A tale of two cinnamons: A comparative review of the clinical evidence of Cinnamomum verum and C. cassia as diabetes interventions

Objective: This review investigates the effectiveness of two cinnamon species, Cinnamomum verum and C. cassia, in diabetes management; their impact on related health conditions and relevant parameters in healthy individuals and safety issues. Methods: PubMed, Cochrane Library, and ScienceDirect were searched from 2000 up to April 2018 for clinical trials using either C. verum or C. cassia in controlling blood glucose and other diabetes-related parameters and conditions. Results: A total of twenty-five studies (n=997) were included for reviewing clinical evidence. Among these trials, fifteen studies investigated the effects on type II diabetes mellitus (T2DM) patients (n=831), four investigated subjects with related clinical conditions (n=82), and six investigated healthy individuals (n=84). Nineteen studies used C. cassia and six used C. verum. Results suggested C. cassia helped manage diabetes at 3-6g, while the effectiveness of C. verum remained inconclusive. In addition, the chemical properties of C. cassia and C. verum differ considerably. Of note, C. cassia contains high levels of the potentially hepatotoxic constituent coumarin. A skin rash was the only adverse event reported. Conclusion: While evidence supports the therapeutic benefit of C. cassia, interchangeability of C. cassia and C. verum remains inconclusive. Further research is warranted to address the effectiveness and safety of these cinnamon species. Given the potential hepatotoxicity of C. cassia, RCTs that include liver function tests are required. Robust RCTs on C. verum are recommended to establish if its efficacy can match its safety profile

Blaming the victim, all over again: Waddell and Aylward's biopsychosocial (BPS) model of disability

The biopsychosocial (BPS) model of mental distress, originally conceived by the American psychiatrist George Engel in the 1970s and commonly used in psychiatry and psychology, has been adapted by Gordon Waddell and Mansell Aylward to form the theoretical basis for current UK Government thinking on disability. Most importantly, the Waddell and Aylward version of the BPS has played a key role as the Government has sought to reform spending on out-of- work disability benefits. This paper presents a critique of Waddell and Aylward’s model, examining its origins, its claims and the evidence it employs. We will argue that its potential for genuine inter-disciplinary cooperation and the holistic and humanistic benefits for disabled people as envisaged by Engel are not now, if they ever have been, fully realized. Any potential benefit it may have offered has been eclipsed by its role in Coalition/Conservative government social welfare policies that have blamed the victim and justified restriction of entitlements

Miniature oxygen resuscitator

Miniature, portable resuscitation system is used during evacuation of patients to medical facilities. A carrying case contains a modified resuscitator head, cylinder of oxygen, two-stage oxygen regulator, low pressure tube, and a mask for mouth and nose

Pulmonary embolectomy in a patient with recent renal homotransplantation

A successful case of pulmonary embolectomy is described. Diagnosis was made when the patient developed cardiac arrest in the hospital ward. The embolus was removed with the aid of cardiopulmonary bypass. The principal clot was discovered in the right pulmonary artery, with an additional small fragment in the left main pulmonary artery. Several unique features of this case increased the problems of care during and after the embolectomy. The patient had received a renal homotransplant to the left iliac fossa from a patient of a different blood type 7 weeks earlier. The embolus was thought to have originated in the left leg distal to the renal vein anastomosis. Technical details of the cardiopulmonary bypass and the subsequent vena caval plication were planned with a view to protecting the function of the graft. The presence of the renal homograft may have contributed to the original formation of the peripheral thrombus. Finally, the postoperative care was complicated by the need to provide cytotoxic drug therapy for the continued protection of the homograft. This therapy, which weakens the immunologic response of the host, had to be modified when septic complications occurred during the postoperative period. Eventual recovery was possible with minimal loss of renal function. © 1964

A cost comparison of traditional drainage and SUDS in Scotland

The Dunfermline Eastern Expansion (DEX) is a 350 ha mixed development which commenced in 1996. Downstream water quality and flooding issues necessitated a holistic approach to drainage planning and the site has become a European showcase for the application of Sustainable Urban Drainage Systems (SUDS). However, there is minimal data available regarding the real costs of operating and maintaining SUDS to ensure they continue to perform as per their design function. This remains one of the primary barriers to the uptake and adoption of SUDS. This paper reports on what is understood to be the only study in the UK where actual costs of constructing and maintaining SUDS have been compared to an equivalent traditional drainage solution. To compare SUDS costs with traditional drainage, capital and maintenance costs of underground storage chambers of analogous storage volumes were estimated. A whole life costing methodology was then applied to data gathered. The main objective was to produce a reliable and robust cost comparison between SUDS and traditional drainage. The cost analysis is supportive of SUDS and indicates that well designed and maintained SUDS are more cost effective to construct, and cost less to maintain than traditional drainage solutions which are unable to meet the environmental requirements of current legislation

The enchantment of Western Herbal Medicine

In the UK the profession of Western Herbal Medicine (WHM) has had to engage with politics and with science in order to survive. Social science work on WHM suggests that traditional knowledge is being overtaken by biomedical knowledge, with one paradigm replacing another, although collaboration with science is also seen as possible. Throughout this work the voices of herbalists themselves have rarely been presented. Drawing from a biographic narrative approach to interviewing, along with supporting ethnographic methods, thirteen cases of individual herbalists are presented here. Eight out of the thirteen cases reveal ‘visible entryways’ to becoming herbalists - beginnings that are congruent with WHM as an increasingly professionalized practice. However, five of these eight cases reveal some sort of ‘enchantment’ with plants or herbal medicines as being important for their practices. Enchantment is characterized as a sensual affective energy and is situated among debates, initiated by Max Weber, on the place of enchantment and disenchantment in the modern world. The five remaining cases reveal‘hidden entryways’, where there are sensual enchanted experiences of crossings between humans and plants on the road to becoming herbalists, often at a young age. Enchantment is also found later on in most of these narratives. The thirteen cases suggest that, rather than a paradigmatic takeover of WHM by science, there is an enchantment of some herbalists by plants and medicines that includes both scientific and traditional approaches to practice. It is argued that the meeting and crossing of herbalists with plants and medicines allows herbalists to draw easily from a diverse range of influences that others may see as incommensurable. Herbs, rather than concepts and theories are, for the most part, at the centre of WHM. The findings suggest that plants and herbal medicines may be seen as having more agency than has been previously considered. Drawing on a herbalist’s engagement with Ivan Illich it is asked whether herbs and herbalists may be seen as each other’s ‘convivial tools’. Beyond WHM, in the plant sciences, the agency of plants is being investigated in the controversial field of plant behaviour and plant neurobiology where the possibility of plant intelligence is raised. Within the social sciences, posthumanism and ontological turns also address the agency of the non-human, where plant agency is beginning to be considered. It is asked whether the profession of WHM in the UK should engage with these developments in the plant and social sciences in order to establish additional networks of support

Sickness presenteeism: measurement and management challenges

Since work can be restorative to health, attending work when unwell should not be viewed as an inherently negative phenomenon. However, the functional benefits are likely to depend on the health condition, and the psychosocial quality of the work provided. The current study used a workforce survey to explore differences in the pattern of presenteeism and absenteeism by health condition, the association of psychosocial work factors with presenteeism compared to absenteeism, and their interaction to predict health. Findings indicate that instead of substituting absenteeism for presenteeism, the two tend to coincide, but the balance differs by health condition. Presenteeism is more likely to occur in poorer psychosocial environments, reinforcing the importance of ensuring work is designed and managed in ways that are beneficial rather than detrimental to health. The findings also highlight the methodological importance of differentiating between the act and impact of presenteeism in future research and practice

Making an impression: error location and repertoire features affect performance quality rating processes

This article examines the effects of composition length, familiarity, and likeability—as well as the location of performance errors—on the process of forming performance quality ratings. Five piano works by Chopin and a twentieth-century composer were cho- sen to vary by length and familiarity. Three of these pieces were then manipulated to contain performance errors in the opening material, and two of those the same error at the recapitulation. Forty-two musicians provided continuous quality evaluations and final quality ratings of the performances, hearing one version of each piece. The results showed that familiarity had no effect within works of a well-known composer, but times to first and final decision were significantly extended for an unfamiliar work of an unfamiliar composer. A shorter piece led to a shorter time to first decision. An error at the beginning of a performance caused a shorter time to first decision and lower initial and final ratings, where the same error at the recapitulation did not have a significant effect on the final judgment, despite causing a temporary negative drop. These findings demonstrate how evaluators’ knowledge of a work can affect their rating process and the importance of making a strong first impression in performance

Rationale, design and methods of the Study of Work and Pain (SWAP): a cluster randomised controlled trial testing the addition of a vocational advice service to best current primary care for patients with musculoskeletal pain (ISRCTN 52269669)

Background Musculoskeletal pain is a major contributor to short and long term work absence. Patients seek care from their general practitioner (GP) and yet GPs often feel ill-equipped to deal with work issues. Providing a vocational case management service in primary care, to support patients with musculoskeletal problems to remain at or return to work, is one potential solution but requires robust evaluation to test clinical and cost-effectiveness. Methods/Design This protocol describes a cluster randomised controlled trial, with linked qualitative interviews, to investigate the effect of introducing a vocational advice service into general practice, to provide a structured approach to managing work related issues in primary care patients with musculoskeletal pain who are absent from work or struggling to remain in work. General practices (n = 6) will be randomised to offer best current care or best current care plus a vocational advice service. Adults of working age who are absent from or struggling to remain in work due to a musculoskeletal pain problem will be invited to participate and 330 participants will be recruited. Data collection will be through patient completed questionnaires at baseline, 4 and 12 months. The primary outcome is self-reported work absence at 4 months. Incremental cost-utility analysis will be undertaken to calculate the cost per additional QALY gained and incremental net benefits. A linked interview study will explore the experiences of the vocational advice service from the perspectives of GPs, nurse practitioners (NPs), patients and vocational advisors. Discussion This paper presents the rationale, design, and methods of the Study of Work And Pain (SWAP) trial. The results of this trial will provide evidence to inform primary care practice and guide the development of services to provide support for musculoskeletal pain patients with work-related issues. Trial registration Current Controlled Trials ISRCTN52269669