The Construction of the A650 Bingley Relief Road Adjacent to an Unstable Tied Sheet Pile Retaining Structure

The proposed A650 Bingley Relief Road in West Yorkshire, UK, required the construction of a new dual carriageway to relieve traffic congestion in the town of Bingley. Part of the scheme involved constructing the road adjacent to an existing tied sheet pile wall, the “Canal Tied Wall” that had a history of movement. In this area the road passes over a kettlehole with peat and soft silts between 10 m and 14 m deep. The Canal Tied Wall forms the boundary between the realigned canal and the proposed new trunk road. It consists of two sets of steel sheet piles approximately 3.5 m apart with stainless steel tie-bars and mass concrete shear walls connecting them at the top. In May 1994 following the completion of the Canal Tied Wall construction and during excavation of material on the roadside of the wall, a 45 m length of wall moved horizontally in excess of 200 mm (into excavation) with associated maximum vertical movement at the top of the wall of 230 mm. The wall was monitored from 1994 until 2001 and subsequently through the construction of the new road. The Highways Agency\u27s requirement for the Canal Tied Wall was to carry out stabilisation works ....... together with any remedial works required to the structure to overcome current and future settlement problems . It was originally envisaged by the Highways Agency that a piled solution would be required. The basis of the Tender design was to reduce the load on the wall and hence stabilise the rate of movement towards the canal. The proposed design consisted of excavating the existing fill (originally placed at the time of construction of the wall) to a level about 0.8 m above its base, and constructing a reinforced earth wall with a gap between it and the sheet pile wall. The geotechnical solution that was eventually adopted was to reduce the load exerted on the wall by the ground behind it, and to surcharge the soft deposits to reduce long term settlements. The system adopted used a mass wall constructed of precast lightweight concrete blocks built behind the tied wall. This solution realised savings to the anticipated cost of the scheme whilst meeting the performance requirements of the specification. Numerical analysis was used to assess the anticipated performance of the ground, the existing structure, and the behaviour of the adjacent railway line during the construction operation and into the future. The lateral movements realised in practice were significantly smaller than those predicted using even relatively sophisticated modelling even though the modelling had been calibrated using data gathered during the advance works. This was as a result of changes to the construction sequence made on site. Whilst these were relatively minor the effect on the movements appears to have been significant. Interpretation of consolidation tests proved to be difficult even with the benefit of quite extensive settlement monitoring during and after the advance works. Several possible combinations of parameters gave an equally good fit to the data. The Observational Method was therefore adopted to provide a framework for adjusting the design during construction, subject to the observed behaviour of the ground. The flexibility this provided enabled necessary changes to the surcharge design to be made during construction, while maintaining control over the stability of the wall

Use of Semi-Structured Interviews to Explore Competing Demands in a Prostate Cancer Prevention Intervention Clinical Trial (PCPICT)

In this paper we report on findings from the first known study using qualitative methods to explore factors influencing physicians’ participation in an ongoing federally-funded prostate cancer chemoprevention clinical trial. We sought to identify ways to improve collaboration between researchers and physicians and enhance the success of future projects and employed purposive sampling to recruit physician/investigators who were involved or invited to participate in the trial. Using the data from open-ended semi-structured interviews, we examined patterns in their languaging and created themes. We found that individual and structural factors served as barriers and facilitators to participation. Willingness and desire to participate in the trial (individual factors) were not always enough to result in actual participation due to practice environment (structural) constraints. Our research provides a better understanding of the complex intersection of factors in this setting and through our findings we extend the theory of competing demands into the arena of prostate cancer prevention clinical trials, moving the science towards solutions to current challenges in recruitment to this type of trial

Making It Work: Health Care Provider Perspectives on Strategies to Increase Colorectal Cancer Screening in Federally Qualified Health Centers

OBJECTIVE: Colorectal cancer screening (CRCS) rates are low among men and women who seek health care at federally qualified health centers (FQHCs). This study explores health care providers' perspectives about their patient's motivators and impediments to CRCS and receptivity to preparatory education. METHODS: A mixed methods design consisting of in-depth interviews, focus groups, and a short survey. Setting: FQHCs in the Tampa Bay area. Participants: Seventeen health care providers practicing in FQHCs. RESULTS: Test-specific patient impediments and motivations were identified including fear of abnormal findings; importance of offering less invasive fecal occult blood tests; and need for patient-centered test-specific educational materials in clinics. Opportunities to improve provider practices were identified including providers' reliance on patients' report of symptoms as a cue to recommend CRCS and overemphasis of clinic-based guaiac stool tests. CONCLUSIONS: This study adds to the literature on CRCS test-specific motivators and impediments. Providers offered unique approaches for motivating patients to follow through with recommended CRCS and were receptive to in-clinic patient education and. Findings are readily inform the design of educational materials and interventions to increase CRCS in FQHCs

Understanding Cancer Worry Among Patients in a Community Clinic-Based Colorectal Cancer Screening Intervention Study

Background: To reduce colorectal cancer (CRC) screening disparities, it is important to understand correlates of different types of cancer worry among ethnically diverse individuals. Objectives: The current study examined the prevalence of three types of cancer worry (i.e., general cancer worry, CRC-specific worry, and worry about CRC test results) as well as sociodemographic and health-related predictors for each type of cancer worry. Methods: Participants were aged 50–75, at average CRC risk, nonadherent to CRC screening guidelines, and enrolled in a randomized controlled trial to increase CRC screening. Participants completed a baseline questionnaire assessing sociodemographics, health beliefs, healthcare experiences, and three cancer worry measures. Associations between study variables were examined with separate univariate and multivariable logistic regression models. Results: Responses from a total of 416 participants were used. Of these, 47% reported experiencing moderate-to-high levels of general cancer worry. Predictors of general cancer worry were salience and coherence (aOR = 1.1, 95% CI [1.0, 1.3]), perceived susceptibility (aOR = 1.2, 95% CI [1.1, 1.3), and social influence (aOR = 1.1, 95% CI [1.0, 0.1]). Fewer (23%) reported moderate-to-high levels of CRC-specific worry or CRC test worry (35%). Predictors of CRC worry were perceived susceptibility (aOR = 1.4, 95% CI [1.3, 1.6]) and social influence (aOR = 1.1, 95% CI [1.0, 1.2]); predictors of CRC test result worry were perceived susceptibility (aOR = 1.2, 95% CI [1.1, 1.3) and marital status (aOR = 2.0, 95% CI [1.1, 3.7] for married/partnered vs. single and aOR = 2.3, 95% CI [1.3, 4.1] for divorced/widowed vs. single). Discussion: Perceived susceptibility consistently predicted the three types of cancer worry, whereas other predictors varied between cancer worry types and in magnitude of association. The three types of cancer worry were generally predicted by health beliefs, suggesting potential malleability. Future research should include multiple measures of cancer worry and clear definitions of how cancer worry is measured