Barriers to engagement at UCL

This case study considers the views of ten University College London (UCL) staff about hard to reach students. Staff were chosen so as to give an insight into the issue for different types of engagement: academic, support, union activities and volunteering. Focusing on these types of engagement together confirms that part-time students face barriers to engaging in many aspects of university life and that all students face barriers to some aspect of university life. This paper also draws attention to the potential risks inherent in focusing on hard-to-reach students as an approach to improving inclusivity. It also raises the issue of how barriers to inclusion interact and whether we should be considering staff engagement alongside student engagement

Which Lenses Best Help us Make our Practices Inclusive?

In this opinion piece, we draw on staff interviews reported on elsewhere in this issue (Marie et al, 2017) to argue that it is important to consider both characteristics of students and the provision that can make them hard to reach. We believe that the concept of hard to reach groups is useful for identifying potential barriers. Whilst it is useful to consider whom provision is designed for and whether that is appropriate, we also need to recognise that the students it is designed for may still face significant barriers to engaging with it

Development and dissemination of blended learning in civil engineering education: a comprehensive approach

This paper describes the development and dissemination of a blended learning module template, based on WebCT Vista. The learning environment designed aims to facilitate the emergence of an active Community of Inquiry leading to deep and meaningful learning. The modular design of the template takes into account the loaded schedules of busy engineering lecturers and it allows them to improve course materials and to develop new learning scenarios to fit the learners' needs, in an easy and flexible way. The authors note that e-learning tools are but one of the means of providing a successful learning experience. Other influential parameters in the learning environment (e.g. teaching and facilitating skills) should be adapted to the demands of blended learning. The template has been designed using the requirements imposed from three perspectives: pedagogical, techno-social, and organisational. It is believed that a comprehensive approach is necessary to the success of the dissemination of blended learning within Civil Engineering education

Ketamine in the management of cancer pain: reply to K. Jackson et al and W. Leppert

We thank Jackson et al and Leppert for the opportunity to respond to their concerns regarding our article. Our main point of contention is the belief, on the part of Jackson et al, that unblinded, nonrandomized, prospective audits can give a true indication of the efficacy or toxicity of a drug. Open-label studies do not meet the specific scientific definition of control. The gross underestimation and overestimation of effects in uncontrolled trials, especially studies that involve small numbers of participants, have been well documented. This issue is particularly emphasized by the high placebo response rate (27%) demonstrated in our blinded, randomized controlled trial

Phase III randomised double-blind controlled trial of oral risperidone, haloperidol or placebo with rescue subcutaneous midazolam for delirium management in palliative care

Aims: Guidelines recommend targeted use of antipsychotics in delirium for specific symptoms however this approach has not been evaluated in randomised trials. To compare the efficacy of risperidone relative to placebo in the control of specific delirium symptoms in palliative care patients (communica- tion, behaviour and/or perceptual disturbances on Nursing Delirium Screening Scale) at 72 hours after study commence- ment. Secondary aims were to compare haloperidol and placebo; and risperidone and haloperidol. Methods: Dose titration occurred twice daily to effect by predefined increments to maximum 4 mg (2 mg if \u3e65). All participants had delirium precipitants managed and non- pharmacological measures. Subcutaneous midazolam rescue was available. Improvement of delirium symptoms was assessed using linear regression (average of scores on day 4), adjusted for baseline score and group. Survival between groups was assessed using the log rank test, and midazolam use by Chi squared test. Results: The trial recruited to its full sample (239 partici- pants) - 80 risperidone; 79 haloperidol; and 80 placebo. For the primary intention-to-treat analysis (with 50 resamples drawn) between risperidone and placebo (n = 160) the risperidone group had significantly greater specific delirium symptoms on average at study end, 0.57 (95% CI 0.17, 0.98, p = 0.006) than the placebo group. The haloperidol group also had significantly greater specific delirium symptoms at study end than the placebo group, 0.29 (95% CI 0.11, 0.48, p = 0.002). In a pooled analysis, those on antipsychotics had a significant reduction in survival compared to placebo (p = 0.026). Midazolam rescue use was markedly lower in placebo group vs antipsychotics on each study day, 18.2 vs. 31.3% (day 1), p = 0.035, 15.9 vs. 29.0% (day 2), p = 0.031 and 13.6 vs. 29.6% (day 3), p = 0.016. Conclusions: This adequately powered study has shown indi- vidualised management of delirium precipitants and non- pharmacological strategies results in better control of delirium symptoms without the need for midazolam rescue and better survival, than seen with the addition of risperidone or haloperidol. These results fundamentally challenge the pharmacological approach to manage delirium

Clinical and genetic characteristics of late-onset Huntington's disease

Background: The frequency of late-onset Huntington's disease (>59 years) is assumed to be low and the clinical course milder. However, previous literature on late-onset disease is scarce and inconclusive. Objective: Our aim is to study clinical characteristics of late-onset compared to common-onset HD patients in a large cohort of HD patients from the Registry database. Methods: Participants with late- and common-onset (30–50 years)were compared for first clinical symptoms, disease progression, CAG repeat size and family history. Participants with a missing CAG repeat size, a repeat size of ≤35 or a UHDRS motor score of ≤5 were excluded. Results: Of 6007 eligible participants, 687 had late-onset (11.4%) and 3216 (53.5%) common-onset HD. Late-onset (n = 577) had significantly more gait and balance problems as first symptom compared to common-onset (n = 2408) (P <.001). Overall motor and cognitive performance (P <.001) were worse, however only disease motor progression was slower (coefficient, −0.58; SE 0.16; P <.001) compared to the common-onset group. Repeat size was significantly lower in the late-onset (n = 40.8; SD 1.6) compared to common-onset (n = 44.4; SD 2.8) (P <.001). Fewer late-onset patients (n = 451) had a positive family history compared to common-onset (n = 2940) (P <.001). Conclusions: Late-onset patients present more frequently with gait and balance problems as first symptom, and disease progression is not milder compared to common-onset HD patients apart from motor progression. The family history is likely to be negative, which might make diagnosing HD more difficult in this population. However, the balance and gait problems might be helpful in diagnosing HD in elderly patients

Reduced Cancer Incidence in Huntington's Disease: Analysis in the Registry Study

Background: People with Huntington's disease (HD) have been observed to have lower rates of cancers. Objective: To investigate the relationship between age of onset of HD, CAG repeat length, and cancer diagnosis. Methods: Data were obtained from the European Huntington's disease network REGISTRY study for 6540 subjects. Population cancer incidence was ascertained from the GLOBOCAN database to obtain standardised incidence ratios of cancers in the REGISTRY subjects. Results: 173/6528 HD REGISTRY subjects had had a cancer diagnosis. The age-standardised incidence rate of all cancers in the REGISTRY HD population was 0.26 (CI 0.22-0.30). Individual cancers showed a lower age-standardised incidence rate compared with the control population with prostate and colorectal cancers showing the lowest rates. There was no effect of CAG length on the likelihood of cancer, but a cancer diagnosis within the last year was associated with a greatly increased rate of HD onset (Hazard Ratio 18.94, p < 0.001). Conclusions: Cancer is less common than expected in the HD population, confirming previous reports. However, this does not appear to be related to CAG length in HTT. A recent diagnosis of cancer increases the risk of HD onset at any age, likely due to increased investigation following a cancer diagnosis