Public awareness of and opinions on the use of mathematical transmission modelling to inform public health policy in the United Kingdom

Mathematical modelling is used to inform public health policy, particularly so during the COVID-19 pandemic. As the public are key stakeholders, understanding the public perceptions of these tools is vital. To complement our previous study on the science-policy interface, novel survey data were collected via an online panel (‘representative’ sample) and social media (‘non-probability’ sample). Many questions were asked twice, in reference to the period ‘prior to’ (retrospectively) and ‘during’ the COVID-19 pandemic. Respondents reported being increasingly aware of modelling in informing policy during the pandemic, with higher levels of awareness among social media respondents. Modelling informing policy was perceived as more reliable during the pandemic than in reference to the pre-pandemic period in both samples. Trust in government public health advice remained high within both samples but was lower during the pandemic in comparison with the (retrospective) pre-pandemic period. The decay in trust was greater among social media respondents. Many respondents explicitly made the distinction that their trust was reserved for ‘scientists’ and not ‘politicians’. Almost all respondents believed governments have responsibility for communicating modelling to the public. These results provide a reminder of the skewed conclusions that could be drawn from non-representative samples

Caught in the conundrum: Neoliberalism and education in post-conflict Northern Ireland – Exploring shared education

Northern Ireland (NI) is emerging from a violent period in its troubled history and remains a society characterized by segregation between its two main communities. Nowhere is this more apparent than in education, where for the most part Catholic and Protestant pupils are educated separately. During the last 30 years there has been twofold pressure placed on the education system in NI – at one level to respond to intergroup tensions by promoting reconciliation, and at another, to deal with national policy demands derived from a global neoliberalist economic agenda. With reference to current efforts to promote shared education between separate schools, we explore the uneasy dynamic between a school-based reconciliation programme in a transitioning society and system-wide values that are driven by neoliberalism and its organizational manifestation – new managerialism. We argue that whilst the former seeks to promote social democratic ideals in education that can have a potentially transformative effect at the societal level, neoliberal priorities have the potential to both subvert shared education and also to embed it.</jats:p

Inferring community transmission of SARS-CoV-2 in the United Kingdom using the ONS COVID-19 Infection Survey.

Key epidemiological parameters, including the effective reproduction number, R(t), and the instantaneous growth rate, r(t), generated from an ensemble of models, have been informing public health policy throughout the COVID-19 pandemic in the four nations of the United Kingdom of Great Britain and Northern Ireland (UK). However, estimation of these quantities became challenging with the scaling down of surveillance systems as part of the transition from the "emergency" to "endemic" phase of the pandemic. The Office for National Statistics (ONS) COVID-19 Infection Survey (CIS) provided an opportunity to continue estimating these parameters in the absence of other data streams. We used a penalised spline model fitted to the publicly-available ONS CIS test positivity estimates to produce a smoothed estimate of the prevalence of SARS-CoV-2 positivity over time. The resulting fitted curve was used to estimate the "ONS-based" R(t) and r(t) across the four nations of the UK. Estimates produced under this model are compared to government-published estimates with particular consideration given to the contribution that this single data stream can offer in the estimation of these parameters. Depending on the nation and parameter, we found that up to 77% of the variance in the government-published estimates can be explained by the ONS-based estimates, demonstrating the value of this singular data stream to track the epidemic in each of the four nations. We additionally find that the ONS-based estimates uncover epidemic trends earlier than the corresponding government-published estimates. Our work shows that the ONS CIS can be used to generate key COVID-19 epidemiological parameters across the four UK nations, further underlining the enormous value of such population-level studies of infection. This is not intended as an alternative to ensemble modelling, rather it is intended as a potential solution to the aforementioned challenge faced by public health officials in the UK in early 2022

Risk of anemia with metformin use in type 2 diabetes:A MASTERMIND study

Objective: To evaluate the association between metformin use and anemia risk in type 2 diabetes, and the time-course for this, in a randomized controlled trial (RCT) and real-world population data. Research Design and Methods: Anemia was defined as a hemoglobin measure of &lt;11 g/dL. In the RCTs A Diabetes Outcome Progression Trial (ADOPT; n = 3,967) and UK Prospective Diabetes Study (UKPDS; n = 1,473), logistic regression was used to model anemia risk and nonlinear mixed models for change in hematological parameters. In the observational Genetics of Diabetes Audit and Research in Tayside Scotland (GoDARTS) population (n = 3,485), discrete-time failure analysis was used to model the effect of cumulative metformin exposure on anemia risk. Results: In ADOPT, compared with sulfonylureas, the odds ratio (OR) (95% CI) for anemia was 1.93 (1.10, 3.38) for metformin and 4.18 (2.50, 7.00) for thiazolidinediones. In UKPDS, compared with diet, the OR (95% CI) was 3.40 (1.98, 5.83) for metformin, 0.96 (0.57, 1.62) for sulfonylureas, and 1.08 (0.62, 1.87) for insulin. In ADOPT, hemoglobin and hematocrit dropped after metformin initiation by 6 months, with no further decrease after 3 years. In UKPDS, hemoglobin fell by 3 years in the metformin group compared with other treatments. At years 6 and 9, hemoglobin was reduced in all treatment groups, with no greater difference seen in the metformin group. In GoDARTS, each 1 g/day of metformin use was associated with a 2% higher annual risk of anemia. Conclusions: Metformin use is associated with early risk of anemia in individuals with type 2 diabetes, a finding consistent across two RCTs and replicated in one real-world study. The mechanism for this early fall in hemoglobin is uncertain, but given the time course, is unlikely to be due to vitamin B12 deficiency alone

Modelling hepatitis C infection acquired from blood transfusions in the UK between 1970 and 1991 for the Infected Blood Inquiry

The Statistics Expert Group was convened at the request of the Infected Blood Inquiry to provide estimates of the number of infections and deaths from blood-borne infections including hepatitis B virus, human immunodeficiency virus, hepatitis C virus (HCV) and variant Creutzfeldt Jakob disease, as a direct result of contaminated blood and blood products administered in the United Kingdom of Great Britain and Northern Ireland (UK). In the absence of databases of HCV infections and related deaths for all nations of the UK, a statistical model was required to estimate the number of infections and subsequent deaths from HCV acquired from blood transfusions from January 1970 to August 1991. We present this statistical model in detail alongside the results of its application to each of the four nations in the UK. We estimated that 26 800 people (95% uncertainty interval 21 300–38 800) throughout the UK were chronically infected with HCV because of contaminated blood transfusions between January 1970 and August 1991. The number of deaths up to the end of 2019 that occurred as a result of this chronic infection is estimated to be 1820 (95% uncertainty interval 650–3320)

Linking prison health care data to other health data: A novel data linkage study in Northern Ireland

Objectives We describe the progress made in the development of a novel linked database designed to improve understanding about the health, mental health, health service use and mortality risk of people following their release from prison in Northern Ireland (NI). Methods This is a collaborative project between the ADRC-NI and the NI Healthcare in Prisons service (HIPS) - South Eastern Health and Social Care Trust (SEHSCT). Data about the health of all adult prisoners between 2012 and 2021 (HIPS) will be linked to a healthcare population spine (National Health Application and Infrastructure Services - NHAIS) via a Health and Care Number (HCN), a unique health identifier for each patient in the NHS in Northern Ireland. Data will subsequently be linked to prescribing data (Enhanced Prescribing Database - EPD), in-patient services data (mental health) and mortality data (General Register Office - GRO). Results Ethical and governance approvals have been obtained. A stepwise approach to the development of this novel health database will be presented. Data cleaning has been undertaken by the HIPS team and records with missing HCNs have been identified and updated. Extraction of prison health data is underway for N=14,898 individuals and N=34,213 custodial episodes. Individuals may have more than one prison episode during the study period. Electronic and manual modes were used to extract 25 health-related variables from prison records. Data will be transferred to the Honest Broker Service (HBS), the trusted research environment for health and social care in NI, for data de-identification and linkage, and data access for analysis. Preliminary results and lessons for other related data-linkage projects will be presented and discussed. Conclusion We will describe our progress regarding the development of a novel health dataset comprising routinely collected administrative data and our work about prisoner health. We will report about our experience of assessing data access, cleaning, extracting, and analysing data and the linkage possibilities with respect to the prison health dataset

The potential for modelling peatland habitat condition in Scotland using long-term MODIS data

Funding: All James Hutton Institute authors are supported by the Scottish Government’s Rural and Environment Research and Analysis Directorate under the current Strategic Research Programme (2016-2021). Sally Johnson, Patricia Bruneau and Louise Ross did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors for this project. The peat spatial extent model was created in part within a UK Government – Department for Business, Energy and Industrial Strategy-funded project (TRN860/07/2014, Scoping the use of the methodology set out in Chapters 2 and 3 of the ‘2013 Supplement to the 2006 IPCC Guidelines for National Greenhouse Gas Inventories: Wetlands in the UK GHG Inventory: Land Use, Land Use Change and Forestry (LULUCF)), with further updates created within the Strategic Research Programme (2016-2021) funding.Peer reviewedPostprin

The context, influences and challenges for undergraduate nurse clinical education: Continuing the dialogue

Introduction – Approaches to clinical education are highly diverse and becoming increasingly complex to sustain in complex milieu Objective – To identify the influences and challenges of providing nurse clinical education in the undergraduate setting and to illustrate emerging solutions. Method: A discursive exploration into the broad and varied body of evidence including peer reviewed and grey literature. Discussion - Internationally, enabling undergraduate clinical learning opportunities faces a range of challenges. These can be illustrated under two broad themes: (1) Legacies from the past and the inherent features of nurse education and (2) Challenges of the present, including, population changes, workforce changes, and the disconnection between the health and education sectors. Responses to these challenges are triggering the emergence of novel approaches, such as collaborative models. Conclusion(s) – Ongoing challenges in providing accessible, effective and quality clinical learning experiences are apparent

Acceptability of Home Monitoring for Neovascular Age-Related Macular Degeneration Reactivation: A Qualitative Study

This study formed part of a diagnostic test accuracy study to quantify the ability of three index home monitoring (HM) tests (one paper-based and two digital tests) to identify reactivation in Neovascular age-related macular degeneration (nAMD). The aim of the study was to investigate views about acceptability and explore adherence to weekly HM. Semi-structured interviews were held with 98 patients, family members, and healthcare professionals. A thematic approach was used which was informed by theories of technology acceptance. Various factors influenced acceptability including a patient’s understanding about the purpose of monitoring. Training and ongoing support were regarded as essential for overcoming unfamiliarity with digital technology. Findings have implications for implementation of digital HM in the care of older people with nAMD and other long-term conditions