Tacrolimus is not associated with gingival overgrowth in renal transplant patients

BACKGROUND: Cyclosporin A is used extensively to prevent the rejection of allogenic renal transplants. However, it is associated with a variety of undesirable side effects including gingival overgrowth. Tacrolimus (FK506), has been marketed as an effective alternative immunosuppressant to cyclosporin A and recent subjective reports suggest patients taking it complain infrequently of gingival problems. This clinical investigation was undertaken to confirm whether or not tacrolimus adversely affected the gingival health of renal transplant recipients.

METHODS: Renal transplant patients (RTPs) under the care of the Renal Transplantation Service at the Manchester Royal Infirmary, who had received a renal allograft at least 18 months earlier, were recruited for this study. All but one of the RTPs had been taking tacrolimus since transplantation. The other had commenced tacrolimus therapy two months after receiving her allograft. A hospital based control group was recruited from non transplanted individuals attending the Turner Dental School, Manchester. Each patient underwent a detailed dental assessment and had dental impressions taken. The extent of gingival overgrowth was determined from plaster models.

RESULTS: 25 renal transplant recipients and 26 control patients were included in the study. None of the individuals in either the tacrolimus or control groups had clinically significant overgrowth. The patients in the tacrolimus group with the highest overgrowth scores were those also taking calcium antagonists as treatment for hypertension.

CONCLUSION: This study demonstrates that tacrolimus has no adverse effects on the gingival tissues and thus has potential as an alternative immunosuppressant for individuals susceptible to developing cyclosporin A-induced gingival overgrowth.

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.

Protocol for the isotoxic intensity modulated radiotherapy (IMRT) in stage III non-small cell lung cancer (NSCLC): a feasibility study.

Introduction The majority of stage III patients with non-small cell lung cancer (NSCLC) are unsuitable for concurrent chemoradiotherapy, the non-surgical gold standard of care. As the alternative treatment options of sequential chemoradiotherapy and radiotherapy alone are associated with high local failure rates, various intensification strategies have been employed. There is evidence to suggest that altered fractionation using hyperfractionation, acceleration, dose escalation, and individualisation may be of benefit. The MAASTRO group have pioneered the concept of ‘isotoxic’ radiotherapy allowing for individualised dose escalation using hyperfractionated accelerated radiotherapy based on predefined normal tissue constraints. This study aims to evaluate whether delivering isotoxic radiotherapy using intensity modulated radiotherapy (IMRT) is achievable.

Methods and analysis Isotoxic IMRT is a multicentre feasibility study. From June 2014, a total of 35 patients from 7 UK centres, with a proven histological or cytological diagnosis of inoperable NSCLC, unsuitable for concurrent chemoradiotherapy will be recruited. A minimum of 2 cycles of induction chemotherapy is mandated before starting isotoxic radiotherapy. The dose of radiation will be increased until one or more of the organs at risk tolerance or the maximum dose of 79.2 Gy is reached. The primary end point is feasibility, with accrual rates, local control and overall survival our secondary end points. Patients will be followed up for 5 years.

Ethics and dissemination The study has received ethical approval (REC reference: 13/NW/0480) from the National Research Ethics Service (NRES) Committee North West—Greater Manchester South. The trial is conducted in accordance with the Declaration of Helsinki and Good Clinical Practice (GCP). The trial results will be published in a peer-reviewed journal and presented internationally.

Trial registration number NCT01836692; Pre-results.

Women of Letters: Gender, Writing and the Life of the Mind in Early Modern England

Women of letters writes a new history of English women's intellectual worlds using their private letters as evidence of hidden networks of creative exchange. The book argues that many women of this period engaged with a life of the mind and demonstrates the dynamic role letter-writing played in the development of ideas. Until now, it has been assumed that women's intellectual opportunities were curtailed by their confinement in the home. This book illuminates the household as a vibrant site of intellectual thought and expression. Amidst the catalogue of day-to-day news in women's letters are sections dedicated to the discussion of books, plays and ideas. Through these personal epistles, Women of letters offers a fresh interpretation of intellectual life in the late seventeenth and early eighteenth centuries, one that champions the ephemeral and the fleeting in order to rediscover women's lives and minds.

An Evaluation of the Dual Diagnosis (substance use and mental health )Strategy in the South Eastern Trust Workers and Service Users Perceptions of Dual Diagnosis Issues

In the UK it is estimated that over 33% of psychiatric patients with enduring mental illness have a substance misuse problem, whilst over 50 % of clients currently accessing drug and alcohol services have a mental health problem. Between 2003 and 2013 in Northern Ireland, there were 741 recorded suicides by patients who were in contact with mental health services. Of this number, 68% (n=501) had a history of either alcohol or drug misuse or both, resulting in an average of 46 patient suicides per year associated with dual diagnosis (University of Manchester 2015).
The current evaluation examined staff attitudes towards working with dual diagnosis (co-existing difficulties) issues, staff confidence in working with clients with dual diagnosis, workers’ perceptions of the South Eastern dual diagnosis strategy and service user perspectives of dual diagnosis service provision.
The purpose of the evaluation was to provide evidence regarding the following in accordance with the current dual diagnosis strategy;
Staff understanding of the concept of dual diagnosis,
Staff attitudes towards working with dual diagnosis,
Staff confidence in working with individuals, who present with dual diagnosis,
Service users’ perspectives of SE Trust provision for dual diagnosis.
Staff views on the South Eastern Trust Dual Diagnosis Strategy.

The Promise of Peace:Revisiting the Northern Irish Model

The Northern Ireland peace process is often eulogized as a successful model of conflict transformation. Although the process exhibited many of the problems that beset other societies seeking to move from conflict to a negotiated peace (including disagreements over the functioning of institutions and the meanings of cultural symbols, unresolved issues relating to the effects of political violence on victims and survivors and society at large; and the residual presence of violent and political ‘spoiler’ groups), the resilience of political dialogue has proven remarkable.
This collection revisits the promise of ‘a truly historic opportunity for a new beginning’ a decade and a half on from the signing of the Belfast/Good Friday Agreement in 1998. The book will bring together academics from across a number of disciplines, including management and organizational behaviour, law, politics, sociology, archaeology and literature.

The different contributions aim to assess what impact it has made in the legal, policy, and institutional areas it specifically targeted: political reform, human rights and equality provision, working through legacies of the past (including police reform, prisoner release and victims' rights) and the building of new relationships within the island of Ireland and between Ireland and Britain. With the emergence of first-time voters who had no direct experience of the violence the book explores what the Agreement offers for future generations.

The book is the culmination of a 12-month research project sponsored by the British Academy and Leverhulme that addressed the following aspects of the peace process:
Peace walls: The euphemistically named peace walls remain one of the most visible reminders of Northern Ireland’s divisions and they are famously the only material manifestations of the conflict that have grown in number and extent since the 1998 Agreement. They were originally placed between antagonistic neighbouring communities – often at their request – at times of heightened tensions. Research under this theme explored the lack of ongoing engagement with their continuing presences, evolving meanings and impact on the communities that reside beside them needs to be overtly addressed.
Cultural division: Cultural differences have often been seen as lying at the heart of the ‘Irish problem’. Despite this, art and artists have increasingly been seen as having the potential to develop new discourses. Research explored the following questions: What role can the arts play in re-imagining the spaces opened up by the promises of the 1998 Agreement? What implication does the confrontation with the legacies of conflict have for artistic practices? What impact do the arts have on constructions of identity, on narratives of history, and on electoral politics?
Institutional transformation: This strand of research explored the significance of the process of organizational change which followed the establishment of the 1998 on political and other public policy institutions such as the police and prison services. It suggested that the experience and lessons learned from such periods of transition have much to contribute to how Northern Ireland begins to address political polarization in other areas of public service infrastructure, chiefly around the sectarian monoliths of education and housing.
Working through the past: ‘Legacy’ issues have gained increasing prominence since 1998: issues to do with public symbolism (particularly relating to the flying of flags and parading), defining victimhood, securing victims’ rights, recovery of the ‘disappeared’, reintegrating ex- prisoners back into society, and the possibilities for truth recovery and reconciliation have all acquired salient and emotive force. Although the 1998 Agreement promised to ‘honour the dead’ through a ‘new beginning’, it is increasingly unclear as to whether an agreed narrative about the past is possible – or even worthwhile pursuing. Research under this theme looked at the complex relationship between memory, commemoration and violence; how commemorative events are performed, organized, policed and represented. It also addressed the fraught issue of how to come to terms with Northern Ireland’s divided and bloodied past.

The editors are in the process of guiding contributors to adapt their papers, which were presented to a series of workshops on the above themes, to the purposes of the book. In particular, the contributors will be guided to focus on the related aims of assessing the extent of change that has occurred and providing an assessment of what remains to be done. To that end, contributors are asked to engage directly with the questions that close the ‘Introduction’, namely: To what extent has the ‘promise’ of the 1998 Agreement been fulfilled? To what extent has the 1998 Agreement given rise to forms of exclusion? To what extent has the 1998 Agreement shaped new forms of debate, dispute and engagement? In the absence of that guidance having been sent out yet, the outlines below are, for the time being, the abstracts of their original papers.

To Hell with Herbert Read

Freee write manifestos by taking a pencil (or a laptop) to an historical text, usually belonging to the entwined traditions of the avant-garde and political activism. Sometimes, as Tristan Tzara advised, we choose the text according to its length, while other times, such as in this instance, we selected the text according to the conditions of the invitation that triggered the writing of the manifesto. Our manifesto ‘To Hell with Herbert Read’ was written originally as a contribution to a conference held in Manchester that took its title from Herbert Read’s book ‘To Hell with Culture’. ‘To Hell with Culture’ is a book that cuts itself off from the world whereas ‘To Hell with Herbert Read’ relocates Read’s book in a world of cultural, social, economic and political actualities that are part of common experience. Read rejects culture because he thinks it is a useless, wasteful, elitist, puffed-up, decorative supplement to the functional, factual, palpable, purposeful world of things. He is a positivist kind of modernist who presents himself as the opposite, an enemy of the status quo. He is an anarchist of a particularly bourgeois hue: he wants us all to have decent pots and pans, not the inferior ones that are supplied by market forces cheaply. Rather than taking his aim precisely to target the dominant forces of his day - the industrial capitalists and their financiers - he rejects the world and all its inhabitants. He not only despises elitist culture but popular culture too.

To Hell with Herbert Read

Freee write manifestos by taking a pencil (or a laptop) to an historical text, usually belonging to the entwined traditions of the avant-garde and political activism. Sometimes, as Tristan Tzara advised, we choose the text according to its length, while other times, such as in this instance, we selected the text according to the conditions of the invitation that triggered the writing of the manifesto. Our manifesto ‘To Hell with Herbert Read’ was written originally as a contribution to a conference held in Manchester that took its title from Herbert Read’s book ‘To Hell with Culture’. ‘To Hell with Culture’ is a book that cuts itself off from the world whereas ‘To Hell with Herbert Read’ relocates Read’s book in a world of cultural, social, economic and political actualities that are part of common experience. Read rejects culture because he thinks it is a useless, wasteful, elitist, puffed-up, decorative supplement to the functional, factual, palpable, purposeful world of things. He is a positivist kind of modernist who presents himself as the opposite, an enemy of the status quo. He is an anarchist of a particularly bourgeois hue: he wants us all to have decent pots and pans, not the inferior ones that are supplied by market forces cheaply. Rather than taking his aim precisely to target the dominant forces of his day - the industrial capitalists and their financiers - he rejects the world and all its inhabitants. He not only despises elitist culture but popular culture too.

In and Out of Synch

A 16mm moving image work and expanded cinema performance co-commissioned by Tate Modern and Arnolfini. Shot at the post-production facilities of Pinewood studios, London, the close-up sequences feature abstract patterns of optical sound encoded as light, printed onto the soundtrack area of the filmstrip. The film features the quivering light of a 16mm mono and a 35mm stereo optical sound camera, providing a seismic glimpse at a sound-wave in formation, on occasions flashing like a stroboscopic Rorschach inkblot. Performances: Tate Modern Oil Tanks (London 2012); Arnfolini (Bristol 2012); Kunstnernes Hus, (Oslo 2013). Exhibitions: Two-person exhibition at Castlefield Gallery, (Manchester 2013). Screenings: Mini-retrospective screening and in conversation with Lis Rhodes, Tate Britain (London 2014); Mini-retrospective screening, DIM Cinema, The Cinematheque (Vancouver 2015); Mini-retrospective at Whitechapel Gallery (London 2016); Mini-retrospective screening, Gertrude Contemporary (Melbourne 2016).

Between the Bullet and the Hole

Between the Bullet and the Hole is a film centred on the elusive and complex effects of war on women's role in ballistic research and early computing. The film features new and archival high-speed bullet photography, schlieren and electric spark imagery, bullet sound wave imagery, forensic ballistic photography, slide rulers, punch cards, computer diagrams, and a soundtrack by Scanner. Like a frantic animation storyboard, it explores the flickering space between the frames, testing the perceptual mechanics of visual interpolation, the possibility of reading or deciphering the gap between before and after. Interpolation - the main task of the women studying ballistics in WW2 - is the construction or guessing of missing data using only two known data points. The film tries to unpack this gap, open it up to interrogation. It questions how we read, interpolate or construct the gaps between bullet and hole, perpetrator and victim, presence and absence. The project involves exchanges with specialists in this area such as the Cranfield University Forensics department, London-based Forensic Firearms consultancy, the Imperial War Museum, the ENIAC programmers project, the Smithsonian Institute, and Forensic Scientists at Palm Beach County Sheriff's Office (USA). Exhibitions: Solo exhibition at Dallas Contemporary (Texas, Jan-Mar 2016), including newly commissioned lenticular prints and a dual slide projector installation; Group exhibition the Sydney Biennale (Sydney, Mar-June 2016); UK premiere and solo retrospective screening at Whitechapel Gallery (London); forthcoming solo exhibition at Iliya Fridman Gallery (NY, Oct-Dec 2016); Film festivals and screenings: International Film Festival Rotterdam (Jan 2016); Whitechapel Gallery (London Feb 2016); Cornerhouse/Home (Manchester Nov 2016); Public lectures: Whitechapel Gallery with prof. David Alan Grier and Morgan Quaintance; Carriageworks (Sydney) Prof. Douglas Khan; Monash University (Melbourne); Gertrude Space (Melbourne). Reviews and interviews: Artforum, Studio International, Mousse Magazine.