Occupying houses: the social relations of tenure

With the shifts in housing tenure patterns in post-war Britain being so decisive and apparently relentless, one of the main issues that concerns those involved with housing is that of the impact of mass home-ownership - especially on those groups new to the tenure. These concerns range from the possible effect of new home-owner ship on voting patterns and political allegiances; to the financial hardship that seems to be increasingly falling on low income owner occupiers; and to the domestic and familial changes entailed by two-income mortgages. It is towards assessing the impact of these changes more fully, that this thesis is aimed. In order to better understand the origins and effects of tenure shifts, two main points are made. Firstly, that the occupation of houses (of whatever tenure) is an issue that involves practically everyone in society, either as individual tenants/owners/homeless persons, or as groups of ratepayers/voters/neighbourhoods or as business/financial/political interests, or as any combination of these. Secondly, it is emphasised that the terms and conditions of the various tenures have been created and have been altered and adapted over time, and that the definition and meaning of the tenures is as crucial to the housing debate as the well-recognised tenure trends. Consequently, it is argued that the changing patterns and definitions of tenures have a crucial and far-reaching effect on wider social relations in society whilst, at the same time, these changes originate from and in part reflect, already occurring events in civil society

Aetiological and clinical aspects of symptomatic gallstone disease and pancreatic cancer.

Introduction This work investigated in a UK prospective cohort study, firstly, the aetiology of gallstone disease, and secondly, that of pancreatic cancer, with a focus on physical activity and diet. The epidemiological studies benefitted from the accuracy of measurement tools, namely a validated physical activity questionnaire and a sevenday food diary (7-DFD). These novel methods aided the improved definition of risk factors thus highlighting biological mechanisms leading to disease and methods of prevention. The third investigation was a clinical survey evaluating benefits for patients of a Pancreatic Support Service (PASS), which screened and treated nutritional and depressive symptoms in patients with pancreatic cancer. Methods The European Prospective Investigation into Cancer-Norfolk enrolled 25 639 men and women, aged 45-74 years, between 1993-1997, measuring anthropometrics, lifestyle factors, diet with 7-DFDs, physical activity and collecting serum samples at baseline. The cohort was followed up until 2010, with multi-variate hazard ratios calculated for incident symptomatic gallstones and pancreatic cancer according to risk factors. The clinical survey, compared survival, doses of chemotherapy and clinical parameters in a retrospective group of 16 patients and then in a prospective group of 19 patients who were also reviewed by PASS. Results For gallstone disease, positive associations were found for obesity, serum triglycerides, dietary calcium and trans fatty acids, with inverse associations for serum HDL, physical activity, alcohol, caffeinated coffee and dietary niacin, cholesterol and iron intake. Pancreatic cancer had inverse associations detected for physical activity, dietary docosahexaenoic acid, dietary vitamin E and selenium, and serum vitamin C. The survey found those reviewed by PASS had fewer and shorter hospital admissions with no effects on survival or doses of chemotherapy. Conclusion This work found associations between various dietary factors and physical activity for both symptomatic gallstones and pancreatic cancer. These findings have implications in understanding biological mechanisms and could lead to preventative public health measures for both diseases. The survey reported the introduction of PASS was associated with a reduced number and duration of hospital admissions and the reasons for this should be explored in future work. *Submitted with two peer-reviewed articles which have not been uploaded to the repository. Articles available as part of thesis deposited at UEA Library

Dietary Fiber and the Risk of Pancreatic Cancer

Objectives: High dietary fiber may protect against pancreatic ductal adenocarcinoma (PDAC). We investigated associations between fiber intake and the risk of PDAC using for the first time 7-day food diaries. Methods: Participants in the European Prospective Investigation Into Cancer–Norfolk completed the 7-day food diaries at recruitment. The cohort was followed up for 17 years to identify those who developed PDAC. Participants were divided into quintiles of fiber intake, and hazard ratios (HR) were estimated with their 95% confidence intervals (CIs). Fiber was tested for effect modification of high red and processed meat intake and smoking and the risk of PDAC. Results: No significant associations for any quintiles of intake (HR Q5 vs Q1, 1.08; 95% CI, 0.56–2.08) were detected with no trend across quintiles. A high-fiber diet modified positive associations between red and processed meats with the development of PDAC (HR trends, 0.89 [95% CI, 0.47–1.69] and 1.02 [95% CI, 0.55–1.88], respectively) but not those with lower fiber intake. Fiber intake did not modify the risk of PDAC in past and current smokers. Conclusion: The findings do not suggest that fiber protects against PDAC, although it may decrease potential deleterious effects of meats

HP Multicolour digital pen

Treball desenvolupat dins el marc del programa 'European Project Semester' i l'"International Design Project Semester".There are many digital pens on the market; however, none of them have more than one colour integrated into their body. The “HP Multicolour Digital Pen” project consists of designing and creating a working prototype of a multicolour digital pen, for the company Hewlett Packard. The pen is aimed at architects and constructors, who are still using traditional methods for working on paper plans, and will help them make the transition from the analogic to the digital world. The final product will work with Anoto technology, therefore, research regarding Anoto technology and pens using this technology are included in the report. This research comprises of: a general description of Anoto digital pens; transmission methods used; processing units; pressure sensors; erasing methods and, to conclude the research, a brief summary of other technologies available. Furthermore, a study of the market has been conducted to analyse the features of different digital pens in the market. For the Mid-Term Report, three design proposals were presented and one was chosen by the company supervisor, in order to create the prototype for the final report. Once the chosen concept was defined, the project incorporated design, mechanism, electronic and interface systems to create a Mark 1 prototype. This is a 2:1 scale prototype, which is used to study how well the systems work. This first prototype will greatly help in the development and refinement of future prototypes, so that the multicolour digital pen becomes a cutting edge, market leading product that is technologically advanced and economically viable

Investigating physical activity in the etiology of pancreatic cancer: The age at which this is measured is important and is independent of body mass index

Objectives: There are plausible biological mechanisms for how increased physical activity (PA) may prevent pancreatic cancer, although findings from epidemiological studies are inconsistent. We investigated whether the risk is dependent on the age at which PA is measured and if independent of body mass index (BMI). Methods: A total of 23,639 participants, aged 40 to 74 years, were recruited into the EPIC-Norfolk (European Prospective Investigation of Cancer) cohort study between 1993 and 1997 and completed validated questionnaires on PA. The cohort was monitored for pancreatic cancer development, and hazard ratios (HRs) were estimated and adjusted for covariates. Results: Within 17 years, 88 participants developed pancreatic cancer (55% female). There was no association between PA and risk in the cohort (HR trend, 1.06; 95% confidence interval [CI], 0.86–1.29). However, in participants younger than 60 years, higher PA was associated with decreased risk (highest vs lowest category HR, 0.27; 95% CI, 0.07–0.99). Higher PA was not inversely associated when older than 60 years (HR trend, 1.23; 95% CI, 0.96–1.57). Including BMI in all models produced similar estimates. Conclusions: The reasons why PA in younger, but not older, people may prevent pancreatic cancer need to be investigated. Physical activity may operate through mechanisms independent of BMI. If this association is causal, 1 in 6 cases might be prevented by encouraging more PA

Dressing disrupted: negotiating care through the materiality of dress in the context of dementia

This paper explores how the materiality of dress mediates and shapes practices of care in the context of dementia. Earlier research called for an approach to conceptualising care that recognised the role played by everyday artefacts. We extend this to a consideration of dress and dressing the body in relation to people with dementia that involves the direct manipulation of material objects, as well as the materiality of bodies. The paper draws on an ESRC funded study Dementia and Dress, which examined experiences of dress for people with dementia, families and care-workers using ethnographic and qualitative methods. Our analysis explores the process of dressing the body, the physicality of guiding and manipulating bodies into clothing, dealing with fabrics and bodies which ‘act back’ and are resistant to the process of dressing. We consider how the materiality of clothing can constrain or enable practices of care, exploring tensions between garments that support ease of dressing and those that sustain identity. Examining negotiations around dress also reveals tensions between competing ‘logics’ of care (Mol 2008)

Pain in patients with pancreatic cancer: prevalence, mechanisms, management and future developments

Pain affects approximately 80% of patients with pancreatic cancer, with half requiring strong opioid analgesia, namely: morphine-based drugs on step three of the WHO analgesic ladder (as opposed to the weak opioids: codeine and tramadol). The presence of pain is associated with reduced survival. This article reviews the literature regarding pain: prevalence, mechanisms, pharmacological, and endoscopic treatments and identifies areas for research to develop individualized patient pain management pathways. The online literature review was conducted through: PubMed, Clinical Key, Uptodate, and NICE Evidence. There are two principal mechanisms for pain: pancreatic duct obstruction and pancreatic neuropathy which, respectively, activate mechanical and chemical nociceptors. In pancreatic neuropathy, several histological, molecular, and immunological changes occur which correlate with pain including: transient receptor potential cation channel activation and mast cell infiltration. Current pain management is empirical rather etiology-based and is informed by the WHO analgesic ladder for first-line therapies, and then endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) in patients with resistant pain. For EUS-CPN, there is only one clinical trial reporting a benefit, which has limited generalizability. Case series report pancreatic duct stenting gives effective analgesia, but there are no clinical trials. Progress in understanding the mechanisms for pain and when this occurs in the natural history, together with assessing new therapies both pharmacological and endoscopic, will enable individualized care and may improve patients’ quality of life and survival

A biomarker-stratified comparison of top-down versus accelerated step-up treatment strategies for patients with newly diagnosed Crohn's disease (PROFILE):a multicentre, open-label randomised controlled trial

Background: Management strategies and clinical outcomes vary substantially in patients newly diagnosed with Crohn's disease. We evaluated the use of a putative prognostic biomarker to guide therapy by assessing outcomes in patients randomised to either top-down (ie, early combined immunosuppression with infliximab and immunomodulator) or accelerated step-up (conventional) treatment strategies. Methods: PROFILE (PRedicting Outcomes For Crohn's disease using a moLecular biomarker) was a multicentre, open-label, biomarker-stratified, randomised controlled trial that enrolled adults with newly diagnosed active Crohn's disease (Harvey-Bradshaw Index ≥7, either elevated C-reactive protein or faecal calprotectin or both, and endoscopic evidence of active inflammation). Potential participants had blood drawn to be tested for a prognostic biomarker derived from T-cell transcriptional signatures (PredictSURE-IBD assay). Following testing, patients were randomly assigned, via a secure online platform, to top-down or accelerated step-up treatment stratified by biomarker subgroup (IBDhi or IBDlo), endoscopic inflammation (mild, moderate, or severe), and extent (colonic or other). Blinding to biomarker status was maintained throughout the trial. The primary endpoint was sustained steroid-free and surgery-free remission to week 48. Remission was defined by a composite of symptoms and inflammatory markers at all visits. Flare required active symptoms (HBI ≥5) plus raised inflammatory markers (CRP &gt;upper limit of normal or faecal calprotectin ≥200 μg/g, or both), while remission was the converse—ie, quiescent symptoms (HBI &lt;5) or resolved inflammatory markers (both CRP ≤ the upper limit of normal and calprotectin &lt;200 μg/g) or both. Analyses were done in the full analysis (intention-to-treat) population. The trial has completed and is registered (ISRCTN11808228). Findings: Between Dec 29, 2017, and Jan 5, 2022, 386 patients (mean age 33·6 years [SD 13·2]; 179 [46%] female, 207 [54%] male) were randomised: 193 to the top-down group and 193 to the accelerated step-up group. Median time from diagnosis to trial enrolment was 12 days (range 0–191). Primary outcome data were available for 379 participants (189 in the top-down group; 190 in the accelerated step-up group). There was no biomarker–treatment interaction effect (absolute difference 1 percentage points, 95% CI –15 to 15; p=0·944). Sustained steroid-free and surgery-free remission was significantly more frequent in the top-down group than in the accelerated step-up group (149 [79%] of 189 patients vs 29 [15%] of 190 patients, absolute difference 64 percentage points, 95% CI 57 to 72; p&lt;0·0001). There were fewer adverse events (including disease flares) and serious adverse events in the top-down group than in the accelerated step-up group (adverse events: 168 vs 315; serious adverse events: 15 vs 42), with fewer complications requiring abdominal surgery (one vs ten) and no difference in serious infections (three vs eight). Interpretation: Top-down treatment with combination infliximab plus immunomodulator achieved substantially better outcomes at 1 year than accelerated step-up treatment. The biomarker did not show clinical utility. Top-down treatment should be considered standard of care for patients with newly diagnosed active Crohn's disease. Funding: Wellcome and PredictImmune Ltd.</p

Thiopurine monotherapy is effective in ulcerative colitis but significantly less so in Crohn’s disease: long-term outcomes for 11 928 patients in the UK inflammatory bowel disease bioresource

Objective: Thiopurines are widely used as maintenance therapy in inflammatory bowel disease (IBD) but the evidence base for their use is sparse and their role increasingly questioned. Using the largest series reported to date, we assessed the long-term effectiveness of thiopurines in ulcerative colitis (UC) and Crohn’s disease (CD), including their impact on need for surgery. Design: Outcomes were assessed in 11 928 patients (4968 UC, 6960 CD) in the UK IBD BioResource initiated on thiopurine monotherapy with the intention of maintaining medically induced remission. Effectiveness was assessed retrospectively using patient-level data and a definition that required avoidance of escalation to biological therapy or surgery while on thiopurines. Analyses included overall effectiveness, time-to-event analysis for treatment escalation and comparison of surgery rates in patients tolerant or intolerant of thiopurines. Results: Using 68 132 patient-years of exposure, thiopurine monotherapy appeared effective for the duration of treatment in 2617/4968 (52.7%) patients with UC compared with 2378/6960 (34.2%) patients with CD (p<0.0001). This difference was corroborated in a multivariable analysis: after adjusting for variables including treatment era, thiopurine monotherapy was less effective in CD than UC (OR 0.47, 95% CI 0.43 to 0.51, p<0.0001). Thiopurine intolerance was associated with increased risk of surgery in UC (HR 2.44, p<0.0001); with a more modest impact on need for surgery in CD (HR=1.23, p=0.0015). Conclusion: Thiopurine monotherapy is an effective long-term treatment for UC but significantly less effective in CD