Modelling the effect of the introduction of antenatal screening for group B Streptococcus (GBS) carriage in the UK

OBJECTIVES: To estimate the potential impact of the addition of culture-based screening for group B streptococcus (GBS) carriage in pregnancy to a risk-based prevention policy in the UK. We aimed to establish agreement within a multidisciplinary group of key stakeholders on the model input parameters. DESIGN: Deterministic model using a consensus approach for the selection of input parameters. SETTING AND PARTICIPANTS: A theoretical annual cohort of 711 999 live births in the UK (excluding births by elective caesarean section). INTERVENTIONS: Culture-based screening for GBS at 35-37 weeks of pregnancy added to the recommended risk-based prevention policy in place on the date of modelling. OUTCOME MEASURES: Outcomes assessed included use of intrapartum antibiotic prophylaxis (IAP), early onset GBS (EOGBS), EOGBS mortality, severe EOGBS-related morbidity and maternal penicillin anaphylaxis. RESULTS: With no prophylaxis strategy, the model estimated that there would be 421 cases of culture positive EOGBS in a year (0.59/1000 live births). In the risk-based prophylaxis scenario, 30 666 women were estimated to receive IAP and 70 cases of EOGBS were prevented. Addition of screening resulted in a further 96 260 women receiving IAP and the prevention of an additional 52 to 57 cases of EOGBS. This resulted in the prevention of three EOGBS deaths and four cases of severe disability. With screening, an additional 1675 to 1854 women receive IAP to prevent one EOGBS case and 24 065 to 32 087 receive IAP to prevent one EOGBS death. CONCLUSIONS: The evidence base available for a broad range of model input parameters was limited, leading to uncertainty in the estimates produced by the model. Where data was limited, the model input parameters were agreed with the multidisciplinary stakeholder group, the first time this has been done to our knowledge. The main impact of screening is likely to be on the large group of low-risk women where the clinical impact of EOGBS tends to be less severe. This model suggests that the reduction in mortality and severe disability due to EOGBS with antenatal GBS screening is likely to be very limited, with a high rate of overdetection and overuse of antibiotics

Tools to Ease the Choice and Design of Protein Crystallisation Experiments

The process of macromolecular crystallisation almost always begins by setting up crystallisation trials using commercial or other premade screens, followed by cycles of optimisation where the crystallisation cocktails are focused towards a particular small region of chemical space. The screening process is relatively straightforward, but still requires an understanding of the plethora of commercially available screens. Optimisation is complicated by requiring both the design and preparation of the appropriate secondary screens. Software has been developed in the C3 lab to aid the process of choosing initial screens, to analyse the results of the initial trials, and to design and describe how to prepare optimisation screens

UK: racial violence and the night-time economy

This article examines fifty-five racist attacks over a six-month period in the UK’s night-time economy, showing the risks faced by members of the public and workers at taxi firms, takeaways, convenience stores and service stations. It argues that flexible and highly casualised labour conditions exacerbate the risk of racial violence

Academics' Responses to Encountered Information: Context Matters

An increasing number of tools are being developed to help academics interact with information, but little is known about the benefits of those tools for their users. This study evaluated academics' receptiveness to information proposed by a mobile app, the SerenA Notebook: information that is based in their inferred interests but does not relate directly to a prior recognized need. The evaluated app aimed at creating the experience of serendipitous encounters: generating ideas and inspiring thoughts, and potentially triggering follow-up actions, by providing users with suggestions related to their work and leisure interests. We studied how 20 academics interacted with messages sent by the mobile app (3 per day over 10 consecutive days). Collected data sets were analyzed using thematic analysis. We found that contextual factors (location, activity, and focus) strongly influenced their responses to messages. Academics described some unsolicited information as interesting but irrelevant when they could not make immediate use of it. They highlighted filtering information as their major struggle rather than finding information. Some messages that were positively received acted as reminders of activities participants were meant to be doing but were postponing, or were relevant to ongoing activities at the time the information was received

Analysing and reporting UK CAMHS outcomes: an application of funnel plots

Author's manuscript version.The final published version of the article is available from the publisher as an open access article via: DOI: 10.1111/camh.12086Child and Adolescent Mental Health published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health. Background: Patient-reported outcomes measures are increasingly being used in child and adolescent mental health services (CAMHS). League tables are a common way of comparing organizations across health and education but have limitations that are not well known in CAMHS. Method: Parent-rated Strengths and Difficulties Questionnaire (SDQ) outcomes data from 15,771 episodes of care across 51 UK CAMHS were analysed using funnel plots, an alternative to league tables. Results: While most services were indistinguishable from the national average there was evidence of heterogeneous outcomes and seven services had outcomes below 99.9% limits for SDQ added-value scores. Conclusions: Funnel plots are powerful tools for navigating national data and can help prompt investigations using clinical theory and local service context. Examples are provided of factors to consider in these investigations. We argue that analyses of the local context are central to the valid application of funnel plots

Nonlinear landscape and cultural response to sea-level rise

Rising sea levels have been associated with human migration and behavioral shifts throughout prehistory, often with an emphasis on landscape submergence and consequent societal collapse. However, the assumption that future sea-level rise will drive similar adaptive responses is overly simplistic. While the change from land to sea represents a dramatic and permanent shift for preexisting human populations, the process of change is driven by a complex set of physical and cultural processes with long transitional phases of landscape and socioeconomic change. Here, we use reconstructions of prehistoric sea-level rise, paleogeographies, terrestrial landscape change, and human population dynamics to show how the gradual inundation of an island archipelago resulted in decidedly nonlinear landscape and cultural responses to rising sea levels. Interpretation of past and future responses to sea-level change requires a better understanding of local physical and societal contexts to assess plausible human response patterns in the future

Assessing the Effectiveness of a Performance Evaluation System in the Public Health Care Sector: Some Novel Evidence from the Tuscany Region Experience

Since 80's the introduction of New Public Management principles has promoted the use of performance measurement to drive a more efficient, effective and accountable public sector. The adoption of a sophisticated and comprehensive multidimensional performance measurement system, which looks beyond traditional financial measures, based on organization strategies, such as the balanced scorecard, has thus been suggested. This revolution in the public management came together with the devolution processes that involved most European public health systems. Set within this context, in the last decade, each of the twenty Italian regions developed its own management tools. Among others, the Tuscan performance evaluation system (PES) has been valued as a particularly innovative and comprehensive system. This paper reports the novel experience of the Tuscan PES; in particular, it measures PES effectiveness and discusses the critical factors that could have led to the PES success. Five are the critical success factors identified by researchers: the visual reporting system, the linkage between PES and CEO's reward system, the public disclosure of data, the high level of employees and managers involvement into the entire process and the strong political commitment. All those factors run together to achieve better results; however, the process of development of the system plays a pivotal role. Scholars suggest the use of a constructive approach in order to gain effective changes in human organization. According to this stream of literature, this paper contributes by the novel experience of the Tuscan PES in addressing as a further fruitful application of the constructivist approach in healthcare

Nonlinear landscape and cultural response to sea-level rise

Dataset S1 (separate file). Relative sea-level database for Scilly comprising directly dated radiocarbon and optically stimulated luminescence samples with corresponding metainformation (lithostratigraphy, elevation, depositional environment and indicative meaning interpretations, paleotidal range change and sea-level calculations) following the ‘HOLSEA’ (‘Geographic Variability of Holocene Relative Sea Level’) protocol (Khan et al., 2019*). Dataset S2 (separate file). Table containing pollen results as relative abundance (genus level), modelled ages and age uncertainty for pollen samples, landcover index results (community cluster numbers and nMDS ordination axes 1 and 2), foraminifera results as species counts and transfer function results as paleomarsh elevations with uncertainty (1σ). Foraminifera samples with low test concentrations have indicative ranges (from mean high water neap tides to highest astronomical tides) in place of paleomarsh elevation estimations. Foraminifera abbreviations: H.wil – Haplophragmoides wilbertii ; J.mac – Jadammina macrescens ; M.fus – Miliammina fusca ; P.ipo – Polysaccammina ipohalina ; T.inf – Trochammina infalta ; T.och – Trochammina ochracea ; A.bat - Ammonia batavus ; A.mam – Asterigerinata mamilla ; B.var – Bolivina variablis; E.cri – Elphidium crispum ; E.wil – Elphidium Williamsoni ; F.spp. – Fissurina spp. ; Elphidium spp. ; H.ger – Haynesina germanica ; L.lob – Lobatula lobatula ; O.spp. – Oolha spp. ; Q.sem – Quinqueloculina seminula; R.spp. – Rosalina spp.. Dataset S3 (separate file). Database containing three worksheets for developing archaeological indices for Scilly. ‘SWBritain’ – Radiocarbon dates from Devon and Cornwall used to develop a summed probability distribution curve as an estimate of population demographic variation in Southwest Britain. ‘NWFrance’ - Radiocarbon dates from Brittany and Normandy used to develop a summed probability distribution curve as an estimate of population demography in Northwest France. ‘Scilly’ – Archaeological monuments from Scilly used to develop a probabilistic index of population variability.The article associated with these datasets is located in ORE at: http://hdl.handle.net/10871/123489Rising sea levels have been associated with human migration and behavioral shifts throughout prehistory, often with an emphasis on landscape submergence and consequent societal collapse. However, the assumption that future sea-level rise will drive similar adaptive responses is overly simplistic. Whilst the change from land to sea represents a dramatic and permanent shift for pre-existing human populations, the process of change is driven by a complex set of physical and cultural processes with long transitional phases of landscape and socio-economic change. Here we use reconstructions of prehistoric sea-level rise, paleogeographies, terrestrial landscape change and human population dynamics to show how the gradual inundation of an island archipelago resulted in decidedly non-linear landscape and cultural responses to rising sea-levels. Interpretation of past and future responses to sea-level change requires a better understanding of local physical and societal contexts to assess plausible human response patterns in the future.Historic EnglandWelsh GovernmentHigher Education Funding Council for Wale