Single vocal cord irradiation:a competitive treatment strategy in early glottic cancer

INTRODUCTION: The treatment of choice for early glottic cancer is still being debated; ultimately it relies on the functional outcome. This paper reports on a novel sparing 4D conformal technique for single vocal cord irradiation (SVCI).

MATERIAL AND METHODS: The records of 164 T1a patients with SCC of the vocal cord, irradiated in the Erasmus MC between 2000 and 2008, were analyzed for local control and overall survival. The quality of life was determined by EORTC H&N35 questionnaires. Also the VHI (voice handicap index), and the TSH (thyroid stimulating hormone) blood levels, were established. On-line image guided SVCI, using cone beam CT or stereotactic radiation therapy (SRT) techniques, were developed.

RESULTS: A LC rate at five-years of 93% and a VHI of 12.7 (0-63) was determined. It appeared feasible to irradiate one vocal cord within 1-2mm accuracy. This way sparing of the contralateral (CL) vocal cord and CL normal tissues, could be achieved.

CONCLUSIONS: Given the accuracy (1-2mm) and small volume disease (CTV limited to one vocal cord), for the use of stereotactic RT techniques SVCI with large fraction sizes is currently being investigated in clinic. It is argued that hypofractionated SVCI can be a competitive alternative to laser surgery.

Flexible fault ride through strategy for wind farm clusters in power systems with high wind power penetration

This paper investigates a flexible fault ride through strategy for power systems in China with high wind power penetration. The strategy comprises of adaptive fault ride through requirements and maximum power restrictions of the wind farms with weak fault ride through capabilities. The slight faults and moderate faults with high probability are the main defending objective of the strategy. The adaptive fault ride through requirement in the strategy consists of two sub fault ride through requirements, a temporary slight voltage ride through requirement corresponding to a slight fault incident, with a moderate voltage ride through requirement corresponding to a moderate fault. The temporary overloading capability of the wind farm is reflected in both requirements to enhance the capability to defend slight faults and to avoid tripping when the crowbar is disconnected after moderate faults are cleared. For those wind farms that cannot meet the adaptive fault ride through requirement, restrictions are put on the maximum power output. Simulation results show that the flexible fault ride through strategy increases the fault ride through capability of the wind farm clusters and reduces the wind power curtailment during faults.

Session organiser/chair: Architecture, Infrastructure and the Making of Modern Ireland

‘A free Ireland would drain the bogs, would harness the rivers, would plant the wastes, would nationalise the railways and the waterways, would improve agriculture, would protect fisheries, would foster industries, would promote commerce, and beautify the cities …’ (Padraig Pearse, ‘From a Hermitage’, 1913)

Somewhat unusually in his often romantic writings Padraig Pearse – poet, pedagogue and revolutionary – chose to describe the future of an independent Ireland in terms of infrastructure and technological processes. Terence Brown’s locating of this excerpt at the beginning his seminal work Ireland: A Social and Cultural History 1922-2002 highlights the simultaneous and interlinking construction of both a new physical and cultural landscape for an independent modern nation. Lacking any significant industrial complex, the construction of new infrastructures in Ireland was seen throughout the 20th century as a key element in the building of the new State, just as the adoption of an international style modernism in architecture was perceived as a way to escape the colonial past. For Paul N. Edwards modernity and infrastructure are intimately connected.

‘infrastructures simultaneously shape and are shaped – in other words, co-construct – the condition of modernity. By linking macro, meso, and micro scales of time, space and social organisation, they form the stable foundation of modern social worlds’ (2003: 186).
Simultaneously omnipresent and invisible – infra means beneath – Edwards also points out that infrastructure tends only to become apparent when it is either new or broken. Interpreting the meso scale as being that of the building, this session calls for papers that critically and analytically investigate aspects of the architectures of infrastructure in 20th-century Ireland. Like the territory they explore these papers may range across scales to oscillate between a concern for the artefact and its physical landscape, and the larger, often hidden systems and networks that co-define this architecture.

Introducing an obstetric emergency training strategy into a simulated environment

Midwifery educators are challenged to produce registrants who are fit for practice at the point of registration with competence at the heart of this expectation. In addition to achieving expertise in normal pregnancy, it is recognised that students need to have the skills of critical decision making where normal processes become adversely affected.
An evaluation was undertaken with final year direct entry midwifery students using questionnaires and focus group interviews to determine whether simulated learning, such as the Practical Obstetric Multi-Professional Training (PROMPT) package, for emergency obstetric training would enhance self-efficacy and confidence levels in preparation for post-registration practice. The main themes that emerged from the study indicate that this style of learning increased midwifery students’ feelings of self-efficacy; highlighted the importance of a safe learning environment; reduced their anxiety regarding their ability to make decisions in clinical practice and reinforced confidence in their level of knowledge.

Constrained Multi-Objective Aerofoil Design Using a Multi-Level Optimisation Strategy

A novel approach for the multi-objective design optimisation of aerofoil profiles is presented. The proposed method aims to exploit the relative strengths of global and local optimisation algorithms, whilst using surrogate models to limit the number of computationally expensive CFD simulations required. The local search stage utilises a re-parameterisation scheme that increases the flexibility of the geometry description by iteratively increasing the number of design variables, enabling superior designs to be generated with minimal user intervention. Capability of the algorithm is demonstrated via the conceptual design of aerofoil sections for use on a lightweight laminar flow business jet. The design case is formulated to account for take-off performance while reducing sensitivity to leading edge contamination. The algorithm successfully manipulates boundary layer transition location to provide a potential set of aerofoils that represent the trade-offs between drag at cruise and climb conditions in the presence of a challenging constraint set. Variations in the underlying flow physics between Pareto-optimal aerofoils are examined to aid understanding of the mechanisms that drive the trade-offs in objective functions.

Collating the knowledge base for core outcome set development: developing and appraising the search strategy for a systematic review

Background: The COMET (Core Outcome Measures in Effectiveness Trials) Initiative is developing a publicly accessible online resource to collate the knowledge base for core outcome set development (COS) and the applied work from different health conditions. Ensuring that the database is as comprehensive as possible and keeping it up to date are key to its value for users. This requires the development and application of an optimal, multi-faceted search strategy to identify relevant material. This paper describes the challenges of designing and implementing such a search, outlining the development of the search strategy for studies of COS development, and, in turn, the process for establishing a database of COS.

Methods: We investigated the performance characteristics of this strategy including sensitivity, precision and numbers needed to read. We compared the contribution of databases towards identifying included studies to identify the best combination of methods to retrieve all included studies.

Results: Recall of the search strategies ranged from 4% to 87%, and precision from 0.77% to 1.13%. MEDLINE performed best in terms of recall, retrieving 216 (87%) of the 250 included records, followed by Scopus (44%). The Cochrane Methodology Register found just 4% of the included records. MEDLINE was also the database with the highest precision. The number needed to read varied between 89 (MEDLINE) and 130 (SCOPUS).

Conclusions: We found that two databases and hand searching were required to locate all of the studies in this review. MEDLINE alone retrieved 87% of the included studies, but actually 97% of the included studies were indexed on MEDLINE. The Cochrane Methodology Register did not contribute any records that were not found in the other databases, and will not be included in our future searches to identify studies developing COS. SCOPUS had the lowest precision rate (0.77) and highest number needed to read (130). In future COMET searches for COS a balance needs to be struck between the work involved in screening large numbers of records, the frequency of the searching and the likelihood that eligible studies will be identified by means other than the database searches.

Ultralow-temperature CO oxidation on an In2O3-Co3O4 catalyst: a strategy to tune CO adsorption strength and oxygen activation simultaneously

Highly efficient In2O3-Co3O4 catalysts were prepared for ultralow-temperature CO oxidation by simultaneously tuning the CO adsorption strength and oxygen activation over a Co3O4 surface, which could completely convert CO to CO2 at temperatures as low as -105 degrees C compared to -40 degrees C over pure Co3O4, with enhanced stability.

A strategy towards professionalism in the dissecting room

The teaching and cultivation of professionalism is an integral part of medical education as professionalism is central to maintaining the public’s trust in the medical profession. Traditionally professional values would have been acquired through an informal process of socialisation and observation of role models. Recently, however, medical educators have accepted the responsibility to explicitly teach and effectively evaluate professionalism. A comprehensive working definition of the term professionalism and a universally agreed list of the constituent elements of professionalism are currently debated. The School of Medicine and Dentistry of The Queen’s University of Belfast uses an approach of self-directed learning for teaching anatomy, and students are given the opportunity to learn anatomy from human dissection. Self-directed learning teams have been found to be underutilised as educational strategies and presented an opportunity to utilise the first year dissection room teaching environment to nurture the development of the attributes of professionalism. An educational strategy based on role-playing was developed to engage all students around the dissection table. Students received comprehensive background reviews on professionalism, its attributes and the identification of such attributes in the context of the dissection room. Roles, with specific duties attached, were allocated to each team member. Circulating academic staff members directly observed student participation and gave formative feedback. Students were given the opportunity to reflect on their ability to identify the attributes and reflect on their own and their peer’s ability to develop and practise these attributes. This strategy indicated that small group learning teams in the dissection room utilise widely accepted principles of adult learning and offer an opportunity to create learning activities that will instil in students the knowledge, values, attitudes and behaviours that characterise medical professionalism. Anatomy faculty have a responsibility to nurture and exemplify professionalism and play a significant role in the early promotion and inculcation of professionalism. It remains imperative not only to assess this strategy but also to create opportunities for critical reflection and evaluation within the strategy. Key words: Medical Education – Professionalism – Anatomy - Reflective Practise – Role-play