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Despite use of 23-valent pneumococcal polysaccharide vaccine (PPV23) in England, disease burden among at-risk adults remains high. We evaluated the public health and budgetary impact of 20-valent pneumococcal conjugate vaccine (PCV20) compared to the current adult pneumococcal vaccination program.Five-year outcomes and costs of invasive pneumococcal disease (IPD) and community-acquired pneumonia (CAP) among adults aged 65-99 years and adults aged 18-64 years with underlying conditions in England were projected using a deterministic cohort model. Hypothetical vaccination with PCV20 versus PPV23 was compared from the National Health Service (NHS) perspective.Replacing PPV23 with PCV20 would prevent 785 IPD hospitalizations, 11,751 CAP hospitalizations, and 1,414 deaths over 5 years, and would reduce medical care costs by £48.5 M. With vaccination costs higher by £107.2 M, projected net budgetary impact is £58.7 M. The budgetary impact would be greatest in year 1 (£26.3 M), and would decrease over time (to £1.6 M by year 5). The average budget increase (£11.7 M/year) represents0.01% of the Department of Health and Social Care total budget and3% of the vaccine budget.Use of PCV20 among adults currently eligible for PPV23 in England would substantially reduce the burden of pneumococcal disease, with modest budgetary impact.

Due to the global COVID-19 pandemic, higher education and library instruction made the quick and necessary pivot to remote delivery. This report discusses one librarian's efforts to address student learning needs, negotiate disciplinary faculty needs, and provide just-in-time instruction for a Nursing department that lacked a full-time subject specialist librarian for several years. A multi-pronged approach was adopted to ensure students had access to course-specific instructional materials presented on a YouTube-inspired channel, research appointments, and the ability to contact the embedded subject librarian. Next steps, improvements, assessments, and future sustainability are considered.

This study investigated dental hospitalisations in Western Australian (WA) children with intellectual disability (ID) and/or autism spectrum disorder (ASD) aged up to 18 years.Data on WA live births from 1983 to 2004 from the WA Midwives Notification System were linked to the Intellectual Disability Exploring Answers database, the WA Hospital Morbidity Data System, and the Western Australian Birth Defects Registry databases. Children were followed from birth to 2010 and the data grouped into three age-groups. Primary and secondary admissions for relevant dental diagnoses were identified and factors associated with having a dental hospitalisation investigated.There were 1366, 1596, and 780 dental hospitalisations amongst 1122, 1154, and 609 children with ID and/or ASD in the 0-6,6-12, and12-18 year age groups, respectively. Children with severe ID were much more likely to be hospitalised than those with mild/moderate ID. More socioeconomically disadvantaged children were less likely to be hospitalised than children whose parents were socially advantaged.There is concern that more vulnerable children in the WA community with ID or ASD are receiving an inadequate level of dental services compared with other groups resulting in potentially preventable hospitalisations, a situation in need of urgent remediation.Implications for rehabilitationLittle is known about why some children with intellectual disability (ID) or autism are being hospitalised for their dental care and others are not.Children with disability whose families are socioeconomically disadvantaged should have equivalent opportunity to receive optimal dental care.Dental practitioners at all levels need training and confidence in treating children with ID.

INTRODUCTION: Immunosenescence is a normal biologic process involving deterioration of protective immune responses. Consequently, older adults experience increased risk of infectious diseases, particularly pneumonia, and its leading bacterial cause, Streptococcus pneumoniae. Pneumococcal vaccine recommendations are often limited to adults with specific medical conditions despite similar disease risks among older adults due to immunosenescence. AREAS COVERED: This article reviews epidemiologic, biologic, and clinical evidence supporting the consideration of older age due to immunosenescence as an immunocompromising condition for the purpose of pneumococcal vaccine policy and the role vaccination can play in healthy aging. EXPERT OPINION: Epidemiologic and biologic evidence suggest that pneumococcal disease risk increases with age and is comparable for healthy older adults and younger adults with immunocompromising conditions. Because immunocompromising conditions are already indicated for pneumococcal conjugate vaccines (PCVs), a comprehensive public health strategy would also recognize immunosenescence. Moreover, older persons should be vaccinated before reaching the highest risk ages, consistent with the approach for other immunocompromising conditions. To facilitate PCV use among older adults, vaccine technical committees (VTCs) could classify older age as an immunocompromising condition based on the process of immunosenescence. With global aging, VTCs will need to consider immunosenescence and vaccine use during healthy aging.

Does recreational marijuana legalization have the potential to transform urban spaces? Using Denver’s “Green Mile” as a case study, this study explores the potential for marijuana legalization to e...

Laacke et al. (2021) argue that an extended concept of patient autonomy—Health-Related Digital Autonomy (HRDA)—is required to address the autonomy-related ethical challenges associated with the pot...

Estimating premorbid cognitive ability is an essential part of assessment as well as being an important consideration in research. The most widely used approach to premorbid assessment, The National Adult Reading Test (NART), relies on word reading ability. However, this can be problematic in patients where communication is impaired. This research assessed the effectiveness of a receptive vocabulary test, the British Picture Vocabulary Scale II (BPVS) as an alternative. Correlations were found between the BPVS, NART and the Weschler Abbreviated Scale of Intelligence (WASI) in 87 healthy participants. Regression equations were calculated relating NART and BPVS raw scores to IQ scores in the healthy sample. WASI, NART and BPVS scores were also obtained in19 patients with varying neurological aetiology as part of their routine assessment. Results showed that 18 out of 19 patients obtained BPVS derived IQ scores similar to or higher than their WASI IQ. Whereas mean BPVS derived IQ did not differ significantly between the standardisation and clinical samples, WASI IQ scores were lower in the patient group. The findings suggest that the BPVS II ‘holds’ after acquired cognitive impairment and is a promising alternative method for estimating premorbid IQ in patients who have difficulties reading or verbalising.

The purpose of this study is to explore the impact of New Public Management (NPM) reform on customers’ perceptions of service quality. This study uses a mixed methods research design. For quantitat...

Prior to implementation of Haemophilus influenzae type b (Hib)-conjugate vaccination programs in the 1990s, Hib was the commonest cause of bacterial meningitis in children aged

Six Delta is a six-dimensional independent platform for outcome-based pricing/contracting. The sixth dimension (δ6) estimates prices on the basis of adherence to the prescribed regimen, whereby man...

What happens after deportation? What contexts must Mexican deportees navigate and contend with after removal from the United States? This article explores the challenges for people postremoval in M...

Six Delta is a six-dimensional independent platform for outcome-based pricing/contracting. The second dimension (δ2) estimates prices on the basis of four willingness-to-pay (WTP) thresholds. We de...

Six Delta is a six-dimensional independent platform for outcome-based pricing/contracting. The fifth dimension (δ5) estimates prices on the basis of the risk of efficacy failure of a drug. We descr...

Six Delta is a six-dimensional independent platform for outcome-based pricing/contracting. The fourth dimension (δ4) estimates prices on the basis of assessments of the safety of the drug using an ...

Six Delta is a six-dimensional independent platform for outcome-based pricing/contracting. The first dimension (δ1) estimates prices on the basis of cost-effectiveness (CEA) and cost-utility analys...

The Aboriginal stone arrangements of Australia’s northwest Pilbara region are cultural features of considerable interest to Australian scholars. Despite decades of investigation, the function and p...

Allogenic stem cell transplantation (HCT) is a potentially curative treatment for patients with various hematologic malignancies. Following HCT it is common practice to assess peripheral blood sort...

This collection explores rock art of the Mississippian region, particularly the cosmograms found in most surviving art and their connections to the surrounding landscape. It covers modern-day Misso...

Purpose Pelvic floor dysfunction is a common and heterogenous condition with numerous clinical manifestations, making the optimal management challenging. The traditional single-specialty approach may fail to address its complex nature. Currently, there are no published data on the impact of joint pelvic floor multidisciplinary team (MDT) meetings on patient management. Patients and methods This study represents a retrospective analysis of prospectively collected data on female patients discussed at a joint pelvic floor MDT over a 12-month period in a tertiary referral center. Results One hundred fifty-two cases were included with a median age of 55 years (range 18-83) and a BMI of 32 kg/m2 (range 17-58). Lower urinary tract dysfunction was the predominant symptom in 75% (114/152). The pelvic organ prolapse symptom of a vaginal bulge was present in 11% (17/152). All cases of vaginal prolapse were accompanied by either urinary incontinence, 59% (10/17), or obstructive defecation, 41% (7/17). Fecal incontinence was recorded in 10% (15/152). Mesh-related complications were reported in 3% (4/152). The MDT recommended a change in the initial management plan in 20% (31/152) of cases, of whom 80% (25/31) were patients with complex urinary incontinence. The MDT agreed a change in the primary care team in 16% (25/152) of cases. Conclusion There is an increasing regulatory requirement for patients with pelvic floor dysfunction to be discussed in an MDT setting. Findings demonstrate that joint pelvic floor MDT meetings are feasible and contribute to a change in the management of complex patients.

Research and practice aimed at enhancing community resilience to disasters such as hurricanes have focused primarily on the survival of individuals and the development of social capital and network...

Starting an insurgency is extremely risky because, in the process of “rising up,” the status quo is contested and the state’s legitimacy to wield power is directly challenged,1 often violently, the...