Coastal road asset management: Dealing with uncertainty using quantitative erosion monitoring and modelling

The A183 is an essential transportation link in the northeast UK that joins coastal areas from South Shields to Sunderland. The route runs through the hinterland of Marsden Bay and concerns have been raised about the proximity of the road to the eroding cliff line. The Shoreline Management Plan (Lane and Guthrie, 2007) sets out the overarching management policy in the area and, based on the analyses of historic map data, uses projected coastal cliff retreat rates of 0.1 – 0.2 m a-1, although more recent investigations have suggested the rates may be nearer 0.04 – 0.1 m a-1. Quantitative data on the true rates and nature of cliff erosion are scarce and asset management decisions typically use the higher rate of 0.2 m a-1 when considering the potential impact on road operations and lifespan in order to account for uncertainty and future sea-level rise; which is additionally used to accelerate the predicted rates of retreat. Consequently, an enhanced high order estimate of cliff erosion rates has restricted the serviceability of the A183 to within 20 – 50 years, and there are three areas (pinch points) of particular concern where the close proximity of the cliff line threatens the safe operation of the road. This approach and the data it uses suggest that significant and potentially costly decisions may soon be required to ensure the viability of this vital transport corridor. Set against the context of assumed high cliff erosion rates, and further predicted increases to this metric, this work presents the results of a re-evaluation of existing map and aerial imagery data that highlights the typically high uncertainty associated with historic map data. The errors often exceed the changes being detected in rock cliffs, producing contradictory results and variability in processing and interpretation that restricts the reliability of the data used in current policy decisions. Using a significance-based analysis, questions are raised about how appropriate it is to reduce a three-dimensional recession process down to a single linear retreat. To provide a more appropriate and accurate assessment of the erosion occurring here we present the results of a monitoring approach of the Marsden Bay site using three-dimensional survey analyses to improve understanding of cliff failures at the site and ultimately to aid policy decisions

Decoding Complex Erosion Responses for the Mitigation of Coastal Rockfall Hazards Using Repeat Terrestrial LiDAR

A key factor limiting our understanding of rock slope behavior and associated geohazards is the interaction between internal and external system controls on the nature, rates, and timing of rockfall activity. We use high-resolution, monthly terrestrial light detection and ranging (LiDAR) surveys over a 2 year monitoring period to quantify rockfall patterns across a 0.6 km-long (15.3 × 103 m2) section of a limestone rock cliff on the northeast coast of England, where uncertainty in rates of change threaten the effective planning and operational management of a key coastal cliff top road. Internal system controls, such as cliff material characteristics and foreshore geometry, dictate rockfall characteristics and background patterns of activity and demonstrate that layer-specific analyses of rockfall inventories and sequencing patterns are essential to better understand the timing and nature of rockfall risks. The influence of external environmental controls, notably storm activity, is also evaluated, and increased storminess corresponds to detectable rises in both total and mean rockfall volume and the volumetric contribution of large (>10 m3) rockfalls at the cliff top during these periods. Transient convergence of the cumulative magnitude–frequency power law scaling exponent (ɑ) during high magnitude events signals a uniform erosion response across the wider cliff system that applies to all lithologies. The tracking of rockfall distribution metrics from repeat terrestrial LiDAR in this way demonstrably improves the ability to identify, monitor, and forecast short-term variations in rockfall hazards, and, as such, provides a powerful new approach for mitigating the threats and impacts of coastal erosion

Exile Vol. XLV No. 2

43rd Year Title Page 3 Epigraph by Ezra Pound 5 Table of Contents 7 Contributors Notes 74-75 Editorial Board 76 INTERVIEWS The Art of Hearing: Interview with Stanley Plumly by Alison Stine \u2700 23-27 ART Self-Portrait by Angela Bliss \u2799 8 For a Living by Angela Bliss \u2799 12 Untitled by Frazier Taylor \u2702 22 Untitled by Amy Deaner \u2799 29 Perfect Knee by David Tulkin \u2701 34 Untitled by Amy Deaner \u2799 43 Still Light by Angela Bliss \u2799 62 Hiding Nature by Amy Deaner \u2799 64 Self-Portrait A by Sarah Leyrer \u2701 73 POETRY Bolted Back by Michelle Grindstaff \u2702 9 Squall by Georgia Riepe \u2702 10 Loaves and Fishes by Maeghan Demmons \u2701 11 World Cafe by Katie Kroner \u2701 28 Gurney Surfer by Tom Hankinson \u2702 31 Japanese Beetles by Alison Stine \u2700 32-33 Shoveling by Bekah Taylor \u2700 40 Tobacco Country by K. Moore \u2701 41 Winton Place by Rachel Colina \u2702 42 Bottom of the Ninth by Michelle Grindstaff \u2702 61 Fall Burning by Alison Stine \u2700 63 rocking by Bekah Taylor \u2700 71 The Armor of the Beach by Georgia Riepe \u2702 72 PROSE In the Aisles of the Night by Tom Dussel \u2701 13-21 From Those Uninvolved by Justin Walker \u2799 30 Frame by Paul Durica \u2700 35-39 The Rose by Rachel Bolton \u2799 44-60 Stop at the Soldier by Hillary Campbell \u2700 65-70 All submissions are reviewed on an anonymous basis, and all editorial decisions are shared equally among the members of the Editorial Board. -76 Cover Art Untitled by Kris Lewis \u2799 / Back Cover Art Figure 25 by Todd Gys \u2799 -76 Printed by Printing Arts Press -7

‘Trying to pin down jelly’ - exploring intuitive processes in quality assessment for meta-ethnography

Background: Studies that systematically search for and synthesise qualitative research are becoming more evident in health care, and they can make an important contribution to patient care. However, there is still no agreement as to whether, or how we should appraise studies for inclusion. We aimed to explore the intuitive processes that determined the ‘quality’ of qualitative research for inclusion in qualitative research syntheses. We were particularly interested to explore the way that knowledge was constructed. Methods: We used qualitative methods to explore the process of quality appraisal within a team of seven qualitative researchers funded to undertake a meta-ethnography of chronic non-malignant musculoskeletal pain. Team discussions took place monthly between October 2010 and June 2012 and were recorded and transcribed. Data was coded and organised using constant comparative method. The development of our conceptual analysis was both iterative and collaborative. The strength of this team approach to quality came from open and honest discussion, where team members felt free to agree, disagree, or change their position within the safety of the group. Results: We suggest two core facets of quality for inclusion in meta-ethnography - (1) Conceptual clarity; how clearly has the author articulated a concept that facilitates theoretical insight. (2) Interpretive rigour; fundamentally, can the interpretation ‘be trusted?’ Our findings showed that three important categories help the reader to judge interpretive rigour: (ii) What is the context of the interpretation? (ii) How inductive is the interpretation? (iii) Has the researcher challenged their interpretation? Conclusions: We highlight that methods alone do not determine the quality of research for inclusion into a meta-ethnography. The strength of a concept and its capacity to facilitate theoretical insight is integral to meta-ethnography, and arguably to the quality of research. However, we suggest that to be judged ‘good enough’ there also needs to be some assurance that qualitative findings are more than simply anecdotal. Although our conceptual model was developed specifically for meta-ethnography, it may be transferable to other research methodologies

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Obeticholic acid for the treatment of non-alcoholic steatohepatitis: interim analysis from a multicentre, randomised, placebo-controlled phase 3 trial

Background Non-alcoholic steatohepatitis (NASH) is a common type of chronic liver disease that can lead to cirrhosis. Obeticholic acid, a farnesoid X receptor agonist, has been shown to improve the histological features of NASH. Here we report results from a planned interim analysis of an ongoing, phase 3 study of obeticholic acid for NASH. Methods In this multicentre, randomised, double-blind, placebo-controlled study, adult patients with definite NASH,non-alcoholic fatty liver disease (NAFLD) activity score of at least 4, and fibrosis stages F2–F3, or F1 with at least oneaccompanying comorbidity, were randomly assigned using an interactive web response system in a 1:1:1 ratio to receive oral placebo, obeticholic acid 10 mg, or obeticholic acid 25 mg daily. Patients were excluded if cirrhosis, other chronic liver disease, elevated alcohol consumption, or confounding conditions were present. The primary endpointsfor the month-18 interim analysis were fibrosis improvement (≥1 stage) with no worsening of NASH, or NASH resolution with no worsening of fibrosis, with the study considered successful if either primary endpoint was met. Primary analyses were done by intention to treat, in patients with fibrosis stage F2–F3 who received at least one dose of treatment and reached, or would have reached, the month 18 visit by the prespecified interim analysis cutoff date. The study also evaluated other histological and biochemical markers of NASH and fibrosis, and safety. This study is ongoing, and registered with ClinicalTrials.gov, NCT02548351, and EudraCT, 20150-025601-6. Findings Between Dec 9, 2015, and Oct 26, 2018, 1968 patients with stage F1–F3 fibrosis were enrolled and received at least one dose of study treatment; 931 patients with stage F2–F3 fibrosis were included in the primary analysis (311 in the placebo group, 312 in the obeticholic acid 10 mg group, and 308 in the obeticholic acid 25 mg group). The fibrosis improvement endpoint was achieved by 37 (12%) patients in the placebo group, 55 (18%) in the obeticholic acid 10 mg group (p=0·045), and 71 (23%) in the obeticholic acid 25 mg group (p=0·0002). The NASH resolution endpoint was not met (25 [8%] patients in the placebo group, 35 [11%] in the obeticholic acid 10 mg group [p=0·18], and 36 [12%] in the obeticholic acid 25 mg group [p=0·13]). In the safety population (1968 patients with fibrosis stages F1–F3), the most common adverse event was pruritus (123 [19%] in the placebo group, 183 [28%] in the obeticholic acid 10 mg group, and 336 [51%] in the obeticholic acid 25 mg group); incidence was generally mild to moderate in severity. The overall safety profile was similar to that in previous studies, and incidence of serious adverse events was similar across treatment groups (75 [11%] patients in the placebo group, 72 [11%] in the obeticholic acid 10 mg group, and 93 [14%] in the obeticholic acid 25 mg group). Interpretation Obeticholic acid 25 mg significantly improved fibrosis and key components of NASH disease activity among patients with NASH. The results from this planned interim analysis show clinically significant histological improvement that is reasonably likely to predict clinical benefit. This study is ongoing to assess clinical outcomes

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

BACKGROUND: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. METHODS: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). FINDINGS: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29-146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0- 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25-1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39-1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65-1·60]; p=0·92). INTERPRETATION: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention. FUNDING: British Heart Foundation

Cost-effective erosion monitoring of coastal cliffs

Structure-from-motion with multi-view stereo methods (SfM-MVS) hold the potential for monitoring and quantifying cliff erosion to levels of accuracy and precision which rival terrestrial laser scanning (TLS) and at a fraction of the cost. We benchmark repeat SfM-MVS against TLS for quantifying rock fall frequency, volume, and cliff face erosion rates for a ∼1km section of coastal cliffs where cliff top infrastructure is threatened by erosion. First, we address a major unknown in these techniques, the number and configuration of control points. Surveys demonstrate that a sparse configuration along the cliff base and top, at spacing equivalent to the cliff height, provides suitable accuracy at acceptable logistic time and expense. Second, we show that SfM-MVS models match equivalent TLS data to within 0.04m, and that the correlation between intersecting TLS- and SfM-derived rock fall volumes improves markedly above a detection threshold of 0.07m3. Rock falls below this size threshold account for ∼77.7% of detected rock falls but only 1.9% of the calculated annual eroded volume. Annual erosion rates for the 1km cliff face as calculated by repeat TLS and SfM differencing are 0.6×10−2m a−1 and 0.7×10−2m a−1, respectively. Kilometre-scale patterns of cliff erosion are dominated by localised zones of high-magnitude, episodic failure that are over an order of magnitude greater than background rates. The ability of non-specialist engineers, geologists, geomorphologists and managers to rapidly capture high quality, accurate erosion data in a cost-effective manner through repeat SfM-MVS has significant potential to inform coastal managers and decision makers. To further empower coastal authorities and communities, policy frameworks must be developed to incorporate and interpret these data