Discriminating Between Spatial and Temporal Variations in Seismic Anisotropy at Active Volcanoes

This thesis addresses the measurement and interpretation of seismic anisotropy around active volcanoes via shear wave splitting analysis. An overpressured magma reservoir will exert a stress on the surrounding country rock that may or may not be manifest as observable strain. Shear wave splitting analysis can be a useful indicator of stress in the crust and hence, the pressure induced by magma movement. Changes in shear wave splitting have already been observed at Mt. Ruapehu following eruptions in 1995/1996 and are inferred to be caused by changes in local stress in response to magma pressure. One of the main problems with the interpretation of temporal changes in shear wave splitting is the possibility of spatial variations being sampled along differing raypaths and being interpreted as temporal changes. Using a dense observational network and an automated shear wave splitting analysis, we examine local earthquakes occurring in 2008 within 100 km of Mt. Ruapehu. We note a strong azimuthal dependence of the fast direction of anisotropy (phi) and so introduce a spatial averaging technique and a two-dimensional tomography of recorded delay times (dt), to observe the spatial variation in more detail. Using this new method of mapping shear wave splitting parameters, we have created a benchmark of spatial variations in shear wave anisotropy around Mt. Ruapehu, against which future temporal changes may be measured. The observed anisotropy is used to define regions in which phi agrees with stress estimations from focal mechanism inversions, suggesting stress-induced anisotropy, and those in which phi aligns with structural features such as fault strikes, suggesting structural anisotropy. Data from past deployments of three-component seismometers have been analysed in the same way as those recorded during the 2008 experiment and the results compared. We identify a stable region of strong anisotropy, interpreted to be caused by schistose mineral alignment, and a transient region of strong anisotropy centred on the volcano during the major magmatic eruption of 1995. We also introduce a method of analysing temporal variations in seismic anisotropy at active volcanoes by using tight clusters of earthquakes and highly correlated multiplets. At Mt. Ruapehu, changes in shear wave splitting parameters associated with the 2006 and 2007 phreatic eruptions are detected using a cluster of earthquakes to the west of the volcano. Similar analyses using another cluster and multiplets from the stable region of strong anisotropy do not reveal temporal changes, although examination of the waveform codas of the repeating earthquakes reveals systematic changes that we interpret as being caused by seismic scatterers associated with the 2006 and 2007 eruptions. These scatterers appear to contaminate the shear wave coda and so inhibit the detection of any subtle changes in shear wave splitting parameters. Finally, we apply some of these methods to data from the 2008 eruption of Okmok volcano, Alaska. Shear wave splitting analysis at Okmok reveals a change in anisotropy associated with the 2008 eruption. This change however, is attributed to a change in dominant hypocentre location. Multiplet analysis at Okmok volcano reveals a similar scatterer contamination of the shear wave arrival. This spurious phase is interpreted to be an S to P conversion from interaction with the magma reservoir

Exploring and evaluating the War Widows InTouch (WW.it) Programme

Experiences of loneliness and social isolation through widowhood are complex and compounded by military bereavement. Digital technology is one method to facilitate social connection, with social interaction being considered as one of the central motivations for older adults being online (Age UK, 2015; Büchi, Just, & Latzer, 2016; Cotten, Anderson, & McCullough, 2013).The use of technology has become central to many of our lives through the COVID-19 pandemic, not only for social connection, but for work, education, shopping, and online banking etc. However, the issue of digital exclusion deters some individuals from using technology to connect with others, either through lack of access (internet access and access to digital devices), lack of skills (and confidence), or not recognising the tangible outcomes individuals perceive from using the internet (Blank & Groselj, 2014; Scheerder, van Deursen, & van Dijk, 2017; van Deursen & Helsper, 2015).The War Widows InTouch (WW.it) programme provided members of the War Widows’ Association (WWA) with iPads and/or iPad training to empower individuals digitally, and to support the development of new skills to connect with others online. The WW.it project aimed to connect members of the WWA across the UK, as well as improve their digital access, digital confidence, and digital skills.This study was carried out independently, aiming to explore and evaluate the implementation and running of the WW.it programme. Specifically, this study aimed to examine the perceived impact of the intervention(s) from the perspective of participants and the instructor, reflect on the perceived facilitators and barriers to implementing the intervention(s), and map perceived changes to social isolation, loneliness, and well-being.The study was carried out across two phases, using both surveys and interviews. In total, 35 participants partook in Phase one (35 completed surveys, and 17 also participated in interviews), and 28 participants took part in Phase two (28 completed surveys, and 12 also participated in interviews). At Phase two, an interview was also conducted with the instructor leading the WW.it training programme.Three themes were generated from Phase one, with survey data integrated throughout the interview findings to highlight pertinent points. The same process was completed for Phase two where a further three themes were generated.Findings demonstrated the benefits of the WW.it programme in improving access to technology and internet connectivity. The iPad training itself led to improved skills and increased confidence, as well as reduced fear around using the iPad; although some did not develop as many skills as they had believed they would before starting training and fear of scamming and online financial affairs remained for many.In Phase one, many participants did not recognise the potential benefits of the iPad as they had no prior experience of using one, however, once they were supported to use this device for their own interests during training, they were able to see how this technology could benefit them, and their own daily living. The personalised learning and programme content supported individuals to recognise tangible outcomes from using the internet. Through this, there were widespread advantages to using the iPad, including enhanced civic participation and social connection. A Wilcoxon Signed Ranks Test showed significant reduction of total loneliness scores following receipt of the iPad and the iPad training. There were no further significant effects observed for social isolation, technological use, or attitudes towards technology.Whilst the WW.it training session was useful for many participants, this was just a launchpad to their learning. Individuals spoke of seeking additional learning opportunities to further enhance their skills and knowledge. Whereas others continued to rely upon friends and family to support them in unfamiliar or financial digital tasks.As part of this project, a reflective tool for delivering digital skills to older adults was developed through the systematic narrative review. This was developed to use when delivering digital skills training programmes for older adults. It focuses specifically upon the negative perceptions of ageing, the learning environment, and the value of technology. The WW.it programme took into account all three of these values, however, lessons can be learned moving forward. This tool can be used by practitioners when reflecting on programme delivery, as well as when evaluating digital skills delivery programmes.Recommendations for practice:Several recommendations were developed from the findings of this study.1. Multiple practical recommendations for digital skills training arose from this study and are recommended for consideration in future delivery programmes aimed at older adults:• Shorter sessions spread across several weeks• Face-to-face, group classes• Importance of demystifying the technology through debunking jargon• Importance of reducing fear of using the system• Focus on accessibility settings• Personalised learning and content2. Training across multiple systems (e.g. Kindles or Android devices) was difficult for the instructor and not always beneficial for the learner. It is recommended, for future programmes, that training focusses upon one system only. This will also support peer-learning between individuals on the programme using the same device.3. Online training allowed for individuals to participate in the WW.it programme from across the UK, however, this geographical dispersal would have been difficult if training was done face-to-face. Therefore, one recommendation for this project would be to roll out training regionally, through peers, or Regional Organisers at the WWA. This would group learners together to benefit from face-to-face, peer-supported learning.4. Multiple participants suggested having training materials to accompany the training, whether this was a paper handout, online aide-memoires, or a recording of the session. One recommendation was to include bitesize help sheets on the WWA members area. This would encourage use of the WWA website and members area, as well as supporting individuals to improve and practise their digital skills. Other organisations could provide similar materials on their own website, provide learners with paper handouts, or online handouts via email.5. Signposting information should be provided by organisations for learners to seek further training once the programme is completed. This could be through local digital champions, national digital organisations, textbooks, or online-only resources.6. It is recommended that organisations utilise the reflective tool when implementing and/or running programmes to improve older adults’ digital skills. Ensuring that the three core areas of the tool are met is fundamental for inclusive, supportive, and empowering digital skills training.a. Following on from this, one drawback for participants was often their own perceptions of ageing. It is recommended that organisations and instructors recognise the importance of this in their learning, and place emphasis on individual learning styles, through use of the reflective tool for delivering digital skills to older adults

Evaluation of a community awareness programme to reduce delays in referrals to early intervention services and enhance early detection of psychosis.

BACKGROUND: Reducing treatment delay and coercive pathways to care are accepted aims for Early Intervention Services (EIS) for people experiencing first episode psychosis but how to achieve this is unclear. A one-year community awareness programme was implemented in a London EIS team, targeting staff in non-health service community organisations. The programme comprised psycho-educational workshops and EIS link workers, and offering direct referral routes to EIS. Its feasibility and its impact on duration of untreated psychosis and pathways to EIS were evaluated. METHODS: Evaluation comprised: pre and post questionnaires with workshop participants assessing knowledge and attitudes to psychosis and mental health services; and a comparison of new service users' "service DUP"(time from first psychotic symptom to first contact with EIS) and pathways to care in the intervention year and preceding year. Focus groups sought stakeholders' views regarding the benefits and limitations of the programme and what else might promote help-seeking. RESULTS: 41 workshops at 36 community organisations were attended by 367 staff. 19 follow up workshops were conducted and 16 services were allocated an EIS link worker. Participants' knowledge and attitudes to psychosis and attitudes to mental health services improved significantly following workshops. In the year of the intervention, only 6 of 110 new service users reached EIS directly via community organisations. For all new referrals accepted by EIS, in the intervention year compared to the previous year, there was no difference in mean or median service DUP. A clear impact on pathways to care could not be discerned. Stakeholders suggested that barriers to referral remained. These included: uncertainty about the signs of early psychosis, disengagement by young people when becoming unwell, and worries about stigma or coercive treatment from mental health services. More general, youth focused, mental health services were proposed. CONCLUSIONS: The community awareness programme did not reduce treatment delays for people experiencing first episode psychosis. Further research is needed regarding effective means to reduce duration of untreated psychosis. Although EIS services are guided to promote access through community engagement, this may not be an effective use of their limited resources. TRIAL REGISTRATION: Current Controlled Trial ISRCTN98260910 Registered 19th May 2010

Development and Psychometric Properties of Surveys to Assess Provider Perspectives on the Barriers and Facilitators of Effective Care Transitions

Background The quality of the discharge process and effective care transitions between settings of care are critical to minimize gaps in patient care and reduce hospital readmissions. Few studies have explored which care transition components and strategies are most valuable to patients and providers. This study describes the development, pilot testing, and psychometric analysis of surveys designed to gain providers’ perspectives on current practices in delivering transitional care services. Methods We underwent a comprehensive process to develop items measuring unique aspects of care transitions from the perspectives of the three types of providers (downstream, ambulatory, and hospital providers). The process involved 1) an environmental scan, 2) provider interviews, 3) survey cognitive testing, 4) pilot testing, 5) a Stakeholder Advisory Group, 6) a Scientific Advisory Council, and 7) a collaborative Project ACHIEVE (Achieving Patient-Centered Care and Optimized Health in Care Transitions by Evaluating the Value of Evidence) research team. Three surveys were developed and fielded to providers affiliated with 43 hospitals participating in Project ACHIEVE. Web-based survey administration resulted in 948 provider respondents. We assessed response variability and response missingness. To evaluate the composites’ psychometric properties, we examined intercorrelations of survey items, item factor loadings, model fit indices, internal consistency reliability, and intercorrelations between the composite measures and overall rating items. Results Results from psychometric analyses of the three surveys provided support for five composite measures: 1) Effort in Coordinating Patient Care, 2) Quality of Patient Information Received, 3) Organizational Support for Transitional Care, 4) Access to Community Resources, and 5) Strength of Relationships Among Community Providers. All factor loadings and reliability estimates were acceptable (loadings ≥ 0.40, α ≥ 0.70), and the fit indices showed a good model fit. All composite measures positively and significantly correlated with the overall ratings (0.13 ≤ r ≤ 0.71). Conclusions We determined that the items and composite measures assessing the barriers and facilitators to care transitions within this survey are reliable and demonstrate satisfactory psychometric properties. The instruments may be useful to healthcare organizations and researchers to assess the quality of care transitions and target areas of improvement across different provider settings

A Highly Stable Blood Meal Alternative for Rearing \u3cem\u3eAedes\u3c/em\u3e and \u3cem\u3eAnopheles\u3c/em\u3e Mosquitoes

We investigated alternatives to whole blood for blood feeding of mosquitoes with a focus on improved stability and compatibility with mass rearing programs. In contrast to whole blood, an artificial blood diet of ATP-supplemented plasma was effective in maintaining mosquito populations and was compatible with storage for extended periods refrigerated, frozen, and as a lyophilized powder. The plasma ATP diet supported rearing of both Anopheles and Aedes mosquitoes. It was also effective in rearing Wolbachia-infected Aedes mosquitoes, suggesting compatibility with vector control efforts

Conference Report: Carnival of Invention

In this report we present a reflection on the Collaborative Poetics Network's first "Carnival of Invention" which was held on 15th June 2018 at the University of Brighton, England. Collaborative poetics is an arts-based research method that brings together expertise from artists, academics, and community participants, to share knowledge and promote social change through engaging and accessible ways. On the day of the Carnival over 40 contributors from around the world came to participate in a series of workshops, presentations, installations and displays. In this article we outline the themes addressed on the day and the media utilized in these interactive and experiential sessions. We argue that this event supported the benefits of arts-based research in developing, analyzing, and communicating rich data sets. Finally, we provide evaluation and reflections from the event (including in haiku, a traditional Japanese form of poetry), in an attempt to creatively capture the events of the day

Implementation of the StandingTall programme to prevent falls in older people:a process evaluation protocol

INTRODUCTION: One in three people aged 65 years and over fall each year. The health, economic and personal impact of falls will grow substantially in the coming years due to population ageing. Developing and implementing cost-effective strategies to prevent falls and mobility problems among older people is therefore an urgent public health challenge. StandingTall is a low-cost, unsupervised, home-based balance exercise programme delivered through a computer or tablet. StandingTall has a simple user-interface that incorporates physical and behavioural elements designed to promote compliance. A large randomised controlled trial in 503 community-dwelling older people has shown that StandingTall is safe, has high adherence rates and is effective in improving balance and reducing falls. The current project targets a major need for older people and will address the final steps needed to scale this innovative technology for widespread use by older people across Australia and internationally. METHODS AND ANALYSIS: This project will endeavour to recruit 300 participants across three sites in Australia and 100 participants in the UK. The aim of the study is to evaluate the implementation of StandingTall into the community and health service settings in Australia and the UK. The nested process evaluation will use both quantitative and qualitative methods to explore uptake and acceptability of the StandingTall programme and associated resources. The primary outcome is participant adherence to the StandingTall programme over 6 months. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the South East Sydney Local Health District Human Research Ethics Committee (HREC reference 18/288) in Australia and the North West- Greater Manchester South Research Ethics Committee (IRAS ID: 268954) in the UK. Dissemination will be via publications, conferences, newsletter articles, social media, talks to clinicians and consumers and meetings with health departments/managers. TRIAL REGISTRATION NUMBER: ACTRN12619001329156

“It’s all about asking from those who have walked the path”: Patient and stakeholder perspectives on how peers may shift substance use stigma in HIV care in South Africa

South Africa has the highest number of people with HIV (PWH) globally and a significant burden of co-occurring substance use disorder (SUD). Health care worker (HCW) stigma towards SUD is a key barrier to HIV care engagement among PWH with SUD. Support from peers—individuals with lived experience of SUD—may be a promising solution for addressing SUD stigma, while also improving engagement in HIV care. We evaluated the perceived acceptability of integrating a peer role into community-based HIV care teams as a strategy to address SUD stigma at multiple levels and improve patient engagement in HIV care. Patients and stakeholders (N = 40) were recruited from publicly-funded HIV and SUD organizations in Cape Town, South Africa. We conducted a quantitative assessment of stigma among stakeholders using an adapted Social Distance Scale (SDS) and patient perceptions of working with a peer, as well as semi-structured interviews focused on experiences of SUD stigma, acceptability of a peer model integrated into community-based HIV care, and potential peer roles. On the SDS, 75% of stakeholders had high stigma towards a patient with SUD, yet 90% had low stigma when in recovery for at least 2 years. All patients endorsed feeling comfortable talking to someone in recovery and wanting them on their HIV care team. Three main themes emerged from the qualitative data: (1) patient-reported experiences of enacted SUD and HIV stigmas were common and impacted HIV care engagement; (2) both patients and stakeholders considered a peer model highly acceptable for integration into HIV care to support engagement and address SUD stigma; and (3) patients and stakeholders identified both individual-level and systems-level roles for peers, how peers could work alongside other providers to improve patient care, and key characteristics that peers would need to be successful in these roles. Findings from this formative work point to the promise of a peer model for reducing SUD stigma among patients and HCWs within community-based HIV care teams in SA.https://doi.org/10.1186/s13722-022-00330-

The international generalisability of evidence for health policy: a cross country comparison of medication adherence following policy change

Copayments for prescriptions may increase morbidity and mortality via reductions in adherence to medications. Relevant data can inform policy to minimise such unintended effects. We explored the generalisability of evidence for copayments by comparing two international copayment polices, one in Massachusetts and one in Ireland, to assess whether effects on medication adherence were comparable. We used national prescription data for public health insurance programmes in Ireland and Medicaid data in the U.S. New users of oral anti-hypertensive, anti-hyperlipidaemic and diabetic drugs were included (total n = 14,259 in U.S. and n = 43,843 in Ireland). We examined changes in adherence in intervention and comparator groups in each setting using segmented linear regression with generalised estimating equations. In Massachusetts, a gradual decrease in adherence to anti-hypertensive medications of −1% per month following the policy occurred. In contrast, the response in Ireland was confined to a −2.9% decrease in adherence immediately following the policy, with no further decrease over the 8 month follow-up. Reductions in adherence to oral diabetes drugs were larger in the U.S. group in comparison to the Irish group. No difference in adherence changes between the two settings for anti-hyperlipidaemic drugs occurred. Evidence on cost-sharing for prescription medicines is not ‘one size fits all’. Time since policy implementation and structural differences between health systems may influence the differential impact of copayment policies in international settings