Integrating technology to increase graduate employability skills: A blockchain case study in Property Law teaching

The discourse of graduate employability skills includes emphasis on digital capabilities. Digital capabilities encompass an understanding of the new and emerging technologies that are driving significant change in business, government and society and by implication, the critical and creative thinking skills to integrate these contexts with the law. By contrast, the accredited law curriculum remains focussed on doctrine thus frequently relegating consideration of law and technology to discrete (elective) subjects. Further, the default method of teaching and learning doctrine remains a case method approach using hypothetical problems. Such an approach to curriculum is, at best, neutral about the relevance of new technologies and the skills required to analyse them in a legal context with consequences for contemporary and likely future employer expectations for law graduates to be prepared for practice. This article first establishes the imperative to incorporate digital contexts into the core law curriculum as a means of providing students with foundational skills for a changing workplace. Secondly, it presents the case for an enhanced approach to teaching legal problem solving. Beyond the backward-looking hypothetical fact scenario, it suggests that a future focused analytical mindset is integral to the lawyer’s suite of thinking tools. Finally, it provides a case study of a critical—and doctrinal—analysis of a recent proposal to fractionalise lots in a Torrens system in tandem with a blockchain. The case study illustrates the application of an enhanced problem-solving approach. It shows how the broader context of new technologies might be integrated into property law teaching through prospective problem-solving

Tree Fern Apical Temperatures at the Royal Botanic Garden Edinburgh

Tree ferns are difficult to maintain out of doors in the British Isles except in western localities, where winter temperatures are moderated by the North Atlantic Drift, or in places where buildings provide a clement microclimate. The present study of tree-fern apical temperatures during winter was carried out on five trunked specimens of Dicksonia antarctica that had been grown satisfactorily out of doors for several years, while planted in the ground of a courtyard at the Royal Botanic Garden Edinburgh (RBGE). The plants were never wrapped or otherwise protected with thermal insulation during the winter months. An electric thermometer was inserted into the apical cleft of each plant in November 2003, and weekly readings of minimum and maximum temperature taken until April 2004. The ambient temperature of the air in the courtyard was similarly recorded and compared with the screen and grass temperatures at the RBGE weather station in the main botanic garden. The lowest grass and screen temperatures were respectively -11.2°C and -7.1°C, whereas the lowest courtyard and fern-apical temperatures were respectively -3.2°C and -0.8°C. Thus in the coldest period of that winter there was over 10°C difference in temperature between ground level in the main garden and a tree fern apical cleft in the sheltered courtyard. The tree ferns were not noticeably damaged by exposure of the apical cleft region to just below freezing point on a few occasions and the fronds stayed green. The five individual plants differed considerably in trunk height, diameter and volume. Regression analysis revealed that there was a significantly increasing thermal-insulating effect in the apical cleft associated with larger trunk diameters and volumes. The RBGE weather station temperatures during the winter of 2003-4 were unexceptional when compared with records from the previous 19 years. Thus the data from 2003-4 may be taken as representing a typical recent winter for this Edinburgh location. This study highlights the benefits of having detailed temperature measurements when assessing the winter-protective capabilities of a particular micro—environment for a semi-hardy species such as D. antarctica

Late Holocene Paleoclimate reconstruction of the northern Gulf of Aqaba using foraminifera as a proxy

Title from PDF of title page, viewed on December 21, 2011Thesis advisor: Tina M. NiemiVitaIncludes bibliographic references (p. 112-119)Thesis (M.S.)--Dept. of Geosciences. University of Missouri-Kansas City, 2011A multiproxy analyses of sediment from a 4.3 m core extracted from 25 m water depth on the shelf of the northern Gulf of Aqaba suggest shifts in depositional environments over the past 4000 yrs. Foraminifera assemblages, grain-size distribution, sediment characterization, and radiocarbon age dating indicate several eco-stratigraphic zones including two periods of aridity from ~3900 to 2900 yr BP and ~1130 yr BP to present, a transitional period from ~2900 to 2500 yr BP, and an abrupt shift to wetter conditions between ~2500 to 1130 yr BP. Furthermore, this study records two foraminifera-barren horizons at 170 and 190 cm that correlate to grain size anomalies at that depth. A tsunami wave generated sometime during 2200-1800 yr BP is one possible explanation for this occurrence. Seismic stratigraphy indicates a reflector at approximately 3 m below the seafloor that delineates the boundary between a relict, coral fringing reef horizon, U8, and the overlying U9 strata. Sedimentation rates that adjust for sediment compaction suggest the sequence lies near the foraminifera-barren horizons at ~200 cm in the core. These data signify a dramatic environmental event possibly corresponding to reef termination on the Northern Gulf of Aqaba shelf.Introduction -- Study area -- Foraminifera -- Methods -- Results -- Discussion -- Conclusion -- Appendix A. Foraminifera spreadsheet -- Appendix B. Foraminifera graphs -- Appendix C. Grain size -- Appendix D. Matrix composition -- Appendix E. Core lithology and field descriptio

Anti-TNF therapy is associated with an increased risk of serious infections in patients with rheumatoid arthritis especially in the first 6 months of treatment: updated results from the British Society for Rheumatology Biologics Register with special emphasis on risks in the elderly

Objectives. To evaluate the risk of serious infections (SIs) in patients with RA treated with anti-TNF therapy with emphasis on the risk across different ages

The use of a risk assessment and decision support tool (CRISP) compared with usual care in general practice to increase risk-stratified colorectal cancer screening: study protocol for a randomised controlled trial.

BACKGROUND: Australia and New Zealand have the highest incidence rates of colorectal cancer worldwide. In Australia there is significant unwarranted variation in colorectal cancer screening due to low uptake of the immunochemical faecal occult blood test, poor identification of individuals at increased risk of colorectal cancer, and over-referral of individuals at average risk for colonoscopy. Our pre-trial research has developed a novel Colorectal cancer RISk Prediction (CRISP) tool, which could be used to implement precision screening in primary care. This paper describes the protocol for a phase II multi-site individually randomised controlled trial of the CRISP tool in primary care. METHODS: This trial aims to test whether a standardised consultation using the CRISP tool in general practice (the CRISP intervention) increases risk-appropriate colorectal cancer screening compared to control participants who receive standardised information on cancer prevention. Patients between 50 and 74 years old, attending an appointment with their general practitioner for any reason, will be invited into the trial. A total of 732 participants will be randomised to intervention or control arms using a computer-generated allocation sequence stratified by general practice. The primary outcome (risk-appropriate screening at 12 months) will be measured using baseline data for colorectal cancer risk and objective health service data to measure screening behaviour. Secondary outcomes will include participant cancer risk perception, anxiety, cancer worry, screening intentions and health service utilisation measured at 1, 6 and 12 months post randomisation. DISCUSSION: This trial tests a systematic approach to implementing risk-stratified colorectal cancer screening in primary care, based on an individual's absolute risk, using a state-of-the-art risk assessment tool. Trial results will be reported in 2020. TRIAL REGISTRATION: Australian and New Zealand Clinical Trial Registry, ACTRN12616001573448p . Registered on 14 November 2016

Intensive therapy for moderate established rheumatoid arthritis: the TITRATE research programme

BackgroundRheumatoid arthritis is a major inflammatory disorder and causes substantial disability. Treatment goals span minimising disease activity, achieving remission and decreasing disability. In active rheumatoid arthritis, intensive management achieves these goals. As many patients with established rheumatoid arthritis have moderate disease activity, the TITRATE (Treatment Intensities and Targets in Rheumatoid Arthritis ThErapy) programme assessed the benefits of intensive management.ObjectivesTo (1) define how to deliver intensive therapy in moderate established rheumatoid arthritis; (2) establish its clinical effectiveness and cost-effectiveness in a trial; and (3) evaluate evidence supporting intensive management in observational studies and completed trials.DesignObservational studies, secondary analyses of completed trials and systematic reviews assessed existing evidence about intensive management. Qualitative research, patient workshops and systematic reviews defined how to deliver it. The trial assessed its clinical effectiveness and cost-effectiveness in moderate established rheumatoid arthritis.SettingObservational studies (in three London centres) involved 3167 patients. These were supplemented by secondary analyses of three previously completed trials (in centres across all English regions), involving 668 patients. Qualitative studies assessed expectations (nine patients in four London centres) and experiences of intensive management (15 patients in 10 centres across England). The main clinical trial enrolled 335 patients with diverse socioeconomic deprivation and ethnicity (in 39 centres across all English regions).ParticipantsPatients with established moderately active rheumatoid arthritis receiving conventional disease-modifying drugs.InterventionsIntensive management used combinations of conventional disease-modifying drugs, biologics (particularly tumour necrosis factor inhibitors) and depot steroid injections; nurses saw patients monthly, adjusted treatment and provided supportive person-centred psychoeducation. Control patients received standard care.Main outcome measuresDisease Activity Score for 28 joints based on the erythrocyte sedimentation rate (DAS28-ESR)-categorised patients (active to remission). Remission (DAS28-ESR ResultsEvaluation of existing evidence for intensive rheumatoid arthritis management showed the following. First, in observational studies, DAS28-ESR scores decreased over 10–20 years, whereas remissions and treatment intensities increased. Second, in systematic reviews of published trials, all intensive management strategies increased remissions. Finally, patients with high disability scores had fewer remissions. Qualitative studies of rheumatoid arthritis patients, workshops and systematic reviews helped develop an intensive management pathway. A 2-day training session for rheumatology practitioners explained its use, including motivational interviewing techniques and patient handbooks. The trial screened 459 patients and randomised 335 patients (168 patients received intensive management and 167 patients received standard care). A total of 303 patients provided 12-month outcome data. Intention-to-treat analysis showed intensive management increased DAS28-ESR 12-month remissions, compared with standard care (32% vs. 18%, odds ratio 2.17, 95% confidence interval 1.28 to 3.68; p = 0.004), and reduced fatigue [mean difference –18, 95% confidence interval –24 to –11 (scale 0–100); p LimitationsThe main limitations comprised (1) using single time point remissions rather than sustained responses, (2) uncertainty about benefits of different aspects of intensive management and differences in its delivery across centres, (3) doubts about optimal treatment of patients unresponsive to intensive management and (4) the lack of formal international definitions of ‘intensive management’.ConclusionThe benefits of intensive management need to be set against its additional costs. These were relatively high. Not all patients benefited. Patients with high pretreatment physical disability or who were substantially overweight usually did not achieve remission.Future workFurther research should (1) identify the most effective components of the intervention, (2) consider its most cost-effective delivery and (3) identify alternative strategies for patients not responding to intensive management.Trial registrationCurrent Controlled Trials ISRCTN70160382.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 8. See the NIHR Journals Library website for further project information.NIH

Does intensive management improve remission rates in patients with intermediate rheumatoid arthritis? (the TITRATE trial): study protocol for a randomised controlled trial.

BACKGROUND: Uncontrolled active rheumatoid arthritis can lead to increasing disability and reduced quality of life over time. 'Treating to target' has been shown to be effective in active established disease and also in early disease. However, there is a lack of nationally agreed treatment protocols for patients with established rheumatoid arthritis who have intermediate disease activity. This trial is designed to investigate whether intensive management of disease leads to a greater number of remissions at 12 months. Levels of disability and quality of life, and acceptability and cost-effectiveness of the intervention will also be examined. METHODS: The trial is a 12-month, pragmatic, randomised, open-label, two-arm, parallel-group, multicentre trial undertaken at specialist rheumatology centres across England. Three hundred and ninety-eight patients with established rheumatoid arthritis will be recruited. They will currently have intermediate disease activity (disease activity score for 28 joints assessed using an erythrocyte sedimentation rate of 3.2 to 5.1 with at least three active joints) and will be taking at least one disease-modifying anti-rheumatic drug. Participants will be randomly selected to receive intensive management or standard care. Intensive management will involve monthly clinical reviews with a specialist health practitioner, where drug treatment will be optimised and an individualised treatment support programme delivered based on several principles of motivational interviewing to address identified problem areas, such as pain, fatigue and adherence. Standard care will follow standard local pathways and will be in line with current English guidelines from the National Institute for Health and Clinical Excellence. Patients will be assessed initially and at 6 and 12 months through self-completed questionnaires and clinical evaluation. DISCUSSION: The trial will establish whether the known benefits of intensive treatment strategies in active rheumatoid arthritis are also seen in patients with established rheumatoid arthritis who have moderately active disease. It will evaluate both the clinical and cost-effectiveness of intensive treatment. TRIAL REGISTRATION: Current Controlled Trials, ID: ISRCTN70160382 . Registered on 16 January 2014.MRC Funding: MC_UP_1302/3 NIHR Funding: RP-PG-0610-1006