Geological and Topographical Maps: Their Interpretation and Use. A Handbook for the Geologist and Civil Engineer

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Evaluating Circles of Support and Accountability: successes, failures and everything in-between

Circles of Support and Accountability is an approach that exists to reduce sexual recidivism and encourage reintegration through volunteer support in the community. Prior research has identified that Circles successfully reduce sexual recidivism risk and promote the wellbeing of those receiving support (Core Members). However, there are a small number of instances in which Circles are less effective and Circles have adverse outcomes, for example, Core Members reoffend. The present research was conducted as part of a wider national evaluation into the success and failure of Circles. The research aimed to understand the implications of adverse outcomes and learn from failure. The research also compared success and failure in Circles and further presented variations of successful Circles in practice. This thesis presents mixed-methods research on Circles of Support and Accountability. The research comprises five empirical research studies and one theoretical chapter. The theoretical chapter presents a conceptualisation of success and failure in Circles utilising the two Core Principles upon which Circles was based: No more victims and No one is disposable. Combined with a review on the literature surrounding success and failure in Circles, it is argued that without agreed-upon definitions of what constitutes a success or failure, the relative success of Circles cannot be measured consistently. Study 1 aimed to identify factors associated with specific outcomes in Circles and comprised quantitative data from (n=163) Circles to develop a typology of Circles. Results demonstrated that discussion of risk within Circles, can contribute to both Core Member and volunteer dropout from Circles. Whilst the absence of risk-related discussions predicted Circle success, Circles in which Core Members had substance abuse problems were also predictive of dropouts of both Core Members and volunteers. This study holds implications for Circle approaches and identifies the need for more specialist support in Circles where Core Members have additional complex needs. Study 2 aimed to investigate the component parts of the Dynamic Risk Review (DRR) through a factor analysis of (n=411) baseline DRR scores. The DRR is a risk assessment tool that was designed specifically for use with Core Members in Circles. The factor analysis identified three factors with good reliability termed: Poor Emotional Wellbeing, Sexual Preoccupation and Emotional Identification with Children, Poor Problem Solving and Low Pro-social Engagement. There was also the potential for a fourth factor termed: Anger and Hostility, although this item had poor reliability and requires further development. Study 3 presented changes in dynamic risk of (n=59) Core Members, as measured by the DRR, over time. Results indicated that DRR scores were significantly reduced after three months on a Circle. However, when data was split between successes and failures, DRR scores showed a significant reduction in DRR scores after six months for Circles with a successful outcome. Study 3 also presented changes in Core Member wellbeing as measured by the WEMWBS, over time. Results demonstrated that Core Member wellbeing was significantly increased after three months on a Circle. When data was split between successes and failures, Core Member wellbeing remained significantly increased after three months for the successful sample of Circles. Study 4 aimed to explore success and failure in Circles through a qualitative analysis of End of Circle Reports (EOCR). (n=84) EOCR were firstly divided into successes and failures before a thematic analysis was conducted on each data set. Six prominent themes emerged from the data consisting of three from each data set. Successful Circles were characterised through the themes: Trusting Relationships, External Support and Reduced Isolation (through active participation). The failed Circles presented a mirror opposite to the successes and were characterised by the themes: Trust Issues, Negative External Influences and Substance Abuse and Isolation. Results were discussed in relation to prior literature. Study 5 presents the results of (n=3) qualitative case studies of successful and completed Circles. Interviews were conducted with Core Members, volunteers and coordinators to provide multiple perspectives from those involved within the inner Circle. The case studies present the experiences of three different Core Members who each maintained good working relationships with their volunteers, built trusting relationships and were able to work through any difficulties to continue to receive support. These case studies demonstrate the uniqueness of Core Members, each with their own distinctive needs, alongside the shared needs of trust and support needed to thrive in the community. The five studies comprise mixed methods research into success and failure in Circles, using the conceptualisation provided in the theoretical chapter. The results of this thesis are discussed in relation to the social exchange theory (Cropanzano & Mitchell, 2005) and the 13 theory of relational desistance (Weaver & McNeill, 2015). The results of the present research are framed within these theoretical frameworks, with the core theme of this thesis being the importance of human connection. Whilst Circles exist to reduce recidivism, Weaver and McNeill (2015) postulated that social relations are central to the desistance process. Furthermore, social relations have been argued to produce relational goods or relational bads (Weaver & McNeill, 2015). Another recurring theme within the present research was the presence or absence of trust. Trust has been described as a form of social exchange (Cropanzano & Mitchell, 2005). Taken together, such relational processes are used to help explain success and failure within Circles. The importance of social exchange, trust development and reciprocity are presented as key components in Circles. The work in this thesis is original, making contributions to the literature on Circles, specifically within the area of failure in Circles. It has been argued that Circles should focus upon support rather than accountability in a bid toward reducing recidivism

Experiential learning for 16-19 year old students : using experiences of risk and failure to make learning more flexible and entrepreneurial

In this thesis the aim has been to consider student learning in Business Education in the 16-19 age range through an examination of aspects of Experiential Learning. The main aspects of Experiential Learning that have been focused on include enterprise, work-related learning, risk and failure and how these impact on student learning and motivation. There is also a focus on the Young Enterprise Programme. The methodology used in the research is underpinned by a pragmatist paradigm in terms of the choice of methods, which has led to the use of a mixed methods or 'blended' approach. Data was collected from the key stakeholders in the 16-19 age phase of education and included the students themselves, educational institutions, teachers, employers, and students involved in the Young Enterprise Programme. The data was then analysed in order to illuminate the six themes for investigation. An initial study was undertaken and the findings from this indicated a dichotomy between schools and colleges in how Experiential Learning was used. More significantly however, there was contradictory evidence with regard to risk taking, and the opportunities which students are given in order to experience failure. These findings, alongside key aspects of the literature, were used to develop six main themes for investigation. The main study that then followed, indicated that experience of risk and failure, often via informal and incidental learning, can lead to new understanding and new modes of thinking. It also indicated that although valuable, work placement does not always provide a meaningful and consistent experience for students, and may encourage them to focus on success and the established ways of doing things. The findings then led to the conclusion that in a successful collaborative group, learners can have the support and encouragement to take risks and make changes. In turn, such groups and the associated support that they provide can promote more effective work related Experiential Learning. The findings from the main study, and the subsequent discussion and analysis of these, and also led to a consideration of the implications of the study for professional practice. Young people seeking work in the future are likely to need to be more flexible and entrepreneurial in their attitudes. The research indicates that the education system needs a greater capacity for innovation and creativity, in relation to facilitating the experience of risk and failure for students, in order to develop those flexible and entrepreneurial attitudes

Juvenile polyposis syndrome affecting the stomach: A case report

<p>Abstract</p> <p>Introduction</p> <p>Juvenile polyposis syndrome(JPS) is a rare autosomal dominant inherited condition. Hamartomatous polyps can affect the entire gastrointestinal tract but usually predominate in the colon. In this case report we present an unusual case of JPS that presented with massive gastric polyposis requiring a total gastrectomy.</p> <p>Case presentation</p> <p>A 51-year-old man presented with symptoms of gastric outlet obstruction and upper gastrointestinal bleeding. Gastroscopy showed massive gastric polyposis with a large antral polyp that had prolapsed through the pylorus causing gastric outlet obstruction. Initially endoscopic polypectomy was performed, but due to progressive symptoms a total gastrectomy was then performed. Histology confirmed massive gastric juvenile polyposis.</p> <p>Conclusion</p> <p>Massive gastric polyposis is an uncommon manifestation of juvenile polyposis syndrome. This case illustrates important principles in managing this condition.</p

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Germline CDH1 deletions in hereditary diffuse gastric cancer families

Germline CDH1 point or small frameshift mutations can be identified in 30–50% of hereditary diffuse gastric cancer (HDGC) families. We hypothesized that CDH1 genomic rearrangements would be found in HDGC and identified 160 families with either two gastric cancers in first-degree relatives and with at least one diffuse gastric cancer (DGC) diagnosed before age 50, or three or more DGC in close relatives diagnosed at any age. Sixty-seven carried germline CDH1 point or small frameshift mutations. We screened germline DNA from the 93 mutation negative probands for large genomic rearrangements by Multiplex Ligation-Dependent Probe Amplification. Potential deletions were validated by RT–PCR and breakpoints cloned using a combination of oligo-CGH-arrays and long-range-PCR. In-silico analysis of the CDH1 locus was used to determine a potential mechanism for these rearrangements. Six of 93 (6.5%) previously described mutation negative HDGC probands, from low GC incidence populations (UK and North America), carried genomic deletions (UK and North America). Two families carried an identical deletion spanning 193 593 bp, encompassing the full CDH3 sequence and CDH1 exons 1 and 2. Other deletions affecting exons 1, 2, 15 and/or 16 were identified. The statistically significant over-representation of Alus around breakpoints indicates it as a likely mechanism for these deletions. When all mutations and deletions are considered, the overall frequency of CDH1 alterations in HDGC is ∼46% (73/160). CDH1 large deletions occur in 4% of HDGC families by mechanisms involving mainly non-allelic homologous recombination in Alu repeat sequences. As the finding of pathogenic CDH1 mutations is useful for management of HDGC families, screening for deletions should be offered to at-risk families

MRCP compared to diagnostic ERCP for diagnosis when biliary obstruction is suspected: a systematic review

BACKGROUND: Magnetic resonance cholangiopancreatography (MRCP) is an alternative to diagnostic endoscopic retrograde cholangiopancreatography (ERCP) for investigating biliary obstruction. The use of MRCP, a non-invasive procedure, may prevent the use of unnecessary invasive procedures. The aim of the study was to compare the findings of MRCP with those of ERCP by the computation of accuracy statistics. METHODS: Thirteen electronic bibliographic databases, covering biomedical, science, health economics and grey literature were searched. A systematic review of studies comparing MRCP to diagnostic ERCP in patients with suspected biliary obstruction was conducted. Sensitivity, specificity, likelihood ratios, acceptability and adverse events were reported. RESULTS: 25 studies were identified reporting several conditions including choledocholithiasis (18 studies), malignancy (four studies), obstruction (three studies), stricture (two studies) and dilatation (five studies). Three of the 18 studies reporting choledocholithiasis were excluded from the analysis due to lack of data, or differences in study design. The sensitivity for the 15 studies of choledocholithiasis ranged from 0.50 to 1.00 while specificity ranged from 0.83 to 1.00. The positive likelihood ratio ranged: from 5.44–47.72 and the negative likelihood ratio for the 15 studies ranged from 0.00–0.51. Significant heterogeneity was found across the 15 studies so the sensitivities and specificities were summarised by a Receiver Operating Characteristic (ROC) curve. For malignancy, sensitivity ranged from 0.81 to 0.94 and specificity from 0.92 to 1.00. Positive likelihood ratios ranged from 10.12 to 43 and negative likelihood ratios ranged from 0.15 to 0.21, although these estimates were less reliable. CONCLUSION: MRCP is a comparable diagnostic investigation in comparison to ERCP for diagnosing biliary obstruction

SARS-CoV-2 infection in acute pancreatitis increases disease severity and 30-day mortality: COVID PAN collaborative study

Objective: There is emerging evidence that the pancreas may be a target organ of SARS-CoV-2 infection. This aim of this study was to investigate the outcome of patients with acute pancreatitis (AP) and coexistent SARS-CoV-2 infection. Design: A prospective international multicentre cohort study including consecutive patients admitted with AP during the current pandemic was undertaken. Primary outcome measure was severity of AP. Secondary outcome measures were aetiology of AP, intensive care unit (ICU) admission, length of hospital stay, local complications, acute respiratory distress syndrome (ARDS), persistent organ failure and 30-day mortality. Multilevel logistic regression was used to compare the two groups. Results: 1777 patients with AP were included during the study period from 1 March to 23 July 2020. 149 patients (8.3%) had concomitant SARS-CoV-2 infection. Overall, SARS-CoV-2-positive patients were older male patients and more likely to develop severe AP and ARDS (p&lt;0.001). Unadjusted analysis showed that SARS-CoV-2-positive patients with AP were more likely to require ICU admission (OR 5.21, p&lt;0.001), local complications (OR 2.91, p&lt;0.001), persistent organ failure (OR 7.32, p&lt;0.001), prolonged hospital stay (OR 1.89, p&lt;0.001) and a higher 30-day mortality (OR 6.56, p&lt;0.001). Adjusted analysis showed length of stay (OR 1.32, p&lt;0.001), persistent organ failure (OR 2.77, p&lt;0.003) and 30-day mortality (OR 2.41, p&lt;0.04) were significantly higher in SARS-CoV-2 co-infection. Conclusion: Patients with AP and coexistent SARS-CoV-2 infection are at increased risk of severe AP, worse clinical outcomes, prolonged length of hospital stay and high 30-day mortality