Cost-effectiveness of child caries management: a randomised controlled trial (FiCTION trial)

Background: A three-arm parallel group, randomised controlled trial set in general dental practices in England, Scotland, and Wales was undertaken to evaluate three strategies to manage dental caries in primary teeth. Children, with at least one primary molar with caries into dentine, were randomised to receive Conventional with best practice prevention (C + P), Biological with best practice prevention (B + P), or best practice Prevention Alone (PA). Methods: Data on costs were collected via case report forms completed by clinical staff at every visit. The coprimary outcomes were incidence of, and number of episodes of, dental pain and/or infection avoided. The three strategies were ranked in order of mean cost and a more costly strategy was compared with a less costly strategy in terms of incremental cost-effectiveness. Costs and outcomes were discounted at 3.5%. Results: A total of 1144 children were randomised with data on 1058 children (C + P n = 352, B + P n = 352, PA n = 354) used in the analysis. On average, it costs £230 to manage dental caries in primary teeth over a period of up to 36 months. Managing children in PA was, on average, £19 (97.5% CI: -£18 to £55) less costly than managing those in B + P. In terms of effectiveness, on average, there were fewer incidences of, (− 0.06; 97.5% CI: − 0.14 to 0.02) and fewer episodes of dental pain and/or infection (− 0.14; 97.5% CI: − 0.29 to 0.71) in B + P compared to PA. C + P was unlikely to be considered cost-effective, as it was more costly and less effective than B + P. Conclusions: The mean cost of a child avoiding any dental pain and/or infection (incidence) was £330 and the mean cost per episode of dental pain and/or infection avoided was £130. At these thresholds B + P has the highest probability of being considered cost-effective. Over the willingness to pay thresholds considered, the probability of B + P being considered cost-effective never exceeded 75%. Trial registration: The trial was prospectively registered with the ISRCTN (reference number ISRCTN77044005) on the 26th January 2009 and East of Scotland Research Ethics Committee provided ethical approved (REC reference: 12/ES/0047)

Fredholm Determinants, Differential Equations and Matrix Models

Orthogonal polynomial random matrix models of NxN hermitian matrices lead to Fredholm determinants of integral operators with kernel of the form (phi(x) psi(y) - psi(x) phi(y))/x-y. This paper is concerned with the Fredholm determinants of integral operators having kernel of this form and where the underlying set is a union of open intervals. The emphasis is on the determinants thought of as functions of the end-points of these intervals. We show that these Fredholm determinants with kernels of the general form described above are expressible in terms of solutions of systems of PDE's as long as phi and psi satisfy a certain type of differentiation formula. There is also an exponential variant of this analysis which includes the circular ensembles of NxN unitary matrices.Comment: 34 pages, LaTeX using RevTeX 3.0 macros; last version changes only the abstract and decreases length of typeset versio

Child caries management: A randomized controlled trial in dental practice

This multicenter 3-arm, parallel-group, patient-randomized controlled trial compared clinical effectiveness of 3 treatment strategies over 3 y for managing dental caries in primary teeth in UK primary dental care. Participants aged 3 to 7 y with at least 1 primary molar with dentinal carious lesion were randomized across 3 arms (1:1:1 via centrally administered system with variable-length random permuted blocks): C+P, conventional carious lesion management (complete carious tooth tissue removal and restoration placement) with prevention; B+P, biological management (sealing in carious tooth tissue restoratively) with prevention; and PA, prevention alone (diet, plaque removal, fluorides, and fissure sealants). Parents, children, and dentists were not blind to allocated arm. Co–primary outcomes were 1) the proportion of participants with at least 1 episode of dental pain and/or infection and 2) the number of episodes of dental pain and/or infection during follow-up (minimum, 23 mo). In sum, 1,144 participants were randomized (C+P, n = 386; B+P, n = 381; PA, n = 377) by 72 general dental practitioners, of whom 1,058 (C+P, n = 352; B+P, n = 352; PA, n = 354) attended at least 1 study visit and were included in the primary analysis. The median follow-up was 33.8 mo (interquartile range, 23.8 to 36.7). Proportions of participants with at least 1 episode of dental pain and/or infection were as follows: C+P, 42%; B+P, 40%; PA, 45%. There was no evidence of a difference in incidence of dental pain and/or infection when B+P (adjusted risk difference [97.5% CI]: −2% [−10% to 6%]) or PA (4% [−4% to 12%]) was compared with C+P. The mean (SD) number of episodes of dental pain and/or infection were as follows: C+P, 0.62 (0.95); B+P, 0.58 (0.87); and PA, 0.72 (0.98). Superiority could not be concluded for number of episodes between B+P (adjusted incident rate ratio (97.5% CI): 0.95 [0.75 to 1.21]) or PA (1.18 [0.94 to 1.48]) and C+P. In conclusion, there was no evidence of a difference among the 3 treatment approaches for incidence or number of episodes of dental pain and/or infection experienced by these participants with high caries risk and established disease (trial registration: ISRCTN77044005)

Evaluation of the Trivedi Effect®- Energy of Consciousness Energy Healing Treatment on the Physical, Spectral, and Thermal Properties of Zinc Chloride

Zinc chloride has the importance in pharmaceutical/nutraceutical industries for the prevention and treatment of several diseases. The objective of the current study was to investigate the impact of The Trivedi Effect®-Energy of Consciousness Healing Treatment (Biofield Energy Healing Treatment) on physical, structural, and thermal properties of zinc chloride using PXRD, PSD, FT-IR, UV-vis, TGA, and DSC analysis. Zinc chloride was divided into two parts. One part was denoted as the control without any, while the other part was defined as the Trivedi Effect® Treated sample, which received the Trivedi Effect® Treatment remotely from eighteen renowned Biofield Energy Healers. The PXRD analysis revealed that the crystallite size and relative intensities of the PXRD peaks significantly altered in the treated sample compared with the control sample. The crystallite size of treated sample was decreased by 4.19% compared with the control sample. The particle size at d10 and d50 of the Biofield Energy Treated sample decreased by 4.72% and 2.70%, respectively compared with the control sample. But, the particle size of the treated sample increased at d90 by 0.83 compared with the control sample. Consequently, the surface area was increased by 3.22% in the treated sample compared with the control sample. The FT-IR spectroscopic analysis revealed that Zn-Cl stretching in the control and treated sample was at 520 cm-1 and 521 cm-1, respectively. The UV-vis analysis exhibited that the wavelength of the maximum absorbance of the control and treated samples was at 196.4 and 196.2 nm, respectively. The TGA thermograms revealed two steps of the thermal degradation and the weight loss of the treated sample was significantly reduced by 22.54% in the 1st step of degradation compared with the control sample. The DSC analysis showed that the enthalpy of decomposition was significantly increased by 34.9% in the treated sample (89.17 J/g) compared with the control sample (66.10 J/g). Overall, DSC and TGA analysis indicated that the thermal stability of the treated sample was increased compared with the control sample. The current study anticipated that The Trivedi Effect®-Energy of Consciousness Healing Treatment might lead to generate a new polymorphic form of zinc chloride, which would be more soluble, stable, and higher absorption rate compared with the control sample. Hence, the treated zinc chloride could be very useful to design the various forms of nutraceuticals and pharmaceutical formulation which might be providing a better therapeutic response against inflammatory diseases, immunological disorders, aging, stress, cancer, etc. https://www.trivedieffect.com/science/evaluation-of-the-trivedi-effect-energy-of-consciousness-energy-healing-treatment-on-the-physical-spectral-and-thermal-properties-of-zinc-chloride http://www.sciencepublishinggroup.com/journal/paperinfo?journalid=118&doi=10.11648/j.ajls.20170501.1

Liquid Chromatography – Mass Spectrometry (LC-MS) Analysis of Withania somnifera (Ashwagandha) Root Extract Treated with the Energy of Consciousness

Withania somnifera (ashwagandha) root extract is very popular ancient herbal medicine. The objective of the study was to characterize and evaluate the impact of The Trivedi Effect®-Biofield Energy Healing Treatment (Energy of Consciousness) on phytoconstituents present in the ashwagandha root extract using LC-MS. Ashwagandha root extract was divided into two parts. One part was denoted as the control, while the other part was defined as The Trivedi Effect® - Biofield Energy Treated sample, which received Energy of Consciousness Healing Treatment remotely from eighteen renowned Biofield Energy Healers. The LC-MS analysis of the control and treated samples showed a very close retention time (Rt), indicated that the polarity of the phytoconstituents present in the root extract are same. The numbers of peaks observed in the total ion chromatograms were 28 and 29 in the control and treated samples, respectively. The change in the peak height% of the phytoconstituents in the treated sample was altered significantly within the range of -50.91% to 118.12% compared with the control sample. Similarly, the change in the peak area% of most of the phytoconstituents in the treated ashwagandha was significantly altered within the range of -54.95% to 66.95% compared with the control sample. An additional peak was appeared in the treated sample at Rt of 5.72 minutes, which was not found in the control sample. The LC-MS spectra indicated the presence of possible withanolides like -hydroxy-2,3-dihydro-withanolide F, withanolide A, withaferine A, withanone, withanolide D, ixocarpalactone A, withanolide S, thiowithanolide, etc. in both the samples. The peak are percentage (%) was altered in the identified withanolides, but withanolide sulfoxide was increased significantly by 12.44% in the treated sample compared with the control sample. These results indicated that The Trivedi Effect® - Biofield Energy Treatment might have an impact on the intrinsic physicochemical properties of the phytoconstituents present in the ashwagandha root extract. This could be the probable cause of alteration in the peak height, peak area, and appearance of a new peak in the treated sample. As a result, the concentrations of the phytoconstituents altered in the treated sample compared with the control sample. The treated ashwagandha root extract would be helpful for designing better pharmaceutical/nutraceutical formulations which might be providing a better therapeutic response against autoimmune diseases, nervous and sexual disorders, infectious diseases, antiaging, diabetes, cancer, ulcer, immunological disorders, stress, arthritis, etc. Source: https://www.trivedieffect.com/science/liquid-chromatography-mass-spectrometry-lc-ms-analysis-of-withania-somnifera-ashwagandha-root-extract-treated-with-the-energy-of-consciousness http://www.sciencepublishinggroup.com/journal/paperinfo?journalid=398&doi=10.11648/j.ajqcms.20170101.1

Patient-, organization-, and system-level barriers and facilitators to preventive oral health care:A convergent mixed-methods study in primary dental care

Background: Dental caries is the most common chronic disease of adult and childhood, a largely preventable yet widespread, costly public health problem. This study identified patient-, organization-, and system-level factors influencing routine delivery of recommended care for prevention and management of caries in primary dental care. Methods: A convergent mixed-methods design assessed six guidance-recommended behaviours to prevent and manage caries (recording risk, risk-based recall intervals, applying fluoride varnish, placing preventive fissure sealants, demonstrating oral health maintenance, taking dental x-rays). A diagnostic questionnaire assessing current practice, beliefs, and practice characteristics was sent to a random sample of 651 dentists in National Health Service (NHS) Scotland. Eight in-depth case studies comprising observation of routine dental visits and dental team member interviews were conducted. Patient feedback was collected from adult patients with recent checkups at case study practices. Key informant interviews were conducted with decision makers in policy, funding, education, and regulation. The Theoretical Domains Framework within the Behaviour Change Wheel was used to identify and describe patient-, organization-, and system-level barriers and facilitators to care. Findings were merged into a matrix describing theoretical domains salient to each behaviour. The matrix and Behaviour Change Wheel were used to prioritize behaviours for change and plan relevant intervention strategies. Results: Theoretical domains associated with best practice were identified from the questionnaire (N-196), case studies (N = 8 practices, 29 interviews), and patient feedback (N = 19). Using the study matrix, key stakeholders identified priority behaviours (use of preventive fissure sealants among 6–12-year-olds) and strategies (audit and feedback, patient informational campaign) to improve guidance implementation. Proposed strategies were assessed as appropriate for immediate implementation and suitable for development with remaining behaviours. Conclusions: Specific, theoretically based, testable interventions to improve caries prevention and management were coproduced by patient-, practice-, and policy-level stakeholders. Findings emphasize duality of behavioural determinants as barriers and facilitators, patient influence on preventive care delivery, and benefits of integrating multi-level interests when planning interventions in a dynamic, resource-constrained environment. Interventions identified in this study are actively being used to support ongoing implementation initiatives including guidance, professional development, and oral health promotion

The FiCTION dental trial protocol - fillings children's teeth: indicated or not?

Background: There is a lack of evidence for effective management of dental caries (decay) in children’s primary (baby) teeth and an apparent failure of conventional dental restorations (fillings) to prevent dental pain and infection for UK children in Primary Care. UK dental schools’ teaching has been based on British Society of Paediatric Dentistry guidance which recommends that caries in primary teeth should be removed and a restoration placed. However, the evidence base for this is limited in volume and quality, and comes from studies conducted in either secondary care or specialist practices. Restorations provided in specialist environments can be effective but the generalisability of this evidence to Primary Care has been questioned. The FiCTION trial addresses the Health Technology Assessment (HTA) Programme’s commissioning brief and research question “What is the clinical and cost effectiveness of restoration caries in primary teeth, compared to no treatment?” It compares conventional restorations with an intermediate treatment strategy based on the biological (sealing-in) management of caries and with no restorations. Methods/Design: This is a Primary Care-based multi-centre, three-arm, parallel group, patient-randomised controlled trial. Practitioners are recruiting 1461 children, (3–7 years) with at least one primary molar tooth where caries extends into dentine. Children are randomized and treated according to one of three treatment approaches; conventional caries management with best practice prevention, biological management of caries with best practice prevention or best practice prevention alone. Baseline measures and outcome data (at review/treatment during three year follow-up) are assessed through direct reporting, clinical examination including blinded radiograph assessment, and child/parent questionnaires. The primary outcome measure is the incidence of either pain or infection related to dental caries. Secondary outcomes are; incidence of caries in primary and permanent teeth, patient quality of life, cost-effectiveness, acceptability of treatment strategies to patients and parents and their experiences, and dentists’ preferences. Discussion: FiCTION will provide evidence for the most clinically-effective and cost-effective approach to managing caries in children’s primary teeth in Primary Care. This will support general dental practitioners in treatment decision making for child patients to minimize pain and infection in primary teeth. The trial is currently recruiting patients

Effect of the Energy of Consciousness (The Trivedi Effect®) on Withania somnifera Root Extract Using Gas Chromatography – Mass Spectrometry and Nuclear Magnetic Resonance Spectroscopy

Withania somnifera (Ashwagandha) root extract is very popular ancient herbal medicine. The objective of the study was to characterize and evaluate the impact of The Trivedi Effect® - Energy of Consciousness Healing Treatment (Biofield Energy Healing) on phytoconstituents present in the ashwagandha root extract using GC-MS and NMR. Ashwagandha root extract was divided into two parts. One part was denoted as the control, while the other part was defined as The Trivedi Effect® - Biofield Energy Treated sample, which received The Trivedi Effect® - Energy of Consciousness Healing Treatment remotely from eighteen renowned Biofield Energy Healers. The GC-MS data indicated that the peak height and peak area of The Trivedi Effect® treated sample were found to be altered compared with the control sample. The peak height of the phytoconstituents present in the treated ashwagandha sample was altered significantly in the range of -8.32% to 89.25% compared with the control sample. Similarly, the peak area of the treated sample was altered significantly in the range of - 4.28% to 216.30% compared with the control sample. Overall, the change in the peak area% of the treated sample was significantly altered in the range of -18.29% to 170.18% compared with the control sample. The GC-MS and NMR analysis results identified the presence of withanolides such as glyco-withanolides, alkaloids, and sugars in the root extract in both the sample. The peak area of 2,3,4,5-tetrahydropyridazine (1), methyl ethyl sulfoxide (2), 5,6-dihydro-2-methyl-4(H)pyran-3,4-dione (4), diethoxy-2-methyl-propane (5), 2,3,4,5-tetrahydroxy-tetrahydro-pyran (6), and 3,4-dimethyl-2(3H)-furanone (7) were significantly increased by 170.18%, 58.21%, 7.74%, 139.50%, 23.16%, and 45.63%, respectively in the treated sample compared with the control sample. On the contrary, the peak area% of 2-hydroxy-γ-butyrolactone (3) was decreased by - 14.96% in the treated ashwagandha compared with the control sample. From the results, it can be hypothesized that The Trivedi Effect® - Biofield Energy Treatment might have the impact on the intrinsic physicochemical properties of the phytoconstituents present in the ashwagandha root extract and responsible for the alteration in the relative peak height/area of treated sample compared with the control sample. As a result, the concentrations of the phytoconstituents assumed to be increased in treated sample compared with the control sample. This treated ashwagandha root extract would be helpful for designing better nutraceutical/pharmaceutical formulations which might be providing a better therapeutic response against autoimmune diseases, nervous and sexual disorders, infectious diseases, antiaging, diabetes, cancer, immunological disorders, stress, arthritis, etc. Source: https://www.trivedieffect.com/science/effect-of-the-energy-of-consciousness-the-trivedi-effect-on-withania-somnifera-root-extract-using-gas-chromatography-mass-spectrometry-and-nuclear-magnetic-resonance-spectroscopy http://www.sciencepublishinggroup.com/journal/paperinfo?journalid=320&doi=10.11648/j.jdmp.20170302.1

Random effects diagonal metric multidimensional scaling models

By assuming a distribution for the subject weights in a diagonal metric (INDSCAL) multidimensional scaling model, the subject weights become random effects. Including random effects in multidimensional scaling models offers several advantages over traditional diagonal metric models such as those fitted by the INDSCAL, ALSCAL, and other multidimensional scaling programs. Unlike traditional models, the number of parameters does not increase with the number of subjects, and, because the distribution of the subject weights is modeled, the construction of linear models of the subject weights and the testing of those models is immediate. Here we define a random effects diagonal metric multidimensional scaling model, give computational algorithms, describe our experiences with these algorithms, and provide an example illustrating the use of the model and algorithms.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45758/1/11336_2005_Article_BF02295730.pd