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Which ethical values underpin England's National Health Service reset of paediatric and maternity services following COVID-19: a rapid review.

BMJ Open 2021 06 8;11(6):e049214. Epub 2021 Jun 8.

Law and Philosophy, Faculty of Humanities and Social Sciences, University of Liverpool, Liverpool, UK.

Objective: To identify ethical values guiding decision making in resetting non-COVID-19 paediatric surgery and maternity services in the National Health Service (NHS).

Design: A rapid review of academic and grey literature sources from 29 April to 31 December 2020, covering non-urgent, non-COVID-19 healthcare. Sources were thematically synthesised against an adapted version of the UK Government's Pandemic Flu Ethical Framework to identify underpinning ethical principles. Read More

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Common variants in Alzheimer's disease and risk stratification by polygenic risk scores.

Nat Commun 2021 06 7;12(1):3417. Epub 2021 Jun 7.

Servei de Neurologia, Hospital Universitari i Politècnic La Fe, Valencia, Spain.

Genetic discoveries of Alzheimer's disease are the drivers of our understanding, and together with polygenetic risk stratification can contribute towards planning of feasible and efficient preventive and curative clinical trials. We first perform a large genetic association study by merging all available case-control datasets and by-proxy study results (discovery n = 409,435 and validation size n = 58,190). Here, we add six variants associated with Alzheimer's disease risk (near APP, CHRNE, PRKD3/NDUFAF7, PLCG2 and two exonic variants in the SHARPIN gene). Read More

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Exploring patient experiences of cancer care in Northern Ireland: A thematic analysis of free-text responses to the 2018 Northern Ireland Patient Experience Survey (NICPES).

BMC Health Serv Res 2021 Jun 7;21(1):564. Epub 2021 Jun 7.

School of Nursing & Midwifery, Queen's University Belfast, Northern Ireland, Belfast, United Kingdom.

Background: Cancer diagnosis, treatment and survivorship is multifaceted, and the cancer patient experience can serve as a key indicator of healthcare performance and quality. The purpose of this paper was to analyse free-text responses from the second Northern Ireland Cancer Patient Experience Survey (NICPES) in 2018, to understand experiences of care, emerging themes and identify areas for improvement.

Methods: A 72-item questionnaire (relating to clinical care experience, socio-demographics and 3 free-text questions) was distributed to all Health & Social Care Northern Ireland patients that met the inclusion criteria (≥ 16 years old; confirmed primary diagnosis of cancer and discharged between 1st May and 31st October 2017) in June 2018. Read More

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How medical students' early workplace experience could benefit the NHS.

BMC Med Educ 2021 Jun 7;21(1):329. Epub 2021 Jun 7.

St George's University of London, Cranmer Terrace, Tooting, London, SW17 0RE, UK.

As senior medical students who have had the privilege of undergoing early year clinical workplace experience, we believe that this opportunity medical students have through experiencing the 'frontline' could be utilised advantageously by the National Health Service (NHS). A system under pressure with depleting resources seemingly persists to be a constant theme that surrounds the NHS. Due to such issues, improvements in all sectors are sought, including costs, patient experience and communication between healthcare professionals. Read More

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Perceptions of Saudi medical students regarding self-directed learning: A qualitative study.

J Pak Med Assoc 2021 May;71(5):1403-1408

Department of Surgery, Dow University of Health Sciences, Karachi, Pakistan.

Objective: To explore students' perceptions regarding self-directed learning, their experience of it, and how it may play a role in life-long learning.

Methods: The exploratory study was conducted at the Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia, in January and February 2018, and comprised male undergraduate medical students from academic years 2-6. Data was collected through focus group discussions regarding the students' perception of self-directed learning. Read More

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Telemedicine remote controlled stroke evaluation and treatment, the experience of radiographers, paramedics and junior doctors in a novel rural stroke management team.

BMC Health Serv Res 2021 Jun 5;21(1):554. Epub 2021 Jun 5.

Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway, University of South-Eastern Norway, Post office box 235, 3603, Kongsberg, Norway.

Background: In the case of ischemic stroke, access to a Computed Tomography (CT) scanner and the start of thrombolytic therapy immediately is imperative. Transport to the nearest hospital from the remote, rural area of Hallingdal in Norway entails a 2-3 h drive. The local medical centre in this area has a CT-scanner operated by radiographers during office hours. Read More

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Accessibility and Universal Design: Do They Provide Economic Benefits?

Stud Health Technol Inform 2021 Jun;282:3-12

Department of Economics and Management, Università degli Studi di Brescia (Italy).

Certainly, the issue of accessibility has, in addition to a well-known social value, obvious economic repercussions. However, these are not easily measurable, as they can be investigated only on the basis of indicators that are mainly qualitative and indirect. That said, this paper will highlight some aspects that can be considered a first approach, identifying the variables and key players in the economic field. Read More

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Experiences of community-dwelling older people with dementia participating in a person-centred multidimensional interdisciplinary rehabilitation program.

BMC Geriatr 2021 06 2;21(1):341. Epub 2021 Jun 2.

Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE-90187, Umeå, Sweden.

Background: There is great need for development of feasible rehabilitation for older people with dementia. Increased understanding of this population's experiences of rehabilitation participation is therefore important. The aim of this study was to explore the experiences of community-dwelling older people with dementia participating in a person-centred multidimensional interdisciplinary rehabilitation program. Read More

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Validity of Hip and Ankle Worn Actigraph Accelerometers for Measuring Steps as a Function of Gait Speed during Steady State Walking and Continuous Turning.

Sensors (Basel) 2021 May 1;21(9). Epub 2021 May 1.

Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 141 83 Stockholm, Sweden.

This study aimed to investigate the accuracy and reliability of hip and ankle worn Actigraph GT3X+ (AG) accelerometers to measure steps as a function of gait speed. Additionally, the effect of the low frequency extension filter (LFEF) on the step accuracy was determined. Thirty healthy individuals walked straight and walked with continuous turns in different gait speeds. Read More

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Training needs assessment: tool utilization and global impact.

BMC Med Educ 2021 May 31;21(1):310. Epub 2021 May 31.

PAHO/WHO Collaborating Center for International Nursing, Birmingham, AL, USA.

Background: Global demand for standardized assessment of training needs and evaluation of professional continuing education programs across the healthcare workforce has led to various instrumentation efforts. The Hennessy-Hicks Training Needs Analysis (TNA) questionnaire is one of the most widely used validated tools. Endorsed by the World Health Organization, the tool informs the creation of tailored training to meet professional development needs. Read More

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Real-time monitoring of COVID-19 dynamics using automated trend fitting and anomaly detection.

Philos Trans R Soc Lond B Biol Sci 2021 07 31;376(1829):20200266. Epub 2021 May 31.

Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.

As several countries gradually release social distancing measures, rapid detection of new localized COVID-19 hotspots and subsequent intervention will be key to avoiding large-scale resurgence of transmission. We introduce ASMODEE (automatic selection of models and outlier detection for epidemics), a new tool for detecting sudden changes in COVID-19 incidence. Our approach relies on automatically selecting the best (fitting or predicting) model from a range of user-defined time series models, excluding the most recent data points, to characterize the main trend in an incidence. Read More

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Shut and re-open: the role of schools in the spread of COVID-19 in Europe.

Philos Trans R Soc Lond B Biol Sci 2021 07 31;376(1829):20200277. Epub 2021 May 31.

Emergency Response Department, Public Health England, London, UK.

We investigate the effect of school closure and subsequent reopening on the transmission of COVID-19, by considering Denmark, Norway, Sweden and German states as case studies. By comparing the growth rates in daily hospitalizations or confirmed cases under different interventions, we provide evidence that school closures contribute to a reduction in the growth rate approximately 7 days after implementation. Limited school attendance, such as older students sitting exams or the partial return of younger year groups, does not appear to significantly affect community transmission. Read More

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Novel coronavirus 2019-nCoV (COVID-19): early estimation of epidemiological parameters and epidemic size estimates.

Philos Trans R Soc Lond B Biol Sci 2021 07 31;376(1829):20200265. Epub 2021 May 31.

Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Lancaster LA1 4AT, UK.

Since it was first identified, the epidemic scale of the recently emerged novel coronavirus (2019-nCoV) in Wuhan, China, has increased rapidly, with cases arising across China and other countries and regions. Using a transmission model, we estimate a basic reproductive number of 3.11 (95% CI, 2. Read More

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Mapping social distancing measures to the reproduction number for COVID-19.

Philos Trans R Soc Lond B Biol Sci 2021 07 31;376(1829):20200276. Epub 2021 May 31.

NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BY, UK.

In the absence of a vaccine, severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) transmission has been controlled by preventing person-to-person interactions via social distancing measures. In order to re-open parts of society, policy-makers need to consider how combinations of measures will affect transmission and understand the trade-offs between them. We use age-specific social contact data, together with epidemiological data, to quantify the components of the COVID-19 reproduction number. Read More

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Challenges in control of COVID-19: short doubling time and long delay to effect of interventions.

Philos Trans R Soc Lond B Biol Sci 2021 07 31;376(1829):20200264. Epub 2021 May 31.

Department of Mathematics, The University of Manchester, Manchester, UK.

Early assessments of the growth rate of COVID-19 were subject to significant uncertainty, as expected with limited data and difficulties in case ascertainment, but as cases were recorded in multiple countries, more robust inferences could be made. Using multiple countries, data streams and methods, we estimated that, when unconstrained, European COVID-19 confirmed cases doubled on average every 3 days (range 2.2-4. Read More

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Segmentation and shielding of the most vulnerable members of the population as elements of an exit strategy from COVID-19 lockdown.

Philos Trans R Soc Lond B Biol Sci 2021 07 31;376(1829):20200275. Epub 2021 May 31.

Usher Institute, University of Edinburgh, Edinburgh, UK.

This study demonstrates that an adoption of a segmenting and shielding strategy could increase the scope to partially exit COVID-19 lockdown while limiting the risk of an overwhelming second wave of infection. We illustrate this using a mathematical model that segments the vulnerable population and their closest contacts, the 'shielders'. Effects of extending the duration of lockdown and faster or slower transition to post-lockdown conditions and, most importantly, the trade-off between increased protection of the vulnerable segment and fewer restrictions on the general population are explored. Read More

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Epidemic interventions: insights from classic results.

Philos Trans R Soc Lond B Biol Sci 2021 07 31;376(1829):20200263. Epub 2021 May 31.

Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford OX3 7LF, UK.

Analytical expressions and approximations from simple models have performed a pivotal role in our understanding of infectious disease epidemiology. During the current COVID-19 pandemic, while there has been proliferation of increasingly complex models, still the most basic models have provided the core framework for our thinking and interpreting policy decisions. Here, classic results are presented that give insights into both the role of transmission-reducing interventions (such as social distancing) in controlling an emerging epidemic, and also what would happen if insufficient control is applied. Read More

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Dynamics of SARS-CoV-2 with waning immunity in the UK population.

Philos Trans R Soc Lond B Biol Sci 2021 07 31;376(1829):20200274. Epub 2021 May 31.

Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford OX3 7LF, UK.

The dynamics of immunity are crucial to understanding the long-term patterns of the SARS-CoV-2 pandemic. Several cases of reinfection with SARS-CoV-2 have been documented 48-142 days after the initial infection and immunity to seasonal circulating coronaviruses is estimated to be shorter than 1 year. Using an age-structured, deterministic model, we explore potential immunity dynamics using contact data from the UK population. Read More

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The population attributable fraction of cases due to gatherings and groups with relevance to COVID-19 mitigation strategies.

Philos Trans R Soc Lond B Biol Sci 2021 07 31;376(1829):20200273. Epub 2021 May 31.

Department of Engineering Mathematics, University of Bristol, Bristol BS8 1UB, UK.

Many countries have banned groups and gatherings as part of their response to the pandemic caused by the coronavirus, SARS-CoV-2. Although there are outbreak reports involving mass gatherings, the contribution to overall transmission is unknown. We used data from a survey of social contact behaviour that specifically asked about contact with groups to estimate the population attributable fraction (PAF) due to groups as the relative change in the basic reproduction number when groups are prevented. Read More

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Household bubbles and COVID-19 transmission: insights from percolation theory.

Philos Trans R Soc Lond B Biol Sci 2021 07 31;376(1829):20200284. Epub 2021 May 31.

University of Bristol School of Veterinary Sciences, Langford BS40 5DU, UK.

In the era of social distancing to curb the spread of COVID-19, bubbling is the combining of two or more households to create an exclusive larger group. The impact of bubbling on COVID-19 transmission is challenging to quantify because of the complex social structures involved. We developed a network description of households in the UK, using the configuration model to link households. Read More

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A spatial model of COVID-19 transmission in England and Wales: early spread, peak timing and the impact of seasonality.

Philos Trans R Soc Lond B Biol Sci 2021 07 31;376(1829):20200272. Epub 2021 May 31.

Mathematics Institute, and School of Life Sciences, University of Warwick, Coventry CV4 7AL, UK.

An outbreak of a novel coronavirus was first reported in China on 31 December 2019. As of 9 February 2020, cases have been reported in 25 countries, including probable human-to-human transmission in England. We adapted an existing national-scale metapopulation model to capture the spread of COVID-19 in England and Wales. Read More

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Exploring surveillance data biases when estimating the reproduction number: with insights into subpopulation transmission of COVID-19 in England.

Philos Trans R Soc Lond B Biol Sci 2021 07 31;376(1829):20200283. Epub 2021 May 31.

Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.

The time-varying reproduction number (: the average number of secondary infections caused by each infected person) may be used to assess changes in transmission potential during an epidemic. While new infections are not usually observed directly, they can be estimated from data. However, data may be delayed and potentially biased. Read More

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The impact of school reopening on the spread of COVID-19 in England.

Philos Trans R Soc Lond B Biol Sci 2021 07 31;376(1829):20200261. Epub 2021 May 31.

The Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics InstituteUniversity of Warwick, Coventry CV4 7AL, UK.

By mid-May 2020, cases of COVID-19 in the UK had been declining for over a month; a multi-phase emergence from lockdown was planned, including a scheduled partial reopening of schools on 1 June 2020. Although evidence suggests that children generally display mild symptoms, the size of the school-age population means the total impact of reopening schools is unclear. Here, we present work from mid-May 2020 that focused on the imminent opening of schools and consider what these results imply for future policy. Read More

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Optimizing time-limited non-pharmaceutical interventions for COVID-19 outbreak control.

Philos Trans R Soc Lond B Biol Sci 2021 07 31;376(1829):20200282. Epub 2021 May 31.

Usher Institute, University of Edinburgh, Edinburgh, UK.

Retrospective analyses of the non-pharmaceutical interventions (NPIs) used to combat the ongoing COVID-19 outbreak have highlighted the potential of optimizing interventions. These optimal interventions allow policymakers to manage NPIs to minimize the epidemiological and human health impacts of both COVID-19 and the intervention itself. Here, we use a susceptible-infectious-recovered (SIR) mathematical model to explore the feasibility of optimizing the duration, magnitude and trigger point of five different NPI scenarios to minimize the peak prevalence or the attack rate of a simulated UK COVID-19 outbreak. Read More

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Engagement and adherence trade-offs for SARS-CoV-2 contact tracing.

Philos Trans R Soc Lond B Biol Sci 2021 07 31;376(1829):20200270. Epub 2021 May 31.

Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK.

Contact tracing is an important tool for allowing countries to ease lockdown policies introduced to combat SARS-CoV-2. For contact tracing to be effective, those with symptoms must self-report themselves while their contacts must self-isolate when asked. However, policies such as legal enforcement of self-isolation can create trade-offs by dissuading individuals from self-reporting. Read More

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Outbreaks in care homes may lead to substantial disease burden if not mitigated.

Philos Trans R Soc Lond B Biol Sci 2021 07 31;376(1829):20200269. Epub 2021 May 31.

Public Health England, Emergency Response, London, UK.

The number of COVID-19 outbreaks reported in UK care homes rose rapidly in early March of 2020. Owing to the increased co-morbidities and therefore worse COVID-19 outcomes for care home residents, it is important that we understand this increase and its future implications. We demonstrate the use of an SIS model where each nursing home is an infective unit capable of either being susceptible to an outbreak (S) or in an active outbreak (I). Read More

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The impact of testing and infection prevention and control strategies on within-hospital transmission dynamics of COVID-19 in English hospitals.

Philos Trans R Soc Lond B Biol Sci 2021 07 31;376(1829):20200268. Epub 2021 May 31.

Modelling and Economics Unit, National Infection Service, Public Health England, London, UK.

Nosocomial transmission of SARS-CoV-2 is a key concern, and evaluating the effect of testing and infection prevention and control strategies is essential for guiding policy in this area. Using a within-hospital SEIR transition model of SARS-CoV-2 in a typical English hospital, we estimate that between 9 March 2020 and 17 July 2020 approximately 20% of infections in inpatients, and 73% of infections in healthcare workers (HCWs) were due to nosocomial transmission. Model results suggest that placing suspected COVID-19 patients in single rooms or bays has the potential to reduce hospital-acquired infections in patients by up to 35%. Read More

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Real-time nowcasting and forecasting of COVID-19 dynamics in England: the first wave.

Philos Trans R Soc Lond B Biol Sci 2021 07 31;376(1829):20200279. Epub 2021 May 31.

Public Health England, National Infection Service, 61 Colindale Avenue, London NW9 5HT, UK.

England has been heavily affected by the SARS-CoV-2 pandemic, with severe 'lockdown' mitigation measures now gradually being lifted. The real-time pandemic monitoring presented here has contributed to the evidence informing this pandemic management throughout the first wave. Estimates on the 10 May showed lockdown had reduced transmission by 75%, the reproduction number falling from 2. Read More

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Using a household-structured branching process to analyse contact tracing in the SARS-CoV-2 pandemic.

Philos Trans R Soc Lond B Biol Sci 2021 07 31;376(1829):20200267. Epub 2021 May 31.

Department of Mathematics, University of Manchester, Manchester M13 9PY, UK.

We explore strategies of contact tracing, case isolation and quarantine of exposed contacts to control the SARS-CoV-2 epidemic using a branching process model with household structure. This structure reflects higher transmission risks among household members than among non-household members. We explore strategic implementation choices that make use of household structure, and investigate strategies including two-step tracing, backwards tracing, smartphone tracing and tracing upon symptom report rather than test results. Read More

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Modelling that shaped the early COVID-19 pandemic response in the UK.

Philos Trans R Soc Lond B Biol Sci 2021 07 31;376(1829):20210001. Epub 2021 May 31.

Department of Mathematics, University of Manchester, Manchester M13 9PL, UK.

Infectious disease modelling has played an integral part of the scientific evidence used to guide the response to the COVID-19 pandemic. In the UK, modelling evidence used for policy is reported to the Scientific Advisory Group for Emergencies (SAGE) modelling subgroup, SPI-M-O (Scientific Pandemic Influenza Group on Modelling-Operational). This Special Issue contains 20 articles detailing evidence that underpinned advice to the UK government during the SARS-CoV-2 pandemic in the UK between January 2020 and July 2020. Read More

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