Pre-Radiotherapy Dental Assessment of Head and Neck Oncology Patients: An Audit.

Objectives: Approximately 300 people are diagnosed with Head and Neck cancer annually in Northern Ireland. The management may include treatment by surgery or by chemotherapy and radiotherapy,
or a combination of modalities. Patients whose oral cavity, teeth, salivary glands and jaws that
will be affected by treatment, particularly radiotherapy should have a pre-treatment assessment. This should be done as early as possible to maximise the time available for dental management. However, this can be challenging owing to the complexities of cancer diagnosis, treatment planning and multidisciplinary management. At the Belfast Dental Hospital, a number of patients were referred post- radiotherapy with complications after not having received a pre-treatment assessment. The referrals for pre- treatment dental assessment were also late in patients’ multidisciplinary journey, limiting the time period
for dental input. The purpose of this audit was to examine the time period between dental assessment and commencement of radiotherapy and whether this was an adequate time frame for dental management. This audit will also examine the dental diseases present and the treatments required pre-radiotherapy. Methods: Data for this audit was collected over 4 months in 2012
by analysing the dental charts and referrals of new patients who were referred to and attended the dental head and neck oncology clinic. A standardised referral pro-forma was introduced from September 2013 to improve the referral process.
A re-audit was conducted over 4 months in 2014. Data was collected similarly as previous. The time period between dental assessment and commencement of radiotherapy was examined. The presence of dental disease and subsequent treatments required were also noted.
Results: 63 new patients were examined in the dental head and neck oncology clinic over 4 months in 2012. 48 (76.2%) were examined pre-radiotherapy. The average length of time between dental assessment and radiotherapy commencement was 11 days. A new standardised referral pro-forma was introduced in 2013. In the re-audit, 65 new patients were seen over 4 months in 2014.
60 (92.3%) patients were examined pre-radiotherapy. The average length of time between dental assessment and radiotherapy commencement was 18 days.
Conclusion: Given the high prevalence of pre-existing dental disease amongst head and neck cancer patients, prompt dental assessment and treatment is vital. Efforts aimed at improving the care pathway are on-going through the implementation of a mandatory referral pro-forma and a dedicated assessment clinic.

The role of complexity metrics in a multi-institutional dosimetry audit of VMAT

OBJECTIVE: To demonstrate the benefit of complexity metrics such as the modulation complexity score (MCS) and monitor units (MUs) in multi-institutional audits of volumetric-modulated arc therapy (VMAT) delivery.

METHODS: 39 VMAT treatment plans were analysed using MCS and MU. A virtual phantom planning exercise was planned and independently measured using the PTW Octavius(®) phantom and seven29(®) 2D array (PTW-Freiburg GmbH, Freiburg, Germany). MCS and MU were compared with the median gamma index pass rates (2%/2 and 3%/3 mm) and plan quality. The treatment planning systems (TPS) were grouped by VMAT modelling being specifically designed for the linear accelerator manufacturer's own treatment delivery system (Type 1) or independent of vendor for VMAT delivery (Type 2). Differences in plan complexity (MCS and MU) between TPS types were compared.

RESULTS: For Varian(®) linear accelerators (Varian(®) Medical Systems, Inc., Palo Alto, CA), MCS and MU were significantly correlated with gamma pass rates. Type 2 TPS created poorer quality, more complex plans with significantly higher MUs and MCS than Type 1 TPS. Plan quality was significantly correlated with MU for Type 2 plans. A statistically significant correlation was observed between MU and MCS for all plans (R = -0.84, p < 0.01).

CONCLUSION: MU and MCS have a role in assessing plan complexity in audits along with plan quality metrics. Plan complexity metrics give some indication of plan deliverability but should be analysed with plan quality.

ADVANCES IN KNOWLEDGE: Complexity metrics were investigated for a national rotational audit involving 34 institutions and they showed value. The metrics found that more complex plans were created for planning systems which were independent of vendor for VMAT delivery.

Economical and operational optimization of CALB immobilization on MP1000 for amidation of olein fatty acids with ethanolamine

Dissertação de Mestrado , Engenharia Biológica, Faculdade de Engenharia de Recursos Naturais, Universidade do Algarve, 2008

Towards a hydrodynamic operational model of the Algarve coast and St. Vincent Cape

This study attempts to implement a hydrodynamic operational model which can ultimately be used for projecting oil spill dispersal patterns and also sewage, pollution and can also be used in wave forecasting. A two layer nested model was created using MOHID Water, which is powerful ocean modelling software. The first layer (father) is used to impose the boundary conditions for the second layer (son). This was repeated for two different wind dominant regimes, Easterly and Westerly winds respectively. A qualitative comparison was done between measured tidal data and the tidal output. Sea surface temperature was also qualitatively compared with the model’s results. The results from both simulations were analysed and compared to historical literature. The comparison was done at the surface layer, 100 metre depth and at 800m depth. In the surface layer the first simulation generated an upwelling event near Cape St. Vincent and within the Algarve. The second simulation generated a non-upwelling event within which the surface was flow reversed and the warm water mass was along the Algarve coastline and evening turning clockwise around Cape St. Vincent. At the 100 metre depth for both simulations, velocity vortexes were observed near Cape St. Vincent travelling northerly and southerly at various instances. At 800metre depth a strong oceanic flow was observed moving north westerly along the continental shelf.

Development of an operational tool for oil spill forecast: application to oil exposed regions

Tese de doutoramento, Ciências do Mar, da Terra e do Ambiente (Modelação), Faculdade de Ciências e Tecnologia, Universidade do Algarve, 2014

The intra-industry effects of going concern withdrawn audit reports

Dissertação de mestrado, Finanças Empresariais, Faculdade de Economia, Universidade do Algarve, 2014

Audit report GE McCormick - 2010

This audit report by the South Carolina State Election Commission for the 2010 general election in McCormick County provides 5 reports generated by the iVotronic voting machines and Unity election system, including comparisons of number of ballots, number of votes for each candidate, and Personal Electronic Ballot devices used.

A method for analysing operational complexity in supply chains

This paper proposes a method for analysing the operational complexity in supply chains by using an entropic measure based on information theory. The proposed approach estimates the operational complexity at each stage of the supply chain and analyses the changes between stages. In this paper a stage is identified by the exchange of data and/or material. Through analysis the method identifies the stages where the operational complexity is both generated and propagated (exported, imported, generated or absorbed). Central to the method is the identification of a reference point within the supply chain. This is where the operational complexity is at a local minimum along the data transfer stages. Such a point can be thought of as a ‘sink’ for turbulence generated in the supply chain. Where it exists, it has the merit of stabilising the supply chain by attenuating uncertainty. However, the location of the reference point is also a matter of choice. If the preferred location is other than the current one, this is a trigger for management action. The analysis can help decide appropriate remedial action. More generally, the approach can assist logistics management by highlighting problem areas. An industrial application is presented to demonstrate the applicability of the method.

NCRF 9 – locações: implicações fiscais e de auditoria

Dissertação apresentada ao Instituto Superior de Contabilidade e Administração do Porto para a obtenção do Grau de Mestre em Auditoria ORIENTAÇÃO: DR. JOÃO COSTA

Fatores influenciadores da gestão da qualidade e independência do auditor: um estudo de caso

Dissertação apresentada ao Instituto Superior de Contabilidade para obtenção do Grau de Mestre em Auditoria Orientada por: Doutora Alcina Dias

A importância da auditoria interna e a avaliação do desempenho da organização: estudo de caso: empresas do sector do calçado

Dissertação de Mestrado apresentado ao Instituto de Contabilidade e Administração do Porto para a obtenção do grau de Mestre em Auditoria, sob orientação da Doutora Alcina Augusta de Sena Portugal Dias

O Sistema de controlo interno nas instituições de Ensino Superior estudo de caso

Dissertação de Mestrado apresentada ao Instituto de Contabilidade e Administração do Porto para a obtenção do grau de Mestre em Auditoria, sob orientação da Professora Doutora Alcina Portugal Dias

On a generalized Laguerre operational matrix of fractional integration

A new operationalmatrix of fractional integration of arbitrary order for generalized Laguerre polynomials is derived.The fractional integration is described in the Riemann-Liouville sense.This operational matrix is applied together with generalized Laguerre tau method for solving general linearmultitermfractional differential equations (FDEs).Themethod has the advantage of obtaining the solution in terms of the generalized Laguerre parameter. In addition, only a small dimension of generalized Laguerre operational matrix is needed to obtain a satisfactory result. Illustrative examples reveal that the proposedmethod is very effective and convenient for linear multiterm FDEs on a semi-infinite interval.