Search

Background: Defining healthcare facility catchment areas is a key step in predicting future healthcare demand in epidemic settings. Forecasts of hospitalisations can be informed by leading indicators measured at the community level. However, this relies on the definition of so-called catchment areas or the geographies whose populations make up the patients admitted to a given hospital, which are often not well-defined. Little work has been done to quantify the impact of hospital catchment area definitions on healthcare demand forecasting. Methods: We made forecasts of local-level hospital admissions using a scaled convolution of local cases (as defined by the hospital catchment area) and delay distribution. Hospital catchment area definitions were derived from either simple heuristics (in which people are admitted to their nearest hospital or any nearby hospital) or historical admissions data (all emergency or elective admissions in 2019, or COVID-19 admissions), plus a marginal baseline definition based on the distribution of all hospital admissions. We evaluated predictive performance using each hospital catchment area definition using the weighted interval score and considered how this changed by the length of the predictive horizon, the date on which the forecast was made, and by location. We also considered the change, if any, in the relative performance of each definition in retrospective vs. real-time settings, or at different spatial scales. Results: The choice of hospital catchment area definition affected the accuracy of hospital admission forecasts. The definition based on COVID-19 admissions data resulted in the most accurate forecasts at both a 7- and 14-day horizon and was one of the top two best-performing definitions across forecast dates and locations. The "nearby" heuristic also performed well, but less consistently than the COVID-19 data definition. The marginal distribution baseline, which did not include any spatial information, was the lowest-ranked definition. The relative performance of the definitions was larger when using case forecasts compared to future observed cases. All results were consistent across spatial scales of the catchment area definitions. Conclusions: Using catchment area definitions derived from context-specific data can improve local-level hospital admission forecasts. Where context-specific data is not available, using catchment areas defined by carefully chosen heuristics is a sufficiently good substitute. There is clear value in understanding what drives local admissions patterns, and further research is needed to understand the impact of different catchment area definitions on forecast performance where case trends are more heterogeneous. [ABSTRACT FROM AUTHOR]

Next generation influenza vaccines are in development and have the potential for widespread health and economic benefits. Determining the potential health and economic impact for these vaccines is needed to drive investment in bringing these vaccines to the market, and to inform which groups public health policies on influenza vaccination should target. We used a mathematical modelling approach to estimate the epidemiological impact and cost-effectiveness of next generation influenza vaccines in England and Wales. We used data from an existing fitted model, and evaluated new vaccines with different characteristics ranging from improved vaccines with increased efficacy duration and breadth of protection, to universal vaccines, defined in line with the World Health Organisation (WHO) Preferred Product Characteristics (PPC). We calculated the cost effectiveness of new vaccines in comparison to the current seasonal vaccination programme. We calculated and compared the Incremental Cost-Effectiveness Ratio and Incremental Net Monetary Benefit for each new vaccine type. All analysis was conducted in R. We show that next generation influenza vaccines may result in a 21% to 77% reduction in influenza infections, dependent on vaccine characteristics. Our economic modelling shows that using any of these next generation vaccines at 2019 coverage levels would be highly cost-effective at a willingness to pay threshold of £20,000 for a range of vaccine prices. The vaccine threshold price for the best next generation vaccines in £-2019 is £230 (95%CrI £192 - £269) per dose, but even minimally-improved influenza vaccines could be priced at £18 (95%CrI £16 - £21) per dose and still remain cost-effective. This evaluation demonstrates the promise of next generation influenza vaccines for impact on influenza epidemics, and likely cost-effectiveness profiles. We have provided evidence towards a full value of vaccines assessment which bolsters the investment case for development and roll-out of next-generation influenza vaccines. [ABSTRACT FROM AUTHOR]

Devices which are used to determine firmness of non-destructive nature do not penetrate the skin or damage the underlying flesh of the fruit and do provide real-time results, avoid raw biomass loss and allow the testing of every individual fruit and repeated testing of the same fruit, thus providing many advantages for researchers and the industry alike. Contrarily, destructive methods puncture the fruit and thus only a subsample, selected to represent all fruit, can be tested. In addition, different operators can generate quite different values for the same fruit using a hand-held penetrometer. Hass avocado from two commercial orchards was collected, and fruit firmness was measured at harvest, during two storage conditions controlled atmosphere (CA) and regular air (RA), during shelf-life and at the ready-to-eat stage using both destructive (Fruit Pressure Tester, mod. FT327, Wagner Instruments, Greenwich, USA) and non-destructive devices (Model TA.XT plusC, Stable Micro Systems Ltd, England). Then, the mathematical relationship between these two devices was assessed using Spearman Correlation coefficient (rho) and p-values adjusted by Benjamini-Hochberg and Bonferroni procedures. Thus, 3,200 fruits were evaluated during two harvests and two subsequent seasons. A moderate and positive association between destructive and non-destructive devices was found (rho coefficient ranging from 0.41 to 0.51). The variance explained by the regression models ranged from 0.53 to 0.63; all of them were significant with good accuracies (i.e., 0.79; 0.78; 0.73; 0.76). The results prompt us to conclude that a non-destructive texture analyser device can be used to accurately predict firmness measured by a penetrometer in Hass avocado fruit and contribute to avoiding fruit discards. [ABSTRACT FROM AUTHOR]

The recovery of elective waiting lists represents a major challenge and priority for the health services of many countries. In England's National Health Service (NHS), the waiting list has increased by 45% in the two years since the COVID-19 pandemic was declared in March 2020. Long waits associate with worse patient outcomes and can deepen inequalities and lead to additional demands on healthcare resources. Modelling the waiting list can be valuable for both estimating future trajectories and considering alternative capacity allocation strategies. However, there is a deficit within the current literature of scalable solutions that can provide managers and clinicians with hospital and specialty level projections on a routine basis. In this paper, a model representing the key dynamics of the waiting list problem is presented alongside its differential equation based solution. Versatility of the model is demonstrated through its calibration to routine publicly available NHS data. The model has since been used to produce regular monthly projections of the waiting list for every hospital trust and specialty in England. [ABSTRACT FROM AUTHOR]

Background: To reduce the coronavirus disease burden in England, along with many other countries, the government implemented a package of non-pharmaceutical interventions (NPIs) that have also impacted other transmissible infectious diseases such as norovirus. It is unclear what future norovirus disease incidence is likely to look like upon lifting these restrictions.Methods: Here we use a mathematical model of norovirus fitted to community incidence data in England to project forward expected incidence based on contact surveys that have been collected throughout 2020-2021.Results: We report that susceptibility to norovirus infection has likely increased between March 2020 and mid-2021. Depending upon assumptions of future contact patterns incidence of norovirus that is similar to pre-pandemic levels or an increase beyond what has been previously reported is likely to occur once restrictions are lifted. Should adult contact patterns return to 80% of pre-pandemic levels, the incidence of norovirus will be similar to previous years. If contact patterns return to pre-pandemic levels, there is a potential for the expected annual incidence to be up to 2-fold larger than in a typical year. The age-specific incidence is similar across all ages.Conclusions: Continued national surveillance for endemic diseases such as norovirus will be essential after NPIs are lifted to allow healthcare services to adequately prepare for a potential increase in cases and hospital pressures beyond what is typically experienced. [ABSTRACT FROM AUTHOR]

Background and Aims: People who inject drugs (PWID) are at high risk of hepatitis C virus (HCV) infection; however, ~50% are undiagnosed in England and linkage‐to‐care is poor. This study investigated the cost‐effectiveness of an intervention (HepCATT) to improve case‐finding and referral to HCV treatment compared with standard‐of‐care pathways in drug treatment centres in England. Design HCV transmission and disease progression model with cost‐effectiveness analysis using a health‐care perspective. Primary outcome and cost data from the HepCATT study parameterized the intervention, suggesting that HepCATT increased HCV testing in drug treatment centres 2.5‐fold and engagement onto the HCV treatment pathway 10‐fold. A model was used to estimate the decrease in HCV infections and HCV‐related deaths from 2016, with costs and health benefits (quality‐adjusted life‐years or QALYs) tracked over 50 years. Univariable and probabilistic sensitivity analyses (PSA) were undertaken. Setting: England‐specific epidemic with 40% prevalence of chronic HCV among PWID. Participants: PWID attending drug treatment centres. Intervention: Nurse facilitator in drug treatment centres to improve the HCV care pathway from HCV case‐finding to referral and linkage to specialist care. Comparator was the standard‐of‐care HCV care pathway. Measurements Incremental cost‐effectiveness ratio (ICER) in terms of cost per QALY gained through improved case‐finding. Findings Over 50 years per 1000 PWID, the HepCATT intervention could prevent 75 (95% central interval 37–129) deaths and 1330 (827–2040) or 51% (30–67%) of all new infections. The mean ICER was £7986 per QALY gained, with all PSA simulations being cost‐effective at a £20 000 per QALY willingness‐to‐pay threshold. Univariable sensitivity analyses suggest the intervention would become cost‐saving if the cost of HCV treatment reduces to £3900. If scaled up to all PWID in England, the intervention would cost £8.8 million and decrease incidence by 56% (33–70%) by 2030. Conclusions: Increasing hepatitis C virus infection case‐finding and treatment referral in drug treatment centres could be a highly cost‐effective strategy for decreasing hepatitis C virus incidence among people who inject drugs. [ABSTRACT FROM AUTHOR]

Background: Following centralisation of UK paediatric intensive care units in 1997, specialist paediatric intensive care retrieval teams (PICRTs) were established to transport critically ill children from district general hospitals (DGHs). The current location and catchment area of PICRTs covering England and Wales are based on historical referral patterns. National quality standards specify that PICRTs should reach the patient bedside within 3 hours of accepting a referral.Objective: To determine what proportion of demand for PICRT services in England and Wales can be reached within 3 hours and to explore the potential coverage impact of more stringent 'time to bedside' standards.Methods: We used mathematical location-allocation methods to: (1) determine the optimal allocation of DGHs to current PICRT locations to minimise road journey time and calculated the proportion of demand reachable within 3 hours, 2 hours, 90 min, 75 min and 1 hour and (2) explore the impact of changing the number and location of PICRTs on demand coverage for the different time thresholds.Results: For current (and optimal) location of 11 PICRTs, 98% (98%) of demand is reachable within 3 hours; 86% (91%) within 2 hours; 59% (69%) within 90 min; 33% (39%) within 75 min; and 20% (20%) within 1 hour. Five hospitals were not reachable within 3 hours. For the 3-hour standard, eight optimally located PICRT locations had similar coverage as the current 11 locations.Conclusions: If new evidence supports reduction in the time to bedside standard, many more hospitals will not be adequately covered. Location-allocation optimisation is a powerful technique for supporting evidence-based service configuration. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the cost‐effectiveness of needle and syringe programmes (NSPs) compared with no NSPs on hepatitis C virus (HCV) transmission in the United Kingdom. Design Cost‐effectiveness analysis from a National Health Service (NHS)/health‐provider perspective, utilizing a dynamic transmission model of HCV infection and disease progression, calibrated using city‐specific surveillance and survey data, and primary data collection on NSP costs. The effectiveness of NSPs preventing HCV acquisition was based on empirical evidence. Setting and participants: UK settings with different chronic HCV prevalence among people who inject drugs (PWID): Dundee (26%), Walsall (18%) and Bristol (45%) Interventions: Current NSP provision is compared with a counterfactual scenario where NSPs are removed for 10 years and then returned to existing levels with effects collected for 40 years. Measurements HCV infections and cost per quality‐adjusted life year (QALY) gained through NSPs over 50 years. Findings Compared with a willingness‐to‐pay threshold of £20 000 per QALY gained, NSPs were highly cost‐effective over a time‐horizon of 50 years and decreased the number of HCV incident infections. The mean incremental cost‐effectiveness ratio was cost‐saving in Dundee and Bristol, and £596 per QALY gained in Walsall, with 78, 46 and 40% of simulations being cost‐saving in each city, respectively, with differences driven by coverage of NSP and HCV prevalence (lowest in Walsall). More than 90% of simulations were cost‐effective at the willingness‐to‐pay threshold. Results were robust to sensitivity analyses, including varying the time‐horizon, HCV treatment cost and numbers of HCV treatments per year. Conclusions: Needle and syringe programmes are a highly effective low‐cost intervention to reduce hepatitis C virus transmission, and in some settings they are cost‐saving. Needle and syringe programmes are likely to remain cost‐effective irrespective of changes in hepatitis C virus treatment cost and scale‐up. [ABSTRACT FROM AUTHOR]

Background: Antibiotic-resistant bacteria (ARB) are selected by the use of antibiotics. The rational design of interventions to reduce levels of antibiotic resistance requires a greater understanding of how and where ARB are acquired. Our aim was to determine whether acquisition of ARB occurs more often in the community or hospital setting.Methods: We used a mathematical model of the natural history of ARB to estimate how many ARB were acquired in each of these two environments, as well as to determine key parameters for further investigation. To do this, we explored a range of realistic parameter combinations and considered a case study of parameters for an important subset of resistant strains in England.Results: If we consider all people with ARB in the total population (community and hospital), the majority, under most clinically derived parameter combinations, acquired their resistance in the community, despite higher levels of antibiotic use and transmission of ARB in the hospital. However, if we focus on just the hospital population, under most parameter combinations a greater proportion of this population acquired ARB in the hospital.Conclusions: It is likely that the majority of ARB are being acquired in the community, suggesting that efforts to reduce overall ARB carriage should focus on reducing antibiotic usage and transmission in the community setting. However, our framework highlights the need for better pathogen-specific data on antibiotic exposure, ARB clearance and transmission parameters, as well as the link between carriage of ARB and health impact. This is important to determine whether interventions should target total ARB carriage or hospital-acquired ARB carriage, as the latter often dominated in hospital populations. [ABSTRACT FROM AUTHOR]

This paper considers the erodible river corridor, which is the area in which the main river channel is free to migrate over a period of time. Due to growing anthropogenic pressure, predicting the corridor width has become increasingly important for the planning of development along rivers. Several approaches can be used to predict the future erodible corridor width but the results possess a large degree of uncertainty in all cases. The work presented here addresses prediction of the erodible corridor width of a reach of the River Irwell, UK, taking into account the uncertainty that arises from input parameters such as representative discharge, channel width, sediment and so on. The work adopts a probabilistic framework for assessment using Monte Carlo type simulations. Future river corridor width predictions, based on a model calibrated on past observations, are presented in a probabilistic manner using confidence levels. The results indicate the necessity of capturing input variability in the modelling process. Furthermore, the understanding gained from a relatively simple model used in a probabilistic framework is greater than a more complex one where only a few runs are feasible. [ABSTRACT FROM AUTHOR]

The necessity of accounting for small-strain behaviour of soils in numerical analyses of the serviceability limit states of geotechnical structures is well established both nationally and internationally. This has led to further development of appropriate soil constitutive models, as well as to further advances in accurate laboratory measurements of small-strain stiffness. The current paper considers recent laboratory research into the behaviour of London Clay, performed at Imperial College in conjunction with the major ground works for Heathrow Terminal 5 in London, UK. This research has shown the small-strain response of London Clay to be different to that assumed previously and in particular to that determined from good-quality commercial experiments. Both sets of small-strain stiffness data are applied in this paper in finite-element analyses of a deep excavation and a tunnel construction in London Clay, with the objective of investigating their effect on predicted ground movements. [ABSTRACT FROM AUTHOR]

The 7th UK Young Coastal Scientists and Engineers Conference welcomed 60 scientists and engineers to come together and discuss coastal research. The conference was hosted by the National Oceanography Centre in Liverpool, 30-31 March 2011. Early career practitioners and researchers presented 42 short papers on a range of topics driven by current issues addressed by UK universities, government agencies and consultancies. Although all presentations had a coastal theme, content varied from small-scale processes to regional-scale monitoring and management, covering topics such as structure impact, sediment transport, morphology, waves, currents, ecology, oxygen, estuarine systems, stratification, modelling, observation, ice, renewables and extreme events. This paper presents the keynote lecture and six abstracts considered to be of particular merit by the panel of judges. The conference continues to travel the UK and will be held at Bangor University in 2012. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Low risk HPV types 6/11 are responsible for some low-grade cytological abnormalities. Most economic analyses of HPV vaccination have estimated the additional benefit of HPV 6/11 protection by the quadrivalent vaccine, over the bivalent, based on reduction of genital warts but have not included reduction in repeat smears and colposcopies due to low-grade abnormalities. We investigate the contribution of HPV types 6/11 to abnormal smears and associated costs in England. Methods: The risk of borderline or mild dysplasia due to HPV 6/11 infection was estimated from a study of type-specific HPV DNA in cervical screening specimens collected throughout England. A Markov model representing 10 million women with HPV 6/11 or with no HPV infection from 24 to 64 years was developed to estimate the number of abnormal smears, subsequent repeat smears and colposcopies due to HPV 6/11 associated with borderline or mild dysplasia. Fitting was achieved by varying the force of infection, probability of borderline or mild dysplasia if HPV-uninfected or infected with HPV 6/11 and the duration of infection. Results: The relative risks of borderline or mild dysplasia when infected with HPV 6/11 compared to not being HPV infected were 6.32 (95% credible interval 1.56–25.6) and 17.5 (1.02–300) respectively. Using best fitting parameters we find the costs incurred are between £170 and £195 per abnormal smear due to infection with HPV 6/11. Conclusions: In England, the impact of cytological abnormalities due to HPV 6/11 is relatively small, but not negligible. A vaccine that protects against HPV 6/11 infections could reduce costs associated with borderline and mild dysplasia, and associated colposcopies. These benefits should be considered when formulating immunisation policy, if possible. Smears and colposcopies in those uninfected with HPV far outnumber those in women infected with HPV 6/11. [Copyright &y& Elsevier]

Abstract: The core idea of complexity science – namely how macroscopic phenomena emerge from the interactions between microscopic quantities – is particularly relevant to the study of the human brain. It is in this context that the term “BrainModes” was adopted to explore how cooperative phenomena (or ‘modes’ of activity) occurring at one spatial or temporal scale give rise to coherent structures at other scales. This Special Issue reports the 2009 BrainModes Workshop, held in Bristol (December 2009) which focussed on the fusion of theoretical, computational, experimental and clinical methods for enhancing our understanding of the role played by neuronal oscillations in healthy and diseased brain states. [Copyright &y& Elsevier]

Abstract: This paper highlights the growing need for a realistic crowd simulation in the design of large venues such as concert halls and stadia. A discrete element method (DEM) technique for modelling crowd dynamics has been developed that represents each person within the model as 3 overlapping circles, a position, orientation and velocity in 2D. Contact forces between elements are included in the model as well as psychological forces, motive forces and moments. The motion of each person is then modelled in a Newtonian manner with a numerical integration time-stepping scheme. The model has been shown previously to work well in predicting egress. In this paper the predicted model behaviour is compared to actual video footage shot at various locations around University Park Campus, Nottingham. It did not match well to the video footage when people are moving towards each other, as in cases of contra-flow on a walkway. In order to improve the model, a general algorithm for ‘avoidance’ was included which appeared to make the model significantly more realistic in these cases. The paper also shows areas for further potential development, such as incorporating people into associative groups such as family or friends. [Copyright &y& Elsevier]

The River Ver, a chalk stream in Hertfordshire, was identified as one of the 'top 40' low-flow rivers of England and Wales in 1992, and measures to improve flows were subsequently proposed under an alleviation of low flows (ALF) scheme. Consequently, the largest groundwater abstraction within the catchment at Friars Wash was closed, other than for emergencies. The impact of this closure on river flows as measured at a gauge near the outlet of the Ver catchment is evaluated. A range of methods was employed: analyses of hydrographs, flow duration curves, flow percentiles, baseflow index, correlations with data from an analogous catchment and rainfall-runoff modelling. Results suggest an apparent increase in river flow in the 11 years since the closure at Friars Wash; however, this cannot be attributed entirely to the ALF scheme. Further modelling investigations are recommended to support the assessment and to allow more localised effects on stream flow to be investigated. [ABSTRACT FROM AUTHOR]

The front-shunt tunnel was the first tunnel of the Terminal 5 project at Heathrow to be constructed, and was the first section of sprayed-concrete-lined (SCL) tunnel to be constructed using the method known as LaserShell. This innovation represented a significant deviation from the methods previously used in SCL construction. Therefore it was subjected to a careful examination before and during construction using sophisticated 3D numerical modelling and monitoring during construction. The paper presents typical results from surface settlement levelling, inclinometers and extensometers, pressure cells and tunnel lining displacement measurements, and comments on the performance of the methods and instruments used. The paper then presents the methodology and typical results of the numerical modelling, and shows that the predictions of displacements and stresses compared well with the field measurements. In terms of the control of ground deformations and structural safety the tunnel performed well. [ABSTRACT FROM AUTHOR]

This paper presents the hierarchy of transport models that has been developed in the West Midlands to support policy-making by metropolitan authorities. Transport policies and schemes-which cost money, have both positive and negative impacts on different parts of the population, and must be assessed on a wider set of criteria, including the impacts on economy, safety and the environment-are increasingly questioned by the public. By transferring state-of-the-art academic developments into practice, validated by real-life observations, the toolkit enables engineering solutions and non-intrusive transport policies to be tested using a robust, comprehensive and integrated set of methods. The visualisation capabilities of the toolkit ease the involvement of non-experts, such as the business community and the public. [ABSTRACT FROM AUTHOR]

The article investigates whether the hypothesis for simplification to a parabolic system without the effect of currents and inshore wind is valid for directional random sea states which occur naturally. The additional and important effects of white-capping, depth-induced breaking and bed friction are represented empirically and may be included in either elliptic or parabolic solvers. Application to the complex coastal bathymetry off East Anglia, England indicates that inshore wave climate is generally only slightly affected by the degree of directionality, tidal currents, and wind forcing over the propagation region.

Self-instigated isolation is heavily relied on to curb severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. Accounting for uncertainty in the latent and prepatent periods, as well as the proportion of infections that remain asymptomatic, the limits of this intervention at different phases of infection resurgence are estimated. We show that by October 2020, SARS-CoV-2 transmission rates in England had already begun exceeding levels that could be interrupted using this intervention alone, lending support to the second national lockdown on 5th November 2020.

By mid-May 2020, cases of COVID-19 in the UK had been declining for over a month; a multi-phase emergence from lockdown was planned, including a scheduled partial reopening of schools on 1 June 2020. Although evidence suggests that children generally display mild symptoms, the size of the school-age population means the total impact of reopening schools is unclear. Here, we present work from mid-May 2020 that focused on the imminent opening of schools and consider what these results imply for future policy. We compared eight strategies for reopening primary and secondary schools in England. Modifying a transmission model fitted to UK SARS-CoV-2 data, we assessed how reopening schools affects contact patterns, anticipated secondary infections and the relative change in the reproduction number, R . We determined the associated public health impact and its sensitivity to changes in social distancing within the wider community. We predicted that reopening schools with half-sized classes or focused on younger children was unlikely to push R above one. Older children generally have more social contacts, so reopening secondary schools results in more cases than reopening primary schools, while reopening both could have pushed R above one in some regions. Reductions in community social distancing were found to outweigh and exacerbate any impacts of reopening. In particular, opening schools when the reproduction number R is already above one generates the largest increase in cases. Our work indicates that while any school reopening will result in increased mixing and infection amongst children and the wider population, reopening schools alone in June 2020 was unlikely to push R above one. Ultimately, reopening decisions are a difficult trade-off between epidemiological consequences and the emotional, educational and developmental needs of children. Into the future, there are difficult questions about what controls can be instigated such that schools can remain open if cases increase. This article is part of the theme issue 'Modelling that shaped the early COVID-19 pandemic response in the UK'.

Chickenpox is caused by varicella-zoster-virus (VZV) and is highly contagious. Immigration detention settings are a high-risk environment for primary VZV transmission, with large, rapidly-changing populations in close quarters, and higher susceptibility among non-UK-born individuals. During outbreaks, operational challenges occur in detention settings because of high-turnover and the potential need to implement population movement restriction for prolonged periods. Between December 2017 and February 2018, four cases of chickenpox were notified amongst 799 detainees in an immigration removal centre (IRC). Microbiological investigations included case confirmation by vesicular fluid polymerase chain reaction, and VZV serology for susceptibility testing. Control measures involved movement restrictions, isolation of cases, quarantining and cohorting of non-immune contacts and extending VZV immunity testing to the wider detainee population to support outbreak management. Immunity was tested for 301/532 (57%) detainees, of whom 24 (8%) were non-immune. The level of non-immunity was lower than expected based on the existing literature on VZV seroprevalence in detained populations in England. Serology results identified non-immune contacts who could be cohorted and, due to the lack of isolation capacity, allowed the placement of cases with immune detainees. The widespread immunity testing of all detainees was proving challenging to sustain because it required significant resources and was having a severe impact on operational capacity and the ability to maintain core business activities at the IRC. Therefore, mathematical modelling was used to assess the impact of scaling back mass immunity testing. Modelling demonstrated that interrupting testing posed a risk of one additional case compared to continuing with testing. As such, the decision was made to stop testing, and the outbreak was successfully controlled without excessive strain on resources. Operational challenges generated learning for future outbreaks, with implications for a local and national policy on IRC staff occupational health requirements, and proposed reception screening of detainees for VZV immunity.

Domestic Energy Performance Certificates (EPCs) are used in the UK to provide energy efficiency ratings for use in policy and investment decisions on individual dwellings and at a stock level. There is evidence that the process of creating an EPC introduces measurement error such that repeat assessments of the same property give different ratings, compromising their reliability. This study presents a novel error analysis to estimate the size of this effect, using repeated EPC assessments of 1.6 million existing dwellings in England and Wales. A statistical model of how measurement error contributes to variation between repeated measurements is set out, and exploratory data analysis is used to decide how to apply this model to the available data. The results predict that the one standard deviation measurement error decreases with EPC rating, from around ± 8.0 EPC points on a rating of 35 to ±2.4 on a rating of 85. This predicted error is higher than the limit recommended in UK guidance except in very efficient buildings; it can also result in dwellings being rated in the wrong EPC band, for example it was estimated that 24% of band D homes are rated as band C. [ABSTRACT FROM AUTHOR]