Oral cancer: current role of radiotherapy and chemotherapy

The term oral cavity cancer (OSCC) constitutes cancers of the mucosal surfaces of the lips, floor of mouth, oral tongue, buccal mucosa, lower and upper gingiva, hard palate and retromolar trigone. Treatment approaches for OSCC include single management with surgery, radiotherapy [external beam radiotherapy (EBRT) and/or brachy therapy], as well as adjuvant systemic therapy (chemotherapy and/or target agents); various combinations of these modalities may also be used depending on the disease presentation and pathological findings. The selection of sole or combined modality is based on various considerations that include disease control probability, the anticipated functional and cosmetic outcomes, tumor resectability, patient general condition, and availability of resources and expertise. For resectable OSCC, the mainstay of treatment is surgery, though same practitioners may advocate for the use of radiotherapy alone in selected "early" disease presentations or combined with chemotherapy in more locally advanced stage disease. In general, the latter is more commonly reserved for cases where surgery may be problematic. Thus, primary radiotherapy ± chemotherapy is usually reserved for patients unable to tolerate or who are otherwise unsuited for surgery. On the other hand, brachytherapy may be considered as a sole modality for early small primary tumor. It also has a role as an adjuvant to surgery in the setting of inadequate pathologically assessed resection margins, as does postoperative external beam radiotherapy ± chemotherapy, which is usually reserved for those with unfavorable pathological features. Brachytherapy can also be especially useful in the reirradiation setting for persistent or recurrent disease or for a second primary arising within a previous radiation field. Biological agents targeting the epithelial growth factor receptor (EGFR) have emerged as a potential modality in combination with radiotherapy or chemoradiotherpy and are currently under evaluation in clinical trials

Income and Wealth in the Irish Longitudinal Study on Ageing

Between 2009 and 2011, data were collected under the first wave of The Irish Longitudinal Study on Ageing (TILDA). Over 8,500 people aged 50 and over and living in Ireland were interviewed on a wide range of topics covering socioeconomic and health issues. Our primary goals in this paper are (a) to present details on two of the variables which will be of particular interest to economists, namely income and wealth and (b) to discuss issues in relation to their use, in particular with respect to missing data. We describe how the income and wealth data were collected. We assess the quality of the income data by comparing them to those obtained through the European Union Statistics on Income and Living Conditions (EU-SILC). We find that the distribution of income in the TILDA sample resembles closely that found in a comparable sample from the EU-SILC. We undertake two pieces of analysis, by way of demonstrating potential applications of the data. First, we examine the joint distribution of income and assets and find that there is a small but non-negligible number of people who have low levels of income but high levels of assets and another similarly sized group in the opposite situation. Second, we consider the relationship between income/wealth and life satisfaction, another variable captured in TILDA. We find that income and housing wealth both affect life satisfaction but that the influence of income is much larger

Coherent adiabatic transport of atoms in radio-frequency traps

Coherent transport by adiabatic passage has recently been suggested as a high-fidelity technique to engineer the center-of-mass state of single atoms in inhomogeneous environments. While the basic theory behind this process is well understood, several conceptual challenges for its experimental observation have still to be addressed. One of these is the difficulty that currently available optical or magnetic micro-trap systems have in adjusting the tunneling rate time dependently while keeping resonance between the asymptotic trapping states at all times. Here we suggest that both requirements can be fulfilled to a very high degree in an experimentally realistic setup based on radio-frequency traps on atom chips. We show that operations with close to 100% fidelity can be achieved and that these systems also allow significant improvements for performing adiabatic passage with interacting atomic clouds

Coherent transport by adiabatic passage on atom chips

Adiabatic techniques offer some of the most promising tools for achieving high-fidelity control of the center-of-mass degree of freedom of single atoms. Because the main requirement of these techniques is to follow an eigenstate of the system, constraints on timing and field strength stability are usually low, especially for trapped systems. In this paper we present a detailed example of a technique to adiabatically transport a single atom between different waveguides on an atom chip. To ensure that all conditions are fulfilled, we carry out fully three-dimensional simulations of the system, using experimentally realistic parameters. We also detail our method for simulating the system in very reasonable time scales on a consumer desktop machine by leveraging the power of graphics-processing-unit computing

The effect of simulation-based training on initial performance of ultrasound-guided axillary brachial plexus blockade in a clinical setting – a pilot study

BACKGROUND: In preparing novice anesthesiologists to perform their first ultrasound-guided axillary brachial plexus blockade, we hypothesized that virtual reality simulation-based training offers an additional learning benefit over standard training. We carried out pilot testing of this hypothesis using a prospective, single blind, randomized controlled trial. METHODS: We planned to recruit 20 anesthesiologists who had no experience of performing ultrasound-guided regional anesthesia. Initial standardized training, reflecting current best available practice was provided to all participating trainees. Trainees were randomized into one of two groups; (i) to undertake additional simulation-based training or (ii) no further training. On completion of their assigned training, trainees attempted their first ultrasound-guided axillary brachial plexus blockade. Two experts, blinded to the trainees’ group allocation, assessed the performance of trainees using validated tools. RESULTS: This study was discontinued following a planned interim analysis, having recruited 10 trainees. This occurred because it became clear that the functionality of the available simulator was insufficient to meet our training requirements. There were no statistically significant difference in clinical performance, as assessed using the sum of a Global Rating Score and a checklist score, between simulation-based training [mean 32.9 (standard deviation 11.1)] and control trainees [31.5 (4.2)] (p = 0.885). CONCLUSIONS: We have described a methodology for assessing the effectiveness of a simulator, during its development, by means of a randomized controlled trial. We believe that the learning acquired will be useful if performing future trials on learning efficacy associated with simulation based training in procedural skills. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01965314. Registered October 17th 2013

Economic (gross cost) analysis of systematically implementing a programme of advance care planning in three Irish nursing homes.

Background: Although advance care planning (ACP) and the use of advanced care directives (ACD) and end-of-life care plans are associated with a reduction in inappropriate hospitalisation, there is little evidence supporting the economic benefits of such programmes. We assessed the economic impact (gross savings) of the Let Me Decide (LMD) ACP programme in Ireland, specifically the impact on hospitalisations, bed days and location of resident deaths, before and after systematic implementation of the LMD-ACP combined with a palliative care education programme. Methods: The LMD-ACP was introduced into three long-term care (LTC) facilities in Southern Ireland and outcomes were compared pre and post implementation. In addition, 90 staff were trained in a palliative care educational programme. Economic analysis including probabilistic sensitivity analysis was performed. Results: The uptake of an ACD or end-of-life care post-implementation rose from 25 to 76 %. Post implementation, there were statistically significant decreases in hospitalisation rates from baseline (hospitalisation incidents declined from 27.8 to 14.6 %, z = 3.96, p < 0.001; inpatient hospital days reduced from 0.54 to 0.36 %, z = 8.85, p < 0.001). The percentage of hospital deaths also decreased from 22.9 to 8.4 %, z = 3.22, p = 0.001. However, length of stay (LOS) increased marginally (7–9 days). Economic analysis suggested a cost-reduction related to reduced hospitalisations ranging between €10 and €17.8 million/annum and reduction in ambulance transfers, estimated at €0.4 million/annum if these results were extrapolated nationally. When unit costs and LOS estimates were varied in scenario analyses, the expected cost reduction owing to reduced hospitalisations, ranged from €17.7 to €42.4 million nationally. Conclusions: Implementation of the LMD-ACP (ACD/end-of-life care plans combined with palliative care education) programme resulted in reduced rates of hospitalisation. Despite an increase in LOS, likely reflecting more complex care needs of admitted residents, gross costs were reduced and scenario analysis projected large annual savings if these results were extrapolated to the wider LTC population in Ireland

Learning to teach (LETS): developing curricular and cross curricular competences in becoming a 'good' secondary teacher: executive summary

The aim of this research, the Learning to Teach Study (LETS), the first of its kind on the Postgraduate Diploma in Education (PGDE) in Ireland, funded by the Department of Education and Skills (DES), was to develop and implement a study of initial teacher education in the PGDE in post-primary education, in the School of Education, University College Cork. Its aim was to identify the individual and contextual dynamics of how student teachers develop curricular and cross-curricular competences during initial teacher education (ITE). Within an overall framework that explores how student teachers develop their skills, competences and identity as teachers, it focuses on curricular competences in mathematics, science and language teaching, and on the cross-curricular competences of reading and digital literacy and the development of inclusive teaching practices. LETS is the first programme level research on the PGDE, familiarly known to generations of student teachers and teachers as ‘the Dip’ or ‘the HDip’. Drawing on research on teacher education both in Ireland and internationally, the LETS report is divided into six sections encompassing thirteen chapters. Section 1 includes the review of literature and study aims in Chapter 1 and the research methodology in Chapter 2. Adopting an interpretive approach, LETS involved the collaborative development of three interviews protocols and a survey by the research team. Seventeen (n=17) students were interviewed three times over the course of PGDE programme, and one hundred and thirty three students completed a detailed survey on their learning to teach experience (n=133, i.e. response rate of 62.7% of the 212 students in the PGDE 2008/09 cohort). The four chapters in Section 2 focus on professional identity as a central dimension of learning to teach. Among the dimensions of learning to teach addressed in this section are the role of observation and cultural scripts in becoming a teacher, the visibility/invisibility of PGDE students as learners and the relationships between emotions, resilience and commitment to teaching. The three chapters in Section 3 focus on mathematics, modern languages and science respectively in the context of conventional and reform-oriented visions of good teaching. A number of common as well as subject-specific themes emerged in this section in relation to subject matter teaching. Section 4 focuses on PGDE students’ experience of inclusion (chapter 10) and reading literacy (chapter 11) while learning to teach. Section 5 focuses on a key aspect of initial teacher education, namely, the school-university partnership. The final section provides a summary of the findings, identifies seven key issues emerging from these findings, makes Learning to Teach Study (LETS) recommendations under four headings (system, teacher education institutions, partnerships in ITE and further research) and discusses some implications for research, policy and practice in initial teacher education. Among the main findings emerging from the study are: (i) schools provide valuable support for PGDE students but this typically does not focus on classroom pedagogy, (ii) PGDE students typically felt that they had to be ‘invisible’ as learners in schools to gain and maintain authority and status, (iii) inherited cultural scripts about what it means to be a ‘good’ subject teacher shaped teacher identity and classroom practice, and (iv) as PGDE students begin to feel competent as teachers of maths, modern languages and science, this feeling of competence typically does not include their capacity to teach for inclusion and reading literacy within their subject teaching. In the context of research on teacher education, many of the findings are not unique to the PGDE or to UCC but reflect perennial dilemmas and emerging challenges in initial teacher education. This fact is important in setting a context for the wider dissemination2 of the Learning to Teach Study

An Absolute Flux Density Measurement of the Supernova Remnant Casseopia A at 32 GHz

We report 32 GHz absolute flux density measurements of the supernova remnant Cas A, with an accuracy of 2.5%. The measurements were made with the 1.5-meter telescope at the Owens Valley Radio Observatory. The antenna gain had been measured by NIST in May 1990 to be $0.505 \pm 0.007 \frac{{\rm mK}}{{\rm Jy}}$. Our observations of Cas A in May 1998 yield $S_{cas,1998} = 194 \pm 5 {\rm Jy}$. We also report absolute flux density measurements of 3C48, 3C147, 3C286, Jupiter, Saturn and Mars.Comment: 30 pages, 4 figures; accepted for publication by AJ. Revised systematic error budget, corrected typos, and added reference