Oral Health Status of Patients Undergoing Treatment for Head and Neck Oncology in Northern Ireland

This study aimed to collect data on the oral health status of patients undergoing treatment for head and neck oncology across Northern Ireland. Data were collected on all patients referred to the Northern Ireland Multidisciplinary Head and Neck Oncology Team for discussion and treatment planning. Each patient underwent pre-treatment dental assessment in the Centre for Dentistry, Queen’s University Belfast, between June 2013 and November 2014. Data were collected from clinical oral examinations supplemented with intra-oral radiographs. During the course of the study 96 patients were assessed and the levels of dental disease observed in this cohort were high. On clinical examination
43% were diagnosed with caries and 46% with periodontal disease. Ten patients were completely edentate. The disease profile of this patient group presents significant challenges to dental services tasked with rendering patients dentally fit prior to undergoing oncology treatment.

Back to the city: University-led Regeneration in Belfast

This paper explores the changing relationship between knowledge creation and city centre spaces, focusing on the relocation of Higher Education Institutions (HEIs) into urban centres and the ensuing economic, social and cultural regeneration. Using the Ulster University's relocation to Belfast city centre, the paper highlights the opportunities a new anchor institution can offer a deprived inner city community. This case study draws attention to the drivers of university relocation and the untapped potential for regeneration in city centres such as Belfast, Northern Ireland. The paper looks to the future and questions whether large-scale city projects, such as the university relocation, can truly form connections with their new neighbouring inner city communities while contending with the mounting pressure of reduced government resources.

Specialty Registrars’ Experience of Managing Head and Neck Cancer Patients

Objective The aim of this study was to collate and compare data on the training of Specialty Registrars in Restorative Dentistry (StRs) in the management of head and neck cancer (HANC) patients across different training units within the UK and Ireland. Methods Current trainees were invited to complete an online questionnaire by the Specialty Registrars in Restorative Dentistry Group (SRRDG). Participants were asked to rate their confidence and experience of assessing and planning treatment for HANC patients, attending theatre alone and manufacturing surgical obturators, and providing implants for appropriate cases. Respondents were also asked to appraise clinical and didactic teaching at their unit, and to rate their confidence of passing a future Intercollegiate Specialty Fellowship Examination (ISFE)-station assessing knowledge of head and neck cancer. Results Responses were obtained from 21 StRs (n=21) training within all five countries of the British Isles. Most respondents were based in England (76%), with one StR in each of Scotland, Wales, Northern Ireland and the Republic of Ireland. A third (33%) were in their 5th year of training. Almost half of the StRs indicated that they were confident of independently assessing (48%) new patients with HANC, with fewer numbers reporting confidence in treatment planning (38%). The majority (52%) of respondents indicated that they were not confident of attending theatre alone and manufacturing a surgical obturator. A third (33%) rated their experience of treating HANC patients with implants as ‘poor’ or ‘very poor’, including three StRs in their 5th year of training. Less than one third (<33%) rated didactic teaching in maxillofacial prosthodontics at their unit as ‘good’ or ‘excellent’, and only 7 StRs indicated that they were confident of passing an ISFE-station focused on HANC. Conclusion Experience and training regarding patients with head and neck cancer is inconsistent for StRs across the UK and Ireland with a number of trainees reporting a lack of clinical exposure.

The prevalence of caries in patients referred for orthodontic assessment in Northern Ireland – A retrospective study

Objectives: To determine the prevalence of untreated carious lesions in permanent teeth in patients (under the age of 18) referred for an orthodontic assessment in specialist practice. In addition, the figures shall be compared with national data for Northern Ireland (as outlined in the recent Child Dental Health Survey 2013)
The Gold standard would be that 100% of patients would be caries free upon presentation.

Methods: The clinical records and radiographs (OPT of quality grading 1 or 2) of 337 patients were reviewed. This encompassed patients who had an orthodontic assessment carried out in specialist practice over a 6 month period (following referral from their general dental practitioner)

Results: A total of 337 patient records were examined. Of these, 149 were male (44.2%) and 188 were female (55.8%), with an age range of 7-17 years at the time of new patient assessment. It was found that 36 patients (10.7%) had evidence (clinical and/or radiographic) of active and untreated dental caries. Of those affected, 14 were male and 22 were female.
Breaking the data down in terms of age, we can also get some indication as to how this cohort compares with national data for Northern Ireland :⃰

7-10 years (Mean = 9.3) = 14.3% caries (versus NI average of 6% for 8 year olds)
11-13 years (Mean = 12.1) = 10.1% caries, (versus NI average of 16% for 12 year olds)
14-17 years (Mean = 15.2) = 9.1% caries (versus NI average of 15% for 15 year olds)

⃰using the diagnostic threshold “Decay into dentine (visual dentine caries excluded)”


Conclusion: In this sample group, a total of 10.7% of patients (9.4% of males, 11.7% of females) presented with evidence of undiagnosed caries upon being assessed as a new patient in specialist orthodontic practice. Hence, the gold standard was not met.

Surviving the industrial city: the female poor and the workhouse in late nineteenth-century Belfast

In common with many British cities, but unlike the rest of Ireland, late nineteenth-century Belfast experienced rapid industrialization and physical expansion. Women formed a significant proportion of the city’s workforce, attracted by the employment opportunities represented in the burgeoning textile industry. Many of them were economically vulnerable, however, and could find themselves destitute for a number of reasons. This article sets Belfast’s Poor Law workhouse in the landscape of welfare in the city, exploring how its use reflected the development of the city and the ways in which the female poor engaged with it in order to survive.

City centre sidewalks: Improving pedestrian experience through design

Sidewalks are integral features of city centres. They provide the channels through which activities and interactions evolve and in turn these interactions cause the sidewalks to evolve. They help to articulate the builtform and open spaces in tying together. However, historically sidewalks have received less attention relative to urban squares and civic spaces. Owing to the concept of walkable cities, sidewalks are gaining importance. This paper provides a critical overview on the apparent ‘amnesia’ in urban design and planning theories and visits a popular sidewalk in Belfast city centre to examine the paradox and perspectives.

Initiating advance care planning on end-of-life issues in dementia: Ambiguity among UK and Dutch physicians

Background
In dementia, advance care planning (ACP) of end-of-life issues may start as early as possible in view of the patient’s decreasing ability to participate in decision making. We aimed to assess whether practicing physicians in the Netherlands and the United Kingdom who provide most of the end-of-life care, differ in finding that ACP in dementia should start at diagnosis.

Methods
In a cross-sectional study, we surveyed 188 Dutch elderly care physicians who are on the staff of nursing homes and 133 general practitioners from Northern Ireland. We compared difference by country in the outcome (perception of ACP timing), rated on a 1–5 agreement scale. Regression analyses examined whether a country difference can be explained by contrasts in demographics, presence, exposure and role perceptions.

Results
There was wide variability in agreement with the initiation of ACP at dementia diagnosis, in particular in the UK but also in the Netherlands (60.8% agreed, 25.3% disagreed and 14.0% neither agreed, nor disagreed). Large differences in physician characteristics (Dutch physicians being more present, exposed and adopting a stronger role perception) hardly explained the modest country difference. The perception that the physician should take the initiative was independently associated with agreeing with ACP at diagnosis.

Conclusions
There is considerable ambiguity about initiating ACP in dementia at diagnosis among physicians practicing in two different European health care systems and caring for different patient populations. ACP strategies should accommodate not only variations in readiness to engage in ACP early among patient and families, but also among physicians.

Towards more sustainable urban forms in the city of Benghazi: a study of urban fragmentation at the neighbourhood level

Urban sprawl is a challenge to the sustainability of many cities around the world. Fragmented urban development and vacant land are widespread problems in many Arab cities (UN-Habitat, 2012) which are, according to Ben-Hamouch, mainly a result of inappropriate modern planning and poor land management (2013). This study addresses the problem of urban fragmentation at the neighbourhood level and examines to what extent the concept of compact urban form can contribute to the improvement of social and environmental sustainability in the Libyan city of Benghazi and Arab cities in general. The objectives and scope of the study have justified a morphological approach, where eleven case studies that present different urban typologies in the city have been investigated. The research strategy and selection of case studies were driven by the availability of data and meant to cover the main urban types and important issues defined within this context. This research, which has been conducted to explore and explain the relationships that exist between local urban forms and their performance in terms of sustainability, has produced valuable knowledge and helped to identify measures which target the improvement of people’s quality of life and environmental sustainability of the city. The research draws on the argument that adopting a type of human scale urban form, which is relatively compact and dense, well-connected and comfortably diverse, coupled with concepts of urban greening and flexible development relevant to the local context, would help to create a high quality urban form that is liveable and accessible, while causing minimum damage to the natural environment. This work is an attempt to respond and add to the ongoing debate on sustainable urban form in the developing countries (see: (Jenks, 2000)). The findings have contributed to the understanding of urban fragmentation and highlighted the relevance of the theory of compact city to sustainable development in Benghazi and the South in general. It is anticipated that this work would raise awareness on the impact of urban fragmentation on the sustainability of the built environment within this context and help to advance research on planning theory and practice based on real-life experience and responses to local circumstances.

Regeneration: the inner city in context

This chapter (12) reviews key publications by Sir Peter Hall in the period 1967-79. In this period he was particularly interested in the 'inner city' and how problems of deprivation, unemployment, poor housing, and increasingly immigration might best be addressed by public policy. Each chapter in the book reviews Sir Peter's publications over a long and distinguished career in research and policy advice to government in honour of his 80th birthday in 2013.

Eco city development in China: addressing the policy implementation challenge

Over the last few decades, China has seen a steep rise in diverse eco city and low carbon city policies. Recently, attention has begun to focus on the perceived shortcomings in the practical delivery of related initiatives, with several publications suggesting a gap between ambitious policy goals and the emerging realities of the newly built environment. To probe this further, in this article we examine – based on the policy network approach – how the gap between high-level national policies and local practice implementation can be explained in the current Chinese context. We develop a four-pronged typology of eco city projects based on differential involvement of key (policy) actor groups, followed by a mapping of what are salient policy network relations among these actors in each type. Our analysis suggests that, within the overall framework of national policy, a core axis in the network relations is that between local government and land developers. In some cases, central government agencies– often with buy-in from international architecture, engineering and consulting firms – seek to influence local government planning through various incentives aimed at rendering sustainability a serious consideration. However, this is mostly done in a top-down manner, which overemphasizes a rational, technocratic planning mode while underemphasizing interrelationships among actors. This makes the emergence of a substantial implementation gap in eco city practice an almost predictable outcome. Consequently, we argue that special attention be paid in particular to the close interdependency between the interests of local government actors and those of land and real estate developers. Factoring in this aspect of the policy network is essential if eco city implementation is to gain proper traction on the ground.

Housing market trend and rail transport investments in the city of Naples

Rail transport investments can influence housing market trends, as demonstrated in the literature. However many empirical researches highlight that different results can derive from different urban context applications and that each case should be threaten separately. It is for this reason that this paper is focused on the single case of the city of Naples, where many rail transport investments have been carried out in the last decades. The aim of this study is to give an interpretation of the housing values changes due to the opening of new metro stations. This study applies GIS tools in order to show the spatial distribution and the intensity of rail impacts in different areas of the urban system from 1994 to 2004. This study shows that the extent of the impacts varies from place to place and the effects intensity requires the presence of several complementary factors such as central location of the new stations and the presence of urban planning policies in the transit corridors. This again testifies how housing market is strictly related to the infrastructures investments planning and urban design.

The costs of urban growth at the fringe of a Chinese city: evidence from Jinshi Village in Suzhou

The rate of city growth in China today correlates well with an overall loss of the most fertile agricultural areas of the country. A consequence of this growth includes the rapid reshaping of peri-urban livelihoods in their densely populated fringe. The policy response from central government has focused on containing city growth and pursuing modern rural development. Both policy directions have failed, in part, to acknowledge the intrinsic nature of the urban fringe in China. This paper explores the features of the fringe of Suzhou, a fast growing city in the Yangtze River Delta. The aim is to outline potential social costs of this current policy framework, through analysing the case study of Jinshi Village. The paper advocates a different regionalist approach to policy implementation.