4DCT radiotherapy for NSCLC: A review of planning methods

Purpose To establish whether the use of a passive or active technique of planning target volume (PTV) definition and treatment methods for non-small cell lung cancer (NSCLC) deliver the most effective results. This literature review assesses the advantages and disadvantages in recent studies of each, while assessing the validity of the two approaches for planning and treatment. Methods A systematic review of literature focusing on the planning and treatment of radiation therapy to NSCLC tumours. Different approaches which have been published in recent articles are subjected to critical appraisal in order to determine their relative efficacy. Results Free-breathing (FB) is the optimal method to perform planning scans for patients and departments, as it involves no significant increase in cost, workload or education. Maximum intensity projection (MIP) is the fastest form of delineation, however it is noted to be less accurate than the ten-phase overlap approach for computed tomography (CT). Although gating has proven to reduce margins and facilitate sparing of organs at risk, treatment times can be longer and planning time can be as much as 15 times higher for intensity modulated radiation therapy (IMRT). This raises issues with patient comfort and stabilisation, impacting on the chance of geometric miss. Stereotactic treatments can take up to 3 hours to treat, along with increases in planning and treatment, as well as the additional hardware, software and training required. Conclusion Four-dimensional computed tomography (4DCT) is superior to 3DCT, with the passive FB approach for PTV delineation and treatment optimal. Departments should use a combination of MIP with visual confirmation ensuring coverage for stage 1 disease. Stages 2-3 should be delineated using ten-phases overlaid. Stereotactic and gated treatments for early stage disease should be used accordingly; FB-IMRT is optimal for latter stage disease.

The role of radiotherapy patients in provision of student interpersonal skills feedback

Background At Queensland University of Technology, student radiation therapists receive regular feedback from clinical staff relating to clinical interpersonal skills. Although this is of great value, there is anecdotal evidence that students communicate differently with patients when under observation. Purpose The aim of this pilot was to counter this perceived observer effect by allowing patients to provide students with additional feedback. Materials and methods Radiotherapy patients from two departments were provided with anonymous feedback forms relating to aspects of student interpersonal skills. Clinical assessors, mentors and students were also provided with feedback forms, including questions about the role of patient feedback. Patient perceptions of student performance were correlated with staff feedback and assessment scores. Results Results indicated that the feedback was valued by both students and patients. Students reported that the additional dimension focused them on communication, set goals for development and increased motivation. These changes derived from both feedback and study participation, suggesting that the questionnaires could be a useful teaching tool. Patients scored more generously than mentors, although there was agreement in relative grading. Conclusions The anonymous questionnaire is a convenient and valuable method of gathering patient feedback on students. Future iterations will determine the optimum timing for this method of feedback.

Sexual abuse prevention education

Child sexual abuse is a serious problem that has received increased attention in recent years. From an ecological perspective, in which social problems are viewed in the context of characteristics of individuals, families, and broader societal systems (Prilleltensky, Peirson, & Nelson, 2001), preventing child sexual abuse involves strengthening capacity to intervene at individual, family/relationship, school, and community levels. School-based education programs have been developed in efforts to prevent child sexual abuse before it happens and to provide children who may already be experiencing it with help seeking information. Use of these programs must be based on evidence rather than ideology. Evaluations of these programs have demonstrated that sexual abuse prevention education can provide children with improved knowledge and skills for responding to and reporting potential sexual abuse. However, this learning does not seem to be maintained over time which means further attention should be given to repeated learning, opportunities for concept reinforcement and integration with other topics. School-based programs typically present information to children by presenting a series of core concepts and messages which are delivered using engaging pedagogical strategies such as multi-media technologies, animations, theatre and songs, puppets, picture books, and games. This chapter will outline the key characteristics of effective child sexual abuse prevention programs, and will provide directions for future research and practice.

Non-separability and substitutability among water pollutants : evidence from India

The design and implementation of environmental policy often involve more than one pollutant, and must consider pollution as a byproduct of the production of marketable output. In this paper, we test the implicit assumption in the empirical literature that (1) production of marketable output, pollution and abatement are separable, and (2) different pollutants can be abated separately. Using unique plant-level data in India, we reject the null hypotheses of separability between marketable output and pollutants, and between different pollutants. Firms must incur abatement costs for reducing pollution levels. In addition, complement and substitute relationships between water pollutants are demonstrated with statistical significance.

Changes in environmentally sensitive productivity and technological modernization in China's iron and steel industry in the 1990s

Technological modernization is widely believed to contribute positively both to economic development and to environmental and resource conservation, through improvements in productivity and strengthening of business competitiveness. However, this may not always be true, particularly in the short term, as it requires substantial investments and may impose financial burdens on firms undertaking such investments. This study empirically examines the effects of technological modernization in China's iron and steel industry in the 1990s on conventional economic productivity (CEP) and environmentally sensitive productivities (ESPs). We employ a directional distance function that can handle multiple inputs and outputs to compute relative production efficiencies. We apply these models to the data covering 27 iron and steel firms in China between 1990 and 1999-a period when the Chinese iron and steel industry modernized rapidly. We find that ESPs have continuously improved, even in the period when the CEP declined.

China's "Responsible Protection" concept : re-interpreting the Responsibility to Protect (R2P) and military intervention for humanitarian purposes

This article assesses the extent to which the recently formulated Chinese concept of “Responsible Protection” (RP) offers a valuable contribution to the normative debate over R2P’s third pillar following the controversy over military intervention in Libya. While RP draws heavily on previous proposals such as the original 2001 ICISS report and Brazil’s “Responsibility while Protecting” (RwP), by amalgamating and re-packaging these earlier ideas in a more restrictive form the initiative represents a new and distinctive interpretation of R2P. However, some aspects of RP are framed too narrowly to provide workable guidelines for determining the permissibility of military intervention for civilian protection purposes, and should therefore be clarified and refined. Nevertheless, the Chinese proposal remains significant because it offers important insights into Beijing’s current stance on R2P. More broadly, China’s RP and Brazil’s RwP initiatives illustrate the growing willingness of rising, non-Western powers to assert their own normative preferences on sovereignty, intervention and global governance.

What is the apparent angle of a Kelvin ship wave pattern?

While the half-angle which encloses a Kelvin ship wave pattern is commonly accepted to be 19.47 degrees, recent observations and calculations for sufficiently fast-moving ships suggest that the apparent wake angle decreases with ship speed. One explanation for this decrease in angle relies on the assumption that a ship cannot generate wavelengths much greater than its hull length. An alternative interpretation is that the wave pattern that is observed in practice is defined by the location of the highest peaks; for wakes created by sufficiently fast-moving objects, these highest peaks no longer lie on the outermost divergent waves, resulting in a smaller apparent angle. In this paper, we focus on the problems of free surface flow past a single submerged point source and past a submerged source doublet. In the linear version of these problems, we measure the apparent wake angle formed by the highest peaks, and observe the following three regimes: a small Froude number pattern, in which the divergent waves are not visible; standard wave patterns for which the maximum peaks occur on the outermost divergent waves; and a third regime in which the highest peaks form a V-shape with an angle much less than the Kelvin angle. For nonlinear flows, we demonstrate that nonlinearity has the effect of increasing the apparent wake angle so that some highly nonlinear solutions have apparent wake angles that are greater than Kelvin's angle. For large Froude numbers, the effect on apparent wake angle can be more dramatic, with the possibility of strong nonlinearity shifting the wave pattern from the third regime to the second. We expect our nonlinear results will translate to other more complicated flow configurations, such as flow due to a steadily moving closed body such as a submarine.

The lily, client and measure of Bruno Taut’s Glashaus

The Glashaus is considered a significant exemplar of early modernist architecture and is generally accepted as having had Expressionist origins. However, current research has revealed that the design origins of this important building are not fully understood. While the historical record acknowledges the contributions of the bohemian poet Paul Scheerbart and the art critic Adolf Behne, the role of the Glashaus’ architect, Bruno Taut, has been moderated. In an attempt to rectify this situation this article proposes that the design origins of the Glashaus can be found in a strong architect-client interaction. It is argued that the Glashaus’ client, the Deutsche Luxfer Prismen Syndikat under the directorship of Frederick Keppler, exerted a significant influence on its design. In order to showcase the glazed products of Luxfer in the best manner possible, Keppler insisted that the design feature a glazed dome, electric lighting, a fountain as well as a cascade. Given the detailed stipulations of this brief, Taut had few options other than to offer interpretations of precedent that derived from the Victoria regia lily and Gothic proportioning. By expounding this architect-client relationship, this article expands our understanding of the Glashaus, and reinvigorates our understanding of this important early example of modern architecture.

Strengthening Social and Emotional Learning in Children with Special Needs

Locally and globally, guiding children’s social and emotional development is no longer optional for educators. Research undertaken over the last 20 years provides compelling evidence that early and ongoing development of socio-emotional skills contributes to an individual’s overall health, wellbeing and competence throughout life. Moreover, competence in this domain is now recognised as fundamental to school readiness, school adjustment and academic achievement. As a consequence, social and emotional learning (SEL) is an important theme in current educational policy, curriculum frameworks and classroom practice. This chapter focuses on a particular group of vulnerable learners – children with special needs – and highlights key strategies for educators to use in their everyday classroom practices to strengthen SEL in children from early years through to the end of primary school.

Psycho-educational assessment of specific learning disabilities: Views and practices of Australian psychologists and guidance counsellors

This paper reports an investigation of the views and practices of 203 Australian psychologists and guidance counsellors with respect to psycho-educational assessment of students with Specific Learning Disabilities (SLDs). Results from an online survey indicated that practitioners draw upon a wide-range of theoretical perspectives when conceptualising and identifying SLDs, including both response to intervention and IQ – achievement discrepancy models. Intelligence tests (particularly the Wechsler scales) are commonly employed, with the main stated reasons for their use being ‘traditional’ perspectives (including IQ-achievement discrepancy-based definitions of SLDs), to exclude a diagnosis of intellectual disability, and to guide further assessment and intervention. In contrast participants reported using measures of academic achievement and tests of specific cognitive deficits known to predict SLDs (e.g., phonological awareness) relatively infrequently.

Making sense of inconsistencies in psycho-educational assessment: A case report

The case is presented of an 8-year-old young boy who was referred for psycho-educational assessment because of difficulties with writing. The paper provides an example of the way in which a case unfolds as further assessment data become available, and describes a number of challenging aspects of the assessment process. In this case, dilemmas arose when test results were inconsistent at different time points, and when the results were inconsistent with clinical observations. The case report illustrates the ways in which practitioners can collaborate to make sense of such discrepancies, with each contributing a slightly different perspective or set of skills that, in combination, assist to better understand a child’s difficulties.