Evaluation of Restorative Dentistry Specialty Registrars’ Clinical Experience of Developmental Disorders: A Survey

Background

Specialty Registrars in Restorative Dentistry (StRs) should be competent in the independent restorative management of patients with developmental disorders including hypodontia and cleft lip/palate upon completion of their specialist training.1 Knowledge and management may be assessed via the Intercollegiate Specialty Fellowship Examination (ISFE) in Restorative Dentistry.2

Objective

The aim of this study was to collate and compare data on the training and experience of StRs in the management of patients with developmental disorders across different training units within the British Isles.

Methods

Questionnaires were distributed to all StRs attending the Annual General Meeting of the Specialty Registrars in Restorative Dentistry Group, Belfast, in October 2015. Participants were asked to rate their confidence and experience of assessing and planning treatment for patients with developmental disorders, construction of appropriate prostheses, and provision of dental implants. Respondents were also asked to record clinical supervision and didactic teaching at their unit, and to rate their confidence of passing a future ISFE station assessing knowledge of developmental disorders.

Results

Responses were obtained from 32 StRs (n=32) training within all five countries of the British Isles. The majority of respondents were based in England (72%) with three in Wales, and two in each of Scotland, Northern Ireland, and the Republic of Ireland. Approximately one third of respondents (34%) were in the final years of training (years 4-6). Almost half of the StRs reported that they were not confident of independently assessing (44%) new patients with a developmental disorder, with larger numbers (72%) indicating a lack of confidence in treatment planning. Six respondents rated their experience of treating obturator patients as ‘poor’ or ‘very poor’. The majority (56%) rated their experience of implant provision in these cases as ‘good’ or ‘excellent’ with three-quarters (75%) rating clinical supervision at their unit as ‘good’ or ‘excellent’. Less than half (41%) rated the didactic teaching at their unit as ‘good’ or ‘excellent’, and only 8 StRs indicated that they were confident of passing an ISFE station focused on developmental disorders.

Conclusion

Experience and training regarding patients with developmental disorders is inconsistent for StRs across the British Isles with a number of trainees reporting a lack of clinical exposure.

Voting behaviour on free votes: Simply a matter of preferences?

Previous research examining the outcomes of free votes concludes that voting behaviour is determined in large part by MPs’ personal preferences. However, most studies do not measure preferences directly and ignore other possible determinants of voting behaviour. This piece illustrates the need to address these shortcomings before one concludes that preferences explain the outcomes of free votes. I illustrate this by examining a series of divisions on the issue of House of Lords reform. Using direct measures of preferences and controlling for alternative explanations, the analysis suggests MPs’ preferences had little effect on voting behaviour on this issue.

Compared with specialist registrars, experienced staff nurses shorten the duration of weaning neonates from mechanical ventilation

OBJECTIVE: To compare the overall performance of specially trained neonatal nurses acting autonomously, unsupervised, and without a protocol with specialist registrars when weaning neonates from mechanical ventilation.

DESIGN: Prospective, randomized, controlled trial.

SETTING: A single neonatal intensive care unit.

PATIENTS: Neonates requiring conventional mechanical ventilation (n = 50).

INTERVENTIONS: Infants on conventional ventilation were randomly assigned to receive either nurse-led (n = 25) or registrar-led (n = 23) weaning. A total of 48 infants completed the study (two infants in the registrar group were excluded when their parents withdrew consent).

MEASUREMENTS AND MAIN RESULTS: The main outcome measure, median weaning time, was 1200 mins (95% confidence interval [CI], 621-1779 mins) in the nurse group and 3015 mins (95% CI, 2650-3380 mins) in the registrar group (p = .0458). The median time from treatment assignment to the first ventilator change was 60 mins (95% CI, 52-68 mins) in the nurse group and 120 mins (95% CI, 103-137 mins) in the registrar group (p = .35). On average, the nurses made ventilator changes every 4.5 hrs (95% CI, 2.9-6 hrs) and the registrars every 7.2 hrs (95% CI, 5.4-9 hrs; p = .003). The median number (range) of backward steps taken per infant was 0 (0-5 steps) in the nurse group and 1 (0-5 steps) in the registrar group (p = .019).

CONCLUSIONS: The findings of this study suggest that additional domains of neonatal critical care could be reviewed for their potential transfer to appropriately prepared nurses.

Evaluation of extended training for general practice in Northern Ireland: qualitative study.

Objective To evaluate participants' perceptions of the impact on them of an additional six months' training beyond the standard 12 month general practice vocational training scheme. Design Qualitative study using focus groups. Setting General practice vocational training in Northern Ireland. Participants 13 general practitioner registrars, six of whom participated in the additional six months' training, and four trainers involved in the additional six months' training. Main outcome measures: Participants' views about their experiences in 18 month and 12 month courses. Results Participants reported that the 12 month course was generally positive but was too pressurised and focused on examinations, and also that it had a negative impact on self care. The nature of the learning and assessment was reported to have left participants feeling averse to further continuing education and lacking in confidence. In contrast, the extended six month component was reported to have restimulated learning by focusing more on patient care and promoting self directed learning. It developed confidence, promoted teamwork, and gave experience of two practice contexts, and was reported as valuable by both ex-registrars and trainers. However, both the 12 and 18 month courses left participants feeling underprepared for practice management and self care. Conclusions 12 months' training in general practice does not provide doctors with the necessary competencies and confidence to enter independent practice. The extended period was reported to promote greater professional development, critical evaluation skills, and orientation to lifelong learning but does not fill all the gaps.

Making 'party identification' more versatile: operationalising the concept for the multiparty setting

The conventional operationalisation of the concept of party identification is not appropriate for the multiparty setting. I offer new measures that facilitate multiple, and negative as well as positive, identities. Using survey evidence from Northern Ireland, these new measures are validated in a number of ways and their role in a comprehensive model of voting is illustrated.

Ownership Patterns and Control in Turkish Listed Companies

The purpose of this paper is to document the prevalent ownership concentration, structure and control in the top 100 companies listed on the Istanbul Stock Exchange. The results are discussed in the context of emerging corporate governance trends in Turkey. Where appropriate, comparisons with other countries are provided. The results of the study indicate that ownership of Turkish companies is highly concentrated, families being the dominant shareholders. The separation of ownership and control among Turkish companies is mainly achieved through pyramidal ownership structures and the presence of big business groups. However, the cash flow and voting rights in Turkish companies are relatively more aligned compared to other family–ownership–dominated insider–system countries.

The Combination of Multiple Classifiers Using an Evidential Reasoning Approach

In many domains when we have several competing classifiers available we want to synthesize them or some of them to get a more accurate classifier by a combination function. In this paper we propose a ‘class-indifferent’ method for combining classifier decisions represented by evidential structures called triplet and quartet, using Dempster's rule of combination. This method is unique in that it distinguishes important elements from the trivial ones in representing classifier decisions, makes use of more information than others in calculating the support for class labels and provides a practical way to apply the theoretically appealing Dempster–Shafer theory of evidence to the problem of ensemble learning. We present a formalism for modelling classifier decisions as triplet mass functions and we establish a range of formulae for combining these mass functions in order to arrive at a consensus decision. In addition we carry out a comparative study with the alternatives of simplet and dichotomous structure and also compare two combination methods, Dempster's rule and majority voting, over the UCI benchmark data, to demonstrate the advantage our approach offers. (A continuation of the work in this area that was published in IEEE Trans on KDE, and conferences)

Why do people non-demand reveal in hypothetical double referenda for public goods?

Hypothetical contingent valuation surveys used to elicit values for environmental and other public goods often employ variants of the referendum mechanism due to the cognitive simplicity and familiarity of respondents with this voting format. One variant, the double referendum mechanism, requires respondents to state twice how they would vote for a given policy proposal given their cost of the good. Data from these surveys often exhibit anomalies inconsistent with standard economic models of consumer preferences. There are a number of published explanations for these anomalies, mostly focusing on problems with the second vote. This article investigates which aspects of the hypothetical task affect the degree of nondemand revelation and takes an individual-based approach to identifying people most likely to non-demand reveal. A clear profile emerges from our model of a person who faces a negative surplus i.e. a net loss in the second vote and invokes non self-interested, non financial motivations during the decision process.

Resolving questions about bias in real and hypothetical referenda

Despite 10 years of research on behavior in hypothetical referenda, conflict remains in the literature on whether or not the mechanism generates biased responses compared to real referenda, and the nature and source of any such bias. Almost all previous inquiry in respect of this issue has concentrated on bias at the aggregate level. This paper reports a series of three experiments which focuses on bias at the individual level and how this can translate to bias at the aggregate level. The authors argue that only an individual approach to hypothetical bias is consistent with the concept of incentive compatibility. The results of these experiments reflect these previous conflicting findings but go on to show that individual hypothetical bias is a robust result driven by the differing influence of pure self-interest and other-regarding preferences in real and hypothetical situations, rather than by a single behavioral theory such as free riding. In a hypothetical situation these preferences cause yea-saying and non-demand revealing voting. This suggests that investigation of individual respondents in other hypothetical one-shot binary choices may also provide us with insights into aggregate behavior in these situations.

Hillary Clinton's Race: Did She Match the Presidential Prototype?

The present research addresses how voters’ perceptions of Hillary Clinton’s warmth and competence influenced decisions to vote for her in the 2008 Democratic primary. We apply research on gender stereotypes and perceptions of women leaders to demonstrate that voters perceived Clinton as highly competent but relatively less warm. Further, this research examines how perceptions of Clinton’s warmth and competence contributed to decisions to vote for her. Results suggest that perceptions of Clinton’s warmth and competence differentially predicted voting behavior for voters strongly and less strongly identified with their political party. This research provides a descriptive analysis of how voters’ beliefs about leaders can be colored by gender, and how such beliefs contribute to electing women candidates.

Direct Democracy and Regional Integration::Citizens' Perceptions of Treaty Implications and the Irish Reversal on Lisbon

Analyses of voting in European Union referendums typically distinguish between ‘second-order’ effects and the impact of substantive ‘issues’. In order to explain change in referendum outcome, two types of substantive issues are distinguished in this article. Focusing on Irish voting in the Lisbon Treaty referendums and using data from post-referendum surveys, it is found that perceptions of treaty implications outperform underlying attitudes to EU integration in predicting vote choice at both referendums, and perceptions of treaty implications are strong predictors of vote change between the referendums. The findings have broadly positive implications for normative assessments of the usefulness of direct democracy as a tool for legitimising regional integration advance.

SOCIAL-CLASS, CLASS ORIGINS AND POLITICAL PARTISANSHIP IN THE REPUBLIC-OF-IRELAND

As Laver (1992) notes, people who write about Irish politics frequently describe Ireland as a rather peculiar place. One aspect of this peculiarity is that voters in the Republic of Ireland do not behave like their European counterparts. In particular, Irish voting patterns appear to be only weakly structured by social class. Recent contributions to the debate employing a more sophisticated categorisation of classes have led to some qualification of the 'politics without social bases' description, but still lead to the broad conclusion that any relationship which does exist between social divisions, on the one hand, and party preference, on the other, is, at most, quite marginal. In this paper we draw on data from the 1990 European Values Study to re-examine this issue. We apply a variety of models to the data, including logit regression and diagonal reference models (Sobel 1981, 1984) to explore the complex fashion in which class and political preferences are related in Ireland. We argue that the relationship between such preferences and social divisions are, in fact, greater than has been hitherto thought. In particular, we show the importance of taking into account not only social class but also class origins and class mobility in understanding the nature of political partisanship in the Republic of Ireland.