SmartStartAllergy: a novel tool for monitoring food allergen introduction in infants.

OBJECTIVES: To estimate the proportion of infants introduced to peanut and other common food allergens by 12 months of age; to collect information about parent-reported reactions to food. DESIGN, SETTING: Observational cohort study, applying the SmartStartAllergy SMS protocol and online questionnaire to parents of 12-month-old infants attending 69 Australian general practices between 21 September 2018 and 3 May 2019. PARTICIPANTS: 3374 parents recruited via the 69 participating general practices. MAIN OUTCOME MEASURES: Proportions of infants who had eaten peanut and other common food allergens; proportions with parent-reported reactions to food. RESULTS: 1940 of 3374 invited parents participated in the study (response rate, 57%), of whom 836 (46%) completed the online questionnaire. At 12 months of age, 1673 of 1940 infants had eaten peanut-including foods (86.2%; 95% confidence interval [CI], 84.6-87.7%); 235 of 1831 parents (12.8%; 95% CI, 11.3-14.5%) reported food-related reactions. Questionnaire responses indicated that dairy was the food type most frequently reported to cause a food-related reaction (72 of 835 exposed infants, 8.6%; 95% CI, 6.8-11%); peanut-related reactions were reported for 20 of 764 exposed children (2.6%; 95% CI, 1.6-4.0%). 97 of 250 parent-reported reactions to food (39%) did not include symptoms that suggested an IgE-mediated allergic reaction. CONCLUSION: Infant feeding practices in Australia have changed over the past decade; a large majority of infants are now fed peanut before 12 months of age. The SmartStartAllergy program allows monitoring of infant feeding practices in primary care, as well as of parent-reported reactions to food in infants.

Symptom profile of patients receiving antibiotics for upper respiratory tract infections in general practice: an observational study using smartphone technology.

BACKGROUND: Upper respiratory tract infections (URTIs) are a common presentation in general practice and are linked to high rates of inappropriate antibiotic prescription. There is limited information about the trajectory of patients with this condition who have been prescribed antibiotics. OBJECTIVE: To document the symptom profile of patients receiving antibiotics for URTIs in Australian general practice using smartphone technology and online surveys. METHODS: In total, 8218 patients received antibiotics after attending one of the 32 general practice clinics in Australia from June to October 2017: 4089 were identified as URTI presentations and were the cohort studied. Patients completed the Wisconsin Upper Respiratory Symptom Survey (WURSS-24) 3 and 7 days after visiting their general practitioner (GP). RESULTS: Six hundred fourteen URTI-specific patients responded to at least one symptom survey (RR 15%). The majority of patients reported moderate to mild symptoms at 72 hours [median global symptom severity score 37 (IQR 19, 59)] post-GP visit which reduced to very mild symptoms or not sick by day 7 [11 (IQR 4, 27)]. Patients receiving antibiotics for URTI reported the same level of symptom severity as patients in previous studies receiving no treatment. CONCLUSIONS: The recovery of most patients within days of receiving antibiotics for URTI mimics the trajectory of patients with viral URTIs without treatment. Antibiotics did not appear to hasten recovery. Monitoring of patients in this context using smart phone technology is feasible but limited by modest response rates.

Randomized Controlled Trial of Text Message Reminders for Increasing Influenza Vaccination.

PURPOSE: Seasonal influenza vaccine is recommended and funded for groups at higher risk of serious infection, but uptake is suboptimal. We conducted a randomized controlled trial of short message service (SMS) reminders for influenza vaccination. METHODS: Six weeks after seasonal influenza vaccinations began, we identified high-risk patients who had a mobile telephone number on record at 10 practices in Western Australia. Thirty-two percent of the selected patients had already been vaccinated in the current year and were ineligible. Of the remaining 12,354 eligible patients at each practice one-half were randomly assigned to receive a vaccination reminder by SMS (intervention) and the rest received no SMS (control). Approximately 3 months after the SMS was sent (the study period), vaccination data were extracted from the patients' electronic medical records. Log-binomial regression models were used to calculate the relative risk (RR) of vaccination between the intervention and control group. RESULTS: Twelve-percent (769 of 6,177) of the intervention group and 9% (548 of 6,177) of the control group were vaccinated during the study period, a 39% relative increase attributable to the SMS (RR = 1.39; 95% CI, 1.26-1.54). For every 29 SMSs sent, costing $3.48, 1 additional high-risk patient was immunized. The greatest effect was observed for children younger than 5 years, whose parents were more than twice as likely to have their child vaccinated if they received a SMS reminder (RR = 2.43; 95% CI, 1.79-3.29). CONCLUSION: We found SMS reminders to be a modestly effective, low-cost means to increase seasonal influenza vaccine coverage among high-risk patients.

The realistic energy yield potential of GaAs-on-Si tandem solar cells: a theoretical case study.

Si based tandem solar cells represent an alternative to traditional compound III-V multijunction cells as a promising way to achieve high efficiencies. A theoretical study on the energy yield of GaAs on Si (GaAs/Si) tandem solar cells is performed to assess their energy yield potential under realistic illumination conditions with varying spectrum. We find that the yield of a 4-terminal contact scheme with thick top cell is more than 15% higher than for a 2-terminal scheme. Furthermore, we quantify the main losses that occur for this type of solar cell under varying spectra. Apart from current mismatch, we find that a significant power loss can be attributed to low irradiance seen by the sub-cells. The study shows that despite non-optimal bandgap combination, GaAs/Si tandem solar cells have the potential to surpass 30% energy conversion efficiency.

Phase space considerations for light path lengths in planar, isotropic absorbers.

Fundamental limits for path lengths of light in isotropic absorbers are calculated. The method of calculation is based on accounting for occupied states in optical phase space. Light trapping techniques, such as scattering or diffraction, are represented by the way how the available states are occupied. One finding of the presented investigation is that the path length limit is independent of the light trapping mechanism and only depends on the conditions for light incidence to, and escape from the absorber. A further finding is that the maximum path length is obtained for every light trapping mechanisms which results in a complete filling of the available states in phase space. For stationary solar cells, the Yablonovitch limit of 4dn², with n the refractive index of the absorber, is a very good approximation of this limit.

Using automated text messages to monitor adverse events following immunisation in general practice.

OBJECTIVE: To assess the performance of SmartVax, a prototypic active monitoring system for adverse events following immunisation (AEFI) using short message service (SMS) text messages and clinical data extracted from commercially available medical practice management software. DESIGN, SETTING AND PARTICIPANTS: Between 11 November 2011 and 10 June 2013, adult patients and parents of paediatric patients receiving routine vaccinations in general practice were sent an SMS by SmartVax enquiring if they had experienced any AEFI and requesting a reply by SMS. Attempts were made to telephone patients who did not reply by SMS. MAIN OUTCOME MEASURES: The proportion of patients sent an SMS who replied by SMS, and the proportion of respondents indicating possible AEFI. RESULTS: Of 3281 vaccinated patients, 3226 (98.3%) had a mobile telephone number on record and were sent an SMS. Of 2342 patients (72.6%; 95% CI, 70.0%-75.1%) who responded by SMS, 264 (11.3%; 95 CI, 9.9%-12.7%) reported possible AEFI. The response rate was ≥ 70% for both paediatric and adult patients. Eighty-per cent of SMS replies were received within 2 hours of transmission of the query SMS. There was no significant difference in the proportion reporting possible AEFI between patients who replied by SMS and those who did not respond by SMS but were subsequently contacted by a telephone call (P = 0.99). CONCLUSIONS: More than 70% of patients responded by SMS to an SMS query about whether they had any vaccine reactions, with the data received in near real-time. Active surveillance of AEFI using SMS has the capacity to complement existing passive reporting systems, potentially permitting more rapid identification of emerging safety signals.

Quantifying the impact of wildfire smoke on solar photovoltaic generation in Australia.

The 2019-20 Australian wildfires caused extreme haze events across New South Wales (NSW), which reduced photovoltaic (PV) power output. We analyze 30-min energy data from 160 geographically separated residential PV systems in NSW with a total capacity of 312 kW from 6 Nov 2019-15 Jan 2020. The observed mean power reduction rate for PV energy generation as a function of the fine particulate matter (PM2.5) concentration is 13 ± 2% per 100 µg/m3 of PM2.5. The resulting energy loss for residential and utility PV systems is estimated at 175 ± 35 GWh, equating to a worst-case financial loss of 19 ± 4 million USD. We found the relative impact to be most significant in the mornings and evenings, which may necessitate the installation of additional energy storage. As PV systems are sensitive to smoke and become ubiquitous, we propose employing them to support wildfire detection and monitoring.

Bypassing the Single Junction Limit with Advanced Photovoltaic Architectures.

Multijunction devices and photon up- and down-conversion are prominent concepts aimed at increasing photovoltaic efficiencies beyond the single junction limit. Integrating these concepts into advanced architectures may address long-standing issues such as processing complexity, microstructure control, and resilience against spectral changes of the incoming radiation. However, so far, no models have been established to predict the performance of such integrated architectures. Here, a simulation environment based on Bayesian optimization is presented, that can predict and virtually optimize the electrical performance of multi-junction architectures, both vertical and lateral, in combination with up- and down-conversion materials. Microstructure effects on performance are explicitly considered using machine-learned predictive models from high throughput experimentation on simpler architectures. Two architectures that would surpass the single junction limit of photovoltaic energy conversion at reasonable complexity are identified: a vertical "staggered half octave system," where selective absorption allows the use of 6 different bandgaps, and the lateral "overlapping rainbow system" where selective irradiation allows the use of a narrowband energy acceptor with reduced voltage losses, according to the energy gap law. Both architectures would be highly resilient against spectral changes, in contrast with two terminal multi-junction architectures which are limited by Kirchhoff's law.

The AuTOMATIC trial: a study protocol for a multi-arm Bayesian adaptive randomised controlled trial of text messaging to improve childhood immunisation coverage.

BACKGROUND: While most Australian children are vaccinated, delays in vaccination can put them at risk from preventable infections. Widespread mobile phone ownership in Australia could allow automated short message service (SMS) reminders to be used as a low-cost strategy to effectively 'nudge' parents towards vaccinating their children on time. METHODS: AuTOMATIC is an adaptive randomised trial which aims to both evaluate and optimise the use of SMS reminders for improving the timely vaccination of children at primary care clinics across Australia. The trial will utilise high levels of digital automation to effect, including eligibility assessment, randomisation, delivery of intervention, data extraction and analysis, thereby allowing healthcare-embedded trial delivery. Up to 10,000 parents attending participating primary care clinics will be randomised to one of 12 different active SMS vaccine reminder content and timing arms or usual practice only (no SMS reminder). The primary outcome is vaccine receipt within 28 days of the scheduled date for the index vaccine (the first scheduled vaccine after randomisation). Secondary analyses will assess receipt and timeliness for all vaccine occasions in all children. Regular scheduled analyses will be performed using Bayesian inference and pre-specified trial decision rules, enabling response adaptive randomisation, suspension of any poorly performing arms and early stopping if a single best message is identified. DISCUSSION: This study will aim to optimise SMS reminders for childhood vaccination in primary care clinics, directly comparing alternative message framing and message timing. We anticipate that the trial will be an exemplar in using Bayesian adaptive methodology to assess a readily implementable strategy in a wide population, capable of delivery due to the levels of digital automation. Methods and findings from this study will help to inform strategies for implementing reminders and embedding analytics in primary health care settings. TRIAL REGISTRATION: ANZCTR: ACTRN12618000789268 .

Making a SmartStart for peanut introduction to support food allergy prevention guidelines for infants.

Background: Food allergy affects up to 10% of Australian infants. It was hypothesized that if parents follow the Australasian Society of Clinical Immunology and Allergy guidelines, Australian food allergy rates may stabilize or decline. Objective: This project aimed to determine whether SmartStartAllergy influenced parental introduction of peanut by age 12 months, including in high-risk infants. Methods: SmartStartAllergy integrates with general practice management software to send text messages to parents via participating general practices. The intervention group participants were sent text messages when their child was aged 6, 9, and 12 months; the control group participants were parents of 12-month-old infants. When their child was aged 12 months, all participants completed a questionnaire regarding eczema and family history of atopy. Infants with severe eczema and/or a family history of atopy were considered high-risk. Results: Between 21 September 2018 and 26 April 2022, a total of 29,092 parents were enrolled in SmartStartAllergy as intervention (n = 18,090) and control (n = 11,002) group members The intervention group was more likely to introduce peanut by 12 months (crude odds ratio = 5.18; P < .0001; 95% CI = 4.35-6.16). After adjustment for the infants' level of risk and family history of atopy and food allergy, the intervention group was more likely to introduce peanut by 12 months of age (adjusted odds ratio = 5.34; P < .01; 95% CI = 4.48-6.37). Conclusion: SmartStartAllergy appears to be an effective tool for encouraging parental introduction of peanut. The ability to provide parents with credible allergy prevention information, along with the capacity to collect simple responses via text along with additional information via an online questionnaire, make this a useful public health tool.

Photovoltaics at multi-terawatt scale: Waiting is not an option.

25% annual PV growth is possible over the next decade.

The role of innovation for economy and sustainability of photovoltaic modules.

The role of innovation for the success of photovoltaics cannot be overstated. Photovoltaics have enjoyed the most substantial price learning of any energy technology. Innovation affects photovoltaic performance in more ways, though. Here, we explore the role of innovation for economics and greenhouse gas savings of photovoltaic modules using replacement scenarios. We find that the greenhouse gas displacement potential of photovoltaic modules has improved substantially over the last 20 years-4-fold for the presented example. We show that the economically ideal time for repowering is after around 20 years, but that repowering may reduce greenhouse gas savings. Expanding photovoltaic installations is generally preferable, economically and sustainably, to repowering. We argue that i) we should maximize the greenhouse gas saving potential of each module, which requires a global strategy, ii) tandem solar cells should aim for stability, and iii) efforts to continue and accelerate innovation in photovoltaic technology are needed.

Adverse events following influenza immunization: understanding the role of age and sex interactions.

BACKGROUND: Reduction of adverse events following immunization (AEFI) could improve vaccine uptake. Evidence suggests sex and age affect AEFI rates but, with limited understanding of their interaction, groups at higher risk for adverse reaction cannot be identified. RESEARCH DESIGN AND METHODS: Using deidentified data (n = 308,481) from Australians receiving influenza vaccinations in the 2020 calendar year, we analyzed the effects of independent predictors (i.e. age and sex), on experiencing an AEFI using logistic regression generalized additive modeling to capture any nonlinear relationships and adjusting for vaccine brand and concomitant vaccination. RESULTS: The overall reaction rate was 5.5%. Modeling revealed significant effects of age (p < 0.001), sex (p < 0.001), and age × sex (p < 0.001). Females were more likely than males to experience AEFIs between 7.5 and 87.5 years of age and exhibited peak odds at about 53 years, while peak odds for males occurred in infancy. CONCLUSION: The results suggest there is a need for targeting AEFI reduction in females, particularly in 30-70-year-olds, to improve the vaccination experience. The results further suggest that reducing concomitant vaccination and choosing less reactogenic vaccine brands could reduce risk of AEFI, however, retaining concomitant vaccination may optimize vaccine uptake.

Safety of Four COVID-19 Vaccines across Primary Doses 1, 2, 3 and Booster: A Prospective Cohort Study of Australian Community Pharmacy Vaccinations.

Four COVID-19 vaccines are approved for use in Australia: Pfizer-BioNTech BNT162b2 (Comirnaty), AstraZeneca ChAdOx1 (Vaxzevria), Moderna mRNA-1273 (Spikevax) and Novavax NVX-CoV2373 (Nuvaxovid). We sought to examine adverse events following immunisation (AEFI) at days 3 and 42 after primary doses 1, 2, 3 and booster. We conducted active vaccine safety surveillance from 130 community pharmacies in Australia integrated with AusVaxSafety, between August 2021-April 2022. Main outcomes: AEFI at 0-3 days post-vaccination; medical review/advice at 3 days and 42 days post-vaccination; SARS-CoV-2 breakthrough infection by day 42. Of 110,024 completed day 3 surveys (43.6% response rate), 50,367 (45.8%) reported any AEFI (highest proportions: Pfizer 42%, primary dose 3; AstraZeneca 58.3%, primary dose 1; Moderna 65.4% and Novavax 58.8%, both primary dose 2). The most common AEFI reported across all doses/vaccines were local reactions, systemic aches and fatigue/tiredness. Overall, 2172/110,024 (2.0%) and 1182/55,329 (2.1%) respondents sought medical review at days 3 and 42, respectively, and 931/42,318 (2.2%) reported breakthrough SARS-CoV-2 infection at day 42. We identified similar AEFI profiles but at lower proportions than previously reported for Pfizer, AstraZeneca, Moderna and Novavax COVID-19 vaccines. Moderna vaccine was the most reactogenic and associated with higher AEFI proportions across primary doses 2, 3, and booster.

Active vaccine safety surveillance of seasonal influenza vaccination via a scalable, integrated system in Western Australian pharmacies: a prospective cohort study.

OBJECTIVES: We integrated an established participant-centred active vaccine safety surveillance system with a cloud-based pharmacy immunisation-recording program in order to measure adverse events following immunisation (AEFI) reported via the new surveillance system in pharmacies, compared with AEFI reported via an existing surveillance system in non-pharmacy sites (general practice and other clinics). DESIGN: A prospective cohort study. PARTICIPANTS AND SETTING: Individuals >10 years receiving influenza immunisations from 22 pharmacies and 90 non-pharmacy (general practice and other clinic) sites between March and October 2020 in Western Australia. Active vaccine safety surveillance was conducted using short message service and smartphone technology, via an opt-out system. OUTCOME MEASURES: Multivariable logistic regression was used to assess the primary outcome: differences in proportions of AEFI between participants immunised in pharmacies compared with non-pharmacy sites, adjusting for confounders of age, sex and influenza vaccine brand. A subgroup analysis of participants over 65 years was also performed. RESULTS: Of 101 440 participants (6992 from pharmacies; 94 448 from non-pharmacy sites), 77 498 (76.4%) responded; 96.1% (n=74 448) within 24 hours. Overall, 4.8% (n=247) pharmacy participants reported any AEFI, compared with 6% (n=4356) non-pharmacy participants (adjusted OR: 0.87; 95% CI: 0.76 to 0.99; p=0.039). Similar proportions of AEFIs were reported in pharmacy (5.8%; n=31) and non-pharmacy participants (6; n=1617) aged over 65 years (adjusted OR: 0.94; 95% CI: 0.65 to 1.35; p=0.725). The most common AEFIs in pharmacy were: pain (2%; n=104), tiredness (1.9%; n=95) and headache (1.7%; n=88); and in non-pharmacy sites: pain (2.3%; n=1660), tiredness (1.9%; n=1362) and swelling (1.5%; n=1121). CONCLUSIONS: High and rapid response rates demonstrate good participant engagement with active surveillance in both pharmacy and non-pharmacy participants. Significantly fewer AEFIs reported after pharmacist immunisations compared with non-pharmacy immunisations, with no difference in older adults, may suggest different cohorts attend pharmacy versus non-pharmacy immunisers. The integrated pharmacy system is rapidly scalable across Australia with global potential.

Smartphone-based active vaccine safety surveillance (SmartVax) at a Swiss adult vaccination clinic - a pilot study.

INTRODUCTION: Post-licensure surveillance of adverse events following immunisation (AEFI) is critical for detecting rare but severe AEFI. SmartVax software, using smartphone technology, actively solicits reports of AEFI via automated, opt-out SMS surveys to vaccine recipients in the days following immunisation. We report on a pilot study to test the feasibility and acceptance of SmartVax in Switzerland. METHODS: Between February and September 2020, consecutive subjects immunised at an adult immunisation clinic and the employee health service at the University Hospital of Basel were screened. Participants included three subgroups: healthcare workers (HCW), subjects with immune-mediated inflammatory diseases (IMID) and clients of the regular adult immunisation clinic. Three days after vaccination, participants received an SMS inquiring if they had any AEFI. In the case of an AEFI, subjects received an automated SMS with a link to an online survey assessing the type and temporal evolution of the AEFI. Descriptive statistics of response rate, time-to-response, frequency and type of AEFI by vaccine and clinical subgroup were performed. RESULTS: Of 293 subjects screened, 276 were included (46.6% routine vaccination check-up visits, 33.3% HCW, 20.1% IMID patients) receiving 625 vaccinations during 360 immunisation visits. The SMS response rate was high (90.3%), with a median time-to-respond of 47 minutes (interquartile range11-205). After 29.8% of immunisation visits at least one AEFI was reported. There were no differences in frequency or type of AEFI between the three clinical subgroups. The recombinant, adjuvanted zoster vaccine Shingrix® was associated with the highest rate of local and systemic reactions. CONCLUSION: Monitoring post-licensure vaccine safety using the active SMS-based surveillance system SmartVax is feasible in Switzerland. We observed a high acceptance in the diverse study population, including healthcare workers and IMID patients. High response rates in the elderly and reliable monitoring almost in real-time make SmartVax a promising tool for COVID-19 vaccine safety monitoring.

Immunisation provider experiences with an automated short message service-based active surveillance system for monitoring adverse events following immunisation: A qualitative descriptive study.

OBJECTIVE: Currently, active surveillance systems to monitor adverse events following immunisation are limited to hospitals, and medical and immunisation clinics. Globally, community pharmacies represent a significant destination for immunisation services. However, until recently, pharmacies lacked active surveillance systems. We therefore wished to explore pharmacists' experiences with SmartVax: an active surveillance system that has recently been integrated for use in Australian community pharmacies. Specifically, we wished to explore pharmacists' perceived (1) benefits of using SmartVax, (2) areas for improvement in the system, and (3) issues with future/ongoing access to the system. METHODS: The present study forms the qualitative arm of a convergent mixed-methods pilot study. In the present study, we performed semi-structured interviews with pharmacist immunisers after a 21- to 22-week trial period with SmartVax. Thematic analysis of interview transcripts was performed independently by two researchers in QSR NVivo 12, using the framework method. RESULTS: Fifteen participants completed the semi-structured interviews. A broad range of perceived benefits were cited by participants, including the usability of SmartVax, the ease of patient follow-up facilitated by the system, and enhancement to the patient-pharmacist relationship. Participants voiced a desire for the system to have more granularity and a faster response time in the report generated for pharmacies. When asked about issues with future/ongoing access to SmartVax, cost concerns of the system were the prevailing theme. CONCLUSIONS: The present study suggests that, among pharmacist immuniser end-users of SmartVax, the system is perceived to be easy-to-use, facilitates patient follow-up, and enhances the patient-pharmacist relationship.

Vaccination reaction rate is unaltered by ambient temperature on the day.

Minor reactions are often experienced following the human papillomavirus (HPV) vaccination and negative vaccination experiences may discourage individuals from seeking future vaccinations. Ambient temperature is suggested to be linked to reaction rates. Optimising immunisation programs requires understanding associations of temperature and reactions. To investigate a potential association between temperature and reactions, logistic regressions were performed on data obtained for a two-year period from a vaccine safety monitoring system for children (ages 10-15 years) who received the HPV vaccination (n = 20466) and from publicly available meteorological records in Australia. Reaction rate was 8.3% overall and higher with concomitant vaccination versus HPV alone (9.3% vs 7.8%, p=<0.001). Logistic regression found no relationship between reactions and maximal temperature on the day of vaccination (p = 0.581); controlling for concomitant vaccination, age and gender did not alter the temperature-reaction relationship (p = 0.851) but did identify concomitant vaccination as a significant predictor. Our results suggest immunisation programs must weigh the advantages of improved vaccination coverage resulting from concomitant vaccination against an increase in reaction rates and, importantly, can be safely administered across a range of temperatures.

The Impact of COVID-19-Related Measures on the Solar Resource in Areas with High Levels of Air Pollution.

Restrictions enacted to reduce the spreading of COVID-19 have resulted in notably clearer skies around the world. In this study, we confirm that reduced levels of air pollution correlate with unusually high levels of clear-sky insolation in Delhi, India. Restrictions here were announced on March 19th, with the nation going into lockdown on March 24th. Comparing insolation data before and after these dates with insolation from previous years (2017 to 2019), we observe an 8.3% ± 1.7% higher irradiance than usual in late March and a 5.9% ± 1.6% higher one in April, while we find no significant differences in values from previous years in February or early March. Using results from a previous study, we calculated the expected increase in insolation based on measured PM2.5 concentration levels. Measurements and calculations agree within confidence intervals, suggesting that reduced pollution levels are a major cause for the observed increase in insolation.