Modelling the impact of local reactive school closures on critical care provision during an influenza pandemic

Despite the fact that the 2009 H1N1 pandemic influenza strain was less severe than had been feared, both seasonal epidemics of influenza-like-illness and future influenza pandemics have the potential to place a serious burden on health services. The closure of schools has been postulated as a means of reducing transmission between children and hence reducing the number of cases at the peak of an epidemic; this is supported by the marked reduction in cases during school holidays observed across the world during the 2009 pandemic. However, a national policy of long-duration school closures could have severe economic costs. Reactive short-duration closure of schools in regions where health services are close to capacity offers a potential compromise, but it is unclear over what spatial scale and time frame closures would need to be made to be effective. Here, using detailed geographical information for England, we assess how localized school closures could alleviate the burden on hospital intensive care units (ICUs) that are reaching capacity. We show that, for a range of epidemiologically plausible assumptions, considerable local coordination of school closures is needed to achieve a substantial reduction in the number of hospitals where capacity is exceeded at the peak of the epidemic. The heterogeneity in demand per hospital ICU bed means that even widespread school closures are unlikely to have an impact on whether demand will exceed capacity for many hospitals. These results support the UK decision not to use localized school closures as a control mechanism, but have far wider international public-health implications. The spatial heterogeneities in both population density and hospital capacity that give rise to our results exist in many developed countries, while our model assumptions are sufficiently general to cover a wide range of pathogens. This leads us to believe that when a pandemic has severe implications for ICU capacity, only widespread school closures (with their associated costs and organizational challenges) are sufficient to mitigate the burden on the worst-affected hospitals

Investigating the Mechanical and Durability Performance of Cement Mortar Incorporated Modified Fly Ash and Ground Granulated Blast Furnace Slag as Cement Replacement Materials

The process of cement manufacturing produces a huge amount of carbon dioxide (CO2). The utilization of alternative waste materials from various industrial processes as a partial substitution to cement is encouraged due to environmental and specific technical requirements. This strategy will have the potential to reduce cost of cement, conserve energy, and reduce waste volumes. Therefore, the aim of this research is to investigate effect of the replacement of cement with modified fly ash (MFA) and ground granulated blast furnace slag (GGBS) to reach 80% total replacement on mechanical and durability performance of cement mortar. Normal consistency, the initial and final setting times, compressive strength and electrical resistivity of all the ternary mixtures were determined and compared with the control binder. Compressive strength and electrical resistivity were tested at various curing ages of 3, 7, 14, and 28 days. Test results revealed that the normal consistency of the ternary mixtures increased with increasing the GGBS and MFA content, while the initial and final setting time decreased compared to that of control mixture. The results also showed that the compressive strength of all the ternary blends mortars were lower at early and later ages in comparison with control mortar. The reductions in the compressive strengths of the ternary mixtures T40, T60 and T80 compared to the control mixture were approximately 16%, 29% and 37%, respectively at 28 days. The surface electrical resistivity of ternary blends mixtures was higher than the control mixture at all curing ages. The use of GGBS and MFA in the production of cement mortar and concrete can significantly help in reducing the CO2 emissions of the cement industry and reduce the overall cost of cement

Combined analysis of the salivary microbiome and host defence peptides predicts dental disease

Understanding the triad of host response, microbiome and disease status is potentially informative for disease prediction, prevention, early intervention and treatment. Using longitudinal assessment of saliva and disease status, we demonstrated that partial least squares modelling of microbial, immunological and clinical measures, grouped children according to future dental disease status. Saliva was collected and dental health assessed in 33 children aged 4 years, and again 1-year later. The composition of the salivary microbiome was assessed and host defence peptides in saliva were quantified. Principal component analysis of the salivary microbiome indicated that children clustered by age and not disease status. Similarly, changes in salivary host defence peptides occurred with age and not in response to, or preceding dental caries. Partial least squares modelling of microbial, immunological and clinical baseline measures clustered children according to future dental disease status. These data demonstrate that isolated evaluation of the salivary microbiome or host response failed to predict dental disease. In contrast, combined assessment of both host response together with the microbiome revealed clusters of health and disease. This type of approach is potentially relevant to myriad diseases that are modified by host–microbiome interactions

Investigating effective building fabric as a passive cooling technique to combat overheating in UK residential buildings

The Intergovernmental Panel on Climate Change has predicted that the earth’s temperature is increasing by 1.5°. Research indicates that 9 out of 10 homes within the United Kingdom may experience overheating. The growing concern of overheating within residential homes should be resolved before occupants turn to the use of mechanical means. Passive cooling strategies need to be implemented into residential homes as a contribution to the current aim of the United Kingdom government to reduce carbon emission by 77% by 2035 compared to 1990 levels. This research investigates the most appropriate building construction fabric as a passive cooling strategy that can be implemented into residential homes to mitigate the impact of climate change. Computational fluid dynamic simulation of different building fabric scenarios of EcoBIM construction, Passivhaus construction and Standard construction are performed using EDSL Tas thermal modelling software. The simulations incorporate Chartered Institution of Building Services Engineering (CIBSE) weather data files for Glasgow, Belfast, Manchester, and London for 2020s, 2050s and 2080s climatic projections. The results from this investigation show that the standard construction overall did present the most effective solution against the number of hours experiencing overheating. The research provides evidence to suggest that the current 2021 Building Regulations in place are not at risk of experiencing overheating in Manchester, Belfast, and Glasgow across the 2020, 2050 and 2080 simulations, as well as for the 2020 and 2050 London simulation. This proposes that within these locations the current 2021 Building Regulations regarding the U values in document Part-L shall be deemed as having an acceptable tolerance to overheating, and further adaptations are not necessary, as there is no concern regarding the encountering of overheating within these regions and weather periods. Furthermore, the utilization of the EcoBIM construction on average did cause significant increased risk of overheating. The only exception to this was the 2080 simulation for London in which the EcoBIM construction obtained 71.10% less overheating compared to the Standard construction. The outcome of this research suggests that London is at extreme risk of enduring overheating by 2080, as all the constructions during this simulation process were perceived as exceeding the CIBSE TM59 requirement

EQ-5D-5L versus 3L: the impact on cost-effectiveness

Objectives To model the relationship between EQ-5D-3L and EQ-5D-5L and examine how differences impact on cost-effectiveness in case studies. Methods We used two datasets that included both EQ-5D-3L and EQ-5D-3L from the same respondents. The EuroQoL dataset (n=3551) included patients with different diseases and a healthy cohort. The National Databank (NDB) dataset included patients with rheumatoid disease (n=5205). We estimated a system of ordinal regressions in each dataset using copula models, to link responses to the 3L instrument to 5L and its tariff, and vice versa. Results were applied to nine cost-effectiveness studies. Results Best-fitting models differed between EuroQoL and NDB datasets in terms of the explanatory variables, copulas and coefficients. In both cases the coefficients of the covariates and latent factor between -3L and -5L were significantly different, indicating that the two instruments are not a uniform realignment of the response levels for most dimensions. In the case studies, moving from 3L to 5L caused a decrease of up to 87% in incremental QALYs gained from effective technologies in almost all cases. ICERs increased, often substantially. Conversely, one technology with a significant mortality gain saw increased incremental QALYs. Conclusion 5L shifts mean utility scores up the utility scale towards full health and compresses them into a smaller range, compared to -3L. Improvements in quality of life are valued less using 5L than with 3L. 3L and 5L can produce substantially different estimates of cost effectiveness. There is no simple proportional adjustment that can be made to reconcile these differences