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The UK experienced a national outbreak of mpox (formerly known as monkeypox) disease that started in May, 2022, as did many other countries worldwide, with case numbers rising rapidly, mainly among gay, bisexual, and other men who have sex with men (GBMSM). To control the outbreak, Modified Vaccinia Ankara–Bavaria Nordic (MVA–BN), an attenuated smallpox vaccine, was offered to at-risk GBMSM. We aimed to assess the effectiveness of a single MVA–BN dose against symptomatic mpox disease in at-risk GBMSM. In this case-coverage study, mpox cases in England were sent questionnaires collecting information on demographics, vaccination history, symptoms, and sexual orientation. Returned questionnaires were linked to laboratory data and a public health case management system (HP Zone) to obtain additional information on symptom onset and specimen date. Cases with a rash onset date (or alternative proxy) between July 4 and Oct 9, 2022, were included. Females, heterosexual men, and those with missing vaccination information were excluded. Vaccine effectiveness was calculated using the case-coverage method in which vaccine coverage among cases is compared with coverage in the eligible population, estimated from doses given to GBMSM and the estimated size of at-risk GBMSM. Sensitivity analyses included an increase and decrease of 20% differences in the estimated high-risk GBMSM population size. By Nov 3, 2022, 1102 people had responded to questionnaires, of which 739 were excluded (52 females or self-declared male heterosexuals, 590 with an index date outside of the study period, and 97 missing a vaccination date). 363 cases were included in the analyses. Vaccine uptake among eligible GBMSM increased steadily from July, 2022, reaching 47% by Oct 9, 2022. Of the 363 confirmed cases, eight cases either did occur or were likely to have occurred at least 14 days after vaccination, 32 within 0–13 days after vaccination, and the rest were unvaccinated. The estimated vaccine effectiveness against symptomatic mpox at least 14 days after a single dose was 78% (95% CI 54 to 89) ranging from 71 to 85 in sensitivity analyses. Vaccine effectiveness within 0–13 days after vaccination was –4% (95% CI –50 to 29). A single MVA–BN dose was highly protective against symptomatic mpox disease among at-risk GBMSM, making it a useful tool for mpox outbreak control when rapid protection is needed. For cases in which numbers at highest risk of infection exceed vaccine supply, there might be benefit in prioritising delivery of first doses. UK Health Security Agency.

Coronavirus Disease 2019 (COVID-19) deaths are rare in children and young people (CYP). The high rates of asymptomatic and mild infections complicate assessment of cause of death in CYP. We assessed the cause of death in all CYP with a positive Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) test since the start of the pandemic in England. CYP aged <20 years who died within 100 days of laboratory-confirmed SARS-CoV-2 infection between 01 March 2020 and 31 December 2021 in England were followed up in detail, using national databases, surveillance questionnaires, post-mortem reports, and clinician interviews. There were 185 deaths during the 22-month follow-up and 81 (43.8%) were due to COVID-19. Compared to non-COVID-19 deaths in CYP with a positive SARS-CoV-2 test, death due to COVID-19 was independently associated with older age (aOR 1.06 95% confidence interval (CI) 1.01 to 1.11, p = 0.02) and underlying comorbidities (aOR 2.52 95% CI 1.27 to 5.01, p = 0.008), after adjusting for age, sex, ethnicity group, and underlying conditions, with a shorter interval between SARS-CoV-2 testing and death. Half the COVID-19 deaths (41/81, 50.6%) occurred within 7 days of confirmation of SARS-CoV-2 infection and 91% (74/81) within 30 days. Of the COVID-19 deaths, 61 (75.3%) had an underlying condition, especially severe neurodisability (n = 27) and immunocompromising conditions (n = 12). Over the 22-month surveillance period, SARS-CoV-2 was responsible for 1.2% (81/6,790) of all deaths in CYP aged <20 years, with an infection fatality rate of 0.70/100,000 SARS-CoV-2 infections in this age group estimated through real-time, nowcasting modelling, and a mortality rate of 0.61/100,000. Limitations include possible under-ascertainment of deaths in CYP who were not tested for SARS-CoV-2 and lack of direct access to clinical data for hospitalised CYP. COVID-19 deaths remain extremely rare in CYP, with most fatalities occurring within 30 days of infection and in children with specific underlying conditions.

This thesis is composed of three chapters. Chapter one is a narrative synthesis of 15 research studies exploring the impact of emotionally unstable personality disorder (EUPD) on the mother-infant relationship. Two main themes emerged: Attunement and Self-Awareness. A model is proposed for how these characteristics might interact. It suggests that mothers with EUPD typically perceive themselves to be less competent as parents and consequently experience emotional dysregulation when faced with stressful parenting situations. This dysregulated emotional state makes sensitive and attuned responding more difficult. Recommendations are made for early interventions that focus on improving maternal self-efficacy and emotion regulation. Chapter two is an empirical qualitative study exploring how women who have been diagnosed with EUPD, and have been hospitalised in relation to this diagnosis, incorporate these experiences into their identity. A Constructivist Grounded Theory approach was used to analyse the interviews of nine participants and to develop a theoretical model of their experiences. Five pairs of core categories reflected polarised experiences of diagnosis and hospitalisation: Validation vs. Confusion; Connection vs. Rejection; Something happened to me vs. Something wrong with me; Me vs. EUPD; and Direction vs. Hopelessness. Three overarching factors interacted with these categories to influence whether EUPD diagnosis and hospitalisation were incorporated into identity in a way that was helpful or harmful: Response of Others, Process of Diagnosis and Identity Fluctuation. Recommendations are made for how professionals should approach diagnosis, with a focus on providing knowledge, empowering service-users and understanding the individual meaning of diagnosis for each person. The final chapter is a reflective paper, which explores the author's journey through the empirical research process. Using concepts from the Power Threat Meaning Framework (PTMF) the author has considered how different stages of the process influenced their position as an academic and clinician. This highlighted the overlap between these roles and identified important ways in which learning from the research experience can be applied in clinical practice.

Over the past decade research on urban thermal inequity has grown, with a focus on denser built environments. In this letter we examine thermal inequity associated with climate change impacts and changes to urban form in a comparatively socio-economically disadvantaged Australian suburb. Local urban densification policies designed to counteract sprawl have reduced block sizes, increased height limits, and diminished urban tree canopy cover (UTC). Little attention has been given to the combined effects of lower UTC and increased heat on disadvantaged residents. Such impacts include rising energy expenditure to maintain thermal comfort (i.e. cooling dwellings). We used a survey of residents (n = 230) to determine their perceptions of climate change impacts; household energy costs; household thermal comfort practices; and dispositions towards using green infrastructure to combat heat. Results suggest that while comparatively disadvantaged residents spend more on energy as a proportion of their income, they appear to have reduced capacity to adapt to climate change at the household scale. We found most residents favoured more urban greening and supported tree planting in local parks and streets. Findings have implications for policy responses aimed at achieving urban climate justice.

Molluscs are a highly speciose phylum that exhibits an astonishing array of colours and patterns, yet relatively little progress has been made in identifying the underlying genes that determine phenotypic variation. One prominent example is the land snail Cepaea nemoralis for which classical genetic studies have shown that around nine loci, several physically linked and inherited together as a ‘supergene’, control the shell colour and banding polymorphism. As a first step towards identifying the genes involved, we used whole-genome resequencing of individuals from a laboratory cross to construct a high-density linkage map, and then trait mapping to identify 95% confidence intervals for the chromosomal region that contains the supergene, specifically the colour locus (C), and the unlinked mid-banded locus (U). The linkage map is made up of 215,593 markers, ordered into 22 linkage groups, with one large group making up ~27% of the genome. The C locus was mapped to a ~1.3 cM region on linkage group 11, and the U locus was mapped to a ~0.7 cM region on linkage group 15. The linkage map will serve as an important resource for further evolutionary and population genomic studies of C. nemoralis and related species, as well as the identification of candidate genes within the supergene and for the mid-banding phenotype.