10 research outputs found
Legislative approaches to recognising the vulnerability of young people and preventing their criminalisation
Discusses the introduction by the Modern Slavery Act 2015 s.45 of a specific defence for children over the minimum age of criminal responsibility, (MACR) but under 18, which recognises their vulnerability, and considers its wider implications. Reviews the politicisation of youth crime, the role of the media, the position in Scotland and Wales, and the arguments for raising the MACR and introducing a further defence of developmental immaturity.
Legislation cited
Modern Slavery Act 2015 (c.30)s.4
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Single-dose BNT162b2 vaccine protects against asymptomatic SARS-CoV-2 infection
The BNT162b2 mRNA COVID-19 vaccine (Pfizer-BioNTech) is being utilised internationally for mass COVID-19 vaccination. Evidence of single-dose protection against symptomatic disease has encouraged some countries to opt for delayed booster doses of BNT162b2, but the effect of this strategy on rates of asymptomatic SARS-CoV-2 infection remains unknown. We previously demonstrated frequent pauci- and asymptomatic SARS-CoV-2 infection amongst healthcare workers (HCWs) during the UK’s first wave of the COVID-19 pandemic, using a comprehensive PCR-based HCW screening programme (Rivett et al., 2020; Jones et al., 2020). Here, we evaluate the effect of first-dose BNT162b2 vaccination on test positivity rates and find a fourfold reduction in asymptomatic infection amongst HCWs ≥12 days post-vaccination. These data provide real-world evidence of short-term protection against asymptomatic SARS-CoV-2 infection following a single dose of BNT162b2 vaccine, suggesting that mass first-dose vaccination will reduce SARS-CoV-2 transmission, as well as the burden of COVID-19 disease
Contemporary Outcomes After Partial Resection of Infected Aortic Grafts
Introduction: Aortic graft infection remains a considerable clinical
challenge, and it is unclear which variables are associated with adverse
outcomes among patients undergoing partial resection.
Methods: A retrospective, multi-institutional study of patients who
underwent partial resection of infected aortic grafts from 2002 to 2014
was performed using a standard database. Baseline demographics,
comorbidities, operative, and postoperative variables were recorded. The
primary outcome was mortality. Descriptive statistics, Kaplan-Meier (KM)
survival analysis, and Cox regression analysis were performed.
Results: One hundred fourteen patients at 22 medical centers in 6
countries underwent partial resection of an infected aortic graft.
Seventy percent were men with median age 70 years. Ninety-seven percent
had a history of open aortic bypass graft: 88 (77%) patients had
infected aortobifemoral bypass, 18 (16%) had infected aortobiiliac
bypass, and 1 (0.8%) had an infected thoracic graft. Infection was
diagnosed at a median 4.3 years post-implant. All patients underwent
partial resection followed by either extra-anatomic (47%) or in situ
(53%) vascular reconstruction. Median follow-up period was 17 months
(IQR 1, 50 months). Thirty-day mortality was 17.5%. The KM-estimated
median survival from time of partial resection was 3.6 years. There was
no significant survival difference between those undergoing in situ
reconstruction or extra-anatomic bypass (P = 0.6). During follow up,
72% of repairs remained patent and 11% of patients underwent major
amputation. On univariate Cox regression analysis, Candida infection was
associated with increased risk of mortality (HR 2.4; P = 0.01) as well
as aortoenteric fistula (HR 1.9, P = 0.03). Resection of a single graft
limb only to resection of abdominal (graft main body) infection was
associated with decreased risk of mortality (HR 0.57, P = 0.04), as well
as those with American Society of Anesthesiologists classification less
than 3 (HR 0.35, P = 0.04). Multivariate analysis did not reveal any
factors significantly associated with mortality. Persistent early
infection was noted in 26% of patients within 30 days postoperatively,
and 39% of patients were found to have any post-repair infection during
the follow-up period. Two patients (1.8%) were found to have a late
reinfection without early persistent postoperative infection. Patients
with any post-repair infection were older (67 vs . 60 years, P = 0.01)
and less likely to have patent repairs during follow up (59% vs. 32%,
P = 0.01). Patients with aortoenteric fistula had a higher rate of any
post-repair infection (63% vs . 29%, P < 0.01)
Conclusion: This large multi-center study suggests that patients who
have undergone partial resection of infected aortic grafts may be at
high risk of death or post-repair infection, especially older patients
with abdominal infection not isolated to a single graft limb, or with
Candida infection or aortoenteric fistula. Late reinfection correlated
strongly with early persistent postoperative infection, raising concern
for occult retained infected graft material