Tiotropium and olodaterol fixed-dose combination versus mono-components in COPD (GOLD 2-4)

Efficacy and safety of tiotropium+olodaterol fixed-dose combination (FDC) compared with the mono-components was evaluated in patients with moderate to very severe chronic obstructive pulmonary disease (COPD) in two replicate, randomised, double-blind, parallel-group, multicentre, phase III trials. Patients received tiotropium+olodaterol FDC 2.5/5 μg or 5/5 μg, tiotropium 2.5 μg or 5 μg, or olodaterol 5 μg delivered once-daily via Respimat inhaler over 52 weeks. Primary end points were forced expiratory volume in 1 s (FEV1) area under the curve from 0 to 3 h (AUC0-3) response, trough FEV1 response and St George's Respiratory Questionnaire (SGRQ) total score at 24 weeks. In total, 5162 patients (2624 in Study 1237.5 and 2538 in Study 1237.6) received treatment. Both FDCs significantly improved FEV1 AUC0-3 and trough FEV1 response versus the mono-components in both studies. Statistically significant improvements in SGRQ total score versus the mono-components were only seen for tiotropium+olodaterol FDC 5/5 μg. Incidence of adverse events was comparable between the FDCs and the mono-components. These studies demonstrated significant improvements in lung function and health-related quality of life with once-daily tiotropium+olodaterol FDC versus mono-components over 1 year in patients with moderate to very severe COPD.

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.

An evidence based approach for the provision of resin-bonded bridgework

Resin bonded bridgework (RBB) is a technique often overlooked by practitioners despite a large amount of evidence supporting the technique. In Cork University Dental School an evidence-based, standardised approach for the delivery of RBB by undergraduate students has been developed over the past 10 years. The aim of this study was to evaluate the success of this standardised approach on the delivery of RBB by students. 222 bridges were reviewed which had been delivered over a 6 year time period between 2002 and 2007. A success rate of 84.1% was achieved with a mean survival time of 41 months. This study illustrates that predictable and highly successful RBB can be delivered by inexperienced clinicians using an evidence-based, standardised approach.

Is the shortened dental arch an underused treatment strategy in the Republic of Ireland?

OBJECTIVES: To determine the proportion of Republic of Ireland 35-44 and 65+ year-olds currently satisfying the criteria for a classic shortened dental arch (SDA) of 20 anterior teeth.

RESEARCH DESIGN: Secondary analysis of data collected in the 2000/02 epidemiological survey of the oral health of Irish adults.

CLINICAL SETTING: Participants underwent a clinical oral examination in health board dental clinics and completed a detailed interview pertaining to dental and general health.

PARTICIPANTS: The analysis is based on a random sample of adults, aged 35 to 44 years (n = 978), and 65 years and older (n = 714).

MAIN OUTCOME MEASURES: The SDA was measured as 20 teeth in the mouth in the positions normally described as from the left second premolar to the right second premolar in each arch.

RESULTS: Only one of the 35-44 year-olds and none of the 65+ year-olds had teeth in their mouths in positions normally described as a classic SDA. However, of the 35-44 year old age group only five patients who had at least a premolar dentition of 20 contiguous teeth had been provided with a removable denture compared to one patient from the 65+ years group.

CONCLUSIONS: Very few older patients in the Republic of Ireland have a SDA based on the measure used. However, very few have been provided with removable dentures where they already possess at least a premolar dentition of 20 contiguous teeth. Suggested reasons for this may include limitations of the data recorded, patient preferences and economic factors.

Prosthodontic care for elderly patients

For older patients, clinicians should consider maintaining teeth and using functionally-orientated treatment strategies as an alternative to removable prostheses. When the remaining dentition has a poor prognosis, key teeth should be preserved as overdenture abutments and a gradual transition to edentulousness planned. Where complete dentures are provided, these can be retained using dental implants to overcome many of the problems associated with conventional replacement dentures.

CLINICAL RELEVANCE: The elderly population of today is better informed and more demanding of oral healthcare providers than previous generations. Clinicians should be aware of all the prosthodontic treatment options available for older patients.

Toothwear and the older patient

Toothwear is commonly observed in dentate older patients and may be physiological or pathological in nature. Toothwear can be caused by abrasion, attrition, erosion or a combination of aetiologies. Where treatment is required, a number of options exist, including the use of adhesive materials and fixed and removable prosthodontics.

CLINICAL RELEVANCE: With patients retaining natural teeth into old age, physiological and pathological toothwear amongst dentate older patients is an increasingly common presentation.

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. 

Partial shoeprint retrieval using multiple point-of-interest detectors and SIFT descriptors

Shoeprint evidence collected from crime scenes can play an important role in forensic investigations. Usually, the analysis of shoeprints is carried out manually and is based on human expertise and knowledge. As well as being error prone, such a manual process can also be time consuming; thus affecting the usability and suitability of shoeprint evidence in a court of law. Thus, an automatic system for classification and retrieval of shoeprints has the potential to be a valuable tool. This paper presents a solution for the automatic retrieval of shoeprints which is considerably more robust than existing solutions in the presence of geometric distortions such as scale, rotation and scale distortions. It addresses the issue of classifying partial shoeprints in the presence of rotation, scale and noise distortions and relies on the use of two local point-of-interest detectors whose matching scores are combined. In this work, multiscale Harris and Hessian detectors are used to select corners and blob-like structures in a scale-space representation for scale invariance, while Scale Invariant Feature Transform (SIFT) descriptor is employed to achieve rotation invariance. The proposed technique is based on combining the matching scores of the two detectors at the score level. Our evaluation has shown that it outperforms both detectors in most of our extended experiments when retrieving partial shoeprints with geometric distortions, and is clearly better than similar work published in the literature. We also demonstrate improved performance in the face of wear and tear. As matter of fact, whilst the proposed work outperforms similar algorithms in the literature, it is shown that achieving good retrieval performance is not constrained by acquiring a full print from a scene of crime as a partial print can still be used to attain comparable retrieval results to those of using the full print. This gives crime investigators more flexibility is choosing the parts of a print to search for in a database of footwear.

Thermography-based virtual MPPT scheme for improving PV energy efficiency under partial shading conditions

This paper proposes a new thermography-based maximum power point tracking (MPPT) scheme to address photovoltaic (PV) partial shading faults. Solar power generation utilizes a large number of PV cells connected in series and in parallel in an array, and that are physically distributed across a large field. When a PV module is faulted or partial shading occurs, the PV system sees a nonuniform distribution of generated electrical power and thermal profile, and the generation of multiple maximum power points (MPPs). If left untreated, this reduces the overall power generation and severe faults may propagate, resulting in damage to the system. In this paper, a thermal camera is employed for fault detection and a new MPPT scheme is developed to alter the operating point to match an optimized MPP. Extensive data mining is conducted on the images from the thermal camera in order to locate global MPPs. Based on this, a virtual MPPT is set out to find the global MPP. This can reduce MPPT time and be used to calculate the MPP reference voltage. Finally, the proposed methodology is experimentally implemented and validated by tests on a 600-W PV array. 

Hα and EUV observations of a partial CME

We have obtained H$\alpha$ high spatial and time resolution observations of the upper solar chromosphere and supplemented these with multi-wavelength observations from the Solar Dynamic Observatory (SDO) and the {\it Hinode} ExtremeUltraviolet Imaging Spectrometer (EIS). The H$\alpha$ observations were conducted on 11 February 2012 with the Hydrogen-Alpha Rapid Dynamics Camera (HARDcam) instrument at the National Solar Observatory's Dunn Solar Telescope. Our H$\alpha$ observations found large downflows of chromospheric material returning from coronal heights following a failed prominence eruption. We have detected several large condensations ("blobs") returning to the solar surface at velocities of $\approx$200 km s$^{-1}$ in both H$\alpha$ and several SDO AIA band passes. The average derived size of these "blobs" in H$\alpha$ is 500 by 3000 km$^2$ in the directions perpendicular and parallel to the direction of travel, respectively. A comparison of our "blob" widths to those found from coronal rain, indicate there are additional smaller, unresolved "blobs" in agreement with previous studies and recent numerical simulations. Our observed velocities and decelerations of the "blobs" in both H$\alpha$ and SDO bands are less than those expected for gravitational free-fall and imply additional magnetic or gas pressure impeding the flow. We derived a kinetic energy $\approx$2 orders of magnitude lower for the main eruption than a typical CME, which may explain its partial nature.

AfterImage:for baroque flute and fixed media

Commissioned by Sonic Arts Network and Huddersfield Contemporary Music Festival with funds from ACGB for Eleanor Dawson (flute)

A belief revision framework for revising epistemic states with partial epistemic states

Belief revision performs belief change on an agent’s beliefs when new evidence (either of the form of a propositional formula or of the form of a total pre-order on a set of interpretations) is received. Jeffrey’s rule is commonly used for revising probabilistic epistemic states when new information is probabilistically uncertain. In this paper, we propose a general epistemic revision framework where new evidence is of the form of a partial epistemic state. Our framework extends Jeffrey’s rule with uncertain inputs and covers well-known existing frameworks such as ordinal conditional function (OCF) or possibility theory. We then define a set of postulates that such revision operators shall satisfy and establish representation theorems to characterize those postulates. We show that these postulates reveal common characteristics of various existing revision strategies and are satisfied by OCF conditionalization, Jeffrey’s rule of conditioning and possibility conditionalization. Furthermore, when reducing to the belief revision situation, our postulates can induce Darwiche and Pearl’s postulates C1 and C2.

Revising Partial Pre-Orders with Partial Pre-Orders: A Unit-Based Revision Framework

Belief revision studies strategies about how agents revise their belief states when receiving new evidence. Both in classical belief revision and in epistemic revision, a new input is either in the form of a (weighted) propositional formula or a total
pre-order (where the total pre-order is considered as a whole).
However, in some real-world applications, a new input can be a partial pre-order where each unit that constitutes the partial pre-order is important and should be considered individually. To address this issue, in this paper, we study how a partial preorder representing the prior epistemic state can be revised by another partial pre-order (the new input) from a different perspective, where the revision is conducted recursively on the individual units of partial pre-orders. We propose different revision operators (rules), dubbed the extension, match, inner and outer revision operators, from different revision points of view. We also analyze several properties for these operators.

Revision over Partial Pre-orders: A Postulational Study

Belief revision is the process that incorporates, in a consistent way,
a new piece of information, called input, into a belief base. When both belief
bases and inputs are propositional formulas, a set of natural and rational properties, known as AGM postulates, have been proposed to define genuine revision operations. This paper addresses the following important issue : How to revise a partially pre-ordered information (representing initial beliefs) with a new partially pre-ordered information (representing inputs) while preserving AGM postulates? We first provide a particular representation of partial pre-orders (called units) using the concept of closed sets of units. Then we restate AGM postulates in this framework by defining counterparts of the notions of logical entailment and logical consistency. In the second part of the paper, we provide some examples of revision operations that respect our set of postulates. We also prove that our revision methods extend well-known lexicographic revision and natural revision for both cases where the input is either a single propositional formula or a total pre-order.