Pre-Radiotherapy Dental Assessment of Head and Neck Oncology Patients: An Audit.

Objectives: Approximately 300 people are diagnosed with Head and Neck cancer annually in Northern Ireland. The management may include treatment by surgery or by chemotherapy and radiotherapy,
or a combination of modalities. Patients whose oral cavity, teeth, salivary glands and jaws that
will be affected by treatment, particularly radiotherapy should have a pre-treatment assessment. This should be done as early as possible to maximise the time available for dental management. However, this can be challenging owing to the complexities of cancer diagnosis, treatment planning and multidisciplinary management. At the Belfast Dental Hospital, a number of patients were referred post- radiotherapy with complications after not having received a pre-treatment assessment. The referrals for pre- treatment dental assessment were also late in patients’ multidisciplinary journey, limiting the time period
for dental input. The purpose of this audit was to examine the time period between dental assessment and commencement of radiotherapy and whether this was an adequate time frame for dental management. This audit will also examine the dental diseases present and the treatments required pre-radiotherapy. Methods: Data for this audit was collected over 4 months in 2012
by analysing the dental charts and referrals of new patients who were referred to and attended the dental head and neck oncology clinic. A standardised referral pro-forma was introduced from September 2013 to improve the referral process.
A re-audit was conducted over 4 months in 2014. Data was collected similarly as previous. The time period between dental assessment and commencement of radiotherapy was examined. The presence of dental disease and subsequent treatments required were also noted.
Results: 63 new patients were examined in the dental head and neck oncology clinic over 4 months in 2012. 48 (76.2%) were examined pre-radiotherapy. The average length of time between dental assessment and radiotherapy commencement was 11 days. A new standardised referral pro-forma was introduced in 2013. In the re-audit, 65 new patients were seen over 4 months in 2014.
60 (92.3%) patients were examined pre-radiotherapy. The average length of time between dental assessment and radiotherapy commencement was 18 days.
Conclusion: Given the high prevalence of pre-existing dental disease amongst head and neck cancer patients, prompt dental assessment and treatment is vital. Efforts aimed at improving the care pathway are on-going through the implementation of a mandatory referral pro-forma and a dedicated assessment clinic.

A Conventional Internal Combustion Engine Versus a Range Extended Electric Vehicle Under the Current Regulatory Regime in the United Kingdom

Transport accounts for 22% of greenhouse gas emissions in the United Kingdom and cars are expected tomore than double by 2050. Car manufacturers are continually aiming for a substantially reduced carbonfootprint through improved fuel efficiency and better powertrain performance due to the strict EuropeanUnion emissions standards. However, road tax, not just fuel efficiency, is a key consideration of consumerswhen purchasing a car. While measures have been taken to reduce emissions through stricter standards, infuture, alternative technologies will be used. Electric vehicles, hybrid vehicles and range extended electricvehicles have been identified as some of these future technologies. In this research a virtual test bed of aconventional internal combustion engine and a range extended electric vehicle family saloon car were builtin AVL’s vehicle and powertrain system level simulation tool, CRUISE, to simulate the New EuropeanDrive Cycle and the results were then soft-linked to a techno-economic model to compare the effectivenessof current support mechanisms over the full life cycle of both cars. The key finding indicates that althoughcarbon emissions are substantially reduced, switching is still not financially the best option for either theconsumer or the government in the long run.

The role of complexity metrics in a multi-institutional dosimetry audit of VMAT

OBJECTIVE: To demonstrate the benefit of complexity metrics such as the modulation complexity score (MCS) and monitor units (MUs) in multi-institutional audits of volumetric-modulated arc therapy (VMAT) delivery.

METHODS: 39 VMAT treatment plans were analysed using MCS and MU. A virtual phantom planning exercise was planned and independently measured using the PTW Octavius(®) phantom and seven29(®) 2D array (PTW-Freiburg GmbH, Freiburg, Germany). MCS and MU were compared with the median gamma index pass rates (2%/2 and 3%/3 mm) and plan quality. The treatment planning systems (TPS) were grouped by VMAT modelling being specifically designed for the linear accelerator manufacturer's own treatment delivery system (Type 1) or independent of vendor for VMAT delivery (Type 2). Differences in plan complexity (MCS and MU) between TPS types were compared.

RESULTS: For Varian(®) linear accelerators (Varian(®) Medical Systems, Inc., Palo Alto, CA), MCS and MU were significantly correlated with gamma pass rates. Type 2 TPS created poorer quality, more complex plans with significantly higher MUs and MCS than Type 1 TPS. Plan quality was significantly correlated with MU for Type 2 plans. A statistically significant correlation was observed between MU and MCS for all plans (R = -0.84, p < 0.01).

CONCLUSION: MU and MCS have a role in assessing plan complexity in audits along with plan quality metrics. Plan complexity metrics give some indication of plan deliverability but should be analysed with plan quality.

ADVANCES IN KNOWLEDGE: Complexity metrics were investigated for a national rotational audit involving 34 institutions and they showed value. The metrics found that more complex plans were created for planning systems which were independent of vendor for VMAT delivery.

Real-time estimation of battery internal temperature based on a simplified thermoelectric model

Li-ion batteries have been widely used in the EVs, and the battery thermal management is a key but challenging part of the battery management system. For EV batteries, only the battery surface temperature can be measured in real-time. However, it is the battery internal temperature that directly affects the battery performance, and large temperature difference may exist between surface and internal temperatures, especially in high power demand applications. In this paper, an online battery internal temperature estimation method is proposed based on a novel simplified thermoelectric model. The battery thermal behaviour is first described by a simplified thermal model, and battery electrical behaviour by an electric model. Then, these two models are interrelated to capture the interactions between battery thermal and electrical behaviours, thus offer a comprehensive description of the battery behaviour that is useful for battery management. Finally, based on the developed model, the battery internal temperature is estimated using an extended Kalman filter. The experimental results confirm the efficacy of the proposed method, and it can be used for online internal temperature estimation which is a key indicator for better real-time battery thermal management.

Wishful Thinking: Lessons from the internal and external evaluations of an innovatory education project in Northern Ireland

From March 1999 to August 2000, the authors were involved in simultaneous internal and external evaluations of the social civic and political education (SCaPE) project in Northern Ireland. This project was a major initiative established by the Citizenship Foundation, the Northern Ireland Council for the Curriculum, Examination and Assessment (CCEA), and the School of Education at the University of Ulster at Coleraine. It was a 2-year project in 25 secondary schools established to design, develop, pilot and evaluate a new programme of social, civic and political education for Northern Ireland. It also aimed to serve as a model for future Citizenship curriculum developments throughout Northern Ireland and elsewhere. This paper describes the background to the project, the design and conduct of the two evaluations, and the links between them. It outlines the main conclusions of each evaluation and describes the way SCaPE has since evolved into a mainstream curriculum development project. The final part of the paper analyses the key opportunities, tensions and challenges involved in running such evaluations at a critical time in the history of Northern Ireland – a time when innovation is both necessary and controversial. It argues that, especially in such circumstances, evaluation cannot be conducted from a neutral, objective standpoint, and that it is incumbent on evaluators to recognise the emotional, personal and political commitment they make to the projects in which they are engaged.

Progressing from internal to supply chain level environmental strategies: The influence of internal support processes

The need for companies to consider the environmental impact of their operations and supply chains has been highlighted in the literature. However, few studies appear to consider how companies’ progress from proactive environmental strategies implemented at the internal, operations level to proactive environmental strategies implemented at the supply chain level. This study assesses the implementation process through the lens of the natural resource-based view and dynamic capabilities perspective. First, the link between the internal strategy ‘pollution prevention’ and the supply chain strategy ‘process stewardship’ is assessed. Second, the mediating influence of the internal support processes ‘integration’ and ‘learning’ on the implementation process is considered. Data collected from a sample of 1200 UK-based food manufacturing companies is analysed using multiple regression analysis. The findings suggest that the progression to environmental efforts at the supply chain level begins with internally-based environmental efforts and that the integration of these efforts and experience gained from them are important supporting factors in this progression.