Health Providers Perspectives on the Access and Use of Formal Health and Social Services by Stroke Caregivers

Informal stroke caregivers, comprised of family and friends, can experience prolonged stress that places them at risk of poor health and social outcomes. These caregivers may benefit from formal health and social services, but they are often underused and challenging to access. This qualitative interpretive description study sought to explore health providers’ perspectives on the factors that impact stroke caregivers\u27 access and use of formal health and social services. In addition, it sought to explore health providers\u27 experiences and how they perceive their role in supporting stroke caregivers\u27. In-depth, semi-structured interviews were conducted with 18 health providers. Through inductive thematic analysis, resultant themes include: (a) a fragmented health system impacts the ability to provide continuity of care, (b) challenges in care provision and accessibility creates moral distress for health providers, (c) access to social support is pivotal for stroke caregivers’ self-care, (d) stroke caregivers require individualized care, (e) providing a single access point for stroke caregiver support is essential for success, and (f) current services are not meeting people living with stroke and stroke caregivers’ needs. Health providers are critical stakeholders due to their rich understanding of this issue, highlighting the importance of their involvement in caregiver initiatives

Estimating the effect of the 2005 change in BCG policy in England:a retrospective cohort study, 2000 to 2015

BackgroundIn 2005 in England, universal Bacillus Calmette-Guérin (BCG) vaccination of school-age children was replaced by targeted BCG vaccination of high-risk neonates.AimEstimate the impact of the 2005 change in BCG policy on tuberculosis (TB) incidence rates in England.MethodsWe conducted an observational study by combining notifications from the Enhanced Tuberculosis Surveillance system, with demographic data from the Labour Force Survey to construct retrospective cohorts relevant to both the universal and targeted vaccination between 1 January 2000 and 31 December 2010. We then estimated incidence rates over a 5-year follow-up period and used regression modelling to estimate the impact of the change in policy on TB.ResultsIn the non-United Kingdom (UK) born, we found evidence for an association between a reduction in incidence rates and the change in BCG policy (school-age incidence rate ratio (IRR): 0.74; 95% credible interval (CrI): 0.61 to 0.88 and neonatal IRR: 0.62; 95%CrI: 0.44 to 0.88). We found some evidence that the change in policy was associated with an increase in incidence rates in the UK born school-age population (IRR: 1.08; 95%CrI: 0.97 to 1.19) and weaker evidence of an association with a reduction in incidence rates in UK born neonates (IRR: 0.96; 95%CrI: 0.82 to 1.14). Overall, we found that the change in policy was associated with directly preventing 385 (95%CrI: -105 to 881) cases.ConclusionsWithdrawing universal vaccination at school age and targeting vaccination towards high-risk neonates was associated with reduced incidence of TB. This was largely driven by reductions in the non-UK born with cases increasing in the UK born

Reassessing the evidence for universal school-age BCG vaccination in England and Wales: re-evaluating and updating a modelling study

OBJECTIVES: In 2005, England and Wales switched from universal BCG vaccination against tuberculosis (TB) disease for school-age children to targeted vaccination of neonates. We aimed to recreate and re-evaluate a previously published model, the results of which informed this policy change. DESIGN: We recreated an approach for estimating the impact of ending the BCG schools scheme, correcting a methodological flaw in the model, updating the model with parameter uncertainty and improving parameter estimates where possible. We investigated scenarios for the assumed annual decrease in TB incidence rates considered by the UK's Joint Committee on Vaccination and Immunisation and explored alternative scenarios using notification data. SETTING: England and Wales. OUTCOME MEASURES: The number of vaccines needed to prevent a single notification and the average annual additional notifications caused by ending the policy change. RESULTS: The previously published model was found to contain a methodological flaw and to be spuriously precise. It greatly underestimated the impact of ending school-age vaccination compared with our updated, corrected model. The updated model produced predictions with wide CIs when parameter uncertainty was included. Model estimates based on an assumption of an annual decrease in TB incidence rates of 1.9% were closest to those estimated using notification data. Using this assumption, we estimate that 1600 (2.5; 97.5% quantiles: 1300, 2000) vaccines would have been required to prevent a single notification in 2004. CONCLUSIONS: The impact of ending the BCG schools scheme was found to be greater than previously thought when notification data were used. Our results highlight the importance of independent evaluations of modelling evidence, including uncertainty, and evaluating multiple scenarios when forecasting the impact of changes in vaccination policy

Acute Pressor Response to Psychosocial Stress Is Dependent on Endothelium‐Derived Endothelin‐1

Background Acute psychosocial stress provokes increases in circulating endothelin‐1 (ET‐1) levels in humans and animal models. However, key questions about the physiological function and cellular source of stress‐induced ET‐1 remain unanswered. We hypothesized that endothelium‐derived ET‐1 contributes to the acute pressor response to stress via activation of the endothelin A receptor. Methods and Results Adult male vascular endothelium‐specific ET‐1 knockout mice and control mice that were homozygous for the floxed allele were exposed to acute psychosocial stress in the form of cage switch stress (CSS), with blood pressure measured by telemetry. An acute pressor response was elicited by CSS in both genotypes; however, this response was significantly blunted in vascular endothelium‐specific ET‐1 knockout mice compared with control mice that were homozygous for the floxed allele. In mice pretreated for 3 days with the endothelin A antagonist, ABT‐627, or the dual endothelin A/B receptor antagonist, A‐182086, the pressor response to CSS was similar between genotypes. CSS significantly increased plasma ET‐1 levels in control mice that were homozygous for the floxed allele. CSS failed to elicit an increase in plasma ET‐1 in vascular endothelium‐specific ET‐1 knockout mice. Telemetry frequency domain analyses suggested similar autonomic responses to stress between genotypes, and isolated resistance arteries demonstrated similar sensitivity to α1‐adrenergic receptor‐mediated vasoconstriction. Conclusions These findings specify that acute stress‐induced activation of endothelium‐derived ET‐1 and subsequent endothelin A receptor activation is a novel mediator of the blood pressure response to acute psychosocial stress

Early mathematical models of COVID-19 vaccination in high-income countries:A systematic review

Objectives : Since COVID-19 first emerged in 2019, mathematical models have been developed to predict transmission and provide insight into disease control strategies. A key research need now is for models to inform long-term vaccination policy. We aimed to review the early modelling methods utilised during the pandemic period (2019–2023) in order to identify gaps in the literature and highlight areas for future model development.Study design : This study was a systematic review.Methods : We searched PubMed, Embase and Scopus from 1 January 2019 to 6 February 2023 for peer-reviewed, English-language articles describing age-structured, dynamic, mathematical models of COVID-19 transmission and vaccination in high-income countries that include waning immunity or reinfection. We extracted details of the structure, features and approach of each model and combined them in a narrative synthesis.Results : Of the 1109 articles screened, 47 were included. Most studies used deterministic, compartmental models set in Europe or North America that simulated a time horizon of 3.5 years or less. Common outcomes included cases, hospital utilisation and deaths. Only nine models included long COVID, costs, life years or quality of life-related measures. Two studies explored the potential impact of new variants beyond Omicron.Conclusions : This review demonstrates a need for long-term models that focus on outcome measures such as quality-adjusted life years, the population-level effects of long COVID and the cost effectiveness of future policies – all of which are essential considerations in the planning of long-term vaccination strategies

Use of Heart Rate Index to Predict Oxygen Uptake – A Validation Study

International Journal of Exercise Science 13(7): 1705-1717, 2020. An equation that uses heart rate index (HRI) defined as HR/HRrest to predict oxygen uptake (VO2) in METs (e.g., METs = 6 × HRI ‒ 5) has been developed retrospectively from aggregate data of 60 published studies. However, the prediction error of this model as used by an individual has not been established. Therefore, the purpose of this study was to examine the predictive validity of the HRI equation by comparing submaximal and maximal VO2 predicted by the equation (VO2-Pred) with that measured by indirect calorimetry (VO2-Meas). Sixty healthy adults (age 20.5 ± 2.4 yr., body mass 69.4 ± 13.4 kg, height 1.7 ± 0.1 m) underwent a VO2max test and an experimental trial consisting of a 15-min resting measurement and three successive 10-min treadmill exercise bouts performed at 40%, 60% and 80% of VO2max. VO2 and HR were recorded during both the submaximal and maximal exercises and used to obtain VO2-Pred and VO2-Meas for each intensity and for VO2max. Validation was carried out by paired t-test, regression analysis, and Bland-Altman plots. A modest but significant (p \u3c 0.05) correlation was observed between VO2-Meas and VO2-Pred at 40% (r = 0.58), 60% (r = 0.53), and 80% of VO2max (r = 0.56) and at VO2max (r = 0.50). No differences between VO2-Pred and VO2-Meas were found at 40% (5.53 ± 1.21 vs. 5.28 ± 0.98 METs, respectively) of VO2max, but VO2-Pred was higher (p \u3c 0.05) than VO2-Meas at 60% (8.42 ± 1.77 vs. 7.96 ± 1.39 METs, respectively) and 80% (10.79 ± 2.13 vs. 10.29 ± 1.81 METs, respectively) of VO2max. In contrast, VO2-Pred was lower (p \u3c 0.05) than VO2-Meas at VO2max (12.32 ± 2.30 vs. 13.38 ± 2.24 METs, respectively). Standard errors of the estimate were 0.81, 1.20, 1.54, and 1.97 METs at 40%, 60%, 80% of VO2max and at VO2max, respectively. These results suggest that further investigation aimed to establish the accuracy of using HRI to predict VO2 is warranted

In-Situ Focusing Inside a Thermal Vacuum Chamber

Traditionally, infrared (IR) space instruments have been focused by iterating with a number of different thickness shim rings in a thermal vacuum chamber until the focus meets requirements. This has required a number of thermal cycles that are very expensive as they tie up many integration and test (I&T)/ environmental technicians/engi neers work ing three shifts for weeks. Rather than creating a test shim for each iteration, this innovation replaces the test shim and can focus the instrument while in the thermal vacuum chamber. The focus tool consists of three small, piezo-actuated motors that drive two sets of mechanical interface flanges between the instrument optics and the focal- plane assembly, and three optical-displacement metrology sensors that can be read from outside the thermal vacuum chamber. The motors are used to drive the focal planes to different focal distances and acquire images, from which it is possible to determine the best focus. At the best focus position, the three optical displacement metrology sensors are used to determine the shim thickness needed. After the instrument leaves the thermal vacuum chamber, the focus tool is replaced with the precision-ground shim ring. The focus tool consists of two sets of collars, one that mounts to the backside of the interface flange of the instrument optics, and one that mounts to the backside of the interface flange of the focal plane modules. The collars on the instrument optics side have the three small piezo-actuated motors and the three optical displacement metrology systems. Before the instrument is focused, there is no shim ring in place and, therefore, no fasteners holding the focal plane modules to the cameras. Two focus tooling collars are held together by three strong springs. The Orbiting Carbon Observatory (OCO) mission spectrometer was focused this way (see figure). The motor described here had to be moved five times to reach an acceptable focus, all during the same thermal cycle, which was verified using pupil slicing techniques. A focus accuracy of .20.100 microns was achieved

High COVID-19 transmission potential associated with re-opening universities can be mitigated with layered interventions

Reopening of universities to students following COVID-19 restrictions risks increased transmission due to high numbers of social contacts and the potential for asymptomatic transmission. Here, the authors use a mathematical model with social contact data to estimate the impacts of reopening a typical non-campus based university in the UK