Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial

Objective To determine whether vaccination of care home staff against influenza indirectly protects residents.Design Pair matched cluster randomised controlled trial.Setting Large private chain of UK care homes during the winters of 2003-4 and 2004-5.Participants Nursing home staff (n = 1703) and residents (n = 2604) in 44 care homes (22 intervention homes and 22 matched control homes).Interventions Vaccination offered to staff in intervention homes but not in control homes.Main outcome measures The primary outcome was all cause mortality of residents. Secondary outcomes were influenza-like illness and health service use in residents.Results In 2003-4 vaccine coverage in full time staff was 48.2% (407/884) in intervention homes and 5.9% (51/859) in control homes. In 2004-5 uptake rates were 43.2% (365/844) and 3.5% (28/800). National influenza rates were substaritially below average in 2004-5. In the 2003-4 period of influenza activity significant decreases were found in mortality of residents in intervention homes compared with control homes (rate difference - 5.0 per 100 residents, 95% confidence interval - 7.0 to - 2.0) and in influenza-like illness (P = 0.004), consultations with general practitioners for influenza-like illness (P = 0.008), and admissions to hospital with influenza-like illness (P = 0.009). No significant differences were found in 2004-5 or during periods of no influenza activity in 2003-4.Conclusions Vaccinating care home staff against influenza can prevent deaths, health service use, and influenza-like illness in residents during periods of moderate influenza activity

Characterization of wood-adhesive bonds in wet conditions by means of nanoindentation and tensile shear strength

The performance of adhesive-hardwood bonds can often be sensitive to humidity and temperature variation. Therefore, it is frequently challenging to achieve standard requirements for structural applications. To gain a better understanding of the wood-adhesive bond, the properties of the individual constituents as well as the local interface of European beech (Fagus sylvatica L.) wood cell walls in contact with structural adhesives were analyzed by means of nanoindentation. These results are compared to classical lap-shear strength. As adhesives two different one-component polyurethane adhesives (1C PUR) and a phenol resorcinol formaldehyde adhesive (PRF) were used. In one case, the beech wood was additionally pre-treated with an adhesion-promoting agent (primer) prior to bonding with 1C PUR. Beech wood joints were analyzed subsequent to several treatments, namely standard climate, after wet storage and in re-dried conditions. In addition, the influence of the primer on the hydroxyl accessibility of beech wood was investigated with dynamic vapor sorption (DVS). The lap-shear strength revealed good performance in dry and re-dried conditions for all adhesives on beech. Both polyurethane adhesives obtained deficits when tested in wet conditions. The use of a primer significantly improved the PUR performance in wet condition. DVS experiment demonstrated a decrease in hydroxyl group accessibility when using a high primer concentration. As novelty, nanoindentation was used for the first time to characterize the local wood–adhesive-interface properties in wet conditions. Nanoindentation showed that all tested 1C PUR perform quite similar in room climate, while PRF achieves considerable higher values for reduced E-modulus and hardness. Wet storage led to a considerable reduction in mechanical properties for all adhesives, while the highest relative change was observed for PRF. After re-drying, the adhesives re-gained a large part of their original mechanical properties in room climate. No distinct effect of the primer on the local micromechanical properties could be detected with nanoindentation in terms of specific work of indentation

Modifying elastic modulus of two-component polyurethane adhesive for structural hardwood bonding

Subject to this study is the modification of an experimental two-component polyurethane (2C PUR) as an alternative adhesive for structural hardwood bonding. The 2C PUR has been adapted by calcium carbonate as filler to increase its modulus of elasticity with the aim of increasing the modulus analogue to the ones typically observed for classic amino- and phenol based adhesives. The 2C PUR system was compared with a commercial one-component polyurethane (1C PUR) and a phenol resorcinol formaldehyde (PRF) adhesive. The wetting properties of the adhesives were tested in terms of surface tension, polar and dispersive part and contact angle on European beech wood ( Fagus sylvatica L.). In addition, adhesive polymer films of 2C PUR were tested for tensile strength and modulus of elasticity (E-Modulus) following ISO 527-1. The adhesives bond performance on beech wood was determined by lap-joints according to EN 302-1 in various climate conditions. The results show that 2C PUR has proper wettability properties on beech wood. Adding 60% wt filler to the polyol component increased the E-Modulus from 2.3 GPa (0%) to 4.4 GPa. The tensile strength of the modified 2C PUR polymer films was comparable with the industrial 1C PUR. Tensile shear strength and wood failure percentage of 2C PUR lap-joints were increased by adding filler and met requirements in dry and re-dried conditions according to EN 302-1. However, the addition of filler didn’t result in an improvement in wet conditions. The present study shows sufficient performance for bonding hardwood with 2C PUR in dry conditions, while the system still needs to be improvement regarding its performance in humid conditions

Social contact, social support, and cognitive health in a population-based study of middle-aged and older men and women in rural South Africa

BACKGROUND: Several theories seek to explain how social connections and cognitive function are interconnected in older age. These include that social interaction protects against cognitive decline, that cognitive decline leads to shedding of social connections and that cognitive decline leads to increased instrumental support. We investigated how patterns of social contact, social support and cognitive health in rural South Africa fit with these three theories. METHOD: We used data from the baseline of "Health and Aging in Africa: a Longitudinal Study of an INDEPTH community in South Africa" (HAALSI), a population-based study of 5059 individuals aged ≥ 40 years. We evaluated how a range of egocentric social connectedness measures varied by respondents' cognitive function. RESULTS: We found that respondents with lower cognitive function had smaller, denser social networks that were more local and more kin-based than their peers. Lower cognitive function was associated with receipt of less social support generally, but this difference was stronger for emotional and informational support than for financial and physical support. Impairment was associated with greater differences among those aged 40-59 and those with any (versus no) educational attainment. CONCLUSIONS: The patterns we found suggest that cognitively impaired older adults in this setting rely on their core social networks for support, and that theories relating to social connectedness and cognitive function developed in higher-income and higher-education settings may also apply in lower-resource settings elsewhere

Sequestered Dark Matter

We show that hidden-sector dark matter is a generic feature of the type IIB string theory landscape and that its lifetime may allow for a discovery through the observation of very energetic gamma-rays produced in the decay. Throats or, equivalently, conformally sequestered hidden sectors are common in flux compactifications and the energy deposited in these sectors can be calculated if the reheating temperature of the standard model sector is known. Assuming that throats with various warp factors are available in the compact manifold, we determine which throats maximize the late-time abundance of sequestered dark matter. For such throats, this abundance agrees with cosmological data if the standard model reheating temperature was 10^10 - 10^11 GeV. In two distinct scenarios, the mass of dark matter particles, i.e. the IR scale of the throat, is either around 10^5 GeV or around 10^10 GeV. The lifetime and the decay channels of our dark matter candidates depend crucially on the fact that the Klebanov-Strassler throat is supersymmetric. Furthermore, the details of supersymmetry breaking both in the throat and in the visible sector play an essential role. We identify a number of scenarios where this type of dark matter can be discovered via gamma-ray observations.Comment: 36 pages, 3 figures; v2: references added, v3: introduction extended and typos correcte

Effect of weighting for sampling and non-response on estimates of STI prevalence in the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

OBJECTIVES: In addition to researcher-designed sampling biases, population-representative surveys for biomarker measurement of STIs often have substantial missingness due to non-contact, non-consent and other study-implementation issues. STI prevalence estimates may be biased if this missingness is related to STI risk. We investigated how accounting for sampling, interview non-response and non-provision of biological samples affects prevalence estimates in the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). METHODS: Natsal-3 was a multistage, clustered and stratified probability sample of 16–74 year-olds conducted between 2010 and 2012. Individuals were sampled from all private residential addresses in Britain; respondents aged 16–44 were further sampled to provide a urine specimen based on characteristics including self-reported sexual behaviours. We generated prevalence estimates and confidence intervals for six STIs in five stages: first without accounting for sampling or non-response, then applying inverse-probability weights cumulatively accounting for interview sampling, interview non-response, urine sampling and urine non-response. RESULTS: Interview non-completion occurred for 42.3% of interview-sampled individuals; urine non-completion occurred for 43.5% of urine-sampled individuals. Interview-sampled individuals, interview respondents, those selected for urine samples and those providing urine samples were each in turn slightly more at-risk for most STIs, leading to lower prevalence estimates after incorporating each set of weights. Researcher-controlled sampling had more impact than respondent-controlled response. CONCLUSIONS: Accounting for both sampling structures and willingness to interview or provide urine specimens can affect national STI prevalence estimates. Using both types of weights, as was done in Natsal-3, is important in reporting on population-based biomarker surveys

Young people's experiences of sexual and reproductive health interventions in rural KwaZulu-Natal, South Africa

Despite efforts to address HIV-infection, adolescents and young peoples’ (AYP) engagement in interventions remain suboptimal. Guided by a risk protection framework we describe factors that support positive and negative experiences of HIV and SRH interventions among AYP in rural KwaZulu-Natal, South Africa, using data from: community mapping; repeat semi-structured individual interviews (n = 58 in 2017, n = 50 in 2018, n = 37 in 2019–2020); and group discussions (n = 13). AYP who had appropriate and accurate HIV-and SRH-related information were reported to use health-care services. Responsive health-care workers, good family and peer relationships were seen to be protective through building close connections and improving self-efficacy to access care. In contrast to cross-generational relationships with men, alcohol and drug use and early pregnancy were seen to put AYP at risk. Policies and interventions are needed that promote stable and supportive relationships with caregivers and peers, positive social norms and non-judgemental behaviour within clinical services

Effectiveness and resource requirements of test, trace and isolate strategies for COVID in the UK

We use an individual-level transmission and contact simulation model to explore the effectiveness and resource requirements of various test-trace-isolate (TTI) strategies for reducing the spread of SARS-CoV-2 in the UK, in the context of different scenarios with varying levels of stringency of non-pharmaceutical interventions. Based on modelling results, we show that selfisolation of symptomatic individuals and quarantine of their household contacts has a substantial impact on the number of new infections generated by each primary case. We further show that adding contact tracing of non-household contacts of confirmed cases to this broader package of interventions reduces the number of new infections otherwise generated by 5–15%. We also explore impact of key factors, such as tracing application adoption and testing delay, on overall effectiveness of TTI

A programme evaluation of \u27First Steps\u27: A peer-conceived, developed and led self-management intervention for people after a Parkinson\u27s diagnosis

\ua9 The Author(s) 2023. Objective: A diagnosis of Parkinson\u27s often leads to uncertainty about the future and loss of perceived control. Peer support may offer a means to address these concerns and promote self-management. Design: A programme evaluation of the feasibility and potential effects of ‘First Steps’, utilising a pragmatic step wedge approach. Comparing First Steps (intervention) to (control) conditions. Setting: In the community at four sites in southern England. Participants: Newly diagnosed (≤ 12months) people with Parkinson\u27s. Intervention: First Steps was a 2-day peer-conceived, developed and led intervention to support self-management. Main measures: At 0, 12 and 24 weeks anxiety and depression (Hospital, Anxiety and Depression Scale, HADS), daily functioning (World Health Organisation Disability Assessment Schedule, WHODAS), physical activity, quality of life (EQ5D), carer strain and service utilisation were assessed. Results: Between February 2018 and July 2019, 36 participants were enrolled into intervention and 21 to control conditions, all were included in statistical analysis. Lost to follow up was n = 1 (intervention) and n = 1 adverse event was reported (control, unrelated). Of the 36 allocated to the intervention n = 22 participants completed both days of First Steps during the study period. Completion of outcome measures was >95% at 24 weeks. Small effects favouring the intervention were found for HADS (odds ratio (OR) = 2.06, 95% confidence interval (CI) 0.24:17.84), Carer Strain Index (OR = 2.22, 95% CI 0.5:9.76) and vigorous (d = 0.42, 95% CI −0.12:0.97) and total physical activity (d = 0.41, 95% CI −0.13:0.95). EQ5D, WHOSDAS and service utilisation, was similar between groups. Conclusions: First Steps was feasible and safe and we found potential to benefit physical activity, mental health and carer strain. Further research with longer-term follow up is warranted

Efficient vaccination strategies for epidemic control using network information

Background: Network-based interventions against epidemic spread are most powerful when the full network structure is known. However, in practice, resource constraints require decisions to be made based on partial network information. We investigated how the accuracy of network data available at individual and village levels affected network-based vaccination effectiveness. / Methods: We simulated a Susceptible-Infected-Recovered process on static empirical social networks from 75 rural Indian villages. First, we used regression analysis to predict the percentage of individuals ever infected (cumulative incidence) based on village-level network properties for simulated datasets from 10 representative villages. Second, we simulated vaccinating 10% of each of the 75 empirical village networks at baseline, selecting vaccinees through one of five network-based approaches: random individuals (Random); random contacts of random individuals (Nomination); random high-degree individuals (High Degree); highest degree individuals (Highest Degree); or most central individuals (Central). The first three approaches require only sample data; the latter two require full network data. We also simulated imposing a limit on how many contacts an individual can nominate (Fixed Choice Design, FCD), which reduces the data collection burden but generates only partially observed networks. / Results: In regression analysis, we found mean and standard deviation of the degree distribution to strongly predict cumulative incidence. In simulations, the Nomination method reduced cumulative incidence by one-sixth compared to Random vaccination; full network methods reduced infection by two-thirds. The High Degree approach had intermediate effectiveness. Somewhat surprisingly, FCD truncating individuals’ degrees at three was as effective as using complete networks. / Conclusions: Using even partial network information to prioritize vaccines at either the village or individual level, i.e. determine the optimal order of communities or individuals within each village, substantially improved epidemic outcomes. Such approaches may be feasible and effective in outbreak settings, and full ascertainment of network structure may not be required