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Summary: Background & Aims: Healthcare service provision in inflammatory bowel disease (IBD) is often designed to meet targets set by healthcare providers rather than those of patients. It is unclear whether this meets the needs of patients, as assessed by patients themselves. This nationwide study assessed patients' experience of IBD and the healthcare they received, aiming to identify factors in IBD healthcare provision associated with perceived high‐quality care. Methods: Using the 2019 IBD Standards as a framework, a national benchmarking tool for quality assessment in IBD was developed by IBD UK, comprising a Patient Survey and Service Self‐Assessment. Results: In all, 134 IBD services and 9757 patients were responded. Perceived quality of care was lowest in young adults then increased with age, was higher in males and those >2 years since diagnosis. No hospital services met all the National IBD Standards for recommended workforce numbers. Key metrics associated with patient‐reported high‐quality care were as follows: identification as a tertiary centre, patient information availability, shared decision‐making, rapid response to contact for advice, access to urgent review, joint medical/surgical clinics and access to research (all p < 0.001). Higher numbers of IBD nurse specialists in a service was strongly associated with patients receiving regular reviews and having confidence in self‐management and reporting high‐quality care. Conclusions: This extensive patient and healthcare provider survey emphasises the importance of aspects of care less often measured by clinicians, such as communication, shared decision‐making and provision of information, and demonstrates that IBD nurse specialists are crucial to meeting the needs of people living with IBD.

Background: Despite high rates of depression and anxiety, little is known about the use of antidepressants amongst individuals diagnosed with inflammatory bowel disease (IBD). Aims: To evaluate temporal trends in the use of antidepressants; rates of antidepressant initiation and adherence of antidepressant use to international guidelines amongst individuals with IBD. Methods: This is a study of 14,525 incident IBD cases from 2004 to 2016 compared with 58,027 controls matched 1:4 for age and sex from the Clinical Practice Research Datalink. After excluding tricyclic antidepressants, we performed a Cox regression analysis to determine the risk associated with antidepressant use and logistic regression analysis to determine risk associated with antidepressant undertreatment. Results: Antidepressant use amongst individuals with IBD increased by 51% during the 12-year study period, who were 34% more likely to initiate antidepressants in the year after IBD diagnosis compared with controls (aHR:1.34, 95% CI 1.21-1.49). In those with IBD starting antidepressants, 67% received treatment lasting less than the duration recommended in international guidelines, of which 34% were treated for 1 month or less. 18-24 year olds were twice as likely to discontinue treatment within 1 month compared with those aged 40-60 years (aHR:2.03, 95% CI 1.40-2.95). Socioeconomic deprivation was also associated with early treatment discontinuation (aHR:1.40, 95% CI 1.07-1.83). Conclusions: In the year following IBD diagnosis individuals are significantly more likely to start antidepressants compared with controls, but treatment duration fell short of recommendations in the majority. Better integration of services may benefit individuals with IBD and psychiatric comorbidity.

Background: The impact of diagnostic delay on the clinical course of inflammatory bowel disease (IBD) remains uncertain. Aim: To perform a systematic review of time to diagnosis and the impact of delayed diagnosis on clinical outcomes in Crohn's disease (CD) and ulcerative colitis (UC). Methods: We searched EMBASE and Medline from inception to 30th November 2022 for studies reporting diagnostic interval, from symptom onset to IBD diagnosis. We calculated the median, interquartile range (IQR) and pooled weighted median, of median diagnostic intervals of eligible studies. We defined delayed diagnosis as individuals above the 75th centile of longest time to diagnosis in each study. Using random effects meta-analysis, we pooled odds ratios (ORs) with 95% confidence intervals (CI) for studies reporting clinical outcomes, according to delayed diagnosis. Results: One hundred and one studies representing 112,194 patients with IBD (CD = 59,359; UC = 52,835) met inclusion criteria. The median of median times to diagnosis was 8.0 (IQR: 5.0–15.2) and 3.7 months (IQR: 2.0–6.7) in CD and UC, respectively. In high-income countries, this was 6.2 (IQR: 5.0–12.3) and 3.2 months (IQR: 2.2–5.3), compared with 11.7 (IQR: 8.3–18.0) and 7.8 months (IQR: 5.2–21.8) in low-middle-income, countries, for CD and UC respectively. The pooled weighted median was 7.0 (95% CI: 3.0–26.4) and 4.6 (95% CI: 1.0–96.0) months, for CD and UC respectively. Eleven studies, representing 6164 patients (CD = 4858; UC = 1306), were included in the meta-analysis that examined the impact of diagnostic delay on clinical outcomes. In CD, delayed diagnosis was associated with higher odds of stricturing (OR = 1.88; CI: 1.35–2.62), penetrating disease (OR = 1.64; CI: 1.21–2.20) and intestinal surgery (OR = 2.24; CI: 1.57–3.19). In UC, delayed diagnosis was associated with higher odds of colectomy (OR = 4.13; CI: 1.04–16.40). Conclusion: Delayed diagnosis is associated with disease progression in CD, and intestinal surgery in both CD and UC. Strategies are needed to achieve earlier diagnosis of IBD.

Mixed methods experimental survey to answer what visual framing is most effective for investment in renewable resources

Contamination by microorganisms such as E, coli and Anthrax has been a source of concern in the agricultural and food processing industries for many years. However, the increasing presence and availability of the more robust microorganisms, such as Anthrax, present a significant threat to the safety and quality of life to which we are currently accustomed. As the knowledge and technology to manufacture and weaponize lethal strains and different suspensions of biological and chemical agents become more available, the knowledge and technology to detect and destroy these biological and chemical agents must also be developed. Methods currently used to decontaminate biological agents include electron beams, exposure to very high heats in excess of 130°C, exposure to Ultraviolet (UV) light, and the use of liquid solvents such as bleach, just to name a few. Based on previous research, another very effective decontamination technique is to expose the agent to an arc jet plume, which exhibits multiple killing mechanisms but is energy inefficient. It is of great interest to explore additional decontamination techniques that decontaminate more rapidly, are more energy efficient, do not harm the contaminated surface, and do not leave behind a residue which must later be cleaned. The pulsed corona discharge (PCD), which generates many of the same killing mechanisms as the arc jet, is thought to be a viable solution to the decontamination of biological and chemical agents; especially when combined with environmental enhancers that increase the amount of water vapor in the air or that increase the temperature of the specimen. A combination of experiments has been performed with the PCD utilizing the environmental enhancements previously mentioned on both chemical and biological specimens with the main goal pointing towards the decontamination of Anthrax in various environments. Additional experiments have been performed to determine if common barriers, such as paper or plastic envelopes, would inhibit the killing efficiency of the pulsed corona discharge. The most immediate benefits of the research performed with the pulsed corona discharge could be applied toward the destruction of Anthrax in contaminated mail.