Setting the agenda for dental education in Scotland: a priority setting exercise including multiple stakehiolders

Introduction The Scottish Oral Health Research Collaboration identified dental education research (DER) as a key strand of their strategy,(1) leading to the formation of the Dental Education Research Group. The starting point for this group was to understand various stakeholders’ perceptions of research priorities, yet no existing studies were found. The aim of the current study was to identify DER priorities for Scotland in the next 3-5 years. Methods The study utilised a similar methodology to that of Dennis et al,(2) in medical education. Data were collected sequentially using two online questionnaires with multiple dental stakeholders represented at undergraduate and postgraduate levels across urban and rural Scotland. 85 participants completed questionnaire 1 (qualitative) and 649 participants completed questionnaire 2 (quantitative). Qualitative and quantitative data analysis approaches were used. Results Of the 24 priorities identified, the top priorities were: role of assessments in identifying competence; undergraduate curriculum prepares for practice; and promoting teamwork within the dental team. Following factor analysis, the priorities loaded on four factors: teamwork and professionalism, measuring and enhancing performance, personal and professional development challenges, and curriculum integration and innovation. The top barriers were lack of time, funding, staff motivation, valuing of DER, and resources/ infrastructure. Discussion There were many similarities between the identified priorities for dental and medical education research2, but also some notable differences, which will be discussed. Overwhelmingly, the identified priorities in dentistry related to fitness for practice and robust assessment practices. Take home message Priority setting exercises with multiple stakeholders are an important first step in developing a national research strategy. References 1. Bagg J, Macpherson L, Mossey P, Rennie J, Saunders B, Taylor M (2010) Strategy for Oral Health Research in Scotland. Edinburgh: The Scottish Government. 2. Dennis A A, Cleland J A, Johnston P, Ker JS, Lough, M Rees CE (2014) Exploring stakeholders’ views of medical education research priorities: a national study. Medical Education, 48(11): 1078-1091.

Planet formation in a triple stellar system: implications of the third star's orbital inclination

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Interleukin-15 in the pathogenesis of multiple sclerosis and its animal models

L'interleukine-15 (IL-15) contribue au développement et à l’activation des lymphocytes T CD8, des cellules immunes qui ont été impliquées dans plusieurs maladies auto-immunes telle la sclérose en plaques. Des niveaux élevés de l'IL-15 ont été trouvés chez les patients atteints de cette maladie comparativement aux témoins, mais aucune étude n'a examiné les effets de tels niveaux élevés sur les lymphocytes T CD8. Les objectifs de notre étude étaient 1- de caractériser l’expression de l'IL-15 par des lymphocytes B humains et de déterminer ses effets sur les fonctions des lymphocytes T CD8, et 2- d’évaluer l'expression in vivo de l'IL-15 dans des modèles murins de la sclérose en plaques. Nous avons établi que les cellules B humaines augmentaient leur expression de l'IL-15 suite à une stimulation via le CD40. De plus, les fonctions effectrices des lymphocytes T CD8 ont été significativement augmentées lors des co-cultures avec des cellules B alloréactives exprimant l'IL-15. Dans les modèles murins de la sclérose en plaques, nous avons détecté au sein du système nerveux central des cellules immunes exprimant l’IL-15 ainsi que des cellules T CD8 exprimant le récepteur pour cette cytokine à différents stades de la maladie. Nous avons démontré que les cellules B modulent des réponses des lymphocytes T CD8 via l’IL-15, ce qui suggère un rôle pour les cellules B dans la pathogenèse de la sclérose en plaques. Nous avons aussi mis en évidence la présence de cellules exprimant l’IL-15 dans le système nerveux central dans des modèles murins de cette maladie.

Liposomal daunorubicin and dexamethasone as a treatment for multiple myeloma - The DD protocol

Context and Objective: Lipasomial daunorubicin has been used to treat hematological malignancies, including multiple myelomo (MM). The goal was to evaluate efficacy, side-effects and toxicity of liposomal daunorubicin and dexamethasone (DD Protocol). Design and Setting: Prospective study of Sírio-Libonês, São Camilo, Brasil and Alemão Oswaldo Cruz hospitals. Methods: Twenty consecutive patients with active MM received four cycles of liposomal daunorubicin intravenously for two hours (25-30 mg/m 2/day) on three consecutive days per month, with oral dexamethasone, (10 mg every six hours) on four consecutive days three times a month. Results: The male/female ratio was 1:1 and median age 60. Nine patients were stage IIA, ten IIIA and one IIIB. The median from diagnosis to starting DD was 13 months. All patients received four cycles, except one. Fifteen had already received chemotherapy before DD. Responses of > 50% reduction in serum monoclonal paraprotein were observed in six patients after first cycle (30%), six after second (30%) and four after third (20%), while four (20%) did not obtain this. Initially, 17 patients (85%) had anemia: 12 (70%) achieved correction. Progressive disease was observed in three patients (15%), while one had minimal response, four (20%) partial and 12 (60%) complete. Hemotologlical toxicity was acceptable: three patients (15%) had neutrophils < 1,000/mm 3; none had thrombocyfopenia. Gastrointestinal toxicity was mild: nausea (10%), anorexio (15%) and no vomiting. Conclusions: This treatment has mild toxicity and good response rate. It may therefore be feasible before autologous bone marraw transplantation.

A new method for conservation planning for the persistence of multiple species

Although the aim of conservation planning is the persistence of biodiversity, current methods trade-off ecological realism at a species level in favour of including multiple species and landscape features. For conservation planning to be relevant, the impact of landscape configuration on population processes and the viability of species needs to be considered. We present a novel method for selecting reserve systems that maximize persistence across multiple species, subject to a conservation budget. We use a spatially explicit metapopulation model to estimate extinction risk, a function of the ecology of the species and the amount, quality and configuration of habitat. We compare our new method with more traditional, area-based reserve selection methods, using a ten-species case study, and find that the expected loss of species is reduced 20-fold. Unlike previous methods, we avoid designating arbitrary weightings between reserve size and configuration; rather, our method is based on population processes and is grounded in ecological theory.

On the zeros of the Abelian integrals for a class of Liénard systems

A planar polynomial differential system has a finite number of limit cycles. However, finding the upper bound of the number of limit cycles is an open problem for the general nonlinear dynamical systems. In this paper, we investigated a class of Liénard systems of the form x'=y, y'=f(x)+y g(x) with deg f=5 and deg g=4. We proved that the related elliptic integrals of the Liénard systems have at most three zeros including multiple zeros, which implies that the number of limit cycles bifurcated from the periodic orbits of the unperturbed system is less than or equal to 3.

A framework for network RTK data processing based on grid computing

Real-Time Kinematic (RTK) positioning is a technique used to provide precise positioning services at centimetre accuracy level in the context of Global Navigation Satellite Systems (GNSS). While a Network-based RTK (N-RTK) system involves multiple continuously operating reference stations (CORS), the simplest form of a NRTK system is a single-base RTK. In Australia there are several NRTK services operating in different states and over 1000 single-base RTK systems to support precise positioning applications for surveying, mining, agriculture, and civil construction in regional areas. Additionally, future generation GNSS constellations, including modernised GPS, Galileo, GLONASS, and Compass, with multiple frequencies have been either developed or will become fully operational in the next decade. A trend of future development of RTK systems is to make use of various isolated operating network and single-base RTK systems and multiple GNSS constellations for extended service coverage and improved performance. Several computational challenges have been identified for future NRTK services including: • Multiple GNSS constellations and multiple frequencies • Large scale, wide area NRTK services with a network of networks • Complex computation algorithms and processes • Greater part of positioning processes shifting from user end to network centre with the ability to cope with hundreds of simultaneous users’ requests (reverse RTK) There are two major requirements for NRTK data processing based on the four challenges faced by future NRTK systems, expandable computing power and scalable data sharing/transferring capability. This research explores new approaches to address these future NRTK challenges and requirements using the Grid Computing facility, in particular for large data processing burdens and complex computation algorithms. A Grid Computing based NRTK framework is proposed in this research, which is a layered framework consisting of: 1) Client layer with the form of Grid portal; 2) Service layer; 3) Execution layer. The user’s request is passed through these layers, and scheduled to different Grid nodes in the network infrastructure. A proof-of-concept demonstration for the proposed framework is performed in a five-node Grid environment at QUT and also Grid Australia. The Networked Transport of RTCM via Internet Protocol (Ntrip) open source software is adopted to download real-time RTCM data from multiple reference stations through the Internet, followed by job scheduling and simplified RTK computing. The system performance has been analysed and the results have preliminarily demonstrated the concepts and functionality of the new NRTK framework based on Grid Computing, whilst some aspects of the performance of the system are yet to be improved in future work.

Examining accountability dimensions in state-owned enterprises

This paper examines accountability in the context of New Zealand's state-owned enterprises (SOEs), and considers an accountability framework which extends beyond traditional (upward and outward) dimensions. While traditional accountability dimensions are clearly detailed in the legislation, less clear are the dilemmas and contradictions faced by SOEs, balancing multiple interests, and at times, conflicting objectives. These issues are explored through interviews conducted in two phases over a two year period with senior executives from 12 of the then 17 SOEs operating in New Zealand. Findings reveal a number of dimensions of accountability that extend beyond current conceptualisations of accountability in the public sector, often including multiple directions of accountability. Implications suggest the need for a more explicit framework of accountability relevant to the SOE context, which may serve useful in identifying potential pathways to conflict mitigation.

Relationship management as a strategy for supply chain engagement in the civil engineering construction industry

Many studies into construction procurement methods reveal evidence of a need to change the culture and attitude in the construction industry, transition from traditional adversarial relationships to cooperative and collaborative relationships. At the same time there is also increasing concern and discussion on alternative procurement methods, involving a movement away from traditional procurement systems. Relational contracting approaches, such as partnering and relationship management, are business strategies that align the objectives of clients, commercial participants and stakeholders. It provides a collaborative environment and a framework for all participants to adapt their behaviour to project objectives and allows for engagement of those subcontractors and suppliers down the supply chain. The efficacy of relationship management in the client and contractor groups is proven and well documented. However, the industry has a history of slow implementation of relational contracting down the supply chain. Furthermore, there exists little research on relationship management conducted in the supply chain context. This research aims to explore the association between relational contracting structures and processes and supply chain sustainability in the civil engineering construction industry. It endeavours to shed light on the practices and prerequisites for relationship management implementation success and for supply sustainability to develop. The research methodology is a triangulated approach based on Cheung.s (2006) earlier research where questionnaire survey, interviews and case studies were conducted. This new research includes a face-to-face questionnaire survey that was carried out with 100 professionals from 27 contracting organisations in Queensland from June 2008 to January 2009. A follow-up survey sub-questionnaire, further examining project participants. perspectives was sent to another group of professionals (as identified in the main questionnaire survey). Statistical analysis including multiple regression, correlation, principal component factor analysis and analysis of variance were used to identify the underlying dimensions and test the relationships among variables. Interviews and case studies were conducted to assist in providing a deeper understanding as well as explaining findings of the quantitative study. The qualitative approaches also gave the opportunity to critique and validate the research findings. This research presents the implementation of relationship management from the contractor.s perspective. Findings show that the adaption of relational contracting approach in the supply chain is found to be limited; contractors still prefer to keep the suppliers and subcontractors at arm.s length. This research shows that the degree of match and mismatch between organisational structuring and organisational process has an impact on staff.s commitment level and performance effectiveness. Key issues affecting performance effectiveness and relationship effectiveness include total influence between parties, access to information, personal acquaintance, communication process, risk identification, timely problem solving and commercial framework. Findings also indicate that alliance and Early Contractor Involvement (ECI) projects achieve higher performance effectiveness at both short-term and long-term levels compared to projects with either no or partial relationship management adopted.

Antibodies against human herpesvirus 8 in black South African patients with cancer

Background Infection with human herpesvirus 8 (HHV-8) has been consistently linked to Kaposi's sarcoma, but its mode of transmission, association with other cancers, and interaction with the human immunodeficiency virus type 1 (HIV-1) are largely unknown. Methods Between January 1992 and December 1997, we interviewed 3591 black patients with cancer in Johannesburg and Soweto, South Africa. Blood was tested for antibodies against HIV-1 and HHV-8 in 3344 of the patients. Antibodies against HHV-8 were detected with an indirect immunofluorescence assay. The intensity of the fluorescent signal correlated well with the titers of antibodies (P<0.001). The relations among the presence of anti–HHV-8 antibodies, sociodemographic and behavioral factors, type of cancer, and the presence or absence of coexistent HIV-1 infection were examined with the use of unconditional logistic-regression models. Results Among the 3293 subjects with cancers other than Kaposi's sarcoma, the standardized seroprevalence of antibodies against HHV-8 was 32 percent, which did not differ significantly from the standardized seroprevalence among black blood donors. Among these 3293 patients, the prevalence of antibodies against HHV-8 increased with increasing age (P<0.001) and an increasing number of sexual partners (P=0.05) and decreased with increasing years of education (P=0.007); it was not strongly associated with HIV-1 infection. Anti–HHV-8 antibodies were more frequent among black than white blood donors (P<0.001). Among the 51 patients with Kaposi's sarcoma, the standardized seroprevalence of antibodies against HHV-8 was 83 percent, significantly higher than the prevalence among those without Kaposi's sarcoma (P<0.001). For 16 other specific types of cancer, including multiple myeloma (108 cases) and prostate cancer (202 cases), the variation in the standardized seroprevalence of antibodies against HHV-8 was not remarkable. At a given intensity of fluorescence of anti–HHV-8 antibodies, Kaposi's sarcoma was more frequent among HIV-1–positive patients than among those who were HIV-1–negative (P<0.001). Conclusions Among black patients with cancer in South Africa, the seroprevalence of anti–HHV-8 antibodies is high and is specifically associated with Kaposi's sarcoma, particularly at high titers.

Peptide-functionalized polymeric nanoparticles for active targeting of damaged tissue in animals with experimental autoimmune encephalomyelitis

Increased permeability of blood vessels is an indicator for various injuries and diseases, including multiple sclerosis (MS), of the central nervous system. Nanoparticles have the potential to deliver drugs locally to sites of tissue damage, reducing the drug administered and limiting associated side effects, but efficient accumulation still remains a challenge. We developed peptide-functionalized polymeric nanoparticles to target blood clots and the extracellular matrix molecule nidogen, which are associated with areas of tissue damage. Using the induction of experimental autoimmune encephalomyelitis in rats to provide a model of MS associated with tissue damage and blood vessel lesions, all targeted nanoparticles were delivered systemically. In vivo data demonstrates enhanced accumulation of peptide functionalized nanoparticles at the injury site compared to scrambled and naive controls, particularly for nanoparticles functionalized to target fibrin clots. This suggests that further investigations with drug laden, peptide functionalized nanoparticles might be of particular interest in the development of treatment strategies for MS.

The skin safety model: Reconceptualizing skin vulnerability in older patients

Purpose: To develop a unique skin safety model (SSM) that offers a new and unified perspective on the diverse yet interconnected antecedents that contribute to a spectrum of potential iatrogenic skin injuries in older hospitalized adults. Organizing Construct: Discussion paper. Methods: A literature search of electronic databases was conducted for published articles written in English addressing skin integrity and iatrogenic skin injury in elderly hospital patients between 1960 and 2014. Findings: There is a multiplicity of literature outlining the etiology, prevention, and management of specific iatrogenic skin injuries. Complex and interrelated factors contribute to iatrogenic skin injury in the older adult, including multiple comorbidities, factors influencing healthcare delivery, and acute situational stressors. A range of injuries can result when these factors are com- plicated by skin irritants, pressure, shear, or friction; however, despite skin injuries sharing multiple ntecedents, no unified overarching skin safety conceptual model has been published. Conclusions: The SSM presented in this article offers a new, unified framework that encompasses the spectrum of antecedents to skin vulnerability as well as the spectrum of iatrogenic skin injuries that may be sustained by older acute care patients. Current skin integrity frameworks address prevention and management of specific skin injuries. In contrast, the SSM recognizes the complex interplay of patient and system factors that may result in a range of iatrogenic skin injuries. Skin safety is reconceptualized into a single model that has the potential for application at the individual patient level, as well as health-care systems and governance levels. Clinical Relevance: Skin safety is concerned with keeping skin safe from any iatrogenic skin injury, and remains an ongoing challenge for healthcare providers. A conceptual framework that encompasses all of the factors that may contribute to a range of iatrogenic skin injuries is essential, and guides the clinician in maintaining skin integrity in the vulnerable older patient.

Matrix analysis of an anisotropic optical thin film

Based on Maxwell's equations, standard boundary conditions are imposed on resultant electric- and magnetic-field vectors at interfaces, and the propagating characteristics of extraordinary waves, such as the forward- and backward-propagating directions of wave vectors, rays and their corresponding refractive indices are determined in a uniaxially birefringent thin film. Furthermore, 2 x 2 characteristic matrices of a birefringent thin film are derived including multiple reflections for the extraordinary wave.

Ecological condition of coastal ocean and estuarine waters of the U.S. South Atlantic Bight: 2000-2004

In March-April 2004, the National Oceanic and Atmospheric Administration (NOAA), U.S. Environmental Protection Agency (EPA), and State of Florida (FL) conducted a study to assess the status of ecological condition and stressor impacts throughout the South Atlantic Bight (SAB) portion of the U.S. continental shelf and to provide this information as a baseline for evaluating future changes due to natural or human-induced disturbances. The boundaries of the study region extended from Cape Hatteras, North Carolina to West Palm Beach, Florida and from navigable depths along the shoreline seaward to the shelf break (~100m). The study incorporated standard methods and indicators applied in previous national coastal monitoring programs — Environmental Monitoring and Assessment Program (EMAP) and National Coastal Assessment (NCA) — including multiple measures of water quality, sediment quality, and biological condition. Synoptic sampling of the various indicators provided an integrative weight-of-evidence approach to assessing condition at each station and a basis for examining potential associations between presence of stressors and biological responses. A probabilistic sampling design, which included 50 stations distributed randomly throughout the region, was used to provide a basis for estimating the spatial extent of condition relative to the various measured indicators and corresponding assessment endpoints (where available). Conditions of these offshore waters are compared to those of southeastern estuaries, based on data from similar EMAP/NCA surveys conducted in 2000-2004 by EPA, NOAA, and partnering southeastern states (Florida, Georgia, South Carolina, North Carolina, Virginia) (NCA database for estuaries, EPA Gulf Ecology Division, Gulf Breeze FL). Data from a total of 747 estuarine stations are included in this database. As for the offshore sites, the estuarine samples were collected using standard methods and indicators applied in previous coastal EMAP/NCA surveys including the probabilistic sampling design and multiple indicators of water quality, sediment quality, and biological condition (benthos and fish). The majority of the SAB had high levels of DO in near-bottom water (> 5 mg L-1) indicative of "good" water quality. DO levels in bottom waters exceeded this upper threshold at all sites throughout the coastal-ocean survey area and in 76% of estuarine waters. Twenty-one percent of estuarine bottom waters had moderate levels of DO between 2 and 5 mg L-1 and 3% had DO levels below 2 mg L-1. The majority of sites with DO in the low range considered to be hypoxic (< 2 mg L-1) occurred in North Carolina estuaries. There also was a notable concentration of stations with moderate DO levels (2 – 5 mg L-1) in Georgia and South Carolina estuaries. Approximately 58% of the estuarine area had moderate levels of chlorophyll a (5-10 μg L-1) and about 8% of the area had higher levels, in excess of 10 μg L-1, indicative of eutrophication. The elevated chlorophyll a levels appeared to be widespread throughout the estuaries of the region. In contrast, offshore waters throughout the region had relatively low levels of chlorophyll a with 100% of the offshore survey area having values < 5 μg L-1.

Ecological condition of coastal ocean waters of the U.S. continental shelf off South Florida: 2007

A study was initiated with field work in May 2007 to assess the status of ecological condition and stressor impacts throughout the U.S. continental shelf off South Florida, focusing on soft-bottom habitats, and to provide this information as a baseline for evaluating future changes due to natural or human-induced disturbances. The boundaries of the study region extended from Anclote Key on the western coast of Florida to West Palm Beach on the eastern coast of Florida, inclusive of the Florida Keys National Marine Sanctuary (FKNMS), and from navigable depths along the shoreline seaward to the shelf break (~100m). The study incorporated standard methods and indicators applied in previous national coastal monitoring programs — U.S. Environmental Protection Agency’s (EPA) Environmental Monitoring and Assessment Program (EMAP) and National Coastal Assessment (NCA) — including multiple measures of water quality, sediment quality, and biological condition. Synoptic sampling of the various indicators provided an integrative weight-of-evidence approach to assessing condition at each station and a basis for examining potential associations between presence of stressors and biological responses. A probabilistic sampling design, which included 50 stations distributed randomly throughout the region, was used to provide a basis for estimating the spatial extent of condition relative to the various measured indicators and corresponding assessment endpoints (where available). The study was conducted through a large cooperative effort by National Oceanic and Atmospheric Administration (NOAA)/National Centers for Coastal Ocean Science (NCCOS), EPA, U.S. Geological Survey (USGS), NOAA/Oceanic and Atmospheric Research (OAR)/Atlantic Oceanographic and Meteorological Laboratory in Miami, FKNMS, and the Florida Fish and Wildlife Conservation Commission (FWC). The majority of the South Florida shelf had high levels of dissolved oxygen (DO) in near-bottom water (> 5 mg L-1) indicative of “good” water quality.. DO levels in bottom waters exceeded this upper threshold at 98.8% throughout the coastal-ocean survey area. Only 1.2% of the region had moderate DO levels (2-5 mg/L) and no part of the survey area had DO <2.0 mg/L. In addition, offshore waters throughout the region had relatively low levels of total suspended solids (TSS), nutrients, and chlorophyll a indicative of oligotrophic conditions. Results suggested good sediment quality as well. Sediments throughout the region, which ranged from sands to intermediate muddy sands, had low levels of total organic carbon (TOC) below bioeffect guidelines for benthic organisms. Chemical contaminants in sediments were also mostly at low, background levels. For example, none of the stations had chemicals in excess of corresponding Effects-Range Median (ERM) probable bioeffect values or more than one chemical in excess of lower-threshold Effects-Range Low (ERL) values. Cadmium was the only chemical that occurred at moderate concentrations between corresponding ERL and ERM values. Sixty fish samples from 28 stations were collected and analyzed for chemical contaminants. Eleven of these samples (39% of sites) had moderate levels of contaminants, between lower and upper non-cancer human-health thresholds, and ten (36% of sites) had high levels of contaminants above the upper threshold.