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Among more than 35,000 health care workers, those who received two doses of BNT162b2 vaccine had a high level of protection against Covid-19, regardless of the between-dose interval, but efficacy began to wane after 6 months. Immunity in vaccinated, previously infected persons was more effective and durable (>1 year) than that in vaccinated persons who had not been infected.

Incarcerated students, especially women and Indigenous Australians in custody, are among the most marginalized, oppressed, and invisible identities in Australian society today. These prison-based university students experience not only multi-layered disadvantages that derive from intersecting experiences of oppression, including race, gender, and class, but they are also further disadvantaged by the experience of incarceration itself, despite their attempts to improve their life chances and social positioning through distance education. This is partly due to the challenges of learning within prison environments, including disruptions, disparities, and disconnections in terms of access to digital technologies, digital literacies, and digital channels. The majority of Australian prisoners have no direct access to the internet, smartphones, or internet-enabled devices which means they are disconnected from social media and other networked communication platforms. Although significant gains have been made in developing and delivering prison-based non-networked digital devices, digital learning platforms and digital education to Australian incarcerated students over the past decade, more work must be done to adequately prepare incarcerated students, with multi-faceted needs, to live and learn as empowered agents within the informational capitalism of the contemporary \"network society.\" The purpose of this article is to argue for a new form of \"network literacy\" education over and above \"digital literacy\" skills for female Australian incarcerated students, through an intersectional theoretical lens which addresses the multidimensional disadvantages experienced by women in custody within Australian prisons.

The B.1.617.2 (delta) Covid-19 variant has surged in India and spread worldwide. In a test-negative case–control study, the effectiveness of two doses of BNT162b2 was 94% against the B.1.1.7 (alpha) variant and 88% against delta; with the ChAdOx1 nCoV-19 vaccine, effectiveness was 74% and 67%, respectively. Protection after a single vaccine injection was low; two doses are needed.

A test-negative case–control study involving more than 6 million persons in England who received two doses of the ChAdOx1-S or BNT162b2 vaccine (interval, 3 to 12 weeks) showed high vaccine effectiveness against hospitalization and death from Covid-19 at 20 weeks or more after vaccination. Protection against infection waned. Waning was greater in older persons and those with underlying risk factors.

Quantum machine learning (QML) has attracted significant research attention over the last decade. Multiple models have been developed to demonstrate the practical applications of the quantum properties. In this study, we first demonstrate that the previously proposed quanvolutional neural network (QuanvNN) using a randomly generated quantum circuit improves the image classification accuracy of a fully connected neural network against the Modified National Institute of Standards and Technology (MNIST) dataset and the Canadian Institute for Advanced Research 10 class (CIFAR-10) dataset from 92.0% to 93.0% and from 30.5% to 34.9%, respectively. We then propose a new model referred to as a Neural Network with Quantum Entanglement (NNQE) using a strongly entangled quantum circuit combined with Hadamard gates. The new model further improves the image classification accuracy of MNIST and CIFAR-10 to 93.8% and 36.0%, respectively. Unlike other QML methods, the proposed method does not require optimization of the parameters inside the quantum circuits; hence, it requires only limited use of the quantum circuit. Given the small number of qubits and relatively shallow depth of the proposed quantum circuit, the proposed method is well suited for implementation in noisy intermediate-scale quantum computers. While promising results were obtained by the proposed method when applied to the MNIST and CIFAR-10 datasets, a test against a more complicated German Traffic Sign Recognition Benchmark (GTSRB) dataset degraded the image classification accuracy from 82.2% to 73.4%. The exact causes of the performance improvement and degradation are currently an open question, prompting further research on the understanding and design of suitable quantum circuits for image classification neural networks for colored and complex data.

ObjectivesTo assess disease trends, testing practices, community surveillance, case-fatality and excess deaths in children as compared with adults during the first pandemic peak in England.SettingEngland.ParticipantsChildren with COVID-19 between January and May 2020.Main outcome measuresTrends in confirmed COVID-19 cases, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity rates in children compared with adults; community prevalence of SARS-CoV-2 in children with acute respiratory infection (ARI) compared with adults, case-fatality rate in children with confirmed COVID-19 and excess childhood deaths compared with the previous 5 years.ResultsChildren represented 1.1% (1,408/129,704) of SARS-CoV-2 positive cases between 16 January 2020 and 3 May 2020. In total, 540 305 people were tested for SARS-COV-2 and 129,704 (24.0%) were positive. In children aged <16 years, 35,200 tests were performed and 1408 (4.0%) were positive for SARS-CoV-2, compared to 19.1%–34.9% adults. Childhood cases increased from mid-March and peaked on 11 April before declining. Among 2,961 individuals presenting with ARI in primary care, 351 were children and 10 (2.8%) were positive compared with 9.3%–45.5% in adults. Eight children died and four (case-fatality rate, 0.3%; 95% CI 0.07% to 0.7%) were due to COVID-19. We found no evidence of excess mortality in children.ConclusionsChildren accounted for a very small proportion of confirmed cases despite the large numbers of children tested. SARS-CoV-2 positivity was low even in children with ARI. Our findings provide further evidence against the role of children in infection and transmission of SARS-CoV-2.

Background Reducing the need for antibiotics is crucial in addressing the global threat of antimicrobial resistance. Catheter-associated urinary tract infection (CAUTI) is one of the most frequent device-related infections that may be amenable to prevention. Interventions implemented nationally in England target behaviours related to catheter insertion, maintenance and removal, but the extent to which they target barriers to and facilitators of these behaviours is unclear. This strategic behavioural analysis applied behavioural science frameworks to (i) identify barriers to and facilitators of behaviours that lead to CAUTI (CAUTI-related behaviours) in primary, community and secondary care and nursing homes; (ii) describe the content of nationally adopted interventions; and (iii) assess the extent to which intervention content is theoretically congruent with barriers and facilitators. Methods A mixed-methods, three-phased study: (1) systematic review of 25 studies to identify (i) behaviours relevant to CAUTI and (ii) barriers to and facilitators of CAUTI-related behaviours, classified using the COM-B model and Theoretical Domains Framework (TDF); (2) content analysis of nationally adopted CAUTI interventions in England identified through stakeholder consultation, classified using the Behaviour Change Wheel (BCW) and Behaviour Change Techniques Taxonomy (BCTTv1); and (3) findings from 1 and 2 were linked using matrices linking COM-B and TDF to BCW/BCTTv1 in order to signpost to intervention design and refinement. Results The most frequently reported barriers to and facilitators of CAUTI-related behaviours related to ‘environmental context and resources’; ‘knowledge’; ‘beliefs about consequences’; ‘social influences’; ‘memory, attention and decision processes’; and ‘social professional role and identity.’ Eleven interventions aiming to reduce CAUTI were identifed. Interventions were primarily guidelines and included on average 2.3 intervention functions (1–5) and six BCTs (2–11), most frequently ‘education’, ‘training’ and ‘enablement.’ The most frequently used BCT was ‘information about health consequences’ which was used in almost all interventions. Social professional role and identity and environmental context and resources were targeted least frequently with potentially relevant BCTs. Conclusions Interventions incorporated half the potentially relevant content to target identifed barriers to and facilitators of CAUTI-related behaviours. There were missed opportunities for intervention as most focus on shaping knowledge rather than addressing motivational, social and environmental influences. This study suggests that targeting motivational, social and environmental influences may lead to more effective intervention design and refinement.

The concept of sustainability has evolved far beyond its initial environmental foundations, expanding into a multidimensional framework that integrates multinational policies, multicultural values, and multigenerational knowledge, but there is a paucity of bottom-up or grassroots research. This paper is a case history comprising oral history supported by rigorous documentation including military records, census data, genealogical records, and scholarship extending over four centuries. A more nuanced understanding of resilience and adaptation emerges. An analysis of recent scholarship indicates that sus-tainability is a dynamic, narrative-driven process that requires an in-depth understanding of the spatial and temporal consequences of global shifts, ranging from climate catastrophes to the global flows of capital and large migrations of people. This paper uses oral history to show the adaptation of a multinational, multicultural, multigenerational family in North America to the social, political, economic, and technological challenges faced over 400 years with a focus on sustainability and resilience.

Staphylococcus aureus persistent bacteraemia is only vaguely defined and the effect of different durations of bacteraemia on mortality is not well established. Our primary aim was to analyse mortality according to duration of bacteraemia and to derive a clinically relevant definition for persistent bacteraemia. We did a secondary analysis of a prospective observational cohort study at 17 European centres (nine in the UK, six in Spain, and two in Germany), with recruitment between Jan 1, 2013, and April 30, 2015. Adult patients who were consecutively hospitalised with monomicrobial S aureus bacteraemia were included. Patients were excluded if no follow-up blood culture was taken, if the first follow-up blood-culture was after 7 days, or if active antibiotic therapy was started more than 3 days after first blood culture. The primary outcome was 90-day mortality. Univariable and time-dependent multivariable Cox regression analysis were used to assess predictors of mortality. Duration of bacteraemia was defined as bacteraemic days under active antibiotic therapy counting the first day as day 1. Of 1588 individuals assessed for eligibility, 987 were included (median age 65 years [IQR 51–75]; 625 [63%] male). Death within 90 days occurred in 273 (28%) patients. Patients with more than 1 day of bacteraemia (315 [32%]) had higher Charlson comorbidity index and sequential organ failure assessment scores and a longer interval from first symptom to first blood culture. Crude 90-day mortality increased from 22% (148 of 672) with 1 day of bacteraemia, to 39% (85 of 218) with 2–4 days, 43% (30 of 69) with 5–7 days, and 36% (10 of 28) with more than 7 days of bacteraemia. Metastatic infections developed in 39 (6%) of 672 patients with 1 day of bacteraemia versus 40 (13%) of 315 patients if bacteraemia lasted for at least 2 days. The second day of bacteraemia had the highest HR and earliest cutoff significantly associated with mortality (adjusted hazard ratio 1·93, 95% CI 1·51–2·46; p<0·0001). We suggest redefining the cutoff duration for persistent bacteraemia as 2 days or more despite active antibiotic therapy. Our results favour follow-up blood cultures after 24 h for early identification of all patients with increased risk of death and metastatic infection. None.

The majority of studies that link antibiotic usage and resistance focus on simple associations between the resistance against a specific antibiotic and the use of that specific antibiotic. However, the relationship between antibiotic use and resistance is more complex. Here we evaluate selection and co-selection by assessing which antibiotics, including those mainly prescribed for respiratory tract infections, are associated with increased resistance to various antibiotics among Escherichia coli isolated from urinary samples. Monthly primary care prescribing data were obtained from National Health Service (NHS) Digital. Positive E. coli records from urine samples in English primary care (n = 888,207) between April 2014 and January 2016 were obtained from the Second Generation Surveillance System. Elastic net regularization was used to evaluate associations between prescribing of different antibiotic groups and resistance against amoxicillin, cephalexin, ciprofloxacin, co-amoxiclav and nitrofurantoin at the clinical commissioning group (CCG) level. England is divided into 209 CCGs, with each NHS practice prolonging to one CCG. Amoxicillin prescribing (measured in DDD/ 1000 inhabitants / day) was positively associated with amoxicillin (RR 1.03, 95% CI 1.01-1.04) and ciprofloxacin (RR 1.09, 95% CI 1.04-1.17) resistance. In contrast, nitrofurantoin prescribing was associated with lower levels of resistance to amoxicillin (RR 0.92, 95% CI 0.84-0.97). CCGs with higher levels of trimethoprim prescribing also had higher levels of ciprofloxacin resistance (RR 1.34, 95% CI 1.10-1.59). Amoxicillin, which is mainly (and often unnecessarily) prescribed for respiratory tract infections is associated with increased resistance against various antibiotics among E. coli causing urinary tract infections. Our findings suggest that when predicting the potential impact of interventions on antibiotic resistances it is important to account for use of other antibiotics, including those typically used for other indications.