RHS Academic Journal

Academic Journal 2019

Contents The RHS Academic Journal

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EPQ

To What Extent Have Medical Advancements

Since the Early 20th Century Influenced the

Treatments of Thermal and Chemical Burns?

To What Extent Does the Prison System Work

to Rehabilitate Offenders in the UK?

6 15

IB Extended Essay

To What Extent Are There Gender Differences on the Efficacy of Pharmacological Treatments Compared to Psychological Treatment for Major Depressive Disorder?

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Talent 2030

An Investigation into How to Reduce the Amount of Black Plastic in Landfill

35

TED Talks

The Romanovs

45

My Research into the Colour Pink

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The Internet - a Drug Changing the Face of Terrorism

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The RHS Academic Journal In this first ever issue, we are delighted to showcase some of the outstanding academic work that has been carried out by our students over the past 2 years.

The Royal High School provides a wealth of opportunities for students to develop their academic curiosity, from specific subject projects, super curricular competitions and our challenging group work undertaken during the CREST award and The Festival of Ideas. In addition, The Aspire programme offers our students the chance to stretch and challenge their academic horizons, developing their skills in debating and synthesising information, interacting with current affairs and reflecting on issues of global perspective. Our bi-termly Aspire Lectures provide excellent forums for students to engage with academic topics outside of the curriculum.

Talent 2030 National Engineering Competition

The Extended Project Qualification

Last year, four Year 12 IB Physics students entered the Talent 2030 National Engineering Competition.

In Year 12, all A Level students attend weekly study skills lessons, with the option to complete an EPQ.

This competition invites girls to solve the major challenges of the 21st century, showing how engineering makes a difference to people and the planet.

Competition entries can be an original solution designed from scratch, or a piece of research about what engineers are currently doing to solve a challenge, which can be an issue in the local area, or something on a global scale The RHS physics students decided to investigate how to reduce the amount of black plastic in landfill.

The EPQ requires students to carry out research on a topic that they have chosen and is not covered by their other qualifications. They use this research to produce a written report and, in the case of practical projects, an artefact or production. A student can take inspiration from something studied in class or something completely unrelated to their studies. The EPQ allows students to extend their abilities beyond the A-level syllabus and prepare for university or their future career. It is worth half an A-level (28 UCAS points) so can be used to earn extra UCAS points.

There were over 300 entries to the competition, so the students were very surprised and extremely happy to be awarded 2nd prize in the 17-18 age category.

As prize-winners they have been invited to showcase their project at The Big Bang UK Young Scientists & Engineers Fair taking place in Birmingham on 16th March.

The EPQ is recognised by universities and employers; many leading universities make alternative offers to students undertaking an EPQ. Last year’s Year 13 cohort were offered a variety of reduced offers from Russell Group universities including Birmingham, Cardiff, Southampton and Queen’s University Belfast.

TED Talks In April 2019, a selection of Aspire group members from Years 9, 10 and 12 gave a range of thought-provoking mini TED talks during one of the bi-termly Aspire Lecture slots.

Each talk demonstrated the student’s academic curiosity, underpinned by diligent independent research and delivered with vocal eloquence and mature presentational skills. Included are transcripts of these TED talks.

The IB Extended Essay The Extended Essay is an indepth study of a focused topic, based on one of the student’s six chosen subjects, or a subject in which the student has background. It is intended to promote high-level research and writing skills, intellectual discovery and creativity. It provides students with an opportunity to engage in personal research in a topic of their own choice. Leading to a major piece of writing, presented in an academic format, and communicating ideas and findings in a reasoned and coherent manner appropriate to the subject chosen.

3

EPQ - Diana Kawonga

To What Extent Have Medical Advancements Since the Early 20th Century Influenced the Treatments of Thermal and Chemical Burns?

Diana Kawonga

Abstract Burn treatment can be very complex, (Woundsinternational .com, 2014) as it incorporates many different aspects of medicine and patient care such as: first aid, surgical treatment and the use and antibiotics. The evolution of burn treatment is extremely fascinating to analyse, understanding how earlier methods of treatment have either been improved or identifying the reasons why they are still in use today.

Furthermore, advancements in technology introduces new innovating methods which can significantly improve of burn treatment, which I find extremely stimulating.

I am extremely passionate about health care and I am interested and dedicated in studying medicine in the near future, hence why I find this topic very alluring. In addition, this area of medicine is one where I will learn a variety of different clinical practices.

My main interest lies within surgery and how less invasive methods of treatment have been invented to improve patient care, this links with burns as over the year’s burn treatment has been developed to reduce healing time and relieve pain (nhs.uk, 2015).

The purpose of this essay is to evaluate the modern methods

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of treatment and evaluate to what extent the methods used in the 20th Century has had an influence on them.

I aim to specifically highlighting any crossovers and identifying any direct implementation of past methods into present ones as well as the effectiveness of the treatment, this will be done by outlining the advantages and disadvantages.

The primal focus of this essay will be on thermal burns as these are the most common, (King, 2018) in addition I will analyse the treatment of chemical burns caused by popular chemical agents used to cause harm. There is some parity within the methods of treatment for chemical and thermal burns, however the main differences includes the skins reaction to the burn and the initial decontamination to the infected area.

I have chosen chemical burns in particular due to the rising increase in acid attacks in the United Kingdom.

‘The UK now has one of the highest number of recorded acid attacks per person of any country in the world, and the figure is expected to rise further’ (Dearden, 2018).

Introduction to Burn Injury ‘Burn injury is damage to the

skin or other body parts caused by extreme heat, flame or contact with heated objects or chemicals’ (McLaughlin and Paterson, 2012). Thermal burn injuries can occur from temperatures as low as 440C, if contact is prolonged. At higher temperatures, such as 800C, one second of contact can result in severe damage to the skin (Burncentrecare.co.uk, 2018). This validates how the occurrence of burn injuries is quite high as many activities involve such temperatures, such as ironing or even making a cup of tea could put you at risk of obtaining a burn injury.

With over 11 million people in the United Kingdom per year acquiring medical attention for burn injuries (WHO, 2004) it is evident that burn injuries are common. Although, many burns are not severe enough to cause any major problems such as severe scaring or the need for surgical intervention. However, those who are unlucky enough to obtain a serious burn, may obtain conditions which could be life changing such as severe scarring or loss of limbs or life shortening (Jeffery, 2009).

Over 25,000 commonly used chemicals in cleaning, agriculture and manufacturing, have been known to having the possibility to cause a chemical burn injury. This therefore establishes that chemical burns are an important risk within the household and work place

EPQ - Diana Kawonga (R. Palao et al. 2010). Many of the chemicals responsible for chemical burns are either strong acids, alkalis or bases.

The severity of a chemical burn determined by a number of factors. ‘Concentration; quantity of the burning agent; duration of skin contact; penetration and the mechanism of action’ (I. Monge et al 2010).

Burn treatment has undoubtedly been existent for countless years, the earliest account of was supposedly recorded approximately in 1500 B.C in Egypt (Bryan, I930). However, although burn treatment has been existent since then, the most significant acceleration in burn care has occurred within the last 50 years, stimulated by the tremendous increase in burn casualties due to great wars and great fires (Moiemen, Lee and Joory, 2018).

Which led to a greater number of medical professionals improving the existing burn treatments in order to increase successful outcomes, at a faster rate. It is no wonder why the mortality of burn victims have decreased substantially since the Second World War.

Classification Treatment of burns prior to the twentieth century were of little benefit to the victims due to the lack of knowledge of the pathophysiological impact of burns (Moiemen, Lee and Joory, 2018).

An example to illustrate this is a method of the classification of burns proposed by Fabry in 1915. Fabry’s classification assessed the burn severity only on its appearance. Recording three degrees: the redness and blistering of the skin, withering of the skin without charring

and eschar formation. The most significant limitation of this method of classification was that it did not take into account the depth of the burn and therefore it was soon deemed un-useful.

(Sonnenburg and Tschmarke, 1915).

Fabry’s method was not the only method of classification created prior to Jacksons. All of the others had been discarded as they were no longer seen as useful. This made it extremely difficult to find lots of information about it as it is no longer relevant. However it is an example of how any unhelpful treatment methods were soon gone and led to improvements being made.

An advancement in the from Fabry’s previous classification is the Jackson’s Burn Wound Model. Jacksons Burn Wound Model is a popular model created in 1947 for describing the pathology of a burn wound. It consists of three zones: The central area which consists of coagulated tissue which is clearly dead and unsalvageable; the zone of ‘stasis’ where although cells may be damaged if treated in favourable conditions they may be potentially recovered and the outermost zone which is described as the ‘zone of hyperaemia’, here the tissues will most likely recover unless there is extreme sepsis.

Jackson’s Burn Wound model is currently very popular and used widely as it is useful tool to help decide what type of response the burn will require, in addition it provides further understanding of the pathophysiology enabling that correct treatment is administrated.

(Hettiaratchy and Dziewulski, 2004).

The classification of burns used today has been heavily influenced by the work of the Jackson burn model. It is frequently used and almost every single website would include the Jackson burn model, therefore demonstrating a positive correlation with very little limitations.

The first step to take when it comes to caring for a burn is assessing the area and establishing the depth of the wound. In order to prevent any complications and provide effective healing an accurate assessment of the surface area and depth of a burn is essential (Wounds international, 2014).

Initial assessment of the burn involves a percentage calculation of the total burn area over the total body surface area. This is quintessential in determining the following clinical management of the wound. There are currently three different methods that are frequently used: Lund and Browder chart; Wallace’s ‘rules of nines’ and palmer surface.

The Lund and Browder chart is a simplified method of assessing burn surface area. It was devised by Charles Lund and Newton Browder in 1944 to provide a more accurate and practical means of estimating the total body surface affected by a burn wound (Forensicmed.co.uk, 2015).

It is one of the most commonly used methods for assessing a burn area. If it is used correctly, it is the most accurate method.

It consists of two drawings of the body, one anterior and the other of the posterior view.

An assessor draws on these illustrations and compares it to values in a table. An advantage of the Lund and Browder chart

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EPQ - Diana Kawonga is that it takes into account variation of body surface area and growth and therefore can be used for children as well as adults however it is more time consuming than the other methods (Minimus DA, 2007).

the wound is then of next importance. Both chemical and thermal burns can be classified as first-, second-, or third degree burns. Chemical burns tend to be second degree burns and above.

The rule of nines was created by Pulaski and Tennison in 1947, and published by AB Wallace in 1951. It is very useful in estimating the total burn area.

It is expressed as a percentage of total body surface. The body is divided into regions of 9% or multiples of 9 and can be calculated from a standard diagram. Despite being a very quick and easy method, recent studies have discovered that the rule of nines tends to overestimate the total burn area.

Burn depth is often made by subjective judgement of the characteristics of the injury. This can be difficult even for the most experienced professionals. New objective methods such as Laser Doppler Imaging have been developed in order to eliminate any uncertainty. Laser Doppler Imaging (LDI) is a new technique introduced to assist surgeons in deciding optimum treatment for each burn wound. In order to achieve successful wound healing, adequate blood flow is essential. Previous studies have demonstrated a positive correlation between skin blood flow and healing time needed for surgery which can be monitored using Laser Doppler Imaging (Jeffery et al. 2014).

Furthermore, it can only be accurately used on adult patients as it doesn’t account for children’s proportional differences such as a larger head and a smaller mass in legs and thighs (Miller-Keane, 2003).

The palmer surface method is very simple and is used for smaller burns. The palm of the patients hand with closed fingers represents approximately 1% of the body surface area (Hammond, 1987).

Both of these are still in use today and therefore demonstrates a great influence in advancements formed in the 20th century being used to this current day. Just like the Jackson burn model there are very little limitations.

Although the limitations that have been discovered such as the unaccountability for children’s proportion size were discovered quite recently with no influence from practices in the 20th century.

Establishing

6

the

depth

of

Prior to this the burns expert would have to judge for themselves to identify the depth purely on observations. This is very subjective and could lead to some inaccuracies. The laser Doppler imaging removes this uncertainty. The laser Doppler imaging is a new technique and therefore has had no influence from the 20th century.

with no blisters. It is painful and sensitive to touch and healing occurs within 10-14 days with potentially no scarring (Urmc.rochester.edu, 2018).

Second degree burns Second degree burns may appear white on the skin. They are painful and also involve blistering to the skin as well as slight damage of the dermis layer with an excess buildup of fluid and blood in the tissues beneath the burn (Merriam-webster.com, 2018).

Third degree burns Third degree burns appear charred or white on the skin, and destroys the epidermis and the dermis layer (layer underneath) and therefore new skin cannot grow (Chop.edu, 2018). Many people often refer to burns using this classification as it is simple and easy to identify however this system is subjected to an individual’s own interpretation of the wound (Worldburn.org, 2018).

Burn Wound Depth and Treatment

However, this is due to the lack of technology not the lack of knowledge as the Jackson burn model had already established the importance.

A classification system that removes any ambiguity is one that primarily grades them on the tissue depth of the wound.

(Smith-nephew.com, 2018). In order of severity burn depth is described as: Epidermal, Superficial Dermal, Mid dermal, Deep Dermal and Full Thickness.

First Degree Burns

Epidermal Burns

First-degree burns are ones of which only the outer epidermis is affected (Stephenson et al., 2018). The burn site is red in colour, dry and

Epidermal burns are very similar and fit the description of first degree burns. Epidermal burns affect only the epidermis, which is the outer layer of the

EPQ - Diana Kawonga skin and appear red in colour.

Epidermal burns usually heal without scarring as many skin cells are still available to ensure the wound achieves epithelialisation to form a covering of epithelial cells over a wound). They are also painful due to damaged nerve endings (Dearden, 2001). In addition, epidermal burns, like first degree burns, have increased blood flow (hyperaemia) (Vicburns.org.au, 2018). A good example of epidermal burns are sun burns.

First Aid Epidermal burns are mainly treated with first aid treatment. First aid and primary management of the burn wound can reduce tissue damage and therefore reduce the chances of mortality (Senarath-Yapa K, 2009).

This includes cooling the burn with cool or tepid running water for 20 minutes and then to cover the burn with a layer of cling film (nhsinform, 2018).

The movement of the running water aids to cool down the burn as well as reducing pain and minimising swelling. Wrapping the burn in cling film keeps the burn clean and retains the water in the wound.

Cling film is also effective in relieving pain as it covers up ant nerve endings that have been exposed. In addition Cling film is transparent so the burn can be easily monitored for any signs of progression or infection.

(Dengate, 2016) Chemical burns require immediate first aid. Removal of the chemical that caused the burn is of first priority, this is known as decontamination.

Decontamination involves

consistent irrigation of the affected area until no pain is experienced or the normal pH has been restored. The severity of the burn determines the treatment required.

Antibiotics, anti-itch medications, debridement, skin grafting and the issuing of intravenous fluids are all typical methods of treatment. Initial first aid of chemical burns is crucial for successful treatment as corrosive chemicals can continue to cause damage to the tissue until it is completely removed (barret et al, 2010)

Fluid Resuscitation Following infection the next biggest complication often experienced in burn injury is dehydration (Pennstatehershey.adam.com, 2018).

The release of chemicals into the blood as well as damage to blood vessels results in an increase in the permeability of capillaries which therefore results in a leaking of fluids into the surrounding tissue (Kramer and Kramer, 2018).

Therefore fluid replacements must be readily available in order to prevent hypovolemic shock (shock due to a loss of blood plasma) and dehydration (Krausz, 2006). The parkland formula is commonly used to calculate the volume of fluids given to a patient (En.wikipedia.org, 2018). It is the most commonly used formula in the United Kingdom and Ireland where 78% of all burn units use it (Baker RH, 2007). The parkland formula was created by Dr. Charles R. Baxter in 1968 when he realised that critical burn patients require large volumes of fluid in the first 24 hours of treatment in order to be stable

(Theemtspot.com, 2011).

However, in recent years, a number of authors have reported that the Parkland formula significantly underestimated the actual fluids required and given to patients. Limitations of the parkland formula includes the over- or under fluid resuscitation of some patients.

In 2000 Dr Basil Pruitt devised the term ‘fluid creep’ to describe when the volume of fluid calculated using the parkland was not enough (Saffle, 2016).

Early management of fluid losses using an accepted fluid resuscitation formula is fundamental to good quality burn care. (Guilabert et al., 2016)

Superficial Dermal Burns Superficial Dermal burns are where the part of the dermis as well as the entire epidermis is damaged. The epidermis is the outer layer of the skin, which acts as a protective barrier to bacteria. The Dermis is the layer of tissue under the epidermis which contains sweat glands, hair follicles, nerve endings and capillaries. Superficial burns are very tender and pink in colour and blisters are common (nhs.uk, 2015).

Topical Therapy Due to the formation of dead tissue surrounded by living tissue (slough), which often occurs in superficial burns, health care professionals such as burn surgeons must first prevent colonisation of bacteria.

Antibiotics do not provide protection as they cannot react bacteria that accumulates in the slough and therefore any antimicrobial agent must be applied topically (Jeffery, 2009).

Topical therapy is often used

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EPQ - Diana Kawonga to treat less severe superficial burns that consist of minimal epidermal loss do not require dressings or surgical treatment (Benson, Dickson and Boyce, 2006). Topical therapy is medication that is applied to a particular place on or in the body (McKay, 1983). As superficial burns are often very painful and sensitive, creams, foams, gels and lotions are often the best option for treatment (En.wikipedia.org, 2018).

The aim of topical therapy has changed due to further understanding of the pathophysiology of burn wounds. (Pdfs.semanticscholar .org, 2005) In the early 20th century the main goal for topical therapies was to prevent the release of toxins form the burn injury. One limitation of topical therapies is that they were recently found to be hepatotoxic (‘damaging or destructive to the liver cells’) (En.wikipedia.org, 2018) however, this is through oral consumption as oppose to application.

The biggest advancement in topical therapy for burns was the discovery of the natural infection fighting ability of silver (Singh, 2014). A common silverbased therapy developed since the discovery was silver nitrate (Moyer et al., 1965) which have influenced current treatment as silver compounds were since by implanted into dressings to fight and prevent infection.

More severe Superficial dermal burns are treated by initially providing a dressing that is comfortable to the patient to protect the wound encouraging further healing as oppose to deepening of the wound (Jeffery 2009).

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Dressings The dynamic characteristic of burn wounds often results in a change in appearance, especially within the first 48 hours. Consequently health care professionals conduct a further assessment after 48 hours to determine whether a conclusive dressing should be applied or if surgical intervention is required (Practitioners, 2018). There are many different burn dressings to choose from for treating burns.

Good first aid and selection of the appropriate dressings can significantly reduce the need for skin grafting. Selection of the burn wound dressing depends on the properties of the burn, including the depth of the burn, site of the burn and extent of the burn (Pankhurst and Pochkhanawala, 2020) which can be referenced to the Jackson’s burn wound model (Practitioners, 2018).

as an initial dressing for burn wounds. These dressings slowly release vapours of silver which has antiseptic, antimicrobial and anti-inflammatory properties (Joy Fong, 2018).

The metallic silver nanocrystalline characteristics of Acticoat inhibits bacterial activity against gram positive and negative bacteria (Wright et al, 1998).

Furthermore Acticoat provides protection against fungal wound pathogens. It is very fast acting, easy to apply and is very flexible (Smith-nephew.com, 1970).

After 48 hours other dressings such as Hydrocolloids may be used. The idea of a maintaining a moist wound originated in the 1970s and therefore resulted in the introduction of hydrocolloid dressings.

The traditional dressing types have developed into further categories.

According to Pankhurst and Pochkhanawala the dressing must ‘protect the wound from physical damage and microorganisms; be comfortable; be nontoxic and be able to allow maximum activity for the wound to heal without retarding or inhibiting any stage of the processes’.

This will prevent an increase of injury to the tissue and therefore promote healing, furthermore the risk of infection will be reduced. As ‘Infection can result in the zone of stasis not surviving, and hence make the burn become deeper.’

(Jeffery, 2009).

Initial burn dressings should therefore be sustainable for 48 hours whilst preventing infection.

The progression of wound healing has increased greatly through intense clinical and scientific research (Queen D, 2004). Hydrocolloid dressings contain gelforming agents that provide moist healing environments (Tissue, 2018).

In the late 20th century the discovery of nanocrystalline silver dressings (e.g. Acticoat) was introduced and then used

This is beneficial as it encourages wound healing, furthermore they are also effective in slough containing

Moist healing environments are important in burn treatment as it prevents the wound from drying and worsening it. Hydrocolloid dressings, however, cannot not be used on infected wounds and full thickness burns (Wounds-uk.com, 2018).

Hydrogel dressings are mostly made of water and their function is to provide moisture to the wound.

EPQ - Diana Kawonga burns as it provides moisture which assists with debridement (Vicburns.org.au, 2018).

Mid-dermal Mid-dermal partial thickness is when there is thermal destruction of the epidermis.

This consist of an area of damaged tissue which is unable to be restored extending throughout the dermis, with damaged however the tissue is still viable. Conservation of this tissue is vital in prevent progression of the wound.

(Vicburns.org.au, 2016) Partial-thickness burns require dressings in order to protect the wound from contaminating bacteria, preventing water loss and decreasing pain (nhs, 2015). The main principles of treatment in partial thickness burns are early debridement of non-viable tissue and subsequent application of an appropriate dressing (Sood et al., 2014). Briobrane is a biosynthetic skin substitute made from an ultra-thin, semipermeable silicon membrane bonded to flexible knitted nylon fabric. Briobrane is beneficial due to its versatility, ease of use and minimisation of frequently changing the dressing. The flexibility and adherence of Briobrane allows it to stretch and move with the patient.

Furthermore, the silicone outer layer of Briobrane behaves like a protective epidermal barrier which reduces water loss and therefore prevents the wound from dehydration. It semipermeable properties also allows for slight water vapour removal which is positive as it prevents excessive fluid accumulation. Briobrane is cost effective and due to the transparency of Briobrane

surgeons and physicians allows for direct wound inspection without having to remove the dressing, overall reducing hospital stay. Despite being an effective skin substitute Briobrane can only adhere once slough is completely removed.

Furthermore due to a lack of anti-microbial properties, thorough wound cleaning is obligatory (Jeffery, 2009)

Deep Dermal Deep dermal partial thickness involves the entire epidermis with very few dermal and epidermal cells can be restored. Deep dermal burn are identified by their development of extensive blisters that are prone to rupturing, leaving the dermis layer exposed. This layer is often dry and pale in colour as a result of the damaged vessels, or red as a result of bleeding from the damaged vessels. The trademark of these types of burns is the poor capillary refill.

‘The capillary refill of a burn is tested by pressing the skin down for four seconds and then checking how long it takes for the burn to regain colour again.’

(Henderson, 2015). The damage to the dermal nerve endings result in a reduction of sensation.

(Vicburns.org.au, 2016)

Full thickness Full thickness involves destruction of the entire epidermis and dermis layers and the wound will not heal without surgical intervention and may penetrate further into underlying structures.

These burns are also painless as the pain receptor system is destroyed.

The skin is white or charred black. Full thickness burns have

coagulated dead skin which has a leathery appearance, this is called eschar.

(Smith-nephew.com, 2018).

Many specialists agree that the most appropriate treatment for deep dermal and full thickness burns is surgical debridement.

The dead eschar is the ultimate location for bacterial growth.

Damage to the skin results in a decrease in its efficiency of its function as a barrier to infection.

Infection is therefore one of the biggest issues a surgeon has to combat within burn treatment.

The discovery of early dead tissue removal (burn excision) has been one of the most significant advances in modern burn care (NS, 2009). This was brought about in World War Two as due to the large increase in burn victims many physicians had to figure out how to help patients recover faster.

Debridement Surgical debridement is the ‘process of removing all the materials that may promote infection and impede healing’ (medicnet.com, 2016).

A surgeon’s main priority is then therefore to remove the dead tissue. Deep dermal and full thickness burns are chronic wounds usually have a covering slough which is unhealthy tissue that is no longer viable, it is usually yellow or cream in colour or eschar which is black dry and black unhealthy tissue. This is the unhealthy tissue that must be removed either from surgical or non-surgical debridement.

The choice of debridement method often depends on the depth of the burn. Dressings and enzymatic debridement are non-surgical methods that can be used to remove slough.

Using dressings as a method

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EPQ - Diana Kawonga of removal of slough can often take a long time and it is not always possible.

Tangential excision Tangential excision is the process of removal of the surface dead skin (necrotic tissue), by slicing parallel to the skin using a skin graft knife (Jackson et al, 1972). Tangential excision involves removing tissue a slice at a time until healthy tissue is reached that will retain the graft (Jeffery, 2009).

The development of the surgical cutting tool used in tangential excisions has improved the precision of the procedure.

The surgical cutting tools chosen to cut off slough is one of great importance when debriding a burn. The most common tool for removing this tissue has been the Watson knife. The Watson knife was produced in 1960 and consists of a blade with a guard that can be adjusted according to the depth of the wound.

This is a big advancement to previous knives created for skin grafts earlier in the 20th century. An example to illustrate this is the skin graft knife developed by Vilray Papin Blair in 1930. Expert plastic surgeons removed the grafts using a free hand method altering the depth by changing the angle of which was in relation to the skin. The limitations of this knife included the possibility of inaccurate or too deep excision and therefore further guarded knifes were developed in order to vary the depth (Ameer et al 2013).

Mortality as a result of burn injuries has decreased greatly since the early 20th century, although despite the advancements in resuscitation and management methods, the most exciting improvement

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in surgical debridement has been the development of the Versajet Hydrosurgery system.

According to Jeffery, this is more a precise method of removal of unhealthy tissue and it also reduces the potential of unnecessary removal of healthy tissue. The benefits of using this technique is that it allows the narrowest removal margin of skin, as little as 0.05mm can be removed which would be extremely difficult to do with conventional blade excision.

Versajet uses water to remove healthy tissue (Boyes, 2017). It works by passing a very fine jet of water over the wound between two openings on the hand held instrument. This creates a vacuum which lifts the unhealthy and dead tissue from the wound bed.

Skin Grafting After the slough has been removed ‘restoring of anatomy, preserving function and rehabilitating the patient’ is of next importance. The aim is to produce an aesthetic and functional recovery (Gilbert et al., 2016). A skin graft is used in burn treatment to replace damaged skin with skin from another part of the body (Cold et al., 2018). Skin grafts are used to treat partial thickness and full thickness burns. The best skin grafts come from the patient’s own skin which are called donor sites. The unburned skin will be taken from areas that are not usually visible such as the buttocks or upper thighs (Burn-recovery.org, n.d.). There are two different types of skin grafts split thickness grafts and full thickness grafts. Split thickness grafts are usually for shallow wounds and only a few layers of skin are removed from the donor site. Full thickness

grafts require the removal of 3 layers of skin (epidermis, dermis and hypodermis) as well as hair follicles, sweat glands and blood vessels that allow the graft area to look and function more normally.

(Burn-recovery.org, 2018).

Primarily many full thickness grafts were unsuccessful due to the lack of healing the donor sites. However in the 1920’s the discovery of the factor responsible for initiating healing at the donor sites allowed for grafts to be harvested at many different depths (Moiemen, Lee and Joory, 2014).

Furthermore, significant improvements to the skin graft technique were brought about in the 1970s (Janzekovic Z, 1971).

The modification included the excision of the bleeding tissue as well as the dead tissue and damaged dermis. This technique was widely adopted as many reported a reduction in mortality and hospital stay.

Furthermore, the length of time patients spent in hospital after receiving treatment significantly decrease. The technique was widely adopted to burn centres world-wide, however it was only limited to small burns.

Skin Substitutes An even more recent break though in technology allows stem cells to be isolated from the patient and spray them onto the affected area using a Stem Cell Gun. ‘Stem cells are Cells with the ability to divide for indefinite periods in culture and to give rise to specialized cells (Stemcells.nih.gov, 2018).

Stem cells are able to develop into new cells and serve as an internal repair system.

They are able to divide either to remain a stem cell or become

EPQ - Diana Kawonga another type of cell with a more specialised function, for example a red blood cell or a skin cell.

Stem cells are different to other cells as they are unspecialised cells and are able to renew themselves through cell division. They are also able to be induced to become new tissue with specific functions. This is very promising for patients suffering from severe burns, as it is a less invasive alternative to skin graft surgery, which take a longer time to heal and are more painful.

Antimicrobials and Antibiotics Skin acts as a natural barrier to infection. Damage to the skin is experienced as a result of burn injury, this provides fertile ground for bacterial growth.

Infections are the main cause of traumatic outcomes and mortality.

Out of 175 patients that had severe burns infections that led to multi organ failure occurred in 83% and 36% of those died as a direct result (Avni et al., 2018).

The discovery of penicillin

by Sir Alexander Fleming in 1928 revolutionised the fight against microbial infection (En.wikipedia.org, 2018).

However large scale production of penicillin was achieved later during World War Two (Moiemen, Lee and Joory, 2018).

The introduction of penicillin was one of which was extremely beneficial to burn treatment as it fought against the Staphylococcus bacteria which regularly infected skin grafts (Abc.net.au, 2018).

Leonard Colebrook, a colleague of Fleming acknowledged the

effectiveness of sulphonamides and penicillin in controlling the infection of burns. Furthermore, he evaluated the techniques of skin-grafting as well as the issue of tissue rejection (Encyclopedia Britannica, 2018).

The introduction of antibiotics that could be applied to burns had a direct impact in dramatically increasing survival (Church et al., 2018).

However the relentless increase in microbial resistance to antibiotics and other antimicrobials has led to a renewed search for alternative approaches to prevent and combat burn infections. In the late 1960s, Fox introduced silversulfadiazine cream for burn wound management.

This dramatically revolutionized the management of burn wounds by reducing the incidence of burn wound infections (Tianhong Dai, 2018).

Conclusion This essay has identified the key elements of burn treatment, highlighting advancements that have been proposed since the early 20th century.

There have indeed been many advancements since the early 20th century that has greatly influenced the methods of treatment used today, such as the Jackson model. This demonstrates a positive correlation between an advancement developed previously and it influencing current treatment.

Fabry’s model is not in use today and therefore highlights how unhelpful methods have not been considered in today’s treatment.

I believe that this was the most significant in terms of revolutionising

the treatment we provide today. This is because with a greater understanding of the pathophysiology of the skin and burn wounds new, innovating methods and approaches of treatment are overall developed or improved in order to adapt to the behaviour and characteristics. The Jackson model in addition to the Wallace rules of nine and the Lund and Browder chart is also now recognised and used worldwide which therefore indicates a great extent of influence .These form fundamental materials for basic wound assessment and although It is evident to see that there are also some limitations however, over the years they have been developed and evaluated to overcome them.

Laser Doppler imagery is an example of a slight lack of influence from methods used in the early 20th century. This is purely because they did not have the technology to do so and therefore many of these technological methods of treatment are fairly new. Now that many experts are aware of the levels of depth and severity resulting new technologies are being developed in order to improve accuracy such as there Laser Doppler imaging.

This links to the techniques used for tangential excision as despite brilliant advancements in developing the Watson knife, in the future it slowly die out as new techniques such as using the Versajet will become more apparent.

It also difficult to compare the treatment for chemical attacks used in the early 20th century to now they used a different chemicals that are not commonly used anymore such as mustard gas and therefore the body would react differently and is therefore not

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EPQ - Diana Kawonga comparable. Moreover, the treatment of burns in the early 20th century is difficult to be looked in direct contrast in treatment used now as there are so many similarities as this was the main starting point of the acceleration of treatment.

Therefore, it is more valuable to the identify modifications.

For example the concept of moist healing originated from the 20th century in the 1970s and this concept was further explored and developments in dressings were accelerated by the production of skin substitutes such as Briobrane and also the creation of the parkland formula.

Most of the treatment developed in the 20th century has had at least a partial influence in

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treatment used today. Whether they were deemed useful or not it would still shape the future treatment. This is because useless treatment methods would be improved and useful treatment would still be used and both would continue to be developed in order to provide the best possible care. An example to illustrate this is that treatments such as the use of antibiotics was revolutionising towards many aspects of medicine however due to antibiotic resistance health care professionals must be careful and only administrate them when necessary. The fundamental aspect of care was developed in the 20th century, however, further knowledge found out more recently have

identified the potential risk and therefore solved the situation.

The advancement of burn care has been closely related with the understanding of its pathophysiology. This was established from the Jackson burn model and therefore there is a great extent of influence from the early 20th century to the treatment that is provided and practiced today. We have now come to understand the impact that burn injury has to many fields of medical science and therefore through in depth research and advancements in technology, especially within the last 50 years, improvements in clinical care have been achieved.

EPQ - Diana Kawonga

Bibliography •

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Liu, H., Zhang, F. and Lineaweaver, W. (2018). History and Advancement of Burn Treatments.

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Moiemen, N., Lee, K. and Joory, K. (2018). History of burns: The past, present and the future.

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Tissue, A. (2018). Your Guide to Hydrocolloid Dressings - Advanced Tissue. [online] Available at: www.advancedtissue.com/guide-hydrocolloid-dressings [Accessed 24 Mar. 2018]

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Vicburns.org.au. (2018). Dressing Types – Vic Burns. [online] Available at: www.vicburns.org.au/minor-burns/dressing-selection/dressing-types [Accessed 24 Mar. 2018].

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•

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EPQ - Ursula Perry

To What Extent Does the Prison System Work to Rehabilitate Offenders in the UK? Ursula Perry

Abstract For my research project, I chose to investigate whether the prison system in the United Kingdom works to rehabilitate offenders as there have been very few changes in terms of the reoffending rate in recent years.

I was thoroughly interested in the topic of crime and law as it is not only a hobby of mine but I am also considering studying law at university and moving on to become a lawyer. My aim is to explore the various options that have been introduced and evaluate whether there is an effective way of reducing reoffending in the UK. I believe it is a very important topic as it would not only save the UK’s economy millions every year but also personally impact every convict that does not return to prison and manages to hold a steady job and find stable accommodation. Rehabilitation of convicts to prevent the offender from returning to prison is now an essential part in the system for dealing with offenders in the United Kingdom. Punishment no longer consists of bodily harm and the term rehabilitation has been redefined as “discipline of the soul� (denoted by the French philosopher Michel Foucault) (Politics.co.uk, N.D).

After the passing of the Penitentiary Act by the government in 1779, rehabilitation has now become

a vital part of the criminal justice system. Serving a sentence is still the main body of imprisonment, but the rehabilitation of an offender into modern society has now been brought to the forefront of prison policy. The idea is to reform the character and attitude of prisoners, to prevent reoffending and to encourage those who have committed a felony to find jobs and transform their lives.

Without help, prisoners will be stuck in the same cycle of offending and will not be able to provide for themselves or relatives, if you cannot provide for yourself or others, crime becomes more favourable.

There are two main different rehabilitation techniques that can be used: training inside prison and resettlement programmes once released.

Education is the traditional method at training offenders as they provide them with a hope of finding employment once released. Employment equals a salary which can deter ex-convicts from joining gangs or committing petty crime.

A job is also the gateway to stable accommodation and the convict being able to afford food and clothing, even being able to provide for their family, which is why these resettlement programmes are so important.

For my research into the rehabilitation that is currently happening in the United

Kingdom, I studied a wide variety of sources written by professionals in the area of crime and law. I found that overall many books and articles written had called for reform of the prison system in order for our justice system to be more effective at reintroducing offenders into society but failed to provide methods of doing this.

Many websites also gave me a brief insight into reoffending and how it works but failed to truly go into depth about what is being done and what should be done. At first, I struggled to find books published and relied on internet websites and reports that had been published on the online government page. Multiple websites were newspaper articles which were biased for and against whether rehabilitation is currently occurring. The method of using the internet worked to an extent, however, I decided that I required a wider variety of sources in order to come to a valid conclusion. The books that I accessed from the university library were not only in abundance but also were written and edited by professionals in the area I was interested in investigating.

Books written by professors and lecturers who have studied the specific subject were more accurate than websites and gave me a wider insight into specific methods for best rehabilitating convicts. I was

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EPQ - Ursula Perry able to access a wide variety of statistics and figures that I have used to back up my argument that the government is failing at reducing the reoffending rate.

I have also come across critics in my research that argue that a harsh punishment is a deterrent of crime and so instead of allowing prisoners the access to facilities like a library, we should instead be restricting their freedoms further. I completely disagreed with this theory as I believe the more contemporary theory of the reconstruction of a convict’s life proves more effective at reducing the reoffending rate than solitary confinement.

argument that the government is not going above and beyond to ensure that the reoffending rate is being reduced each year.

In a government publication on reoffending, it was stated that “almost 60% of adult offenders released from short prison sentences in the year to March 2013 went on to reoffend within the next twelve months: a total of 16,719 re-offenders committing 85,047 further offences” (GOV.UK, 2010 to 2015 government policy: reoffending and rehabilitation, 2015).

more likely to enter and leave prison repeatedly and so these are the target groups which the government must first target.

The graph from the gov.uk website page on justice shows that convicts are more likely to reoffend if they have experienced a shorter sentence.

Community service was seen by the government as a better option for those with shorter sentences. During their time in a correctional facility, prisoners do not have the option to participate in educational

There has consequently been a number of biased sources that I have had to come to a judgement about due to the tension between advocates for tough regimes and those who supported rehabilitation.

What is currently occurring in prison?

According to the Independent, the current reoffending rate is at 26.8 percent which has increased 0.3% from the previous year (Grierson, 2013).

There has been a notable rise in the reoffending rate despite government promises to fix this – Ministry of Justice figures state that “more than one in four criminals reoffended within a year” and committed 500,000 offences in total.

Around 280,000 of these crimes were committed by persons that had “11 or more previous offences” and around 50,000 of these offences were committed by 11,000 criminals “who had previously been jailed at least 11 times”.

This is key evidence in the

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Graph from: https://www.gov.uk/government/uploads/system /uploads/attachment_data/file/585908/proven-reoffendingquarterly-bulletin.pdf The estimated cost to our economy is between £9.5 and £13 billion, and from this number, £7-10 billion is from offenders serving short sentences.

The information that the graph displays, confirms that those with 11 or more previous offences have a higher change of reoffending. This is clear data that shows the government is failing at preventing crime.

Those that serve shorter but more frequent sentences are

training and subsequently they are released in the same state as when they were arrested. In 2015-2016, ninety-five thousand adults participated in some form of education whilst in prison, a decrease of seven percent from the previous year. It has been proven by the Ministry of Justice that engagement with schooling can reduce reoffending; one year reoffending rates were lower by one quarter for those who received learning support compared to those who did not. However, as the length of

EPQ - Ursula Perry the prison sentence increases, the likelihood of reoffending decreases. Both education and training along with the removal of freedom has deterred convicts from recommitting a crime. Therefore, more work should be done to reduce the reoffending rate for those spending less than twelve months in prison which will not only benefit the prisoners themselves and their families, but also the wider community, saving the government millions in the process. The government believes that punishment is an ‘essential part of the justice system’ but it fails to prevent the half of adults that leave prison from reoffending – the majority do so within one year.

This can be seen particularly in those serving shorter sentences, as stated in their report ‘the same criminals repeatedly pass through the courts’ and yet, not enough is being done to stop this.

Graph from: http://open.justice. gov.uk/reoffending/prisons/ (GOV.UK, The Truth about prisons, 2016) At present, the Prison Reform Trust has highlighted many areas that could be improved and why they are failing.

Overcrowding is a key factor in the availability of resources and staff to convicts. A report in May 2017 showed that 76

of the 117 prisons in England and Wales were overcrowded and twenty-one thousand people were living in congested accommodation – this is nearly a quarter of the population living in prisons which has remained unchanged for the past decade (Trust, Bromley Briefings Prison Factfile, 2017).

Prisons have made poor efforts to reduce reoffending as 44% of adults are reconvicted within a year of release (according to HMPPS) and for convicts serving a sentence of less than 12 months, the average rises to 59%.

The Royal Society of Arts (a charity that set up the ‘Future Prison Project’ in order to promote creativity) have said that “the service needed to be overhauled to reduce reoffending rates that cost the taxpayer billions of pounds” (reoffending by recent convicts cost the economy between £9.5 and £13 billion annually) (NEWS, 2016). The charity called for increased staff presence in penitentiaries, explaining that this would promote creativity and even later lead to increased job prospects.

Furthermore, the ‘inconsistent’ leadership from government politicians has founded a system that puts those in custody at risk without reducing reoffending rates at all. The cost of running a prison has reduced from 2009 to 2015 by 20%, due to a 26% reduction of staff. This again suggests a correlation between the rate of reoffending and the presence of personnel.

Her Majesty’s Prisons and Probation Service reduced its budget by one quarter since 2010, four years following it has accumulated £900m.

This money could be used, as

well as the additional funding promised by the government to finance a reform programme widely available to all in custody.

The government has also promised £1.3 billion to be invested into reforming the Britain’s penitentiaries along with the building of nine new prisons, five of which by 2020.

The government promised to reduce reoffending in order to decrease not only the cost to the taxpayer as well as the number of victims. The government is eager to use what they called a ‘payment by results approach’ which would be used to “implement effective ways of rehabilitating offenders and rewarding providers that devise and deliver the most effective programmes” (GOV.UK, 2010 to 2015 government policy: reoffending and rehabilitation, 2015).

This incentive should hopefully encourage experts in the field to test and come to a conclusion about what works the best in the rehabilitation of offenders.

Inspectors established that work in many prisons across the UK was prosaic and repetitive which rarely links to positive rehabilitation. Unemployment is high among convicts and skills developed during work went unrecorded which did not contribute to employment when discharged. Reforms such as regulated working hours are the start of introducing a daily routine to convicts that can continue to be followed once released.

More meaningful work that would provide prisoners with skills useful in society is also important, as well as the prevention of drug misuse inside penitentiaries and the option for counselling during the sentence

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EPQ - Ursula Perry and after release to ensure the prevention of crime due to the abuse of drugs. Despite all of these ideas costing vast sums of money, the amount that the government would save far outweighs the primary costs of the programmes and would also greatly impact the lives of those who commit these crimes.

Funding available has also been one of the main problems when selecting programmes for rehabilitation, along with overcrowding.

Prisons have faced much criticism about the level of rehabilitation that occurs and the lack thereof. The success of these programmes is also inhibited by the lack of essential skills needed or social and mental problems that convicts may be suffering from.

Homelessness too is a rising problems among ex-convicts – three-quarters of offenders are said to have mental health complications and almost twothirds have drug problems.

Many of those that enter prison lack the basic skill set to understand that the crime they committed was wrong and are unable to show remorse about going against the law. In order to successfully rehabilitate prisoners, basic skills must be taught, as well as the opportunity to access healthcare. The delivery of programmes is complicated and difficult, however by pursuing the idea of an educated prison workforce, we can begin to improve the lives of those who spend time in prison.

The author of a report made by the Prison Governors Association, Rachel O’Brien, stated that changes to the prison system that could have made to reduce re-offending

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and increase community safety have “been undermined by a lack of consistent political leadership and clear purpose”.

She continued to state that “this has led to reactive policy, episodic change and an over-centralised system, which has disempowered the workforce and undermined public confidence”. Her report emphasizes common thoughts that modern-day prisons in the United Kingdom are failing to prepare prisoners for the wider world and in turn lead to a rise in those returning to detention centres. After an anomalous rise of brutality in prisons, an independent enquiry was called into standards in prison and the effect it has on reoffending rates.

The report clearly shows that not enough is being done to encourage ex-convicts to improve their lifestyle once released – the government in the United Kingdom must work harder in order to prevent this becoming more common. The RSA (Royal Society of Arts) encouraged the commitment to reforming prisons and suggested the return to staff numbers seen in 2010 as well as the tracking of individuals to compose what they called “a national rehabilitation strategy”.

The information supplied by the charity, implies that there should be a set of requirements to be met in order to truly improve prisons, and without these convicts cannot be ready to effectively be released to find employment and accommodation without falling back on old habits. According to the government policy on Reoffending and Rehabilitation (2010-2015), half of the convicts in prison have already committed a crime and spent time in a rehabilitation centre.

By considering the fact that there is a significant strain on the prison services but also the cost to the economy (between £9.5 and £13 billion each year), it is critical that rehabilitation be addressed by the government.

This would not only appease critics but also save a significant amount of money each year.

The government report believes that to achieve a working prison system “we need a tough but intelligent criminal justice system that punishes people properly when they break the law, but also supports them so they don’t commit crime in the future”. This sums up the argument for how the justice system should be working in the United Kingdom; at present, we are able to punish the offender but offer no means of support for after release. This means that the reconviction rates barely change each year and will continue to do so if drastic measures are not introduced.

What can be done?

Prison must prepare convicts for the challenge of reentering the community such as finding accommodation and employment as well as avoiding the opportunities to become involved in crime again. Work needs to be done to improve neighbourhoods commonly occupied by ex-convicts (Dickson, 2014). In addition to this, assistance from community services must also be available in order to assist those in need of financial resources and support (Hipp, Jannetta, Shah & Turner, 2011).

One of the article’s writers, Devon Polaschek, is a professor of psychology in New Zealand and is well-known for studying violent offenders both in prison

EPQ - Ursula Perry and once on parole. She has openly stood by her belief that “psychopaths who had many previous convictions became worse after poorly implemented treatment”. In addition to this, according to ‘What works: reducing reoffending’ by James McGuire and Philip Priestley (1995), it has been known that disciplinary measures do not work to reduce the rate of crime and reoffending and it has been suggested that it contributes to an increase in crime (McGuire, 1995.).

Prison is seen as “the ultimate symbol of power of the state to enforce conformity with the law and maintenance of social order” (Garland, 1990).

Imprisonment works to deprive a person of their liberty as a method of preventing the offender from committing another crime. However, in a review done on punishmentbased programmes done by Lipsey (1992a, 1992b), extreme approaches to discipline led to an increase of 25% in reoffending rates compared to the control groups. Emphasis must be put on the implementation of suggested plans to improve the management and attitude to rehabilitation and its impacted offenders. The government can no longer ignore evidence which clearly demonstrates that there are methods that can be used to reduce reoffending.

The graph shows that the lowest index offence is fraud at 9.6%. In contrast, theft is the reason for the highest proportion of reoffenders, thus lack of employment consequently leads to higher numbers of robbery and theft.

Public order is the third most prominent reason – the removal of freedom is obviously not a deterrent of crime as prisoners

are unaware of how to act once released. Employment is obviously the most important for convicts once released as a job decreases the chances of the person turning to crime in their time of need.

Drugs are still an important motive for reoffending but as shown on the graph, theft and robbery are the key issues that must first be focused on.

It is wise to consider there is a significant rise in the number of those who reoffend that are classed as juveniles – this is clear evidence that implies the government should focus their efforts into the younger members of society.

to offend again” (Towl, 2008).

Psychological research in prison suggests that unstable accommodation is one of the most significant reasons for reconviction, along with substance abuse. As well as providing motivation to reoffend, this diminishes the prospects of finding employment. Research done into reoffending and what increases it has portrayed government efforts as negative – not enough is being done to take into account the state of prisoners entering a facility.

As well as providing programmes to teach offenders key transferable skills and an education, prisons must also

Graph from: https://www.gov.uk/government/uploads/system/ uploads/attachment_data/file/585908/proven-reoffendingquarterly-bulletin.pdf The biggest gaps between adults and juveniles are in fraud and summary motoring, which includes crimes such as driving whilst disqualified or speeding.

Other crimes common among young people are called ‘summary non-motoring’ which describes less serious crimes and damage to society.

McGuire (2002) said that “the greater their ‘criminogenic need’, the more likely they are

accommodate the mental and physical state or their inmates before allowing them to enter the workplace. Peter Lang’s ‘Education’s prisoners: schooling, the political economy, and the prison industrial complex’ published in 2008, states that “the need for a large domestic labour force is declining” (McGrew, 2008).

So, despite prisoners generally choosing to participate in work during their time in prisons

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EPQ - Ursula Perry to earn money, they are only considering short term over long term gains. The system should be working towards offenders who take responsibility for their actions and will continue to do so in the future.

The point of a prison sentence should be to change the attitude of the offender rather than only punish as a preventative measure.

However, along with being able to provide correctional treatment programmes in prisons, convicts must also be willing to participate in order to improve their prospects for employment.

The study done into predicting offender participation by Anouk Bosma, Maarten Kunst, Joni Reef, Anja Dirkzwager and Paul Niewbeerta (2016) observed that “offenders who were ready for treatment were more than two times more likely to complete treatment programmes, compared with offenders who were not”. The group analysed previous studies done into participation and its outcomes, then compared it to their own current study in order to come to a conclusion on what influences engagement in these programmes.

The ‘Risk-Need-Responsivity Model’, a universally regarded example of the treatment of offenders, was brought up in the research. This model is used to analyse prisoners to come to a conclusion on the treatment of offenders based on the risk they pose and what sort of environment they will work most effectively. In Egardo Rotman’s book “Beyond Punishment: a new view on the rehabilitation of criminal offenders”, he describes the original function of prisons and compares them to the modern-day use of these facilities (Rotman, 1990). His

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belief is that the aspirations of prisons, which were designed to serve “preventative and retributive goals sought by penal sanctions’ are largely ineffective and imprisonment is now seen by the author as harmful to the rehabilitation of its inmates.

The concluding argument of the sources I have studied for my research has shown that experts believe prison rehabilitation is not as effective as it could be, mainly due to the lack of staffing and resources. Rotman’s background in criminal law as well as his time spent representing the United States of America at the International Penal and Penitentiary Foundation suggests that although his research has not been directed at prisons in the United Kingdom directly, his thoughts on the practice of rehabilitation are general and can be applied to changes that ought to be made in the UK. He emphasised the need for “a minimally decent environment, security, medical assistance, recreation, and fair treatment” as a key part of an effective institution.

In a report into the “Evaluation of effectiveness of correctional education” conducted in 2013, (Davis, 2013) “the odds of obtaining employment postrelease among inmates who participated in correctional education (either academic or vocational programmes) was 13 percent higher than the odds for those who had not participated”. One of the major challenges that offenders face when being reintegrated into society is the lack of education.

There is clear evidence that those who enter prison having received education or those who receive education during

their time in prison have a higher chance in finding employment than inmates who didn’t. In an article by Ian Nash (2015) titled ‘A basic skills revolution in UK prisons demand firm action not just fine words’, the government and Michael Gove especially are criticized for promising changes to prisons but not delivering. Lack of resources and a lack of access to these programmes was stated as the biggest failures which leads to the recommitting of crimes.

Education was also highlighted in the report as lacking when compared to the population not in prison; only half of convicts have a qualification compared to 85% of those not in prison.

‘One in five [inmates] need help with basic reading, writing and maths’ said the Association of Colleges and the Ministry of Justice have partly blamed prison education programmes – in contrast those who run these programmes in prisons have blamed living conditions, numbers of staff and access to facilities. In a study done by Feinstein and Sabates (2005), arts interventions were used to remodel the lives of offenders; a wide range of benefits was observed, however the quality of the research was not high and a wide range of limitations prevent the study from being useful.

A lack of control groups and baseline information shows there is not conclusive evidence that schools can have a direct influence on youth crime. On the other hand, the evidence obtained suggests poor academic attainment and detachment from school are closely associated with offending. Arts-based activities are claimed to strengthen physical and mental health

EPQ - Ursula Perry whilst reducing offending behavior (Jermyn 2004). I do not believe that the arts and creative programmes can be used effectively to reduce reoffending as there are less prospects for employment once released.

Generally, prisoners are lacking in basic skills such as reading and writing which are vital for almost every job as well as living in the world outside prison. Jason Warr, a member of the rehabilitation charity User Voice, who spent time in prison described his experiences with education in prison in a Guardian article. He noticed the lack of “a focus on basic literacy and numeracy that left opportunities for higher-level learning neglected” (Williams, 2012). He also noted that officers focused on the offenders that had already received previous education and so were more likely to concentrate and in turn flourish. He emphasized the importance of setting targets in prisons, and accused establishments of only allowing a small number of convicts to participate so as to not have prison budgets reduced.

Despite being a biased source, we can clearly see the importance of education and despite the government’s promise to reform the prison education system, there is still a gap in widespread education for all. As well as teaching in literacy and numeracy, there should also be a focus on skills that can be transferred to a wide variety of employment options. There are many links between education that can be provided for prisoners and the likelihood of this occurring – money and staffing levels have a direct impact on this.

Prisoners themselves would

rather be working during their time in prison to earn money, whilst education has no current benefits for offenders. However, this work that they participate in requires virtually no skills and provides no long-term gains – after being released, prisoners find that without the possession of quality skills, they struggle to find employment, leading to an increased potential to reoffend.

Has the government been doing enough?

In the ‘Handbook on Prisons’ written by Yvonne Jewkes in 2007, she describes the aim of a prison as the “deliberate infliction of suffering and hardships upon those contained within its walls”. The third edition of government’s Corporate Plan, published in 2002, outlined the aims of the prison service which can be compared to how prisons are working more recently to truly observe whether the United Kingdom’s government has lived up to their promises.

Their vision of the prison was “to provide a service, through both directly managed and contracted prisons, of which the public can be proud and which will be regarded as a standard of excellence around the world”.

However, I don’t agree that very much has changed in terms of providing services for prisoners that can drastically improve their lives.

Below is what the government stated their goals were (Government Corporate Plan 3rd edition 2002): •

Keep prisoners in custody

•

Maintain order, control, discipline and a safe environment

•

Provide decent conditions

for prisoners and meet their needs including healthcare •

Provide positive regimes which help prisoners address their offending behaviour and allow them as full and responsible life as possible

•

Help prisoners prepare for their return to the community

•

Deliver prison services using the resources provided by Parliament with maximum efficiency

(Handbook on Prisons edited by Yvonne Jewkes (2007)) The graph from the Ministry of Justice, published in 2017, shows how the reoffending rate has changed between 2004 until 2015. It does show that the number of reoffenders has been reduced but not at the impressive rate that it could fall. The government spends an extortionate amount of money on prisoners who reoffend each year; despite programmes being costly in terms of money and time to implement, they do produce long term benefits.

Michael Gove, during his time as the Justice Secretary, emphasized the importance of ‘tackling re-offending rates’ (Telegraph article). The government has realized that to improve the prison system, they must invest into programmes that will drastically improve the lives of those in the system, and by doing this they will truly reduce the rates of reoffending. Accommodation, drug and alcohol misuse and employment are the major problems that convicts face – the lack of support provided proves that programmes that teach prisoners basic transferable skills are a vital part

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EPQ - Ursula Perry of the reduction of reoffending.

Government reforms published in 2010-2015 Reoffending and Rehabilitation Policy made a wide range of promises in the hopes of improving prison quality which in turn will reduce the rate of reoffending in the UK. A new public sector would be created to manage high risk offenders and a reorganization of prisons was promised to encourage the resettlement of convicts through a method of extended aid that continues after their release as well as the introduction of incentivise innovation which would pay providers by results for delivering reductions in reoffending.

The government further stated that they aimed to approach the topic of rehabilitation with integrity and openness. They stated that “staff are the most important asset of the Prison Service” however the reduction in staff since the publishing of this document contradicts this. The paper also stated that the ‘programmes should focus on criminogenic targets with

medium to high-risk offenders’.

I believe this is incorrect as data has shown that the prisoners with the highest reoffending rate are those that have served sentences under 12 months. By focusing on high-risk offenders who are less likely to be released, the government is neglecting those that need the most help.

As a convict, it is very easy to serve a short sentence and then find yourself with no accommodation and no means of employment – there’s a greater temptation to reoffend.

The government also believed that “programmes should engage in high levels of offender responsivity”. In contrast to what they have previously stated, I agree with this. It has been proven in the study done by Anouk Bosma, Maarten Kunst, Joni Reef, Anja Dirkzwager and Paul Niewbeerta (discussed previously) that people who are ready to participate in the programmes offered are more likely to follow through with treatment and in turn experience a positive effect.

Yvonne Jewkes stated that “the overarching aim of the prison is to fulfil its punishment role: the deliberate infliction of suffering and hardships upon those contained within its walls”.

However, I completely disagree as I believe that the removal of freedom influences change to a certain extent but provides those incarcerated with no means of improving their lifestyle once released. She continued with the argument that imprisonment can be justified because of its ability to change and reform those it houses for the better, “through its provision of a means of social defence and public protection for future crimes by its deterrent or incapacitative effect”. These ideas go against what I believe is the point of attending prison, the convict should realise what did they did and why it was wrong so that when they are released, they can go on to be a functioning member of society.

Without programmes offering education and basic skills, the United Kingdom will end up looking after a large number of ex-prisoners who possess no abilities to fend for themselves and instead have to rely on the government.

Conclusion

Graph from: https://www.gov.uk/government/uploads/system/ uploads/attachment_data/file/585908/proven-reoffendingquarterly-bulletin.pdf

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In conclusion, the multiple studies that have been analysed in this research paper have shown that at this time, the government has failed to take into account that rehabilitation is a simple process that would not only save the country millions but also improve the livelihood of ex-convicts and their families. Despite attempts to reduce reoffending and improve rehabilitation in prisons, more than 400,000

EPQ - Ursula Perry crimes were committed by persons discharged from prisons (figures taken from the Ministry of Justice). Many figures that have been published from both the government reports but also charities and leading figures in the prison services, have shown that efforts to reduce reoffending and increase prospects for convicts after being released have not been working to the extent hoped for. The rise in the number of criminals committing serious

sexual and violent crimes suggests that the government should be doing more to not only keep the streets of the UK safe, but to also help those released from prison to find employment and a stable means of income.

The rehabilitation of prisoners is no longer a new idea and should be an essential part of prison life. Harsh prison sentences provide no benefits for both the prisoner and the government – we would save billions every

year just by introducing teachers to convicts. The ultimate goal would be for those who enter the justice system to leave having understood where they made mistakes but also leaving with better prospects than they entered with and a hope for a better life. Crime becomes favourable to those that have no employment or accommodation so this is what prisons must focus on.

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EPQ - Ursula Perry

Bibliography

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Andrews. D. A, Bonta. J, Wormith. J. S. (2011). Criminal Justice and Behaviour. Vol. 38, No. 7. [online] Available at: www.journals.sagepub.com/doi/pdf/ 10.1177/0093854811406356 [Accessed 3rd Feb, 2018.]

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Barrett. D. (2016). Nearly 3000 Serious Offences Committed by Reoffending Criminals Last Year by the Telegraph. [online] Available at: www.telegraph.co.uk/news/uknews/crime/12127936/Nearly-3000-serious-offencescommitted-by-reoffending-criminals-last-year.html [Accessed 30th Jan, 2018.]

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Beijersbergen, K.A., Dirkzwager, A.J. and Nieuwbeerta, P. (2016). Reoffending after release: Does procedural justice during imprisonment matter?. Criminal Justice and Behavior, 43(1), pp.63-82.

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Bosma, A., Kunst, M., Reef, J., Dirkzwager, A. and Nieuwbeerta, P. (2016). Prison-based rehabilitation: Predictors of offender treatment participation and treatment completion. Crime & Delinquency, 62(8)

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Bottoms. A. E, Light. R. (1987). Problems of long-term imprisonment

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Curtis, S. (1989). Juvenile offending: Prevention through intermediate treatment. London: Batsford. Prison Project in the Netherlands

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Dalkin, J. and Padel, U. (2004). The reducing re-offending action plan and prisoner resettlement.

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Dewar-Langridge. E. (2017). Teaching in a prison: ‘Education has the best chance of turning lives around’. [online] Available at: www.theguardian.com/teacher-network/2017/dec/06/teaching-in-a-prisoneducation-has-the-best-chance-of-turning-lives-around [Accessed 4th Mar, 2018.]

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Dickson, S. a. (2014). Planning to avoid risk or planning for a positive life: The relationship between release plan valence and reoffending. International journal of offender therapy and comparative criminology.

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Gibbs. C (2017). Professor Devon Polashek: How to Spot a Pyschopath. [online] Available at: www nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11900738 [Accessed 4th Mar, 2018.]

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GOV.UK. (2015). 2010 to 2015 government policy: reoffending and rehabilitation. [online] Available at: www.gov.uk/ government/publications/2010-to-2015-government-policyreoffending-and-rehabilitation/2010-to-2015-government-policy-reoffending-and-rehabilitation [Accessed 30th Dec, 2017]

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GOV.UK. (2016). [online] The Truth about prisons.

Available at: www.open.justice.gov.uk/reoffending/prisons/ [Accessed 30th Dec, 2017]

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GOV.UK. Proven Reoffending Statistics. [online] Available at: www.gov.uk/government/collections/proven-reoffending-statistics [Accessed 30th Dec, 2017]

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GOV.UK. Reducing Reoffending in Adults. [online] Available at: www.gov.uk/government/uploads/system/uploads/attachment_data/file/449347/ reducing-reoffending-in-adults.pdf [Accessed 30th Dec, 2017]

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GOV.UK. A guide to Proven Reoffending Statistics. [online] Available at: www.gov.uk/government/uploads/system/uploads/attachment_data/file/658384 /guide-to-proven-reoffending-statistics-oct17.pdf [Accessed 30th Dec, 2017]

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Grierson, J. (2013). Reoffending Rate Increases. [online] Available at: www.independent.co.uk/news/uk/crime/reoffending-rate -increases-8475391.html [Accessed 30th Dec, 2017]

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Hagell, A., Newburn, T. and Rowlingson, K. (1995). Financial difficulties on release from prison (Vol. 791). Policy Studies Institute.

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Jewkes, Y. C. (J. eds., 2016). Handbook on prisons . Routledge.

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McGrew, K. P. (2008). Education’s prisoners: Schooling, the political economy, and the prison industrial complex (Vol. 325).

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McGuire, J. (1995). What works: Reducing reoffending: Guidelines from research and practice. .

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Morgan, A. (2007). Young People and Offending: Education, Youth Justice and Social Inclusion.

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Politics.co.uk. (N.D). Prison Rehabilitation. [online] Available at: www.politics.co.uk/reference/prison-rehabilitation [Accessed 30th Dec, 2017]

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115). . Westport, CT: Greenwood Press

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IB Extended Essay - Artemis Kwok

To What Extent Are There Gender Differences on the Efficacy of Pharmacological Treatments Compared to Psychological Treatment for Major Depressive Disorder?

Artemis Kwok Depressive disorder, commonly known as depression or clinical depression, is a common mood disorder characterised mainly by “feelings of hopelessness, or pessimism”, as well as a “persistent sad, anxious, or ‘empty’ mood”. To be diagnosed with this mental condition, the individual has to experience or exhibit depressive symptoms for at least two weeks, most of the day or nearly every day (National Institute of Mental Health).

In 2015, 4.4% of the world’s population were estimated to suffer from depression, equivalent to over 300 million people at a global level.

Furthermore, more females are diagnosed with depression (5.1%) than males (3.6%) (World Health Organisation, 2017, p.8).

According to the indicators from the Organisation for Economic Cooperation and Development (OECD) which investigated the antidepressant use in 29 countries, there is an increase of antidepressant drug consumption in the recent years (OCED, 2017). This growing trend of antidepressant prescription (2016) may indicate the prevalence of depression.

Theories have been postulated regarding the aetiology of depression, and an array of different treatments have been established to attempt to cure

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or to lessen the symptoms of depression.

However, there are no validated and diagnostically useful tests to aid the understanding of the true aetiology of this complex disorder, and the reason for the gender differences found in the number of the clinically diagnosed patients remains uncertain. With the gender stigma attached that depression is stereotypically more of a female mental health condition, it leads to the question of whether gender plays a role in the efficacy of the treatments.

This essay will focus on two psychological perspectives, the biological and the cognitive approach, to discuss gender differences on the efficacy of the treatments for depression.

Selective serotonin re-uptake inhibitors (SSRIs) and cognitive behavioural therapy (CBT) will be evaluated on their relative efficacy in treating depressive disorders in respect of different genders.

Pharmacological Treatments The medical model in treating mental disorders is to regard them as any other disease, in which the professional psychiatrists prescribe medication for patients to

improve the symptoms caused by the disorder. There are three main classes of antidepressants to treat depression: 1) tricyclic and related antidepressants (TCAs), 2) selective serotonin reuptake inhibitors (SSRIs), and 3) monoamine oxidase inhibitors (MAOIs). There are several types of SSRIs, for example, citalopram (Cipramil), escitalopram (Cipralex), fluoxetine (Prozac or Oxactin), paroxetine (Seroxat) and sertraline (Zoloft) (National Institution for Health and Care Excellence).

One of the major theories, the monoamine hypothesis, suggests that the causation of depression is due to neurochemical abnormalities or imbalances in the central nervous system, which is built on the fact that “various neurotransmitters seem to be manufactured, released, or used at abnormal levels in the brain of someone suffering for depression”(Gleitman, Fridlund and Reisberg, 2003, p.663).

The monoamine paradigm allowed psychologists to have a more direct method in investigating the role of monoamine played in depression. This led to the creation of antidepressants which are known to increase the neurotransmission of serotonin, dopamine, and norepinephrine.

IB Extended Essay - Artemis Kwok Research has shown that antidepressants are an effective treatment for depression.

Cipriano et al. (2018) analysed the comparative efficacy and reaction of 21 antidepressant drugs and placebo on depressed adults. A systematic review and wide meta-analysis were conducted using 116,477 participants of both sexes with depression. The results show that when compared to a placebo, all antidepressants were more efficacious. The sample is large and is neither androcentric nor gynocentric, which is representative and can be generalised to both genders. As a systematic review is an overview that summarises all the available evidence, this study has a high level of reliability. However, publication bias could have affected the outcome as negative results are likely to be suppressed.

SSRIs will be discussed as an example to compare its efficacy in relation with CBT in treating in this essay.

How do SSRIs work?

Serotonin deficiency theory postulates that depression is due to “a net reduction in serotonin transmission” and the pathophysiological of depression may possibly relate to a decrease in serotonin, or 5 - hydroxytryptophan (5-HT) availability (Kerr, C, 1994).

By the late 1980s, antidepressants such as SSRIs were developed as a second-generation of antidepressants with improved safety and tolerability due to the prevalent public stigma at the time. They were found to have fewer potential side effects compared to the previous generation—the

earliest drugs MAOIs and TCAs in the 1950s to 1960s, and SSRIs still remain as one of the most popular prescribed drugs till today. SSRIs selectively inhibit the 5-HT re-uptake into presynaptic neurons, in which chronic receptions will result in increasing 5-HT levels in the brain (Yohn, C. Gergues, M. Samuels, B.,2017). Since SSRIs block the re-uptake of serotonin, there is more serotonin available at the synapse which is able to increase the level of neurotransmission.

Whilst SSRIs are shown to be effective, there are limitations. Patients receiving SSRIs may have adverse drug reactions (ADRs) just like other medications. Since serotonin receptors comprise different sub-receptor levels, and they mediate a variety of functions related to mood, like sleep, appetite, and sexual function, and symptoms such as pain, nausea, depression and anxiety.

Preventing serotonin re-uptake increases the availability of the neurotransmitter to interact with any of these receptors, which denotes the relationship between drug dosage and serotonergic effects (Ferguson, J. 2001). For long-term SSRI therapy, adverse effects include sexual dysfunction, weight gain and sleep disturbance.

Furthermore, gender differences have to be considered as a mean to evaluate its efficacy as the biological differences of the sexes may cause them to react differently. According to the study by Ekhart et al. (2018), whose aim was to explore whether gender differences exist in reported ADRs of SSRIs in the database of the Netherlands Pharmacovigilance Centre Lareb, women were statistically significantly more reported for 16 ADRs while men were

more reported for 4 ADRs. Elkhart et al. (2018) concluded that as differences in the pharmacokinetics of SSRIs between men and women might be an explanation as to why women appeared to have more dose-related ADRs when using SSRIs than men.

Another study also suggests that women respond differently than men to SSRIs. Khan et al. (2005) conducted an investigation into sex differences in antidepressant treatment response.

323 depressed patients were included into 15 randomised, placebo-controlled trials, in which women were shown to have a significantly greater response than men to SSRI antidepressants. Khan concluded that the findings show implications and possibility that antidepressant may work differently in men and women.

The strength of this study is that randomised placebo-controlled trials help to remove allocation bias and can minimise the possible placebo effect in the statistical analysis, therefore it has high internal validity.

Also, clinical trials are highly controlled, which increases the internal validity of the study.

However, the report from Entsuah et al. (2001) did not find gender differences in antidepressant treatment. A meta-analysis was carried out to examine the clinical efficacy of antidepressants across gender and age groups, by conducting 8 double-blinded and randomised clinical trials on different subpopulations.

2045 depressed patients aged 18 to 83 years old who met the Diagnostic and Statistical Manual of Mental Disorders criteria of major depressive disorder were randomised into three conditions to receive

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IB Extended Essay - Artemis Kwok either venlafaxine, one type of SSRIs, or placebo for 8 weeks.

The Hamilton Rating Scale for Depression (HAM-D) was used to assess the remission and response of the antidepressants.

The results showed that male and female patients of different ages receiving a given antidepressant treatment had similar rates of remission, response and absence of depressed mood. Entsuah et al. concluded that the reported data suggested there was not a significant difference between responses from both genders across various age groups. This study has high internal validity as the clinical trials are doubleblinded and randomised, therefore it reduces researcher bias, social desirability effect and demand characteristics.

The time period of 8 weeks ensures that the patients have more than enough time for the medication to work as two to six weeks are usually required for most people, thus it increases the reliability of the result.

Moreover, HAM-D is utilised to administer the response of the treatment which has a high level of reliability. However, it may be unethical and impractical for participants in the placebo condition as they are denied to have treatments for that period of time and may have affected negatively on their progress of recovering.

One of the strengths of SSRI as a method of treating patients with depressive disorders is the availability of antidepressants.

Although pharmacological and psychological treatments of depressions are present, antidepressants are prescribed more frequently due to inadequate resources, availability and cost. In spite of that, the massive increasing use of antidepressant raises

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concerns about whether this trend indicates that more people are seeking out help resulting in an over-pathologisation (The Guardian, 2017).

However, SSRIs also face several limitations.

As previously mentioned, liabilities of a chemical substance may include short-term or longterm side effects and the probability of addiction for the drug. Symptoms of depression may also fluctuate depending on different factors, such as environmental influences, individual differences as well as genetic differences may vary the response to antidepressants and the occurrence of adverse effects. The impact of female hormones like estradiol or progesterone may be one of the limiting factors regarding the efficacy of SSRIs as these reproductive hormones may interfere with the mechanism of antidepressants. Older women seem to have significantly poorer SSRI response, however, hormone replacement therapy (HRT) appears to eliminate the difference (Thase et al., 2005).

This suggests that factors like gender, age and hormonal status could interact and influence individual physiological and behavioural responses to SSRIs. Although neurochemical imbalances might explain the changes in a patient’s mood and energy, it would be reductionist to solely study depressive disorder by the biological approach, utterly diminishing the factor to a neurotransmitter level. There is no unifying theory that can elucidate the alterations in serotonin levels in a depressed patient, since patients have to believe the therapeutic power of the medication to agree to consume it, and it is impossible

to completely eliminate placebo effect to measure the independent biological impact of antidepressants. Further, it is not known that whether serotonin imbalance is a cause or a consequence of depression, hence a casual relationship cannot be established.

Psychological Therapies Albert Ellis’ Rational Emotive Behavior Therapy (REBT) in the 1950s and Cognitive Therapy (CT) developed by Aaron Beck in the 1960s gave rise to the earliest forms of Cognitive Behavioural Therapy (CBT). It is defined as “a therapeutic approach that emphasised a cognitive and emotional treatment approach” (Psychology Review, 2018, p.30).

According to Beck’s cognitive specificity hypothesis (Beck et al., 1979, cited in Simos, 2002), each disorder has its own specific cognitive profile and depressed patients primarily show themes of “loss, defeat and failure in their cognitive content”. CBT is based on Beck’s cognitive model of mental illness, which is a framework that helps the understanding of an individual’s mental problem. It hypothesises that people’s emotions and behaviours are determined by their perceptions and how they interpret the situation, not the situation per se (Beck, 1964, cited in Fenn et al., 2013). For instance, depressed patients are considered to appraise events in an excessively negative way (Beck, 1976, cited by Fenn et al., 2013). Beck (1967, cited in McLeod, 2015) proposed three mechanisms that might be responsible for depression: 1) the cognitive triad, 2) dysfunctional assumptions, and 3) negative automatic thoughts (NATs).

IB Extended Essay - Artemis Kwok The cognitive triad is three forms of negative core beliefs held by an individual about the self, the world and the future. The individuals will view themselves as worthless and helpless, interpret the world in a defeatist way and think that they are inadequate to handle the world, therefore the future is hopeless.

When these three forms interact, it creates a continuous cycle that interferes with the individual’s normal cognitive processing, ultimately leading to psychiatric impairments.

Dysfunctional assumptions are rigid suppositions that people adopt and apply to interpret meaning in a situation which is faulty thinking, and NATs are automatically activated negative thoughts that are involuntary.

How does CBT work?

As stated in Psychotherapy for Psychologists (Guilford Press and Routledge, 2017), one of CBT-specific components is collaborative empiricism.

Different from other therapies where patients may take a passive role, CBT prioritises active participation and fosters a collaborative relationship between the clients and therapists who act as a mere guide that facilitates the clients to identify maladaptive cognitions and behaviour then work towards their desired goals (Fenn et al., 2013). Mutual contribution is a special feature of the therapeutic relationship in CBT, which invites and motivates the patients to have an active role to be the agent of change. This may greatly increase their adherence to the treatment because the structure of the therapy designed accordingly to have more

engagement rather than having the patients to comply the plan, which reflects shared work as one of the fundamentals of CBT. Beck (1979) defined CBT as “an active, directive, time-limited, structured approach used to treat a variety of psychiatric disorders (such as depression, anxiety, phobias etc.)”. Unlike other therapies that deal with past experiences, it is problemoriented and focuses on the individual’s current state of mind by breaking down a problem and setting goals to achieve.

By the nature of the name, both cognitive and behavioural components are included in many CBT strategies. Guided discovery (Padesky, 1993, cited

by Fenn, 2013) is a cognitive therapeutic stance which attempts to understand the patient’s point of view, aid them to confront their underlying negative assumptions and to find alternative perspectives on events and solutions for their problems. Socratic questioning is a technique to promote cognitive restructuring and critical thinking.

Clinician utilises Socratic questions to provide patients an opportunity to think outside of their current focus and question their negative core beliefs in order to discover other perspectives.

Behavioural techniques include activity scheduling and graded task assignment which aim to increase enjoyable and productive experiences (Fenn, 2013). Both of the methods require collaborative designing to make sure the patients have manageable steps to overcome difficult situations, sustainable improvement between sessions and try to reactive their motivation towards life.

Moreover, these help patients to maintain daily routines, achieve more pleasurable tasks

and deal with their depression.

Due to its time-sensitive and goal-oriented nature and thereby it is cost-saving, the length of the treatment typically lasts from 5 to 20 sessions, which is relatively a short period of time compared to other therapies (NHS, 2016).

CBT may have a better longterm outcome as the strategies that are learnt from the sessions can be transferred to everyday life, even after the treatment has finished. The structure of CBT can be tailored as per the need of the patients into different formats, but because CBT emphasises on the present time, it only addresses current problems, ignoring possible underlying causes, such as unpleasant childhood or past experience. In addition, the degree of efficacy may depend on the level of therapist experience or expertise as the way the therapist handle or deal with the situation may greatly influence the reaction and progress of the client.

To evaluate the efficacy of gender as a moderator in CBT, Watson et al. (2008) demonstrated in a study with 35 male and 55 female depressed patients, that both genders demonstrated equivalent pretreatment and post-treatment illness severity and a comparable gradient of improvement on outcomes. Cuijpers (2008), cited

by Weissman (2014, p.385), also found that there was no association between effect size and gender when comparing a psychological treatment with a control condition in a metaanalysis of controlled clinical trials of psychotherapy for depression, though women with post-partum depression had higher effect sizes was

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IB Extended Essay - Artemis Kwok an exception. The hormonal fluctuations of women with post-partum depression may explain why they had higher effect sizes and this may indicate that female hormones have a positive effect on the efficacy of the treatment to some extent. Although there is not a great gender difference in the efficacy of CBT, the majority of samples were women, and some trials only included women, which raises the issue of un-representation on the number of men being recruited.

This may affect the statistical power to show how gender affects treatment response.

However, the results from Pieh et al. (2012) contradict Cuijpers’. 298 patients with 154 women underwent a standardised five-week CBT-orientated multimodal treatment. The findings show that depressed women benefit significantly more from CBT and reduce significantly more depressive symptoms than men.

Depressive symptoms were measured respectively before and after the treatment with the German version of the Center for Epidemiological Studies Depression Scale (CES-D) which increased the internal validity of the study. Normally, the course of treatment lasts for 5 to 20 weekly sessions, the longevity of a five-week treatment may not be enough for some depressed participants due to individual differences and may decrease the validity of the results.

Another substantial fact is that CBT requires cooperation and its effectiveness is limited by the level of motivation of the patients. The extra assignment demands time and effort, so if the individual is not willing to progress or fail to change their perspectives, CBT may not be

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effective for that person.

Traditional masculine stereotype might hinder and negatively influence the therapeutic engagement and process of CBT. According to Englar-Carlson (2006, cited in Spendelow, 2015), men have been reported to view psychotherapy itself as antimasculine.

Males may feel that they are under stereotype threat because the act of seeking help for depressive symptoms is portrayed as more feminine compared to those who do not seek assistance, they are pressured socially and probably culturally to conform in response to perceptions about their own gender.

Consequently, less depressed men would be favourable toward help-seeking or that they would be reluctant to disclose themselves, in which their rigid cognitive gender identity may contribute to poor engagement and retention in the treatment and greatly decrease the effectiveness of CBT. This may be a reason why CBT is more effective on some women.

Evaluation It is clear that both approaches of pharmacological and psychological therapy encounter strengths and limitations.

Antidepressants do not necessarily treat the cause of depression but rather the symptoms. Most people with depression will get better without any treatment after 8 months (RCPSYCH, 2009), to some extent, the efficacy of antidepressants may not be that high. Furthermore, only 50% to 65% of moderately severe depressed patients

that are being treated with antidepressants for three months would show definite improvement, which suggests that not all people respond to this medication (RCPSYCH, 2009). Therefore, there is a need for psychological therapy as a valuable alternative intervention for those individuals who do not respond to the first trial with antidepressants.

Secondly, patients that might be drug responsive may refuse to take medications due to personal objections and some may have developed adverse effects and have to terminate the use.

Psychotherapy might be more beneficial than medications in terms of long-term effectiveness because patients can learn and utilise psychological methods from his or her psychotherapeutic experience to cope with depression, not solely relying on drugs. This type of mindfulness-based psychotherapy may be more effective and be a longerlasting alternative as it provides a direct approach that targets the negative thoughts of the patients. Moreover, as stated by Dobson et al. (2008), they found that CBT was less expensive in a randomised trial of CBT and ADM (antidepressant medication). CBT costs more initially, but the cumulative expense of continued mediations is shown to be more expensive in the long run.

However, due to the fact that the impact of gender on the efficacy for both treatments is inconsistent with some studies and the lack of studies on gender differences in CBT, it is difficult to determine whether there are gender differences on the efficacy of pharmacological treatments compared to

IB Extended Essay - Artemis Kwok psychological treatment for depression. In addition, the cause of the gender gap in focus on gender diagnosis of depression still remains unknown. Biological factors such as genetics, hormones and environmental stress may engender females to be more vulnerable to depressive disorder and cause gender differences in treatments.

According to Harvard Health Publishing (2001), hormonal fluctuations due to menstruation in each month, post-partum period and peri-menopause create similar mood changes to that of depression, in which around 10% to 15% of new mothers develop post-partum depression. Social factors and cultural stressors may also play a role in the gender gap, as women are more likely to face gender inequality and discrimination. For instance, gender-based abuse, unequal social status and income, which may increase the risk factors for having depression. Further, doctors are more likely to diagnose depression in females compared to males due to the gender stigma of mental illness. Women may be more prone to depression because they may be more likely to become depressed under stress and ruminate over events, which may predispose some individuals to depression.

Nonetheless, the research done

by Scheibe et al. (2003) indicates that a certain personality type may potentially predispose an individual to develop clinical depression rather than gender. The study investigated the gender differences in antidepressant treatment response and personality. The sample consisted of 129 male and 246 female outpatients with major depression in

a tertiary care centre and received antidepressant treatment (including SSRIs).

Comparisons with regard to their “symptoms of depression, the course of illness, treatment response and personality” were contrasted, and the findings showed that women were found to “experience more vegetative and atypical symptoms, anxiety, and anger” than men and to “report higher severity of depression on self-report measures”, but there were no significant differences in the course of illness and treatment response. The findings have low generalisability as they are not applicable to inpatient or community samples. Some of the gender differences may be attributable to the gender differences in the behaviour of seeking treatment, and the fact that the gender imbalance of the sample—the number of women sampled is doubled the number of men, which this sampling bias may affect the internal validity of the findings.

Conclusion In overview, SSRIs and CBT are effective to a certain extent and some gender differences can be found. Whilst they are very different in the methodologies of treatments and approaches, they share the same goal of trying to alleviate and aid patients that cannot deal with their disorders to restore back to normal functioning, we have to acknowledge the limitations and understand that they are indeed effective for some individuals.

than drug treatment alone, and psychotherapy helps to keep patients in treatment with longer therapies. Overall, patients improved significantly with combined treatment than with those receiving medications alone. The result also shows that combined treatment has an advantage as there is a significant reduction in dropouts compared with non-responders in longer trials. This indicates that a combination of both therapies is comparably more beneficial than monotherapy, as SSRI targets the biological problem while CBT provides skills for the patients to improve current cognitive problem and prevent future recurrence of depression.

Sex may have played a role in the efficacy of both treatments, in which, factors such as female hormones, gender stereotype may have contributed to the gender differences. However, more investigations are needed to be carried out in order to evaluate whether gender is an important factor to be considered so that further modifications can be made to increase the efficacy of the treatments for depression.

Pampallona et al. (2004) suggest that a combination of psychological treatment and antidepressant therapy has a higher improvement rate

31

IB Extended Essay - Artemis Kwok

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32

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Pampallona, S. Bollini, P. Tibaldi, G. Kupelnick, B. Munizza, C. (2004). Combined Pharmacotherapy and Psychological Treatment for Depression—A Systematic Review. Arch Gen Psychiatry, [online] Volume 61(7), p.714-719.

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Pieh, C. Altmeppen, J. Neumeier, S. Loew, T. Angerer, M. Lahmann, C. (2012). Gender differences in response to CBT-orientated multimodal treatment in depressed patients with chronic pain.

Psychiatrische Praxis, [online] Volume 39(6), pp.280-5.

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IB Extended Essay - Artemis Kwok

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Yohn, C. Gergues, M. Samuels, B. (2017). The role of 5-HT receptors in depression. Molecular Brain, [online] Available at: www.molecularbrain.biomedcentral.com/articles/10.1186/s13041-017-0306-y [Accessed 8 Jun. 2018].

Talent 2030 - National Engineering Competition for Girls

An Investigation into How to Reduce the Amount of Black Plastic in Landfill Genevieve Baller, Honor Erskine, Charlotte McCorry & Clara Williams Our task for the Talent 2030 competition was to identify a 21st century problem and research or create solutions to this problem.

The problem we identified was that of black plastic; how it physically has recyclable properties, but due to its colour, is not being sorted correctly and therefore ends up in landfill. We aimed to find solutions for both the material and or colourants being used, and the sensor which detects the plastic.

This is a big issue due to the quantity of black plastics that does not get recycled in recycling facilities due to the Near Infrared (NIR) sensors not being able to detect carbon black, the colouring of most black packaging, as it does not reflect any light. Currently there is no commercially viable way to detect these black plastics, resulting in them being picked out by hand to be recycled or sent to landfill, which is neither cost effective nor environmentally friendly.

We tasked ourselves with finding different ways to increase the quantity of black plastic that is recycled, and thereby reducing the amounts of black plastic going into landfill.

Our team researched the current method of plastic sorting, NIR optical sorting, and the Carbon Black colourant which is used to make common un-recyclable black plastics, the majority of which is used for

food packaging. After looking at all of the data that we gathered, we concluded that there were a number of different areas that could be changed concerning the methods of how black plastic is recycled, but the most economically viable or realistic solutions were to change the pigment being used so current sensors could detect the plastic, or to opt for a newly developed sensor which results in there being no need to change any manufacturing methods of the black plastics.

We feel that this should be implemented in all recycling sites, or manufacturing bases across the country to reduce the waste of black plastic and to benefit the overall population.

However further testing is needed for the commercial use of the new colourants or the newly developed sensors.

Our group explored the current recycling method of plastic sorting and why black plastic does not work with this method.

After identifying this, we researched into changeable aspects of current recycling methods and the black plastic itself in order reduce the amount of black plastic in landfill.

Identifying the Problem The 21st century problem we have chosen to research is the use of carbon black pigment in the colouring of black

plastic food containers. This type of plastic is not currently detectable by the automatic NIR sorting systems, common in recycling plants.

Plastics containing these pigments can be manually removed and recycled, but most end up as residue and are sent to landfill.

Approximately 1.3 billion black plastic trays are produced in the UK alone [1], and there is currently no infrastructure in place by which to recycle them efficiently, resulting in 3.5 million tonnes of black plastic going to landfill annually [2].

Areas of research The specific points we decided to research were: •

Plastic sorting methods

•

Black plastic colourants

Within these topic areas we will also discuss possible solutions for the future.

Optical Plastic Sorting Explained Most plastic is sorted using a Near Infrared (NIR) sensor, although this is not applicable to black plastic packaging.

NIR plastic sorting is a technology which uses optical sensors to sort plastics depending on polymer type.

The sensor that detects the

35

Talent 2030 - National Engineering Competition for Girls plastic’s recyclability properties is in the Photoelectric Sensor family.

There are 3 different types of photoelectric sensors, they are: •

Diffused

•

Retro-reflective

•

Thru-beam

Plastic is identified with a Diffused Mode Photoelectric Sensor (DMPS).

A benefit of a DMPS is that both the transmitter and receiver are in the same facility, additionally, no secondary device such as a reflector is needed. As a DMPS detects reflected light it works best within a short distance of its target, which makes it relatively compact, lending itself to a factory environment.

The target’s colour, size and finish all directly affect its ability to reflect light.

The transmitter emits light which strikes the target (plastic on the conveyor belt), the

36

light reflects to the receiver at arbitrary angles, this angle determines the strand of plastic.

The problem of black plastic is that it absorbs almost all light, so the receiver doesn’t detect any light reflected and assumes it is non-recyclable.

The diagram shows the different NIR reflection of different strands of plastics such as PETE1 and HDPE2 from which the recyclability of the plastic is determined.

Differently angled air jets then project the plastics onto the correlating conveyor belts for recycling or landfill. As almost no light is reflected from black plastic, the black plastic is projected onto the landfill conveyor belt.

Possible Future Sorting Systems There are many possible alternative systems to NIR plastic sorting, below we have outlined the potential for seven

alternatives.

WRAP.org.uk [3] performed many tests to obtain results about how well each alternative to the current NIR Detecting sensor works.

Here we will outline what investigation was taken and elaborate on what their results showed.

We are particularly interested in the Reflective MIR Sensor and the Laser Raman Fluorescence Spectroscopy as they had the most promising results.

Mid Infrared (MIR) Spectroscopy Technology & Testing “The MIR tests were performed to determine whether MIR spectroscopy is a suitable technique for identification and sorting of black plastic packaging that is coloured with carbon black.” - WRAP.org.uk Several

trays

with

varying

Talent 2030 - National Engineering Competition for Girls amounts of carbon black pigment, of which the investigators did not know the value of, were used to test the reliability of the Mid Infrared Spectroscopy. A static laboratory MIR Spectrometer performed measurements of the spectra and material recognition testing.

Measurements were taken across the mid-infrared spectral region. Details of the testing facility and the wavelength range in which the

Sensor Name

measurement were performed are confidential as the process is in commercial development, so we cannot explore the setting in with the sensor is placed.

This tray was easily detected by the MIR Spectroscopy, which also allowed it to be instantly sorted for recycling rather than ending up as waste.

However, there were many technical limitations with the MIR system that need to be engineered to overcome. An example of a limitation is that

Our Findings

Comments

Has potential, but equipment limitations exist.

Systems available and are being used for high speed sorting of black plastic flakes, but not currently available for sorting of packaging articles such as trays.

Laser Raman Fluoresence Spectroscopy

Is being used as a solution currently but has extreme limitations

Already companies like UNISENSOR and Visys NV are working on and developing this system so it can become commercially viable.

LIBS/LIPS

A very promising development for the future.

No commercial systems available.

Electrostatic Separation

May provide adequate separation.

Surface contamination may interfere with this system.

Tack Separation

Does supply separation, but not for complex plastic, of which most packaging is.

Potential for development, but little to no manufacturers are investigating it due to other, more viable solutions

Addition of Markers

Fluorescent markers could provide a costeffective method of identification

The addition rates required to work effectively in black plastics needs to be established.

Reflective MIR

some black plastics would melt when under the MIR light source, which resulted is an obstructed reading, the reading was determined as “inconclusive� but the plastic got automatically sent to landfill. Another limitation, linked to the problem of plastic melting, is that when detecting black plastic polymers, the MIR system was 50% of the speed that the current NIR systems are, making the price and time of sorting not worth the amount of black plastic that would be recycled.

MIR automatic sorting is still not commercially available due to the price and speed of the equipment. Even though there are many developments to be made, the MIR Spectroscopy is a clear contender for the future of black plastic recycling.

MIR Technology Conclusion The commercial samples used for the tests were coloured with an unknown amount of carbon black. Under NIR spectroscopy the spectra were found to have very low intensity levels and appeared random (without a unique spectral signature). The trial results proved that trays coloured with carbon black could not be detected by means of NIR-spectroscopy.

The MIR system showed a number of technical limitations that still need to be overcome.

For example the tests showed spectra with low signal-to-noise of the black plastics due to localised melting of the black plastic trays when under the MIR light source, this issue needs to be further evaluated. MIR spectroscopy based systems also need further development

37

Talent 2030 - National Engineering Competition for Girls

With NIR, TITECH found that, as expected, NIR could not detect any of the commercially available carbon black coloured trays. Moulded trial plaques compounded with varying levels of carbon black could not be detected even with addition levels as low as 0.1%, at which the samples already had a translucent black tint rather than an opaque black.

Laser Spectroscopy Technology & Testing Warp.org.uk used the Powersort 200, designed by Unisensor, to investigate the success of Laser Spectroscopy Technology.

The Powersort 200 utilises the material’s overall emission spectrum, also referred to as the material’s fingerprint, to be able to profile it. This system can measure up to 1,000,000 spectra per second due to its wide-band measurement ranging from the Ultra-violet to Infrared spectrums. The Powersort 200 is able to detect and differentiate many different materials including some black materials.

We decided this was a good sensor system to look into further as it is already being used for separation of different black plastics in the automotive area, but not commercially.

“The Powersort 200 is able to achieve a high level of 99.7% purity after a sort and two resorting passes in an operation where 50% of the incoming

38

Intensity

in polymer identification speeds, so that the MIR systems can match those of current commercial NIR units and to achieve this sufficient cooling is needed to prevent melting of the polymer materials during the identification step.

c o m p a n i e sWavelengthsuch

as

flakes are black.” - Unisensor (If the percentage of incoming black flakes is significantly lower then re-sorting may not be necessary.)

There was a significant spectral response obtained by the Powersort 200 for a black PET tray, so therefore the laser spectroscopic system can easily detect and differentiate black PET trays from a conveyor belt (but only when under industrial processing conditions).

Facilities that currently use MRF or PRF (systems that can sort plastics into flake formats, not including Carbon black) to sort plastics can be easily converted to be able to use the more successful laser spectroscopic system.

Flake sorting systems such as MRF or PRF are usually only used after the plastics have been sorted by polymer type, so a laser spectroscopic system would mitigate the extra step and therefore decrease the time taken and increase the effectiveness.

Commercially, laser sorting systems are available from

UNISENSOR Visys NV.

GmbH

and

Unisensor use Laser Raman Fluorescence Spectroscopy and Visys NV systems utilise the reflection of laser light to perform detection.

While economically viable in the high value PET recycling industry, they may not be economically viable purely for the purposes of recovering black plastic packaging.

Laser Technology Conclusion The commercial trays tested showed an infrared range spectrum which can be detected

by MIR spectroscopes.

MIR sorting has potential as a method for sorting rigid plastics coloured with carbon black pigments. MIR sorting is still in commercial development and has processing issues which must be resolved before it could become commercially viable.

Pricing is also an issue with MIR sorting, it is not certain currently

Talent 2030 - National Engineering Competition for Girls MIR spectroscopic system.

but it is suspected to be higher than NIR sorting and so MIR spectroscopy as it is may not be economically justified to only be used for black plastic.

A significant spectra was obtained from black PET, CPET and PS when a laser spectroscopy system was used to detect the spectra. This allowed for PET, CPET and PS to be easily differentiated and detect in industrial conditions.

Manufacture evidence suggests that polypropylene, starch based plastic and thermoplastic materials had a lower chance of being detected, whereas almost all other types of black plastic had a close to 100% success of being detected.

The manufacturer of the Powersort 200, Unisensor, claim that they have since done tests and there is a substantial improvement in the detection of the polymer materials, and they claim to be continuing the development of the Powersort 200 until a reliable 100% accuracy at detecting all black plastics is met.

The laser spectroscopy based Unisensor Powersort 200 system returned positive identifications for PET and PS tray samples with standard carbon black colourant, but could not detect black PP and starch trays.

Conclusions Most UK and EU waste facilities currently use NIR technology to sort plastic for recycling, because this is the only commercially developed and economically viable solution at the moment. This part of the research project aimed to find alternative to NIR technology, to aid in the recycling of black plastic.

All the techniques require investment in additional sorting equipment, ranging from an additional spectroscopic sorting stage through to reconfiguration of the plant to allow physical sorting of the out-throw stream.

Technical limitations make physical methods unlikely to provide a viable solution for commercial use. Markers (material additives which allow the black plastic to be identified) were found to be too expensive and current systems are not yet suitable for high speed sorting systems. Plaques and trays containing standard carbon black colourant were tested by two commercial systems, an NIR based system supplied by TITECH, and a Raman (Laser) spectroscopic system supplied by Unisensor.

These were also compared with results from a noncommercial (developmental)

The spectra obtained from commercial black PP and thermoplastic starch based trays showed low intensity and detection of the polymer type was difficult. Unisensor have reported that detection of black PP flakes at high speed is achievable but difficult, but there is potential for Laser Raman fluorescence spectroscopy system to accurately detect and sort larger articles such as black trays once commercial systems are developed.

Black Plastic Colourants Currently, the most common pigment responsible for the colouring of black plastic is Carbon Black. This pigment is not detectable by automatic near infrared (NIR) sorting systems used in the recycling of plastic, due to the fact that it absorbs all light in the visible region of the electromagnetic spectrum and strongly absorbs the UV and infrared spectral ranges.

3.1 Benefits Black plastic

of

Carbon

One of the reasons for the common use of Carbon Black plastic is its aesthetic qualities, many foods are packaged in black, like ready meals.

•

One benefit of carbon black colourants is that it can allow the thermoforming process to happen quicker, due to the higher infrared absorption properties, which allow the equipment to heat up faster when thermoforming from sheet plastic.

•

It is low cost

•

It has good dispersion and

39

Talent 2030 - National Engineering Competition for Girls masking properties, which allows black plastic to be made from cut-offs of other waste plastic items

Alternative Colourants Our aim in this part of the investigation was to research alternative dyes and pigments to carbon black. Ideally alternatives could be used to colour the black plastic but that could also be detected by NIR systems. We could also try to research and develop addition marker substances that can be identified by the systems but do not alter the appearance of the plastic.

It is possible to use alternative colourants to dye the plastic which appear black and can also be detected by current NIR sensors. The key characteristics that are necessary in identifying suitable black colourants are: •

High absorption of visible light

•

Reflection in the NIR spectrum

The five alternative colourants found were: •

Sicopal K0095 (pigment)

•

Lumogen FK4210 (pigment)

•

Black 95530 (pigment)

•

Black 95492 (pigment)

•

Black 95493 (pigment)

•

Dye Black-5 (liquid colourant)

Selection and Experimentation Through undertaken

40

experimentation by

WRAP.org.uk, the colourant systems were optimised to improve tint strength, as many retailers said that the black dyes were not dark enough for satisfactory commercial use. The colourants that were selected for large scale APET, CPET and PP (common plastics used for packaging) trials were Black 95530 for PP and CPET, and Dye Black 5 for APET and CPET. •

Food contact trays were made for each of the colourants using sheet thermoforming for PP, APET and CPET, with a 2% addition of the colourants.

•

Repeated recycling of PET and PP materials for both colourants did not impact the quality of the colour.

•

Lab trials of filling and sealing tray samples were successful and the different colourants were found to make no significant difference to the heat required to achieve the seals.

In large scale sorting trials over 99% of the plastic trays were correctly sorted by NIR detectors. (At Jayplas Plastics manufacturing centres) Other NIR sorting machine manufacturers also conducted trials with these trays and found that they could sort them by polymer type and colour, with only a small adjustment to the machines to differentiate the black trays from the clear trays which appear black against the black conveyor belt.

Costs Evaluation A cost evaluation was conducted for lightweight PP trays and heavier CPET trays in the alternative colourants

compared to carbon black [4].

It was discovered that detectable black colourants are more expensive than conventional carbon black colourants with a price range of around £9-£16 per kg. This would lead to an increase in cost of £1.80-£3.50 per 1000 PET trays at a 1% addition rate of pigment.

For the thinner PP trays this would be around £0.75-£1.50 per 1000 trays, also at a 1% addition rate.

The final cost change is affected by the addition rate (of the colourant).

The analysis table below outlines the costs of different colourants depending on the % of additional pigment and the type of plastic.

Possible Future Colourant Solutions Where possible, NIR detectable colourants should be used in black plastic manufacturing to maximise black plastic recycling. However, where a black colour is desired, in order for the packaging supply chain to more widely adopt the new colourants, further optimisation, testing and validation is needed to increase the intensity of the black colour.

This optimisation will cover issues concerning the economics, manufacture, filling, shelf stability, distributing and sorting during recycling.

One of the benefits of carbon black as a colourant is its masking properties, allowing many different coloured offcuts to be combined after recycling, into black plastic.

Further investigation into the alternative colourants is needed

Talent 2030 - National Engineering Competition for Girls to determine whether the lower masking abilities of the dyes would be a major issue and how it could be accommodated.

Alternatively, an investigation and development could be carried out to optimise the pigments to improve their masking qualities.

on specific packaging would involve assessments across the whole supply chain. This would include tray manufacture, filling and sealing trials, shelf life trials, microbiological and organoleptic testing, in store and distribution trials and economic assessments.

stringent colour migration (where the plastic colourants move from the packaging to the contents due to the application of heat) and bleed tests to ensure that the colourants would not migrate or bleed into the food when it is being cooked or reheated in the packaging.

Large Scale Demonstration Trials

If these trials are deemed successful, NIR software settings would have to be updated to enable colour sorting of black plastics.

The colourants tested are approved for use with food, however suppliers need to ensure that the colourants are food contact compliant under ambient storage conditions as well as under defined conditions for specific applications including cooking or reheating of ready meals.

Once the colourants have been optimised to provide the required level of masking strength, retailers and brand owners could work with their suppliers to carry out large scale trial production runs on specific packaging. If this is successful, the range of products using the new colourants could be widened to eventually replace all carbon black products.

Large scale production trials

Colour Optimisation, Migration and Bleed Tests The shade and tint requirements of black plastic packaging are subjective, so optimisation based on customer’s aesthetic requirements is important. Any developments for ready meal products would need to include

Packaging samples would need to be tested for overall and specific migration following the methods laid out in Commission Regulation (EU) No 10/2011 on plastic materials and articles intended to come into contact with food.

% Base Cost at colourant Tray material Cost at Cost at Cost Base 1% cost of base Colourant weight cost per 0.50% 0.75% per kg material addition material (g) 1000 addition addition cost at 1% trays addition Dye Black £16.00 5

11

PP

£10.12

£0.89

£1.34

£1.78

17.61%

Dye Black £16.00 5

25

PET

£23.00

£2.03

£3.04

£4.05

17.61%

Colour tone 95530

£9.20

11

PP

£10.12

£0.51

£0.76

£1.01

10.00%

Colour tone 95530

£9.20

25

PET

£23.00

£1.15

£1.73

£2.30

10.00%

Carbon Black

£2.10

11

PP

£10.12

£0.12

£0.17

£0.23

2.28%

Carbon Black

£2.10

25

PET

£23.00

£0.26

£0.39

£0.53

2.28%

41

Talent 2030 - National Engineering Competition for Girls The packaging would need to meet all existing performance and subjective specifications agreed between the manufacturer, packer and retailer.

Optimising Hot Seal and Film Lidding Conditions Further sealing trials need to be performed on production equipment, preliminary assessments have shown that trays containing the novel black colourants developed in this investigation can be sealed with lidding films. To be viable this needs to be assessed in large scale trials.

Summaries In general, the sheet extrusion using the NIR detectable colourants is successful, with all thermoforming operations running with no issues or processing changes needed from standard settings. Both the Colour Tone IRR 95530 colourant used in the PP resin and the ColorMatrix Dye Black 5 liquid colourant used in PET perform well in all stages of tray manufacturing.

One conclusion from the manufacturing trial was that the colourants need to be matched to the polymers for full scale manufacturing which would ensure colour depth that is satisfactory to retailers and that no colour bleed occurs.

The colour bleeding from the PET trays when exposed to hot oil was an initial concern but further optimisation work on the colourant components resolved the issue by replacing the component that bled.

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The current ColorMatrix Dye Black 5 formulation appears to be unsuitable for use in a polymer with a highly crystalline structure such as PET, but the company believe that it can develop a suitable alternative black colourant for use in PET applications that will be more stable.

Conclusions Manufacturing Trial There were no issues with manufacturing both colourants into PP and PET packaging products, no processing settings had to be changed. ColorMatrix Dye Black 5 is suitable for use in PET and other ambient applications but not for use in oven ready applications where food is cooked in the packaging due to colour migration Colour Tone IRR 95530 was found to be suitable for PP tray packaging but not for PET ready meal products due to the colour migration The company produced an improved colourant IRR 95559 by removing the component that bled and replaced it with a stable component which allowed it to be suitable for PP and PET applications including oven ready applications The newly developed colourants need to be specifically formulated and matched to the polymers and tests need to be carried out to measure the satisfaction of colour depth and that no colour bleeding occurs in specific applications of the packaging.

black colourants that can be detected by NIR sensors currently used in sorting facilities, the recovery of black plastic packaging will become possible. The packaging will be collected as part of either the coloured fraction of the specific polymer stream or as part of the mixed plastics fraction.

The initiation of the recovery of these plastics will mean that the additional materials will boost the economic efficiency of recycling operations due to improved material yields, lower levels of residue wastes to landfill and the opportunity for greater revenues from the sale of recycled resins produced from the recovered black plastics.

Recommendations The research we have discussed in this report has shown that it is technically possible to use alternative black colourants that can be detected by NIR sensors currently used in recycling centres. However further testing is needed to determine whether these colourants would be completely safe for food contact specific packaging.

The intention of our report was to highlight the research done by engineers to find carbon black alternatives and or technology capability of detecting black plastic.

We cannot make a direct comparison from the data in this report because all experiments were completed under different conditions.

This

research

has

shown

Implications of introducing two possible solutions for NIR detectable packaging the problem of black plastic With the introduction of the

recycling. One is the use of

Talent 2030 - National Engineering Competition for Girls carbon black alternatives (Black 95530 and Dye Black 5), and the other is the use of mid-infrared scanners or laser spectroscopy.

The use of alternative colourants is simultaneous with the current NIR scanners in place in recycling plants, and the use of MIR scanners can be used with carbon black colourants.

The use of alternative colourants have proven to be ÂŁ7-14 more expensive per kilogram than the conventional carbon black colourant, however it has not been discovered whether this increase in price would outweigh the cost of not recycling black plastic, i.e. the cost of taking it to landfill and creating new virgin black plastic.

This means that further research would be needed to determine whether it would be cheaper to use carbon black and create new virgin plastic, or whether it would be cheaper to use a more expensive dye, and recycle the black plastic.

However these prices are based on preliminary trials and the costs vary depending on the addition rates and tint strength required for specific packaging.

Furthermore, these colourants have been identified as NIR detectable, but need further testing to measure the safety of the dyes in the black plastic when in contact with food, as food packaging is the primary use of black plastic.

MIR technology requires further commercial developments as there are some technical and processing issues which need to be resolved before the system can be used commercially.

One of the issues with the MIR system is that the commercial price is unknown, but is expected to be higher than NIR

systems, which could reduce its potential for use in the recovery of black plastic.

Laser spectroscopy was also researched and it was discovered that black PET, CPET and PS showed a significant spectra, enabling them to be easily detected and separated from other plastic waste under industrial conditions.

There is potential for the Lasar Raman Fluorescence Spectroscopy system to be able to accurately detect and sort black plastic items, although these systems need to be developed.

In summary, this report has condensed the information found by the research team at WRAP into the possible future recyclability methods of black plastic, and has identified two different colourants that have high potential for being used instead of carbon black in black plastic; and two possible physical sorting techniques which can be used with the current carbon black colourant.

The techniques required to use these physical sorting techniques require further development and research to allow them to be used commercially. The plastics which use the alternative colourants can be used in the packaging industry, but also electronic and automotive sectors which are the next biggest users of black plastic, and can be detected and recovered automatically by current NIR sensors so that they can be used in the place of virgin plastic.

This will provide significant improvements to recycling revenues along with savings on carbon emissions and landfill volumes.

Appendices Reflections Completing this investigation has been a learning curve for all of us and from it we have aquifer many new skills.

The subject of our report is a topic of which none of us had ever explored before, we had no prior knowledge of the colourants or the sensor; because of this we were always motivated to continue to learn more, we also needed to utilise the resources we had around us such as books, teachers and the internet.

We also learned how to properly structure a technical report and the type of Standard English which is appropriate.

We have all chosen to study the International Baccalaureate which means we have had to become proficient in time management and organisation, we have developed skills in meeting set deadlines and sharing workloads to ensure our teammates did not feel burdened with work which they should not have to do.

However, despite our best efforts, the heavy workload of the IB meant that although we worked hard and often, we could not find the time to complete the report in greater detail.

We would have liked to have conducted practical research ourselves and thought of our own solutions to the problem we were researching

43

Talent 2030 - National Engineering Competition for Girls

Bibliography

44

•

[1] Carter, K. (2017). The One Show tackles black plastic confusion. [online] Available at: www.resource.co/article/one-show-tackles-black-plastic-confusion-11742

•

[2] DS Smith. (2018). Closing the loop on black plastic ready meal trays. [online] Available at: www.dssmith.com/recycling/insights/blogs/2017/8/closing-the-loop-on-blackplastic-ready-meal-trays

•

[3] WRAP. (2011). Development of NIR Detectable Black Plastic Packaging. [online] Available at: www.wrap.org.uk/sites/files/wrap/Recyclability%20of%20black%20plastic%20 packaging.pdf

•

[4] ColourTone. (2011). Innovative Black Colourants Open up New Markets For Recycling Packaging Waste. [online] Available at: www.colourton-masterbatch.co.uk/pages/lib/innovative.html

TED Talk - Daisy Whittard

TED Talk The Romanovs Daisy Whittard 1917. World War I is raging throughout Europe but something else is burning in Russia – revolution.

In the March of 1917, the wave of revolution swept away the Imperial government, but the second wave in the November (or October for the Russian calendar) placed the Bolsheviks firmly at the top. What is shocking is that this year destroyed the 300 years of Tsarism rule under one family…the Romanovs. The Russian revolution was one of the most destructive in history with just the sheer volume of deaths – and when you take into account that Russia was, until the Bolsheviks came into power, still disastrously fighting the first world war under the practically useless command of Tsar Nicholas II, you can imagine how many Russian’s had lost their lives.

So how do I try and change these people’s death from statistics to real individuals. How about this – I tell one story and this one you might have heard before…but I’ll tell it in a slightly different way.

It all centres around these five children.

Tatiana, Anastasia, Alexei, Maria and Olga. 5 children. Now what sets them apart from every other child in Russia – that would be there parents.

Their father was Tsar Nicholas and their mother the Empress Alexandra (grand daughter of Queen Victoria). After the revolution the family were

moved from place to place with the Bolsheviks unsure with what to do with them – they were useful political pawns, but they needed to be kept away from the Royalist White army that was closing in.

Eventually they placed the family in a remote Siberian town called Ekaterinburg in a house aptly named ‘the house of special purpose’. There, in the early hours of the 18th of July, the family and a few loyal servants were led into the basement where they were brutally murdered.

As time has gone on, the murder of the Romanov family has been romanticised to no end and the children, the girls in particular, are seen as nothing more than a mass of pretty white dresses – the perfect idea of youthful innocence.

Well I’m going to tell you a different story, a story of five real children each kept in a perfect cage blissfully unaware of the hatred towards their parents – they were more concerned with the fact that the youngest of them (and next in line to the throne) Alexei was a haemophiliac – a condition that meant his blood didn’t clot and a small bump could kill him – this was an early death sentence in the early 1900s with average age of death at 16 – Alexei wouldn’t make it to 16 but it wasn’t the haemophilia that killed him.

Preoccupied

with

her

son

constantly in danger, Alexandra simply put her daughters in 2 pairs – the big pair and the little pair as she called them.

However, the girls themselves reinforced this group mentality referring to themselves as OTMA – standing for their initials. This is the children’s story.

Olga Romanov was born on the 15th of November 1895 as the first child of the Tsar and Tsarina. Out of all the children she was the most sensitive with a very strong mind of her own; she was very independent and intelligent. She could sometimes prove hard to handle being quite temperamental and moody at times – however her compassion for other was undeniable and she had an unbreakable bound with her father.

She was very close to her sister Tatiana but had a good relationship with all her siblings and she is often seen to be looking after her brother.

However, after the abdication of her father and their exile, she became withdrawn, sad and practically cut herself off from all her siblings including Tatiana, preferring isolation or occasionally her father’s company. She never really shook off childhood and was treated as a child her entire life.

This is the last know photograph of Olga. She was 22 when she was brutally murdered.

Tatiana Romanov was born on the 10th June 1897 – her birth was a slight disappointment

45

TED Talk - Daisy Whittard as Russian laws of inheritance stated that only boys could inherit the throne, but her parents remained unbothered.

Tatiana was proclaimed the most beautiful of her siblings and was thought to most closely resemble her mother who she was very close to.

She was more reserved than her other siblings but was most respected by them. They called her the governess as it was her who became the head of the children being very dutiful, good at organising and getting things done – although her occasional bossiness was sometimes a cause for annoyance. She was very close to her sister Olga and as time went on, and Olga became more withdrawn, she became closer to her younger siblings especially Anastasia; like all her sisters she was also very close to her brother. Like her sister, she was a child her entire life.

She was 21 when she was brutality murdered.

Maria Romanov was born on the 26th of June 1899 and much despair was shown by her extended family for once again being a girl, despair her parents were oblivious to. Maria suffered from classic middle child syndrome which started from when she was a toddler and her older sisters would refer to her as their stepsister because she was too well behaved.

She was said to have had the best nature of all her siblings but was constantly seeking the approval of Olga, Tatiana and their mother. She was devoted to her younger sister Anastasia who was sometimes known to take advantage of sweet Maria. Despite of this, Maria was cheerful, friendly and accommodating. However,

46

evidence suggests that her open nature nearly destroyed her entire family life during their exile. An affair with a soldier guarding the house in Ekaterinburg meant that she was cold shouldered by Olga and her mother for the rest of their lives. It is maybe hardly surprising considering she said that she couldn’t wait to marry and have a large family.

She was 19 when she died was brutally murdered.

When Anastasia Romanov was born on June 18th, 1901, it was beginning to get ridiculous to many that a boy was still not walking the halls of a palace.

However, attention seeking, clownish, defiant, disobedient, rough and adventurous Anastasia never worried about her not being a boy. Her undeniable charm gave her a huge sense of life and she was one of those children with hated or loved by others.

Despite her torment of her sister Maria, she was very close to her – she also had a very close relationship with her brother, and they formed their own little pair – leaving Maria feeling quite left out. Throughout her life and exile, she was a constant joker and in dark times it would be her dry sense of humour that kept the family together. She was a loose cannon, but her humour was unbeatable. Out of all the children, it is her who has been romanticised the most – the speculation of her survival has captured the public’s imagination the most. The most famous of her imposters was Anna Anderson who, until DNA testing 1994, was widely thought of to be Anastasia. The rumours of her survival have sparked books, movies and even a Broadway musical. But

through this fantasy the real Anastasia has been lost.

She was 17 when she was brutally murdered.

Alexei Romanov was born on the 12th August 1904 and his birth was met by great joy by all – finally a son and heir.

However, his parents joy was short lived after it was found that their only son and heir to the imperial throne of Russia had haemophilia – this led to the introduction of Grigori Rasputin into the imperial court who inspired the 1978 hit ‘Rasputin’

by Boney M. Alexei was a pretty child, compassionate and vivacious.

He was very intelligent and a quick learner but was nervous around strangers. He was doted on by his entire family and even when he was a young teenager, he was still nicknamed baby – but as he was the heir to the Russian throne you wouldn’t put this baby in the corner...that’s from my mum’s favourite film so I promised to put it in...

Alexei was close with his entire family but especially Olga who he saw as a mother figure (he called himself Olga’s boy) and Anastasia – his partner in crime.

He found himself very frustrated with his haemophilia and the restrictions it caused him. Some historians have speculated that it was his parents’ obsession with his safety that caused them to neglect their duties towards their country, meaning if he wasn’t a haemophiliac, the story could be very different.

He was 14 when he was brutally murdered – the same age I am now.

Five siblings, their lives destroyed by their own parent’s inability to not only rule a country but accept any blame

TED Talk - Daisy Whittard for their own actions. In that basement in Ekaterinburg it was the adults who died first, the children had to be shot at point blanc and bayoneted to death due to the soldiers being drunk and unable to pull off a clean execution.

executed for crimes against Russia. What had those children ever done against the country they had refused to leave when given the choice. What had any of those innocent people murdered in world war I or the Russian revolution ever done.

of these children anymore just as we cannot romanticise the slaughter of millions of men women and children during WWI and WWII - remember them as who they were and what they have now grown to stand for.

I ask you this now. They were

We can’t romanticise the murder

Thank you.

TED Talk My Research into the Colour Pink Maddie Whitmore I conducted my research into different aspects of the colour pink (my favourite colour!).

I researched the pink versus blue stereotype, an interesting experiment to do with a particular shade of the colour and found out more about a book I read recently called ‘Feminists Don’t Wear Pink and Other Lies’, championing this female stereotype.

The colour pink was named after a flowering plant called the ‘pink’ and was first used as a noun in the 17th century – the colour was originally worn by young boys in the Victorian era as they were seen as ‘small men’.

Their fathers wore red uniforms, so they logically wore a diluted version of this colour. Pink was associated with boys as it was a strong, rich colour, whereas blue was seen to be dainty, so was given to girls.

The trade journal ‘The Infants’ Department’ published an article in 1918 titled ‘Pink or Blue’, stating that pink was a male colour because of it being ‘a decided and stronger colour

more suitable for the boy.’

society to do so.

Although at the start of the 1900s pink was still seen as a boy’s colour, people began buying pink items for girls more commonly so that by 1940, it had become normal to see girls dressed in this colour. The issue of pink versus blue became even more important when, in the 1980s, parents began to discover the gender of their child while it was still in the womb. They then wanted to buy gender-specific items for their children – and of course, shops and department stores were happy to indulge in this.

A study taken in 2011 took a group of one-year-old girls and boys and showed them each two different objects, one pink and one of another colour. At that age, they were no more likely to choose pink than any other colour.

The interesting question that emerged at the beginning of the 21st century was this – why is it that we still associate pink with girls and blue with boys when we are being taught more and more frequently that these stereotypes that are integrated within our society can be damaging? But maybe this could be the answer – we still associate certain colours with the genders because it is so integrated in modern

When the experiment was repeated with toddlers a year older, the girls began to show a preference for the pink objects and when the study was repeated again with four-year olds, the boys were determined to choose anything but this colour.

The scientists suggested that perhaps the children began to show a stronger preference the older they got because they began to become more aware of the biases separating their genders and what defined them as either a boy or a girl.

This experiment is particularly interesting because it shows the pink versus blue stereotype in action; the children that took part were clearly being exposed to the societal expectations

47

TED Talk - Maddie Whitmore surrounding colour and gender from such a young age that it began to affect their behaviour.

My second area of research relating to this colour was about a particular shade called ‘Baker Miller Pink’. Baker Miller Pink (also known as ‘Schauss Pink’ or ‘Drunk Tank Pink’) is a colour ‘claimed to reduce hostile, violent or aggressive behaviour’. In 1969 a scientist called Alexander Schauss became interested in people’s psychological and physiological responses to pink and began carrying out various studies to do with the colour. Schauss took his shade of pink to various American prisons in 1979.

He told officers in the naval correctional institute in Seattle to paint some of the prison cells pink and to let him measure and study the behavioural results of placing particularly volatile prisoners in the pink rooms (Baker-Miller pink was named after the two directors of the institute, Baker and Miller).

A naval report published after this study said, ‘Since the initiation of this procedure on 1st March 1979, there have been no incidents of erratic or hostile behaviour.’ A prisoner could spend as little as ten minutes in one of the pink rooms to have their behaviour drop from extremely volatile and aggressive to remarkably calm. Despite this fascinating experiment, there isn’t actual scientific evidence that this shade of paint physically changes our brains – as far as I am aware, no further studies were conducted into Baker Miller pink.

Finally, I found out more about a modern feminist movement called ‘The Pink Protest’, and how it was the inspiration for

48

one the most interesting books I have ever read: ‘Feminists Don’t Wear Pink and Other Lies.’

This book is an anthology of feminist manifestos curated by Scarlett Curtis.

It features writing from women of all backgrounds, from teenage GirlUp club leaders in Africa to Hollywood actresses and writers whom everyone will have heard of. It attempts to give examples of what feminism means to women from all walks of life and how different issues in different women’s lives affect the way they view feminism and take action. The curator of the book, Scarlett Curtis, also cofounded the Pink Protest, which ‘aims to redefine what activism means to young people.’ The Pink Protest host events and holds online protests and marches around London. Every week on social media they highlight one action you can take in your everyday life to become an activist.

I thoroughly enjoyed doing research into the colour pink – I found it thought-provoking and learnt a lot of new information about my favourite colour.

Bibliography •

Wikipedia

•

The Pink Protest website

•

‘Feminist’s Don’t Wear Pink and Other Lies’

•

BBC Future – ‘The ‘pink vs blue’ gender myth’

TED Talk - Maddie Whitmore

TED Talk The Internet - a Drug Changing the Face of Terrorism Daisy John and Eliza Hyde Firstly, what is a drug?

A drug is an external entity that has effects on the body and senses. And of critical importance to this argument, a drug can cause addiction.

When people first think about what a drug is, people often picture a pill, however a drug can come in many different shapes and forms. For example, dangerous sports, such as, solo climbing, this can be seen as a drug, and is when someone climbs mountains without equipment or the company of anyone else.

People can become addicted to the thrill of dangerous activities like this. The internet can be classed as a drug as it fits the definition and has effects on people and their senses The important concept for this argument is that some drugs cause addiction.

Secondly, what does addiction mean?

consisting of interconnected networks using standardized communication protocols. This can be accessed via phones, TVs, computers, tablets and more.

The internet can be classed as a drug, and people are addicted to it as when people are not on the internet, they feel withdrawal, and they get stuck in the endless cycle of addiction.

Internet Addiction or any addiction is bad as it imprisons people within the loop of compulsion and withdrawal.

When in that loop they have reduced freedom of will, autonomy and may cause harm to themselves or others.

A recent US study from Statista has shown many examples of addictive behaviour. On average, US smartphone owners check their phone 47 times a day, this shows how severe the addiction is and how many people are stuck in the loop of addiction.

Finally, what is the internet?

It also shows that 85% use it while talking to friends and family. Meaning the richness of communication is limited to just the words, as people won’t be able to see facial expressions, body language and eye contact, while staring at a device. It also completely disrespects the person who is speaking.

The definition for internet a global computer network providing a variety of information and communication facilities,

Statistics show that 38% of college students can’t go 10 minutes without checking their email, tablet or smart phone. So,

The definition for addiction is the fact or condition of being addicted to a particular substance or activity. Addiction involves the loop of compulsion and unpleasant withdrawal, for this reason it’s bad.

the students aren’t developing skills to be able to focus for long periods of time, which are skills that are of absolute importance in many jobs, ranging from lorry drivers to pilots and surgeons.

For example, if someone was flying a plane or performing surgery, they couldn’t stop every ten minutes to check their phones.

Social media has not only dramatically transformed the way we all connect with each other, but it has actually enabled terrorists to recruit and use propaganda with greater ease and has therefore changed the way we must combat extremism.

The UK’s current counter terrorism strategy consists of 4 elements: Pursue, Prepare.

Prevent,

Protect,

Pursue to stop terrorist attacks.

Prevent to stop people becoming terrorists or supporting terrorism. – this is targeted at the potentially vulnerable individual at risk of radicalisation.

Protect to strengthen protection against a terrorist attack, protecting the public.

Prepare to mitigate the impact of a terrorist attack.

These four sections, currently include no specific reference at all to social media but if social

49

TED Talk - Daisy John and Eliza Hyde media is in fact playing a huge role in changing the face of terrorism, surely the counter terrorism strategy MUST target social media platforms?

A major issue is that we all have access to this extremist material increasing the number of people becoming radicalised.

This extremist content can reach across continents in seconds and this scale of extremist activity is something we haven’t seen before. Islamic State have promoted life in the caliphate by posting pictures on Facebook of fighters cuddling kittens as well as footage of the fighters in the style of music videos. In this way it recruited men, women and even children from all over the world including the Bethnal Green Academy girls.

Every single minute there are on average 510,000 comments and 136,000 photos shared on Facebook, 350,000 tweets posted on Twitter and 300 hours of video uploaded to YouTube.

Given this, the biggest companies extensively rely on artificial intelligence (AI).

Facebook’s uses of AI include image matching. This prevents users from uploading a photo or video that matches another photo or video that has previously been identified as terrorist. Similarly, YouTube reported that 98% of the videos that it removes for violent extremism are also flagged by machine learning algorithms.

One difficulty the social media companies face is that, if a terrorist group is blocked from one platform, it might simply move to a different one. In response to this the “Global Internet Forum to Counter Terrorism” – GIFCT members have created a shared industry database of “hashes”. A hash is

50

a unique digital fingerprint that can be used to identify specific content. When pro-terrorist material is removed by one GIFCT member, its hash is shared with the other participating companies to enable them to block the content on their own platforms.

The GIFCT were on track to meet its target of 100,000 hashes.

Imagine, 100 000 hashes – what does this statistic mean? 100 000 examples of pro-terrorist content having to be removed!

And these efforts have undoubtedly disrupted terrorists’ use of social media platforms.

For example, Twitter has suspended over a million accounts for promoting extremism. Nearly half of these were removed within two hours of upload, demonstrating how proactive social media giants have become in the fight against terrorism.

I believe that social media has radically changed the face of terrorism. Indeed, it has been argued that IS could not have existed without the platform of social media. Vulnerable people can easily be targeted for radicalisation through a simple click of a button and

terrorist propaganda can be instantly shared internationally.

However, social media companies are responding by finding new ways to block this dangerous content. To conclude, whereas terrorism in Northern Ireland in the 1970s was fought by the armed forces on the streets, today, the international fight against terrorism is being led by IT experts in Silicon Valley.

In conclusion, if we can counteract the addictive effects of the internet, we can greatly reduce the number of vulnerable people getting sucked in by terrorist gangs through internet propaganda. We can overcome both of these problems, in these three simple steps: Firstly, increase pressure on tech companies Secondly, improve awareness of the dangers associated with the internet Finally, introduce new government policies with direct mention of social media. As students we realise that we cannot directly contribute to these steps, but we can help to raise a greater awareness, helping to combat terrorism.