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Among nursing home outbreaks of coronavirus disease 2019 (COVID-19) with ≥3 breakthrough infections when the predominant severe acute respiratory coronavirus virus 2 (SARS-CoV-2) variant circulating was the SARS-CoV-2 δ (delta) variant, fully vaccinated residents were 28% less likely to be infected than were unvaccinated residents. Once infected, they had approximately half the risk for all-cause hospitalization and all-cause death compared with unvaccinated infected residents.
Young people with social disability and severe and complex mental health problems have poor outcomes, frequently struggling with treatment access and engagement. Outcomes may be improved by enhancing care and providing targeted psychological or psychosocial intervention.
Aims
We aimed to test the hypothesis that adding social recovery therapy (SRT) to enhanced standard care (ESC) would improve social recovery compared with ESC alone.
Method
A pragmatic, assessor-masked, randomised controlled trial (PRODIGY: ISRCTN47998710) was conducted in three UK centres. Participants (n = 270) were aged 16–25 years, with persistent social disability, defined as under 30 hours of structured activity per week, social impairment for at least 6 months and severe and complex mental health problems. Participants were randomised to ESC alone or SRT plus ESC. SRT was an individual psychosocial therapy delivered over 9 months. The primary outcome was time spent in structured activity 15 months post-randomisation.
Results
We randomised 132 participants to SRT plus ESC and 138 to ESC alone. Mean weekly hours in structured activity at 15 months increased by 11.1 h for SRT plus ESC (mean 22.4, s.d. = 21.4) and 16.6 h for ESC alone (mean 27.7, s.d. = 26.5). There was no significant difference between arms; treatment effect was −4.44 (95% CI −10.19 to 1.31, P = 0.13). Missingness was consistently greater in the ESC alone arm.
Conclusions
We found no evidence for the superiority of SRT as an adjunct to ESC. Participants in both arms made large, clinically significant improvements on all outcomes. When providing comprehensive evidence-based standard care, there are no additional gains by providing specialised SRT. Optimising standard care to ensure targeted delivery of existing interventions may further improve outcomes.
Soldier operational performance is determined by their fitness, nutritional status, quality of rest/recovery, and remaining injury/illness free. Understanding large fluctuations in nutritional status during operations is critical to safeguarding health and well-being. There are limited data world-wide describing the effect of extreme climate change on nutrient profiles. This study investigated the effect of hot-dry deployments on vitamin D status (assessed from 25-hydroxyvitamin D (25(OH)D) concentration) of young, male, military volunteers. Two data sets are presented (pilot study, n 37; main study, n 98), examining serum 25(OH)D concentrations before and during 6-month summer operational deployments to Afghanistan (March to October/November). Body mass, percentage of body fat, dietary intake and serum 25(OH)D concentrations were measured. In addition, parathyroid hormone (PTH), adjusted Ca and albumin concentrations were measured in the main study to better understand 25(OH)D fluctuations. Body mass and fat mass (FM) losses were greater for early (pre- to mid-) deployment compared with late (mid- to post-) deployment (P<0·05). Dietary intake was well-maintained despite high rates of energy expenditure. A pronounced increase in 25(OH)D was observed between pre- (March) and mid-deployment (June) (pilot study: 51 (sd 20) v. 212 (sd 85) nmol/l, P<0·05; main study: 55 (sd 22) v. 167 (sd 71) nmol/l, P<0·05) and remained elevated post-deployment (October/November). In contrast, PTH was highest pre-deployment, decreasing thereafter (main study: 4·45 (sd 2·20) v. 3·79 (sd 1·50) pmol/l, P<0·05). The typical seasonal cycling of vitamin D appeared exaggerated in this active male population undertaking an arduous summer deployment. Further research is warranted, where such large seasonal vitamin D fluctuations may be detrimental to bone health in the longer-term.
The large volume production of flexible electronics by solution based roll-to-roll (R2R) manufacturing technologies is a promising upscaling strategy for the organic electronics industry. Typical optoelectronic devices like organic light emitting diodes (OLEDs) consist of a complex stack of functional layers. Solution deposition of these structures eliminates the need for expensive vacuum processing. This contribution presents approaches for solution based R2R production methods of functional OLED layers on flexible polymer substrates. The development of a R2R line with two slot-die coating stations is discussed which can deposit two uniform layers consecutively in a single run (“tandem coating”) at web speeds up to 30 m/min. Furthermore, it offers the unique feature that there is no contact between the rollers and the top side of the substrate where the functional coating is deposited. Thereby, an important source of particle contamination and other damage to the device is eliminated. In addition to continuous deposition, stripe and intermittent coating techniques have been developed, allowing the production of patterned layers. Finally, examples will be shown of OLEDs where two functional materials are deposited by R2R processing from solution.
The sweet potato weevil (SPW), Cylas formicarius, is a serious pest of sweet potato in Australia and Papua New Guinea. Ten strains of Metarhizium sp. isolated from Australian soil samples were evaluated for their growth characteristics and screened for virulence to adult SPW under laboratory conditions. All isolates except QD62 (48.6%) had moderate to high germination (66–97%), and all took 2 to 4 days to sporulate at 25 °C. The optimal temperature for radial growth for the majority of isolates was 30 °C, and there was a significant interaction between isolate and temperature (P< 0.05). Isolate QS155 showed the fastest radial growth at 30 °C. The internal transcribed spacer sequences showed slight variations among the isolates; however, all isolates were shown to be Metarhizium anisopliae. Isolates varied greatly in their virulence. At 10 days after inoculation (DAI) by immersion in a suspension of 1 × 107conidia/ml, 9 of the 10 isolates were virulent, causing 80–100% mortality of adult SPW. Only two isolates (QS001-6 and QS155) caused more than 50% mortality at 5 DAI. In dose-mortality bioassays, isolate QS155 had the lowest 20-day LC50 and LC90 values; however, there were no statistically significant differences in mortality among the three most promising isolates tested (QD66, QS001-6 and QS155). These results show that M. anisopliae isolate QS155 has potential as a microbial control agent for SPW, and that further evaluation under glasshouse and field conditions is warranted.
Understanding the nutritional demands on serving military personnel is critical to inform training schedules and dietary provision. Troops deployed to Afghanistan face austere living and working environments. Observations from the military and those reported in the British and US media indicated possible physical degradation of personnel deployed to Afghanistan. Therefore, the present study aimed to investigate the changes in body composition and nutritional status of military personnel deployed to Afghanistan and how these were related to physical fitness. In a cohort of British Royal Marines (n 249) deployed to Afghanistan for 6 months, body size and body composition were estimated from body mass, height, girth and skinfold measurements. Energy intake (EI) was estimated from food diaries and energy expenditure measured using the doubly labelled water method in a representative subgroup. Strength and aerobic fitness were assessed. The mean body mass of volunteers decreased over the first half of the deployment ( − 4·6 (sd 3·7) %), predominately reflecting fat loss. Body mass partially recovered (mean +2·2 (sd 2·9) %) between the mid- and post-deployment periods (P< 0·05). Daily EI (mean 10 590 (sd 3339) kJ) was significantly lower than the estimated daily energy expenditure (mean 15 167 (sd 1883) kJ) measured in a subgroup of volunteers. However, despite the body mass loss, aerobic fitness and strength were well maintained. Nutritional provision for British military personnel in Afghanistan appeared sufficient to maintain physical capability and micronutrient status, but providing appropriate nutrition in harsh operational environments must remain a priority.
Indonesia has a diverse range of cetacean species, yet there are few records of their distribution, especially from remote regions. Incidental sightings from aerial surveys were conducted in 2006 and boat-based surveys were conducted from 2006–2011 in Raja Ampat in the Bird's Head Seascape, Indonesia. This paper is the first to provide a species list and an indication of the spatial and temporal distribution of cetaceans in central and southern Raja Ampat. Seven dolphin and six whale species were documented, including Indo-Pacific humpback dolphins Sousa chinensis, Bryde's Balaenoptera edeni, sperm Physeter macrocephalus, killer Orcinus orca and pygmy killer Feresa attenuata whales. Temporal differences in sightings suggest Raja Ampat is an important area for migratory whale species and resident populations of Indo-Pacific humpback Sousa chinensis, spinner Stenella longirostris and common bottlenose Tursiops truncatus dolphins. Cetacean diversity was highest in the months of January–February, May and October–November, with most sightings recorded in Kofiau marine protected area and Dampier and Sagewin Straits. Diversity and species distribution data are critical for managing cetaceans in Indonesia. Emerging threats to cetaceans in Raja Ampat include seismic surveys for seabed oil and gas exploration, potential strikes from increasing ship traffic, entanglement in fishing nets and increasing discharge of plastic pollution from urban areas. In addition to regulations for marine protected areas, a wider conservation strategy is required to address or better manage emerging threats to Raja Ampat, and to ensure the long-term protection of resident and migratory dolphin and whale species.
The Australian Imaging, Biomarkers and Lifestyle (AIBL) Flagship Study of Ageing is a prospective study of 1,112 individuals (211 with Alzheimer's disease (AD), 133 with mild cognitive impairment (MCI), and 768 healthy controls (HCs)). Here we report diagnostic and cognitive findings at the first (18-month) follow-up of the cohort. The first aim was to compute rates of transition from HC to MCI, and MCI to AD. The second aim was to characterize the cognitive profiles of individuals who transitioned to a more severe disease stage compared with those who did not.
Methods:
Eighteen months after baseline, participants underwent comprehensive cognitive testing and diagnostic review, provided an 80 ml blood sample, and completed health and lifestyle questionnaires. A subgroup also underwent amyloid PET and MRI neuroimaging.
Results:
The diagnostic status of 89.9% of the cohorts was determined (972 were reassessed, 28 had died, and 112 did not return for reassessment). The 18-month cohort comprised 692 HCs, 82 MCI cases, 197 AD patients, and one Parkinson's disease dementia case. The transition rate from HC to MCI was 2.5%, and cognitive decline in HCs who transitioned to MCI was greatest in memory and naming domains compared to HCs who remained stable. The transition rate from MCI to AD was 30.5%.
Conclusion:
There was a high retention rate after 18 months. Rates of transition from healthy aging to MCI, and MCI to AD, were consistent with established estimates. Follow-up of this cohort over longer periods will elucidate robust predictors of future cognitive decline.
The UK Society for Academic Primary Care (SAPC) is re-examining the sustainability of careers in academic primary care (APC). The motivation for this is a number of significant changes within the context of APC since the last such investigation (SAPC, 2003). It is now timely to review the current situation.
Methods
As a first phase, semi-structured interviews were undertaken with 15 SAPC members from different disciplines and career stages.
Results
Findings show that lack of clarity about APC career pathways persist, but important factors linked with sustainability were identified at individual and organisational levels. These include being proactive, developing resilience, mentorship and a positive organisational culture with a strong shared vision about why APC is important.
Further Research
Sustainability is undermined by funding difficulties, lack of integration of members of different APC disciplines, leading to disparities in career progression and lack of clarity about what APC is. Phase 2 will comprise a UK-wide survey.
The aim of this review paper is to consider how the principles of clinical audit could be applied to the development of an audit of nutritional care in hospitals and care homes, based on criteria derived from the Essence of Care: Food and Drink. A literature review identified fifteen key papers that included guidance or standards for nutritional care in hospitals or care homes. These were used to supplement the ten factors suggested by the Essence of Care to develop a set of potential audit criteria covering all aspects of the nutritional care pathway including the identification of risk of malnutrition, implementation of nutritional care plans, referral to healthcare professionals for further nutritional assessment and nutritional support strategies. A series of audit tools have been developed, including an organisational level audit tool, a staff questionnaire, a patients' and residents' records audit tool and a patients' and residents' experiences questionnaire. Further issues to consider in designing a national nutritional audit include the potential role of direct observation of care, the use of trained auditors and the scope for including the results of pre-existing local audits. In conclusion, a national audit would need to encompass a very large number of health and care organisations of widely varying sizes and types and a diverse range of people.
The present study was undertaken to determine the influence of some major constituents of plant essential oils on the toxicity and fate of thymol, a phenolic monoterpene from garden thyme (Thymus vulgaris L.) (Lamiaceae), following topical administration to the cabbage looper, Trichoplusia ni (Hubner) (Lepidoptera: Noctuidae). Tested individually, trans-anethole (LD50 = 71.2 µg/larva) and methyl salicylate (93.6 µg/larva) were the most toxic, whereas phenylethyl propionate (555.8 µg/larva) and mineral oil (2279.3 µg/larva) were the least toxic. However, when coadministered, mineral oil was the most synergistic (synergy ratio, SR = 25). A proprietary blend of essential oils (A4 Blend) was strongly synergistic (SR = 9), as was trans-anethole (SR = 5), while the majority of the other compounds tested yielded SRs of 2–3. Based on experiments using tritiated thymol as a radiotracer, the fate of this plant toxin within 60 min of topical administration varied widely with the essential oil carrier. Some carriers facilitated rapid disappearance of thymol from the insects' integument and rapid appearance internally, whereas others prolonged the tenure of thymol on the integument and delayed entry into the insect. The highest internal levels of radioactivity were observed when phenylethyl propionate was the carrier (47% of the topical dose), the lowest when rosemary oil was the carrier (9%). The highest proportion of the dose was excreted when eugenol was the carrier (20% of the topical dose), the lowest when mineral oil was the carrier (4%). Overall, there are no apparent trends linking the fate of thymol in the different carrier oils to the synergies observed or to the relative polarities of the carriers.
This study used analytical flow cytometry (AFC) to monitor the abundance of phytoplankton, coccoliths, bacteria and viruses in a transect that crossed a high reflectance area in the western English Channel. The high reflectance area, observed by satellite, was caused by the demise of an Emiliania huxleyi bloom. Water samples were collected from depth profiles at four stations, one station outside and three stations inside the high reflectance area. Plots of transect data revealed very obvious differences between Station 1, outside, and Stations 2–4, inside the high reflectance area. Inside, concentrations of viruses were higher; E. huxleyi cells were lower; coccoliths were higher; bacteria were higher and virus:bacteria ratio was lower than at Station 1, outside the high reflectance area. This data can simply be interpreted as virus-induced lysis of E. huxleyi cells in the bloom causing large concentrations of coccoliths to detach, resulting in the high reflectance observed by satellite imagery. This interpretation was supported by the isolation of two viruses, EhV84 and EhV86, from the high reflectance area that lysed cultures of E. huxleyi host strain CCMP1516. Basic characterization revealed that they were lytic viruses approximately 170 nm–190 nm in diameter with an icosahedral symmetry. Taken together, transect and isolation data suggest that viruses were the major contributor to the demise of the E. huxleyi population in the high reflectance area. Close coupling between microalgae, bacteria and viruses contributed to a large organic carbon input. Consequent cycling influenced the succession of an E. huxleyi-dominated population to a more characteristic mixed summer phytoplankton community.