Investigating the Potential Impact of Four-dimensional Computed Tomography (4DCT) on Toxicity, Outcomes and Dose Escalation for Radical Lung Cancer Radiotherapy

AIMS: To investigate the potential dosimetric and clinical benefits predicted by using four-dimensional computed tomography (4DCT) compared with 3DCT in the planning of radical radiotherapy for non-small cell lung cancer.

MATERIALS AND METHODS:
Twenty patients were planned using free breathing 4DCT then retrospectively delineated on three-dimensional helical scan sets (3DCT). Beam arrangement and total dose (55 Gy in 20 fractions) were matched for 3D and 4D plans. Plans were compared for differences in planning target volume (PTV) geometrics and normal tissue complication probability (NTCP) for organs at risk using dose volume histograms. Tumour control probability and NTCP were modelled using the Lyman-Kutcher-Burman (LKB) model. This was compared with a predictive clinical algorithm (Maastro), which is based on patient characteristics, including: age, performance status, smoking history, lung function, tumour staging and concomitant chemotherapy, to predict survival and toxicity outcomes. Potential therapeutic gains were investigated by applying isotoxic dose escalation to both plans using constraints for mean lung dose (18 Gy), oesophageal maximum (70 Gy) and spinal cord maximum (48 Gy).

RESULTS:
4DCT based plans had lower PTV volumes, a lower dose to organs at risk and lower predicted NTCP rates on LKB modelling (P < 0.006). The clinical algorithm showed no difference for predicted 2-year survival and dyspnoea rates between the groups, but did predict for lower oesophageal toxicity with 4DCT plans (P = 0.001). There was no correlation between LKB modelling and the clinical algorithm for lung toxicity or survival. Dose escalation was possible in 15/20 cases, with a mean increase in dose by a factor of 1.19 (10.45 Gy) using 4DCT compared with 3DCT plans.

CONCLUSIONS:
4DCT can theoretically improve therapeutic ratio and dose escalation based on dosimetric parameters and mathematical modelling. However, when individual characteristics are incorporated, this gain may be less evident in terms of survival and dyspnoea rates. 4DCT allows potential for isotoxic dose escalation, which may lead to improved local control and better overall survival.

Understandings of citizenship education in Northern Ireland and the Republic of Ireland: Public discourses among stakeholders in the public and private sectors

Internationally, citizenship education has come to the fore in the past decade. It may be particularly importantwithin the context of societies with a legacy of political conflict, such as Northern Ireland and the Republic of Ireland, where it is being implemented as part of the statutory curriculum. This article explores understandingsof citizenship education among stakeholders in the private and public sectors in Northern Ireland and the Republic of Ireland with the aim to compare these with curricular conceptualizations of citizenship inboth contexts. Semi-structured interviews were conducted in both societies involving non-governmentalorganizations, political parties, trade unions and the police. Results indicated that levels of awareness aboutcitizenship education varied substantially and understandings mainly reflected current theory and curriculumpractice in citizenship. Commonalities emerged as in both societies similar key concepts were identified whiledifferences transpired over issues relating to national identity and political conflict, which may raise questionsfor history and citizenship education in both societies.

'Research Training and Professional Social Work Education: Developing Research-Minded Practice' Social Work Education, .

The movement towards developing practice more firmly grounded on empirical research has, arguably, been one of the most significant international trends in social work during the past decade. However, in the UK the implications of this trend for pedagogical practices and the design of educational programmes have still to be fully explored. This paper reports on the findings of a repeated cross-sectional survey of MSW students in Queen's University Belfast which focused on their perceptions of the value of research training to professional practice. The study, conducted over a four year period, explored students' awareness of the relationship between research and practice and their readiness to engage with research training. The findings suggested that the majority of students perceived research training as a valuable component of professional development. However, the study also found a level of scepticism among students about its practical utility along with some resistance towards actively embracing a research agenda. The paper evaluates the significance of these findings for developing research and evidence-based practice as integral components of the new degrees in social work in the UK and for social work education programmes in other countries aiming to develop research-minded practice.

Teachers’ understandings of reconciliation and inclusion in four troubled societies.

In this article, the authors examine how teachers in four troubled societies – Israel, Cyprus, Northern Ireland and South Africa – understand and implement reconciliation in light of the increasing diversity of these societies. The authors particularly pay attention to a dialogical encounter between reconciliation and inclusion, as they look for ways to contemplate how each might be of mutual benefit in educational theory and practice. In the first part of the article, the authors give an overview of current thinking on reconciliation and its role in education, and suggest that the notion of inclusiveness can enrich it. The context of the research is then provided by looking briefly at the socio-political and educational settings in which the study was conducted, followed by a discussion of the research methodology. The findings from the study are then presented with the main themes identified as arising across the four research locations. These themes concern understandings of reconciliation and inclusion, student diversity, teachers’ challenges, helping students deal with conflict, and teachers’ development. Finally, whilst acknowledging the exploratory nature of these findings, the authors discuss what policy makers, school leaders and teachers might change about policies and practices for reconciliation education in the four settings studied and, by implication, other comparable settings.

Using survey data to explore preschool children’s ethnic awareness and attitudes

This article presents the findings of a large-scale survey (n = 1049) of ethnic awareness and attitudes among three to four-year-old children in Northern Ireland. In drawing upon and applying Bourdieu’s notion of habitus, the article demonstrates how, even at this age, the children are already beginning to embody and internalize the cultural habits and dispositions of their respective ethnic groups; namely the Protestant and Catholic communities. This is illustrated in the present article in relation to the children’s attitudes towards particular national flags and awareness of specific sports associated with their respective communities. Informed by the work of Bourdieu, the article concludes by arguing for the need for greater use of quantitative methods in conjunction with in-depth qualitative and ethnographic research to help further our understanding of the influence of ethnicity in young children’s lives.

Extension of general practice training from three to four years: experiences of a vocational training programme in Southern Ireland

The aim of this study was to evaluate the experiences of trainees taking part in an extended (four-year) general practice training programme introduced in the South Eastern region of the Republic of Ireland to replace the previous traditional (three-year) programme. In a qualitative design, eight homogeneous focus groups were held to determine the value of the additional year of training. The first cohort of trainees was interviewed towards the start and at the end of their fourth year. Trainees finishing the following year were also interviewed, as were graduates from the final three-year programme. GP trainers and the four members of the programme directing team comprised two further independent focus groups. Trainees reported that the integration of hospital posts and general practice attachments over the four years was particularly beneficial. The exposure to a variety of different general practices and the opportunity to take part in specialty clinics were considered extremely useful. The fourth year of training was felt to be less pressurised than previous years. Professional and personal development was enhanced; improved readiness to practise and confidence were noted. Perceived disadvantages of extended training included a lack of acknowledgment for doctors in their fourth year and excessive emphasis placed on research during the final year of training. The addition of an extra year of vocational training improves professional and personal development and changes the learning experience for doctors. Doctors felt more confident and ready to enter independent practice at the end of the fourth year of training.

A comparison of four extraction methods for substance P, neurokinin A and calcitonin gene-related peptide from human dental pulp tissue

Measuring neuropeptides in biological tissues by radioimmunoassay requires efficient extraction that maintains their immunoreactivity. Many different methods for extraction have been described, but there is little information on optimal extraction methods for individual neuropeptides from human dental pulp tissue. The aim was therefore to identify an effective extraction procedure for three pulpal neuropeptides: substance P. neurokinin A and calcitonin gene-related peptide. Tissue was obtained from 20 pulps taken from teeth freshly extracted for orthodontic reasons. The pulp samples were divided into four equal groups and different extraction methods were used for each group. Boiling whole pulp in acetic acid gave the highest overall yield and, in addition, offered an easy and rapid means of pulp tissue processing. The use of protease inhibitors did not increase the recovery of the immunoreactive neuropeptides but did provide the best combination of maximal recoveries and minimal variability. These results should be useful for planning the extraction of these neuropeptides from human pulp tissue in future studies. (C) 1999 Elsevier Science Ltd. All rights reserved.

Children’s Reasoning About the Temporal Order of Past and Future Events

Four- and five-year-olds completed two sets of tasks that involved reasoning about the temporal order in which events had occurred in the past or were to occur in the future. Four-year-olds succeeded on the tasks that involved reasoning about the order of past events but not those that involved reasoning about the order of future events, whereas 5-year-olds passed both types of tasks. Individual children who failed the past-event tasks were not particularly likely to fail the more difficult future-event tasks. However, children's performance on the reasoning tasks was predictive of their performance on a task assessing their comprehension of the terms “before” and “after.” Our results suggest that there may be a developmental change over this age range in the ability to flexibly represent and reason about the before-and-after relationships between events.

The effect of month of birth on the attainments of primary and secondary school pupils

Background: Previous research has produced conflicting results regarding the effects of season of birth and age-position on cognitive attainments. In Northern Ireland the school year divides the summer season into two providing an opportunity to evaluate the relative contribution of season of birth and age-position effects. Aims: To investigate the relationship between attainment in literacy skills and month of birth for primary and secondary school pupils and to determine the relationship between motor skills and month of birth in primary school pupils. Sample: One thousand one hundred and twenty four primary school pupils participated, and results for key stage 3 (KS3) English and GCSE English Language, for 3,493 Year 10 and 3,697 Year 12 secondary school pupils, respectively, were obtained. Method: Primary school pupils were individually assessed using standardised reading and spelling tests, as well as tests of motor skill. They were also assessed using a standardised group reading test in their class groups. For the secondary school pupils, the results for two year cohorts, in KS3 English and GCSE English language, respectively, were analysed. Results: For the primary school pupils there was evidence of both a season of birth and an age-position effect on all of the cognitive measures, particularly in the early years of schooling. There was, also, evidence of a significant age-position effect at both KS3 and GCSE in favour of the older pupils. For the younger primary school pupils there was evidence of significant age-position effects on both motor measures. Conclusions: The findings from the present study suggest that month of birth may be related to both season of birth and age-position effects. These effects may be compounded, particularly in the early years of primary school, when summer born children are youngest in their year, as in England. In Northern Ireland, age-position effects are also evident in secondary school public examination results, which may have implications for long-term life choices. © 2009 The British Psychological Society.

Implementing a play-based and developmentally appropriate curriculum in NI primary schools:what lessons have we learned?

In the United Kingdom tensions have existed for many years between the pedagogical traditions of pre-school, which tend to adopt developmentally oriented practices, and the more formal or subject-oriented curriculum framework of primary school. These tensions have been particularly acute in the context of Northern Ireland, which has the earliest school starting age throughout Europe. In response to international research evidence and practice, a play-based and developmentally appropriate curriculum, known as the Enriched Curriculum (EC), was introduced as a pilot in Year 1 and 2 classes in over 100 primary schools in Northern Ireland between 2000 and 2002 and continued until the Foundation Stage became statutory for all primary schools in 2007. This paper outlines four key lessons that have been learned from the first four years of the evaluation of this experience. These include the value and the meaning of a play-based curriculum; the importance of teachers’ confidence and knowledge; teaching reading in a play-based curriculum; and easing transitions in a play-based curriculum.

Defining Target Volumes for Stereotactic Ablative Radiotherapy of Early-stage Lung Tumours:A Comparison of Three-dimensional F-fluorodeoxyglucose Positron Emission Tomography and Four-dimensional Computed Tomography

Aims: High local control rates are achieved in stage I lung cancer using stereotactic ablative radiotherapy. Target delineation is commonly based on four-dimensional computed tomography (CT) scans. Target volumes defined by positron emission tomography/computed tomography (PET/CT) are compared with those defined by four-dimensional CT and conventional ('three-dimensional') F-fluorodeoxyglucose (F-FDG) PET/CT. Materials and methods: For 16 stage I non-small cell lung cancer tumours, six approaches for deriving PET target volumes were evaluated: manual contouring, standardised uptake value (SUV) absolute threshold of 2.5, 35% of maximum SUV (35%SUV), 41% of SUV (41%SUV) and two different source to background ratio techniques (SBR-1 and SBR-2). PET-derived target volumes were compared with the internal target volume (ITV) from the modified maximum intensity projection (MIP ITV). Volumetric and positional correlation was assessed using the Dice similarity coefficient (DSC). Results: PET-based target volumes did not correspond to four-dimensional CT-based target volumes. The mean DSC relative to MIP ITV were: PET manual = 0.64, SUV2.5 = 0.64, 35%SUV = 0.63, 41%SUV = 0.57. SBR-1 = 0.52, SBR-2 = 0.49. PET-based target volumes were smaller than corresponding MIP ITVs. Conclusions: Conventional three-dimensional F-FDG PET-derived target volumes for lung stereotactic ablative radiotherapy did not correspond well with those derived from four-dimensional CT, including those in routine clinical use (MIP ITV). Caution is required in using three-dimensional PET for motion encompassing target volume delineation. © 2012 The Royal College of Radiologists.

Defining target volumes for stereotactic ablative radiotherapy of early-stage lung tumours: a comparison of three-dimensional 18F-fluorodeoxyglucose positron emission tomography and four-dimensional computed tomography.:PETCT versus 4DCT for SABR in Early Stage NSCLC

AIMS: High local control rates are achieved in stage I lung cancer using
stereotactic ablative radiotherapy. Target delineation is commonly based on
four-dimensional computed tomography (CT) scans. Target volumes defined by
positron emission tomography/computed tomography (PET/CT) are compared with those defined by four-dimensional CT and conventional ('three-dimensional')
(18)F-fluorodeoxyglucose ((18)F-FDG) PET/CT.

MATERIALS AND METHODS: For 16 stage I non-small cell lung cancer tumours, six
approaches for deriving PET target volumes were evaluated: manual contouring,
standardised uptake value (SUV) absolute threshold of 2.5, 35% of maximum SUV
(35%SUV(MAX)), 41% of SUV(MAX) (41%SUV(MAX)) and two different source to
background ratio techniques (SBR-1 and SBR-2). PET-derived target volumes were compared with the internal target volume (ITV) from the modified maximum
intensity projection (MIP(MOD) ITV). Volumetric and positional correlation was
assessed using the Dice similarity coefficient (DSC).

RESULTS: PET-based target volumes did not correspond to four-dimensional CT-based target volumes. The mean DSC relative to MIP(MOD) ITV were: PET manual = 0.64, SUV2.5 = 0.64, 35%SUV(MAX) = 0.63, 41%SUV(MAX) = 0.57. SBR-1 = 0.52, SBR-2 =0.49. PET-based target volumes were smaller than corresponding MIP ITVs.

CONCLUSIONS: Conventional three-dimensional (18)F-FDG PET-derived target volumes for lung stereotactic ablative radiotherapy did not correspond well with those derived from four-dimensional CT, including those in routine clinical use
(MIP(MOD) ITV). Caution is required in using three-dimensional PET for motion
encompassing target volume delineation.

Reforming civil engineering studies in recession times

The recent global economic and financial crisis has led the economies of many countries into recession, in particular at the periphery of the European Union. These countries currently face a significant contraction of both public investment in infrastructure and private investment in buildings and, as a result, the unemployment is particularly noticeable in the civil engineering and building sectors. Consequently, in all countries in recession the professional development of fresh civil engineering graduates is disproportionate to their high study effort and qualifications, since they rarely have the opportunity to gain experience in practice and their knowledge gradually becomes obsolete. Under these circumstances, it is imperative for the technical universities in countries in recession to plan and implement a substantial reform of the civil engineering studies syllabus. The objective should be to enable graduates to broaden the scope of their professional activity and increase their employability. In this paper, the widening of civil engineering studies curricula is proposed, in particular in the light of the development of the graduates’ potential on project, programme and portfolio management. In this direction, after a thorough literature review, including ASCE's Body of Knowledge for the 21st century and IPMA's Competence Baseline, it is recommended among others: to increase significantly the offered modules on project management and add new modules on strategy management, leadership behavior, delivery management, organization and environment etc; to provide adequate professional training during the university studies five year period; and to promote fresh graduates’ certification by professional bodies. The proposals are exemplified by presenting a reformed syllabus for the civil engineering studies offered currently by the National Technical University of Athens.