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Background Botulinum toxin type B (BTX-B, Myobloc™, San Francisco, CA, USA) was FDA-approved for the treatment of cervical dystonia in December 2000. It has since been used off-label for the treatment of axillary hyperhidrosis. However, there are sparse data in the medical literature evaluating the safety and efficacy of Myobloc™ (botulinum toxin type B) for this indication. Objective To assess the safety, efficacy and duration of action of Myobloc™ (botulinum toxin type B) in the treatment of bilateral axillary hyperhidrosis. Methods This study was a double-blinded, randomized, pilot study conducted in an outpatient office setting at a private academic medical center beginning in November 2001. Twenty-three male and female volunteers between the ages of 18 and 80 were screened for participation; 20 participants with primary axillary hyperhidrosis were enrolled. Participants were injected subcutaneously with either Myobloc™ (botulinum toxin type B) (2500 U, or 0.5 ml, per axilla) or 0.5 ml vehicle (100 mM NaCl, 10 mM succinate, and 0.5 mg/ml human albumin) into bilateral axillae. Participants who received placebo were rolled over and received Myobloc™ (botulinum toxin type B) at subsequent visits. All participants were followed until sweating returned to baseline levels. This trial was initially conceived as a placebo-controlled study; however, owing to the insufficient size of the placebo group, the placebo arm of this trial was dropped during data analysis. The main outcome measures were safety, efficacy, and duration of effect. Results According to participant assessment of axillary hyperhidrosis improvement (A-HI) and quality of life (A-HQOL) scores and the physician assessment scores, a significant difference was observed in treatment response at Day 30 in the participants receiving Myobloc™ (botulinum toxin type B) injections. Duration of action ranged from 2.2 to 8.1 months (mean 5.0 months). The adverse event profile included bruising, flu-like symptoms, and dry eyes. Conclusion Myobloc™ (botulinum toxin type B) proved to be safe and efficacious for the treatment of bilateral axillary hyperhidrosis. More studies are needed to assess the duration of response using different doses of Myobloc™ (botulinum toxin type B).

The shape and form of effective teacher–pupil talk has recently become the focus of attention within policy guidelines such as the National Numeracy and Literacy Strategies. Prior to this, research on classroom discourse has established that social context plays an important role in determining the quality of teacher–pupil talk since it directs teachers' and pupils' interpretations of what is said. This paper presents a multi-layered approach to the analysis of whole-class discussions which highlights the impact of wider, institutional and historical aspects of the classroom context on the meanings relayed within interactions. Video and audio data, collected over a five-month period of participant observation in a primary school mathematics classroom, highlights how issues such as teacher expectations and time pressure influence the quality of interactions pupils experience. The paper concludes that teacher–pupil interactions play an instrumental role in determining the social positioning of pupils within...

Myobloc, known as Neurobloc in Europe, is a member of the botulinum toxin family. It has been used for a myriad of problems since its approval in the United States in December 2000. It is currently not approved for cosmetic use but has been used for this purpose. This article reviews what is currently known about botulinum toxin type B and its efficacy and safety.

Crow's feet develop with age and are one of the earliest signs of the normal aging process. Botulinum toxin type A, approved by the Food and Drug Administration for the treatment of glabellar wrinkles in April 2002, has been used off-label to treat facial wrinkles since 1981. Botulinum toxin type B (BTX-B, Myobloc) was Food and Drug Administration-approved for use in cervical dystonia in the United States in December 2000 and has subsequently been used in an off-label indication to treat facial wrinkles. There are sparse data in the literature evaluating the safety and efficacy of BTX-B for the treatment of facial wrinkles. In this pilot study, participants with moderate or severe crow's feet wrinkles were treated with Myobloc versus placebo. The duration of correction and side effect profile are reported.

This ex vivo human percutaneous absorption study evaluated a set of six model drugs (ketamine hydrochloride, bupivacaine hydrochloride, diclofenac sodium, gabapentin, orphenadrine citrate, pentoxifylline) from two popular formulations for topically applied compounding preparations. The compounded preparations used in this study were Versatile cream and a reference cream. Each formulation was applied to human trunk skin mounted on Franz Diffusion Cells, 50 mg/chamber (or 28.2 mg/cm2). Serial dermal receiver solutions were collected for 48 hours. Analysis of the resultant data supports the concept that the Versatile base formulation provides improved characteristics relative to the reference base. This is of key importance where the patient does not show clinical improvement when a conventional topical delivery vehicle is used in the formulation. From the results, it is reasonable to anticipate that, relative to the reference formulation, the Versatile formulation provides enhanced transdermal delivery of some analgesic medications.

This paper investigates treatment for anger and aggression using a variety of methods. Assessments include direct observation, self-recording of frequency of aggressive incidents, self-recording of feelings of aggression, provocation role-plays, and provocation inventories. Treatment approaches include two forms of relaxation (BRT and APR), discussions and exercises on the understanding of emotion, role-plays to develop skills for dealing with feelings of anger, and exercises in the way in which individuals construe various situations. Three participants illustrate how these assessment and treatment methods can be used to tailor treatment to suit the particular problems displayed by individuals. The reasons for choosing particular methods are discussed as are the ways in which individuals respond to the programmes of therapy.

Purpose. Despite increasing evidence that anger may play a contributing role in the violent behaviour of psychiatric patients, as yet there is a dearth of evidence concerning the utility of anger control treatment procedures with this population. This paper describes the development and preliminary evaluation of an anger treatment protocol modified to meet the needs of secure hospital patients. Method. Four patients having recurrent problems of anger and aggression were provided with anger control treatment based on the new protocol. Evaluation of the intervention was based on clinical assessments and by quantified structured interviews obtained post-treatment with each patient's psychiatrist, key worker, and day-care worker. Results. Therapist assessment and clinical staff ratings testifiy to modest but significant treatment gains for patients. Experience from clinical implementation highlights key issues in treatment process and institutional system integration for achieving efficacy. Conclusions. The results support the application of anger control treatment procedures to severely disordered psychiatric patients in a forensic institution. Given the preliminary nature of this evidence, and in the absence of a controlled clinical trial, continued work is needed on treatment and research protocols.

In this paper we describe the validation of two scales constructed to measure pre-university students' changing disposition (i) to enter Higher Education (HE) and (ii) to further study mathematically-demanding subjects. Items were selected drawing on interview data, and on a model of disposition as socially- as well as self- attributed. Rasch analyses showed that the two scales each produce robust one-dimensional measures on what we call a 'strength of commitment to enter HE' and 'disposition to study mathematically-demanding subjects further' respectively. However, the former scale was initially found to suffer psychometrically from a ceiling effect, which we 'corrected' by adding some harder items at a later data point, and revised the scale according to our interpretation of subsequent results. We finally discuss the potential significance of the constructed measures of learning outcomes, as variables in monitoring or even explaining students' progress into different subjects in HE.

Since SCN1A is expressed in the motor neuron initial segment, we explored whether motor neuron dysfunction could contribute to gait disturbance and orthopedic misalignment in patients with Dravet syndrome due to SCN1A mutations.We assessed 12 consecutive patients who presented to our institution between January and March 2013. All of them were older than 2 years and were positive for the SCN1A mutation. We performed nerve conduction velocity studies and needle EMG recordings.We included 4 females and 8 males aged 2 to 17 years (median 7.5 years). All 12 patients showed gait disturbance regardless of age. Tendon reflexes were decreased in 4 of 12 patients. None presented cerebellar signs such as tremor, dysmetria, or adiadochokinesia. Nerve conduction study was normal or nearly normal in all patients, but EMG showed features of chronic denervation. Motor neuropathy/neuronopathy was definite in 7 patients and probable in 3.SCN1A mutations may alter axonal function, causing motor neuropathy/neuronopathy. This may contribute to gait disturbance and orthopedic misalignment, which is characteristic of patients with Dravet syndrome.

Vorapaxar is an orally active protease-activated receptor 1 (PAR-1) antagonist that inhibits thrombin-induced platelet aggregation. This open-label study assessed the pharmacokinetics and pharmacodynamics of single-dose warfarin in the presence/absence of multiple-dose vorapaxar in 12 healthy men.Subjects received two treatments separated by ≥ 7-day washout: Treatment A warfarin 25 mg (Day 1); Treatment B vorapaxar 2.5 mg/day on Days 1-6 and vorapaxar 40 mg coadministered with warfarin 25 mg (Day 7). R-warfarin, S-warfarin, and prothrombin time (PT) were assayed predose and up to 120 h postdose.The geometric mean ratio (GMR) as a percentage (warfarin + vorapaxar/warfarin) was calculated. The GMR (90 % CIs) estimates of C(max) were 105 (99, 111) and 105 (99, 112) for R- and S-warfarin, respectively. The GMR (90 % CIs) estimates of AUC(0-∞) were 108 (101, 116) and 105 (96, 115) for R- and S-warfarin, respectively. The GMR (95 % CIs) estimates of AUC(0-120 h) for PT and INR were 97 (95, 98) and 96 (94, 98), respectively.Results of this study indicate that vorapaxar has no meaningful effect on the pharmacokinetics or pharmacodynamics of warfarin, suggesting that the coadministration of these two drugs or vorapaxar coadministered with other CYP2C9/CYP2C19 substrates is unlikely to cause a clinically significant pharmacokinetic drug interaction.

This book brings together scholars working in the field of mathematics education to examine the ways in which learners form particular relationships with mathematics in the context of formal schooling. While demand for the mathematically literate citizen increases, many learners continue to reject mathematics and experience it as excluding and exclusive, even when they succeed at it. In exploring this phenomenon, this volume focuses on learners' developing sense of self and their understanding of the part played by mathematics in it. It recognizes the part played by emotional responses, the functioning of classroom communities of practice, and by discourses of mathematics education in this process. It thus blends perspectives from psychoanalysis, socio-cultural theory and discursive approaches in a focus on the classic issues of selection and assessment, pedagogy, curriculum, choice, and teacher development.

Whole-class discussions have long been the focus of much research. They are a dominant practice in many classrooms and are, potentially, key sites for fostering children’s learning (Barnes, 1976; Cazden, 2001; Edwards & Mercer, 1987; Wells, 1999). In England, we have seen the endorsement of whole-class teaching within educational policy (Department for Education and Employment (DfEE), 1998, 1999, 2001), not only as a pedagogic tool for standards-based educational reform (Reynolds & Muijs, 1999), but also as a means to achieving inclusivity within an increasingly diverse classroom environment. For example, the National Literacy Strategy Framework for Teaching introduced the notion of interactive whole class teaching, stating that it benefits children who need help to access the curriculum for example low attainers, those with special needs or limited fluency in English, by introducing them to challenging work, teaching them skills in a highly supportive context and raising their expectations and self esteem. (DfEE, 1998, p. 96)

1. Although nurses are at considerable risk for assaults, there are few practical and specific guidelines for controlling anger and aggression. 2. A training course was developed to give staff the necessary skills and knowledge to cope with clients who have the potential to become angry and assaultive, or those who have already become violent. 3. Participants in the training course felt more confident in managing potentially violent situations, and they reported relying on methods to de-escalate the situation to halt a sequence that would ultimately lead to violence.

Alitretinoin (9-cis-retinoic acid) is an FDA-approved topical therapy for the treatment of Kaposi sarcoma. Alitretinoin is a naturally occurring endogenous retinoid that binds to and activates all known intracellular retinoic acid receptor (RAR) subtypes alpha, beta, and gamma and retinoic X receptor (RXR) subtypes alpha, beta, and gamma. Photoaging of the skin is the result of accumulated exposure to solar UV radiation. Several topically applied retinoids have been proven clinically effective for treating the appearance of photoaging. Tretinoin and tazarotene, which have been shown to improve photodamaged skin, bind RAR subtypes only. The theoretic benefit of alitretinoin gel 0.1% (Panretin) in the treatment of photoaged skin stems from the binding and activation of both RARs and RXRs, which promote the repair mechanisms in damaged skin. The objective of this study was to evaluate the safety and efficacy of topical alitretinoin gel 0.1% in the treatment of photodamaged skin. The treatment was well tolerated by participants (N=20) and subjectively showed improvement of benign skin lesions (eg, seborrheic keratoses) and precancerous lesions (eg, actinic keratoses). Larger, blinded, controlled trials are needed to investigate the role of this novel retinoid in the treatment of photoaging.

Background Palmar hyperhidrosis is a problem of unknown etiology that affects patients both socially and professionally. Botulinum toxin type B (Myobloc), approved by the Food and Drug Administration for use in the treatment of cervical dystonia in the United States in December 2000, has subsequently been used effectively in an off-label indication to treat hyperhidrosis. There are sparse data, however, in the literature evaluating the safety and efficacy of BTX-B for the treatment of palmar hyperhidrosis. Objective We evaluated the safety and efficacy of Myobloc in the treatment of bilateral palmar hyperhidrosis. This was a double-blind, randomized, placebo-controlled study to report on the safety and efficacy of Myobloc. Methods Twenty participants (10 men, 10 women) diagnosed with palmar hyperhidrosis were injected with either Myobloc (5,000 U per palm) or a 1.0 mL vehicle (100 mM NaCl, 10 mM succinate, and 0.5 mg/mL human albumin) into bilateral palms (15 Myobloc, 5 placebo). The participants were followed until sweating returned to baseline levels. The main outcome measures were safety, efficacy versus placebo, and duration of effect. Results A significant difference was found in treatment response at day 30, as determined by participant assessments, between 15 participants injected with Myobloc and 3 participants injected with placebo. The duration of action, calculated in the 17 participants who received Myobloc injections and completed the study, ranged from 2.3 to 4.9 months, with a mean duration of 3.8 months. The single most reported adverse event was dry mouth or throat, which was reported by 18 of 20 participants. The adverse event profile also included indigestion or heartburn (60%), excessively dry hands (60%), muscle weakness (60%), and decreased grip strength (50%). Conclusion Myobloc proved to be efficacious for the treatment of palmar hyperhidrosis. Myobloc had a rapid onset, with most participants responding within 1 week. The duration of action ranged from 2.3 to 4.9 months, with a mean of 3.8 months. The adverse event profile included dry mouth, indigestion or heartburn, excessively dry hands, muscle weakness, and decreased grip strength. MYOBLOC WAS PROVIDED FOR THIS STUDY BY ELAN PHARMACEUTICALS.

Therapeutic interventions for anger and aggression have progressed significantly in the past decade, yet the treatment of this very problematic emotion/action complex remains neglected among seriously disordered populations. Recent work by Howells and his colleagues (Howells, 1989; Howells & Hollin, 1989; Levey & Howells, 1991) has certainly provided an impetus to addressing problems of anger, aggression, and violence among institutionalized patients.1 Most assuredly, the management of patients’ aggressive behavior presents formidable challenges to clinical staff who must be concerned with risks to themselves and to the welfare of other patients. Moreover, a patient’s inability to control aggressive behavior will certainly forestall discharge and perpetually remain a liability for social adaptation. Because assaultive behavior is often mediated by anger, treatment procedures that aim to provide clients with anger-control capabilities are important therapeutic resources, especially be-cause they seek to promote anger regulatory competency through the development of coping skills that have larger implications for psychosocial adjustment.

This paper builds on previous work (Black et al., Educational Studies in Mathematics 73(1):55-72, 2010) which developed the notion of a leading identity (derived from Leont’ev’s concept of ‘leading activity’) which, we argued, defined students’ motive for studying during late adolescence. We presented two case studies of students in post-compulsory education (Mary and Lee) and highlighted how the concept of a leading identity might be relevant to understanding motivation in mathematics education and particularly the ‘exchange value’ or ‘use value’ of mathematics for these students. (Lee’s identity was mediated by mathematics’ potential exchange value in becoming a university student, and Mary’s more by its perceived use value to her leading identity as an engineer.) In this paper, we follow up Mary’s story as she progresses to university, and we see how she is now ‘led’ by contradictory motives and identities: Mary’s aspirations and decisions seem to be now as much related to her identity as a Muslim woman as to her identity as an engineer. Therefore, we argue that more than one identity/activity may be considered as ‘leading’ at this point in time—e.g. work versus motherhood/parenting, for instance—and this raises conflicts and tensions. We conclude with a more reflexive account of leading identity which recognises the adolescent’s developing awareness of self—an ongoing process of organisation as they experience contradictions in managing their education, work, domestic, community and other lives.

The construction of positive mathematical identities (MIs) is a complex and central issue in school mathematics, where girls are usually “counted out” of the field. This study explores positive MIs (high achiever and positive relationship with mathematics) of 3 girls. We employed a nested model of identity based on a case study approach (i.e., female mathematics students nested within a cluster of students nested within a mathematics classroom). The results highlight diversity in how these girls experienced mathematics: They valued different forms of doing mathematics (independent and collaborative; wider and complex; and straightforward, procedure-oriented mathematics), showed different forms of engagement (detachment, protagonist and challenging, and compliant and support-seeker), and narrated different MIs (efficient, different, and responsible). The study also explores and discusses the roles of mathematical practice and belonging to different peer clusters in these different forms of identification.

This paper reports on the processes and impact of STEM volunteers working with primary schools. STEM volunteers are often undergraduate or postdoctoral science or engineering students, or professional scientists and engineers. Primary school teachers can request involvement with STEM volunteers through a range of placement schemes. The teachers involved are often those who hold specific roles for the development of science teaching, learning and assessment practices across the school. In this project, the University of Manchester’s Science & Engineering Education Research and Innovation Hub (SEERIH) acted as project developer and the broker for ‘setting up’ the associations between the schools and the STEM volunteers. This paper reviews what a consultative group (formed from stakeholders, including teachers, STEM volunteers, SEERIH staff, STEMNET staff and University of Manchester Widening Participation staff) identified as features of successful STEM volunteer placements in primary schools, and reports on the findings, observations and interviews with the STEM volunteers and teachers about their experiences.