Predictors of Chest Wall Toxicity after Lung Stereotactic Ablative Radiotherapy

AIMS: To determine the incidence and predictive factors of rib fracture and chest wall pain after lung stereotactic ablative radiotherapy (SABR).

MATERIALS AND METHODS: Patients were treated with lung SABR of 48-60 Gy in four to five fractions. The treatment plan and follow-up computed tomography scans of 289 tumours in 239 patients were reviewed. Dose-volume histogram (DVH) metrics and clinical factors were evaluated as potential predictors of chest wall toxicity.

RESULTS: The median follow-up was 21.0 months (range 6.2-52.1). Seventeen per cent (50/289) developed a rib fracture, 44% (22/50) were symptomatic; the median time to fracture was 16.4 months. On univariate analysis, female gender, osteoporosis, tumours adjacent (within 5 mm) to the chest wall and all of the chest wall DVH metrics predicted for rib fracture, but only tumour location adjacent to the chest wall remained significant on the multivariate model (P < 0.01). The 2 year fracture-free probability for those adjacent to the chest wall was 65.6%. Among those tumours adjacent to the chest wall, only osteoporosis (P = 0.02) predicted for fracture, whereas none of the chest wall DVH metrics were predictive. Eight per cent (24/289) experienced chest wall pain without fracture.

CONCLUSIONS: None of the chest wall DVH metrics independently predicted for SABR-induced rib fracture when tumour location is taken into account. Patients with tumours adjacent (within 5 mm) to the chest wall are at greater risk of rib fracture after lung SABR, and among these, an additional risk was observed in osteoporotic patients.

Modulating mythology in a post-traumatic era: Murals and re-imaging in Northern Ireland.

Arguably the most ancient of the social media, wall paintings have been a persistent vehicle of cultural meaning management. The dynamics of myth markets are reflected in the sectarian murals of Northern Ireland. In this paper, we draw from consumer research literature on mythology and street art to explore the continuous revision of these wallscapes that seeks to address the enduring contradictions of civic ideology in contested political space. In particular, we focus on the use of classical, historical and pop-cultural mythologies to transform private space into public place. We examine the decommissioning of murals occurring in the wake of the Peace Accords, and speculate on the implications of the creation of a shared mythology for the future of mural painting and the state.

Investigation of thermal resistance and bridging in examples of contemporary and vernacular solid wall architecture

Contemporary architecture has tended to increase envelope insulation levels in an unceasing effort to reduce U-values. Traditional masonry architecture in contrast was devoid of insulation, except for the inherent insulative nature of vernacular materials. Also the consistency of the outer membrane of the building skin diminished any impact due to bridging. In contemporary highly insulated walls bridges are numerous due to the necessity to bind inner and outer structural skins through insulation layers. This paper examines thermal bridging in an example of contemporary façade design and compares it with an example of traditional vernacular architecture currently being researched which is characterized by a lack of bridging elements. Focus is given to heavy weight materials of high thermal mass, which appropriately for passive architecture help moderate fluctuations in internal temperature. In an extensive experimental study samples of highly insulated precast concrete sandwich panels and lime rendered masonry walls are tested in a guarded hot-box. The building construction methods are compared for static and dynamic thermal transmittance, via heat flux and surface temperature differential measurements. Focus is given to the differential heat loss due to the thermal bridging in the sandwich panels and its associated impact on overall heat loss relative to traditional masonry construction.

Street Medicine – Assessment Work Strategies of Paramedics on the Front lines of Emergency Health Services

This article is based on an institutional ethnographic inquiry into the work of paramedics and the institutional setting that organizes and coordinates their work processes in a major City in Canada. Drawing on over 200 hours of observations and over 100 interviews with paramedics (average length of 18 minutes) and other emergency medical personnel, this article explores the standard and not so standard work of paramedics as they assess and care for their patients on the front lines of emergency health services. The multiplicity of interfacing social, demographic, locational, and situational factors that shape and organize the work of paramedics are analyzed. In doing so, this article provides insights into the complex work of an understudied yet ever-important profession in healthcare.

Street Space—North Street, Belfast

The Belfast city center is fractured, divided by motorways, parking lots, empty buildings, and big box stores. Its 19th-century heyday put it on the international map of textile production, which transformed and enriched its built structure. This tight architectural fabric was slowly destroyed in the 1940s by the Blitz, in the 1970s by road plans and “the troubles” and in the 1990s by large retail buildings. Few pedestrian streets traverse Belfast, and among them, most are recently-developed conduits for the passage of shoppers from one chain store to the next.Within this seemingly bleak urban landscape, there remain a few areas that offer a richer, more architecturally and socially diverse, more memory-laden conception of public space. Current redevelopment plans, however, threaten the mere existence of these few remaining historic streets in Belfast.This reality inspired the current project of one of the Masters in Architecture design units at Queen’s University Belfast. Our team (led by urban designer Michael Corr and myself) has been exploring North Street, one of the main arteries in Belfast City Center. Although North Street has a reputation for being run-down, derelict, and in need of redevelopment, it is one of the few intact 19th-century streets left in the area, and as such is worthy of study as an example of public space that is not strictly synonymous with commercial space.

Gaze behavior of the visually impaired during street crossing.

PURPOSE:

This study explored the gaze patterns of fully sighted and visually impaired subjects during the high-risk activity of crossing the street.

METHODS:

Gaze behavior of 12 fully sighted subjects, nine with visual impairment resulting from age-related macular degeneration and 12 with impairment resulting from glaucoma, was monitored using a portable eye tracker as they crossed at two unfamiliar intersections.

RESULTS:

All subject groups fixated primarily on vehicles and crossing elements but changed their fixation behavior as they moved from "walking to the curb" to "standing at the curb" and to "crossing the street." A comparison of where subjects fixated in the 4-second time period before crossing showed that the fully sighted who waited for the light to change fixated on the light, whereas the fully sighted who crossed early fixated primarily on vehicles. Visually impaired subjects crossing early or waiting for the light fixate primarily on vehicles.

CONCLUSIONS:

Vision status affects fixation allocation while performing the high-risk activity of street crossing. Crossing decision-making strategy corresponds to fixation behavior only for the fully sighted subjects.

Slot width augmentation in a slotted-wall transonic linear cascade wind tunnel

Transonic tests in linear cascade wind tunnels can suffer
from significant test section boundary interference effects in pitch. A slotted tailboard has been designed and optimised with an in-house Euler numerical method to reduce such ef- fects. Wind tunnel measurements on an overspeed Mach 1.27 discharge from a Rolls-Royce T2 cascade, featuring strong end-wall shock-induced interference, showed a 77% reduction in the flow pitchwise periodicity error with the optimised tail- board, with respect to the baseline open-jet cascade flow. Two-dimensional Euler predictions were also cross-validated against a three-dimensional Reynolds averaged computation, to explore the three-dimensionality of the discharge