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Bacterial resistance or tolerance to antibiotics is costly to patients and healthcare providers. With the impact of antibiotic resistance forecast to grow, alternative antimicrobial approaches are needed to help treat patients with antibiotic refractory infections and reduce reliance upon existing antibiotics. There is renewed interest in bacteriophage (phage) therapy as a promising antimicrobial strategy. We therefore performed the first multi-specialty survey about phage therapy and the first such survey among clinicians in the United Kingdom. An anonymous 10-question survey of clinicians from medical and surgical specialties in two Scottish Health Boards was performed. The 90 respondents spanned 26 specialties and were predominantly consultants (73.3%). The respondents were concerned about antibiotic resistance in their clinical practice; 83 respondents estimated having seen 711 patients in the last 12 months whose infections were refractory to antibiotics (delaying or preventing resolution). Over half (58.8%) of the respondents had previously heard of phage therapy. Staphylococci, Pseudomonas and E . coli were identified as the highest cross-specialty priorities for the development of phage therapy. Together, 77 respondents estimated seeing 300 patients in the last 12 months for whom phage therapy may have been appropriate (an average of 3.9 patients per clinician). Most respondents (71.1%, n = 90) were already willing to consider using phage therapy in appropriate cases. Additional comments from the respondents affirmed the potential utility of phage therapy and highlighted a need for more information. The results of this survey demonstrate substantial demand for and willingness to use phage therapy in appropriate cases, both from individual clinicians and across specialties. Demand from a wide range of specialties illustrates the broad clinical utility of phage therapy and potential scope of impact. Widening access to phage therapy could deliver substantial clinical and financial benefits for patients and health authorities alike.

ObjectivesTo determine the indirect consequences of the COVID-19 pandemic on paediatric healthcare utilisation and severe disease at a national level following lockdown on 23 March 2020.DesignNational retrospective cohort study.SettingEmergency childhood primary and secondary care providers across Scotland; two national paediatric intensive care units (PICUs); statutory death records.Participants273 455 unscheduled primary care attendances; 462 437 emergency department attendances; 54 076 emergency hospital admissions; 413 PICU unplanned emergency admissions requiring invasive mechanical ventilation; and 415 deaths during the lockdown study period and equivalent dates in previous years.Main outcome measuresRates of emergency care consultations, attendances and admissions; clinical severity scores on presentation to PICU; rates and causes of childhood death. For all data sets, rates during the lockdown period were compared with mean or aggregated rates for the equivalent dates in 2016–2019.ResultsThe rates of emergency presentations to primary and secondary care fell during lockdown in comparison to previous years. Emergency PICU admissions for children requiring invasive mechanical ventilation also fell as a proportion of cases for the entire population, with an OR of 0.52 for likelihood of admission during lockdown (95% CI 0.37 to 0.73), compared with the equivalent period in previous years. Clinical severity scores did not suggest children were presenting with more advanced disease. The greatest reduction in PICU admissions was for diseases of the respiratory system; those for injury, poisoning or other external causes were equivalent to previous years. Mortality during lockdown did not change significantly compared with 2016–2019.ConclusionsNational lockdown led to a reduction in paediatric emergency care utilisation, without associated evidence of severe harm.

In the 20th century, the global tobacco industry employed diverse marketing tactics, often targeting specific groups, including children and young people (CYP). E-cigarette manufacturer JUUL paid out nearly half a billion US dollars to settle claims by multiple US states of illegal targeting of minors. The same blog reports that ‘we’re strengthening the regulation of vape flavours, packaging and how they are displayed in shops’ and ‘to crack down on underage sales, trading standards officers will have the power to issue an ‘on the spot’ fine when they spot the sale of tobacco and vapes to children in England and Wales’. European Respiratory Society statement on novel nicotine and tobacco products, their role in tobacco control and 'harm reduction'.

The UK worked hard to reduce the exposure of children to combustible tobacco and its toxic by-products such as nicotine. Since the 1960s, teenage use of cigarettes has steadily decreased via a campaign highlighting negative health impacts, stopping advertising, banning use in social spaces, raising the legal age and limiting access in shops. Data from the Centers for Disease Control and Prevention have shown, to date, 2558 hospitalised patients with non-fatal EVALI and 60 patients with a fatal outcome.4 While it is true that most fatalities were associated with tetrahydrocannabinol-containing liquids, around one-third were products containing nicotine only. How many children vape and what do they vape? Since 2014, e-cigarettes have been the most popular type of nicotine product used by adolescents in the USA.6 In 2018, 43% of high school students had tried vaping nearly 20% more than had tried traditional cigarettes.

The sound of a person’s voice is commonly used to identify the speaker. The sound of speech is also starting to be used to detect medical conditions, such as depression. It is not known whether the manifestations of depression in speech overlap with those used to identify the speaker. In this paper, we test the hypothesis that the representations of personal identity in speech, known as speaker embeddings, improve the detection of depression and estimation of depressive symptoms severity. We further examine whether changes in depression severity interfere with the recognition of speaker’s identity. We extract speaker embeddings from models pre-trained on a large sample of speakers from the general population without information on depression diagnosis. We test these speaker embeddings for severity estimation in independent datasets consisting of clinical interviews (DAIC-WOZ), spontaneous speech (VocalMind), and longitudinal data (VocalMind). We also use the severity estimates to predict presence of depression. Speaker embeddings, combined with established acoustic features (OpenSMILE), predicted severity with root mean square error (RMSE) values of 6.01 and 6.28 in DAIC-WOZ and VocalMind datasets, respectively, lower than acoustic features alone or speaker embeddings alone. When used to detect depression, speaker embeddings showed higher balanced accuracy (BAc) and surpassed previous state-of-the-art performance in depression detection from speech, with BAc values of 66% and 64% in DAIC-WOZ and VocalMind datasets, respectively. Results from a subset of participants with repeated speech samples show that the speaker identification is affected by changes in depression severity. These results suggest that depression overlaps with personal identity in the acoustic space. While speaker embeddings improve depression detection and severity estimation, deterioration or improvement in mood may interfere with speaker verification.

Background and objectiveCardiorespiratory polygraphy (CRP) is the predominant technology used to diagnose obstructive sleep apnoea (OSA) in tertiary centres in the UK. Nocturnal pulse oximetry (NPO) is, however, cheaper and more accessible. This study evaluated the ability of NPO indices to predict OSA in typically developing (TD) children.MethodsIndices from simultaneous NPO and CRP recordings were compared in TD children (aged 1–16 years) referred to evaluate OSA in three tertiary centres. OSA was defined as an obstructive apnoea–hypopnoea index (OAHI) ≥1 event/hour. Receiver operating characteristic curves assessed the diagnostic accuracy of NPO indices including ODI3 (3% Oxygen Desaturation Index, ODI4 (4% Oxygen Desaturation Index), delta 12 s index and minimum oxygen saturation. Two-by-two tables were generated to determine the sensitivities and specificities of whole number cut-off values for predicting OAHIs ≥1, 5 and 10 events/hour.ResultsRecordings from 322 TD children, 197 male (61.2%), median age 4.9 years (range 1.1–15.6), were reviewed. OAHI was ≥1/hour in 144 (44.7%), ≥5/hour in 61 (18.9%) and ≥10/hour in 28 (8.7%) cases. ODI3 and ODI4 had the best diagnostic accuracy. ODI3 ≥7/hour and ODI4 ≥4/hour predicted OSA in TD children with sensitivities/specificities of 57.6%/85.4% and 46.2%/91.6%, respectively. ODI3 ≥8/hour was the best predictor of OAHI ≥5/hour (sensitivity 82.0%, specificity 84.3%).ConclusionRaised ODI3 and ODI4 predict OSA in TD children with high specificity but variable sensitivity. NPO may be an alternative to diagnose moderate-severe OSA if access to CRP is limited. Low sensitivities to detect mild OSA mean that confirmatory CRP is needed if NPO is normal.

IntroductionAccurate evaluation of respiratory rate and pattern is important in health and disease; however, it can be challenging in children and babies due to small size and poor tolerability of existing monitoring equipment. This protocol outlines a study evaluating the feasibility of collecting respiratory data using a chest-worn accelerometer-based motion sensor in paediatric patients at risk of apnoea, respiratory failure and sudden death.Methods and analysisThis is an observational feasibility study over a 2-year period. The biosensor is an accelerometer worn on an ECG electrode during standard care at the Royal Hospital for Children, Glasgow. We aim to recruit three groups of patients (75 patients to each group): (1) Children attending for overnight cardiorespiratory polygraphy (0 to ≤16 years), (2) neonatal inpatients (from 30 weeks gestation) and (3) children attending for video telemetry at the epilepsy monitoring unit (0 to ≤16 years). Measurements will include (1) chest and/or abdominal wall motion measured by the worn biosensors; (2) standard clinical monitoring data will be collected to support biosensor data interpretation and (3) acceptability will be measured by a feedback questionnaire completed by patients and their parents/guardians.Ethics and disseminationThis study protocol was reviewed and approved by Yorkshire and The Humber-Leeds East Research Ethics Committee, approval number 314 696. This study involves human participants; written informed consent and assent, when appropriate, will be obtained from participants (or their parent/legal guardian/next of kin) to participate in the study. The study will be carried out in accordance with the World Medical Association Declaration of Helsinki (1964) standard reporting. Study findings will be reported clearly and transparently with relevant stakeholders including researchers, practitioners and publicly available databases. Results from this study will be presented at national and international conferences and reported in peer-reviewed publications.Trial registration numberNCT06292299 pre-results stage.

Correspondence to Dr Ross Langley, Department of Paediatric Respiratory and Sleep Medicine, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK; rosslangley@nhs.net This is the frequent argument I have listened to from anti-vax parents, determined to justify their polarised stance when I have tried, often in vain, to persuade them to have their child vaccinated against deadly infectious diseases. Despite the availability of vaccines, I have personally witnessed the deaths of children with whooping cough, influenza, meningitis and pneumococcal disease, and observed devastating neurological sequelae of chicken pox and measles. Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Bacteriophage (phage) therapy is a promising alternative antimicrobial approach which has the potential to transform the way we treat bacterial infections. Phage therapy is currently being used on a compassionate basis in multiple countries. Therefore, if a patient has an antibiotic refractory infection, they may expect their clinician to consider and access phage therapy with the hope of improvement. The expectations of clinicians may be similar and may also include expectations around data collection. However, there are multiple biological and practical barriers to fulfilling patient and clinician expectations. While it is possible to access phage therapy, the path to acquisition is not straightforward and expectations therefore need to be managed appropriately to avoid raising false hope and undermining confidence in phage therapy. Phage scientists have an important contribution to make in educating clinicians and the broader public about phage therapy. However, it is clinicians that are responsible for managing the expectations of their patients and this relies on clear communication about the barriers and limitations.