Browsing by Author "Parker, Steven"

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    After the applause: Understanding Public Management and Public Service Ethos in the fight against Covid - 19
    (Public Management Review, 2022-01-20) Shand, Rory; Parker, Steven; Liddle, Joyce; Spolander, Gary; Warwick, Lisa; Ainsworth, Susan
    Covid-19 has led to renewed public support for public services. Frontline workers symbolise a renewed ideal of public service ethos (PSE), though little attention has been paid to how the public managers delivering vital services interpret and mobilise PSE. We show how PSE is implemented by public managers reflecting their local contexts. We examine the theoretical roots of PSE and challenges by newer theories of public management before illustrating its contemporary manifestations through three case studies of local government responses to Covid-19 in England, showing how PSE has been adapted in current contexts and continues to inform public management practice.
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    Current Concepts of Laser–Oral Tissue Interaction.
    (MDPI, 2020-06-28) Parker, Steven; Anagnostaki, Eugenia; Mylona, Valina; Cronshaw, Mark; Lynch, Edward; Grootveld, Martin
    Fundamental to the adjunctive use of laser photonic energy for delivering therapy and tissue management, is the ability of the incident energy to be absorbed by target tissues. The aim of this review is to examine the differential performance of the separate components of oral hard and soft tissues when exposed to laser photonic irradiance of variable wavelengths and power values. Through an examination of peer-reviewed published data and materials, the interaction of laser photonic energy and target tissues are explored in detail. Varying laser wavelength emissions relative to anatomical structures explores the ability to optimise laser–tissue interactions, and also identifies possible risk scenarios as they apply to adjacent non-target structures. The concepts and practical aspects of laser photonic energy interactions with target oral tissues are clearly demonstrated. Emphasis was placed on optimising the minimum level of laser power delivery in order to achieve a desired tissue effect, whilst minimising the risk or outcome of collateral tissue damage.
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    Debate: Public Service Motivation, Citizens and Leadership Roles
    (Taylor and Francis, 2015) Parker, Steven
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    Elected Officials in an Era of Austerity: Stewards, Mediators, and Catalysts
    (Palgrave, 2020-04-29) Needham, Catherine; Mangan, Catherine; Bottom, Karin; Parker, Steven
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    The Influence of Delivery Power Losses and Full Operating Parametry on the Effectiveness of Diode Visible – Near Infra-red (445 - 1064nm) Laser Therapy in Dentistry – A Multi-Center Investigation
    (Springer, 2022-01-14) Parker, Steven; Cronshaw, Mark; Grootveld, Martin; Anagnostaki, Eugenia; Mylona, Valina; Chala, Marianna; George, Roy; Walsh, Laurence
    The development of protocols for laser-assisted therapy demands strict compliance with comprehensive operating parametry. The purpose of this investigation was to examine the accuracy of correlation between laser control panel and fibre emission power values in a selection of diode dental lasers. Through retrospective analysis using successive systematic review and meta-analysis, it is clear that there is inconsistency in the details, and possible inaccuracies in laser power applied and associated computed data. Through a multi-centre investigation, 38 semi-conductor (“diode”) dental laser units were chosen, with emission wavelengths ranging from 445 to 1064 nm. Each unit had been recently serviced according to manufacturer’s recommendations, and delivery fibre assembly checked for patency and correct alignment with the parent laser unit. Subject to the output capacity of each laser, four average power values were chosen using the laser control panel—100 mW, 500 mW, 1.0 W, and 2.0 W. Using a calibrated power meter, the post-fbre emission power value was measured, and a percentage power loss calculated. For each emission, a series of six measurements were made and analysed to investigate sources of power losses along the delivery fibre, and to evaluate the precision of power loss determinations. Statistical analysis of a dataset comprising % deviations from power setting levels was performed using a factorial ANOVA model, and this demonstrated very highly significant differences between devices tested and emission power levels applied (p<10–142 and<10–52 respectively). The devices emission power interaction effect was also markedly significant (p<10–66), and this confirmed that differences observed in these deviations for each prior power setting parameter were dependent on the device employed for delivery. Power losses were found to be negatively related to power settings applied. Significant differences have emerged to recommend the need to standardize a minimum set of parameters that should form the basis of comparative research into laser–tissue interactions, both in vitro and in vivo.
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    Laser Photonic Energy Delivery in Clinical Dentistry: Scrutiny of Parameter Variables.
    (De Montfort University, 2023-03) Parker, Steven
    Laser use in the disciplines of clinical dentistry, oral surgery and oral medicine have developed during a period of over 30 years. During that time, from a rudimentary base of non-awareness of the scientific processes involved or scope of possible application, the knowledge and understanding of lasers has grown and benefitted from structured research, postgraduate courses and qualifications. Both the sophistication and scope of use of laser photonic energy has increased significantly, to the extent that lasers can be incorporated to benefit almost all areas of patient-centred clinical dentistry. Research into laser-assisted therapies has reinforced the importance of “light dose” in order to maximise the benefits of applied coherent, monochromatic light energy to a given procedure, while minimising the risk of conversion of excessive energy into collateral thermal damage. This thesis by concurrent publication provides a thorough examination of both ablative surgical laser-tissue interaction and sub-ablative photobiomodulation. The importance of achieving accurate light-dose levels of irradiation of oral hard and soft tissues remains fundamental to delivery of appropriate laser therapy whilst minimising the risk of collateral damage to adjacent, non-target oral hard and soft tissues. As demonstrated through published systematic reviews, it is significant to note the absence of full operating parametry in many peer-reviewed published studies; such omission compromises the opportunity to achieve accurate laser applications that are chosen as adjunctive to a clinical procedure. In addition, the consequence of poorly or inaccurately calibrated optic fibre photonic delivery, as the method of choice with visible and near infra-red wavelength “diode” lasers, may compromise the intended outcome of a clinical procedure; taken as a component of a poorly designed study, such errors may distort the development of laser-assisted therapy through inaccurate data acquisition and interpretation arising out of calibration errors. Once receiving peer-reviewed publication, any reference incorporating laser use helps define the expansion of knowledge and use for the clinician; there is a consequent responsibility to ensure that published studies that directly affect clinical application of laser use are fully detailed, to avoid subsequent misinterpretation and maltreatment. A further area of concern remains the persistence in attribution of post-surgical healing phenomena, by way of photobiomodulation to those laser wavelengths solely within the “optical window” range of 650 – 1350 nanometers. Both clinical and underlying biochemical data support the concept of “uneventful healing” with all laser wavelengths in dentistry, and exploration of key biochemical processes provide testimony to both photo- and possible thermo-biomodulation actions that follow laser irradiation. Through examination of the many potential errors that may affect post-irradiation outcome, it is concluded that the risk would appear of greater significance with lower, photobiomodulation (PBM) fluences. The small difference between benefit and non-benefit with PBM, either as a stand-alone therapy or adjunctive to a surgical laser procedure, defines a perspective that underlines the balance of this thesis.
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    Laser-Assisted aPDT Protocols in Randomized Controlled Clinical Trials in Dentistry: A Systematic Review
    (MDPI, 2020-09-22) Mylona, Valina; Anagnostaki, Eugenia; Parker, Steven; Cronshaw, Mark; Lynch, Edward; Grootveld, Martin
    Background: Antimicrobial photodynamic therapy (aPDT) has been proposed as an effective alternative method for the adjunctive treatment of all classes of oral infections. The multifactorial nature of its mechanism of action correlates with various influencing factors, involving parameters concerning both the photosensitizer and the light delivery system. This study aims to critically evaluate the recorded parameters of aPDT applications that use lasers as the light source in randomized clinical trials in dentistry. Methods: PubMedandCochrane search engineswere used to identifyhuman clinical trials of aPDT therapy in dentistry. After applying specific keywords, additional filters, inclusion and exclusion criteria, the initial number of 7744 articles was reduced to 38. Results: Almost one-half of the articles presented incomplete parameters, whilst the others had different protocols, even with the same photosensitizer and for the same field of application. Conclusions: No safe recommendation for aPDT protocols can be extrapolated for clinical use. Further research investigations should be performed with clear protocols, so that standardization for their potential dental applications can be achieved.
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    Leading and recognizing public value
    (Wiley, 2018-10-12) Hartley, Jean; Parker, Steven; Beashel, Jim; Parker
    This article examines the relationship between leadership and public value, which is particularly challenging in a context of explicit contest and conflict. The theoretical framework is illustrated through a case study of policing rural crime. The study reveals that the police worked with multiple and competing publics rather than a single homogeneous public, and that part of their leadership role was to create and convene a public space in which different voices and divergent views could be expressed. The study notes that research needs to pay attention to the loss and displacement of public value, not solely its creation and recognition. The need to convene multiple publics required the police to lead, as part of a leadership constellation, and with political astuteness. The findings have wider relevance for other public services, and for studies of leadership and public value at the intersection between the state and civil society.
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    Leading for public value in multi-agency collaboration
    (Sage, 2021-03-21) Parker, Steven; Hartley, Jean; Beashel, Jim; Vo, Quoc
    This paper examines the relationship between leadership and public value in a multi-agency service, requiring the delicate navigation of tensions when there are diverse and competing interests among public service collaborators. The paper adopts an actor-focused perspective arguing for the need to develop theory about leadership in collaborative settings which includes understanding political astuteness in leadership, as this can have an impact on whether or not public value is created. The setting is a multi-agency service hub and the empirical research is based on interviews and document analysis. The paper makes two contributions: first, it analyses the pluralistic leadership processes exercised in the pursuit of public value; secondly, it identifies how political astuteness is a key capability in leading diverse interest in cross-organisational collaborations.
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    New development: Expanding public service value to include dis/value
    (Taylor and Francis, 2020-03-11) Cluley, Victoria; Parker, Steven; Radnor, Zoe
    This article introduces two new terms to the public value lexicon: ‘public service ethos’ and ‘dis/value’. Both terms serve to progress the conceptualization of public value. ‘Public service ethos’ is used to refer to the prevailing assumption that the inclusion of service user voices in the delivery and improvement of public services creates individual and societal benefits (public value). ‘Dis/value’ refers to the public value relationships that fall outside of the public service ethos. Three service assemblages are used to exemplify this. These examples show that a theory–practice disjuncture is present, whereby the ‘public service ethos’ is not practicable based on its anthropomorphic focus and the consequent failure to recognize complexity. To overcome this, the authors draw on new materialist theory to reposition public value as a relational assemblage that can accommodate value in all combinations. For public service managers and policy-makers, value is now a common buzzword and its creation or production processes represent common approaches to service delivery. Increasing numbers of academic studies argue that public value is overly optimistic and premised on overly positive ideals of universal benefit. Two new terms are proposed in this article that both critique current approaches to public value and also expand the concept to reflect the complex reality of public service practice: dis/value and public service ethos. Public service ethos represents the idealism associated with the public value and dis/value accounts for public value relationships and experiences that fall outside of this. These terms are intended to further the conceptualization of value and also translate theoretical development into a language that both reflects and can be used in public service practice.
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    Photobiomodulation and Oral Mucositis: A Systematic Review
    (MDPI, 2020-08-05) Cronshaw, Mark; Parker, Steven; Anagnostaki, Eugenia; Mylona, Valina; Lynch, Edward; Grootveld, Martin
    Oral mucositis (OM) is a debilitating complication of chemotherapy, and head and neck radiotherapy. In an effort to offer the best possible advice within the limitations of published research, a systematic review with an extended discussion and commentary on dosimetry and dose delivery is presented. Using keywords as listed, Pubmed, Google Scholar and Cochrane databases were searched during a period extending from 1995 to 2019. A total of 782 abstracts were identified. A total of 50 papers were analysed, and of these, 29 satisfied criteria required for systematic review in accordance with an optimized PRISMA statement. Clinical outcome as reported was subject to analysis with respect to time of intervention, incidence and severity of oral mucositis, and pain amelioration, and a comprehensive combined univariate and multivariate statistical analysis of the methods employed was performed. Recommendations are made with respect to the timing of the intervention. Moreover, there is an extended discussion available on the treatment care rationale of photobiomodulation (PBM), and its adjunctive association with OM. In conclusion, early prophylactic application offers clear advantages in clinical management. The many studies and associated variables and covariables assessed here revealed a choice of delivery techniques, associated wavelengths and many further indices to consider with regard to the accomplishment of optical parameters. It is therefore our recommendation that clinicians use PBM as a therapy with a full and proper understanding and training in order to optimise the clinical effects achievable.
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    Photobiomodulation Delivery Parameters in Dentistry: An Evidence based Approach.
    (Mary Ann Liebert Inc, 2022-01-13) Parker, Steven; Cronshaw, Mark; Grootveld, Martin
    Notwithstanding around 50 years of continued research, and with an ascending level of current research submissions, there is at present no agreed methodology and process to adopted treatment protocols. Dosimetry at target tissue level is, however, largely agreed, and more recent proposals have promoted the concept of a multiphasic dose–response to clinical outcomes [1]. Higher dosimetry appears to be the most effective for analgesia, and a lower dose bracket for the growth-promoting and optimal tissue healing benefits associated with tissue regeneration and the resolution of inflammation [2–6]. There is, however, no agreement with respect to wavelengths adopted, spectral emission modes, optical beam spatial profiles, and the optical surface spot size, together with the inter-relationship of these variables to optimize therapy outcome. Further, energy delivery to subsurface targets has proven to be a significant challenge, with the requirement for the operator to deliver a meaningful photonic dose to target through overlying anisotropic multiple layers of variable tissue types [7–9]. However, despite the many difficulties that have been encountered by researchers and clinicians alike, there is considerable interest in harnessing the proven benefits of photobiomodulation (PBM) as a therapy. This has led the authors to consider broadly and as widely as possible within the prior published evidence base factors that can more consistently lead to reduced operator errors and a higher level of research and clinical endeavor outcomes. For the purpose of this study, the authors considered that a prime objective in maintaining the sustainability of evidence-based data is to mandate a full description of laser operating parameters, both those concerning control panel running parameters and computed data relating to photonic dose. In this regard, the authors conducted an audit of published randomized clinical trial (RCT)-level articles that formed the basis of five recent systematic reviews. Within a total of 141 published articles, a selection of criteria that contributed to a ‘‘risk of bias’’ determination was examined. From this, it is asserted that the high level of absence of some basic values of photonic energy delivery renders cause for concern regarding the scientific rigor of conclusions obtained in such studies.
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    Photobiomodulation Dose Parameters in Dentistry: A Systematic Review and Meta-Analysis
    (MDPI, 2020-10-06) Cronshaw, Mark; Parker, Steven; Anagnostaki, Eugenia; Mylona, Valina; Lynch, Edward; Grootveld, Martin
    Objective: This systematic review and meta-analysis of published randomized controlled trials examines a possible relationship between optical spot size at surface tissue, irradiance, radiant exposure, total energy delivered, operator technique and reported clinical outcomes. Background: Clinical photobiomodulation (PBM) therapy has achieved a high level of evidence-based acceptance in the mitigation of oral mucositis associated with cancer radiotherapy and chemotherapy, and supportive clinical research in relation to orthodontic tooth movement, oral medical conditions, including burning mouth syndrome, xerostomia and lichen planus. Inconsistent outcomes have been reported not withstanding a substantial body of primary supportive research from clinical, in vitro and animal studies. Materials and Methods: PubMed, Cochrane Database of Reviews and Google Scholar search engines were applied to identify human clinical trials of PBM therapy in clinical dentistry. A total of 766 articles between February 2009 and June 2020 were identified and following a full text evaluation, 38 papers with sufficient data to permit analyses are included in this investigation. Results: Following a detailed assessment of potential factors that may have an influence in clinical outcome, a clear trend is apparent associating optical spot size to a positive or negative effect. Furthermore, there is a clear difference in the reported results in relation to total energy applied, delivery techniques and optical parameters, which merits further investigation. Factorial statistical analyses identified an association between smaller optical surface applications and an overall lower level of reported clinical success in treating superficial and deeper targets, and correspondingly sub-surface larger target tissues were found to be more responsive to therapy by use of a larger optical surface spot size. Moreover, use of multiple small diameter probe applications was found to provide inconsistent results. Conclusions: Many factors can confound clinical success including variations in anatomy, site location, clinical condition and subject individuality. To achieve higher levels of predictable outcome, a mature appreciation of these factors, plus an expanded understanding of laser parametry, tissue volume and target depth to deliver an adequate dose within current recommended guidelines, is essential.
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    Photothermal Effects of High-Energy Photobiomodulation Therapies: An In Vitro Investigation
    (MDPI, 2023-06-04) Cronshaw, Mark; Parker, Steven; Grootveld, Martin; Lynch, Edward
    The purpose of this study was to investigate photothermal aspects of photobiomodulation therapies (PBMT) in vitro to assist in the development of safe clinical parameters with respect to higher-power devices with large surface applicators. Laser wavelengths in the range of 650 nm–1064 nm were investigated using a thermal camera. Thermographic measures of surface and sub-surface temperature variations of similar lean porcine muscle tissue samples were recorded for a series of calibrated experiments. A thermal comparison was then made between Flat-top and Gaussian beam spatial distribution devices. Outcome data were subjected to statistical analysis using an ANOVA model. Results acquired at similar parameters of irradiance indicated that the application of the 980 nm wavelength was associated with the highest rise in temperature, which decreased with other wavelengths in the order 980 > 1064 ≈ 650 >>> 810 nm (p < 5 × 10−20). All wavelengths assessed were associated with a significant temperature increase, and with the exception of 810 nm, all exceeded the threshold of a 6 °C rise within the prescribed parameter limits. Optical scanning by movement of the applied source over a relevant area was found to offer effective mitigation of these temperature increases. An extended discussion is presented, analysing the clinical significance of the study outcomes. Recommendations are made within the limits of this in vitro study in order to assist future clinical investigations.
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    Systematic review of post-surgical laser-assisted oral soft tissue outcomes using surgical wavelengths outside the 650–1350 nm optical window.
    (Mary Ann Liebert Inc, 2020-10-07) Parker, Steven; Anagnostaki, Eugenia; Mylona, Valina; Cronshaw, Mark; Lynch, Edward; Grootveld, Martin
    Objective: To explore via systematic review the validation of uneventful post-surgical healing, associated with shorter and longer laser wavelength applications in minor oral surgery procedures. Methods: From April 28 to May 11, 2020, PubMed, Cochrane Database of Systemic Reviews, and Google Scholar search engines were applied to identify human clinical trials of photobiomodulation (PBM) therapy in clinical dentistry. The searches were carried out with reference to (1) dental laser wavelengths shorter than 650 nm; (2) wavelengths localized within the 2780-2940 nm; and (3) the 9300-10,600 nm range. Selected articles were further assessed by three independent reviewers for strict compliance with PRISMA guidelines and modified Cochrane Risk of Bias to determine eligibility. Results: Using selection filters of randomized clinical trials, moderate/low risk of bias, and the applied period, and following PRISMA guidelines, 25 articles were selected and examined. A risk of bias was completed, where 11 out of 25 publications were classified as low risk of bias, and 14 out of 25 were classified as medium risk status. In total, 6 out of 13 (46% of) studies comparing the examined laser wavelengths with scalpel-based treatment showed positive results, whereas 6 out of 13 (46%) showed no difference, and only 1 out of 13 (7.7%) presented a negative outcome. In addition, 5 out of 6 (83% of) studies comparing the examined laser wavelengths with other diodes (808-980 nm) showed positive results, whereas 1 out of 6 (17%) had negative outcomes. Conclusions: A detailed and blinded examination of published studies has been undertaken, applying strict criteria to demonstrate research outcome data, which suggests positive or at worst neutral comparatives when a given laser wavelength system is used against an alternative control therapy. As such, substantiated evidence for laser surgery in delivering uneventful healing and analgesic effects, as an expression of a PBM-like (quasi-PBM) influence, has been shown.
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    Unleashing the Hidden Potential: The Dynamic Duo of Antimicrobial Photodynamic Therapy and Photobiomodulation: A Spectrophotometric Study
    (MDPI, 2023-06-28) Mylona, Valina; Anagnostaki, Eugenia; Petrakis, Stylianos; Kosma, Kyriaki; Parker, Steven; Cronshaw, Mark; Papadogiannis, Nektarios; Grootveld, Martin
    Background: Despite intensive research, the ideal protocol applied to maximize the overall benefits of antimicrobial photodynamic therapy (aPDT) remains unexplored. Evidence exists that following aPDT, the diffused light beyond the photosensitizer can exert a secondary therapeutic effect known as photobiomodulation (PBM), which stimulates the healing of the surrounding tissues. Therefore, the aim of this study was to examine the attenuation properties of five different photosen- sitizers activated by their corresponding laser wavelengths. Methods: The illumination of various concentrations of chosen photosensitizers, curcumin, methylene blue, toluidine blue, indocyanine green and a methylene blue derivative, irradiated by their respective laser wavelengths (445 nm, 635 nm, 660 nm and 808 nm) was explored via a spectrophotometric analysis. The onward transmitted light intensities for each combination of a photosensitizer and laser wavelength were assessed. The attenuation percentages observed were statistically evaluated using an analysis-of-variance (ANOVA) model. A Tukey’s post hoc test was performed to determine the significance of differences between individual group mean values. Results: With the exception of toluidine blue illuminated by an 808 nm laser, which showed the lowest intensity loss, all the other photosensitizers presented an attenuation range of 63% to 99%. Conclusions: At appropriate concentrations, all the examined photosensitizers may allow the passage of sufficient wavelength-dependent light transmission. Calculated fluences are proposed to achieve secondary, beneficial PBM effects.
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    What is the meaning of philosophy for local government officers?
    (Taylor and Francis, 2018-12-07) Parker, Steven
    This article reflects on how the philosophical foundations of public administration and the practice of local government can be linked together. Informed by Ongaro, E. (2017. Philosophy and public administration: An introduction. Edward Elgar), the relationship between philosophy and public administration is considered, followed by a discussion of what this means for local government. Virtue ethics and utilitarianism are applied to two current examples of local government practice. The article ends by detailing key points for the future relationship between philosophy and local government.