Genomic epidemiology of SARS-CoV-2 in a UK university identifies dynamics of transmission

AbstractUnderstanding SARS-CoV-2 transmission in higher education settings is important to limit spread between students, and into at-risk populations. In this study, we sequenced 482 SARS-CoV-2 isolates from the University of Cambridge from 5 October to 6 December 2020. We perform a detailed phylogenetic comparison with 972 isolates from the surrounding community, complemented with epidemiological and contact tracing data, to determine transmission dynamics. We observe limited viral introductions into the university; the majority of student cases were linked to a single genetic cluster, likely following social gatherings at a venue outside the university. We identify considerable onward transmission associated with student accommodation and courses; this was effectively contained using local infection control measures and following a national lockdown. Transmission clusters were largely segregated within the university or the community. Our study highlights key determinants of SARS-CoV-2 transmission and effective interventions in a higher education setting that will inform public health policy during pandemics.</jats:p

Improving home mechanical ventilation

© 2017 Dr Liam Michael HannanHome mechanical ventilation (HMV) is a complex assistive technology that can support individuals with respiratory failure to remain in the community. There is a lack of expert consensus regarding which disorders might benefit from HMV and also how best to apply the technology in order to achieve those benefits. Quality of care is therefore difficult to define for individuals receiving assisted ventilation as objective evidence is often lacking and broad consensus amongst expert clinicians remains elusive. In this thesis, differences in the use of HMV are described and the available evidence that underlies different approaches is considered. Two similarly resourced HMV providers in Canada and Australia are shown to use very different care models with these differences persisting after adjustment for underlying population attributes. This suggests that the strategies represent true differences in approach. They were also not associated with the cross-sectional health-related quality of life (HRQoL) of users of HMV in a multivariable model. To assist in the design of longitudinal studies involving non-invasive positive pressure ventilation (NIPPV), a systematic review of the literature considers the response of non-physiological outcome measures across different disease groups. This demonstrates that the subjective benefits of NIPPV are inconsistent and vary according to underlying diagnosis. Measures of somnolence and fatigue appear to be the most consistently influenced by NIPPV and these aspects of health should be incorporated in clinical studies in these often heterogeneous populations, along with relevant physiological and clinical endpoints. Health policy makers frequently require cost-utility analyses to confirm the cost-effectiveness of new interventions or technology. Few of the available instruments have been evaluated in individuals receiving assisted ventilation. A comparison of responses to two generic preference-based HRQoL instruments is presented. This demonstrates that the way in which mobility items are framed within the EuroQoL (EQ-5D-5L) and the Assessment of Quality of Life (AQoL-8D) contributes to the lack of agreement between the index scores produced with these instruments. This highlights critical measurement properties of the two instruments and underlines the need for careful consideration of HRQoL instruments in future research. In particular, the use of instruments that measure the behaviour of walking rather than the capacity to mobilise may be problematic in studies that may include individuals that are unable walk. Finally, a randomised controlled trial evaluating the role of polysomnography (PSG) titration of NIPPV is described, the design of which was guided by the preceding analyses. PSG is used routinely by only some HMV providers and it remains uncertain if it should form part of high quality care for users of HMV. Those undergoing PSG titration of NIPPV had significantly lower levels of patient-ventilator asynchrony and a trend towards improved adherence in comparison to the control group. However, there was no difference in the frequency of EEG arousals during sleep and there were no short-term differences between groups in measures of gas exchange, symptoms or HRQoL. These findings suggest that practice differences between HMV providers are significant, reflect differences in approach to care, and are likely driven by a relative lack of both objective evidence and broad expert consensus. The heterogeneity of populations managed with HMV poses a challenge to evaluating the quality of care, and careful selection of non-physiological endpoints (particularly symptom scales and measures of HRQoL) is required to ensure important treatment effects are not missed in future studies. While PSG titration may have advantages over clinical titration, conclusive evidence of benefit has not been demonstrated in the short-term study presented in this thesis. It is therefore proposed that further multicentre randomised controlled trials are required to answer this and other important clinical questions for HMV users. Other study designs (including longitudinal observational studies with collaborative data sharing) should be used as part of comparative effectiveness research. The current difficulty in defining high quality of care for individuals receiving assisted ventilation represents an extremely undesirable situation. A concerted effort involving users, carers, clinicians and policy makers could rectify this. This need will become more pressing as the prevalence of HMV – and the demand for high quality HMV services – increases over time

Multiple Keyboards - New music for 2 pianos, 4 pianos, piano and toy piano (1 player, and 2 players), 2 toy pianos (1 player & 2 players), piano duet

Curated by Diana Blom and Michael Hannan, this event included three premieres performed by the Viney-Grinberg Duo, including new works for two pianos by Diana Blom, Michael Hannan and Paul Smith. The project has led to two CD outputs, including a 2017 release on Tall Poppies that includes Hannan's Cloudcatcher

Building Scalable Communities from International Knowledge Networks

Small organizations frequently implement knowledge networks where people use their personal uncoordinated connections to transfer information. Although small knowledge networks may be very effective, they often experience problems as they grow. One way organizations can counteract this is by developing communities of practice. Cycling Without Age (CWA) is an organization that faces issues with knowledge sharing due to a rapidly expanding network. The goal of this project was to help CWA develop a community of practice that allows for more effective knowledge transfer. We investigated CWA’s knowledge network structure and analyzed their social learning group behavior in order to develop a governance structure around the network and implement a new platform

Typical within and between person variability in non-invasive ventilator derived variables among clinically stable, long-term users

Background Despite increasing capacity to remotely monitor non-invasive ventilation (NIV), how remote data varies from day to day and person to person is poorly described.Methods Single-centre, 2-month, prospective study of clinically stable adults on long-term NIV which aimed to document NIV-device variability. Participants were switched to a ventilator with tele-monitoring capabilities. Ventilation settings and masking were not altered. Raw, extensible markup language data files were provided directly from Philips Respironics (EncoreAnywhere). A nested analysis of variance was conducted on each ventilator variable to apportion the relative variation between and within participants.Results Twenty-nine people were recruited (four withdrew, one had insufficient data for analyses; 1364 days of data). Mean age was 54.0 years (SD 18.4), 58.3% male with body mass index of 37.0 kg/m2 (13.7). Mean adherence was 8.53 (2.23) hours/day and all participants had adherence &gt;4 hours/day. Variance in ventilator-derived indices was predominantly driven by differences between participants; usage (61% between vs 39% within), Apnoea–Hypopnoea Index (71% vs 29%), unintentional (64% vs 36%) and total leak (83% vs 17%), tidal volume (93% vs 7%), minute ventilation (92% vs 8%), respiratory rate (92% vs 8%) and percentage of triggered breaths (93% vs 7%).Interpretation In this clinically stable cohort, all device-derived indices were more varied between users than the day-to-day variation within individuals. We speculate that normative ranges and thresholds for clinical intervention need to be individualised, and further research is necessary to determine the clinically important relationships between clinician targets for therapy and patient-reported outcomes

Lung volume recruitment acutely increases respiratory system compliance in individuals with severe respiratory muscle weakness

The aim of the present study was to determine whether lung volume recruitment (LVR) acutely increases respiratory system compliance (Crs) in individuals with severe respiratory muscle weakness (RMW). Individuals with RMW resulting from neuromuscular disease or quadriplegia (n=12) and healthy controls (n=12) underwent pulmonary function testing and the measurement of Crs at baseline, immediately after, 1 h after and 2 h after a single standardised session of LVR. The LVR session involved 10 consecutive supramaximal lung inflations with a manual resuscitation bag to the highest tolerable mouth pressure or a maximum of 50 cmH2O. Each LVR inflation was followed by brief breath-hold and a maximal expiration to residual volume. At baseline, individuals with RMW had lower Crs than controls (37±5 cmH2O versus 109±10 mL·cmH2O−1, p0.05). LVR had no significant effect on measures of pulmonary function at any time point in either group (all p>0.05). During inflations, mean arterial pressure decreased significantly relative to baseline by 10.4±2.8 mmHg and 17.3±3.0 mmHg in individuals with RMW and controls, respectively (both p<0.05). LVR acutely increases Crs in individuals with RMW. However, the high airway pressures during inflations cause reductions in mean arterial pressure that should be considered when applying this technique