The adaptation of the education profession in identifying radicalisation in schools. A review of the evidence and observations from a cohort of educators and prevent practioners

This thesis examines how the educational profession has adapted to the role of identifying extremism in the classroom. It explores how in a liberal, secular democracy, a security policy, Prevent, has been wrapped in the language of safeguarding and implemented as such. The Prevent duty was made a statutory requirement under the Counter Terrorism and Security Act 2015 in which responsible authorities must have due regard for those at risk of radicalisation. This research explores the lived experiences and assessments of a cohort of Designated Safeguarding Leads and senior school leaders. It further asks a group of Prevent practitioners, whose responsibility it is to investigate claims of vulnerability and concerns of extremism, how they see the adoption of the duty by educationalists. The thesis looks at a portion of the published literature which focuses its attention on Prevent in the classroom, which questions the educational professional about how the policy is working in their school. Through a series of semi-structured questioned interviews, this thesis seeks to understand the feelings of those tasked to have due regard for young people vulnerable to extremism. Finally it asks whether they think the Prevent duty achieves its aims. The analysis of responses indicates a profession comfortable with the Prevent duty and their role within it. It shows how educationalists and practitioners have worked together in understanding each other’s perspectives, but feel there is more to do and understand. This thesis concludes that the Prevent duty has been legitimised and normalised into school safeguarding policies. The terminology adopted emulates that of other safeguarding procedures and provides common ground for educator and Prevent investigator. It is now part of every day school life, its effectiveness imprecise and it remains a complex theory in the eyes of educationalists and practitioners

Predictors of Overtesting in Pulmonary Embolism Diagnosis

© 2019 Background: The benefits of computed tomography pulmonary angiography (CTPA) for pulmonary embolism (PE) diagnosis must be weighed against its risks, radiation-induced malignancy, and contrast-induced nephropathy. Appropriate use of CTPA can be assessed by monitoring yield, the percentage of tests positive for PE. We identify factors that are associated low CTPA yield, which may predict overtesting. Methods: This was a retrospective cohort study of six emergency departments between June 2014 and February 2017. The electronic health record was queried for CTPAs ordered for adult patients in the emergency department. We assessed the following patient factors: age, gender, body mass index, number of comorbidities, race, and ethnicity, provider factors: type (resident, fellow, attending, physician assistant) and environment factors: test time of day, season of visit, and crowdedness of the department. Results: A total of 14,782 CTPAs were reviewed, of which 1366 were found to be positive for PE, resulting in an overall CTPA yield of 9.24%. Provider type was not associated with a difference in yield. Testing was less likely to be positive in younger patients, females, those with lower body mass indexes and those identifying as Asian or Hispanic. Testing was also less likely to be positive when ordered during the overnight shift and during the winter and spring seasons. Conclusion: Our study identified several patient and environmental factors associated with low CTPA yield suggesting potential targets for overtesting. Targeting education and clinical decision support to assist providers in these circumstances may meaningfully improve yields

Study of an Acrylamide-based Photopolymer for use as a Holographic Data Storage Medium

An acrylamide-based photopolymer formulated in the Centre for Industrial and Engineering Optics has been investigated with a view to further optimisation for holographic optical storage. Series of 15 to 30 gratings were angularly multiplexed in a volume of the photopolymer layers with different thickness at a spatial frequency of 1500 lines/mm. Since the photopolymer is a saturable material, an exposure scheduling method was used to exploit the entire dynamic range of the material and allow equal strength gratings to be recorded. From this investigation the photopolymer layer’s M/# was determined with regard to the recording geometry used. The temporal stability of photopolymer layers was studied in terms of diffraction efficiency and change of the reconstructed angle due to material shrinkage. In addition, the potential of the photopolymer as a holographic data storage medium was demonstrated by recording bit data-pages

ATR-FTIR Spectroscopic Studies of Polymer-Based Identification Cards

Counterfeit production of polymer identity cards poses a significant economic cost to society and a threat to national security. Identifying these counterfeits is a challenge for ‘frontline’ personnel who lack training in specialised document examination. This study investigates the use of attenuated total reflectance Fourier Transform infrared (ATR-FTIR) spectroscopy with chemometrics as a potential approach to assessing polymer card authenticity. In situ analysis of several cards found that differentiation could be achieved based on the core polymer composition. A chemometric model was thus built for three driver’s licence series produced in Western Australia and tested using a separate set of seven licences. The majority of test samples were correctly matched to the series of issue, with atypical samples recognisable based on their discriminant values. Synchrotron FTIR imaging revealed that differentiation between each series was possibly related to the adhesive used between the core layers. The approach presented in this work has the potential to be developed as a rapid screening method to identify suspect polymer cards warranting further examination

Novel colours and the content of experience

I propose a counterexample to naturalistic representational theories of phenomenal character. The counterexample is generated by experiences of novel colours reported by Crane and Piantanida. I consider various replies that a representationalist might make, including whether novel colours could be possible colours of objects and whether one can account for novel colours as one would account for binary colours or colour mixtures. I argue that none of these strategies is successful and therefore that one cannot fully explain the nature of the phenomenal character of perceptual experiences using a naturalistic conception of representation

Why the idea of framework propositions cannot contribute to an understanding of delusions

One of the tasks that recent philosophy of psychiatry has taken upon itself is to extend the range of understanding to some of those aspects of psychopathology that Jaspers deemed beyond its limits. Given the fundamental difficulties of offering a literal interpretation of the contents of primary delusions, a number of alternative strategies have been put forward including regarding them as abnormal versions of framework propositions described by Wittgenstein in On Certainty. But although framework propositions share some of the apparent epistemic features of primary delusions, their role in partially constituting the sense of inquiry rules out their role in helping to understand delusions

CRISPR/Cas9-Induced fad2 and rod1 Mutations Stacked With fae1 Confer High Oleic Acid Seed Oil in Pennycress (Thlaspi arvense L.)

Pennycress (Thlaspi arvense L.) is being domesticated as an oilseed cash cover crop to be grown in the off-season throughout temperate regions of the world. With its diploid genome and ease of directed mutagenesis using molecular approaches, pennycress seed oil composition can be rapidly tailored for a plethora of food, feed, oleochemical and fuel uses. Here, we utilized Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)/Cas9 technology to produce knockout mutations in the FATTY ACID DESATURASE2 (FAD2) and REDUCED OLEATE DESATURATION1 (ROD1) genes to increase oleic acid content. High oleic acid (18:1) oil is valued for its oxidative stability that is superior to the polyunsaturated fatty acids (PUFAs) linoleic (18:2) and linolenic (18:3), and better cold flow properties than the very long chain fatty acid (VLCFA) erucic (22:1). When combined with a FATTY ACID ELONGATION1 (fae1) knockout mutation, fad2 fae1 and rod1 fae1 double mutants produced ∼90% and ∼60% oleic acid in seed oil, respectively, with PUFAs in fad2 fae1 as well as fad2 single mutants reduced to less than 5%. MALDI-MS spatial imaging analyses of phosphatidylcholine (PC) and triacylglycerol (TAG) molecular species in wild-type pennycress embryo sections from mature seeds revealed that erucic acid is highly enriched in cotyledons which serve as storage organs, suggestive of a role in providing energy for the germinating seedling. In contrast, PUFA-containing TAGs are enriched in the embryonic axis, which may be utilized for cellular membrane expansion during seed germination and seedling emergence. Under standard growth chamber conditions, rod1 fae1 plants grew like wild type whereas fad2 single and fad2 fae1 double mutant plants exhibited delayed growth and overall reduced heights and seed yields, suggesting that reducing PUFAs below a threshold in pennycress had negative physiological effects. Taken together, our results suggest that combinatorial knockout of ROD1 and FAE1 may be a viable route to commercially increase oleic acid content in pennycress seed oil whereas mutations in FAD2 will likely require at least partial function to avoid fitness trade-offs

Live usability testing of two complex clinical decision support tools: Observational study

© 2019 Journal of Medical Internet Research. All rights reserved. Background: Potential of the electronic health records (EHR) and clinical decision support (CDS) systems to improve the practice of medicine has been tempered by poor design and the resulting burden they place on providers. CDS is rarely tested in the real clinical environment. As a result, many tools are hard to use, placing strain on providers and resulting in low adoption rates. The existing CDS usability literature relies primarily on expert opinion and provider feedback via survey. This is the first study to evaluate CDS usability and the provider-computer-patient interaction with complex CDS in the real clinical environment. Objective: This study aimed to further understand the barriers and facilitators of meaningful CDS usage within a real clinical context. Methods: This qualitative observational study was conducted with 3 primary care providers during 6 patient care sessions. In patients with the chief complaint of sore throat, a CDS tool built with the Centor Score was used to stratify the risk of group A Streptococcus pharyngitis. In patients with a chief complaint of cough or upper respiratory tract infection, a CDS tool built with the Heckerling Rule was used to stratify the risk of pneumonia. During usability testing, all human-computer interactions, including audio and continuous screen capture, were recorded using the Camtasia software. Participants\u27 comments and interactions with the tool during clinical sessions and participant comments during a postsession brief interview were placed into coding categories and analyzed for generalizable themes. Results: In the 6 encounters observed, primary care providers toggled between addressing either the computer or the patient during the visit. Minimal time was spent listening to the patient without engaging the EHR. Participants mostly used the CDS tool with the patient, asking questions to populate the calculator and discussing the results of the risk assessment; they reported the ability to do this as the major benefit of the tool. All providers were interrupted during their use of the CDS tool by the need to refer to other sections of the chart. In half of the visits, patients\u27 clinical symptoms challenged the applicability of the tool to calculate the risk of bacterial infection. Primary care providers rarely used the incorporated incentives for CDS usage, including progress notes and patient instructions. Conclusions: Live usability testing of these CDS tools generated insights about their role in the patient-provider interaction. CDS may contribute to the interaction by being simultaneously viewed by the provider and patient. CDS can improve usability and lessen the strain it places on providers by being short, flexible, and customizable to unique provider workflow. A useful component of CDS is being as widely applicable as possible and ensuring that its functions represent the fastest way to perform a particular task

Rationale, design, and implementation protocol of an electronic health record integrated clinical prediction rule (iCPR) randomized trial in primary care

<p>Abstract</p> <p>Background</p> <p>Clinical prediction rules (CPRs) represent well-validated but underutilized evidence-based medicine tools at the point-of-care. To date, an inability to integrate these rules into an electronic health record (EHR) has been a major limitation and we are not aware of a study demonstrating the use of CPR's in an ambulatory EHR setting. The integrated clinical prediction rule (iCPR) trial integrates two CPR's in an EHR and assesses both the usability and the effect on evidence-based practice in the primary care setting.</p> <p>Methods</p> <p>A multi-disciplinary design team was assembled to develop a prototype iCPR for validated streptococcal pharyngitis and bacterial pneumonia CPRs. The iCPR tool was built as an active Clinical Decision Support (CDS) tool that can be triggered by user action during typical workflow. Using the EHR CDS toolkit, the iCPR risk score calculator was linked to tailored ordered sets, documentation, and patient instructions. The team subsequently conducted two levels of 'real world' usability testing with eight providers per group. Usability data were used to refine and create a production tool. Participating primary care providers (n = 149) were randomized and intervention providers were trained in the use of the new iCPR tool. Rates of iCPR tool triggering in the intervention and control (simulated) groups are monitored and subsequent use of the various components of the iCPR tool among intervention encounters is also tracked. The primary outcome is the difference in antibiotic prescribing rates (strep and pneumonia iCPR's encounters) and chest x-rays (pneumonia iCPR only) between intervention and control providers.</p> <p>Discussion</p> <p>Using iterative usability testing and development paired with provider training, the iCPR CDS tool leverages user-centered design principles to overcome pervasive underutilization of EBM and support evidence-based practice at the point-of-care. The ongoing trial will determine if this collaborative process will lead to higher rates of utilization and EBM guided use of antibiotics and chest x-ray's in primary care.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov Identifier <a href="http://www.clinicaltrials.gov/ct2/show/NCT01386047">NCT01386047</a></p