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1.
Artigo em Inglês | MEDLINE | ID: mdl-34209105

RESUMO

Self-isolation and quarantine measures were introduced by the UK Government on 12 March 2020 as part of the 'delay' phase to control the spread of SARS-CoV-2. Non-adherence to self-isolation for 7 days after the development of symptoms is considered suboptimal and little is known about adherence to quarantine for 14 days if a co-habitant developed symptoms. This study aims to analyse non-adherence behaviours to self-isolation and quarantine measures by identifying their potential psycho-social and demographic predictors and by exploring people's accounts of their experiences with these measures. A mixed-methods convergent design was used, comprising an online survey (n = 681) completed by residents in six North London boroughs and qualitative interviews with a subsample of participants (n = 16). Findings identified not accessing community support, lack of control over leaving the house, and lack of perceived benefit and need to follow the rules as behaviours associated with non-adherence to quarantine (42.7%). Non-adherence to self-isolating measures (24.4%) was associated with individuals' perceived lack of control over responsibilities, lack of control over leaving the house, uncertainty about symptoms experienced, lack of access to tests, and distrust in the Government. Adherence to self-isolation and quarantine could be improved through strengthening perceived benefit to self-isolate with messages emphasising its effectiveness, by implementing a two-way information system to support symptoms identification, and with Government-funded, locally supported packages at different levels (financial, food, and practical needs).


Assuntos
COVID-19 , Quarentena , Humanos , Londres , SARS-CoV-2 , Reino Unido
2.
BMJ Open ; 11(7): e049611, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34244281

RESUMO

INTRODUCTION: As the world continues to grapple with the COVID-19 pandemic, emerging evidence suggests that individuals from ethnic minority backgrounds may be disproportionately affected. The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH) project has been initiated to generate rapid evidence on whether and why ethnicity affects COVID-19 diagnosis and clinical outcomes in healthcare workers (HCWs) in the UK, through five interlinked work packages/work streams, three of which form the basis of this protocol. The ethico-legal work (Work Package 3) aims to understand and address legal, ethical and acceptability issues around big data research; the HCWs' experiences study (Work Package 4) explores their work and personal experiences, perceptions of risk, support and coping mechanisms; the stakeholder engagement work (Work Package 5) aims to provide feedback and support with the formulation and dissemination of the project recommendations. METHODS AND ANALYSIS: Work Package 3 has two different research strands: (A) desk-based doctrinal research; and (B) empirical qualitative research with key opinion leaders. For the empirical research, in-depth interviews will be conducted digitally and recorded with participants' permission. Recordings will be transcribed, coded and analysed using thematic analysis. In Work Package 4, online in-depth interviews and focus groups will be conducted with approximately 150 HCWs, from across the UK, and these will be recorded with participants' consent. The recordings will be transcribed and coded and data will be analysed using thematic analysis. Work Package 5 will achieve its objectives through regular group meetings and in-group discussions. ETHICS AND DISSEMINATION: Ethical approval has been received from the London-Brighton & Sussex Research Ethics Committee of the Health Research Authority (Ref No 20/HRA/4718). Results of the study will be published in open-access journals, and disseminated through conference presentations, project website, stakeholder organisations, media and scientific advisory groups. TRIAL REGISTRATION NUMBER: ISRCTN11811602.


Assuntos
COVID-19 , Grupos Étnicos , Teste para COVID-19 , Pessoal de Saúde , Humanos , Londres , Grupos Minoritários , Pandemias , Pesquisa Qualitativa , SARS-CoV-2 , Participação dos Interessados , Reino Unido
3.
Euro Surveill ; 26(27)2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34240699

RESUMO

We investigated a COVID-19 outbreak of the SARS-CoV-2 Delta variant of concern in a London care home, where 8/21 residents and 14/21 staff had received a single dose of Vaxzevria (ChAdOx1-S; AstraZeneca) vaccine. We identified 24 SARS-CoV-2 infections (16 residents, 8 staff) among 40 individuals (19 residents, 21 staff); four (3 residents, 1 staff) were hospitalised, and none died. The attack rate after one vaccine dose was 35.7% (5/14) for staff and 81.3% (13/16) for residents.


Assuntos
COVID-19 , SARS-CoV-2 , Vacinas contra COVID-19 , Surtos de Doenças , Inglaterra , Humanos , Londres/epidemiologia , Vacinação
4.
BMC Public Health ; 21(1): 1378, 2021 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-34247621

RESUMO

BACKGROUND: Despite considerable institutional experimentation at national and international levels in response to calls for global health security reform, there is little research on organisational models that address outbreak preparedness and response. Created in the aftermath of the 2013-16 West African Ebola epidemic, the United Kingdom's Public Health Rapid Support Team (UK-PHRST) was designed to address critical gaps in outbreak response illuminated during the epidemic, while leveraging existing UK institutional strengths. The partnership between the government agency, Public Health England, and an academic consortium, led by the London School of Hygiene and Tropical Medicine, seeks to integrate outbreak response, operational research and capacity building. We explored the design, establishment and early experiences of the UK-PHRST as one of the first bodies of its kind globally, paying particular attention to governance decisions which enabled them to address their complex mission. METHODS: We conducted a qualitative case study using 19 in-depth interviews with individuals knowledgeable about the team's design and implementation, review of organisational documents, and observations of meetings to analyse the UK-PHRST's creation, establishment and initial 2 years of operations. RESULTS: According to key informants, adopting a triple mandate (response, research and capacity building) established the team as novel in the global epidemic response architecture. Key governance decisions recognised as vital to the model included: structuring the team as a government-academic collaboration which leveraged long-term and complementary UK investments in public health and the higher education sector; adopting a more complex, dual reporting and funding structure to maintain an ethos of institutional balance between lead organisations; supporting a multidisciplinary team of experts to respond early in outbreaks for optimal impact; prioritising and funding epidemic research to influence response policy and practice; and ensuring the team's activities reinforced the existing global health architecture. CONCLUSION: The UK-PHRST aims to enhance global outbreak response using an innovative and integrated model that capitalises on institutional strengths of the partnership. Insights suggest that despite adding complexity, integrating operational research through the government-academic collaboration contributed significant advantages. This promising model could be adopted and adapted by countries seeking to build similar outbreak response and research capacities.


Assuntos
Surtos de Doenças , Saúde Pública , Surtos de Doenças/prevenção & controle , Inglaterra , Saúde Global , Humanos , Londres , Reino Unido/epidemiologia
5.
BMJ Open ; 11(6): e050312, 2021 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-34140345

RESUMO

INTRODUCTION: Streptococcus pneumoniae (the pneumococcus) is commonly carried as a commensal bacterium in the nasopharynx but can cause life-threatening disease. Transmission occurs by human respiratory droplets and interruption of this process provides herd immunity. A 2017 WHO Consultation on Optimisation of pneumococcal conjugate vaccines (PCV) Impact highlighted a substantial research gap in investigating why the impact of PCV vaccines in low-income countries has been lower than expected. Malawi introduced the 13-valent PCV (PCV13) into the national Expanded Programme of Immunisations in 2011, using a 3+0 (3 primary +0 booster doses) schedule. With evidence of greater impact of a 2+1 (2 primary +1 booster dose) schedule in other settings, including South Africa, Malawi's National Immunisations Technical Advisory Group is seeking evidence of adequate superiority of a 2+1 schedule to inform vaccine policy. METHODS: A pragmatic health centre-based evaluation comparing impact of a PCV13 schedule change from 3+0 to 2+1 in Blantyre district, Malawi. Twenty government health centres will be randomly selected, with ten implementing a 2+1 and 10 to continue with the 3+0 schedule. Health centres implementing 3+0 will serve as the direct comparator in evaluating 2+1 providing superior direct and indirect protection against pneumococcal carriage. Pneumococcal carriage surveys will evaluate carriage prevalence among children 15-24 months, randomised at household level, and schoolgoers 5-10 years of age, randomly selected from school registers. Carriage surveys will be conducted 18 and 33 months following 2+1 implementation. ANALYSIS: The primary endpoint is powered to detect an effect size of 50% reduction in vaccine serotype (VT) carriage among vaccinated children 15-24 months old, expecting a 14% and 7% VT carriage prevalence in the 3+0 and 2+1 arms, respectively. ETHICS AND DISSEMINATION: The study has been approved by the Malawi College of Medicine Research Ethics Committee (COMREC; Ref: P05.19.2680), the University College London Research Ethics Committee (Ref: 8603.002) and the University of Liverpool Research Ethics Committee (Ref: 5439). The results from this study will be actively disseminated through manuscript publications and conference presentations. TRIAL REGISTRATION NUMBER: NCT04078997.


Assuntos
Infecções Pneumocócicas , Streptococcus pneumoniae , Portador Sadio/epidemiologia , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Humanos , Lactente , Londres , Malaui/epidemiologia , Nasofaringe , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas , África do Sul , Vacinas Conjugadas
6.
G Ital Nefrol ; 38(3)2021 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-34169690

RESUMO

Background: Frailty is a known predictor of mortality and poor outcomes during hospital admission. In this large renal retrospective cohort study, we investigated whether frailer COVID-19 positive renal patients had worse outcomes. Design: All SARS-Cov-2 positive renal patients aged ≥18 years who presented to the emergency department at the Royal Free Hospital or at the satellite dialysis centres from 10th of March until the 10th of May 2020, with recent data on frailty, were included. The follow up was until 26th of May 2020. Age, gender, ethnicity, body mass index, chronic kidney disease stage, modality of renal replacement therapy, co-morbidities, Rockwood clinical frailty score (CFS), C reactive protein and the neutrophil-to-lymphocyte count were collected at presentation. The primary outcome was the overall mortality rate following COVID-19 diagnosis. Secondary outcomes included the need for hospital admission. Results: A total of 200 renal patients were SARS-Cov-2 positive. In the 174 patients who had a CFS recorded, the age was 65.4 years ± 15.8 (mean ± SD) and 57,5% were male. At the end of follow up, 26% had died. Frail patients (CFS 5-7) were more than three times more likely to die compared to less frail patients (CFS of 1-4) (odds ratio (OR) 3.3, 95% confidence interval (CI) 1.0-10.6). 118 patients (68%) required admission, but there was no difference in hospital admission rates for frail vs non-frail patients (OR 0.6, CI 0.3-1.7). Conclusions: Frailty is a better predictor of mortality than age and co-morbidities in COVID-19 positive renal patients.


Assuntos
COVID-19/mortalidade , Fragilidade/mortalidade , Nefropatias/mortalidade , Pandemias , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Comorbidade , Serviço Hospitalar de Emergência , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Nefropatias/terapia , Transplante de Rim/estatística & dados numéricos , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Diálise Renal/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Transplantados/estatística & dados numéricos , Adulto Jovem
7.
Artigo em Inglês | MEDLINE | ID: mdl-34072367

RESUMO

The basis for achieving success in sport is technical preparation supported by adequate level of physical fitness. During judo competitions, athletes use technique to meet tactical objectives aimed to achieve victory. The modification of the rules of combat in judo that has been carried out in recent years has changed the course of competition. It seems to be interesting if there are relations between technical and tactical preparation expressed by means of indices and modification of the course of the fight caused by changes in the rules. The purpose of the paper was to determine the values of technical and tactical preparation of judokas during competition at the elite level. A hundred and twenty bouts during the Olympic Games in London in 2012 as well as 136 bouts fought during the World Championships in Rio de Janeiro in 2013 were analyzed. Verification was performed by calculating indicators of technical and tactical preparation. The results show a significant correlation between the indicators of technical and tactical preparation and the ranking in the general classification of the analyzed competitions. There were no statistically significant correlations between the change of fighting rules and the level of the examined indices of technical and tactical preparation. The results of the study verified the appropriate method of preparation for the competitions analyzed.


Assuntos
Desempenho Atlético , Artes Marciais , Atletas , Brasil , Humanos , Londres
8.
Artigo em Inglês | MEDLINE | ID: mdl-34073011

RESUMO

(1) Background: Dialectical Behaviour Therapy (DBT) is the recommended treatment for Borderline Personality Disorder (BPD) symptoms in adults, however, research investigating the effectiveness of DBT for adolescents is limited. The present study explores the experiences of young people and their parents/carers of a DBT service using qualitative methodology. (2) Methods: Young people and their parents/carers, who completed DBT within the National and Specialist Child and Adolescent Mental Health DBT Service based at the Maudsley Hospital in London, were asked questions regarding their experience of the service. Data was collected from young people who completed treatment between July 2019 and July 2020 (n = 18) and their parents and carers (n = 7). (3) Results: Amongst young people, the themes identified were: a new way of living, better understanding of self, new skills, person-centred approach, and relationships with others. Parent and carer interviews revealed themes of improved relationships, feeling supported, improved quality of life, and time/timing. (4) Conclusions: Young people reported improvements in emerging BPD symptomology after completing DBT. Parents and carers reported improvements in their young person and families since starting DBT. A longer DBT programme, earlier DBT intervention, and the time-consuming nature of DBT were highlighted as areas for improvement.


Assuntos
Cuidadores , Terapia do Comportamento Dialético , Adolescente , Adulto , Assistência Ambulatorial , Criança , Humanos , Londres , Qualidade de Vida
9.
BMJ Open ; 11(6): e049762, 2021 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-34108173

RESUMO

INTRODUCTION: Profiles of high risk for future dementia are well understood and are likely to concern mostly those in low-income and middle-income countries and people at greater disadvantage in high-income countries. Approximately 30%-40% of dementia cases have been estimated to be attributed to modifiable risk factors, including hypertension, smoking and sedentary lifestyle. Tailored interventions targeting these risk factors can potentially prevent or delay the onset of dementia. Mobile health (mHealth) improves accessibility of such prevention strategies in hard-to-reach populations while at the same time tailoring such approaches. In the current study, we will investigate the effectiveness and implementation of a coach-supported mHealth intervention, targeting dementia risk factors, to reduce dementia risk. METHODS AND ANALYSIS: The prevention of dementia using mobile phone applications (PRODEMOS) randomised controlled trial will follow an effectiveness-implementation hybrid design, taking place in the UK and China. People are eligible if they are 55-75 years old, of low socioeconomic status (UK) or from the general population (China); have ≥2 dementia risk factors; and own a smartphone. 2400 participants will be randomised to either a coach-supported, interactive mHealth platform, facilitating self-management of dementia risk factors, or a static control platform. The intervention and follow-up period will be 18 months. The primary effectiveness outcome is change in the previously validated Cardiovascular Risk Factors, Ageing and Incidence of Dementia dementia risk score. The main secondary outcomes include improvement of individual risk factors and cost-effectiveness. Implementation outcomes include acceptability, adoption, feasibility and sustainability of the intervention. ETHICS AND DISSEMINATION: The PRODEMOS trial is sponsored in the UK by the University of Cambridge and is granted ethical approval by the London-Brighton and Sussex Research Ethics Committee (reference: 20/LO/01440). In China, the trial is approved by the medical ethics committees of Capital Medical University, Beijing Tiantan Hospital, Beijing Geriatric Hospital, Chinese People's Liberation Army General Hospital, Taishan Medical University and Xuanwu Hospital. Results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: ISRCTN15986016.


Assuntos
Telefone Celular , Demência , Aplicativos Móveis , Idoso , China , Demência/prevenção & controle , Humanos , Londres , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
West J Emerg Med ; 22(3): 603-607, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-34125034

RESUMO

INTRODUCTION: Emergency department (ED) attendances fell across the UK after the 'lockdown' introduced on 23rd March 2020 to limit the spread of coronavirus disease 2019 (COVID-19). We hypothesised that reductions would vary by patient age and disease type. We examined pre- and in-lockdown ED attendances for two COVID-19 unrelated diagnoses: one likely to be affected by lockdown measures (gastroenteritis), and one likely to be unaffected (appendicitis). METHODS: We conducted a retrospective cross-sectional study across two EDs in one London hospital Trust. We compared all adult and paediatric ED attendances, before (January 2020) and during lockdown (March/April 2020). Key patient demographics, method of arrival, and discharge location were compared. We used Systemised Nomenclature of Medicine codes to define attendances for gastroenteritis and appendicitis. RESULTS: ED attendances fell from 1129 per day before lockdown to 584 in lockdown, 51.7% of pre-lockdown rates. In-lockdown attendances were lowest for under-18s (16.0% of pre-lockdown). The proportion of patients admitted to hospital increased from 17.3% to 24.0%, and the proportion admitted to intensive care increased fourfold. Attendances for gastroenteritis fell from 511 to 103, 20.2% of pre-lockdown rates. Attendances for appendicitis also decreased, from 144 to 41, 28.5% of pre-lockdown rates. CONCLUSION: ED attendances fell substantially following lockdown implementation. The biggest reduction was for under-18s. We observed reductions in attendances for gastroenteritis and appendicitis. This may reflect lower rates of infectious disease transmission, although the fall in appendicitis-related attendances suggests that behavioural factors were also important. Larger studies are urgently needed to understand changing patterns of ED use and access to emergency care during the coronavirus 2019 pandemic.


Assuntos
Apendicite/epidemiologia , COVID-19/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Gastroenterite/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Controle de Doenças Transmissíveis/métodos , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , SARS-CoV-2 , Adulto Jovem
11.
BMJ Open ; 11(6): e050717, 2021 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-34140346

RESUMO

INTRODUCTION: People who are homeless experience higher morbidity and mortality than the general population. These outcomes are exacerbated by inequitable access to healthcare. Emerging evidence suggests a role for peer advocates-that is, trained volunteers with lived experience-to support people who are homeless to access healthcare. METHODS AND ANALYSIS: We plan to conduct a mixed methods evaluation to assess the effects (qualitative, cohort and economic studies); processes and contexts (qualitative study); fidelity; and acceptability and reach (process study) of Peer Advocacy on people who are homeless and on peers themselves in London, UK. People with lived experience of homelessness are partners in the design, execution, analysis and dissemination of the evaluation. ETHICS AND DISSEMINATION: Ethics approval for all study designs has been granted by the National Health Service London-Dulwich Research Ethics Committee (UK) and the London School of Hygiene and Tropical Medicine's Ethics Committee (UK). We plan to disseminate study progress and outputs via a website, conference presentations, community meetings and peer-reviewed journal articles.


Assuntos
Pessoas em Situação de Rua , Medicina Estatal , Atenção à Saúde , Humanos , Londres , Reino Unido
12.
Exp Appl Acarol ; 84(3): 593-606, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34125334

RESUMO

Assessing the risk of tick-borne disease in areas with high visitor numbers is important from a public health perspective. Evidence suggests that tick presence, density, infection prevalence and the density of infected ticks can vary between habitats within urban green space, suggesting that the risk of Lyme borreliosis transmission can also vary. This study assessed nymph density, Borrelia prevalence and the density of infected nymphs across a range of habitat types in nine parks in London which receive millions of visitors each year. Ixodes ricinus were found in only two of the nine locations sampled, and here they were found in all types of habitat surveyed. Established I. ricinus populations were identified in the two largest parks, both of which had resident free-roaming deer populations. Highest densities of nymphs (15.68 per 100 m2) and infected nymphs (1.22 per 100 m2) were associated with woodland and under canopy habitats in Richmond Park, but ticks infected with Borrelia were found across all habitat types surveyed. Nymphs infected with Borrelia (7.9%) were only reported from Richmond Park, where Borrelia burgdorferi sensu stricto and Borrelia afzelii were identified as the dominant genospecies. Areas with short grass appeared to be less suitable for ticks and maintaining short grass in high footfall areas could be a good strategy for reducing the risk of Lyme borreliosis transmission to humans in such settings. In areas where this would create conflict with existing practices which aim to improve and/or meet historic landscape, biodiversity and public access goals, promoting public health awareness of tick-borne disease risks could also be utilised.


Assuntos
Grupo Borrelia Burgdorferi , Borrelia burgdorferi , Cervos , Ixodes , Doença de Lyme , Animais , Londres/epidemiologia , Doença de Lyme/epidemiologia , Ninfa , Reino Unido
13.
BMJ Open ; 11(6): e046545, 2021 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-34155074

RESUMO

OBJECTIVE: To examine the social determinants of influenza and pertussis vaccine uptake among pregnant women in England. DESIGN: Nationwide population-based cohort study. SETTING: The study used anonymised primary care data from the Clinical Practice Research Datalink and linked Hospital Episode Statistics secondary care data. PARTICIPANTS: Pregnant women eligible for pertussis (2012-2015, n=68 090) or influenza (2010/2011-2015/2016, n=152 132) vaccination in England. MAIN OUTCOME MEASURES: Influenza and pertussis vaccine uptake. RESULTS: Vaccine uptake was 67.3% for pertussis and 39.1% for influenza. Uptake of both vaccines varied by region, with the lowest uptakes in London and the North East. Lower vaccine uptake was associated with greater deprivation: almost 10% lower in the most deprived quintiles compared with the least deprived for influenza (34.5% vs 44.0%), and almost 20% lower for pertussis (57.7% vs 76.0%). Lower uptake for both vaccines was also associated with non-white ethnicity (lowest among women of black ethnicity), maternal age under 20 years and a greater number of children in the household. The associations between all social factors and vaccine uptake were broadly unchanged in fully adjusted models, suggesting the social determinants of uptake were largely independent of one another. Among 3111 women vaccinated against pertussis in their first eligible pregnancy and pregnant again, 1234 (40%) were not vaccinated in their second eligible pregnancy. CONCLUSIONS: Targeting promotional campaigns to pregnant women who are younger, of non-white ethnicity, with more children, living in areas of greater deprivation or the London or North East regions, has potential to reduce vaccine-preventable disease among infants and pregnant women, and to reduce health inequalities. Vaccination promotion needs to be sustained across successive pregnancies. Further research is needed into whether the effectiveness of vaccine promotion strategies may vary according to social factors.


Assuntos
Vacinas contra Influenza , Influenza Humana , Complicações Infecciosas na Gravidez , Coqueluche , Adulto , Criança , Estudos de Coortes , Registros Eletrônicos de Saúde , Inglaterra/epidemiologia , Feminino , Número de Gestações , Humanos , Influenza Humana/prevenção & controle , Londres , Vacina contra Coqueluche , Gravidez , Determinantes Sociais da Saúde , Vacinação , Coqueluche/prevenção & controle , Adulto Jovem
14.
Environ Sci Technol ; 55(13): 8535-8541, 2021 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-34101466

RESUMO

Radiocarbon (14C) measurements offer a unique investigative tool to study methane emissions by identifying fossil-fuel methane in air. Fossil-fuel methane is devoid of 14C and, when emitted to the atmosphere, causes a strong decrease in the ratio of radiocarbon to total carbon in methane (Δ14CH4). By observing the changes in Δ14CH4, the fossil fraction of methane emissions can be quantified. Presently, there are very few published Δ14CH4 measurements, mainly because it is challenging to collect and process the large volumes of air needed for radiocarbon measurements. We present a new sampling system that collects enough methane carbon for high precision Δ14CH4 measurements without having to transport large volumes of air. The system catalytically combusts CH4 into CO2 and adsorbs the combustion-derived CO2 onto a molecular sieve trap, after first removing CO2, CO, and H2O. Tests using reference air show a Δ14CH4 measurement repeatability of 5.4‰, similar or better than the precision in the most recent reported measurements. We use the system to produce the first Δ14CH4 measurements in central London and show that day-to-day differences in Δ14CH4 in these samples can be attributed to fossil methane input. The new system could be deployed in a range of settings to investigate CH4 sources.


Assuntos
Poluentes Atmosféricos , Metano , Poluentes Atmosféricos/análise , Atmosfera , Dióxido de Carbono/análise , Fósseis , Londres , Metano/análise
15.
Artigo em Inglês | MEDLINE | ID: mdl-34067997

RESUMO

The multidimensional iterative composition of urban landscapes and the formation mechanism of the aesthetic perception dimension are elucidated. The cognitive schema theory aims to reveal the intrinsic mechanism of urban landscape aesthetic activities. Using London as an empirical case to explore the representation and structure of urban landscape aesthetic, a cognitive schema, the cognitive map of its urban landscape, was constructed based on the qualitative analysis of the texts derived from travel notes. Eight aspects of urban landscapes, together with 21 representative concepts of cognitive schema closely related to aesthetic perception, indicate the structures and approaches people perceive in urban landscapes. This article provides experience and reference for urban landscape enhancement and related practices in China by studying the contemporary Western urban landscape.


Assuntos
Cognição , Sensação , China , Estética , Humanos , Londres
16.
BMC Res Notes ; 14(1): 231, 2021 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-34112219

RESUMO

OBJECTIVE: To investigate the psychometric properties of the validated Chichewa version of the London Measure of Unplanned Pregnancy in a large representative community-based sample in Malawi, a low-income country. We collected data on pregnancy intention from a cohort of 4244 pregnant women in Malawi using the validated Chichewa version of the London Measure of Unplanned Pregnancy (LMUP). We evaluated the psychometric properties of the Chichewa LMUP using classical test theory and confirmatory factor analysis to re-assess the performance of items one and six, which had weaker performance in the original smaller, facility-based validation sample. RESULTS: The Chichewa version of the LMUP met all pre-set criteria for validation. There are now nine validations of the LMUP in different low-and-middle-income countries, confirming the validity and applicability of the LMUP in these settings.


Assuntos
Gravidez não Planejada , Feminino , Humanos , Londres , Malaui , Gravidez , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
17.
Stem Cell Res ; 53: 102373, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34088002

RESUMO

We report the genome-editing of an existing iPSC line carrying the London mutation in APP (V717I) into an iPSC line in which the pathogenic mutation was corrected. The resulting isogenic iPSC line maintained pluripotent stem cell morphology, a normal karyotype, expression of pluripotency markers and the ability to differentiate into the three germ-layers in vitro.


Assuntos
Doença de Alzheimer , Células-Tronco Pluripotentes Induzidas , Doença de Alzheimer/genética , Humanos , Londres , Mutação
18.
Funct Plant Biol ; 48(7): iii-ix, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34099100

RESUMO

This special issue is a tribute to the Australian plant biologist Professor Charles Barry Osmond - Fellow of the Australian Academy of Sciences, the Royal Society of London, and Leopoldina, the German National Academy of Sciences - and his many contributions to our understanding of the biochemistry and physiological ecology of CAM (crassulacean acid metabolism) photosynthesis. This water-conserving photosynthetic pathway is characterised by nocturnal uptake of atmospheric CO2 and typically enables succulent plants to perform and survive in warm semiarid terrestrial and epiphytic habitats. The idea for this issue is to mark the occasion of Barry's 80th birthday in 2019. The foreword highlights some of his outstanding contributions and introduces the research papers of the special issue.


Assuntos
Dióxido de Carbono , Metabolismo Ácido das Crassuláceas , Austrália , Londres , Fotossíntese , Estados Unidos
19.
BMJ Open ; 11(6): e046992, 2021 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-34112643

RESUMO

INTRODUCTION: Health systems responsiveness is a key objective of any health system, yet it is the least studied of all objectives particularly in low-income and middle-income countries. Research on health systems responsiveness highlights its multiple elements, for example, dignity and confidentiality. Little is known, however, about underlying theories of health systems responsiveness, and the mechanisms through which responsiveness works. This realist synthesis contributes to bridging these two knowledge gaps. METHODS AND ANALYSIS: In this realist synthesis, we will use a four-step process, comprising: mapping of theoretical bases, formulation of programme theories, theory refinement and testing of programme theories using literature and empirical data from Ghana and Vietnam. We will include theoretical and conceptual pieces, reviews, empirical studies and grey literature, alongside the primary data. We will explore responsiveness as entailing external and internal interactions within health systems. The search strategy will be purposive and iterative, with continuous screening and refinement of theories. Data extraction will be combined with quality appraisal, using appropriate tools. Each fragment of evidence will be appraised as it is being extracted, for its relevance to the emerging programme theories and methodological rigour. The extracted data pertaining to contexts, mechanisms and outcomes will be synthesised to identify patterns and contradictions. Results will be reported using narrative explanations, following established guidance on realist syntheses. ETHICS AND DISSEMINATION: Ethics approvals for the wider RESPONSE (Improving health systems responsiveness to neglected health needs of vulnerable groups in Ghana and Vietnam) study, of which this review is one part, were obtained from the ethics committees of the following institutions: London School of Hygiene and Tropical Medicine (ref: 22981), University of Leeds, School of Medicine (ref: MREC19-051), Ghana Health Service (ref: GHS-ERC 012/03/20) and Hanoi University of Public Health (ref: 020-149/DD-YTCC).We will disseminate results through academic papers, conference presentations and stakeholder workshops in Ghana and Vietnam. PROSPERO REGISTRATION NUMBER: CRD42020200353. Full record: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020200353.


Assuntos
Países em Desenvolvimento , Pobreza , Gana , Humanos , Londres , Literatura de Revisão como Assunto , Vietnã
20.
BMJ Open Qual ; 10(2)2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34112657

RESUMO

The COVID-19 pandemic prompted a rapid change in primary care provision. There was a significant shift from face-to-face appointments to remote methods such as electronic consultation (e-consultation). Patients from a primary care provider in London were actively encouraged to use an online consultation platform called 'Dr iQ'. A group of high frequency users of Dr iQ emerged and clinicians were concerned their health needs were not being met through the platform. High frequency attendance in a traditional general practice setting is associated with increased time and healthcare costs.This project evaluated the number of high frequency users (identified as 10 or more consultations a month) of Dr iQ in one busy inner city practice over a 5-month period. We aimed to decrease the subsequent monthly usage frequency of all Dr iQ high frequency users from 10 or more consultations to less than 10 consultations. Our interventions included a semi-structured telephone interview, discussion among the multidisciplinary team, and regular scheduled telephone or face-to-face appointments. Following two Plan-Do-Study-Act cycles, all 12 high frequency users showed a decrease in the number of consultations submitted to Dr iQ to less than 10 consultations a month.This project proposes a method of case managing high frequency users of e-consultation. The majority of high frequency users had unmet health needs and felt a lack of continuity of care on Dr iQ. They often had complex physical and mental health problems. As remote consulting technology continues to develop, more research is required to understand the epidemiology and aetiology of e-consultation high frequency use in order to improve patient outcomes.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Consulta Remota/estatística & dados numéricos , Adulto , COVID-19/prevenção & controle , COVID-19/transmissão , Tecnologia Digital/métodos , Feminino , Humanos , Londres , Masculino , Satisfação do Paciente , Relações Médico-Paciente , Atenção Primária à Saúde/métodos , Melhoria de Qualidade , Consulta Remota/métodos
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