The impact of peer review on the radiotherapy treatment planning process in the treatment of lung cancer

Background:
Advanced radiotherapy techniques permit accurate delivery of radiotherapy to lung tumours. Improved accuracy increases the possibility of radiotherapy field geographic miss of the tumour. One source of error is the accuracy of target volume (TV) delineation by the clinical oncologist. Colleague peer review of all curative intent lung cancer plans has been mandatory in our institution since May 2013. At least 2 clinical oncologists review plans checking treatment paradigm, TV delineated, dose to tumour and dose to critical organs. We report the impact of peer review on the radiotherapy planning process for lung cancer.

Methods:
The radiotherapy treatment plans of all patients receiving radical radiotherapy were presented at weekly peer review meetings after their TVs volumes were provisionally signed off by the treating consultant or post-fellowship registrar. All cases and any resultant change to the treatment plan were recorded in our prospective peer review database. We present the summary of changes agreed following the peer review process for a 6 month period.

Results:
Fifteen peer review sessions, including 46 patients (36 NSCLC, 10 SCLC) were analysed. An average of 3 cases were discussed per meeting (range 1 5). 24% of treatment courses were changed. In 4% there was a complete change in paradigm
of treatment (1 patient proceeded to induction chemotherapy, 1 patient had high dose palliative radiotherapy). In 16% there was a change in TV delineated and in 9% a change in dose (2 dose reductions and 2 alterations to post-operative dose fractionations).

Conclusions:
Consultant led peer review resulted in a change in a component of the treatment plan for 28% of patients that would not otherwise have taken place. Given this impact, consultant led peer review should be considered as an essential component in the radiotherapy planning process for all patients treated with curative radiotherapy.

Replacing the ASBO with the injunction to prevent nuisance and annoyance: a plea for legislative scrutiny and amendment

In May 2013, the Coalition Government introduced a Bill which if passed will streamline the tools available to tackle anti-social behaviour. One of their proposals is to replace the controversial anti-social behaviour order (ASBO) with what is termed an Injunction to Prevent Nuisance and Annoyance (IPNA). Although designed to tackle criminal and sub-criminal behaviour, this new intervention will be a purely civil order replacing the civil-criminal hybrid ASBO. This article explores some of the more troubling aspects of this part of the Bill including its expansive definition of anti-social behaviour, the avoidance of due process protections, the extensive restrictions that respondents may face and the likely impact of its use on young people. With legislation presently under Parliamentary scrutiny, this article calls for amendments to avoid the most problematic aspects of the ASBO being not just replicated but amplified.

Polemic and apocalyptic in the Cromwellian invasion of Scotland

This article describes the culture of print and polemic associated with the Cromwellian invasion of Scotland and the resistance of the Church of Scotland. It argues that print solidified Parliamentary ideas during the invasion but that it did not continue to do so after English dominance had been established. These texts illustrate the divisions between the mentalité of the Cromwellian rank-and-file and that of the rather small and probably unrepresentative body of opinion formers who sought to control and represent it.

Political Extremism in the 1920s and 1930s: Do German Lessons Generalize?

We examine the impact of the Great Depression on the share of votes for right-wing extremists in elections in the 1920s and 1930s. We confirm the existence of a link between political extremism and economic hard times as captured by growth or contraction of the economy. What mattered was not simply growth at the time of the election, but cumulative growth performance. The impact was greatest in countries with relatively short histories of democracy, with electoral systems that created low hurdles to parliamentary representation, and which had been on the losing side in World War I.

Automated Methods for Aircraft Design Integrated with Manufacturing

Aircraft design is a complex, long and iterative process that requires the use of various specialties and optimization tools. However these tools and specialities do not include manufacturing, which is often considered later in the product development process leading to higher cost and time delays. This work focuses on the development of an automated design tool that accounts for manufacture during the design process focusing on early geometry definition which in turn informs assembly planning. To accomplish this task the design process needs to be open to any variation in structural configuration while maintaining the design intent. Redefining design intent as a map which links a set of requirements to a set of functions using a numerical approach enables the design process itself to be considered as a mathematical function. This definition enables the design process to utilise captured design knowledge and translate it into a set of mathematical equations that design the structure. This process is articulated in this paper using the structural design and definition for an aircraft fuselage section as an exemplar.

Bicameralism in the Republic of Ireland: The Seanad Abolition Referendum

Whether or not a legislature is uni- or bi-cameral has been found to have important consequences. Ireland's 1937 constitution provided for a directly elected lower chamber (Dáil Éireann) and an indirectly elected upper chamber (Seanad Éireann). With the appointment to government in 2011 of two political parties with a common electoral commitment to abolish bicameralism, the subsequent coalition agreement included a promise to hold a referendum offering voters the option to move to a unicameral parliamentary system. On 4 October 2013, the electorate voted to retain the upper chamber, albeit by a narrow majority of 51.7 per cent, on a turnout of 39.17 per cent. The outcome was arguably surprising, given that opinion polls signalled a plurality of voters favoured abolition, and there was a general public antipathy towards political institutions in the midst of a major economic crisis. Public opinion research suggests that a combination of factors explained voting behaviour, including a lack of interest amongst those who did not vote. A cost savings argument was a significant factor for those favouring abolition, while concerns over government control of the legislative process appear to have been most prominent in the minds of those who voted to retain the upper chamber.

Forgoing primacy: Damaging democratic policing in the West Bank

Since the Oslo Accords were signed between Israel and the Palestinian Liberation Organization (PLO) in September 1993, the international community has supported civil policing programmes. It has done so as part of its development commitments to Palestinian state-building. Such programmes were, until the outbreak of the second Intifada in 2000, largely regarded as successful in terms of supporting the establishment of a Palestinian civil police (PCP). Such programmes were essentially Western imported models which loosely mixed community and public order policing approaches. With re-engagement in the Palestinian security sector (PSS) in the West Bank in 2007, the international community has once again sought to play a major role in PSS reform. This role includes supporting rehabilitation and retraining of the PCP as a principal institution of state-building. Such activities alongside the so-called transformation efforts within the wider realm of the PSS have re-established as their goal law and order. Within the transformation agenda, there are inherent demands with respect to Israel and the Palestinian National Authority's security and counterterrorism agendas. This analysis examines these activities, and accompanying political intent to contend that such approaches are undermining principles of democratic policing including civil police primacy (CPP). CPP reinforces police universality and means supporting rule of law by putting security under governmental control with proper mechanisms of accountability. This article argues that support to the security sector in the West Bank has increasingly only paid lip service or sought to subvert normative approaches to democratic policing.

Listening to the World Through New Ears:Reinvention of the soundtrack in the works of Lucrecia Martel and Sofia Coppola

This paper explores the production and post-production techniques and tensions in designing sound for film. Considering the films of Lucrecia Martel and Sofia Coppola, amongst others, Greene and Yang will discuss how the soundtrack takes on a primary role in these films and becomes a medium for symbolism, reflection, characterisation, as well as storytelling. There will be a close examination of the processes involved in creating character-orientated soundscapes. These processes are sensitive to the effects sound has on an audience. Exploring how these filmmakers (with their sound teams) utilise the listening experience, including attention to point of audition and sound perception, this paper will critically unpick how such creative decisions are arrived at during various stages of the production process. Outlining the use of diegetic and non-diegetic sound and the potential musicality of sound effect design, issues of reverberation, noise and intent are discussed to highlight the sonic framing of these creative teams. Greene will approach these soundtracks from a production/post-production perspective, while Yang will explore the composer’s/designer’s ear.

OperationCheckpoint: SDN Application Control

One of the core properties of Software Defined Networking (SDN) is the ability for third parties to develop network applications. This introduces increased potential for innovation in networking from performance-enhanced to energy-efficient designs. In SDN, the application connects with the network via the SDN controller. A specific concern relating to this communication channel is whether an application can be trusted or not. For example, what information about the network state is gathered by the application? Is this information necessary for the application to execute or is it gathered for malicious intent? In this paper we present an approach to secure the northbound interface by introducing a permissions system that ensures that controller operations are available to trusted applications only. Implementation of this permissions system with our Operation Checkpoint adds negligible overhead and illustrates successful defense against unauthorized control function access attempts.

The British conservative party and Europe:The choosing of John Major

This article provides an empirical analysis of voting behaviour in the second ballot of the 1990 Conservative leadership contest that resulted in John Major becoming party leader and prime minister. Seven hypotheses of voting behaviour are generated from the extant literature relating voting to socio-economic variables (occupational and educational background), political variables (parliamentary experience, career status, age and electoral marginality) and ideological variables (drawn from survey data on MPs' positions on economic, European and moral issues). These hypotheses are tested using data on voting intentions gathered from published lists of MPs' declarations, interviews with each of the leadership campaign teams, and correspondence with MPs. Bivariate relationships are presented, followed by logistic regression analysis to isolate the unique impact that each variable had on voting. This shows that educational background, parliamentary experience and (especially) attitudes to Europe were the key factors determining voting. The importance of Europe in the contest is particularly instructive: the severe problems for Major's leadership which were caused by the issue can be attributed to, and understood in the context of, the 1990 contest in which he became leader.

Managing for Legitimacy: Agency Governance in its “Deep” Constitutional Context

Recent literature on bureaucratic structure has gone further than studying discretions given to bureaucrats in policy making, and much attention is now paid to understanding how bureaucratic agencies are managed. This article proposes that the way in which executive governments manage their agencies varies according to their constitutional setting and that this relationship is driven by considerations of the executive’s governing legitimacy. Inspired by Tilly (1984), we compare patterns of agency governance in Hong Kong and Ireland, in particular configurations of assigned decision-making autonomies and control mechanisms. This comparison shows that in governing their agencies the elected government of Ireland’s parliamentary democracy pays more attention to input (i.e. democratic) legitimacy while the executive government of Hong Kong’s administrative state favors output (i.e. performance) legitimacy. These different forms of autonomy and control mechanism reflect different constitutional models of how political executives acquire and sustain their governing legitimacy.

Northern Ireland Representation at Westminster: Constitutional Conundrums and Political Manoeuvres

This article focuses on the issue of Northern Ireland's representation at Westminster. It investigates the political context of the decision to increase Northern Ireland's representation in the house of commons at Westminster from 12 members to 17 in 1978-9. Exploring this episode in more detail, it is argued, provides a more informed overall understanding of the history of devolution in the UK and of the way issues concerning Northern Ireland often overlapped with questions of constitutional change in Scotland and Wales. The article also throws light on the matter of Northern Ireland MPs and their voting rights at Westminster during Northern Ireland's experience of devolution prior to 1972.

Interface management for automating finite element analysis workflows

This paper outlines the importance of robust interface management for facilitating finite element analysis workflows. Topological equivalences between analysis model representations are identified and maintained in an editable and accessible manner. The model and its interfaces are automatically represented using an analysis-specific cellular decomposition of the design space. Rework of boundary conditions following changes to the design geometry or the analysis idealization can be minimized by tracking interface dependencies. Utilizing this information with the Simulation Intent specified by an analyst, automated decisions can be made to process the interface information required to rebuild analysis models. Through this work automated boundary condition application is realized within multi-component, multi-resolution and multi-fidelity analysis workflows.

Catholicism and Fascism in Interwar Ireland

The interwar era saw the collapse of liberal democracy and the rise of anti-democratic authoritarian movements and states throughout much of Europe. Parliamentary or liberal democracy proved especially vulnerable in countries with large Catholic populations and ‘successor states’ – those states that achieved independence following the Great War. Despite meeting both criteria, the democratic structures of the Irish Free State – established in 1922 following a revolutionary struggle against British rule – proved remarkably resilient: indeed, it was arguably the only successor state to remain fully democratic by 1939 This outcome appears all the more striking given the formation of the state amidst a civil war, a form of conflict that frequently prevented the successful emergence of democracy. This is an article about the dog that didn’t bark: why did the kind of authoritarian political movements that flourished in many other parts of interwar Europe attract negligible support in the Irish Free State, and what does this have to tell us about the relationship between Catholicism and authoritarian politics? It begins by surveying the Irish Catholic Church’s attitudes to far-right politics in Continental Europe, and assessing how ‘official’ Catholic attitudes shaped popular perceptions of fascism and clerical authoritarianism within Ireland. It then explores the extent to which Ireland’s only significant fascistic movement – the Blueshirts – was influenced by, and sought to exploit, Catholicism. It concludes by questioning whether the immense influence of the Catholic Church and Catholic values within Irish political culture and society facilitated or hindered the cause of authoritarian politics in Ireland.