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.

A realistic evaluation of track and trigger systems and acute care training for early recognition and treatment of deteriorating ward-based patients: research protocol.

Aim The aim of the study is to evaluate factors that enable or constrain the implementation and service delivery of early warnings systems or acute care training in practice. Background To date there is limited evidence to support the effectiveness of acute care initiatives (early warning systems, acute care training, outreach) in reducing the number of adverse events (cardiac arrest, death, unanticipated Intensive Care admission) through increased recognition and management of deteriorating ward based patients in hospital [1-3]. The reasons posited are that previous research primarily focused on measuring patient outcomes following the implementation of an intervention or programme without considering the social factors (the organisation, the people, external influences) which may have affected the process of implementation and hence measured end-points. Further research which considers the social processes is required in order to understand why a programme works, or does not work, in particular circumstances [4]. Method The design is a multiple case study approach of four general wards in two acute hospitals where Early Warning Systems (EWS) and Acute Life-threatening Events Recognition and Treatment (ALERT) course have been implemented. Various methods are being used to collect data about individual capacities, interpersonal relationships and institutional balance and infrastructures in order to understand the intended and unintended process outcomes of implementing EWS and ALERT in practice. This information will be gathered from individual and focus group interviews with key participants (ALERT facilitators, nursing and medical ALERT instructors, ward managers, doctors, ward nurses and health care assistants from each hospital); non-participant observation of ward organisation and structure; audit of patients' EWS charts and audit of the medical notes of patients who deteriorated during the study period to ascertain whether ALERT principles were followed. Discussion & progress to date This study commenced in January 2007. Ethical approval has been granted and data collection is ongoing with interviews being conducted with key stakeholders. The findings from this study will provide evidence for policy-makers to make informed decisions regarding the direction for strategic and service planning of acute care services to improve the level of care provided to acutely ill patients in hospital. References 1. Esmonde L, McDonnell A, Ball C, Waskett C, Morgan R, Rashidain A et al. Investigating the effectiveness of Critical Care Outreach Services: A systematic review. Intensive Care Medicine 2006; 32: 1713-1721 2. McGaughey J, Alderdice F, Fowler R, Kapila A, Mayhew A, Moutray M. Outreach and Early Warning Systems for the prevention of Intensive Care admission and death of critically ill patients on general hospital wards. Cochrane Database of Systematic Reviews 2007, Issue 3. www.thecochranelibrary.com 3. Winters BD, Pham JC, Hunt EA, Guallar E, Berenholtz S, Pronovost PJ (2007) Rapid Response Systems: A systematic review. Critical Care Medicine 2007; 35 (5): 1238-43 4. Pawson R and Tilley N. Realistic Evaluation. London; Sage: 1997

Presbyopia and near-vision impairment in rural northern China.

PURPOSE: Presbyopia limits activities of daily living, but population-based data from rural China are scarce. METHODS: A population-based, cross-sectional study was conducted in 2009 among all persons aged 40+ years in a rural area near Shenyang, China. Distance and near VA were measured using logMAR E charts. Individuals with pinhole-corrected distance vision ≥20/63 underwent detailed eye examination and near refraction. RESULTS: A total of 1008 (91.5%) respondents were examined (mean age, 58.4 ± 10.7 years for men, 56.8 ± 9.89 years for women). Women and older subjects were more likely to participate. The prevalence of functional presbyopia (near vision <20/50 [N8] improved by ≥1 line with correction) was 67.3% (95% confidence interval [CI], 64.30%-70.09%), increasing from 27.6% at 40 to 49 years of age to 81.8% at 60 to 69 years. Multivariate analysis showed that older age (P < 0.001), but not gender or education, was significantly associated with a higher risk of presbyopia. Self-reported presbyopic spectacle correction coverage was 51.5%. In multivariate logistic regression models, worse presenting near vision (P = 0.013) and higher required spherical equivalent power (P < 0.001) were associated with having correction, while age, gender, education, and distance vision were unassociated. Major barriers reported by persons without near correction included poor quality of available glasses (33.1%) and lack of awareness of the condition and its treatment (28.8%). CONCLUSIONS: Presbyopia is highly prevalent in rural China, and nearly half of affected persons have no access to correction. Interventions should focus on education and improvement in the quality of refractive services.

Investigating Fractured Flow from Orthopaedics to Rehabilitation

Patients often spend time as inpatients in hospitals outside their home area because of the need to access specialist services. If there is a need for ongoing care after the need for specialist care has passed, patients are transferred (or ‘repatriated’) back to the inpatient care of a hospital in their local Health and Social Care Trust. The need for bed space in specialist units means that there is pressure for this transition to occur in a timely way. We investigated the flow of patients through a trauma and orthopaedics unit using the 6M Design® framework and Vitals Charts® in order to investigate concerns about delayed repatriation. We found that repatriation was part of a complex system that had interdependent components. There was considerable variation in the number of discharges (to any destination) by day of week, with a reduction on Saturdays and Sundays. Understanding that the pressure for quicker repatriation was really due to high work-in-progress led us to model the effects of strategies to address the high work-in-progress. We found that, because only a small proportion of patients require repatriation, expediting the repatriation process by one day for each patient would only reduce WIP by an average of 1.6 patients. Reducing the average length of stay for all trauma and orthopaedics inpatients by one day would reduce the WIP by 10 patients, which would make a much greater impact on the problem of high bed occupancy. Though the smooth and timely repatriation of patients to rehabilitation units is desirable, it is unlikely that efforts to achieve this will have a substantial impact on the problem of high WIP, so other strategies will be required. We will model the effects of strategies to reduce variation in daily discharges by the day of week in a future essay.

Besov spaces and the Laplacian on fractal H-sets

Nesta tese são estudados espaços de Besov de suavidade generalizada em espaços euclidianos, numa classe de fractais designados conjuntos-h e em estruturas abstractas designadas por espaços-h. Foram obtidas caracterizações e propriedades para estes espaços de funções. Em particular, no caso de espaços de Besov em espaços euclidianos, foram obtidas caracterizações por diferenças e por decomposições em átomos não suaves, foi provada uma propriedade de homogeneidade e foram estudados multiplicadores pontuais. Para espaços de Besov em conjuntos-h foi obtida uma caracterização por decomposições em átomos não suaves e foi construído um operador extensão. Com o recurso a cartas, os resultados obtidos para estes espaços de funções em fractais foram aplicados para definir e trabalhar com espaços de Besov de suavidade generalizada em estruturas abstractas. Nesta tese foi também estudado o laplaciano fractal, considerado a actuar em espaços de Besov de suavidade generalizada em domínios que contêm um conjunto-h fractal. Foram obtidos resultados no contexto de teoria espectral para este operador e foi estudado, à custa deste operador, um problema de Dirichlet fractal no contexto de conjuntos-h.

Avaliação cognitiva em traumatizados crânio-encefálicos ligeiros

O aumento da incidência de traumatismos crânio-encefálicos (TCE) a nível internacional, tem vindo a fomentar o desenvolvimento de estudos neste domínio. O presente estudo pretende determinar a deterioração cognitiva e o estado depressivo em indivíduos com TCE ligeiro e sem TCE; analisar a deterioração cognitiva e o estado depressivo nos indivíduos com TCE ligeiro e sem TCE em relação ao sexo, idade, estado civil, residência e tipo de traumatismo; analisar a relação entre a deterioração cognitiva e o estado depressivo dos indivíduos com TCE e o tipo de traumatismo sofrido. Através de um estudo comparativo, avaliamos uma amostra total de 40 indivíduos, tendo o emparelhamento sido feito entre 2 grupos:  grupo clínico: 20 indivíduos com TCE ligeiro (entre 6 e 18 meses após lesão) com idades compreendidas entre os 18 e os 65 anos;  grupo de controlo: 20 indivíduos sem ter tido TCE ou patologia conducente a handicap psiquiátrico ou neurológico. A deterioração cognitiva foi avaliada através do Mini Mental State Examination (Folstein et al., 1975-versão portuguesa, adaptada por Guerreiro, 1993) que é um teste constituído por seis grupos que avaliam o defeito cognitivo do sujeito. Também foi utilizada a Bateria de Avaliação Neuropsicológica de Luria- Nebraska / versão experimental portuguesa de Maia, Loureiro e Silva, 2002, traduzida e adaptada de Golden, Hammeke e Purisch, 1979, que é uma bateria que visa avaliar o funcionamento neuropsicológico de indivíduos com manifestações neuropsicológicas. O estado depressivo foi avaliado através do Inventário de Avaliação Clínica da Depressão-IACLIDE (Serra, 1994) que mede a intensidade dos quadros clínicos depressivos, bem como uma ficha de registo individual de dados biográficos e clínicos. Os principais resultados são: Os indivíduos do grupo clínico, ou seja, aqueles que sofreram TCE ligeiro evidenciam maior deterioração cognitiva comparativamente com os que o não sofreram. Aqueles indivíduos também evidenciam estados depressivos significativamente mais graves do que os indivíduos que não sofreram aquele traumatismo. O TCE ligeiro induz um aumento dos sintomas depressivos em termos biológicos, cognitivos, inter-pessoais e desempenho de tarefas e tende a agravar os níveis de depressão endógena e a causar perturbação na relação do indivíduo consigo próprio; O TCE ligeiro conduz a um aumento significativo da incapacidade dos indivíduos para a vida geral, para o trabalho, para a vida social e para a vida familiar; Os indivíduos que sofreram TCE ligeiro evidenciam funções motoras, linguagem expressiva e raciocínio aritmético mais perturbadas que os que o não sofreram; O TCE ligeiro induz alterações neuropsicológicas que diminuem significativamente a capacidade dos mesmos. Os dados obtidos indicam, que os indivíduos que sofreram TCE do sexo feminino evidenciaram alteração cognitiva mais acentuada do que os do sexo masculino; os indivíduos mais velhos que sofreram TCE ligeiro, tendem a evidenciar maior deterioração do estado cognitivo e avaliação neuropsicológica mais baixa; verificamos também que no grupo clínico os indivíduos casados revelaram pior estado neuropsicológico na escala da bateria referente à leitura; os indivíduos que sofreram TCE ligeiro que residiam em aldeias evidenciam níveis mais elevados de depressão do que aqueles que residiam em vilas; por fim, os indivíduos que sofreram traumatismo aberto revelam maiores alterações neuropsicológicas nas funções motoras e visuais, no ritmo e na aritmética comparativamente com os outros.

Sediment dynamics and tidal inlet relocation in mixed-energy settings: the case of Ancão inlet (Algarve - Portugal)

Tese de dout., Ciências do Mar, Faculdade de Ciências do Mar e do Ambiente, Univ. do Algarve, 2003

Biopolymers - facts and statistics

The IfBB – Institute for Bioplastics and Biocomposites is a research institute within the Hochschule Hannover, University of Applied Sciences and Arts, which was established in 2011 to respond to the growing need for expert knowledge in the area of bioplastics. With its practice-oriented research and its collaboration with industrial partners, the IfBB is able to shore up the market for bioplastics and, in addition, foster unbiased public awareness and understanding of the topic. As an independent research-led expert institution for bioplastics, the IfBB is willing to share its expertise, research findings and data with any interested party via the Internet, online and offline publications or at fairs and conferences. In carrying on these efforts, substantial information regarding market trends, processes and resource needs for bioplastics is being presented here in a concise format, in addition to the more detailed and comprehensive publication and “Engineering Biopolymers”1. One of our main concerns is to furnish a more rational basis for discussing bioplastics and use fact-based arguments in the public discourse. Furthermore, “Biopolymers – facts and statistics” aims to provide specific, qualified answers easily and quickly for decision-makers in particular from public administration and the industrial sector. Therefore, this publication is made up like a set of rules and standards and largely foregoes textual detail. It offers extensive market-relevant and technical facts presented in graphs and charts, which means that the information is much easier to grasp. The reader can expect comparative market figures for various materials, regions, applications, process routes, agricultural land use or resource consumption, production capacities, geographic distribution, etc.

Industrial resources, Horry County: Conway

This is a 1968 report generated by the Conway Chamber of Commerce and the South Carolina State Development Board to provide potential industrial developers with information about industry in Horry County, particularly Conway, and to promote new development. The report includes detailed statistics and descriptive information about industry in Horry County and in Conway in the form of text statements as well as charts and maps. This information covers, at the county and city levels: county and community services and resources, agricultural resources, communications, labor supply, economics, and education, state, county, and city taxation, utility and transportation availability, weather and climate data, local recreation, and industrial site availability.

A moral, mural! : as ideias nos mapas e quadros parietais

Tese de doutoramento, Educação (História da Educação), Universidade de Lisboa, Instituto de Educação, 2014

Turismo e transportes num mundo global : uma experiência didática no 8º ano de escolaridade

Relatório da prática de ensino supervisionada, Mestrado em Ensino de História e Geografia para o 3º ciclo do Ensino Básico e do Ensino Secundário, Universidade de Lisboa, 2014

O repertório cerâmico da sala nº 1(Vidigueira), na sequência Neolítico final e Calcolítico do Alentejo Médio

O trabalho aqui proposto tem como objectivo central, a realização de análises ao conjunto dos recipientes cerâmicos pertencentes ao povoado da Sala nº1. Repertório esse, que se baseou no acervo retirado do sítio arqueológico Sala nº1, intervencionado pelo Professor Victor S. Gonçalves (1988, 1989 e 1995). As análises e descrições efectuadas foram sempre norteadas para a tentativa de estabelecer uma sequência de formas que se pudesse verificar quanto à sua normalização e frequência nos contextos presentes ao povoado da Sala nº1. Traduzindo nessa realidade, a diacronia transversal entre os estratos arqueológicos pertencentes ao Neolítico final e os estratos pertencentes ao Calcolítico. Tendo sempre como parâmetros de análise, as metodologias e critérios descritivos dos recipientes cerâmicos, presentes nos trabalhos publicados sobre as realidades cronológicas semelhantes no Sul de Portugal. O próprio conjunto de recipientes cerâmicos aqui analisado foi submetido a essas metodologias, com fim de obter primordialmente as formas e as tipologias a que pertencem. Nesse sentido procurei criar um quadro de referência local e regional, e posteriormente coloca-lo num enquadramento geral do Neolítico final e início do Calcolítico do Alentejo Médio, tentando verificar as similitudes nos quadros tipológicos existentes, como os estabelecidos por Carlos Tavares da Silva e Joaquina Soares. Sendo este um estudo que abrange um tempo cronológico de praticamente 1500 anos, premiei através da amplitude dos contornos que moldaram esta análise, algumas perspectivas possíveis. Quer ao nível das tipologias, quer ao nível das estratégias de ocupação do território, aplicáveis para o espaço e o tempo em análise. Verificando a realidade escassa nos contextos alentejanos (publicados), em que a cultura material se integra numa estratigrafia e cronologias com uma diacronia semelhante à do povoado da Sala nº1. Tentei integrar este povoado num estudo que não sendo comparativo, tivesse essa componente em relação às tipologias e formas cerâmicas identificadas. Procurou-se dar enfase à realidade artefactual das taças carenadas, e à sua possível evolução para formas mais adaptáveis ao uso e consumo quotidiano das comunidades contemporâneas das fases Calcolíticas do povoado.

Walls of Indifference: Arizona and the Ecology of Militarization

Thesis (Ph.D.)--University of Washington, 2013

Tarefas de investigação na aprendizagem do tema energia : do sol para a terra

Relatório da Prática de Ensino Supervisionada, Mestrado em Ensino de Física e Química no 3º ciclo do Ensino Básico e no Ensino Secundário, Universidade de Lisboa, 2015

Securitisation law: EU and US disclosure regulations

Providing key guidance on the process of securitisation, this comprehensive title explains in detail exactly what practitioners need to know. Featuring the most up-to-date commentary, Securitisation Law and Practice cuts through this complicated process using practical aids such as flow charts and checklists. The book also contains discussion on the latest case law (including case studies) and critical legal issues. The book also features: (1) Analysis of the recent securities regulations regarding asset-backed securities disclosures in the US and EU, providing an understanding of the differences in regulatory reporting requirements between jurisdictions. (2) Discussion of the various types of asset-backed structures that have been created over the last 30 years. (3) Analysis of the major legal decisions in the US and EU regarding securitisation transactions, including such cases as Enron, Parmalat and the recent sub-prime problem.