Inflammatory bowel disease in the United Kingdom: Epidemiological trends in primary care and associations with contraception

Background: The epidemiology of inflammatory bowel disease (IBD) in the UK is poorly described. Primary care contraceptive prescribing data published by the NHS are not linked to individual patients. Studies have linked contraceptive pills to the development of IBD. However, there is a paucity of literature on how contraceptive formulation and duration of therapy affect IBD risk. Aims: To describe changes in the incidence and prevalence of IBD in the UK from 2000-2018. To describe non-barrier contraceptive prescribing patterns in primary care over the same period. To investigate the associations between exposure to contraception and development of IBD. Methods: Three epidemiological studies using IQVIATM Medical Research Data; a cohort study examining temporal trends in IBD incidence and prevalence, a repeated cross-sectional study exploring trends in contraceptive prescribing, a nested case-control study investigating the associations between a range of contraceptives and development of IBD. Results: Overall, the incidence of IBD is falling, but prevalence continues to rise. Some of the highest recorded incidence and prevalence rates globally were observed, with a 94% rise in incidence in adolescents since the year 2000. Over the same period, combined hormonal contraception prescribing has halved whereas progestogen-only pill prescribing has more than doubled. Methods of contraception prescribed by GPs are influenced by social deprivation. Withdrawal of a pay-for-performance incentive may have adversely affected adolescent long-acting reversible contraception uptake. Results suggest that oestrogen-containing contraception is associated with development of IBD whereas progestogen-only methods have minimal to no effect. Conclusion: This thesis provides evidence relating to a wide range of temporal trends in the epidemiology of IBD and patterns of contraceptive prescribing in the UK. Although previous associations between oral contraceptive pills and IBD have been made, this thesis provides the first epidemiological evidence that oestrogen-containing contraceptives, but not progestogen-only methods, are associated with development of IBD

Teaching and Professional Fellowship Report 2007-2008 : Make the Numbers Count, Improving students' learning experiences through an analysis of Library and Learning Resources data

Feedback on Library and Learning Resources (LLR) services and support at the University of the Arts London (UAL) is received from a very extensive range of sources. However, although a considerable quantity of information is available for analysis, it remains very difficult for LLR staff to extract meaningful data from these numerous sources, which can reveal, in depth, the true, individual student experience of LLR services. LLR is aware that there is a lot that is not known, or is not being asked of our students, about their individual experience, which could prove extremely helpful for effective decision-making and service design and delivery. In particular, LLR is interested in identifying and resolving issues of access and support for students currently studying at UAL who are from under represented groups in higher education. Make the numbers counts has enabled the Fellowship Team to move beyond looking at usage figures, gate counts, numbers of issue and renewal transactions, borrower numbers and percentage satisfaction levels, and to extend and add to our knowledge-base of what students at UAL really think and feel about academic libraries. It has enabled us to explore how individual students make use of the services and support provided by LLR. The qualitative data collected through this project has been compared to existing sources of information and to staff experience and understanding of the issues raised, to see if the findings of our research challenge or correlate with other evidence which relates to LLR use and non-use. The focus of the Fellowship has been to explore the particular experience of students who are the first in their family to go to university and who are currently studying at Camberwell, Chelsea and Wimbledon (CCW) and the London College of Communication. Research has shown that this group of students is important amongst the range of students who are now entering higher education through the expansion of participation in university and tertiary-level study. Talking to first generation students was a key element of the project and the greatest source of learning for the Project Team

A survey and evaluation of microbased computer aided design systems for design education and practice in Scotland primarily in the area of product design: their application, problems and potential solutions

The initial premise of the research centred around the relatively new adoption by the Product Design sector of Computer Aided Design technology. Problems were expected to occur in applying the hardware and understanding the terminology of the software by this sector which prides itself In its artisan skills. The aim of the work was to determine the extent of the adoption of Computer Aided Design and to clarify the problem areas. The research determined, by study of more experienced but similar Computer Aided Design users, that the expected problems Were not insurmountable and were being overcome by the constant improvements of computer hardware and software. However, the problems that were pinpointed actually involved the human issues encountered In working with a Computer Aided Design system and involved issues such as the management skills required, working conditions and understanding of the advantages and disadvantages of Computer Aided Design. The research focused on what had to be considered and what should be known about Computer Aided Design so that it could be effectively used in Product Design. The research was undertaken to establish general solutions to the introduction of Computer Aided Design into companies. These solutions are intended to provide a guide to potential and current users on how to improve the effectiveness of the use of Computer Aided Design systems in Product Design. The research has identified the themes and topics that should be covered in training staff on the use and potential of Computer Aided Design systems

Advanced training of nurses in oral health care and oral assessments to formulate and deliver comprehensive preventive oral care plans to improve oral health of residents with early dementia: A Feasibility study.

A10 week residential care feasibility study investigated whether ‘Lead advocate’ nurses after 12 hours of advanced oral health training could be trained to be primary oral health care assessors to create oral health care plans for early dementia residents. Trained nurses were able to complete multi-factor oral health risk assessments using Shortened Xerostomia Index (SXI-D), Oral Health Impact Profile (OHIP14), Oral Health Assessment Tool (OHAT) and a modified saliva test to formulate individualised Nurse Scheduled Comprehensive Oral Care Plans (NSCOCPs). NSCOCPs allowed nurses to schedule appropriate multi-component preventive interventions and products multiple times over 3 nursing shift throughout a 24 hour period. Nurses were responsible for implementing and monitoring care plans. Nurse assessments, saliva tests and oral care plans were validated against Oral Health Therapist (OHT) assessments and tests blind to each other’s results. A high correlation was found between nurse and OHT results. Compliance of NSCOCPs was very high with untrained nurses able to follow the many scheduled interventions despite initially not understanding the reason for each intervention. Using multi-component interventions integrated into an overall “nurse scheduled, comprehensive oral care plan” is a new approach that may be a more effective strategy than concentrating on individual risk factors or single preventive interventions. Similar approaches are found in other geriatric studies in which more than one risk factor is related to outcomes. The combination of all or some of the preventive interventions acting together may have an additive effect on positive outcomes. Low mouth pH was found to be an important risk factor. Periodic interventions to raise mouth pH using sodium bicarbonate toothpaste, chewing and oral moisturisers were important components of NSCOCP to change an unhealthy oral environment to a healthier state. This approach allows trained nurse to assess new residents soon after entry into a residential facility and periodically thereafter to implement oral care plans. NSCOCPs initiated and monitored by lead advocate nurses offer another dimension in the delivery of oral care where timely visits by dental professionals to examine residents and prescribe preventive interventions are infrequent or unlikely

Understanding and mitigating the impact of Internet demand in everyday life

Digital devices and online services are increasingly embedded within our everyday lives. The growth in usage of these technologies has implications for environmental sustainability due to the energy demand from the underlying Internet infrastructure (e.g. communication networks, data centres). Energy efficiencies in the infrastructure are important, but they are made inconsequential by the sheer growth in the demand for data. We need to transition users’ Internet-connected practices and adapt HumanComputer Interaction (HCI) design in less demanding and more sustainable directions. Yet it’s not clear what the most data demanding devices and online activities are in users’ lives, and how this demand can be intervened with most effectively through HCI design. In this thesis, the issue of Internet demand is explored—uncovering how it is embedded into digital devices, online services and users’ everyday practices. Specifically, I conduct a series of experiments to understand Internet demand on mobile devices and in the home, involving: a large-scale quantitative analysis of 398 mobile devices; and a mixed-methods study involving month-long home router logging and interviews with 20 participants (nine households). Through these studies, I provide an in-depth understanding of how digital activities in users’ lives augment Internet demand (particularly through the practice of watching), and outline the roles for the HCI community and broader stakeholders (policy makers, businesses) in curtailing this demand. I then juxtapose these formative studies with design workshops involving 13 participants; these discover how we can reduce Internet demand in ways that users may accept or even want. From this, I provide specific design recommendations for the HCI community aiming to alleviate the issue of Internet growth for concerns of sustainability, as well as holistically mitigate the negative impacts that digital devices and online services can create in users’ lives

What do critical care nurses require from a clinical information system : is it possible for a system to meet these needs?

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

PAPIERCRAFT: A PAPER-BASED INTERFACE TO SUPPORT INTERACTION WITH DIGITAL DOCUMENTS

Many researchers extensively interact with documents using both computers and paper printouts, which provide an opposite set of supports. Paper is comfortable to read from and write on, and it is flexible to be arranged in space; computers provide an efficient way to archive, transfer, search, and edit information. However, due to the gap between the two media, it is difficult to seamlessly integrate them together to optimize the user's experience of document interaction. Existing solutions either sacrifice inherent paper flexibility or support very limited digital functionality on paper. In response, we have proposed PapierCraft, a novel paper-based interface that supports rich digital facilities on paper without sacrificing paper's flexibility. By employing the emerging digital pen technique and multimodal pen-top feedback, PapierCraft allows people to use a digital pen to draw gesture marks on a printout, which are captured, interpreted, and applied to the corresponding digital copy. Conceptually, the pen and the paper form a paper-based computer, able to interact with other paper sheets and computing devices for operations like copy/paste, hyperlinking, and web searches. Furthermore, it retains the full range of paper advantages through the light-weighted, pen-paper-only interface. By combining the advantages of paper and digital media and by supporting the smooth transition between them, PapierCraft bridges the paper-computer gap. The contributions of this dissertation focus on four respects. First, to accommodate the static nature of paper, we proposed a pen-gesture command system that does not rely on screen-rendered feedback, but rather on the self-explanatory pen ink left on the paper. Second, for more interactive tasks, such as searching for keywords on paper, we explored pen-top multimodal (e.g. auditory, visual, and tactile) feedback that enhances the command system without sacrificing the inherent paper flexibility. Third, we designed and implemented a multi-tier distributed infrastructure to map pen-paper interactions to digital operations and to unify document interaction on paper and on computers. Finally, we systematically evaluated PapierCraft through three lab experiments and two application deployments in the areas of field biology and e-learning. Our research has demonstrated the feasibility, usability, and potential applications of the paper-based interface, shedding light on the design of the future interface for digital document interaction. More generally, our research also contributes to ubiquitous computing, mobile interfaces, and pen-computing