An investigation of the predictors, barriers and facilitators to recruitment and retention of children and families to oral health trials

This thesis presents a detailed investigation into the predictors, barriers and facilitators to recruitment and retention of children and families in oral health trials. Study 1 is a systematic review of the predictors of recruitment and retention to RCTs involving children and families with no specific health focus. This study concludes that younger, those with low socioeconomic backgrounds, less well-educated and ethnic minority parents are less likely to be recruited and retained on RCTs; although there was disagreement between studies. Study 2 has an oral health focus and investigates study design predictors of recruitment and retention to trials involving children and families. The study findings were that trials over a year in length, set in community based settings with healthy participants were most likely to experience problems with recruitment and retention. Study 3 is a qualitative interview and focus group study with participants who continued and/or withdrew from the Salford Bright Smiles Baby Study (a community based early childhood caries trial with children ages 1-3 and their parents). Parents were motivated to take part in the study through wanting to be a better parent and wanting good oral health for their child. Facilitators to participation were flexibility in how the study was designed and delivered, e.g. nursery and home appointments and multiple forms of contact. Amongst the barriers to taking part were fear of being judged by others and the burden of participation. Finally study 4 is a quantitative analysis of the sociodemographic and oral health belief predictors of retention of participants on the Salford Bright Smiles Baby Study. This found that younger, unemployed lesser educated parents were less likely to remain on the trial to the end of the study. The thesis also provides insight into the quality of reporting of recruitment and retention in oral health trials. Whilst study two found that use of the CONSORT guidelines has increased over time, oral health trials still have a lower use of the guidelines than other research areas. To date very few studies have investigated predictors of recruitment and retention with children and families, even fewer in the field of oral health. This thesis presents a unique investigation into the actual barriers and facilitators to participation and provides findings that can be applied to future research with children and families. Specifically, recommendations to increase participation in longitudinal, community based oral health trials are presented

Electronic cigarette use and risk perception in a Stop Smoking Service in England

Introduction: Electronic cigarette (e-cigarette) use rose substantially within the UK in recent years but currently, Stop Smoking Services in England do not prescribe them due to a lack of regulation. Previous research has examined e-cigarette use and attitudes within English Stop Smoking Services using samples of practitioners and managers; the current study recruited a sample of service users. Methods: Participants (N¼319) aged 18–60 years old were recruited from Roy Castle FagEnds, Liverpool, England (Stop Smoking Service). A cross-sectional questionnaire was completed, which recorded demographic variables, e-cigarette use alongside risk perception, and lastly, smoking behaviour i.e. smoking duration, cigarettes per day, and nicotine dependence. Results: Most participants were female (57.1%), current smokers (53.0%), and current or former e-cigarette users (51.7%). Participants who perceived e-cigarettes as less harmful than smoked tobacco were more likely to have smoked fewer cigarettes per day (p¼0.008). Furthermore, those who felt uncertain whether e-cigarettes were safer than smoked tobacco, were less likely to have tried them (p50.001). Conclusion: This study suggests that e-cigarette use is becoming common among users of Stop Smoking Services (despite e-cigarettes being unavailable from such services) and that e-cigarette risk perception is related to e-cigarette status. The results highlight the importance of providing smokers intending to quit smoking with current and accurate e-cigarette information. Findings may inform future Stop Smoking Services provision and the results demonstrate that further research is warranted

Protocol for the Delirium and Cognitive Impact in Dementia (DECIDE) study: A nested prospective longitudinal cohort study

BACKGROUND: Delirium is common, affecting at least 20% of older hospital inpatients. It is widely accepted that delirium is associated with dementia but the degree of causation within this relationship is unclear. Previous studies have been limited by incomplete ascertainment of baseline cognition or a lack of prospective delirium assessments. There is an urgent need for an improved understanding of the relationship between delirium and dementia given that delirium prevention may plausibly impact upon dementia prevention. A well-designed, observational study could also answer fundamental questions of major importance to patients and their families regarding outcomes after delirium. The Delirium and Cognitive Impact in Dementia (DECIDE) study aims to explore the association between delirium and cognitive function over time in older participants. In an existing population based cohort aged 65 years and older, the effect on cognition of an episode of delirium will be measured, independent of baseline cognition and illness severity. The predictive value of clinical parameters including delirium severity, baseline cognition and delirium subtype on cognitive outcomes following an episode of delirium will also be explored. METHODS: Over a 12 month period, surviving participants from the Cognitive Function and Ageing Study II-Newcastle will be screened for delirium on admission to hospital. At the point of presentation, baseline characteristics along with a number of disease relevant clinical parameters will be recorded. The progression/resolution of delirium will be monitored. In those with and without delirium, cognitive decline and dementia will be assessed at one year follow-up. We will evaluate the effect of delirium on cognitive function over time along with the predictive value of clinical parameters. DISCUSSION: This study will be the first to prospectively elucidate the size of the effect of delirium upon cognitive decline and incident dementia. The results will be used to inform future dementia prevention trials that focus on delirium intervention

Bonded by nature: humans form equally strong and reciprocated bonds with similar raised dogs and wolves

Introduction: To explore human-canid relationships, we tested similarly socialized and raised dogs (Canis familiaris) and wolves (Canis lupus) and their trainers in a wildlife park. The aims of our study were twofold: first, we aimed to test which factors influenced the relationships that the trainers formed with the dogs or wolves and second, we investigated if the animals reacted to the trainers in accordance with the trainers’ perceptions of their relationship. Methods: To achieve these goals, we assessed the relationships using a human-animal bonds survey, which the trainers used to rate the bonds between themselves and their peers with the canids, and by observing dyadic trainer-canid social interactions. Results: Our preliminary results given the small sample size and the set-up of the research center, demonstrate that our survey was a valid way to measure these bonds since trainers seem to perceive and agree on the strength of their bonds with the animals and that of their fellow trainers. Moreover, the strength of the bond as perceived by the trainers was mainly predicted by whether or not the trainer was a hand-raiser of the specific animal, but not by whether or not the animal was a wolf or a dog. In the interaction test, we found that male animals and animals the trainers felt more bonded to, spent more time in proximity of and in contact with the trainers; there was no difference based on species. Discussion: These results support the hypothesis that wolves, similarly to dogs, can form close relationships with familiar humans when highly socialized (Canine Cooperation Hypothesis). Moreover, as in other studies, dogs showed more submissive behaviors than wolves and did so more with experienced than less experienced trainers. Our study suggests that humans and canines form differentiated bonds with each other that, if close, are independent of whether the animal is a wolf or dog

Birth data accessibility via primary care health records to classify health status in a multi-ethnic population of children: an observational study

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Recurrent delirium over 12 months predicts dementia: results of the Delirium and Cognitive Impact in Dementia (DECIDE) study

Background: Delirium is common, distressing and associated with poor outcomes. Previous studies investigating the impact of delirium on cognitive outcomes have been limited by incomplete ascertainment of baseline cognition or lack of prospective delirium assessments. This study quantified the association between delirium and cognitive function over time by prospectively ascertaining delirium in a cohort aged ≥ 65 years in whom baseline cognition had previously been established. Methods: For 12 months, we assessed participants from the Cognitive Function and Ageing Study II-Newcastle for delirium daily during hospital admissions. At 1-year, we assessed cognitive decline and dementia in those with and without delirium. We evaluated the effect of delirium (including its duration and number of episodes) on cognitive function over time, independently of baseline cognition and illness severity. Results: Eighty two of 205 participants recruited developed delirium in hospital (40%). One-year outcome data were available for 173 participants: 18 had a new dementia diagnosis, 38 had died. Delirium was associated with cognitive decline (−1.8 Mini-Mental State Examination points [95% CI –3.5 to –0.2]) and an increased risk of new dementia diagnosis at follow up (OR 8.8 [95% CI 1.9–41.4]). More than one episode and more days with delirium (>5 days) were associated with worse cognitive outcomes. Conclusions: Delirium increases risk of future cognitive decline and dementia, independent of illness severity and baseline cognition, with more episodes associated with worse cognitive outcomes. Given that delirium has been shown to be preventable in some cases, we propose that delirium is a potentially modifiable risk factor for dementi

AMoDSim: An Efficient and Modular Simulation Framework for Autonomous Mobility on Demand

Urban transportation of next decade is expected to be disrupted by Autonomous Mobility on Demand (AMoD): AMoD providers will collect ride requests from users and will dispatch a fleet of autonomous vehicles to satisfy requests in the most efficient way. Differently from current ride sharing systems, in which driver behavior has a clear impact on the system, AMoD systems will be exclusively determined by the dispatching logic. As a consequence, a recent interest in the Operations Research and Computer Science communities has focused on this control logic. The new propositions and methodologies are generally evaluated via simulation. Unfortunately, there is no simulation platform that has emerged as reference, with the consequence that each author uses her own custom-made simulator, applicable only in her specific study, with no aim of generalization and without public release. This slows down the progress in the area as researchers cannot build on each other's work and cannot share, reproduce and verify the results. The goal of this paper is to present AMoDSim, an open-source simulation platform aimed to fill this gap and accelerate research in future ride sharing systems