Effectiveness of granular columns in containing settlement

Laboratory-based research studies and full-scale evaluations of the behaviour of ground improved with granular columns are ample regarding bearing capacity, but limited in respect to the settlement response. This paper presents a laboratory model study that considers the settlement performance of isolated pad footings bearing on reinforced sand deposits under the influence of a fluctuating groundwater table. This is a particularly onerous condition for loose sand deposits in coastal areas which may undergo significant collapse settlement over time. Loose and dense experimental sand beds were constructed and the performance of rigid footings under a maintained load and bearing on sand incorporating different column configurations were monitored under cycling of the water table over a period of 28 days, with one filling/empting cycle every 18 h. It was found that settlement, while greatly reduced compared with unreinforced footings, was ongoing and typically occurred at a much greater rate for loose sand than dense sand. Also, settlement rates were slightly higher for fully penetrating than partially penetrating columns and also for footings reinforced by a column group rather than a single column. This was attributed to the migration of sand grains into the larger column voids.

Effectiveness of the Construction Management Courses

This research assesses the effectiveness of current MSc. Construction Project Management programmes within the UK and Ireland. A review of published prospectuses is used to create questionnaires for universities, graduates and employers. Responses provide an insight into programme creation and their relative success in addressing the needs of industry and in achieving other educational objectives. Since the majority of learning institutions have attained professional accreditation, it is useful to review these awards and to assess their potential value to both graduates and industry alike. Interviews are conducted with representatives from the main professional accrediting bodies to understand their procedures and rigour in enforcing standards of education and training. The results show that project management education could be further enhanced by the inclusion of more practical learning and that current programmes place greater emphasis on hard skills at the expense of the softer human skills. There is clearly a need for a closer working relationship between academics and practitioners to tackle the perceived gap between theoretical learning and construction practice. Learning institutions can use the findings to improve their programmes and address the education deficiencies identified by the industry, by the professional institutions and by graduates.

Assessment of the effectiveness of the guard ring in obtaining a uni-directional flow in an in situ water permeability test

The non-destructive evaluation of the water permeability of concrete structures is a long standing challenge, principally due to the difficulty of achieving a uni-direction flow for computing the water permeability coefficient. The use of a guard ring (GR) was originally proposed for the in situ sorptivity test, but little information can be found for the water permeability test. In this study, the effect of a GR was carefully examined through the flow simulation, which was verified by carrying out experiments. It was observed that the GR can confine the flow near the surface, but cannot achieve a uni-directional flow across the whole depth of flow. To achieve a better performance, it is essential to consider the effects of the size of the inner seal and the GR and the significant interaction between these two. The analysis of the experimental data has indicated that the GR influences the flow for porous concretes, but there is no significant effect for dense concretes. Further investigation, validated using the flow-net theory, has shown a strong correlation between the water permeability coefficients obtained with the GR (K w-GR) and without it (K w-No GR), suggesting that one dimensional flow is not essential for interpreting data for site tests. Another practical issue was that more than 30 % of the tests with GR failed due to the difficulty of achieving a good seal between the inner and the outer chambers. Based on the work reported in this paper, a new water permeability test is proposed.

First steps: study protocol for a randomized controlled trial of the effectiveness of the Group Family Nurse Partnership (gFNP) program compared to routine care in improving outcomes for high-risk mothers and their children and preventing abuse

Background: Evidence from the USA suggests that the home-based Family Nurse Partnership program (FNP), extending from early pregnancy until infants are 24 months, can reduce the risk of child abuse and neglect throughout childhood. FNP is now widely available in the UK. A new variant, Group Family Nurse Partnership (gFNP) offers similar content but in a group context and for a shorter time, until infants are 12 months old. Each group comprises 8 to 12 women with similar expected delivery dates and their partners. Its implementation has been established but there is no evidence of its effectiveness.

Methods/Design: The study comprises a multi-site randomized controlled trial designed to identify the benefits of gFNP compared to standard care. Participants (not eligible for FNP) must be either aged <20 years at their last menstrual period (LMP) with one or more previous live births, or aged 20 to 24 at LMP with low educational qualifications and no previous live births. 'Low educational qualifications' is defined as not having both Maths and English Language GCSE at grade C or higher or, if they have both, no more than four in total at grade C or higher. Exclusions are: under 20 years and previously received home-based FNP and, in either age group, severe psychotic mental illness or not able to communicate in English. Consenting women are randomly allocated (minimized by site and maternal age group) when between 10 and 16 weeks pregnant to either to the 44 session gFNP program or to standard care after the collection of baseline information. Researchers are blind to group assignment. The primary outcomes at 12 months are child abuse potential based on the revised Adult-Adolescent Parenting Inventory and parent/infant interaction coded using the CARE Index based on a video-taped interaction. Secondary outcomes are maternal depression, parenting stress, health related quality of life, social support, and use of services.

Discussion: This is the first study of the effectiveness of gFNP in the UK. Results should inform decision-making about its delivery alongside universal services, potentially enabling a wider range of families to benefit from the FNP curriculum and approach to supporting parenting.

A lesson in business: cost-effectiveness analysis of a novel financial incentive intervention for increasing physical activity in the workplace

Background: Recently both the UK and US governments have advocated the use of financial incentives to encourage healthier lifestyle choices but evidence for the cost-effectiveness of such interventions is lacking. Our aim was to perform a cost-effectiveness analysis (CEA) of a quasi-experimental trial, exploring the use of financial incentives to increase employee physical activity levels, from a healthcare and employer’s perspective.

Methods: Employees used a ‘loyalty card’ to objectively monitor their physical activity at work over 12 weeks. The Incentive Group (n=199) collected points and received rewards for minutes of physical activity completed. The No Incentive Group (n=207) self-monitored their physical activity only. Quality of life (QOL) and absenteeism were assessed at baseline and 6 months follow-up. QOL scores were also converted into productivity estimates using a validated algorithm. The additional costs of the Incentive Group were divided by the additional quality adjusted life years (QALYs) or productivity gained to calculate incremental cost effectiveness ratios (ICERs). Cost-effectiveness acceptability curves (CEACs) and population expected value of perfect information (EVPI) was used to characterize and value the uncertainty in our estimates.

Results: The Incentive Group performed more physical activity over 12 weeks and by 6 months had achieved greater gains in QOL and productivity, although these mean differences were not statistically significant. The ICERs were £2,900/QALY and £2,700 per percentage increase in overall employee productivity. Whilst the confidence intervals surrounding these ICERs were wide, CEACs showed a high chance of the intervention being cost-effective at low willingness-to-pay (WTP) thresholds.

Conclusions: The Physical Activity Loyalty card (PAL) scheme is potentially cost-effective from both a healthcare and employer’s perspective but further research is warranted to reduce uncertainty in our results. It is based on a sustainable “business model” which should become more cost-effective as it is delivered to more participants and can be adapted to suit other health behaviors and settings. This comes at a time when both UK and US governments are encouraging business involvement in tackling public health challenges.

Bogeymen, lunatics and fanatics: collective actions and the private enforcement of European competition law

The European desire to ensure that bearers of EU rights are adequately compensated for any infringement of these rights, particularly in cases where the harm is widely diffused, and perhaps not even noticed by those affected by it, collides with another desire: to avoid the perceived excesses of an American-style system of class actions. The excesses of these American class actions are in European discourse presented as a sort of bogeyman, which is a source of irrational fear, often presented by parental or other authority figures. But when looked at critically, the bogeyman disappears. In this paper, I examine the European (and UK) proposals for collective action. I compare them to the American regime. The flaws and purported excesses of the American regime, I argue, are exaggerated. A close, objective examination of the American regime shows this. I conclude that it is not the mythical bogeyman of a US class action that is the barrier to effective collective redress; rather, the barriers to effective, wide-ranging group actions lie within European legal culture and traditions, particularly those mandating individual control over litigation.

The link between the learning organisation and curriculum innovation:A comparative study of public and private primary schools in Greece

This article examines the relationship between the learning organisation and the implementation of curriculum innovation within schools. It also compares the extent of innovative activity undertaken by schools in the public and the private sectors. A learning organisation is characterised by long-term goals, participatory decision-making processes, collaboration with external stakeholders, effective mechanisms for the internal communication of knowledge and information, and the use of rewards for its members. These characteristics are expected to promote curriculum innovation, once a number of control factors have been taken into account. The article reports on a study carried out in 197 Greek public and private primary schools in the 1999-2000 school year. Structured interviews with school principals were used as a method of data collection. According to the statistical results, the most important determinants of the innovative activity of a school are the extent of its collaboration with other organisations (i.e. openness to society), and the implementation of development programmes for teachers and parents (i.e. communication of knowledge and information). Contrary to expectations, the existence of long-term goals, the extent of shared decision-making, and the use of teacher rewards had no impact on curriculum innovation. The study also suggests that the private sector, as such, has an additional positive effect on the implementation of curriculum innovation, once a number of human, financial, material, and management resources have been controlled for. The study concludes by making recommendations for future research that would shed more light on unexpected outcomes and would help explore the causal link between variables in the research model.

The role of private care in the interval between diagnosis and treatment of breast cancer in Northern Ireland: an analysis of Registry data

Objective: To examine the differences in the interval between diagnosis and initiation of treatment among women with breast cancer in Northern Ireland.

Design: A cross-sectional observational study.
Setting: All breast cancer care patients in the Northern Ireland Cancer Registry in 2006.
Participants: All women diagnosed and treated for breast cancer in Northern Ireland in 2006.
Main outcome measure: The number of days between diagnosis and initiation of treatment for breast cancer.

Results: The mean (median) interval between diagnosis and initiation of treatment among public patients was 19 (15) compared with 14 (12) among those whose care involved private providers. The differences between individual public providers were as marked as those between the public and private sector - the mean (median) ranging between 14 (12) and 25 (22) days. Multivariate models revealed that the differences were evident when a range of patient characteristics were controlled for including cancer stage.

Conclusions: A relatively small number of women received care privately in Northern Ireland but experienced shorter intervals between diagnosis and initiation of treatment than those who received care wholly in the public system. The variation among public providers was as great as that between the public and private providers. The impact of such differences on survival and in light of waiting time targets introduced in Northern Ireland warrants investigation.

Effectiveness of a programme of exercise on physical function in survivors of critical illness following discharge from the ICU: study protocol for a randomised controlled trial (REVIVE)

Background: Following discharge home from the ICU, patients often suffer from reduced physical function, exercise capacity, health-related quality of life and social functioning. There is usually no support to address these longer term problems, and there has been limited research carried out into interventions which could improve patient outcomes. The aim of this study is to investigate the effectiveness and cost-effectiveness of a 6-week programme of exercise on physical function in patients discharged from hospital following critical illness compared to standard care.

Methods/Design: The study design is a multicentre prospective phase II, allocation-concealed, assessor-blinded, randomised controlled clinical trial. Participants randomised to the intervention group will complete three exercise sessions per week (two sessions of supervised exercise and one unsupervised session) for 6 weeks. Supervised sessions will take place in a hospital gymnasium or, if this is not possible, in the participants home and the unsupervised session will take place at home. Blinded outcome assessment will be conducted at baseline after hospital discharge, following the exercise intervention, and at 6 months following baseline assessment (or equivalent time points for the standard care group). The primary outcome measure is physical function as measured by the physical functioning subscale of the Short-Form-36 health survey following the exercise programme. Secondary outcomes are health-related quality of life, exercise capacity, anxiety and depression, self efficacy to exercise and healthcare resource use. In addition, semi-structured interviews will be conducted to explore participants’ perceptions of the exercise programme, and the feasibility (safety, practicality and acceptability) of providing the exercise programme will be assessed. A within-trial cost-utility analysis to assess the cost-effectiveness of the intervention compared to standard care will also be conducted.

Discussion: If the exercise programme is found to be effective, this study will improve outcomes that are meaningful to patients and their families. It will inform the design of a future multicentre phase III clinical trial of exercise following recovery from critical illness. It will provide useful information which will help the development of services for patients after critical illness.

Collaborative evolution: the context surrounding the formation and the effectiveness of a school partnership in a divided community in Northern Ireland

This paper examines an initiative promoting collaboration between schools located in a city setting in Northern Ireland, which is broadly divided along ethnic and political lines. The schools involved, like the vast majority of schools in Northern Ireland, educate Protestant and Catholic children separately. This presents particular challenges for school collaboration as it implies the establishment of new, connected relationships in an education system, which is historically and contemporaneously more characterised by division. Since 2007, the schools in this study have been involved in an education initiative which promotes cross-sectoral shared learning in core areas of the curriculum with a view to promoting school improvement; the additional, indirect goal is also about improving community relations. However, over this period, the relationship between the institutions has deepened, leading schools to examine how they can sustain partnership and evolve collaborative practice. This paper explores how the partnership has evolved and assesses its effectiveness as a collaborative enterprise. The paper concludes by demonstrating how effective collaboration between schools in Northern Ireland mitigates the potentially negative impacts of educating children separately, but also how effective models of school collaboration are capable of providing enhanced learning opportunities for pupils and are also capable of developing the communities in which they are located.

A Non-Inferiority Randomized Controlled Trial Comparing the Clinical Effectiveness of Anesthesia Obtained by Application of a Novel Topical Anesthetic Putty With the Infiltration of Lidocaine for the Treatment of Lacerations in the Emergency Department

We test the hypothesis that anesthesia, measured as pain scores, induced by a novel topical anesthetic putty is non-inferior (margin=1.3) to that provided by conventional lidocaine infiltration for the repair of lacerations.

Relative Biological Effectiveness Variation Along Monoenergetic and Modulated Bragg Peaks of a 62-MeV Therapeutic Proton Beam: A Preclinical Assessment

iological optimization of proton therapy critically depends on detailed evaluation of relative biological effectiveness (RBE) variations along the Bragg curve. The clinically accepted RBE value of 1.1 is an oversimplification, which disregards the steep rise of linear energy transfer (LET) at the distal end of the spread-out Bragg peak. We observed significant cell killing RBE variations dependent on beam modulation, intrinsic radiosensitivity, and LET in agreement with the LEM predicted values, indicating dose-averaged LET as a suitable parameter for biological effectiveness. Data have also been used to validate a RBE parameterized model.