Drift-filled hollows in the London basin: characteristics, origins and assessment of risk

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonAnomalous geology creates sub-surface risk to engineering projects. Within the London Basin, anomalous geological depressions, named drift-filled hollows (DFHs) have been identified and inducing sub-surface risk for the last century. DFHs are depressions identified at an anomalous depth to the local bedrock, infilled with largely unconsolidated sediment and occasionally local bedrock. The features range in size from 5-500 m wide and up to 75 m deep, narrowing with depth. Not visible from ground level, DFHs are often missed during site investigations which induces sub-surface risk on construction projects. Not addressing the features if and once encountered could lead to failure through differential subsidence, tunnel face collapse, impact on nationally-significant infrastructure, excessive and unplanned costs, damage to groundwater resources and loss of life. This thesis compiles information to create the largest DFH dataset of 89 features and their known characteristics. A multi-disciplinary approach is employed to further understanding of the physical characteristics of DFHs as well as to use an evidence-based approach to determine their origin and processes which have shaped their current form. The results illustrate the high level of variability between features and within a single feature. Data quality restrictions and methodological limitations are discussed in detail throughout. These limitations are then amplified with highly variable sediments, such as the infill of DFHs. Further outcomes of the research include furthering the understanding of London’s geology, not solely through identifying further anomalies, but through mapping the sub-surface of two differing areas and showing notable differences in depth to bedrock and presence and absence of strata within relatively short distances. A guide for the site investigation sector has also been created to readily identify and characterise DFHs and so reduce risk. All of the outcomes reduce sub-surface risk through an increased knowledge of the features and London’s geology as a whole. Finally, the enlarged dataset and the recognition of the high level of variability within a single feature and between features has enabled the existing and potential process hypotheses to be analysed and a new formation hypothesis is proposed for features with a diapir being formed through an increase of water and gas pressure

EBook Exploration: How EBooks Support Emergent Literacy

Abstract This research study explores how eBooks support young children’s emergent literacy development. Specifically, it focuses on what kinds and modes are available in eBooks for young children, how eBooks motivate or engage students to read and write and how they support students’ decoding and comprehension skills through a home-based qualitative active inquiry. This study took place during hour long tutoring sessions held twice per week with two elementary aged siblings in an Upstate New York middle class home. The collected data included informal and field notes, student artifacts, comprehension conversations, and student interviews. One student enjoyed reading the eBooks and was motivated by them while the other enjoyed reading paper books better and was not motivated by the eBooks. It was found that some features of eBooks support student’s decoding and comprehension, while some modes of eBooks did not. Pre-teaching of eReader features and previewing the eBook help student comprehend the stories. Student comprehension was aided by the narration features of the eReaders, however animations in TumbleBooks interfered with one student’s comprehension. Use of the Table of Contents and picture cues also contributed to their understanding of eBooks. Finding an eBook at Student One’s reading level was challenging. Both students lost track of the words on the page at times. Technological issues interfered with book reading several times. The Read to Me narration options helped both students with word decoding, especially the beginning reader. More research is needed on how eBooks support student’s decoding and on how beneficial the narration features on eBooks are to beginning readers

Teachers’ Perspectives on Year Two Implementation of a Kindergarten Readiness Assessment

In this study we examined teachers’ perspectives regarding the second year of implementing a Kindergarten Readiness Assessment (KRA). Using a mixed-methods approach, we focused on the administration process, the perceived benefits of the assessment, and how teachers used the assessment to inform instruction. We also investigated whether these differed by teacher and district characteristics and how KRA experiences were different in the second year of implementation. Research Findings: Teachers generally did not view the KRA as beneficial for instruction or for students, reporting administration difficulties, inadequate KRA content, and limited utility of KRA data for supporting instruction as ongoing barriers to KRA use. Although the administration process seemed to be easier in the second year, teachers still reported it as burdensome, cutting into important beginning of kindergarten activities. Notably, teacher training and experience were associated with perceptions. Practice or Policy: Reasons for perceived lack of utility have important implications for future KRA design and implementation. These include better integration of KRAs into existing assessment systems, recognizing the added burden of KRAs to teachers (particularly at the beginning of kindergarten), and the role that additional training may have in supporting use of KRAs at the local level

Boot Camp: Preparing Teacher Candidates for the Discipline

Colleges and universities commonly implement orientation courses to help freshmen and transfer students adjust to the academic demands and social challenges of higher education. This article examines one university’s implementation of a similar concept for teacher candidates transitioning from general to professional studies. The seminar, known as Boot Camp, is designed to prepare students for the rigor of coursework/clinical responsibilities and the teaching profession. Through a pre-post seminar questionnaire, participants showed growth in their perceptions and understandings of seminar topics. A faculty questionnaire indicated positive student outcomes from the seminar as observed through coursework and daily interactions with teacher candidates

Does the provision of a DVD-based audio-visual presentation improve recruitment in a clinical trial? A randomised trial of DVD trial invitations

Abstract Background Recruitment to clinical trials can be challenging. Methods that improve the efficiency of trial recruitment are needed to increase successful study completions. The aim of this study was to ascertain whether sending an audio-visual presentation on a digital versatile disc (DVD), along with usual study invitation materials, would improve recruitment to the Febuxostat versus Allopurinol Streamlined Trial (FAST), a clinical trial in patients with established gout. Methods Potential participants for the FAST study who were identified by searches of GP records in Scottish primary care practices between August 2013 and July 2014 were included in this study. Individuals were randomly allocated to receive either a standard invitation (letter and information leaflet) or a standard invitation and a DVD containing an audio-visual presentation explaining the background and operation of FAST. Data on invitation response rates, screening attendances and randomisations were collected by research nurses. Results One thousand fifty potential participants were invited to take part in FAST during this period. 509 individuals were randomised to receive the DVD presentation and the standard invitation and 541 received a standard invitation only. DVD recipients were less likely to respond to the initial invitation (adjusted OR 0.76, CI 0.58–0.99) and marginally less likely to return a positive response (OR 0.75, CI 0.59–0.96). There was no statistically significant difference between the groups in attendance for screening or randomisation. The DVD did not influence the age, gender, or socioeconomic deprivation scores of those responding positively to a letter of invitation. Conclusions The inclusion of a DVD presentation with FAST study invitations did not make any practical difference to the rate of positive response to invitation. Further innovation and evaluation will be required to improve recruitment to clinical trials. Trial registration EU Clinical Trials Register. EudraCT Number: 2011–001883-23. ISRCTN registry. ISRCTN72443278

‘It was like coming back from the clouds’:a qualitative analysis of the lived experience of overdose consequent to drug use among a cohort of people who use drugs in Scotland

Background: Globally, non-fatal overdose (NFOD) rates consequent to drug use, typically opioids, continue increasing at a startling rate. Existing quantitative research has revealed myriad factors and characteristics linked to experiencing NFOD, but it is critically important to explore the lived context underlying these associations. In this qualitative study, we sought to understand the experiences of NFOD among people who use drugs in a Scottish region in order to: enhance public policy responses; inform potential intervention development to mitigate risk; and contribute to the literature documenting the lived experience of NFOD.Methods: From June to July 2021, two peer researchers conducted face-to-face semi-structured interviews with people who use drugs who had experienced recent NFOD attending harm reduction services in Tayside, Scotland. These were transcribed verbatim and evaluated using thematic analysis with an inductive approach which had an experiential and essentialist orientation.Results: Twenty people were interviewed across two sites. Of those, 15 (75%) were male and mean age was 38.2 (7.7) years. All had experienced at least one NFOD in the prior six months, and all reported polydrug use. Five themes were identified, within which 12 subthemes were situated. The themes were: social context; personal risk-taking triggers; planned and impulsive consumption; risk perception; and overdose reversal. The results spoke to the environmental, behavioural, cognitive, economic, and marketplace, factors which influence the context of NFOD in the region.Conclusions: A complex interplay of behavioural, psychological, and situational factors were found to impact the likelihood of experiencing NFOD. Structural inequities which policy professionals and civic leaders should seek to remedy were identified, while service providers may seek to reconfigure healthcare provision for people who use drugs to account for the interpersonal, psychological, and social factors identified, which appear to precipitate NFOD.Trial registration: Not applicable

Strategic Management

This Grants Collection for Strategic Management was created under a Round Two ALG Textbook Transformation Grant. Affordable Learning Georgia Grants Collections are intended to provide faculty with the frameworks to quickly implement or revise the same materials as a Textbook Transformation Grants team, along with the aims and lessons learned from project teams during the implementation process. Documents are in .pdf format, with a separate .docx (Word) version available for download. Each collection contains the following materials: Linked Syllabus Initial Proposal Final Reporthttps://oer.galileo.usg.edu/business-collections/1002/thumbnail.jp

Pharmacy-led implementation of evidence based medicine in primary care : Evaluating Diuretics in Usual Care study (EVIDENCE)

Introduction Obtaining evidence of comparative effectiveness and safety of widely prescribed drugs in a timely cost-effective way is emerging as a major global challenge for healthcare systems. The Evaluating Drugs in Normal Care (EVIDENCE) programme addresses this challenge through novel methodology. We describe an exemplar pilot study comparing thiazide type diuretics for hypertension. Method Patients prescribed either indapamide or bendroflumethiazide for hypertension were identified in each primary care practice recruited. Random allocation of a prescribing policy for one or other of these drugs was then applied to the whole practice and where required repeat prescriptions were switched to comply with randomised policy. Patients were informed of the potential switch by letter with the option to discuss further with the study team and/or opt-out of the switch. Routinely collected hospitalization and death data in NHS will be used to compare cardiovascular event rates between the two policies. Results We found bendroflumethiazide was prescribed to 78% of patients prescribed either of these drugs despite recent NICE preference for indapamide. 29 primary care practices in 5 Scottish NHS boards were recruited and 14 randomised to indapamide and 15 to bendroflumethiazide creating a study population of 5985 patients. Less than 0.23% of patients opted out. Conclusion This pilot study demonstrated the feasibility and cost efficiency of the EVIDENCE approach. A relatively large study was generated rapidly with negligible disruption to practice workflows. EVIDENCE methodology offers a novel way to compare the effectiveness of a wide range of medicines where there is clinical equipoise.Non peer reviewe

Cluster randomised trials of prescribing policy:an ethical approach to generating drug safety evidence? A discussion of the ethical application of a new research method

For most chronic medical conditions, multiple medications are available and prescribers often have limited evidence about which therapy is likely to be the most effective and safe for an individual patient. As many patients are exposed every day to medicines that may be less effective than available alternatives, this is of public health importance. Cluster randomised trials of prescribing policy offer an opportunity to rapidly obtain evidence of comparative effectiveness and safety. These trials can pose a low risk to patients and cause minimal disruption to usual care. Despite the potential scientific value of this approach, there remain valid concerns about consent, medication switching and the use of routinely collected data in research. We discuss these concerns with reference to an ongoing pilot study (Evaluating Diuretics in Normal Care (EVIDENCE) - a cluster randomised evaluation of hypertension prescribing policy, ISRCTN 46635087, registered 11 August 2017)

Evaluating Diuretics in Normal Care (EVIDENCE):Protocol of a cluster randomised controlled equivalence trial of prescribing policy to compare the effectiveness of thiazide-type diuretics in hypertension

Abstract Introduction Healthcare systems must use treatments that are effective and safe. Regulators licensed many currently used older medications before introducing the stringent evidential requirements imposed on modern treatments. Also, there has been little encouragement to carry out within-class, head-to-head comparisons of licensed medicines. For commonly prescribed drugs, even small differences in effectiveness or safety could have significant public health implications. However, conventional clinical trials that randomise individual subjects are costly and unwieldy. Such trials are also often criticised as having low external validity. We describe an approach to rapidly generate externally valid evidence of comparative safety and effectiveness using the example of two widely used diuretics for the management of hypertension. Methods and analysis The EVIDENCE (Evaluating Diuretics in Normal Care) study has a prospective, cluster-randomised, open-label, blinded end-point design. By randomising prescribing policy in primary care practices, the study compares the safety and effectiveness of commonly used diuretics in treating hypertension. Participating practices are randomised 1:1 to a policy of prescribing either indapamide or bendroflumethiazide when clinically indicated. Suitable patients who are not already taking the policy diuretic are switched accordingly. All patients taking the study medications are written to explaining the rationale for changing the prescribing policy and notifying them they can opt-out of any switch. The prescribing policies’ effectiveness and safety will be compared using rates of major adverse cardiovascular events (hospitalisation with myocardial infarction, heart failure or stroke or cardiovascular death), routinely collected in national healthcare administrative datasets. The study will seek to recruit 250 practices to provide a study population of approximately 50,000 individuals with a mean follow-up time of two years. A primary intention-to-treat time-to-event analysis will be used to estimate the relative effect of the two policies. Ethics and dissemination EVIDENCE has been approved by the East of Scotland Research Ethics Service (17/ES/0016, current approved protocol version 5, 26 August 2021). The results will be disseminated widely in peer reviewed journals, guideline committees, National Health Service (NHS) organisations and patient groups. Trial registration ISRCTN 46635087 . Registered on 11 August 2017 (pre-recruitment)