Community Resilience Research: UK Case Studies, Lessons and Recommendations report to the Cabinet Office and Defence Science and Technology Laboratory.

This report presents four case studies carried out for the Community Resilience project funded by DSTL and supported by the Civil Contingency Secretariat (CCS), Cabinet Office. The work for this project was carried out between September and December 2011. The aim of the Community Resilience project was to develop a better understanding of the role of community resilience in emergency response and recovery situations in order to inform Cabinet Office / Civil Contingencies Secretariat policy on community resilience and to inform the development of future work

The predictive capacity of biomarkers for clinical pulmonary oedema in patients with severe falciparum malaria is low: a prospective observational study

Background: Pulmonary oedema is a feared and difficult to predict complication of severe malaria that can emerge after start of antimalarial treatment. Proinflammatory mediators are thought to play a central role in its pathogenesis. Methods: An exploratory study was conducted to evaluate the predictive capacity of biomarkers for development of clinical pulmonary oedema in patients with severe falciparum malaria at two hospitals in Bangladesh. Plasma concentrations of interleukin-6 (IL-6), IL-8, tumour necrosis factor (TNF), soluble Receptor of Advanced Glycation End-products (sRAGE), surfactant protein-D (SP-D), club cell secretory protein (CC16), and Krebs von den Lungen-6 (KL-6) on admission were compared with healthy controls. Correlations between these biomarker and plasma lactate and Plasmodium falciparum histidine-rich protein 2 (PfHRP2) levels were evaluated. Receiver Operating Characteristic (ROC) curves were constructed to assess the predictive capacity for clinical pulmonary oedema of the biomarkers of interest. Results: Of 106 screened patients with falciparum malaria, 56 were classified as having severe malaria with a mortality rate of 29%. Nine (16%) patients developed clinical pulmonary oedema after admission. Plasma levels of the biomarkers of interest were higher in patients compared to healthy controls. IL-6, IL-8, TNF, sRAGE, and CC16 levels correlated well with plasma PfHRP2 levels (rs = 0.39; P = 0.004, rs = 0.43; P = 0.001, rs = 0.54; P < 0.001, rs = 0.44; P < 0.001, rs = 0.43; P = 0.001, respectively). Furthermore, IL-6 and IL-8 levels correlated well with plasma lactate levels (rs = 0.37; P = 0.005, rs = 0.47; P < 0.001, respectively). None of the biomarkers of interest had predictive capacity for development of clinical pulmonary oedema. Conclusions: IL-6, IL-8, TNF, sRAGE, SP-D, CC16 and KL-6 cannot be used in predicting clinical pulmonary oedema in severe malaria patients

The clinical implications of thrombocytopenia in adults with severe falciparum malaria: a retrospective analysis

BackgroundThrombocytopenia is a common finding in adults with severe falciparum malaria, but its clinical and prognostic utility is incompletely defined.MethodsClinical and laboratory data from 647 adults with severe falciparum malaria were analysed retrospectively to determine the relationship between a patient&rsquo;s platelet count on admission to hospital and their subsequent clinical course.ResultsOn admission, 614 patients (94.9%) were thrombocytopenic (platelet count &lt;150&thinsp;&times;&thinsp;109/L) and 328 (50.7%) had a platelet count &lt;50&thinsp;&times;&thinsp;109/L. The admission platelet count was inversely correlated with parasite biomass (estimated from plasma PfHRP2 concentrations, rs&thinsp;=&thinsp;&minus;0.28, P&thinsp;=&thinsp;0.003), the degree of microvascular sequestration (measured with orthogonal polarizing spectral imaging, rs&thinsp;=&thinsp;&minus;0.31, P&thinsp;=&thinsp;0.001) and disease severity (the number of World Health Organization severity criteria satisfied by the patient, rs&thinsp;=&thinsp;&minus;0.21, P &lt;0.001). Platelet counts were lower on admission in the patients who died (median: 30 (interquartile range 22 to 52)&thinsp;&times;&thinsp;109/L versus 50 (34 to 78)&thinsp;&times;&thinsp;109/L in survivors; P &lt;0.001), but did not predict outcome independently from other established laboratory and clinical prognostic indices. The 39 patients (6%) with profound thrombocytopenia (platelet count &lt;20&thinsp;&times;&thinsp;109/L) were more likely to die (odds ratio: 5.00, 95% confidence interval: 2.56 to 9.75) than patients with higher platelet counts, but these high-risk patients could be identified more rapidly with simple bedside clinical assessment. The admission platelet count did not reliably identify the 50 patients (7.7%) with major bleeding during the study.ConclusionsThrombocytopenia is a marker of disease severity in adults with falciparum malaria, but has limited utility in prognostication, triage and management

Simple direct formation of self-assembled N-heterocyclic carbene monolayers on gold and their application in biosensing

CRL acknowledges the Engineering and Physical Sciences Research Council (UK) for the funding of his PhD studentship (EP/M506631).The formation of organic films on gold employing N-heterocyclic carbenes (NHCs) has been previously shown to be a useful strategy for generating stable organic films. However, NHCs or NHC precursors typically require inert atmosphere and harsh conditions for their generation and use. Herein we describe the use of benzimidazolium hydrogen carbonates as bench stable solid precursors for the preparation of NHC films in solution or by vapour-phase deposition from the solid state. The ability to prepare these films by vapour-phase deposition permitted the analysis of the films by a variety of surface science techniques, resulting in the first measurement of NHC desorption energy (158±10 kJ mol−1) and confirmation that the NHC sits upright on the surface. The use of these films in surface plasmon resonance-type biosensing is described, where they provide specific advantages versus traditional thiol-based films.Publisher PDFPeer reviewe

Detection and quantification of antibody to SARS CoV 2 receptor binding domain provides enhanced sensitivity, specificity and utility

Accurate and sensitive detection of antibody to SARS-CoV-2 remains an essential component of the pandemic response. Measuring antibody that predicts neutralising activity and the vaccine response is an absolute requirement for laboratory-based confirmatory and reference activity.The viral receptor binding domain (RBD) constitutes the prime target antigen for neutralising antibody. A double antigen binding assay (DABA), providing the most sensitive format has been exploited in a novel hybrid manner employing a solid-phase S1 preferentially presenting RBD, coupled with a labelled RBD conjugate, used in a two-step sequential assay for detection and measurement of antibody to RBD (anti-RBD).This class and species neutral assay showed a specificity of 100 % on 825 pre COVID-19 samples and a potential sensitivity of 99.6 % on 276 recovery samples, predicting quantitatively the presence of neutralising antibody determined by pseudo-type neutralization and by plaque reduction. Anti-RBD is also measurable in ferrets immunised with ChadOx1 nCoV-19 vaccine and in humans immunised with both AstraZeneca and Pfizer vaccines. This assay detects anti-RBD at presentation with illness, demonstrates its elevation with disease severity, its sequel to asymptomatic infection and its persistence after the loss of antibody to the nucleoprotein (anti-NP). It also provides serological confirmation of prior infection and offers a secure measure for seroprevalence and studies of vaccine immunisation in human and animal populations.The hybrid DABA also displays the attributes necessary for the detection and quantification of anti-RBD to be used in clinical practice. An absence of detectable anti-RBD by this assay predicates the need for passive immune prophylaxis in at-risk patients

Assessment in the service of learning: challenges and opportunities or Plus ça Change, Plus c’est la même Chose

This paper begins with a brief overview of literature indicating that, although there have been significant advances in the field’s capacity to conduct both formative and summative assessments over the past decades, those advances have not been matched by comparable impact. The bulk of the paper is devoted to a series of examples from the Mathematics Assessment Project that illustrate issues of methods, and the unrealized potential for advances