Oral health policy: International implications for Australia

The worlds of researchers and of policy makers are completely different. With apologies to John Gray, it could be said that “researchers are from Venus and policymakers are from Mars.” It summarises in one sentence what has been called the two communities theory which posits that the producers and users of knowledge live in separate worlds with different and often conflicting values, different reward systems, and different languages. Researchers all too often produce high quality research which is simply not used by policy makers. Policy making has traditionally been conducted by professional organisations, the private sector and government. One way APHCRI has gone about breaking down these different world views is by establishing Centres of Research Excellence, one of which is the Centre of Research Excellence in Primary Oral Health Care. Analysis of how policy is formed is a very small research area within oral health. Only a small set of papers have analysed the problem of evidence translation and largely focus on evidence-practice translation: Improving the translation of evidence from clinical trials, clinical guidelines and for specific challenges, such as women’s oral health. Until this research, no studies existed on whether oral health evidence influenced policy. Between 2000 and 2012, at least 127,193 unique papers with abstracts were published in oral health, but it had not been systematically analysed for its content relevance to oral health policy priorities. A Health Policy research indicates that the relevance of research content to policy may be more important than research methodology in policy take-up of research than using the quality hierarchy dominated by the ‘blue chip’ standard of randomised controlled trials. This study described the conceptual content of the entire corpus of oral health research abstracts 2000-2012 and compared it to the content of national oral health policy documents so as to build understandings of the nature of the evidence-policy divide so that research can better serve policy efforts to address oral health inequity.The worlds of researchers and of policy makers are completely different. With apologies to John Gray, it could be said that “researchers are from Venus and policymakers are from Mars.” It summarises in one sentence what has been called the two communities theory which posits that the producers and users of knowledge live in separate worlds with different and often conflicting values, different reward systems, and different languages. Researchers all too often produce high quality research which is simply not used by policy makers. Policy making has traditionally been conducted by professional organisations, the private sector and government. One way APHCRI has gone about breaking down these different world views is by establishing Centres of Research Excellence, one of which is the Centre of Research Excellence in Primary Oral Health Care. Analysis of how policy is formed is a very small research area within oral health. Only a small set of papers have analysed the problem of evidence translation and largely focus on evidence-practice translation: Improving the translation of evidence from clinical trials, clinical guidelines and for specific challenges, such as women’s oral health. Until this research, no studies existed on whether oral health evidence influenced policy. Between 2000 and 2012, at least 127,193 unique papers with abstracts were published in oral health, but it had not been systematically analysed for its content relevance to oral health policy priorities. A Health Policy research indicates that the relevance of research content to policy may be more important than research methodology in policy take-up of research than using the quality hierarchy dominated by the ‘blue chip’ standard of randomised controlled trials. This study described the conceptual content of the entire corpus of oral health research abstracts 2000-2012 and compared it to the content of national oral health policy documents so as to build understandings of the nature of the evidence-policy divide so that research can better serve policy efforts to address oral health inequity. Aims The aim of the study was to answer the following research questions, How well matched is the content of research to national oral health policy? What are the implications of this for developing oral health research that is more policy relevant, particularly for the challenge of addressing unequal oral health outcomes?The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

A randomized trial of balloon kyphoplasty and nonsurgical management for treating acute vertebral compression fractures: vertebral body kyphosis correction and surgical parameters.

Objective. To compare the efficacy and safety of balloon kyphoplasty (BKP) with nonsurgical management (NSM) during 24 months in patients with painful vertebral compression fractures (VCFs). Summary of Background Data. Recently, several large randomized controlled trials have been conducted and reported how vertebral augmentation compares with NSM for patients with acute VCFs. Few of these trials report on the surgical aspects and radiographical vertebral deformity results. Methods. Adults with 1 to 3 VCFs were randomized within 3 months of pain to undergo bilateral BKP (n = 149) or NSM (n = 151). Surgical parameters, subjective quality of life assessments and objective functional (timed up and go) and radiographical assessments were collected. Results. Compared with NSM, the BKP group had greater improvements in SF-36 physical component summary (PCS) scores at 1 month (5.35 points; 95% CI, 3.41 - 7.30; P < 0.0001) and when averaged across the 24 months (overall treatment effect 2.71 points; 95% CI, 1.34-4.09; P = 0.0001). The kyphoplasty group also had greater functionality by assessing timed up and go (overall treatment effect - 2.49 s; 95% CI, - 0.82 to - 4.15; P = 0.0036). At 24 months, the change in index fracture kyphotic angulation was statistically significantly improved in the kyphoplasty group (average 3.13° of correction for kyphoplasty compared with 0.82° in the control, P = 0.003). Number of baseline prevalent fractures (P = 0.0003) and treatment assignment (P = 0.004) are the most predictive variables for PCS improvement; however, in patients who underwent BKP, there may also be a link with kyphotic angulation. In BKP, the highest quart for kyphotic angulation correction had higher PCS improvement (13.4 points) than the quart having lowest correction of angulation (7.40 points, P = 0.0146 for difference). The most common adverse events temporally related to surgery (i.e., within 30 d) were back pain (20 BKP, 11 NSM) new VCF (11 BKP, 7 NSM), nausea/vomiting (12 BKP, 4 NSM), and urinary tract infection (10 BKP, 3 NSM). Several other adverse events were possibly related to patient positioning in the operating room. Conclusion. Compared with NSM, BKP improves patient quality of life and pain averaged during 24 months and results in better improvement of index vertebral body kyphotic angulation. Perioperative complications may be reduced with more care in patient positioning

Alternative analyses for handling incomplete follow-up in the intention-to-treat analysis: the randomized controlled trial of balloon kyphoplasty versus non-surgical care for vertebral compression fracture (FREE).

Background: Clinical trial participants may be temporarily absent or withdraw from trials, leading to missing data. In intention-to-treat (ITT) analyses, several approaches are used for handling the missing information - complete case (CC) analysis, mixed-effects model (MM) analysis, last observation carried forward (LOCF) and multiple imputation (MI). This report discusses the consequences of applying the CC, LOCF and MI for the ITT analysis of published data (analysed using the MM method) from the Fracture Reduction Evaluation (FREE) trial. Methods. The FREE trial was a randomised, non-blinded study comparing balloon kyphoplasty with non-surgical care for the treatment of patients with acute painful vertebral fractures. Patients were randomised to treatment (1:1 ratio), and stratified for gender, fracture aetiology, use of bisphosphonates and use of systemic steroids at the time of enrolment. Six outcome measures - Short-form 36 physical component summary (SF-36 PCS) scale, EuroQol 5-Dimension Questionnaire (EQ-5D), Roland-Morris Disability (RMD) score, back pain, number of days with restricted activity in last 2 weeks, and number of days in bed in last 2 weeks - were analysed using four methods for dealing with missing data: CC, LOCF, MM and MI analyses. Results: There were no missing data in baseline covariates values, and only a few missing baseline values in outcome variables. The overall missing-response level increased during follow-up (1 month: 14.5%; 24 months: 28%), corresponding to a mean of 19% missing data during the entire period. Overall patterns of missing response across time were similar for each treatment group. Almost half of all randomised patients were not available for a CC analysis, a maximum of 4% were not included in the LOCF analysis, and all randomised patients were included in the MM and MI analyses. Improved estimates of treatment effect were observed with LOCF, MM and MI compared with CC; only MM provided improved estimates across all six outcomes considered. Conclusions: The FREE trial results are robust as the alternative methods used for substituting missing data produced similar results. The MM method showed the highest statistical precision suggesting it is the most appropriate method to use for analysing the FREE trial data. Trial Registration. This trial is registered with ClinicalTrials.gov (number NCT00211211)

The type IIb SN 2008ax: the nature of the progenitor

A source coincident with the position of the type IIb supernova (SN) 2008ax is identified in pre-explosion Hubble Space Telescope (HST) Wide Field Planetary Camera 2 observations in three optical filters. We identify and constrain two possible progenitor systems: (i) a single massive star that lost most of its hydrogen envelope through radiatively driven mass loss processes, prior to exploding as a helium-rich Wolf-Rayet star with a residual hydrogen envelope, and (ii) an interacting binary in a low mass cluster producing a stripped progenitor. Late time, high resolution observations along with detailed modelling of the SN will be required to reveal the true nature of this progenitor star.Comment: 5 pages, 2 figures, resolution of figure 1 reduced, figure 2 revised, some revision following referee's comments, accepted for publication in MNRAS letter

Supernovae and radio transients in M 82

We present optical and near-infrared (IR) photometry and near-IR spectroscopy of SN 2004am, the only optically detected supernova (SN) in M 82. These demonstrate that SN 2004am was a highly reddened type II-P SN similar to the low luminosity type II-P events such as SNe 1997D and 2005cs. We show that SN 2004am was located coincident with the obscured super star cluster M 82-L, and from the cluster age infer a progenitor mass of 12 +7/-3 Msun. In addition to this, we present a high spatial resolution Gemini-N K-band adaptive optics image of the site of SN 2008iz and a second transient of uncertain nature, both detected so far only at radio wavelengths. Using image subtraction techniques together with archival data from the Hubble Space Telescope, we are able to recover a near-IR transient source co-incident with both objects. We find the likely extinction towards SN 2008iz to be not more than Av ~ 10. The nature of the second transient remains elusive and we regard an extremely bright microquasar in M 82 as the most plausible scenario.Comment: 14 pages, 8 figures, accepted for publication in MNRA

The 'idioglossia' cases of the 1890s and the clinical investigation and treatment of developmental language impairment

The early history of developmental language impairment in late 19th century Britain is considered through the critical examination of three papers appearing in 1891 by Hadden, Golding-Bird and Hale White, and Taylor. They represent innovative investigations of child language disorders whose themes and concerns are resonant today. The term ‘idioglossia’ was coined to identify this new impairment and reflected the belief by some that these children spoke an invented language. Rather than viewing these children as having some constitutional deficiency, these 19th century physicians were novel in insisting that children with language impairments merited extensive clinical investigation and treatment. Their case descriptions and the subsequent debates regarding classification and prognosis are reviewed. Further consideration is given to how these cases led to questioning the relation between language and speech and other aspects of child development and disorder. Reflection on the early sources of clinical categories provides a new perspective on our current formulations for variation in developmental language trajectories

Indirect excitation of ultrafast demagnetization

Does the excitation of ultrafast magnetization require direct interaction between the photons of the optical pump pulse and the magnetic layer? Here, we demonstrate unambiguously that this is not the case. For this we have studied the magnetization dynamics of a ferromagnetic cobalt/palladium multilayer capped by an IR-opaque aluminum layer. Upon excitation with an intense femtosecond-short IR laser pulse, the film exhibits the classical ultrafast demagnetization phenomenon although only a negligible number of IR photons penetrate the aluminum layer. In comparison with an uncapped cobalt/palladium reference film, the initial demagnetization of the capped film occurs with a delayed onset and at a slower rate. Both observations are qualitatively in line with energy transport from the aluminum layer into the underlying magnetic film by the excited, hot electrons of the aluminum film. Our data thus confirm recent theoretical predictions

A Comparison Analysis Between Pre-departure and Transitioned Expat-Preneurs

This paper contributes to the understanding on the reasons that lead to entrepreneurship in other countries. We focus on expat-preneurs, those who decided to undertake business opportunities in other countries (before or after settling there). Using comparison analysis and logistic regression, we examine pre-departure and transitioned expat-preneurs’ demographic characteristics and push-pull factors that lead them to expatriate. From a survey conducted in 2015-2016 of 5,532 Lithuanians expatriated in 24 countries, a sample of 308 respondents with their own businesses abroad was selected. This research contributes to the literature on expat-preneurs, with empirical evidence on pre-departure and transitioned self-initiated (SI) expat-preneurs. The results revealed that demographic features matter when studying such global entrepreneurs. It is a process experienced differently by males and females and, as such, it can be considered as gender selective. Thus, more pre-departure expat-preneurs are male than female, but there is a growing number of female transitioned expat-preneurs. Pre-departure expat-preneurs are older and less educated than transitioned ones and have been pushed to move abroad by issues such as political corruption or a nonsupportive tax system, and are attracted by a higher possibility of self-realisation as well as the prestige of the host country. Meanwhile, transitioned expat-preneurs have been pushed to emigrate due to family reasons or too few employment opportunities in their home country.Lithuanian Council of Science S-MIP-17-11