“I didn’t have any option”: Experiences of people receiving in-centre haemodialysis during the COVID-19 pandemic

People receiving in-centre haemodialysis (ICHD) during the COVID-19 pandemic had to adjust to more challenging treatment conditions. To explore people’s experiences of adjustment to ICHD during the pandemic. Thematic analysis of in-depth, semi-structured interviews with 14 adult UK ICHD patients. Findings: Four themes were identified: ‘perceptions of the threat’, ‘impacts on treatment’, ‘impaired communication’ and ‘coping and positive adjustment’. These described participants’ experiences of vulnerability to COVID-19; the ways the pandemic affected dialysis and clinical care; the impact that measures to reduce viral transmission had on communication and interaction within dialysis units; and ways that participants coped and made positive adjustments to the adversities imposed by the pandemic. The findings give insights into adjustment during extreme adversity. They also help to identify ways that support for ICHD patients could be improved as pandemic conditions recede, and ways that dialysis units could prepare for future outbreaks of infectious illness

Understanding Analysts Forecasts

The purpose of this paper is to model analysts ’ forecasts. The paper differs from the previous research in that we do not focus on how accurate these predictions may be. Accuracy may indeed be an important quality but we argue instead that another equally important aspect of the analysts ’ job is to predict and describe the impact of jump events. In effect, the analysts ’ role is one of scenario prediction. Using a Bayesian-inspired generalised method of moments estimation procedure, we use this notion of scenario prediction combined with the structure of the Morgan Stanley analysts’ forecasting database to model normal (base), optimistic (bull) and pessimistic (bear) forecas

Invasive serogroup B meningococci in England following three years of 4CMenB vaccination - First real-world data.

OBJECTIVES: In 2015 the UK became the first country to implement the meningococcal B (MenB) vaccine, 4CMenB, into the national infant program. 4CMenB is expected to cover meningococci expressing sufficient levels of cross-reactive proteins. This study presents clonal complex, 4CMenB antigen genotyping, and 4CMenB coverage data for all English invasive MenB isolates from 2014/15 (1 year pre-vaccine) through 2017/18 and compares data from vaccinated and unvaccinated ≤3 year olds. METHODS: Vaccine coverage of all invasive MenB isolates from 2014/15 to 2017/18 (n = 784) was analysed using the Meningococcal Antigen Typing System. Genotyping utilised the Meningococcus Genome Library. RESULTS: Among ≤3 year olds, proportionally fewer cases in vaccinees (1, 2 or 3 doses) were associated with well-covered strains e.g. cc41/44 (20.5% versus 36.4%; P<0.01) and antigens e.g. PorA P1.4 (7.2% versus 17.3%; P = 0.02) or fHbp variant 1 peptides (44.6% vs 69.1%; P<0.01). Conversely, proportionally more cases in vaccinees were associated with poorly-covered strains e.g. cc213 (22.9% versus 9.6%; P<0.01) and antigens e.g. variant 2 or 3 fHbp peptides (54.2% versus 30.9%; P<0.01). CONCLUSIONS: 4CMenB reduces disease due to strains with cross-reactive antigen variants. No increase in absolute numbers of cases due to poorly covered strains was observed in the study period

Propositive follow-up: Long-term immune responses to the 4CMenB and MenACWY vaccines in people living with HIV.

BACKGROUND: People living with HIV have an increased risk of meningococcal disease. The Propositive trial evaluated co-administration of two doses of a four-component recombinant protein-based MenB vaccine (4CMenB) and a quadrivalent conjugate polysaccharide MenACWY vaccine (MenACWY-CRM197) given 1 month apart in people with HIV. The follow-up trial assessed the immunogenicity of these vaccines at 1.5 and 2.5 years after primary vaccination. METHODS: Participants who completed the parent Propositive trial were invited to the follow-up study. Immunogenicity analysis was performed at 18 and 30 months after primary vaccination. Primary outcome measures were serum bactericidal antibody (SBA) geometric mean titres (GMTs) against three MenB reference strains and the proportion of participants maintaining a protective SBA titre of ≥4 at 18 and 30 months. Secondary outcome measures were SBA GMTs against MenA, C, W, and Y serogroups and the proportion of participants maintaining a protective SBA titre of ≥8 at 18 and 30 months. The trial is registered with Clinicaltrials.gov (NCT042394300). RESULTS: A total of 40 participants aged 22-47 years were enrolled. Geometric mean titres waned by 18 and 30 months but remained higher than pre-vaccination for all MenB strains and MenA, C, W, and Y. In total, 75%-85% of participants retained protective SBA titres by 30 months against individual MenB strains, whereas 68.8% of patients retained protective antibody titres against all three MenB strains. Antibodies against MenC waned more rapidly than did those against MenA, W, and Y. The proportion of participants with protective titres against MenC at 30 months was also lower (46.9%) than that with protective titres against MenA (87.5%), W (78.1%), and Y (87.5%). CONCLUSIONS: Immune responses against MenB in our cohort of people living with HIV at 2.5 years of follow-up were reassuring, with 68.8% of participants retaining protection against all three reference strains. However, responses against MenC were lower than those against MenA, W, and Y serogroups

“At least we have somewhere to go”: an exploration of adjustment experiences among people with chronic kidney disease who continued attending in-centre haemodialysis during the COVID-19 pandemic

Introduction In the United Kingdom, there are over 25,000 people with Chronic Kidney Disease (CKD) receiving in-centre haemodialysis (ICHD). Individuals with this long-term condition have been classified as clinically extremely vulnerable from COVID-19 (Ikizler, 2020; Raab, 2020), and data from the UK Renal Registry (2020) has also shown higher rates of infection and increased risk of mortality among this patient population. However, people with CKD must adhere to their treatment regime and continue to attend clinical centres for dialysis despite the risk of contracting COVID-19 with potentially serious consequences. This has had a detrimental impact on people’s experiences of ICHD and increased their risk of psychological distress and disturbance. Therefore, the aim of this study was to investigate the impact of COVID-19 on ICHD patients’ coping, adjustment and wellbeing, as well as to explore how people experienced ICHD during the pandemic and gain insights into how those experiences affected their psychological adjustment and mental health. Methods This study utilised a mixed-methods design, by collecting questionnaire surveys and conducting qualitative semi-structured interviews with people with CKD receiving ICHD in the UK during the COVID-19 pandemic. Forty people (18 female, 22 male) completed a questionnaire survey and reported COVID-19-related adverse impacts on treatment and rated their COVID-19-related concerns. They then completed the Depression, Anxiety and Stress Scale (DASS-21) and four scales of the Kidney Disease Quality of Life Short-Form (KDQLS). Fourteen respondents also took part in a semi-structured interview following completion of the questionnaire to discuss their experiences. The interviews were audio-recorded and transcribed verbatim, before being analysed using thematic analysis (Braun & Clarke, 2006). Results The questionnaire results detailed that the most common adverse impacts were staff shortages/changes and impaired interaction with staff/patients. Of the respondents, 32.4% were severely depressed, 14.7% severely anxious and 18.9% severely stressed. Participants who had tested positive for COVID-19 were more depressed and reported more adverse impacts. Older and married/cohabiting participants had better adjustment and wellbeing. The thematic analysis identified four themes: perceptions of the threat of COVID-19; impacts on treatment; impaired communication; and coping and positive adjustment. Participants’ experiences extended understanding of how they were affected by measures taken to mitigate for COVID-19 and gave insights into ways that psychological impacts of COVID-19 could be mitigated by additional informational and supportive measures within dialysis units. Discussion The findings show how the impact of the COVID-19 pandemic on patients’ experiences of dialysis treatment influenced their coping, adjustment and wellbeing. Adjustment and wellbeing among participants were low, and levels of depression, anxiety and stress were higher than for pre-COVID studies of ICHD patients using the same measure. Participants indicated having a lower quality of life, and their experiences demonstrated that those undergoing ICHD during the pandemic understood their vulnerability to disease, which combined with lockdown mitigations significantly heightened their risk of adverse mental health impacts. The results can help to identify the additional psychological support that dialysis patients need to maintain positive adjustment and wellbeing and inform enhanced clinical practice for ICHD during outbreaks of infectious disease

Increasing turnout using compulsory voting

In a recent issue of Politics Ben Saunders argued that the use of compulsory voting to increase turnout is misguided: lower turnout – even if unequal across social groups – is not necessarily undemocratic and may even serve democratic values. While accepting Saunders' normative premises that democratic decisions should be made by those affected by them and that distortions should be eliminated from the electoral process, I show that when implementing such ideals against empirical trends in voter behaviour and government responsiveness, compulsory voting is vindicated rather than invalidated.Lisa Hil