Assessment of the Calibration of Periodontal Diagnosis and Treatment Planning Among Dental Students at Three Dental Schools

Calibration in diagnosis and treatment planning is difficult to achieve due to variations that exist in clinical interpretation. To determine if dental faculty members are consistent in teaching how to diagnose and treat periodontal disease, variations among dental students can be evaluated. A previous study reported high variability in diagnoses and treatment plans of periodontal cases at Indiana University School of Dentistry. This study aimed to build on that one by extending the research to two additional schools: Marquette University School of Dentistry and West Virginia University School of Dentistry. Diagnosis and treatment planning by 40 third- and fourth-year dental students were assessed at each of the schools. Students were asked to select the diagnosis and treatment plans on a questionnaire pertaining to 11 cases. Their responses were compared using chi-square tests, and multirater kappa statistics were used to assess agreement between classes and between schools. Logistic regression models were used to evaluate the effects of school, class year, prior experience, and GPA/class rank on correct responses. One case had a statistically significant difference in responses between third- and fourth-year dental students. Kappas for school agreement and class agreement were low. The students from Indiana University had higher diagnosis and treatment agreements than the Marquette University students, and the Marquette students fared better than the West Virginia University students. This study can help restructure future periodontal courses for a better understanding of periodontal diagnosis and treatment planning

Protected gates for topological quantum field theories

We study restrictions on locality-preserving unitary logical gates for topological quantum codes in two spatial dimensions. A locality-preserving operation is one which maps local operators to local operators --- for example, a constant-depth quantum circuit of geometrically local gates, or evolution for a constant time governed by a geometrically-local bounded-strength Hamiltonian. Locality-preserving logical gates of topological codes are intrinsically fault tolerant because spatially localized errors remain localized, and hence sufficiently dilute errors remain correctable. By invoking general properties of two-dimensional topological field theories, we find that the locality-preserving logical gates are severely limited for codes which admit non-abelian anyons; in particular, there are no locality-preserving logical gates on the torus or the sphere with M punctures if the braiding of anyons is computationally universal. Furthermore, for Ising anyons on the M-punctured sphere, locality-preserving gates must be elements of the logical Pauli group. We derive these results by relating logical gates of a topological code to automorphisms of the Verlinde algebra of the corresponding anyon model, and by requiring the logical gates to be compatible with basis changes in the logical Hilbert space arising from local F-moves and the mapping class group.Comment: 50 pages, many figures, v3: updated to match published versio

A Lunar-Based Spacecraft Propulsion Concept - The Ion Beam Sail

We describe a concept for spacecraft propulsion by means of an energetic ion beam, with the ion source fixed at the spacecraft starting point (e.g., a lunar-based ion beam generator) and not onboard the vessel. This approach avoids the substantial mass penalty associated with the onboard ion source and power supply hardware, and vastly more energetic ion beam systems can be entertained. We estimate the ion beam parameters required for various scenarios, and consider some of the constraints limiting the concept. We find that the "ion beam sail' approach can be viable and attractive for journey distances not too great, for example within the Earth-Moon system, and could potentially provide support for journeys to the inner planets

Nursing Home Staff Palliative Care Knowledge and Practices: Results of a Large Survey of Frontline Workers

CONTEXT: Deficits in quality end-of-life care for nursing home (NH) residents are well known. Palliative care is promoted as an approach to improve quality. The Palliative Care Survey (PCS) is designed to measure NH staff palliative care knowledge and practice. OBJECTIVES: To comparing palliative care knowledge and practices across NH staff roles using the PCS, and to examine relationships between facility characteristics and PCS scores. METHODS: The PCS was administered to frontline NH staff-certified nursing assistants (CNAs), licensed practical nurses (LPNs), registered nurses (RNs), and social workers (SWs)-in 51 facilities in 2012. Descriptive statistics were calculated by job role. Linear mixed effects models were used to identify facility and individual factors associated with palliative care practice and knowledge. RESULTS: The analytic sample included 1200 surveys. CNAs had significantly lower practice and knowledge scores compared to LPNs, RNs, and SWs (P < 0.05). LPNs had significantly lower psychological, end-of-life, and total knowledge scores than RNs (P < 0.05 for all). Although knowledge about physical symptoms was uniformly high, end-of-life knowledge was notably low for all staff. A one-point higher facility star rating was significantly associated with a 0.06 increase in family communication score (P = 0.003; 95% CI: 0.02-0.09; SE = 0.02). Higher penetration of hospice in the NH was associated with higher end-of-life knowledge (P = 0.003; parameter estimate = 0.006; 95% CI: 0.002-0.010; SE = 0.002). Sixty-two percent of respondents stated that, with additional training, they would be interested in being leaders in palliative care. CONCLUSION: Given observed differences in palliative care practice and knowledge scores by staff training, it appears the PCS is a useful tool to assess NH staff. Low end-of-life knowledge scores represent an important target for quality improvement

Book Reviews

Professor Hicks has done for a few great lawyers and \u27a few great books what it is hoped he may do for many more lawyers and many more books. Out of his full and intimate knowledge of the literature of our profession he has gathered and presented to us in most entertaining fashion the human as well as the intellectual and professional characteristics of a full half dozen men, each of whom holds a somewhat unique place in the development of Anglo-Saxon law

Fibered orbifolds and crystallographic groups

In this paper, we prove that a normal subgroup N of an n-dimensional crystallographic group G determines a geometric fibered orbifold structure on the flat orbifold E^n/G, and conversely every geometric fibered orbifold structure on E^n/G is determined by a normal subgroup N of G, which is maximal in its commensurability class of normal subgroups of G. In particular, we prove that E^n/G is a fiber bundle, with totally geodesic fibers, over a b-dimensional torus, where b is the first Betti number of G. Let N be a normal subgroup of G which is maximal in its commensurability class. We study the relationship between the exact sequence 1 -> N -> G -> G/N -> 1 splitting and the corresponding fibration projection having an affine section. If N is torsion-free, we prove that the exact sequence splits if and only if the fibration projection has an affine section. If the generic fiber F = Span(N)/N has an ordinary point that is fixed by every isometry of F, we prove that the exact sequence always splits. Finally, we describe all the geometric fibrations of the orbit spaces of all 2- and 3-dimensional crystallographic groups building on the work of Conway and Thurston.Comment: 26 pages, 1 Table. Some new theorems have been added to v

Hospice in the nursing home: perspectives of front line nursing home staff

OBJECTIVE: Use of hospice has been associated with improved outcomes for nursing home residents and attitudes of nursing home staff toward hospice influences hospice referral. The objective of this study is to describe attitudes of certified nursing assistants (CNAs), nurses, and social workers toward hospice care in nursing homes. DESIGN, SETTING, AND PARTICIPANTS: We conducted a survey of 1859 staff from 52 Indiana nursing homes. MEASUREMENTS: Study data include responses to 6 scaled questions and 3 open-ended qualitative prompts. In addition, respondents who cared for a resident on hospice in the nursing home were asked how often hospice: (1) makes their job easier; (2) is responsive when a patient has symptoms or is actively dying; (3) makes care coordination smooth; (4) is needed; (5) taught them something; and (6) is appreciated by patients/families. Responses were dichotomized as always/often or sometimes/never. RESULTS: A total of 1229 surveys met criteria for inclusion. Of the respondents, 48% were CNAs, 49% were nurses, and 3% were social workers; 83% reported caring for a nursing home patient on hospice. The statement with the highest proportion of always/often rating was 'patient/family appreciate added care' (84%); the lowest was 'hospice makes my job easier' (54%). More social workers responded favorably regarding hospice responsiveness and coordination of care compared with CNAs (P = .03 and P = .05, respectively). CONCLUSIONS: A majority of staff responded favorably regarding hospice care in nursing homes. About one-third of nursing home staff rated coordination of care lower than other aspects, and many qualitative comments highlighted examples of when hospice was not responsive to patient needs, representing important opportunities for improvement

The value of source data verification in a cancer clinical trial

Background Source data verification (SDV) is a resource intensive method of quality assurance frequently used in clinical trials. There is no empirical evidence to suggest that SDV would impact on comparative treatment effect results from a clinical trial. Methods Data discrepancies and comparative treatment effects obtained following 100% SDV were compared to those based on data without SDV. Overall survival (OS) and Progression-free survival (PFS) were compared using Kaplan-Meier curves, log-rank tests and Cox models. Tumour response classifications and comparative treatment Odds Ratios (ORs) for the outcome objective response rate, and number of Serious Adverse Events (SAEs) were compared. OS estimates based on SDV data were compared against estimates obtained from centrally monitored data. Findings Data discrepancies were identified between different monitoring procedures for the majority of variables examined, with some variation in discrepancy rates. There were no systematic patterns to discrepancies and their impact was negligible on OS, the primary outcome of the trial (HR (95% CI): 1.18(0.99 to 1.41), p = 0.064 with 100% SDV; 1.18(0.99 to 1.42), p = 0.068 without SDV; 1.18(0.99 to 1.40), p = 0.073 with central monitoring). Results were similar for PFS. More extreme discrepancies were found for the subjective outcome overall objective response (OR (95% CI): 1.67(1.04 to 2.68), p = 0.03 with 100% SDV; 2.45(1.49 to 4.04), p = 0.0003 without any SDV) which was mostly due to differing CT scans. Interpretation Quality assurance methods used in clinical trials should be informed by empirical evidence. In this empirical comparison, SDV was expensive and identified random errors that made little impact on results and clinical conclusions of the trial. Central monitoring using an external data source was a more efficient approach for the primary outcome of OS. For the subjective outcome objective response, an independent blinded review committee and tracking system to monitor missing scan data could be more efficient than SDV

An algebraic interpretation of the Wheeler-DeWitt equation

We make a direct connection between the construction of three dimensional topological state sums from tensor categories and three dimensional quantum gravity by noting that the discrete version of the Wheeler-DeWitt equation is exactly the pentagon for the associator of the tensor category, the Biedenharn-Elliott identity. A crucial role is played by an asymptotic formula relating 6j-symbols to rotation matrices given by Edmonds.Comment: 10 pages, amstex, uses epsf.tex. New version has improved presentatio

Flinders Island spotted fever rickettsioses caused by "marmionii" strain of rickettsia honei, Eastern Australia

Australia has 4 rickettsial diseases: murine typhus, Queensland tick typhus, Flinders Island spotted fever, and scrub typhus. We describe 7 cases of a rickettsiosis with an acute onset and symptoms of fever (100%), headache (71%), arthralgia (43%), myalgia (43%), cough (43%), maculopapular/petechial rash (43%), nausea (29%), pharyngitis (29%), lymphadenopathy (29%), and eschar (29%). Cases were most prevalent in autumn and from eastern Australia, including Queensland, Tasmania, and South Australia. One patient had a history of tick bite (Haemaphysalis novaeguineae). An isolate shared 99.2%, 99.8%, 99.8%, 99.9%, and 100% homology with the 17 kDa, ompA, gltA, 16S rRNA, and Sca4 genes, respectively, of Rickettsia honei. This Australian rickettsiosis has similar symptoms to Flinders Island spotted fever, and the strain is genetically related to R. honei. It has been designated the "marmionii" strain of R. honei, in honor of Australian physician and scientist Barrie Marmion