Master of Science

thesisMaterials that have feature sizes on the mesoscale present unique properties based on diffusion and chemical reactions. Despite the breadth of work done in this area, there is little work done connecting biological mesostructures and the well-developed inorganic mesoporous materials. This thesis presents work done on mesostructured and mesoporous materials to connect biological mesostructures to the field of inorganic mesoporous materials. Specifically, we have developed novel methods for making self-assembled biological-inorganic mesoporous composites, densified mesoporous solids, and investigated tunability of mesostructured biological emulsions (cubosomes). Cubosomes were investigated for tunability of the lattice parameter via addition of a designer peptide and was characterized by cryogenic transmission electron microscopy and small-angle x-ray scattering, which revealed a swelling of the lattice parameter and the appearance of a hexagonal phase at low peptide concentrations. Self-assembled biological-inorganic composite materials was shown to possess order on the mesoscale when observed by transmission electron microscopy and were loaded with Rhodamine B. Fluorescence studies revealed successful loading of the dye and changes in the salt or acid concentration unloaded the dye. SBA-type silica was densified while maintaining mesoporosity using spark plasma sintering and proof of principle were done to illustrate how these materials could be chemically modified into semiconductors relevant to energy applications

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

A cultural approach to a Canadian tragedy: the Indian residential schools as a sacred enterprise

For over a century, the Canadian state funded a church-run system of residential schools designed to assimilate Aboriginal children into Euro-Canadian culture. In addition to the problems associated with its ethnocentric philosophy, the school system was also characterised by terrible health conditions and physical and sexual abuse of the students was widespread. Recently, the schools have been the object of the most successful struggle for redress in Canadian history. One particularly puzzling aspect about the school system is that it persisted for so long, despite that many of its failings were known very early in its operation. In this article, this puzzle is addressed via a cultural analysis of a political struggle over the residential schools that occurred within Canadian Anglicanism at the outset of the twentieth century. The article concludes that the meaning of the school system as a sacred enterprise contributed to its persistence

The Role of Teacher Regulatory Talk in Students’ Self-Regulation Development Across Cultures

This study is the first to explore the contribution of different types of teacher regulatory talk—directive, guiding, and autonomy supportive talk—in children's development of self‐regulation across cultures. Teacher‐to‐student talk was analyzed under naturalistic conditions in eight Year 4 classrooms, all situated in different primary schools in England (student N = 25) and Chile (N = 24). Self‐regulation was studied by observing students’ effective metacognitive monitoring (awareness of errors) and effective metacognitive control (effective control of problems) in a series of 11–13 cube assembly tasks. Mann–Whitney U tests showed that English participants demonstrated higher levels of effective metacognitive monitoring and control, and participating teachers a similar level of teacher regulatory talk across cultures. The function that regulatory talk had in predicting students’ self‐regulation, however, tended to vary according to culture. OLS multiple regressions revealed that while guiding talk had the same positive effect across cultures, directive talk had a negative effect in England but null effect in Chile, and autonomy supportive talk had a positive effect in Chile but negative in England. These results indicate that it would be valuable to explore further the culturally adaptive functionality of teacher talk for students’ self‐regulation development

The wet, the wild and the domesticated: The Mesolithic-Neolithic transition on the West coast of Scotland

Models of the Mesolithic-Neolithic transition in Britain in recent years have tended to downplay the role of changes in the subsistence economy, emphasizing a very gradual adoption of new domesticated resources. This view has been particularly pervasive for the west coast of Scotland, which in the context of Britain presents a relatively marginal environment for farming. In this article, we challenge this too-quickly emerging orthodoxy through the presentation and discussion of both new and previously published stable isotope data and AMS dates. The palaeodietary information, while limited, strongly suggests a very rapid and complete change in the subsistence economy coincident with the earliest manifestations of the Neolithic on the west coast of Scotland early in the fourth millennium cal. BC. Whatever explanation is invoked to account for the transition needs to engage with the isotopic data. The possibility of colonization at some level needs to be seriously reconsidered