how a group of researchers have, over a number of years, developed improvised participatory theatre as a means of engaging healthcare practitioners, patients and other lay people in situations where it is legitimate to reappraise their practice and reunderstand the nature of an illness such as chronic pain. One conclusion was to consider that it is a relational rather than an individual phenomenon that in turn demands alternative practice. Through iterative workshop processes of improvised theatre, participants are encouraged to experience the vulnerable, the unknown, and the need to be alternatively present when dealing with patients whose situation is imbued with suffering.
The seeing place: Talking theatre and medicine
Authors: Bowman Deborah , Bowman Joanna
Published: April 2018

A Professor of Medical Ethics and a theatre director, also mother and daughter, talk about health, illness, suffering, performance and practice. Using the lenses of ethical and performance theory, they explore what it means to be a patient, a spectator and a practitioner and cover many plays, texts and productions: Samuel Beckett’s Not I and All That Fall, Sarah Kane’s Crave, Tim Crouch’s An Oak Tree, Enda Walsh’s Ballyturk, Annie Ryan’s adaptation of Eimear McBride’s novel A Girl Is a Half-Formed Thing, Duncan MacMillan’s People, Place and Things and Henrik Ibsen’s Hedda Gabler. These were selected because first we have seen, studied or worked with each and they have continued to inspire us. Second, they offer rich and revealing insights into the ways in which meaning(s) is/are both negotiated and contested in relation to health and illness. It is the iterative negotiation of meaning(s) that, it is argued, is the essence of narrative practice, be it in medicine or in the theatre. The difference and divergence of perception, response and interpretation to dramatic performance can test relationships, be they professional, creative or familial. Yet, the capacity to understand, and embrace, disagreement and uncertainty is vital; fundamental to a flourishing life. For it is by recognising our part in creating narratives, broken and otherwise, that we can begin to recognise the necessary interactionism and humanity of both medicine and theatre.
Safety and feasibility audit of a home-based drug-transitioning approach for patients with pulmonary arterial hypertension: an observational study
Authors: Dawson A , Reddecliffe S , Coghlan C , Schreiber BE , Coghlan JG
Published: April 2018

Background:

Newer endothelin receptor antagonists (ERAs) used to treat patients with pulmonary arterial hypertension (PAH) are associated with fewer drug–drug interactions than bosentan and require less monitoring. This, combined with a pharmacokinetic basis for improved efficacy, means there may be a clinical rationale for changing therapies. However, this can be challenging and few data on its safety in patients with PAH are available.

Aims:

At the Royal Free Hospital in London, UK, home-based medication transitioning has been standard practice since 2009 to avoid unnecessary hospital visits for patients, unless there is a clinical imperative. In this audit of standard practice we evaluated the consequences of adopting such a strategy when transitioning PAH patients between ERA therapies.

Methods and results:

Using a Clinical Nurse Specialist-led, home-based transitioning strategy, 92 patients with PAH were transitioned from bosentan to macitentan or ambrisentan. Observational data were analysed retrospectively. The majority of patients were female with PAH associated with connective tissue disease and their ERA was changed in the hope of improving efficacy. The process was well tolerated with no adverse events associated with the process. Seventeen patients died during the study (macitentan, n = 5; ambrisentan, n = 12). None of the deaths was considered related to ERA treatment. The majority of patients remained clinically stable, based on WHO functional class and exercise capacity.

Conclusion:

An established home-based transitioning strategy can be adopted safely for patients with PAH changing ERA therapies. Most patients remained stable and the therapy change was well tolerated.
A comparative study of the online film ratings of US and Chinese audiences: An analytical approach based on big data
Authors: Feng Guangchao C
Published: April 2018

Many movies have influenced many societies in various ways, but the factors that affect films’ ratings remain understudied. This article goes beyond examining a variety of factors that determine such ratings by focusing on the interaction effect of the country difference with other predictors of film ratings between the world’s top two movie markets, the US and China, using big data gathered from the Internet. The country difference significantly moderates the effect of predictors such as the film’s year of release, its Motion Picture Association of America ratings, country of origin, and its awards. Predictors such as whether it was adapted from a novel, whether it was based on a true story, its production budget, and its ‘star power’ exert the consistent main effects on film ratings across the countries. However, box office success and sequels were found to be insignificant predictors of film ratings. The article then discusses the implications of these findings and suggests directions for future research.
The prevalence and predictors of elevated C-reactive protein after a coronary heart disease event
Authors: Munkhaugen John , Otterstad Jan Erik , Dammen Toril , Gjertsen Erik , Moum Torbjørn , Husebye Einar , Gullestad Lars
Published: April 2018

Objective

An interleukin-beta antagonist reduces the risk of subsequent cardiovascular events in coronary patients with high-sensitivity C-reactive protein (hs-CRP) ≥2 mg/L. It remains to be defined how large the coronary population at inflammatory risk is, and what the predictors of elevated risk are.

Methods

A cross-sectional study investigated the proportion of patients with elevated hs-CRP (i.e. ≥2 mg/L) and the respective demographic and clinical predictors in 971 patients without concomitant inflammatory diseases who had been hospitalized with myocardial infarction (80%) and/or a revascularization procedure. Data were collected from hospital records, a self-report questionnaire and a clinical examination with blood samples.

Results

After 2–36 month follow-up, 39% ( n = 378) had hs-CRP ≥ 2 mg/L, among whom 64% ( n = 243) had low-density lipoprotein cholesterol (LDL-C) ≥1.8 mmol/L and 47% ( n = 176) used a low-intensity statin regime. Only 24% had both LDL and hs-CRP at target range, 27% had elevation of both, whereas 12% had hs-CRP ≥ 2 mg/L and LDL-C < 1.8 mmol/L. Somatic comorbidity (odds ratio (OR) 1.3/1.0 point on the Charlson score), ≥1 previous coronary event (OR 2.4), smoking (OR 2.2), higher body mass index (OR 1.2/1.0 kg/m2), high LDL-C (OR 1.4/1.0 mmol/L) and higher anxiety scores (OR 1.1/1.0 point increase on the Hospital Anxiety and Depression Scale-Anxiety subscale score) were significantly associated with hs-CRP ≥2 mg/L in adjusted analyses.

Conclusions

Elevated hs-CRP was frequently observed after a coronary event and associated with unfavourable LDL-C and unhealthy lifestyles and psychosocial distress. Intensified statin therapy and strategies to target these modifiable factors are the encouraged first steps to reduce inflammation and improve LDL-C in these patients.
Thyroid-stimulating hormone and adverse left ventricular remodeling following ST-segment elevation myocardial infarction
Authors: Reindl Martin , Feistritzer Hans-Josef , Reinstadler Sebastian Johannes , Mueller Lukas , Tiller Christina , Brenner Christoph , Mayr Agnes , Henninger Benjamin , Mair Johannes , Klug Gert , Metzler Bernhard
Published: April 2018

Background:

Adverse left ventricular remodeling is one of the major determinants of heart failure and mortality in patients surviving ST-segment elevation myocardial infarction (STEMI). The hypothalamic–pituitary–thyroid axis is a key cardiovascular regulator; however, the relationship between hypothalamic–pituitary–thyroid status and post-STEMI left ventricular remodeling is unclear. We aimed to investigate the association between thyroid-stimulating hormone concentrations and the development of left ventricular remodeling following reperfused STEMI.

Methods:

In this prospective observational study of 102 consecutive STEMI patients, thyroid-stimulating hormone levels were measured at the first day after infarction and 4 months thereafter. Cardiac magnetic resonance scans were performed within the first week as well as at 4 months follow-up to determine infarct characteristics, myocardial function and as primary endpoint left ventricular remodeling, defined as a 20% or greater increase in left ventricular end-diastolic volume.

Results:

Patients with left ventricular remodeling ( n=15, 15%) showed significantly lower concentrations of baseline (1.20 [0.92–1.91] vs. 1.73 [1.30–2.60] mU/l; P=0.02) and follow-up (1.11 [0.86–1.28] vs. 1.51 [1.15–2.02] mU/l; P=0.002) thyroid-stimulating hormone. The association between baseline thyroid-stimulating hormone and left ventricular remodeling remained significant after adjustment for major clinical (peak high-sensitivity cardiac troponin T and C-reactive protein, heart rate; odds ratio (OR) 5.33, 95% confidence interval (CI) 1.52–18.63; P=0.01) and cardiac magnetic resonance predictors of left ventricular remodeling (infarct size, microvascular obstruction, ejection fraction; OR 4.59, 95% CI 1.36–15.55; P=0.01). Furthermore, chronic thyroid-stimulating hormone was related to left ventricular remodeling independently of chronic left ventricular remodeling correlates (infarct size, ejection fraction, left ventricular end-diastolic volume, left ventricular end-systolic volume; OR 9.22, 95% CI 1.69–50.22; P=0.01).

Conclusions:

Baseline and chronic thyroid-stimulating hormone concentrations following STEMI were independently associated with left ventricular remodeling, proposing a novel pathophysiological axis in the development of post-STEMI left ventricular remodeling.
Cost Recommendations in the Second Edition of Cost-Effectiveness in Health and Medicine: A Review
Authors: Nyman John A.
Published: April 2018

A 2nd edition of Cost-Effectiveness in Health and Medicine has now been published by a group of medical decision-making experts known collectively as the 2nd Panel. This is a critical review of the recommendations for how to deal with costs in cost-effectiveness analysis, recommendations that are contained in Chapter 8 of that edition, titled “Estimating Costs and Valuations of Non-Health Benefits in Cost-Effectiveness Analysis,” authored primarily but not exclusively by Anirban Basu. This review focuses on the correspondence between the costs in the numerator of the incremental cost-effectiveness ratio (ICER) and what is measured in the denominator of the ICER by the quality-adjusted life years (QALYs). Although it raises a number of issues regarding what is actually being measured in the numerator and denominator of the ICER, it primarily challenges the 2nd Panel’s recommendation that the costs of non-health consumption in any additional years of life generated by the intervention in question be accounted for in the numerator, even though no measures of the benefits are included in the QALYs in the denominator. This review is adapted from a review of the entire 2nd edition that was sent to the 2nd Panel steering committee on January 8, 2016.
Phase II Study of Two Weeks on, One Week off Sunitinib Scheduling in Patients With Metastatic Renal Cell Carcinoma
Authors: Jonasch Eric , Slack Rebecca S. , Geynisman Daniel M. , Hasanov Elshad , Milowsky Matthew I. , Rathmell W. Kimryn , Stovall Summer , Juarez Donna , Gilchrist Troy R. , Pruitt Lisa , Ornstein Moshe C. , Plimack Elizabeth R. , Tannir Nizar M. , Rini Brian I.
Published: April 2018

Purpose

Standard frontline treatment of patients with metastatic renal cell carcinoma currently includes sunitinib. A barrier to long-term treatment with sunitinib includes the development of significant adverse effects, including diarrhea, hand-foot syndrome (HFS), and fatigue. This trial assessed the effect of an alternate 2 weeks on, 1 week off (2/1) schedule of sunitinib on toxicity and efficacy in previously untreated patients with metastatic renal cell carcinoma.

Methods

Patients started with oral administration of 50 mg sunitinib on a 2/1 schedule and underwent schedule and dose alterations if toxicity developed. The primary end point was < 15% grade ≥ 3 fatigue, diarrhea, or HFS. With 60 patients, the upper bound of the CI would fall below the published 4/2 schedule grade ≥ 3 toxicity rate of 25% to 30%.

Results

Fifty-nine patients were treated between August 2014 and March 2016. Seventy-seven percent were intermediate or poor risk per Memorial Sloan Kettering Cancer Center criteria. With a median follow-up of 17 months, 25% of patients experienced grade 3 fatigue, HFS, or diarrhea; 37% required a dose reduction, and 10% discontinued because of toxicity. The overall response rate was 57%, median progression-free survival was 13.7 months, and median overall survival was not reached. At 12 weeks, Functional Assessment of Cancer Therapy–General scores dropped between 0% and 10% from baseline, with less reduction in patients who continued treatment longer.

Conclusion

The primary end point of decreased grade 3 toxicity was not met; however, treatment with a 2/1 sunitinib schedule is associated with a lack of grade 4 toxicity, a low patient discontinuation rate, and high efficacy.
Disparities in Breast, Lung, and Cervical Cancer Trials Worldwide
Authors: Ramaswami Ramya , Paulino Eduardo , Barrichello Adriana , Nogueira-Rodrigues Angelica , Bukowski Alexandra , St. Louis Jessica , Goss Paul E.
Published: April 2018

Purpose

As cancer burden has risen worldwide, physicians, patients, and their advocates have become aware that the clinical cancer trial research paradigm is not ubiquitous. Furthermore, the number and characteristics of trials that are registered in low- and middle-income countries (LMICs) compared with that in high-income countries (HICs) are unknown.

Methods

We collected retrospective data on trials for breast, lung, and cervical cancer registered in ClinicalTrials.gov or with the WHO International Clinical Trial Registry Platform between 2010 and 2017. The data were then classified as trials within LMICs or HICs using definitions from the World Bank.

Results

Included in these analyses were 6,710 trials, of which 3,164 (47%) were breast cancer trials, 3,283 (49%) were lung cancer trials, and 263 (4%) were cervical cancer trials. There were 1,951 (29%) trials from LMICs and 4,759 (71%) trials from HICs ( P < .001). Although the proportion of phase III trials in HICs versus LMICs was similar (18% v 17%; P = .66), the number of phase I trials in LMICs was significantly lower than that of HICs (20% v 2%; P < .001). For several LMICs with the highest mortality-to-incidence ratios for breast, lung, or cervical cancer, there were no cancer trials registered in the registration data bases searched for this work.

Conclusion

There are differences in access to cancer clinical trials in LMICs compared with HICs. Several factors, such as excessive cost and a lack of infrastructure and expertise, may explain these differences.
Monitoring InBaskets With Feedback to Providers Enhances the Timeliness of Patient Care
Authors: Trant Amelia A. , Strait Michael , Kaplan Rory , Dest Vanna , Roshka Adam , Lyons Catherine A. , Vest Kevin A. , Steffen Tessa , Chiang Anne , Adelson Kerin B.
Published: April 2018

Purpose:

Electronic health records have changed providers’ workflow. Epic’s InBasket supplants traditional communication and is a central hub for clinical information. Failure to promptly complete records impairs communication and revenue collection. By tracking providers’ InBasket activities and offering feedback, we hoped to improve InBasket management and interdisciplinary communication.

Methods:

We created a report to track 273 providers’ InBasket activities, including ambulatory transcriptions, chart cosignatures, order cosignatures, patient calls, results, and billable encounters. The report showed how often and for how long each activity was delinquent. We completed three Plan-Do-Study-Act cycles. During cycle 1 (November to December 2015), we sent all providers automated e-mails with their monthly results. During cycle 2 (January to April 2016), we focused solely on billable encounter closure and sent targeted e-mails to providers with > 50 delinquent encounters. The e-mails stated that providers had 30 days to complete encounters or their practices would be closed to new patients; at 30 days, noncompliant providers had 60 days before practice suspension. During cycle 3 (May to September 2016), we continued to monitor and send targeted e-mails to providers who accumulated > 50 encounters. We modeled the financial impact of the intervention using net closure data, the report’s aging function, and billing logs.

Results:

InBasket monitoring with structured feedback decreased open encounters by 53.43%. We did not see improvements in the other metrics that the report tracked. We estimate that $231,724 was saved as a result of the intervention and $349,179 was lost to filing deadlines.

Conclusion:

Automated e-mails did not reduce open encounters; targeted e-mails to providers improved InBasket management.
Older E-bike Users: Demographic, Health, Mobility Characteristics, and Cycling Levels
Authors: VAN CAUWENBERG JELLE , DE BOURDEAUDHUIJ ILSE , CLARYS PETER , DE GEUS BAS , DEFORCHE BENEDICTE
Published: April 2018

Purpose

Electric bicycles (e-bikes) may offer an opportunity to stimulate physical activity among older adults. The current study compared Flemish (Belgian) older e-bike users with those not using an e-bike on sociodemographics, health characteristics, and access to motorized transport. In addition, it examined the association between e-bike use and levels of cycling and the moderating effects of sex, body mass index (BMI), and cycling limitations.

Methods

An online or interview version of the same questionnaire was completed by 1146 participants. Data were analyzed using logistic regression and hurdle models.

Results

Women, those with a higher BMI, and those with one (compared with no) motorized vehicle in the household had higher odds of being an e-bike user. E-bike use was related to higher odds of having cycled for transport in the past week, and this relationship was stronger among those with a higher BMI (low BMI: odds ratio, 1.89; 95% confidence interval (CI), 1.24–2.91; high BMI: odds ratio, 3.34; 95% CI, 2.26–5.00). Among those who cycled for transport in the last week, e-bike use was associated with 35% more minutes of cycling for transport (95% CI, 17%–56%). E-bike use was related to 183% higher odds of having biked for recreation (95% CI, 115%–274%). Among women and those with cycling limitations who cycled for recreation in the last week, e-bike use was also related to 57% (95% CI, 18%–109%) and 180% (95% CI, 63%–381%) more minutes of cycling for recreation, respectively.

Conclusion

E-bikes may provide an opportunity to promote cycling among older adults, particularly among subgroups at risk for physical inactivity.
Actual questions of contact interaction between police officers and minors with deviant behavior.
Authors: Дорофеева Юлия , Dorofeeva Yuliya
Published: April 2018

In the article are considered the main questions of organization of contact interaction between police officers and minors with deviant behavior. The author suggests recommendations for improving this process. The presence of sharp resistance to interaction on the part of minors, the ironic-manipulative style of communication, the closed contact and unpreparedness of the police officers themselves for such forms of interaction, requires not only the upgrading of police officers skills in solving operational problems, but also arming them with specially developed interpersonal contact technologies for each type of deviant behavior. A special case is the need to refine the algorithms based on the contact interaction technique. Filonov for cases of adolescents who detect any forms of suicidal (autoaggressive) manifestations.
The psychometric of questionnaire to measure the tendencies toward the violation of service discipline in the study of behavior of servicemen
Authors: Петров Владислав , Petrov Vladislav
Published: April 2018

The article is devoted to the psychometric study of the author's questionnaire evaluation of propensity to violation of service (military) discipline. It analyzes the problems of assessing the personal characteristics of military personnel, who periodically and grossly violate the established order and rules of conduct, are characterized by professional insecurity and low performance discipline. Theoretical analysis of the problem of discipline allowed to justify the creation of innovative diagnostic techniques. Psychometric research was carried out in the form of evaluation of structural validity of the questionnaire, as well as the study of the type of distribution of the indicator "Propensity to violation of military discipline". A correlation with some indicators of other diagnostic techniques aimed at identifying constructs that are theoretically known to be associated with the tendency of military personnel to behave in violation of the established order was established. In the course of comparative research the dynamics of development of cadets of the Military University of the Ministry of defense of Russia propensity to violation of military discipline was studied. It is shown that in the process of training and professionalization of the personality of the cadets have been harmonized as the personality of the soldier (in terms of compliance with the service (military) discipline). The study material makes it possible to predict the probability of occurrence of deviations of behavior in military personnel, as well as to carry out appropriate preventive work in a timely manner.
Simple Policies for Managing Flexible Capacity
Authors: Janakiraman Ganesh , Nagarajan Mahesh , Veeraraghavan Senthil
Published: April 2018

In many scenarios, a fixed capacity is shared flexibly between multiple products. To manage such multiproduct systems, firms need to make two sets of decisions. The first one requires setting an inventory target for each product, and the second requires dynamically allocating the scarce capacity among the products. It is not known how to make these decisions optimally. In this paper, we propose easily implementable policies that have both theoretical and practical appeal. We first suggest simple and intuitive allocation rules that determine how such scarce capacity is shared. Given such rules, we calculate the optimal inventory target for each product. We demonstrate analytically that our policies are optimal under two asymptotic regimes represented by high service levels (i.e., high shortage costs) and heavy traffic (i.e., tight capacity). We also demonstrate that our policies outperform current known policies over a wide range of problem parameters. In particular, the cost savings from our policies become more significant as the capacity gets more restrictive.

The online appendix is available at https://doi.org/10.1287/msom.2017.0648 .
Real-Time Ambulance Dispatching and Relocation
Authors: Nasrollahzadeh Amir Ali , Khademi Amin , Mayorga Maria E.
Published: April 2018

In this study, we develop a flexible optimization framework for real-time ambulance dispatching and relocation. In addition to ambulance redeployment, we consider a general dispatching and relocation strategy by which the decision maker has the option to (i) select any available ambulance to dispatch to a call or to queue the call and (ii) send an idle ambulance to cover the location of an ambulance just dispatched to a call. We formulate the problem as a stochastic dynamic program, and, because the state space is unbounded, an approximate dynamic programming (ADP) framework is developed to generate high-quality solutions. We assess the quality of our solutions by developing a lower bound on the expected response time and computing a lower bound on the expected fraction of late calls of any relocation policy. We test the performance of our policies and available benchmarks on an emergency medical services system in Mecklenburg County, North Carolina. The results show that our policies are near optimal and significantly outperform available benchmarks. In particular, our ADP policy reduces the expected response time and fraction of high-priority late calls by 12% and 30.6%, respectively, over the best available static benchmarks in the case study. Moreover, the results provide insights on the contribution of each dispatching, redeployment, and reallocation strategy.

The online appendix is available at https://doi.org/10.1287/msom.2017.0649 .
Cost-effectiveness of an electroceutical device in treating non-healing venous leg ulcers: results of an RCT
Authors: Guest Julian F , Singh Heenal , Rana Karan , Vowden Peter
Published: April 2018

Objective:

To estimate the cost-effectiveness of an externally applied electroceutical (EAE) device, Accel-Heal, in treating non-healing venous leg ulcers (VLUs) in the UK.

Method:

This was a prospective, randomised, double-blind, placebo-controlled, multi-centre study of patients aged ≥18 years with a non-healing VLU. Patients were randomised in the ratio of 1:1 to receive six units of the EAE (consisting of a self-contained, programmed electric microcurrent generator and two skin contact pads) or an identical-looking placebo device over 12 consecutive days. Patients were followed-up for 24 weeks from randomisation, during which time patients received wound care according to the local standard care pathway, completed health-related quality of life (HRQoL) instruments, and health-care resource use was measured. The cost-effectiveness of the EAE device was estimated at 2015/16 prices in those patients who fulfilled the study's inclusion and exclusion criteria (economic analysis population).

Results:

At 24 weeks after randomisation, 34% and 30% of VLUs in the EAE and placebo groups in the economic analysis population, respectively, had healed. The time-to-healing was a mean of 2.6 and 3.5 months in the EAE and placebo groups, respectively. The area of the wounds that healed in the EAE group was nearly twice that of those in the placebo group (mean: 13.3 versus 7.7cm2 per VLU). Additionally, the pre-randomised duration of the wounds that healed in the EAE group was double that of those in the placebo group (mean: 2.6 versus 1.2 years per VLU). By the end of the study, EAE-treated patients reported less pain, more social functioning and greater overall wellbeing/satisfaction than placebo-treated patients. None of these differences reached statistical significance, but they may be important to patients. There were no significant differences in health-care resource use between the two groups. The incremental cost per quality-adjusted life year (QALY) gained with the EAE device was £4480 at eight weeks, decreasing to £2265 at 16 weeks and −£2388 (dominant) at 24 weeks. The study was confounded by unwarranted variation in patient management between centres and between individual clinicians within each centre.

Conclusion:

Despite the unwarranted variation in the provision of wound care observed in this study, the use of the EAE device resulted in some improved clinical outcomes and patient-reported outcomes, for the same or less cost as standard care, by 24 weeks. Clinicians managing VLUs may wish to consider the findings from this study when making treatment decisions.
Traditional culture methods fail to detect principle pathogens in necrotising soft tissue infection: a case report
Authors: Zhao-Fleming Hannah H. , Barake Suhaireirene R. Suady , Hand Audrey , Wilkinson Jeremy E. , Sanford Nick , Winn Richard , Dissanaike Sharmila
Published: April 2018

Objective:

Necrotising soft tissue infections (NSTIs) progress rapidly and mortality remains high, ranging from 10% to 30%, representing a significant challenge for health professionals. Early accurate diagnosis is crucial because timely and aggressive surgical intervention remains the number one indicator for a better clinical outcome. Understanding the microbial background of NSTIs would aid early diagnosis.

Presentation:

We present a case of NSTI, in a seemingly healthy adult male, originating from a tooth abscess. The NSTI progressed rapidly, and eventually covered the patient's chest and abdominal skin and underlying soft tissue.

Results:

Traditional blood and tissue culture only found Group C Streptococcus where 16S sequencing detected abundant Prevotella spp., a more likely causal organisms of the NSTI. The use of antibiotics with the approriate anaerobe coverage, in combination with timely surgical intervention, contributed to the ultimate successful clinical outcome. Complete wound healing and successful graft was achieved within one month of diagnosis of the microbes present.

Conclusion:

While surgical intervention remains the most important consideration in treatment of NSTI, correct identifcation of the microbial flora could also contribute to successful treatment.
The evolution of physiotherapist non-medical prescribers
Authors: Hey Martin
Published: April 2018

Physiotherapist and non-medical prescriber, Martin Hey, reflects on his personal journey, and that of the profession as a whole, to becoming an independent prescriber and running a secondary care pain service
Solve the case: Falls, anorexia and poor mobility
Authors: Nazarko Linda
Published: April 2018

Mrs Sarah Thomas has become increasingly frail over the past 18 months, her appetite has been poor, she has lost a lot of weight, become less mobile and has now been admitted with a fall. This case history examines what led to Mrs Thomas becoming frail and how she can be helped to regain ability and confidence.
A case study of an unusual incident of Pica
Authors: Duncan Deborah , Croft Christine
Published: April 2018

This article is a case study of a patient who initially attended a minor illness clinic with restless leg syndrome. During the consultation it became obvious that the patient had pica. Pica is an eating disorder where people ingest a non-nutritive substance for at least 1 month. Angela (pseudonym) had been eating one full sheet of sand paper a day. The case study reviews the assessment and management of the patient. The usual management is a multidisciplinary approach to care.
Is our prescribing really patient-centred?
Authors: Brack Graham
Published: April 2018

While prescribers may intend their prescribing to be patient-centred, there are occasions when this is not apparent to the patient. The reasons for this are often organisational, but occasionally they are transactional. The provision of specialist care in a number of long-term conditions could impede an holistic approach, concentrating on a single condition rather than the patient as a whole. Organisational priorities and imperatives may also lead to the adoption of population-level policies that militate against individually tailored care. Where this happens, prescribers should advocate for the patient. The management of individual consultations must allow space for the patient to insert concerns and questions of their own.
Policy spotlight
Authors: Davies John
Published: April 2018

This regular feature aims to provide key political news in relation to dentistry and an update on the Faculty’s policy activities. You can find out more in the Government Relations and Media sections of the FDS website.
Oral and maxillofacial surgery: a view from the East
Authors: Thomson Peter
Published: April 2018

As our regular contributor takes up a new academic role at Hong Kong University, he reflects on the evolution of the specialty in the region.
Barriers to oral hygiene in a rural Indian population
Authors: Crossley Eleanor , Patel Mitul , Sikka Mehak
Published: April 2018

How various socioeconomic issues experienced in India might be relevant to an increasingly diverse UK population.
A bone of contention
Authors: Simmons Gerald
Published: April 2018

Why dentists and physicians need to work more closely together when it comes to managing patients on bisphosphonates.
Vir inversus - Männlichkeiten im spanischen Schelmenroman
Authors: Schuhen Gregor
Published: April 2018

Mit dem anonym publizierten Lazarillo de Tormes erscheint 1554 der erste Schelmenroman der Weltliteratur. Die Hauptfigur, der pícaro, gilt als Kleinkrimineller, der in locker miteinander verwobenen Episoden seine Lebensgeschichte erzählt und dabei aus der Froschperspektive des Außenseitermilieus einen kritischen Blick auf die Gesellschaft wirft. Er selbst und seine wechselnden Herren sind männlichen Geschlechts; seine Abenteuer handeln von Gewalt, Ehre und sozialer Ungleichheit. Gregor Schuhen nimmt dies zum Anlass, die novela picaresca aus Sicht der Männlichkeitsforschung zu beleuchten und nach den spezifisch männlichen Praktiken und Idealvorstellungen zu fragen, die darin auf satirische Weise verhandelt werden.
Plane Symmetric Inflationary Universe with Hybrid Expansion Law and Time Varying Î›
Authors: Wankhade Rajesh
Published: April 2018

Plane symmetric inflationary cosmological model using Hybrid Expansion Law (HEL) with flat potential and time varying in General Theory of Relativity has been studied. The solution of the Einsteinâ€™s field equations is obtained under the assumption of HEL which yields a time-dependent deceleration parameter presenting transition of the universe from the early decelerating phase to the recent accelerating phase. The physical and kinematical parameters of the models have been studied and discussed.
"Spirits Rejoice!: Jazz and American Religion" by Jason C. Bivins
Authors: Shelley Braxton D.
Published: April 2018

Book Review
Revision of type and non-type material assigned to the genus Orthocladius by Goetghebuer (1940–1950), deposited in the Royal Belgian Institute of Natural Sciences (Diptera: Chironomidae)
Authors: Magoga Giulia , Montagna Matteo , Marziali Laura , Rossaro Bruno
Published: April 2018

Selected type and non-type material belonging to the genus Orthocladius van der Wulp, 1874 (Diptera: Chironomidae) sensu GOETGHEBUER (1940-1950), deposited in the Royal Belgian Institute of Natural Sciences (RBINS), originally comprising specimens dry pinned or stored in isinglass, were mounted on microscope slides and re-examined. Other chironomids present in the RBINS collection belonging to other genera were also examined. Fifty slides were prepared and identified to species, or to generic level when the condition of the specimens did not allow species identification. The following types, representing taxa formerly considered as nomina dubia, were examined and the concerned species are stated here as valid: Georthocladius collarti (Goetghebuer, 1941) comb. nov., Georthocladius scaturiginis (Goetghebuer, 1940) comb. nov., Lapposmittia succinea (Goetghebuer, 1942) comb. nov., Orthocladius (Euorthocladius) tolleti Goetghebuer, 1944 (new subgenus placement), Orthocladius (Orthocladius) timoni Goetghebuer & Timon-David, 1939, Pseudorthocladius hockaiensis (Goetghebuer, 1933). Orthocladius (Orthocladius) mitisi Goetghebuer, 1938, previously stated as junior synonym of Orthocladius (Orthocladius) glabripennis (Goetghebuer, 1921), is reinstated as valid species. The following new synonyms are proposed: Georthocladius (Georthocladius) collarti = Parachaetocladius retezati Albu, 1972: 19, syn. nov.; Cricotopus (Paratrichocladius) rufiventris (Meigen, 1830) = Orthocladius franzi Goetghebuer, 1949, syn. nov.; Cricotopus (Paratrichocladius) skirwithensis Edwards, 1929 = Orthocladius nigritus Goetghebuer, 1938, syn. nov. = Paratrichocladius spiesi Ashe & O’Connor, 2012; Hydrobaenus distylus (Potthast, 1914) = Orthocladius antennalis Goetghebuer, 1944, syn. nov. Lectotypes of Orthocladius collarti Goetghebuer, 1941, Orthocladius antennalis Goetghebuer, 1944, Orthocladius timoni Goetghebuer & Timon-David, 1939, and Orthocladius hockaiensis Goetghebuer, 1933 are designated. Non-type material assigned to Orthocladius was also mounted on slides and identified. Although a list of the non-Orthocladius taxa is also provided, no taxonomic changes are proposed for the latter.
Alepia bifida, a new species of moth flies from Central America (Diptera: Psychodidae: Psychodinae)
Authors: Tkoč Michal , Ježek Jan , Le Pont François
Published: April 2018

A new species of moth flies, Alepia bifida sp. nov., is described and figured based on males, females and eggs. The type specimens were collected in central Nicaragua, Cerro Musún Mt. This new species is characterized by unique morphology of the wing, basiphallus, distiphallus and gonostyli. The genus Alepia Enderlein, 1937 is one of the most diverse genera of Neotropical Psychodinae (54 known species including the one described here), but it is so well characterized morphologically that no generic synonyms have been proposed.
Predictors of Foreign Language Anxiety: A Study of College-Level L2 Learners of Chinese
Authors: Luo Han
Published: April 2018

This study investigated seven learner variables (i.e., age, motivation, perception of the difficulty of the Chinese language, self-perceived achievement, self-perceived language learning ability, self-expectation in the Chinese class, and perception of the importance of the Chinese language) as potential predictors of Chinese language learning anxiety. Correlation analyses showed that all seven variables were significantly correlated with anxiety level in isolation. Perception of the difficulty of the Chinese language and age were found to have positive relationships with anxiety, whereas the remaining five variables were reported to have negative relationships. Multiple regression analysis revealed that all the variables except self-expectation in the Chinese class and perception of the importance of the Chinese language contributed significantly to the prediction of Chinese language learning anxiety when examined simultaneously. The five significant predictors altogether explained 34.7% of the variance in anxiety. Perception of the difficulty of the Chinese language was found to be the best predictor and self-perceived achievement the second-best predictor, followed by self-perceived foreign language learning ability, age, and motivation.
Generic Variation & Private Intention: A Multi-Dimensional Exploration of Book Reviews and Prefaces
Authors: Xiao Liang , Deng Liming
Published: April 2018

Based on Bhatia’s multi-dimensional analytical framework for discourse analysis, we explore key issues involved in genres construction such as private intention, manipulation of generic value and interdiscursive strategies. Two prefaces and two book reviews by expert linguists were collected and analyzed at great length from both text-internal and text-external perspectives. Meanwhile, four professionals from relevant disciplines were interviewed for their insights into the issues investigated. Through examining textual features, covert interdiscursivity and narrative accounts of the professional writers, the following findings are generated. 1) Generic variation occurs within and between the two genres due to expert writers’ intentional manipulation of generic value. 2) Interdiscursive strategies like “genre embedding”, “genre bending” and “genre mixing” are exploited by expert writers to achieve their particular private intention. Specifically, preface genre can be presented, to some extent, as a research article mixed with some promotional flavor, and features of research article genre, promotional genre and introductory genre are found mixed in the review genre. 3) Representations of the preface and book review genres such as linguistic feature, move structure and interdiscursivity are ultimately affected by generic value, authors’ private intention, professional practice and disciplinary culture. The findings have important implications for ESP/EAP writing practitioners and learners.
Decomposable branching processes with two types of particles
Authors: Vatutin Vladimir A. , Dyakonova Elena E.
Published: April 2018

A two-type critical decomposable branching process with discrete time is considered in which particles of the first type may produce at the death moment offspring of both types while particles of the second type may produce at the death moment offspring of their own type only. Assuming that the offspring distributions of particles of both types may have infinite variance, the asymptotic behavior of the tail distribution of the random variable Ξ
2, the total number of the second type particles ever born in the process is found. Limit theorems are proved describing (as N → ∞) the conditional distribution of the amount of the first type particles in different generations given that either Ξ
2 = N or Ξ
2 > N.
Limit theorem for the size of an image of subset under compositions of random mappings
Authors: Zubkov Andrey M. , Serov Aleksandr A.
Published: April 2018

Let 𝓧𝓝 be a set consisting of N elements and F
1,F
2, … be a sequence of random independent equiprobable mappings 𝓧𝓝 → 𝓧𝓝. For a subset S
0 ⊂ 𝓧𝓝, |S
0| = n, we consider a sequence of its images St
= Ft
(… F
2(F
1(S
0))…), t = 1, 2 … The conditions on n, t, N → ∞ under which the distributions of image sizes |St
| are asymptotically connected with the standard normal distribution are presented.
On generalized fractional cosine and sine transforms
Authors: Hudzik Henryk , Jain Pankaj , Kumar Rajender
Published: April 2018

In this paper, we define and investigate fractional cosine and sine transforms for functions as well as distributions.
For these transforms, several properties are provided, the representation theorems are proved and the analyticity is established.
Influence of Loranthus micranthus on hepatic and renal antioxidant status and impaired glycolytic flux in streptozotocin-induced diabetic rats
Authors: Ebokaiwe Azubuike P. , Ijomone Omamuyovwi M. , Edeh Oscar , Oteh Ifebunachi , Ebuka David E.
Published: April 2018

Background

The use of Loranthus micranthus in folklore medicine for treatment of diabetes and its associated complications is a common practice around the world. The present study investigated this traditional affirmation by in vivo investigation into the effect of L. micranthus leaf extract on hepatic and renal, oxidative status and glucose metabolism in streptozotocin (STZ)-induced diabetic rats.

Methods

Diabetes mellitus was induced in adult male Wistar rats by intraperitoneal injection of STZ (60 mg/kg). The diabetic rats were thereafter treated orally once per day with 5 mg/kg gilbenclamide or L. micranthus leaf extract (100 or 200 mg/kg) and monitored for 14 days. Clinical observations, plasma biochemistry, hormonal profile, oxidative stress parameters, glucose metabolism enzymes and histopathologic examination of the liver and kidney were evaluated to monitor treatment-related effects of L. micranthus leaf extract in STZ-induced diabetic rats.

Results

Loranthus micranthus leaf extract administration significantly ameliorated hyperglycemia-mediated damage by decreasing the blood glucose level (45.9% and 84.7% on days 7 and 14 posttreatment, respectively), enhancing the antioxidant status, inhibiting lipid peroxidation and improving the architecture of the liver and kidney in STZ-induced diabetic rats. Furthermore, intervention of L. micranthus leaf extract restored the liver and kidney function biomarkers and increased the plasma levels of triiodothyronine and thyroxine to normal control in STZ-induced diabetic rats.

Conclusions

The findings from this investigation provide credible scientific support for the traditional use of L. micranthus leaf extract in the treatment of diabetes and its associated complications.
Lipschitz stability estimates in inverse source problems for a fractional diffusion equation of half order in time by Carleman estimates
Authors: Kawamoto Atsushi
Published: April 2018

In this article, we consider a fractional diffusion equation of half order in time.
We study inverse problems of determining the space-dependent factor in the source term
from additional data at a fixed time and
interior or boundary data over an appropriate time interval.
We establish the global Lipschitz stability estimates in the inverse source problems.
Our methods are based on Carleman estimates.
Here we prove and use
the Carleman estimates for a fractional diffusion equation of half order in time.
Prediction of Fundamental Modal Field for Graded Index Fiber in the Presence of Kerr Nonlinearity
Authors: Chakraborty Subhalaxmi , Mandal Chintan Kumar , Gangopadhyay Sankar
Published: April 2018

The power series formulation for modal field of single-mode graded index fibers by Chebyshev technique has worked excellently in predicting accurately different propagation characteristics in simple fashion. Here we develop a simple iterative method involving Chebyshev formalism to predict the modal field of single-mode graded index fiber in the presence of Kerr-type nonlinearity. Taking step and parabolic index fibers as typical examples, we show that our results match excellently with the available exact results obtained vigorously. Thus, the reported technique can be considered as an accurate alternative to the existing cumbersome techniques. Accordingly, this formalism will be beneficial to the technologies for evaluation of modal noise in single-mode Kerr-type nonlinear graded index fibers.
Association between UCP polymorphisms and adipokines with obesity in Mexican adolescents
Authors: Sámano Reyna , Huesca-Gómez Claudia , López-Marure Rebeca , Hernández-Cabrera Ana-Karen , Rodríguez-Ventura Ana , Tolentino Maricruz , Morales Rosa María , Gamboa Ricardo
Published: April 2018

Background:

It has been reported that the uncoupling proteins (UCPs) can contribute to energy metabolism, and are thus involved in the pathogenesis of obesity. The objective of the study was to analyze the association between UCP polymorphisms, clinical parameters and leptin and adiponectin plasma levels in an adolescent population with overweight and obesity.

Methods:

We analyzed the UCP1 -3826 C/T, UCP2-866 G/A, Ala55Val and UCP3 -55 C/T polymorphisms and the levels of adipokines in adolescents with normal weight and with overweight or obesity. The study included 270 students aged between 12 and 18 years categorized according to the percentiles from Mexico City. Adipokines levels were measured by immunoassay methods and the UCP polymorphisms were determined using Taqman real-time polymerase chain reaction (RT-PCR).

Results:

No significant differences were found in the UCP polymorphisms in seven inheritance models studied. Most of the significant differences in the clinical parameters were found under a recessive model, the UCP2 -866 polymorphism was associated with diastolic blood pressure (p=0.008), triglycerides (p=0.045), low-density lipoprotein-cholesterol (LDL-C) (p=0.003), high-density lipoprotein-cholesterol (HDL-C) (p=0.050) and plasma levels of leptin (p<0.001). Also, the obese group was found to have higher leptin levels and lower adiponectin levels in GA+AA vs. GG (recessive model).

Conclusions:

This study demonstrated a direct relationship between the clinical characteristics and UCP2-866 in a recessive model, associated with high levels of leptin and decreased levels of adiponectin in an obese or overweight Mexican adolescent population.