Pandemic Continuity Planning: will coronavirus test local authority business continuity plans? A case study of a local authority in the north of England

This paper considers the potential impact of the coronavirus on a UK Local Authority’s ability to manage excess deaths, and models the potential impact of a 50% clinical attack rate and a 1% and a 2.5% death rate. The case study was undertaken in 2019 prior to the coronavirus outbreak and was originally focussed on a pandemic flu epidemic, but the findings are relevant to the potential impacts of this new virus

The Fe and Zn isotope composition of deep mantle source regions: Insights from Baffin Island picrites

Young (61 Ma) unaltered picrites from Baffin Island, northwest Canada, possess some of the highest 3He/4He (up to 50 Ra) seen on Earth, and provide a unique opportunity to study primordial mantle that has escaped subsequent chemical modification. These high-degree partial melts also record anomalously high 182W/184W ratios, but their Sr-Nd-Hf-Pb isotopic compositons (including 142Nd) are indistinguishable from those of North Atlantic mid-ocean ridge basalts. New high precision Fe and Zn stable isotope analyses of Baffin Island picrites show limited variability with δ56Fe ranging from −0.03‰ to 0.13‰ and δ66Zn varying from 0.18‰ to 0.28‰. However, a clear inflection is seen in both sets of isotope data around the composition of the parental melt (MgO = 21 wt %; δ56Fe = 0.08 ± 0.04‰; and δ66Zn = 0.24 ± 0.03‰), with two diverging trends interpreted to reflect the crystallisation of olivine and spinel in low-MgO samples and the accumulation of olivine at higher MgO. Olivine mineral separates are significantly isotopically lighter than their corresponding whole rocks (δ56Fe ≥ −0.62‰ and δ66Zn ≥ −0.22‰), with analyses of individual olivine phenocrysts having extremely variable Fe isotope compositions (δ56Fe = −0.01‰ to −0.80‰). By carrying out modelling in three-isotope space, we show that the very negative Fe isotope compositions of olivine phenocryst are the result of kinetic isotope fractionation from disequilibrium diffusional processes. An excellent correlation is observed between δ56Fe and δ66Zn, demonstrating that Zn isotopes are fractionated by the same processes as Fe in simple systems dominated by magmatic olivine. The incompatible behaviour of Cu during magmatic evolution is consistent with the sulfide-undersaturated nature of these melts. Consequently Zn behaves as a purely lithophile element, and estimates of the bulk Earth Zn isotope composition based on Baffin Island should therefore be robust. The ancient undegassed lower mantle sampled at Baffin Island possesses a δ56Fe value that is within error of previous estimates of bulk mantle δ56Fe, however, our estimate of the Baffin mantle δ66Zn (0.20 ± 0.03‰) is significantly lower than some previous estimates. Comparison of our new data with those for Archean and Proterozoic komatiites is consistent with the Fe and Zn isotope composition of the mantle remaining constant from at least 3 Ga to the present day. By focusing on large-degree partial melts (e.g. komatiites and picrites) we are potenitally biasing our record to samples that will inevitably have interacted with, entrained and melted the ambient shallow mantle during ascent. For a major element such as Fe, that will continuosly participate in melting as it rises through the mantle, the final isotopic compositon of the magama will be a weighted average of the complete melting column. Thus it is unsuprising that minimal Fe isotope variation are seen between localities. In contrast, the unique geochemical signatures (e.g. He and W) displayed by the Baffin Island picrites are inferred to solely originate from the lowermost mantle and will be continuously diluted upon magma ascent

Screening of the novel antimicrobial drug, XF-73, against 2,527 Staphylococcus species clinical isolates

XF-73 (exeporfinium chloride) is a synthetic, di-cationic porphyrin derivative with rapid, potent bactericidal properties and a low propensity for engendering bacterial resistance. It is being developed clinically for the decolonization of Staphylococcus aureus in the nasal cavity to prevent post-operative staphylococcal infections. This study reports the minimum inhibitory concentration (MIC) of XF-73 in comparison to 22 antibiotics against a panel of >2,500 clinical isolates composed of 16 different Coagulase-positive and -negative Staphylococcus species from 33 countries. XF-73 was found to be effective against all isolates tested, with MICs ranging between ≤0.12 – 4 µg/ml (MIC50 and MIC90 values of 0.5 and 1 µg/ml respectively). XF-73 was found to be equally effective against antibiotic resistant isolates as antibiotic sensitive isolates, with no impact of pre-existing antibiotic resistance mechanisms to cell wall synthesis inhibitors (β-lactams, carbapenems, glycopeptides and cephalosporins), protein synthesis inhibitors (oxazolidinones, macrolides and tetracyclines), DNA synthesis inhibitors (fluoroquinolones) and a folate synthesis inhibitor. The panel selected also included examples of multidrug-resistant S. aureus isolates and, in all cases, the XF-73 MIC ranges were found to be similar against each of these groups. This dataset expands the knowledge of the breadth of activity of this novel antibacterial against a wide range of global S. aureus isolates and supports the potential utility of XF-73 for the treatment of patients who are S. aureus nasal carriers. Similar results were also obtained for multidrug-resistant isolates of other Staphylococcus species included in the study and collectively support the continued clinical development of XF-73 as an effective anti-staphylococcal drug

Pioglitazone and cause-specific risk of mortality in patients with type 2 diabetes: extended analysis from a European multidatabase cohort study.

OBJECTIVES: Describe and compare the risk of cardiovascular and non-cardiovascular mortality in patients whose antidiabetic therapy is modified to include pioglitazone compared with an alternative antidiabetic medication at the same stage of disease progression. RESEARCH DESIGN AND METHODS: This exploratory linked database cohort analysis used pooled health and mortality data from three European countries: Finland, Sweden and the UK. Propensity score together with exact matching was used to match 31 133 patients with type 2 diabetes first prescribed pioglitazone from 2000 to 2011, to 31 133 patients never prescribed pioglitazone. Exact matching variables were treatment stage, history of diabetes, diabetes complications and cardiovascular disease, and year of cohort entry. Mean follow-up time was 2.60 (SD 2.00) and 2.69 (SD 2.31) years in the pioglitazone and non-pioglitazone-exposed groups, respectively. Crude cause-specific mortality rates were ascertained. Association with pioglitazone use was estimated using Cox proportional hazards models adjusted a priori for country, age, sex, the propensity score quintile and time-dependent variables representing use of antidiabetic drugs. Stepwise testing identified no additional confounders to include in adjusted models. RESULTS: The crude mortality rate was lower in the pioglitazone-exposed group than the non-exposed group for both cardiovascular and non-cardiovascular mortality. Adjusted HRs comparing pioglitazone to alternative antidiabetic exposure were 0.58 (95% CI 0.52 to 0.63) and 0.63 (95% CI 0.58 to 0.68) for cardiovascular and non-cardiovascular mortality, respectively. A protective effect associated with pioglitazone was also found for all specific cardiovascular causes. CONCLUSIONS: This analysis suggests that pioglitazone is associated with a decrease in both cardiovascular and non-cardiovascular mortality. Results should be interpreted with caution due to the potential for residual confounding in this exploratory analysis. Further studies, specifically designed to test the association between pioglitazone use and patient-focused outcomes, are suggested. STUDY REGISTRATION NUMBER: European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP; EUPAS3626)

Zinc isotope evidence for sulfate-rich fluid transfer across subduction zones

Subduction zones modulate the chemical evolution of the Earth?s mantle. Water and volatile elements in the slab are released as fluids into the mantle wedge and this process is widely considered to result in the oxidation of the sub-arc mantle. However, the chemical composition and speciation of these fluids, which is critical for the mobility of economically important elements, remain poorly constrained. Sulfur has the potential to act both as oxidizing agent and transport medium. Here we use zinc stable isotopes ( \ensuremathδ 66 Zn) in subducted Alpine serpentinites to decipher the chemical properties of slab- derived fluids. We show that the progressive decrease in \ensuremathδ 66Zn with metamorphic grade is correlated with a decrease in sulfur content. As existing theoretical work predicts that Zn-SO42- complexes preferentially incorporate heavy \ensuremathδ 66Zn, our results provide strong evidence for the release of oxidized, sulfate-rich, slab serpentinite-derived fluids to the mantle wedge.This work was supported by an ERC Starting Grant (HabitablePlanet; 306655) and a NERC Deep Volatiles Consortium Grant (NE/M0003/1) awarded to H.W. H.W. and P.B. also acknowledge salary support from a NERC Advanced Fellowship (NE/F014295/2) and ERC Starting Grant (279828, MASE), respectivel

Using online patient feedback to improve NHS services : the INQUIRE multimethod study

Background Online customer feedback has become routine in many industries, but it has yet to be harnessed for service improvement in health care. Objectives To identify the current evidence on online patient feedback; to identify public and health professional attitudes and behaviour in relation to online patient feedback; to explore the experiences of patients in providing online feedback to the NHS; and to examine the practices and processes of online patient feedback within NHS trusts. Design A multimethod programme of five studies: (1) evidence synthesis and stakeholder consultation; (2) questionnaire survey of the public; (3) qualitative study of patients’ and carers’ experiences of creating and using online comment; (4) questionnaire surveys and a focus group of health-care professionals; and (5) ethnographic organisational case studies with four NHS secondary care provider organisations. Setting The UK. Methods We searched bibliographic databases and conducted hand-searches to January 2018. Synthesis was guided by themes arising from consultation with 15 stakeholders. We conducted a face-to-face survey of a representative sample of the UK population (n = 2036) and 37 purposively sampled qualitative semistructured interviews with people with experience of online feedback. We conducted online surveys of 1001 quota-sampled doctors and 749 nurses or midwives, and a focus group with five allied health professionals. We conducted ethnographic case studies at four NHS trusts, with a researcher spending 6–10 weeks at each site. Results Many people (42% of internet users in the general population) read online feedback from other patients. Fewer people (8%) write online feedback, but when they do one of their main reasons is to give praise. Most online feedback is positive in its tone and people describe caring about the NHS and wanting to help it (‘caring for care’). They also want their feedback to elicit a response as part of a conversation. Many professionals, especially doctors, are cautious about online feedback, believing it to be mainly critical and unrepresentative, and rarely encourage it. From a NHS trust perspective, online patient feedback is creating new forms of response-ability (organisations needing the infrastructure to address multiple channels and increasing amounts of online feedback) and responsivity (ensuring responses are swift and publicly visible). Limitations This work provides only a cross-sectional snapshot of a fast-emerging phenomenon. Questionnaire surveys can be limited by response bias. The quota sample of doctors and volunteer sample of nurses may not be representative. The ethnographic work was limited in its interrogation of differences between sites. Conclusions Providing and using online feedback are becoming more common for patients who are often motivated to give praise and to help the NHS improve, but health organisations and professionals are cautious and not fully prepared to use online feedback for service improvement. We identified several disconnections between patient motivations and staff and organisational perspectives, which will need to be resolved if NHS services are to engage with this source of constructive criticism and commentary from patient

The behavior of iron and zinc stable isotopes accompanying the subduction of mafic oceanic crust: A case study from Western Alpine ophiolites

Arc lavas display elevated Fe3+/ΣFe ratios relative to MORB. One mechanism to explain this is the mobilization and transfer of oxidized or oxidizing components from the subducting slab to the mantle wedge. Here we use iron and zinc isotopes, which are fractionated upon complexation by sulfide, chloride, and carbonate ligands, to remark on the chemistry and oxidation state of fluids released during prograde metamorphism of subducted oceanic crust. We present data for metagabbros and metabasalts from the Chenaillet massif, Queyras complex, and the Zermatt-Saas ophiolite (Western European Alps), which have been metamorphosed at typical subduction zone P-T conditions and preserve their prograde metamorphic history. There is no systematic, detectable fractionation of either Fe or Zn isotopes across metamorphic facies, rather the isotope composition of the eclogites overlaps with published data for MORB. The lack of resolvable Fe isotope fractionation with increasing prograde metamorphism likely reflects the mass balance of the system, and in this scenario Fe mobility is not traceable with Fe isotopes. Given that Zn isotopes are fractionated by S-bearing and C-bearing fluids, this suggests that relatively small amounts of Zn are mobilized from the mafic lithologies in within these types of dehydration fluids. Conversely, metagabbros from the Queyras that are in proximity to metasediments display a significant Fe isotope fractionation. The covariation of δ56Fe of these samples with selected fluid mobile elements suggests the infiltration of sediment derived fluids with an isotopically light signature during subduction

Iron and zinc stable isotope evidence for open-system high-pressure dehydration of antigorite serpentinite in subduction zones

Subducted serpentinites have the potential to control the exchange of volatile and redox sensitive elements (e.g., Fe, S, C, N) between the slab, the mantle wedge and the deep mantle. Here we examine the mobility of iron and zinc in serpentinite-derived fluids by using their stable isotopes (δ56Fe and δ66Zn) in high-pressure subducted meta-serpentinites from the Cerro del Almirez massif (Spain). This massif preserves a metamorphic front between antigorite (Atg-serpentinite) and antigorite-olivine-orthopyroxene (transitional lithologies) -bearing serpentinites, and chlorite-bearing harzburgite (Chl-harzburgite), displaying granofels, spinifex and fine-grained recrystallized textures. Those rocks were formed at eclogite facies conditions (1.6�1.9 GPa and 680�710 °C). The mean δ56Fe of all the Cerro del Almirez meta- serpentinites (+0.05 ± 0.01 �) is identical within an error to that of primitive mantle (+0.03 ± 0.03 �). A positive correlation between δ56Fe and indices of peridotite protolith fertility (e.g., Al2O3/SiO2) suggests that the δ56Fe values of Cerro del Almirez samples predominantly reflect protolith compositional variations, likely produced by prior episodes of melt extraction. In contrast, the Zn concentrations (Zn = 34�67 ppm) and isotope signatures (δ66Zn = +0.18 � +0.55 �) of the Cerro del Almirez samples show a broad range of values, distinct to those of the primitive mantle (Zn = 54 ppm; δ66Zn = +0.16 ± 0.06 �). The Atg- serpentinites (Zn = 34�46 ppm; δ66Zn = +0.23 ± 0.06 �) display similar Zn and δ66Zn values to those of slab serpentinites from other high-pressure meta-ophiolites. Both Zn and δ66Zn increase in transitional lithologies (Zn = 45�67 ppm; δ66Zn = +0.30 ± 0.06 �) and Chl-harzburgites with granofels (Zn = 38� 59 ppm; δ66Zn = +0.33 ± 0.04 �) or spinifex (Zn = 48�66 ppm; δ66Zn = +0.43 ± 0.09 �) textures. Importantly, Cerro del Almirez transitional lithologies and Chl-harzburgites display abnormally high Zn relative to abyssal peridotites and serpentinites (29�45 ppm) and a positive correlation exists between Zn and δ66Zn. This correlation is interpreted to reflect the mobilization of Zn by subduction zone fluids at high pressures and temperatures coupled with significant Zn stable isotope fractionation. An increase in Zn and δ66Zn from Atg-serpentinite to Chl-harzburgite is associated with an increase in U/Yb, Sr/Y, Ba/Ce and Rb/Ce, suggesting that both Zn and δ66Zn record the interaction of the transitional lithologies and the Chl- harzburgites with fluids that had equilibrated with metasedimentary rocks. Quantitative models show that metasediment derived fluids can have isotopically heavy Zn as a consequence of sediment carbonate dissolution and subsequent Zn complexation with carbonate species in the released fluids (e.g., ZnHCO3(H2O)5+ or ZnCO3(H2O)3). Our models further demonstrate that Zn complexation with reduced carbon species cannot produce fluids with heavy δ66Zn signature and hence explain the δ66Zn variations observed in the Chl-harzburgites. The most straightforward explanation for the heavy δ66Zn of the Cerro del Almirez samples is thus serpentinite dehydration accompanied by the open system infiltration of the massif by oxidized, carbonate-rich sediment-derived fluids released during prograde subduction-related metamorphism

Pioglitazone use and risk of bladder cancer in patients with type 2 diabetes: retrospective cohort study using datasets from four European countries.

OBJECTIVE:  To evaluate the association between pioglitazone use and bladder cancer risk in patients with type 2 diabetes. DESIGN:  Retrospective cohort study using propensity score matched cohorts. SETTINGS:  Healthcare databases from Finland, the Netherlands, Sweden, and the United Kingdom. Data comprised country specific datasets of linked records on prescriptions, hospitals, general practitioners, cancer, and deaths. PARTICIPANTS:  Patients with type 2 diabetes who initiated pioglitazone (n=56 337) matched with patients with type 2 diabetes in the same country exposed to diabetes drug treatments other than pioglitazone (n=317 109). Two matched cohorts were created, using a 1:1 fixed ratio (nearest match cohort) and a 1:10 variable ratio (multiple match cohort). Patients were matched on treatment history and propensity scores accounting for several variables associated with pioglitazone initiation. MAIN OUTCOME MEASURES:  Hazard ratios and 95% confidence intervals were estimated by Cox's proportional hazards model with adjustments for relevant confounders. To assess the robustness of the findings, several sensitivity and stratified analyses were performed. RESULTS:  In the cohort exposed to pioglitazone treatment, 130 bladder cancers occurred over a mean follow-up time of 2.9 years. In the nearest match and multiple match cohorts not exposed to pioglitazone treatment, 153 and 970 bladder cancers were recorded, with a mean follow‑up time of 2.8 and 2.9 years, respectively. With regards to bladder cancer risk, the adjusted hazard ratio for patients ever exposed versus never exposed to pioglitazone was 0.99 (95% confidence interval 0.75 to 1.30) and 1.00 (0.83 to 1.21) in the nearest and multiple match cohorts, respectively. Increasing duration of pioglitazone use and increasing cumulative dose were not associated with risk of bladder cancer (>48 months of pioglitazone use, adjusted hazard ratio 0.86 (0.44 to 1.66); >40 000 mg cumulative dose, 0.65 (0.33 to 1.26) in the nearest match cohort). CONCLUSIONS:  This study shows no evidence of an association between ever use of pioglitzone and risk of bladder cancer compared with never use, which is consistent with results from other recent studies that also included a long follow-up period. TRIAL REGISTRATION:  Registered to the European Union electronic register of post-authorisation studies (EU PAS register no EUPAS3626)