Health Visitors experiences of MMR vaccination for children

Background In 2012 there was a large measles outbreak in Liverpool. The MMR vaccine has had low uptake rates since 1998 and the historical low uptake rates may have contributed to the outbreak. Parental and GP attitudes towards MMR have been well documented. What have not been reported are the experiences of Health Visitors during childhood vaccination appointments. Health Visitors are the main point of contact with new parents and their perceptions are under explored. Aim The aim of the study was to investigate the experiences of Health Visitors during appointments that are arranged with parents to discuss and administer the MMR vaccination for children. Methods A qualitative study using semi-structured interviews was used to explore the experiences of Health Visitors during appointments and discussions with parents in relation to vaccinations in general and the MMR specifically. A total of 10 Health Visitors were interviewed. Each interview was recorded, transcribed verbatim and analysed using thematic analysis. Findings There are 3 main findings reported. Firstly, the experiences and training of Health Visitors appears to have influenced their opinions of vaccinations. Secondly, the Health Visitors appear to categorise families on their caseloads according to ii subgroups. The perceived groups have a variety of needs that appear not to be met by the national one-size-fits-all approach to childhood vaccinations. The final finding is that there is a perception that there have been changes of risk perception since the recent measles outbreak and more families are choosing to have their children vaccinated. Conclusions If the perceptions of the Health Visitors are correct, the second finding leads us to conclude that the present national one-size fits all approach to childhood vaccinations is not appropriate for a rich and varied society. Through best practice and tweaking existing practices, MMR uptake can be increased

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

Automated Additive Construction (AAC) for Earth and Space Using In-situ Resources

Using Automated Additive Construction (AAC), low-fidelity large-scale compressive structures can be produced out of a wide variety of materials found in the environment. Compressionintensive structures need not utilize materials that have tight specifications for internal force management, meaning that the production of the building materials do not require costly methods for their preparation. Where a certain degree of surface roughness can be tolerated, lower-fidelity numerical control of deposited materials can provide a low-cost means for automating building processes, which can be utilized in remote or extreme environments on Earth or in Space. For space missions where every kilogram of mass must be lifted out of Earth’s gravity well, the promise of using in-situ materials for the construction of outposts, facilities, and installations could prove to be enabling if significant reduction of payload mass can be achieved. In a 2015 workshop sponsored by the Keck nstitute for Space Studies, on the topic of Three Dimensional (3D) Additive Construction For Space Using In-situ Resources, was conducted with additive construction experts from around the globe in attendance. The workshop explored disparate efforts, methods, and technologies and established a proposed framework for the field of Additive Construction Using In-situ Resources. This paper defines the field of Automated Additive Construction Using In-situ Resources, describes the state-of-the-art for various methods, establishes a vision for future efforts, identifies gaps in current technologies, explores investment opportunities, and proposes potential technology demonstration missions for terrestrial, International Space Station (ISS), lunar, deep space zero-gravity, and Mars environments

Measles outbreaks in the UK, is it when and where, rather than if? A database cohort study of childhood population susceptibility in Liverpool, UK

Objectives There was a large outbreak of measles in Liverpool, UK, in 2012–2013, despite measles, mumps and rubella (MMR) immunisation uptake rates that were higher than the national average. We estimated measles susceptibility of a cohort of children born in Liverpool between 1995 and 2012 to understand whether there was a change in susceptibility before and after the outbreak and to inform vaccination strategy. Design Retrospective cohort study. Setting The city of Liverpool, North West UK. Participants All children born in Liverpool (72 101) between 1995 and 2012 inclusive who were identified using the Child Health Information System (CHIS) and were still resident within Liverpool in 2014. Primary and secondary outcome measures We estimated cohort age-disaggregated and neighbourhood-disaggregated measles susceptibility according to WHO thresholds before and after the outbreak for children aged 1–17 years. Results Susceptibility to measles was above WHO elimination thresholds before and after the measles outbreak in the 10+ age group. The proportion of children susceptible before and after outbreak, respectively: age 1–4 years 15.0% before and 14.9% after; age 5–9 years 9.9% before and 7.7% after; age 10+ years 8.6% before and 8.5% after. Despite an intensive MMR immunisation catch-up campaign after the 2012–2013 measles outbreak, the overall proportion of children with no MMR remains high at 6.1% (4390/72 351). Across all age groups and before and after the outbreak, measles susceptibility was clustered by neighbourhood, with deprived areas having the greatest proportion of susceptible children. Conclusions The risk of sustained measles outbreaks remains, especially as large pools of susceptible older children will start leaving secondary education and continue to aggregate in higher education, employment and other community settings and institutions resulting in the potential for a propagated measles outbreak

Crummer SunTrust Portfolio Recommendations: Crummer Investment Management

The following report will walk you through this analysis beginning with an economic outlook, which in turn influences our portfolio design. The designated sector analysts then assess the portfolio holdings of each sector and determine whether the positions align with our forecast. This assessment includes a broad sector outlook, as well as a fundamental outlook for each individual holding. The decision to buy, hold, or sell is based on the sector analysts’ valuation. Finally, the report concludes with an overall portfolio assessment given the proposed changes supported by mean variance efficiency and a value at risk diagnosis

Modelling lake cyanobacterial blooms:disentangling the climate-driven impacts of changing mixed depth and water temperature

1. Climate change is already having profound impacts upon the state and dynamics of lake ecosystems globally. A specific concern is that climate change will continue to promote the growth of phytoplankton, particularly blooms of toxic cyanobacteria, via lake physical processes including warming surface waters and shallowing of the mixed layer. These two mechanisms will have different impacts on lake phytoplankton communities, but their inter-connectedness has made it difficult to disentangle their independent effects. 2. We fill this knowledge gap by performing 1666 numerical modelling experiments with the phytoplankton community model, PROTECH, in which we separated the independent effects on lake phytoplankton of temperature change and changes in the depth of the surface mixed layer. Given the large global abundance of small lakes (< 1 km2) and the importance of their ecosystems in global processes and budgets, we used a small meso-eutrophic lake as an example study site for the modelling experiments. 3. Increasing the lake temperature and positioning the mixed layer at a shallower depth had different ecological impacts, with warming typically resulting in more biomass and a dominance of cyanobacteria. 4. The response to mixed depth shallowing depended on the original depth where mixing occurred. As anticipated, where the original mixed depth was moderate (4–6 m) and there was a simultaneous increase in water temperature, cyanobacterial biomass increased. However, when the same absolute difference in shallowing and temperature increase were applied to a deeper mixed depth (9–13 m), lower cyanobacterial biomass resulted, owing to poorer conditions for low-light tolerant cyanobacteria. 5. Our study shows that the response of cyanobacterial blooms to climate-induced warming and shallowing of mixed layers in lakes around the world will not be universal, but rather will be system-specific, depending upon the average mixed layer depth of the lake in question and the light affinity of the dominant cyanobacteria species

The Role of Complement in age-Related Macular Degeneration : Heparan Sulphate, a ZIP Code for Complement Factor H?

Age-related macular degeneration (AMD) is the leading cause of blindness in developed nations and has been associated with complement dysregulation in the central retina. The Y402H polymorphism in the complement regulatory protein factor H (CFH) can confer a >5-fold increased risk of developing AMD and is present in approximately 30% of people of European descent. CFH, in conjunction with other factors, regulates complement activation in host tissues, and the Y402H polymorphism has been found to alter the protein’s specificity for heparan sulphate (HS) – a complex polysaccharide found ubiquitously in mammals. HS, which is present on the cell surface and also in the extracellular matrix, exhibits huge structural diversity due to variations in the level/pattern of sulphation, where particular structures may act as ‘ZIP codes’ for different tissue/cellular locations. Recent work has demonstrated that CFH contains two HS-binding domains that each recognize specific HS ZIP codes, allowing differential recognition of Bruch’s membrane (in the eye) or the glomerular basement membrane (in the kidney). Importantly, the Y402H polymorphism impairs the binding of CFH to the HS in Bruch’s membrane, which could result in increased complement activation and chronic local inflammation (in 402H individuals) and thereby contribute to AMD pathology

Modelling lake cyanobacterial blooms: disentangling the climate‐driven impacts of changing mixed depth and water temperature

1. Climate change is already having profound impacts upon the state and dynamics of lake ecosystems globally. A specific concern is that climate change will continue to promote the growth of phytoplankton, particularly blooms of toxic cyanobacteria, via lake physical processes including warming surface waters and shallowing of the mixed layer. These two mechanisms will have different impacts on lake phytoplankton communities, but their inter‐connectedness has made it difficult to disentangle their independent effects. 2. We fill this knowledge gap by performing 1666 numerical modelling experiments with the phytoplankton community model, PROTECH, in which we separated the independent effects on lake phytoplankton of temperature change and changes in the depth of the surface mixed layer. Given the large global abundance of small lakes (<1 km2) and the importance of their ecosystems in global processes and budgets, we used a small meso‐eutrophic lake as an example study site for the modelling experiments. 3. Increasing the lake temperature and positioning the mixed layer at a shallower depth had different ecological impacts, with warming typically resulting in more biomass and a dominance of cyanobacteria. 4. The response to mixed depth shallowing depended on the original depth where mixing occurred. As anticipated, where the original mixed depth was moderate (4–6 m) and there was a simultaneous increase in water temperature, cyanobacterial biomass increased. However, when the same absolute difference in shallowing and temperature increase were applied to a deeper mixed depth (9–13 m), lower cyanobacterial biomass resulted, owing to poorer conditions for low‐light tolerant cyanobacteria. 5. Our study shows that the response of cyanobacterial blooms to climate‐induced warming and shallowing of mixed layers in lakes around the world will not be universal, but rather will be system‐specific, depending upon the average mixed layer depth of the lake in question and the light affinity of the dominant cyanobacteria species

Radiocarbon data reveal contrasting sources for carbon fractions in thermokarst lakes and rivers of Eastern Canada (Nunavik, Quebec)

Greenhouse gas (GHG) emissions from permafrost organic carbon decomposition in lakes and rivers can accelerate global warming. We used radiocarbon (14C) measurements to determine the predominant sources of dissolved organic carbon (DOC), particulate organic carbon (POC), dissolved inorganic carbon (DIC), and methane (CH4) in five thermokarst lakes and three rivers in an area of widespread permafrost degradation in Northern Quebec to assess contributions from thawing permafrost and other old carbon (fixed before CE 1950) reservoirs. We compared emission pathways (dissolved gas and ebullition), seasons (summer and winter), and surface soil type (mineral and peat soils). Modern carbon (fixed after CE 1950) was the dominant source of DOC, DIC, and CH4 of non‐peatland aquatic systems, while POC and sediment carbon were predominantly fixed in the last millennia. In the peatland systems, modern and permafrost carbon were important sources of DOC, lake DIC, lake ebullition CO2, and lake dissolved CH4. In contrast, POC, lake ebullition CH4, and river DIC were dominated by millennial‐old carbon. In winter, the 14C age of DOC, DIC, and POC in the peatland lakes increased, but the 14C age of dissolved CH4 did not change. Our results point to a clearly older overall carbon source for ebullition CH4 relative to dissolved CH4 in the peatland lakes, but not the non‐peatland lakes. The younger ages of diffusive CH4 and DIC relative to DOC and POC in all lakes suggest that recent primary productivity strongly influences the large total lake CH4 emissions in this area, as diffusion fluxes greatly exceed ebullition fluxes

Predicting forefoot-orthosis interactions in rheumatoid arthritis using computational modelling

Foot orthoses are prescribed to reduce forefoot plantar pressures and pain in people with rheumatoid arthritis. Computational modelling can assess how the orthoses affect internal tissue stresses, but previous studies have focused on a single healthy individual. This study aimed to ascertain whether simplified forefoot models would produce differing biomechanical predictions at the orthotic interface between people with rheumatoid arthritis of varying severity, and in comparison to a healthy control. The forefoot models were developed from magnetic resonance data of 13 participants with rheumatoid arthritis and one healthy individual. Measurements of bony morphology and soft tissue thickness were taken to assess deformity. These were compared to model predictions (99th% shear strain and plantar pressure, max. pressure gradient, volume of soft tissue over 10% shear strain), alongside clinical data including body mass index and Leeds Foot Impact Scale–Impairment/Footwear score (LFIS-IF). The predicted pressure and shear strain for the healthy participant fell at the lower end of the rheumatoid models’ range. Medial first metatarsal head curvature moderately correlated to all model predicted outcomes (0.529 < r < 0.574, 0.040 < p < 0.063). BMI strongly correlated to all model predictions except pressure gradients (0.600 < r < 0.652, p < 0.05). There were no apparent relationships between model predictions and instances of bursae, erosion and synovial hypertrophy or LFIS-IF score. The forefoot models produced differing biomechanical predictions between a healthy individual and participants with rheumatoid arthritis, and between individuals with rheumatoid arthritis. Models capable of predicting subject specific biomechanical orthotic interactions could be used in the future to inform more personalised devices to protect skin and soft tissue health. While the model results did not clearly correlate with all clinical measures, there was a wide range in model predictions and morphological measures across the participants. Thus, the need for assessment of foot orthoses across a population, rather than for one individual, is clear