Delaying the COVID‐19 epidemic in Australia: evaluating the effectiveness of international travel bans

Objective: Following the outbreak of novel Severe Acute Respiratory Syndrome Coronavirus‐2 (SARS‐CoV‐2), and the disease named COVID‐19, in Wuhan, China in late 2019, countries have implemented different interventions such as travel bans to slow the spread of this novel virus. This brief report evaluates the effect of travel bans imposed to prevent COVID‐19 importation in the Australian context. Methods: We developed a stochastic meta‐population model to capture the global dynamics and spread of COVID‐19. By adjusting our model to capture the travel bans imposed globally and in Australia, the predicted COVID‐19 cases imported to Australia were evaluated in comparison to observed imported cases. Results: Our modelling results closely aligned with observed cases in Australia and elsewhere. We observed a 79% reduction in COVID‐19 importation and a delay of the COVID‐19 outbreak in Australia by approximately one month. Further projection of COVID‐19 to May 2020 showed spread patterns depending on the basic reproduction number. Conclusion: Imposing the travel ban was effective in delaying widespread transmission of COVID‐19. However, strengthening of the domestic control measures is needed to prevent Australia from becoming another epicentre. Implications for public health: This report has shown the importance of border closure to pandemic control

Understanding how Victoria, Australia gained control of its second COVID-19 wave

During 2020, Victoria was the Australian state hardest hit by COVID-19, but was successful in controlling its second wave through aggressive policy interventions. We calibrated a detailed compartmental model of Victoria's second wave to multiple geographically-structured epidemic time-series indicators. We achieved a good fit overall and for individual health services through a combination of time-varying processes, including case detection, population mobility, school closures, physical distancing and face covering usage. Estimates of the risk of death in those aged ≥75 and of hospitalisation were higher than international estimates, reflecting concentration of cases in high-risk settings. We estimated significant effects for each of the calibrated time-varying processes, with estimates for the individual-level effect of physical distancing of 37.4% (95%CrI 7.2-56.4%) and of face coverings of 45.9% (95%CrI 32.9-55.6%). That the multi-faceted interventions led to the dramatic reversal in the epidemic trajectory is supported by our results, with face coverings likely particularly important

Überwachung und Optimierung von Biomasse-Feuerungsanlagen mit Hilfe automatischer Bildanalyseverfahren

Die Regelung heutiger, industriell genutzter Biomasse-Feuerungsanlagen erfolgt meistens über fest eingestellte Parameter. Bei Veränderungen des Brennstoffs dienen visuelle Beobachtungen der Mitarbeiter als Basis der Neueinstellung dieser Parameter. Das Ziel der Forschung besteht in der Optimierung solcher Regelungen durch den Einsatz von Kamerasystemen in Kombination mit einer automatisierten Regelung, die auf Basis von Flammenbild-Analysen funktioniert. Ein solches System wäre auch unabhängig von der Art des Brennstoffs

Online Messung prozessrelevanter Zulaufdaten der KA Rospe zur Vorhersage des CSB mittels Methoden des Machine Learning

Die Messung des Chemischen Sauerstoffbedarfs (CSB) im Zulauf von Kläranlagen ist von zentraler Bedeutung für die Optimierung und Regelung der Abbauprozesse der Nitrifikation und Denitrifikation. Allerdings ist die Messung des CSB bislang sehr zeitaufwändig und kostenintensiv, da 24-Stunden Mischproben im Labor nasschemisch analysiert werden müssen. Online-Messtechnik in Form von spektroskopischen Messgeräten (10.000 ̶ 20.000 €) oder nass-chemischen Online-Analysatoren (> = 50.000 €) sind insbesondere für kleine und mittlere Kläranlagen aus Kostengründen keine Alternative. Eine extrem kostengünstige Alternative ist der im Folgenden beschriebene Softsensor für CSB im Kläranlagenzulauf, der auf Basis von Standardmesstechnik im Zulauf von kleinen und mittleren kommunalen Kläranlagen sowie mit zusätzlicher Online-Messtechnik für Trübung sowie Ammonium- und Nitratstickstoff (NH4-N und NO3-N) die aktuelle CSB-Konzentration bestimmt. Zur Entwicklung des Softsensors werden Regressionsmethoden aus dem Bereich des Machine Learning eingesetzt. Die Ergebnisse einer Entwicklungs- und Testphase an der Kläranlage Rospe in Gummersbach zeigen, dass die Werte des Softsensors sehr gut mit den Originaldaten übereinstimmen. Die Korrelationswerte beim Vergleich mit CSB-Messungen liegen bei der Regression mit Support Vector Regression bei 0,98 mit einem RSME von 2,45 mg/l

The risk of global epidemic replacement with drug-resistant Mycobacterium tuberculosis strains

ObjectivesMultidrug-resistant tuberculosis (MDR-TB) is a threat to tuberculosis (TB) control. To guide TB control, it is essential to understand the extent to which and the circumstances in which MDR-TB will replace drug-susceptible TB (DS-TB) as the dominant phenotype. The issue was examined by assessing evidence from genomics, pharmacokinetics, and epidemiology studies. This evidence was then synthesized into a mathematical model.MethodsThis model considers two TB strains, one with and one without an MDR phenotype. It was considered that intrinsic transmissibility may be different between the two strains, as may the control response including the detection, treatment failure, and default rates. The outcomes were explored in terms of the incidence of MDR-TB and time until MDR-TB surpasses DS-TB as the dominant strain.Results and conclusionsThe ability of MDR-TB to dominate DS-TB was highly sensitive to the relative transmissibility of the resistant strain; however, MDR-TB could dominate even when its transmissibility was modestly reduced (to between 50% and 100% as transmissible as the DS-TB strain). This model suggests that it may take decades or more for strain replacement to occur. It was also found that while the amplification of resistance is the early cause of MDR-TB, this will rapidly give way to person-to-person transmission

Sustaining effective COVID-19 control in Malaysia through large-scale vaccination

Introduction: As of 3rd June 2021, Malaysia is experiencing a resurgence of COVID-19 cases. In response, the federal government has implemented various non-pharmaceutical interventions (NPIs) under a series of Movement Control Orders and, more recently, a vaccination campaign to regain epidemic control. In this study, we assessed the potential for the vaccination campaign to control the epidemic in Malaysia and four high-burden regions of interest, under various public health response scenarios. Methods: A modified susceptible-exposed-infectious-recovered compartmental model was developed that included two sequential incubation and infectious periods, with stratification by clinical state. The model was further stratified by age and incorporated population mobility to capture NPIs and micro-distancing (behaviour changes not captured through population mobility). Emerging variants of concern (VoC) were included as an additional strain competing with the existing wild-type strain. Several scenarios that included different vaccination strategies (i.e. vaccines that reduce disease severity and/or prevent infection, vaccination coverage) and mobility restrictions were implemented. Results: The national model and the regional models all fit well to notification data but underestimated ICU occupancy and deaths in recent weeks, which may be attributable to increased severity of VoC or saturation of case detection. However, the true case detection proportion showed wide credible intervals, highlighting incomplete understanding of the true epidemic size. The scenario projections suggested that under current vaccination rates complete relaxation of all NPIs would trigger a major epidemic. The results emphasise the importance of micro-distancing, maintaining mobility restrictions during vaccination roll-out and accelerating the pace of vaccination for future control. Malaysia is particularly susceptible to a major COVID-19 resurgence resulting from its limited population immunity due to the country's historical success in maintaining control throughout much of 2020

Evaluating outcomes of therapies offered by occupational therapists in adult mental health

Background: Attitudes towards the use of outcome measures by professionals working in mental health have been shown to be variable. Occupational therapists appear to have difficulty specifying goals and measuring the outcomes of interventions. Aims: To measure the outcomes of therapies offered by occupational therapists and to assess concurrent validity of the Van du Toit Model of Creative Ability (VdT MoCA) assessment. Method: The Global Assessment of Functioning (GAF), VdT MoCA assessment and Canadian Occupational Performance Measure (COPM) were used. Changes in mean scores on the measures were assessed using appropriate tests. Correlations between measures were assessed using Spearman's non-parametric test. Results: Mean post-therapy scores were significantly higher than pre-therapy scores on all three measures. VdT MoCA assessment scores pre- and post-therapy were highly correlated with GAF scores. The COPM outcome scores were uncorrelated with VdT MoCA assessment and GAF scores. Conclusions: The results offer a promising indication that occupational therapy interventions may increase functioning and thus aid clients' recovery. The VdT MoCA assessment is promising as a measure of improvement in functioning. Further research is needed to confirm these results and to further explore issues around occupational therapists' use of outcome measures

COVID-19 collaborative modelling for policy response in the Philippines, Malaysia and Vietnam

Mathematical models that capture COVID-19 dynamics have supported public health responses and policy development since the beginning of the pandemic, yet there is limited discourse to describe features of an optimal modelling platform to support policy decisions or how modellers and policy makers have engaged with each other. Here, we outline how we used a modelling software platform to support public health decision making for the COVID-19 response in the Western Pacific Region (WPR) countries of the Philippines, Malaysia and Viet Nam. This perspective describes an approach to support evidence-based public health decisions and policy, which may help inform other responses to similar outbreak events. The platform we describe formed the basis for one of the inaugural World Health Organization (WHO) Western Pacific (WPRO) Innovation Challenge awards, and was backed by collaboration between epidemiological modellers, those providing public health advice, and policy makers

Quality of Longer Term Mental Health Facilities in Europe: Validation of the Quality Indicator for Rehabilitative Care against Service Users’ Views

BACKGROUND: The Quality Indicator for Rehabilitative Care (QuIRC) is a staff rated, international toolkit that assesses care in longer term hospital and community based mental health facilities. The QuIRC was developed from review of the international literature, an international Delphi exercise with over 400 service users, practitioners, carers and advocates from ten European countries at different stages of deinstitutionalisation, and review of the care standards in these countries. It can be completed in under an hour by the facility manager and has robust content validity, acceptability and inter-rater reliability. In this study, we investigated the internal validity of the QuIRC. Our aim was to identify the QuIRC domains of care that independently predicted better service user experiences of care. METHOD: At least 20 units providing longer term care for adults with severe mental illness were recruited in each of ten European countries. Service users completed standardised measures of their experiences of care, quality of life, autonomy and the unit's therapeutic milieu. Unit managers completed the QuIRC. Multilevel modelling allowed analysis of associations between service user ratings as dependent variables with unit QuIRC domain ratings as independent variables. RESULTS: 1750/2495 (70%) users and the managers of 213 units from across ten European countries participated. QuIRC ratings were positively associated with service users' autonomy and experiences of care. Associations between QuIRC ratings and service users' ratings of their quality of life and the unit's therapeutic milieu were explained by service user characteristics (age, diagnosis and functioning). A hypothetical 10% increase in QuIRC rating resulted in a clinically meaningful improvement in autonomy. CONCLUSIONS: Ratings of the quality of longer term mental health facilities made by service managers were positively associated with service users' autonomy and experiences of care. Interventions that improve quality of care in these settings may promote service users' autonomy

Feasibility of achieving the 2025 WHO global tuberculosis targets in South Africa, China, and India: a combined analysis of 11 mathematical models.

BACKGROUND: The post-2015 End TB Strategy proposes targets of 50% reduction in tuberculosis incidence and 75% reduction in mortality from tuberculosis by 2025. We aimed to assess whether these targets are feasible in three high-burden countries with contrasting epidemiology and previous programmatic achievements. METHODS: 11 independently developed mathematical models of tuberculosis transmission projected the epidemiological impact of currently available tuberculosis interventions for prevention, diagnosis, and treatment in China, India, and South Africa. Models were calibrated with data on tuberculosis incidence and mortality in 2012. Representatives from national tuberculosis programmes and the advocacy community provided distinct country-specific intervention scenarios, which included screening for symptoms, active case finding, and preventive therapy. FINDINGS: Aggressive scale-up of any single intervention scenario could not achieve the post-2015 End TB Strategy targets in any country. However, the models projected that, in the South Africa national tuberculosis programme scenario, a combination of continuous isoniazid preventive therapy for individuals on antiretroviral therapy, expanded facility-based screening for symptoms of tuberculosis at health centres, and improved tuberculosis care could achieve a 55% reduction in incidence (range 31-62%) and a 72% reduction in mortality (range 64-82%) compared with 2015 levels. For India, and particularly for China, full scale-up of all interventions in tuberculosis-programme performance fell short of the 2025 targets, despite preventing a cumulative 3·4 million cases. The advocacy scenarios illustrated the high impact of detecting and treating latent tuberculosis. INTERPRETATION: Major reductions in tuberculosis burden seem possible with current interventions. However, additional interventions, adapted to country-specific tuberculosis epidemiology and health systems, are needed to reach the post-2015 End TB Strategy targets at country level. FUNDING: Bill and Melinda Gates Foundation