Influenza vaccination for healthcare workers in the UK: appraisal of systematic reviews and policy options

Background: The UK Department of Health recommends annual influenza vaccination for healthcare workers, but uptake remains low. For staff, there is uncertainty about the rationale for vaccination and evidence underpinning the recommendation. Objectives: Clarify the rationale, and evidence-base, for influenza vaccination of healthcare workers from the occupational health, employer, and patient safety perspectives. Design: Systematic appraisal of published systematic reviews Results: The quality of the 11 included reviews was variable; some included exactly the same trials but made conflicting recommendations. Three reviews assessed vaccine effects in healthcare workers and found one trial reporting a vaccine efficacy of 88%. Six reviews assessed vaccine effects in healthy adults and vaccine efficacy was consistent with a median of 62% (95% CI 56 to 67). Two reviews assessed effects on working days lost in healthcare workers (three trials), and three reported effects in healthy adults (four trials). The meta-analyses presented by the most recent reviews do not reach standard levels of statistical significance, but may be misleading as individual trials suggest benefit with wide variation in size of effect. The 2013 Cochrane review reported absolute effects close to zero for laboratory-confirmed influenza, and hospitalization for patients, but excluded data on clinically-suspected influenza and all-cause mortality which had shown potentially important effects in previous editions. A more recent systematic review reports these effects as a 42% reduction in clinically-suspected influenza (95% CI 27 to 54), and a 29% reduction in all-cause mortality (95% CI 15 to 41). Conclusions: The evidence for employer and patient safety benefits of influenza vaccination is not straightforward, and has been interpreted differently by different systematic review authors. Future uptake of influenza vaccination among healthcare workers may benefit from a fully transparent guideline process by a panel representing all relevant stakeholders, which clearly communicates the underlying rationale, evidence-base, and judgements made

The impact of digital technology in care homes on unplanned secondary care usage and associated costs.

BackgroundA substantial number of Emergency Department (ED) attendances by care home residents are potentially avoidable. Health Call Digital Care Homes is an app-based technology that aims to streamline residents’ care by recording their observations such as vital parameters electronically. Observations are triaged by remote clinical staff. This study assessed the effectiveness of the Health Call technology to reduce unplanned secondary care usage and associated costs.MethodsA retrospective analysis of health outcomes and economic impact based on an intervention. The study involved 118 care homes across the North East of UK from 2018 to 2021. Routinely collected NHS secondary care data from County Durham and Darlington NHS Foundation Trust was linked with data from the Health Call app. Three outcomes were modelled monthly using Generalised Linear Mixed Models: counts of emergency attendances, emergency admissions and length of stay of emergency admissions. A similar approach was taken for costs. The impact of Health Call was tested on each outcome using the models.FindingsData from 8,702 residents were used in the analysis. Results show Health Call reduces the number of emergency attendances by 11% [6–15%], emergency admissions by 25% [20–39%] and length of stay by 11% [3–18%] (with an additional month-by-month decrease of 28% [24–34%]). The cost analysis found a cost reduction of £57 per resident in 2018, increasing to £113 in 2021.InterpretationThe introduction of a digital technology, such as Health Call, could significantly reduce contacts with and costs resulting from unplanned secondary care usage by care home residents

Ligand selectivity in stabilising tandem parallel folded G-quadruplex motifs in human telomeric DNA sequences

Biophysical studies of ligand interactions with three human telomeric repeat sequences (d(AGGG(TTAGGG)n, n = 3, 7 and 11)) show that an oxazole-based ‘click’ ligand, which induces parallel folded quadruplexes, preferentially stabilises longer telomeric repeats providing evidence for selectivity in binding at the interface between tandem quadruplex motifs

Revolution and the end of history: Caryl Churchill's Mad Forest

Caryl Churchill’s Mad Forest, written and performed very soon after the Romanian revolution in 1990 and performed both in London and Bucharest, is a dynamic, inter-cultural play that represents a variety of perspectives on the revolutionary events, as well as oscillating between English and Romanian cultural and language coordinates. It has a peculiar topicality in its detailed and specific usages of different aspects of the revolutionary narrative, its sketches of family life before and after the revolution, and the inclusion of the revolution as reported in quasi-documentary-style testimony. The perspective in this article is one that places the play within a framework that thinks through Mad Forest’s relationship to the triumphant, neoliberalist heralding of “the end of history,” most famously argued by Francis Fukuyama in his 1989 article of that name. This discourse gained further confidence from the collapse of Eastern Europe, a collapse that was viewed by proponents of the end-of-history argument as signalling the permanent disintegration of communism and a victory for capitalism. However, Mad Forest is considered here as a play that reflects multiple perspectives on the revolutionary period and, while declining to provide political solutions as such, simultaneously refuses to accede to the implications of the end-of-history argument

Evaluating Health Research Capacity Building: An Evidence-Based Tool

Bates and colleagues describe the development of a tool to assess capacity-building programs in health research, which they used in Kumasi, Ghana

Extensive Gene Amplification as a Mechanism for Piperacillin-Tazobactam Resistance in Escherichia coli.

Although the TEM-1 β-lactamase (BlaTEM-1) hydrolyzes penicillins and narrow-spectrum cephalosporins, organisms expressing this enzyme are typically susceptible to β-lactam/β-lactamase inhibitor combinations such as piperacillin-tazobactam (TZP). However, our previous work led to the discovery of 28 clinical isolates of Escherichia coli resistant to TZP that contained only blaTEM-1 One of these isolates, E. coli 907355, was investigated further in this study. E. coli 907355 exhibited significantly higher β-lactamase activity and BlaTEM-1 protein levels when grown in the presence of subinhibitory concentrations of TZP. A corresponding TZP-dependent increase in blaTEM-1 copy number was also observed, with as many as 113 copies of the gene detected per cell. These results suggest that TZP treatment promotes an increase in blaTEM-1 gene dosage, allowing BlaTEM-1 to reach high enough levels to overcome inactivation by the available tazobactam in the culture. To better understand the nature of the blaTEM-1 copy number proliferation, whole-genome sequence (WGS) analysis was performed on E. coli 907355 in the absence and presence of TZP. The WGS data revealed that the blaTEM-1 gene is located in a 10-kb genomic resistance module (GRM) that contains multiple resistance genes and mobile genetic elements. The GRM was found to be tandemly repeated at least 5 times within a p1ESCUM/p1ECUMN-like plasmid when bacteria were grown in the presence of TZP.IMPORTANCE Understanding how bacteria acquire resistance to antibiotics is essential for treating infected patients effectively, as well as preventing the spread of resistant organisms. In this study, a clinical isolate of E. coli was identified that dedicated more than 15% of its genome toward tandem amplification of a ~10-kb resistance module, allowing it to escape antibiotic-mediated killing. Our research is significant in that it provides one possible explanation for clinical isolates that exhibit discordant behavior when tested for antibiotic resistance by different phenotypic methods. Our research also shows that GRM amplification is difficult to detect by short-read WGS technologies. Analysis of raw long-read sequence data was required to confirm GRM amplification as a mechanism of antibiotic resistance. MBio 2018 Apr 24; 9(2):e00583-18

Flexible thin-film acoustic wave devices with off-axis bending characteristics for multisensing applications

Flexible surface acoustic wave (SAW) devices have recently attracted tremendous attention for their widespread applications in sensing and microfluidics. However, for these applications, the SAW devices often need to be bent into off-axis deformations between the acoustic-wave propagation direction and bending direction. Currently there are few studies on this topic, and the bending mechanisms under off-axis bending deformations have remained unexplored for multi-sensing applications. Herein, we fabricated aluminum nitride (AlN) flexible SAW devices by using high quality AlN films deposited on flexible glass substrates and systematically investigated their complex deformation behaviors. A theoretical model was firstly developed using coupling wave equations and boundary condition method to analyze the device’s characteristics with bending and off-axis deformation under elastic strains. The relationships between frequency shifts of the SAW device with bending strain and off-axis angle were obtained which showed the identical results with those from the theoretical calculations. Finally, we performed proof-of-concept demonstrations of multi-sensing applications by monitoring human wrist movements at various off-axis angles and detecting UV light intensities on a curved surface, thus paving the ways for versatile flexible electronics applications

High-Dose vs. Low-Dose Dexamethasone in Patients With COVID-19: A Cohort Study in Rural Central America

To compare the clinical outcomes of a low dose dexamethasone strategy vs. a high-dose dexamethasone strategy in hypoxemic COVID-19 patients. A retrospective observational study comparing low-dose (8 mg) and high-dose dexamethasone (24 mg) of COVID-19 patients admitted from September 1, 2020 to October 31, 2020 in a hospital in Honduras. We included 81 patients with confirmed COVID-19 who required oxygen therapy. The mean age was similar between groups (57.49 vs. 56.95 years). There were more male patients in the group of 24 mg (p = 0.01). Besides, patients on the 24 mg dose had more prevalence of hypertension (p = 0.052). More patients in the 24 mg group had a higher rate of invasive mechanical ventilation (15.00% vs. 2.56%, p = 0.058). When evaluating the association between the high dose group and outcomes, we find no significant association with mortality, nosocomial infections, high flow mask, invasive mechanical ventilation, or the need for vasopressors. We find no significant differences in the Kaplan–Meier analysis regarding the survival (log-rank p-value = 0.315). We did not find significant differences between the use of 24 mg and 8 mg of dexamethasone in hypoxemic COVID-19 patients.Revisión por pare