Specialty Registrars’ Experience of Managing Head and Neck Cancer Patients

Objective The aim of this study was to collate and compare data on the training of Specialty Registrars in Restorative Dentistry (StRs) in the management of head and neck cancer (HANC) patients across different training units within the UK and Ireland. Methods Current trainees were invited to complete an online questionnaire by the Specialty Registrars in Restorative Dentistry Group (SRRDG). Participants were asked to rate their confidence and experience of assessing and planning treatment for HANC patients, attending theatre alone and manufacturing surgical obturators, and providing implants for appropriate cases. Respondents were also asked to appraise clinical and didactic teaching at their unit, and to rate their confidence of passing a future Intercollegiate Specialty Fellowship Examination (ISFE)-station assessing knowledge of head and neck cancer. Results Responses were obtained from 21 StRs (n=21) training within all five countries of the British Isles. Most respondents were based in England (76%), with one StR in each of Scotland, Wales, Northern Ireland and the Republic of Ireland. A third (33%) were in their 5th year of training. Almost half of the StRs indicated that they were confident of independently assessing (48%) new patients with HANC, with fewer numbers reporting confidence in treatment planning (38%). The majority (52%) of respondents indicated that they were not confident of attending theatre alone and manufacturing a surgical obturator. A third (33%) rated their experience of treating HANC patients with implants as ‘poor’ or ‘very poor’, including three StRs in their 5th year of training. Less than one third (<33%) rated didactic teaching in maxillofacial prosthodontics at their unit as ‘good’ or ‘excellent’, and only 7 StRs indicated that they were confident of passing an ISFE-station focused on HANC. Conclusion Experience and training regarding patients with head and neck cancer is inconsistent for StRs across the UK and Ireland with a number of trainees reporting a lack of clinical exposure.

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.

Factors that Determine the Severity of Betula spp. Pollen Seasons in Poland (Poznań and Krakow) and the United Kingdom (Worcester and London)

The aim of this paper is to analyse variations in the severity of Betula pollen seasons, particularly in relation to meteorological parameters at four sites, Poznań and Krakow in Poland and Worcester and London in the United Kingdom. Results show that there is a significant relationship between Betula pollen season severity and weather conditions in the year before pollination as well as conditions in the same year that pollen is released from the plant. Furthermore, it is likely that the magnitude of birch pollen seasons in Poznań, Worcester and London is linked in some way to different phases of the North Atlantic Oscillation (NAO). Significant positive relationships exist between birch pollen counts at Poznań and temperatures, rainfall and averages of the NAO in the year before pollination. An opposite relationship is evident at the two sites studied in the British Isles. There were significant positive correlations between the severity of birch pollen seasons recorded at Worcester and London and temperatures and averages of the NAO during the year of pollination, and negative correlations with similar variables from the previous year. In addition, Betula pollen seasons in Krakow do not appear to be influenced by the NAO, which is probably the result of Krakow having a more continental climate.

Atmospheric Concentrations of Alternaria, Cladosporium, Ganoderma and Didymella Spores Monitored in Cork (Ireland) and Worcester (England) During the Summer of 2010

This study represents the first international intercomparison of fungal spore observations since 1990, focusing on atmospheric concentrations of Alternaria, Cladosporium, Ganoderma and Didymella spores. The campaigns were performed at sites located in Cork (Ireland) and Worcester (England) during summer 2010. Observations were made using Hirst-type volumetric spore traps and corresponding optical identification at the genus level by microscope. The measurements at both sites (including meteorological parameters) were compared and contrasted. The relationships between the fungal spore concentrations with selected meteorological parameters were investigated using statistical methods and multivariate regression trees (MRT). The results showed high correlations between the two sites with respect to daily variations. Statistically significant higher spore concentrations for Alternaria, Cladosporium and Ganoderma were monitored at the Worcester site. This result was most likely due to the differences in precipitation and local fungal spore sources at the two sites. Alternaria and Cladosporium reached their maxima a month earlier in Cork than in Worcester, and Didymella with Ganoderma peaked simultaneously with similar diurnal trends found for all the investigated spore types. MRT analysis helped to determine threshold values of the meteorological parameters that exerted most influence on the presence of spores: they were found to vary at the two sites. Our results suggest that the aeromycological profile is quite uniform over the British Isles, but a description of bioaerosols with respect to overall load and daily concentration can be quite diverse although the geographical difference between sites is relatively small. These variations in the concentrations therefore need to be explored at the national level

Order to create a General Board of Health in the Town of Niagara, June 25, 1832

In the early nineteenth century, a widespread outbreak of cholera occurred in continental Europe, eventually spreading to the British Isles. The disease subsequently spread to Canada as impoverished British immigrants seeking a better life arrived in the country. To help curb the spread of the disease, local Boards of Health were created.

Order to create a General Board of Health in the Town of Niagara, June 25, 1832.

In the early nineteenth century, a widespread outbreak of cholera occurred in continental Europe, eventually spreading to the British Isles. The disease subsequently spread to Canada as impoverished British immigrants seeking a better life arrived in the country. To help curb the spread of the disease, local Boards of Health were created.

Essai de détection de processus migratoires à travers les isotopes de strontium et d’oxygène : étude des restes humains du cimetière Saint-Matthew (Québec, 1771-1860)

Afin de distinguer les immigrants de première génération des individus nés à Québec et de discuter de l’identité des immigrants de cette ville aux XVIIIe et XIXe siècles, trente-quatre squelettes humains exhumés du cimetière protestant Saint-Matthew (Québec, 1771-1860) ont fait l’objet d’analyses ostéologiques et isotopiques du strontium (87Sr/86Sr) et de l’oxygène (δ18O). Les teneurs obtenues, bien que moins précises que les données historiques, ont permis de distinguer trois groupes d’origine, soit les individus nés à Québec (N = 12), les immigrants de première génération provenant le plus probablement des îles Britanniques et du nord de la France (N = 19) et les immigrants de première génération dont l’origine ne peut être précisée (N = 3). De plus, l’origine écossaise de certains individus a pu être suggérée en fonction de compositions isotopiques variant entre -10,0 et -9,09 % vs VSMOW. La comparaison des groupes d’origine à des données provenant de sources historiques et d’une étude antérieure a permis de dresser un portrait de l’identité des immigrants, à la fois sur les plans populationnel et individuel. De plus, les compositions isotopiques (δ18O, 87Sr/86Sr, δ13C et δ15N) nous laissent croire qu’au moins un individu pourrait être d’origine amérindienne et qu’un autre proviendrait d’une partie de l’Europe plus appauvrie en 18O (possiblement un pays scandinave ou une région alpine). La distribution spatiale des sépultures nous a également permis d’émettre des hypothèses sur les liens familiaux et sociaux d’immigrants inhumés en caveaux ou entassés de façon particulièrement modeste.

Évolution des pratiques alimentaires en cours de vie : une étude isotopique multi-matérielle de la population du cimetière Saint-Matthew (Québec, 1771-1860)

En tant que population majoritairement immigrante, les protestants inhumés au cimetière Saint-Matthew, ville de Québec (1771-1860) ont dû s'adapter à un nouvel environnement à leur arrivée au Québec, et donc à de nouvelles ressources. Parallèlement, les 18e et 19e siècles sont marqués par un contexte socio-économique en pleine mutation avec l'arrivée graduelle de la période industrielle, et la ville de Québec, avec son contexte portuaire, a ainsi été au coeur de ces changements. L'objectif de ce mémoire est d'évaluer si la géochimie des isotopes stables appliquée à plusieurs matériaux du squelette humain (collagène et apatite de l'os, collagène de la dentine, et carbonate de l'émail) permet de mieux comprendre comment les comportements alimentaires des individus analysés provenant de ce cimetière cosmopolite (n=40) ont évolué en cours de vie. L'alimentation étant influencée par des conditions socio-économiques, culturelles et environnementales, cela peut nous informer indirectement sur les processus d'adaptation et l'identité d'un individu. C'est dans cette perspective d'écologie culturelle que nous avons interprété les données recueillies lors de ce projet, en complément aux analyses effectuées précédemment par Morland (2009) et Caron (2013). Nos résultats corroborent les tendances déjà observées, soit des pratiques alimentaires semblables à celles que l'on retrouve en Europe, et des immigrants provenant majoritairement des Îles Britanniques. Ils démontrent également une légère augmentation de la consommation de ressources C4, comme le maïs et la canne à sucre, à l'âge adulte pour 90% des individus analysés, de même qu'une baisse du niveau de protéines. Par ailleurs, les individus étudiés ont généralement eu tendance à conserver le même niveau alimentaire les uns par rapport aux autres tout au cours de leur vie, même si les pratiques étaient moins diversifiés à l'âge adulte. Finalement, on constate des similarités de comportements avec les populations irlandaises et britanniques plus pauvres durant l'enfance, alors qu'ils ressemblent davantage à ceux visibles dans la vallée laurentienne en fin de vie, notamment en ce qui concerne l'apport en protéines. Nos résultats suggèrent donc des changements alimentaires significatifs, fort possiblement liés aux processus de migration et à une adaptation constante à un nouvel environnement de la part des individus étudiés.

Storm tracks and climate change

Extratropical and tropical transient storm tracks are investigated from the perspective of feature tracking in the ECHAM5 coupled climate model for the current and a future climate scenario. The atmosphere-only part of the model, forced by observed boundary conditions, produces results that agree well with analyses from the 40-yr ECMWF Re-Analysis (ERA-40), including the distribution of storms as a function of maximum intensity. This provides the authors with confidence in the use of the model for the climate change experiments. The statistical distribution of storm intensities is virtually preserved under climate change using the Intergovernmental Panel on Climate Change (IPCC) Special Report on Emissions Scenarios (SRES) A1B scenario until the end of this century. There are no indications in this study of more intense storms in the future climate, either in the Tropics or extratropics, but rather a minor reduction in the number of weaker storms. However, significant changes occur on a regional basis in the location and intensity of storm tracks. There is a clear poleward shift in the Southern Hemisphere with consequences of reduced precipitation for several areas, including southern Australia. Changes in the Northern Hemisphere are less distinct, but there are also indications of a poleward shift, a weakening of the Mediterranean storm track, and a strengthening of the storm track north of the British Isles. The tropical storm tracks undergo considerable changes including a weakening in the Atlantic sector and a strengthening and equatorward shift in the eastern Pacific. It is suggested that some of the changes, in particular the tropical ones, are due to an SST warming maximum in the eastern Pacific. The shift in the extratropical storm tracks is shown to be associated with changes in the zonal SST gradient in particular for the Southern Hemisphere.

Women and writing c1340-c1650; the domestication of print culture

The transition from medieval manuscript to early printed book is currently a mmajor topic of academic interest, but has received little attention in relation to women's involvement. The essays in this volume both add female names to the list of those authors who created English Literature, and examine women's responses to older texts. Taking its cue from the advances made by recent work on manuscript culture and book history, this volume also includes studies of material evidence. These reveal women's participation in the making of books, and also the traces they left behind when handling individual volumes. Finally, studies of women's roles in relation to apparently ephemeral texts, such as letters, pamphlets and almanacs, challenge traditional divisions between public and private spheres and between manuscript and print.

Domesticating the calendar: the hours and the almanac in Tudor England

This article examines two genres of text which were extremely popular in the late-medieval and early modern periods, and it pays particular attention to women users. The printed almanacs of sixteenth-century England were enormously influential; yet their contents are so formulaic and repetitive as to appear almost empty of valuable information. Their most striking feature is their astrological guidance for the reader, and this has led to them being considered 'merely' the repository of popular superstition. Only in the last decade have themes of gender and medicine been given serious consideration in relation to almanacs; but this work has focused on the seventeenth century. This chapter centres on a detailed analysis of sixteenth-century English almanacs, and the various kinds of scientific and household guidance they offered to women readers. Both compilers and users needed to chart a safe course through the religious and scientific battles of the time; and the complexities involved are demonstrated by considering the almanacs in relation to competing sources of guidance. These latter are Books of Hours and 'scientific' works such as medical calendars compiled by Oxford scholars in the late middle ages. A key feature of this chapter is that it gives practical interpretations of this complex information, for the guidance of modern readers unfamiliar with astrology.