Minimal intervention dentistry and older patients part 2: minimally invasive operative interventions

As described in the first paper of this two part series, the expansion of our older population and the concomitant reduction in levels of edentulism will result in an increase in the number of patients presenting in general practice with complex restorative challenges. The application of the concepts of minimal intervention dentistry and minimally invasive operative techniques may offer a powerful armamentarium to the general dentist to provide ethical and conservative treatment to older patients.

Clinical Relevance: When it is unavoidable, operative intervention should be as minimally invasive as practicable in older patients to preserve the longevity of their natural dentition.

Accelerated partial breast irradiation (APBI): Are breath-hold and volumetric radiation therapy techniques useful?

Background: In a selective group of patients accelerated partial breast irradiation (APBI) might be applied after conservative breast surgery to reduce the amount of irradiated healthy tissue. The role of volumetric modulated arc therapy (VMAT) and voluntary moderately deep inspiration breath-hold (vmDIBH) techniques in further reducing irradiated healthy – especially heart – tissue is investigated.

Material and methods: For 37 partial breast planning target volumes (PTVs), three-dimensional conformal radiotherapy (3D-CRT) (3 – 5 coplanar or non-coplanar 6 and/or 10 MV beams) and VMAT (two partial 6 MV arcs) plans were made on CTs acquired in free-breathing (FB) and/or in vmDIBH. Dose-volume parameters for the PTV, heart, lungs, and breasts were compared. 

Results: Better dose conformity was achieved with VMAT compared to 3D-CRT (conformity index 1.24 0.09 vs. 1.49 0.20). Non-PTV ipsilateral breast receiving 50% of the prescribed dose was on average reduced by 28% in VMAT plans compared to 3D-CRT plans. Mean heart dose (MHD) reduced from 2.0 (0.1 – 5.1) Gy in 3D-CRT(FB) to 0.6 (0.1 – 1.6) Gy in VMAT(vmDIBH). VMAT is benefi cial for MHD reduction if MHD with 3D-CRT exceeds 0.5Gy. Cardiac dose reduction as a result of VMAT increases with increasing initial MHD, and adding vmDIBH reduces the cardiac dose further. Mean dose to the ipsilateral lung decreased from 3.7 (0.7 – 8.7) to 1.8 (0.5 – 4.0) Gy with VMAT(vmDIBH) compared to 3D-CRT(FB). VMAT resulted in a slight increase in the contralateral breast dose (DMean ) always remaining 1.9 Gy). 

Conclusions: For APBI patients, VMAT improves PTV dose conformity and delivers lower doses to the ipsilateral breast and lung compared to 3D-CRT. This goes at the cost of a slight but acceptable increase of the contralateral breast dose. VMAT reduces cardiac dose if MHD exceeds 0.5 Gy for 3D-CRT. Adding vmDIBH results in a further reduction of heart and ipsilateral lung dose. 

A tree augmented classifier based on Extreme Imprecise Dirichlet Model

We present TANC, a TAN classifier (tree-augmented naive) based on imprecise probabilities. TANC models prior near-ignorance via the Extreme Imprecise Dirichlet Model (EDM). A first contribution of this paper is the experimental comparison between EDM and the global Imprecise Dirichlet Model using the naive credal classifier (NCC), with the aim of showing that EDM is a sensible approximation of the global IDM. TANC is able to deal with missing data in a conservative manner by considering all possible completions (without assuming them to be missing-at-random), but avoiding an exponential increase of the computational time. By experiments on real data sets, we show that TANC is more reliable than the Bayesian TAN and that it provides better performance compared to previous TANs based on imprecise probabilities. Yet, TANC is sometimes outperformed by NCC because the learned TAN structures are too complex; this calls for novel algorithms for learning the TAN structures, better suited for an imprecise probability classifier.

Decadent Conservatism: Politics and Aesthetics in The Senate

The relationship between late-Victorian Decadence and Aestheticism and politics has long been vexed. This article explores the hitherto under-explored confluence of conservatism and avant-garde literature in the period by introducing The Senate, a Tory-Decadent journal that ran from 1894-7. While Decadent authors occupied various political positions, this article argues that The Senate offers a crucial link between conservatism and Decadence The article presents the journal in its political and publishing context, outlining its editorial position on such issues as the Liberal Unionist-Conservative coalition governments, Britain's relationship with Europe and the threat of ‘State Socialism’, as well as its valorisation of Bollingbroke and eighteenth-century Toryism, and its relationship to, and difference from, key Decadent journals the Yellow Book and The Savoy. It then goes on to articulate its relationship to Decadence by focussing on the presence of Paul Verlaine in its pages and its vitriolic response to the press coverage of Oscar Wilde's trials. The article concludes by exploring the surprising wake of The Senate, briefly tracing the editors' influence in the development of Modernism and links with the journal BLAST.

The Deconstructed Church: Understanding Emerging Christianity

The Emerging Church Movement (ECM) is a reform movement within Western Christianity that reacts against its roots in conservative evangelicalism by “de-constructing” contemporary expressions of Christianity. Emerging Christians see themselves as overturning out-dated interpretations of the bible, transforming hierarchical religious institutions, and re-orientating Christianity to step outside the walls of church buildings toward working among and serving others in the “real world.”

Drawing on ethnographic observations from emerging congregations, pub churches, neo-monastic communities, conferences, online networks, in-depth interviews, and congregational surveys in the US, UK, and Ireland, this book provides a comprehensive social scientific analysis of the development and significance of the ECM. Emerging Christians are shaping a distinct religious orientation that encourages individualism, deep relationships with others, new ideas around the nature of truth, doubt, and God, and innovations in preaching, worship, Eucharist, and leadership.

Activism and Restraint within the UK Supreme Court

This article provides evidence for the extent to which the UK Supreme Court as a body - and Supreme Court Justices as individuals - have displayed an activist or restrained attitude to their decision-making role. Taking October 2009 as the starting point (when the UKSC came into existence) the article surveys the degree to which the Court and individual Justices have (1) departed from precedents, (2) interpreted legislation in unanticipated ways, (3) rejected the government's position on matters of social, economic or foreign policy, and (4) developed the common law. The article concludes that, while the Supreme Court as a whole remains as conservative as the Appellate Committee of the House of Lords which preceded it (with the possible exception of its approach to immigration law), there are notable differences between the attitudes of individual Justices, one or two of whom appear to be straining at the leash.

Selective deuterium ion acceleration using the Vulcan petawatt laser

We report on the successful demonstration of selective acceleration of deuterium ions by target-normal sheath acceleration (TNSA) with a high-energy petawatt laser. TNSA typically produces a multi-species ion beam that originates from the intrinsic hydrocarbon and water vapor contaminants on the target surface. Using the method first developed by Morrison et al. [Phys. Plasmas 19, 030707 (2012)], an ion beam with >99% deuterium ions and peak energy 14 MeV/nucleon is produced with a 200 J, 700 fs, > 10 20 W/cm 2 laser pulse by cryogenically freezing heavy water (D<inf>2</inf>O) vapor onto the rear surface of the target prior to the shot. Within the range of our detectors (0°-8.5°), we find laser-to-deuterium-ion energy conversion efficiency of 4.3% above 0.7 MeV/nucleon while a conservative estimate of the total beam gives a conversion efficiency of 9.4%.

Transnational Culture Wars

The well-known ‘culture wars’ clash in the United States between civil society actors has now gone transnational. Political science scholarship has long detailed how liberal human rights non-governmental organizations NGOs engage in extensive transnational activity in support of their ideals. More recently, US conservative groups (including faith-based NGOs) have begun to emulate these strategies, promoting their convictions by engaging in transnational advocacy. NGOs thus face off against each other politically across the globe. Less well known is the extent to which these culture wars are conducted in courts, using conflicting interpretations of human rights law. Many of the same protagonists, particularly NGOs that find themselves against each other in US courts, now find new litigation opportunities abroad in which to fight their battles. These developments, and their implications, are the focus of this article. In particular, the extent to which US faith-based NGOs have leveraged the experience gained transnationally to use international and foreign jurisprudence in interventions before the US Supreme Court is assessed.

PAlliative Care in chronic Kidney diSease: the PACKS study—quality of life, decision making, costs and impact on carers in people managed without dialysis

BACKGROUND: The number of patients with advanced chronic kidney disease opting for conservative management rather than dialysis is unknown but likely to be growing as increasingly frail patients with advanced renal disease present to renal services. Conservative kidney management includes ongoing medical input and support from a multidisciplinary team. There is limited evidence concerning patient and carer experience of this choice. This study will explore quality of life, symptoms, cognition, frailty, performance decision making, costs and impact on carers in people with advanced chronic kidney disease managed without dialysis and is funded by the National Institute of Health Research in the UK.

METHODS: In this prospective, multicentre, longitudinal study, patients will be recruited in the UK, by renal research nurses, once they have made the decision not to embark on dialysis. Carers will be asked to 'opt-in' with consent from patients. The approach includes longitudinal quantitative surveys of quality of life, symptoms, decision making and costs for patients and quality of life and costs for carers, with questionnaires administered quarterly over 12 months. Additionally, the decision making process will be explored via qualitative interviews with renal physicians/clinical nurse specialists.

DISCUSSION: The study is designed to capture patient and carer profiles when conservative kidney management is implemented, and understand trajectories of care-receiving and care-giving with the aim of optimising palliative care for this population. It will explore the interactions that lead to clinical care decisions and the impact of these decisions on informal carers with the intention of improving clinical outcomes for patients and the experiences of care givers.

A field and reactive transport model study of arsenic in a basaltic rock aquifer

The use of geothermal energy as a source for electricity and district heating has increased over recent decades. Dissolved As can be an important constituent of the geothermal fluids brought to the Earth's surface. Here the field application of laboratory measured adsorption coefficients of aqueous As species on basaltic glass surfaces is discussed. The mobility of As species in the basaltic aquifer in the Nesjavellir geothermal system, Iceland was modelled by the one-dimensional (1D) reactive transport model PHREEQC ver. 2, constrained by a long time series of field measurements with the chemical composition of geothermal effluent fluids, pH, Eh and, occasionally, Fe- and As-dissolved species measurements. Di-, tri- and tetrathioarsenic species (As(OH)S22-, AsS₃H^2-, AsS33- and As(SH)4-) were the dominant form of dissolved As in geothermal waters exiting the power plant (2.556μM total As) but converted to some extent to arsenite (H₃AsO₃) and arsenate HAsO42- oxyanions coinciding with rapid oxidation of S2- to S2O32- and finally to SO42- during surface runoff before feeding into a basaltic lava field with a total As concentration of 0.882μM following dilution with other surface waters. A continuous 25-a data set monitoring groundwater chemistry along a cross section of warm springs on the Lake Thingvallavatn shoreline allowed calibration of the 1D model. Furthermore, a series of ground water wells located in the basaltic lava field, provided access along the line of flow of the geothermal effluent waters towards the lake. The conservative ion Cl^- moved through the basaltic lava field (4100m) in less than10a but As was retarded considerably due to surface reactions and has entered a groundwater well 850m down the flow path as arsenate in accordance to the prediction of the 1D model. The 1D model predicted a complete breakthrough of arsenate in the year 2100. In a reduced system arsenite should be retained for about 1ka. © 2011 Elsevier Ltd.

Perspectives on the Future of Public Private Partnership in the UK

During the past two decades the UK has played a leading position in the development and application of Public Private Partnership (PPP) based infrastructure procurement through its Private Finance Initiative model. This model had been developed during the last years of the Major Government and expanded during the early years of the Blair Government. The banking and economic crisis of 2007-09 has created major challenges to the use of PPP in the UK, making the sustainability of past levels of PPP investment and the future direction of PPP based infrastructure procurement in that country uncertain. This chapter summarises key developments in UK PPP up to the crisis; reviews the economic issues that have led up to the crisis; discusses the immediate impact of the crisis on the UK PFI and PPP market together with the transition arrangements that were put into to place by the Brown government; and, lastly, looks at recent initiatives taken by Cameron’s Conservative-Liberal Coalition Government under the designation of Private Finance 2 (PF2).

Unlock the Pain: Exercise is the Key

Back pain is a common complaint in pregnancy, affecting approximately two-thirds of pregnant women [Pennick and Lidle, 2013]. This can lead to increased disability, affecting daily activities and cause absence from work. Evidence-based recommendations can be made for the use of exercise as an effective conservative treatment for the relief of back pain in pregnancy [Benten et al, 2014]. This poster explores the background to back pain in pregnancy and the advice women should be offered in relation to exercise to help normalise their pregnancy experience and enhance wellbeing.

The Abbey Rebels of 1916: A Lost Revolution

The Abbey Theatre played a leading role in the politicisation of the revolutionary generation that won Irish freedom, but comparatively little is known about the men and women who formed the lifeblood of the institution: those whose radical politics drove them to fight in the 1916 Rising.

Drawing on a huge range of previously unpublished material, The Abbey Rebels of Easter 1916 explores the experiences, hopes and dreams of these remarkable but largely forgotten individuals: Máire Nic Shiubhlaigh, the Abbey’s first leading lady; Peadar Kearney, author of the national anthem; feminist Helena Molony, the first female political prisoner of her generation; Seán Connolly, the first rebel to die in the Rising; carpenter Barney Murphy; usherette Ellen Bushell; and Hollywood star Arthur Shields.

Invigorating and provocative, this is the story of how, in the years following the Easter Rising, the radical ideals that inspired their revolution were gradually supplanted by a conservative vision of the nation Ireland would become. Lavishly illustrated with 200 documents and images, it provides a fresh and compelling account of the Rising and its aftermath.

Optimising postbuckling composite panels for damage resistance

The design of current composite primary aerostructures, such as fuselage or wing stiffened panels, tends to be conservative due to the susceptibility of the relatively weak skin-stiffener interface. This weakness is due to through-thickness stresses which are exacerbated by deformations due to buckling. This paper presents a finite-elementbased optimization strategy, utilizing a global-local modelling approach, for postbuckling stiffened panels which takes into account damage mechanisms which may lead to delamination and subsequent failure of the panel due to stiffener debonding. A genetic algorithm was linked to a finite element package to automate the iterative procedure and maximize the damage resistance of the panel in postbuckling. For a given loading condition, the procedure optimized the panel’s skin layup leading to a design displaying superior damage resistance compared to non-optimized designs