Outbreak of SARS-CoV-2 in a teenage discotheque in Northern Ireland-November 2021.

OBJECTIVES: To report key findings associated with an outbreak of SARS-CoV-2 following a teenage disco in Northern Ireland. STUDY DESIGN: Observational case series. METHODS: A case was defined as an individual who attended the event with a positive SARS-CoV-2 result between 6th and 20th November 2021. Demographic and clinical information, including symptom status, date of onset and school attended, were recorded during contact tracing. Vaccination status was derived from the COVID-19 Vaccine Management System. Forty-five samples associated with the outbreak were sequenced as part of the NI Whole Genome Sequencing (WGS) programme. RESULTS: Only 2.4% (5/205) of cases received a COVID-19 vaccine more than 14 days before the event. 84.9% (174/205) had received no vaccine at the time of the event and 12.7% (26/205) had been vaccinated within 14 days, offering only limited disease protection. The AY4.2.2 lineage of two cases who attended the event after symptom onset was found in 69% of sequenced outbreak cases. CONCLUSIONS: This study demonstrates extensive COVID-19 transmission in largely unvaccinated teenagers in an indoor venue with limited social distancing, close social contact and mixing, limited ventilation and singing and shouting. Public Health authorities developing COVID-19 entertainment regulations should consider congregations of teenagers in these settings, especially if vaccination rates are low in this group or they are not eligible for vaccination at that time. Public communications should be developed to ensure young people with COVID-19 symptoms follow public guidance regarding self-isolation and in particular avoid indoor events with larger numbers.

Knowledge may not be the best target for strategies to influence evidence-based practice: using psychological models to understand RCT effects.

BACKGROUND: Interventions to enhance the implementation of evidence-based practice have a varied success rate. This may be due to a lack of understanding of the mechanism by which interventions achieve results. PURPOSE: Use psychological models to further an understanding of trial effects by piggy-backing on a randomised controlled trial testing 2 interventions (Audit & Feedback and Computer-aided Learning) in relation to evidence-based third molar management. METHOD: All participants of the parent trial (64 General Dental Practitioners across Scotland), regardless of intervention group, were invited to complete a questionnaire assessing knowledge and predictive measures from Theory of Planned Behaviour and Social Cognitive Theory. The main outcome was evidence-based extracting behaviour derived from patient records. RESULTS: Neither intervention significantly influenced behaviour in the parent trial. This study revealed that the interventions did enhance knowledge, but knowledge did not predict extraction behaviour. However, the interventions did not influence variables that did predict extraction behaviour (attitude, perceived behavioural control, self-efficacy). Results suggest both interventions failed because neither influenced possible mediating beliefs for the target behavior. CONCLUSION: Using psychology models elucidated intervention effects and allowed the identification of factors associated with evidence based practice, providing the basis for improving future intervention design.

Changing clinicians' behavior: a randomized controlled trial of fees and education.

The fissure-sealing of newly erupted molars is an effective caries prevention treatment, but remains underutilized. Two plausible reasons are the financial disincentive produced by the dental remuneration system, and dentists' lack of awareness of evidence-based practice. The primary hypothesis was that implementation strategies based on remuneration or training in evidence-based healthcare would produce a higher proportion of children receiving sealed second permanent molars than standard care. The four study arms were: fee per sealant treatment, education in evidence-based practice, fee plus education, and control. A cost-effectiveness analysis was conducted. Analysis was based on 133 dentists and 2833 children. After adjustment for baseline differences, the primary outcome was 9.8% higher when a fee was offered. The education intervention had no statistically significant effect. 'Fee only' was the most cost-effective intervention. The study contributes to the incentives in health care provision debate, and led to the introduction of a direct fee for this treatment.

Measuring access to health services: General Dental Services in Scotland.

OBJECTIVE: Recently the issue of access to health services has been brought into sharp focus by clear evidence of rationing--patients queuing for NHS registration--in the NHS General Dental Services (GDS). Conventional estimates suggest that about 50% of adults are registered per annum. This paper demonstrates that these conventional measures of access and utilisation can generate potentially misleading inferences. DESIGN: By analysing individual-level claims data from over 35,000 patients over six years we are able to: identify the underlying patterns of utilisation that generate the aggregate 50% registration rate; provide more detailed estimates of utilisation and access; and suggest possible determinants of the patterns of utilisation we observe. SETTING: Primary care health services. RESULTS: In contrast to conventional estimates of access we find that close to 80% of the adult population in Scotland has had access to GDS over a six year period. Moreover, we find that the population is comprised of a relatively large group of patients (30% of the population) who access GDS at least once a year and a substantial group (19% of the adult population) who access services only once in six years. The groups who access services at intermediate frequencies are less numerous. CONCLUSIONS: Assessing the effectiveness of the public provision of health care services requires accurate information regarding access to those services. This paper sets out a framework for analysing and interpreting longitudinal data to provide information on the extent of access to health care services.

Communication, information and well-being for Australians with physical disabilities.

PURPOSE: This paper is a literature review, the purpose of which was to examine the legislative framework and the Australian Government Information Policy and how this has impacted on virtual communication and the well-being of Australians with disabilities. METHOD: This has been a systematic review of current Australian literature that considers especially how communication and information can contribute positively towards connecting people with disabilities with other people during and post-rehabilitation. RESULTS: The results of this systematic literature review has been encouraging in that Australians with disabilities are being taken account of in the planning processes and evaluation of communications technologies. CONCLUSION: The paper also deals with how these interactive telecommunications may play an important role by assisting persons with disabilities in dealing with the loss of a sense of control over one's destiny, which is often prevalent during the acute phase of injury in persons with disabilities.

Effectiveness of strategies to disseminate and implement clinical guidelines for the management of impacted and unerupted third molars in primary dental care, a cluster randomised controlled trial.

OBJECTIVE: To investigate the effectiveness and cost-effectiveness of different guideline implementation strategies, using the Scottish Intercollegiate Guidelines Network (SIGN) Guideline 42 "Management of unerupted and impacted third molar teeth" (published 2000) as a model. DESIGN: A pragmatic, cluster RCT (2x2 factorial design). SUBJECTS: Sixty-three dental practices across Scotland. Clinical records of all 16-24-year-old patients over two, four-month periods in 1999 (pre-intervention) and 2000 (post-intervention) were searched by a clinical researcher blind to the intervention group. Data were also gathered on the costs of the interventions. INTERVENTIONS: Group 1 received a copy of SIGN 42 Guideline and had an opportunity to attend a postgraduate education course (PGEC). In addition to this, group 2 received audit and feedback (A and F). Group 3 received a computer aided learning (CAL) package. Group 4 received A and F and CAL. PRINCIPAL OUTCOME MEASUREMENT: The proportion of patients whose treatment complied with the guideline. RESULTS: The weighted t-test for A and F versus no A and F (P=0.62) and CAL versus no CAL (P=0.76) were not statistically significant. Given the effectiveness results (no difference) the cost effectiveness calculation became a cost-minimisation calculation. The minimum cost intervention in the trial consisted of providing general dental practitioners (GDPs) with guidelines and the option of attending PGEC courses. Routine data which subsequently became available showed a Scotland-wide fall in extractions prior to data collection. CONCLUSION: In an environment in which pre-intervention compliance was unexpectedly high, neither CAL nor A and F increased the dentists' compliance with the SIGN guideline compared with mailing of the guideline and the opportunity to attend a postgraduate course. The cost of the CAL arm of the trial was greater than the A and F arm. Further work is required to understand dental professionals' behaviour in response to guideline implementation strategies.

Acquisition, generalization, and maintenance of question-answering skills in autistic children.

We conducted an investigation to evaluate the effects of a training strategy for teaching autistic students generalized responses to three forms of wh--questions (what, how, and why). Students were taught, using modeling and reinforcement procedures, to answer questions with magazine pictures as the referents. Each question form was divided into two or more subcomponents reflective of common social usage and was taught within the context of a modified multiple probe design across subcomponents. Following acquisition of each subcomponent, generalization to natural context and storybook questions was assessed; additional probes were conducted to assess responding over time and whether acquisition of responses to questions promoted question-asking skills. Results showed that the picture training procedure was effective in teaching a generalized response to questions for which the relevant cue was visible, whereas specific generalization programming was required for situations in which the relevant cue was not visible. All acquired responses were durable over time.

An analysis of patient expenditure in the GDS in Scotland 1998-2007.

Introduction The purpose of this paper is to examine the size and variability of patients' expenditure in the general dental service (GDS) in Scotland during the recent past.Methods Retrospective analysis of individual patient's expenditure drawn from a 5% random sample of patients treated in the GDS in Scotland between January 1998 and September 2007. Three measures of expenditure per patient were used to assess the size and variability of patients' expenditure in the GDS: patient expenditure per claim, patient expenditure during a 12-month period and patient expenditure during the sample period.Results The size of patients' expenditure on the GDS is small relative to non-NHS insurance arrangements and other components of personal expenditure. There is relatively little variability in patients' GDS expenditure.Conclusions The relatively small size and variability of patient expenditure in the GDS in Scotland suggests that the system of patient charges provides some insurance against the cost of oral healthcare. However, a complete assessment of the insurance properties of the system of patient charges would require several other factors to be accounted for.

Monogamous bivalency of IgG antibodies. I. Deficiency of branched ABHI-active oligosaccharide chains on red cells of infants causes the weak antiglobulin reactions in hemolytic disease of the newborn due to ABO incompatibility.

This study shows that monogamous bivalency of human IgG anti-A and anti-B is necessary to maintain sensitization of red cells in the antiglobulin test. On red cells of infants and of adults of i phenotype, the known deficiency of branched ABHI-active oligosaccharide chains limits monogamous bivalency, and these accounts for the relatively weak direct antiglobulin reactions in hemolytic disease of the newborn due to ABO incompatbility. One corollary of this finding is that there is strong biologic selection against the transition on fetal red cells from the straight-chain i phenotype to branched-chain I phenotype, since such branching of cell-surface oligosaccharide chains would compromise ABO-incompatible pregnancies.

Human blood-group A- and H-specified glycosyltransferase levels in the sera of newborn infants and their mothers.

The level of blood-group A1-specified alpha,3'-N-acetyl-D-galactosaminyl-transferase in the serum of recently-delivered women was found to be appreciably lower than the level of this enzyme in the serum of non-pregnant adults and of newborn infants; a similar but less striking decrease was observed in the levels of the A2-specified alpha,3'-N-acetyl-D-galactosaminyltransferase and the H-specified alpha,2'-L-fucosyltransferase. Although the red cells of newborn infants are known to have relatively few A and H antigen sites, the serum of neonates was found to have a level of A1- and A2-dependent N-acetylgalactosaminyltransferases and H-dependent fucosyltransferase as high as, if not higher than, the serum of non-pregnant adults. This finding is compatible with the fact that the haemopoietic tissue contributes only about 20% of the serum transferase level.

Red blood cell survival studies in patients with anti-Cha, anti-Yka, anti-Ge, and anti-Vel.

The survival of red blood cells, which were strongly incompatible in vitro, was measured in five patients whose serum contained an antibody to a high-frequency antigen. In the two patients with anti-Cha, and in the patient with anti-Yka, the cells survived normally. In the patient with anti-Ge, a small proportion of the cells was destroyed at an increased rate during the first 24 hours, but the remaining cells survived normally. In the patient with anti-Vel, the injected cells were rapidly destroyed.

A and B and A1Leb substances in glycosphingolipid fractions of human serum.

A and B and A1Leb substances were adsorbed onto red cells exposed to glycosphingolipid fractions prepared from the serum of group A and B and A1,Le(a minus b plus) donors. Group O cells exposed to fractions prepared from the serum of group A or B donors were agglutinated by an IgM cross-reacting antibody present in some group O sera. Cells exposed to fractions from A1,Le(a minus b plus) serum were agglutinated by anti-A1Leb. The amount of A substance in the fractions was related to the A subtype (A1 or A2) and to the Lewis and secretor phenotype of the donor. The uptake of blood-group substances from the lipid fractions was inhibited by the addition of whole serum to the fractions.

Qualitative differences in the N-acetyl-D-galactosaminyltransferases produced by human A1 and A2 genes.

This study describes the kinetic properties of N-acetyl-D-galactosaminyltransferase in serum from subjects with blood groups A(1) and A(2). When the A(1) and A(2) enzymes were compared, with lacto-N-fucopentaose I and 2'-fucosyllactose as acceptors, the enzymes differed in their cation requirements, pH optima, and K(m) values. The two acceptors competed for the same transferase. Mixing experiments showed that the lower activity of the A(2) enzyme could not be attributed to a modifier or inhibitor in serum. It was concluded that the A(1) and A(2) enzymes differ qualitatively.

Wound-factor-induced and cell cycle phase-dependent expression of 9E3/CEF4, the avian gro gene.

The gro genes encode for secreted proteins with sequence homologies to inflammatory mediators. Little is known about the function of these proteins or their regulation. The chicken gro (9E3/CEF4) is expressed abundantly in the cells of proliferating cultures but at very low levels in confluent cultures. In vivo, this gene is expressed in connective tissue and overexpressed at sites of injury, especially in areas of neovascularization. Here we provide a bridge between these observations by examining in culture the effect on 9E3 expression and DNA synthesis induced by cell damage and by addition of factors known to be released on wounding. We mimicked wounding by scraping swaths across confluent cultures of embryonic fibroblasts and determined the time dependence of expression of 9E3 mRNA and incorporation of 3H-thymidine. We find that 9E3 is (1) transiently expressed after "wounding" or serum-stimulation; (2) expressed in a cell cycle phase-dependent manner; it is triggered during the G0-G1 transition or early in G1 and subsides during S-phase; and (3) stimulated to high levels by a-fibroblast growth factor (aFGF), bFGF, transforming growth factor alpha (TGF alpha), and TGF beta, to intermediate levels by platelet-derived growth factor and not stimulated by epidermal growth factor. We also find that cells that are constantly cycling do not express 9E3, indicating that they skip either the portion of the cell cycle where 9E3 is induced or that they constitutively express a repressor of transcription or an RNA-degrading enzyme. Taken together, these observations suggest that the product of this gene could play more than one role in vivo. For example, in normal tissues the 9E3 protein could be involved in the exit of cells from the resting stage, whereas during wound healing the secreted protein or its cleavage products also could play a role in angiogenesis.

A further example of human blood group chimaerism.

Blood group chimaerism was detected in a healthy fertile woman, not known to be a twin. Her peripheral lymphocytes had a male karyotype (46/XY); fibroblasts cultured from her skin had a female karyotype (46/XX). The mechanism of chimaerism could not be established.

Evidence that blood group A antigen on lymphocytes is derived from the plasma.

Serum from group O volunteers, who had been injected with porcine A blood group substance, was used in lymphocytotoxicity tests. Positive reactions were obtained only with lymphocytes of group A secretors; the strongest reactors were Le(a--b--). The same group O sera reacted with group O lymphocytes which had been exposed to a glycosphingolipid fraction prepared from the plasma of A,Le(a--b--) secretors. These reactions were specifically inhibited by A substance. It is suggested that, unlike the A antigen on red cells, the A antigen detected in lymphocytotoxicity tests is entirely derived from the plasma.