Converting Treatment Plans From Helical Tomotherapy to L-Shape Linac: Clinical Workflow and Dosimetric Evaluation.

This work evaluated a commercial fallback planning workflow designed to provide cross-platform treatment planning and delivery. A total of 27 helical tomotherapy intensity-modulated radiotherapy plans covering 4 anatomical sites were selected, including 7 brain, 5 unilateral head and neck, 5 bilateral head and neck, 5 pelvis, and 5 prostate cases. All helical tomotherapy plans were converted to 7-field/9-field intensity-modulated radiotherapy and volumetric-modulated radiotherapy plans through fallback dose-mimicking algorithm using a 6-MV beam model. The planning target volume (PTV) coverage ( D1, D99, and homogeneity index) and organs at risk dose constraints were evaluated and compared. Overall, all 3 techniques resulted in relatively inferior target dose coverage compared to helical tomotherapy plans, with higher homogeneity index and maximum dose. The organs at risk dose ratio of fallback to helical tomotherapy plans covered a wide spectrum, from 0.87 to 1.11 on average for all sites, with fallback plans being superior for brain, pelvis, and prostate sites. The quality of fallback plans depends on the delivery technique, field numbers, and angles, as well as user selection of structures for organs at risk. In actual clinical scenario, fallback plans would typically be needed for 1 to 5 fractions of a treatment course in the event of machine breakdown. Our results suggested that <1% dose variance can be introduced in target coverage and/or organs at risk from fallback plans. The presented clinical workflow showed that the fallback plan generation typically takes 10 to 20 minutes per case. Fallback planning provides an expeditious and effective strategy for transferring patients cross platforms, and minimizing the untold risk of a patient missing treatment(s)

Flowers Hospital: Nearing Perfection on Core Measures

Describes elements of a strategy for achieving high process-of-care performance by continuously monitoring patients in four clinical areas and ensuring they receive the right care -- including concurrent reviews and quality improvement teams

Focus groups of value concepts of producers: National Report UK

The Organic Revision project was funded by the EU with the aim of supporting the further development of the EU Regulation 2092/91 on organic production. As part of the project focus groups were run in five European countries on value concepts of organic producers and other stakeholders, during 2004-2005. The project aims to provide an overview of values held among organic stakeholders, and of similarities and differences among the various national and private organic standards. In the UK, three focus groups with producers were carried out, one in England and two in Wales. Two of these groups were with established producers and one group were newly converted producers. A further focus group was held with researchers and professionals from Organic Centre Wales. Overall, this survey showed that in 2004/05 the UK organic sector was characterised by slowed down growth in both retail sales and conversion, a heavy reliance on multiple retailers as the main outlets with negative impact on farm gate prices, a higher supply than demand in some livestock markets. On the other hand there appears to be a growing interest in direct sales and local food and efforts to diversify into different sales channels. Few studies have investigated the values of organic producers in the UK, but several have looked at the motivation to convert. There are indications that motives for organic producers have changed to some degree. In the first surveys improvements to husbandry were mentioned by the majority of producers, in later studies the environment and financial considerations appear more important, but the reasons for this change are not fully understood, but external circumstances have also changed. It also appears that organic producers are not homogenous in relation to their attitudes with factors such as farm type and marketing channel, explaining some of the observed differences

Issues of quality assurance in the management of plagiarism in blended learning environments

Increasing access to and availability of electronic resources presents students with a rich library of opportunities for independent study. But students also find themselves in the confusing territory of how they should best use these resources within their assessment activities. Likewise, teaching institutions are faced with the problems of plagiarism and collusion, and the challenges of educating, deterring, detecting, and dealing with breaches of policy in a fair and consistent way across all disciplines. This paper examines issues of quality assurance in the management of plagiarism by discussing the following questions: – How can effective automated plagiarism detection services be introduced and managed across the institution? – What teaching and assessment practices can be adopted to deter plagiarism? – What part should collusion and plagiarism detection tools play in educating and deterring students? – What are appropriate penalties for plagiarism and collusion and how can these be applied consistently across disciplines? Drawing together three distinct strands of research, in both distance and campus based institutions, the authors discuss how practice and policy have evolved in recent years in an attempt to reduce the incidence of plagiarism and collusion. The paper will illustrate this evolution by reporting on recent developments in assessment strategy, detection tools, and policy within two UK HE Institutions: The UK Open University and Manchester Metropolitan University

Demutualization and its Problems

Over the last three decades cooperatives experienced acceleration of institutional innovation with the introduction of many variations to the reference model. It is certainly not surprising that coops changed their organizational structure over time to face the challenges of world. In the United States and in Canada they are commonly referred to as New generation cooperatives, in Italy and Spain as cooperative groups or network of cooperatives. One of the main feature of these new organizational structures is their attempt to take some advantages of the investor oriented firms (above all in capital raising activities) while retaining the mutual/cooperative status. Many of these changes have been undertaken to facilitate the growth of the enterprises both in domestic market and abroad. Due to the wideness of the phenomenon we could name the last three decades the age of hybridization. However in some cases the search for new structures went further and assumed the aspect of conversion of mutuals into stock firms. Our paper will deal with this latter part of the story, focusing on cooperatives that preferred conversion or demutualization to hybridization. The paper describes the chronology and the geography of demutualization and analyses the forces that drove it over the last decades. The main conclusion is that demutualization provided solutions for real problems, as hybridization did, however the choice between these two options seems to have been more a matter of ideology than of efficiency.

A hierarchy of SPI activities for software SMEs: results from ISO/IEC 12207-based SPI assessments

In an assessment of software process improvement (SPI) in 15 software small- and –medium-sized enterprises (software SMEs), we applied the broad spectrum of software specific and system context processes in ISO/IEC 12207 to the task of examining SPI in practice. Using the data collected in the study, we developed a four-tiered pyramidal hierarchy of SPI for software SMEs, with processes in the higher tiers undergoing SPI in more companies than processes on lower level tiers. The development of the hierarchy of SPI activities for software SMEs can facilitate future evolutions of process maturity reference frameworks, such as ISO/IEC 15504, in better supporting software development in software SMEs. Furthermore, the findings extend our body of knowledge concerning the practice of SPI in software SMEs, a large and vital sector of the software development community that has largely avoided the implementation of established process maturity and software quality management standards