Explore the vast range of titles available.

Perspective-taking in virtual reality has been exploited in different areas, including using avatars for self-dialogue. We explore the effect of performing self-dialogue in VR, alternating between a non-lookalike ‘self’ and an age-congruent or age-incongruent ‘other’. We used an independent-sample design, with 28 females aged 18–35, starting a conversation in their ‘self’ avatar while describing a stressful daily-life problem, swapping immediately after with the ‘other’ (either young or mature-looking) avatar to listen and respond. Results showed that the importance of the change regarding their problem immediately after the experiment was significantly higher for the mature avatar condition ( p  = 0.01), an effect not found at follow-up. Further, there is a trend towards specific factors of embodiment (e.g., self-recognition and body recognition) being related to understanding their problem better or how helpful the exercise was perceived. To conclude, while the mature avatar showed a short-term advantage, long-term effects were not observed. Future studies with tighter controls are warranted.

Background Long COVID, a diverse set of symptoms that persist after a minimum of 4 weeks from the initial SARS-CoV-2 infection, has posed substantial burden to healthcare systems. There is some evidence that COVID-19 vaccination may be associated with lower risk of long COVID. However, little is known about the association between vaccination status and long COVID-associated healthcare resource utilisation (HCRU) and costs. Methods We conducted a cohort study using primary care electronic health record data in England from the Clinical Practice Research Datalink (CPRD) Aurum dataset linked to Hospital Episode Statistics where available. Adult (≥ 18 years) patients were indexed on a COVID-19 diagnosis between 1st March 2021 and 1st December 2021. Vaccination status was assessed at index: unvaccinated or completed primary series (two doses for immunocompetent and three doses for immunocompromised patients). Covariate balance was conducted using entropy balancing. Weighted multivariable Poisson regression was used to estimate the incidence rate ratio (IRR) for incident long COVID, and separately long COVID primary care resource use, by vaccination status. Patients were followed up to a maximum of 9-months post index. Results A total of 35,713 patients who had completed primary series vaccination, and 75,522 unvaccinated patients were included. The weighted and adjusted IRR for long COVID among patients vaccinated with the primary series compared to being unvaccinated was 0.81 (95% CI: 0.77–0.86) in the overall cohort, 0.83 (95% CI: 0.78–0.88) in the immunocompetent cohort and 0.28 (95% CI: 0.13–0.58) in the immunocompromised cohort. Among those with long COVID, there was no association between the rate of primary care consultations and vaccination status in the overall and immunocompetent cohorts. Cost of primary care consultations was greater in the unvaccinated group than for those who completed primary series. Conclusion Vaccination against COVID-19 may reduce the risk of long COVID in both immunocompetent and immunocompromised patients. However, no association was found between frequency of primary care visits and vaccination among patients diagnosed in 2021. Future studies with larger sample size, higher vaccine uptake, and longer study periods during the pandemic are needed to further quantify the impact of vaccination on long COVID.

Background The aim of this study was to estimate the impact of mild-to-moderate COVID-19 on health-related quality of life (HRQoL) over time among individuals in the United Kingdom, adding to the evidence base that had focussed on severe COVID-19. Methods A bespoke online survey was administered to individuals who self-reported a positive COVID-19 test. An amended version of a validated generic HRQoL instrument (EQ-5D-5L) was used to measure HRQoL retrospectively at different timepoints over the course of an infection: pre-COVID-19, acute COVID-19, and long COVID. In addition, HRQoL post-COVID-19 was captured by the original EQ-5D-5L questionnaire. A mixed-effects model was used to estimate changes in HRQoL over time, adjusted for a range of variables correlated with HRQoL. Results The study recruited 406 participants: (i) 300 adults and 53 adolescents with mild-to-moderate COVID-19 who had not been hospitalised for COVID-19 during acute COVID-19, and (ii) 53 adults who had been hospitalised for COVID-19 in the acute phase and who had been recruited for validation purposes. Data were collected between January and April 2022. Among participants included in the base-case analysis, EQ-5D-5L utility scores were lower during both acute COVID-19 (β=-0.080, p  = 0.001) and long COVID (β=-0.072, p  < 0.001) compared to pre COVID-19. In addition, EQ-5D-5L utility scores post-COVID-19 were found to be similar to the EQ-5D-5L utility scores before COVID-19, including for patients who had been hospitalised for COVID-19 during the acute phase or for those who had experienced long COVID. Moreover, being hospitalised in the acute phase was associated with additional utility decrements during both acute COVID-19 (β=-0.147, p  = 0.026) and long (β=-0.186, p  < 0.001) COVID. Conclusion Patients perceived their HRQoL to have varied significantly over the course of a mild-to-moderate COVID-19 infection. However, HRQoL was found to return to pre-COVID-19 levels, even for patients who had been hospitalised for COVID-19 during the acute phase or for those who had experienced long COVID. Key points Health-related quality of life was significantly lower during the acute and long COVID-19 phases compared to before COVID-19. Results suggested that health-related quality of life returned to pre-COVID-19 levels, even for patients who had been hospitalized for COVID-19 during the acute phase or for those who had experienced long COVID. Symptoms specific to the acute COVID-19 phase were found to be associated with additionally lower health-related quality of life.

The aim of this exploratory research is to capture spatial evolution patterns in the Bucharest metropolitan area using sets of single polarised synthetic aperture radar (SAR) satellite data and multi-temporal radar interferometry. Three sets of SAR data acquired during the years 1992–2010 from ERS-1/-2 and ENVISAT, and 2011–2014 from TerraSAR-X satellites were used in conjunction with the Small Baseline Subset (SBAS) and persistent scatterers (PS) high-resolution multi-temporal interferometry (InSAR) techniques to provide maps of line-of-sight displacements. The satellite-based remote sensing results were combined with results derived from classical methodologies (i.e., diachronic cartography) and field research to study possible trends in developments over former clay pits, landfill excavation sites, and industrial parks. The ground displacement trend patterns were analysed using several linear and nonlinear models, and techniques. Trends based on the estimated ground displacement are characterised by long-term memory, indicated by low noise Hurst exponents, which in the long-term form interesting attractors. We hypothesize these attractors to be tectonic stress fields generated by transpressional movements.

Background Pneumococcal disease burden remains high in England despite use of 23-valent pneumococcal polysaccharide vaccine (PPV23) among all adults ≥65 years and those aged 18–64 years with risk conditions. We conducted cost-effectiveness (CE) and return on investment (ROI) analyses of adult vaccination with the available 20-valent pneumococcal conjugate vaccine (PCV20) to estimate societal net benefit associated use of PCV20 versus PPV23 in the current programme. Methods A probabilistic cohort model projected lifetime risks and costs of invasive pneumococcal disease (IPD) and all-cause community-acquired pneumonia (CAP) and expected impact of vaccination. Population included adults aged 18–64 years with risk conditions and all adults aged 65–99 years ( N  = 15,900,480). Inputs were based on publicly available data. Clinical outcomes included cases of IPD, CAP, and associated deaths. Economic costs included direct medical care and non-medical care costs. Analyses were conducted from the societal perspective (discounting, 3.5%/year). CE and ROI were estimated as cost per quality-adjusted life year (QALY) gained and averted total costs, respectively. An opportunity cost scenario and probabilistic sensitivity analyses were undertaken. Results Replacing PPV23 with PCV20 would prevent 10,196 IPD cases, 169,738 inpatient CAP cases, 74,707 outpatient CAP cases, and 27,259 pneumococcal-related deaths, increasing QALYs by 114,763. Total medical care costs decreased by £1,017·0 M and non-medical care costs by £144·0 M, and vaccination costs increased by £378·7 M. PCV20 yielded net savings of £782·3 M, and hence was dominant (vs. PPV23), with ROI of £3.1 for every £1 invested. Adjusting opportunity costs associated with suboptimal resource use in periods of excess demand on National Health Service increased total savings to £1,864·2 M and ROI to £5.9 per £1 invested. Conclusions Our findings suggest that use of PCV20—in lieu of PPV23—among all adults aged ≥65 years and those aged 18–64 years with underlying risk conditions in England will be cost-saving and have a substantial net benefit to society. Key summary points Why carry out this study? ◦ Despite existing adult vaccination programmes, pneumococcal disease burden among adults in the UK remains high with pneumococcal infections being the main cause of pneumonia-related adult hospitalisations pre-COVID-19 pandemic. ◦ Novel, higher valency (≥20 serotypes) pneumococcal conjugate vaccines—which elicit a more durable immune response than 23-valent pneumococcal polysaccharide vaccine (PPV23) and provide protection against non-bacteraemic pneumonia—have the potential to address the substantial pneumococcal disease burden in the UK is used at coverage levels similar to currently recommended PPV23. ◦ We evaluated the cost-effectiveness and return on investment (ROI) of 20-valent pneumococcal conjugate vaccine (PCV20) to help inform decision makers in England and elsewhere who are considering use of novel pneumococcal vaccines to protect against pneumococcal disease. What was learned from the study? ◦ Results suggest implementing PCV20 alone as a replacement for the current PPV23 programme among all adults aged ≥65 years and adults aged 18–64 years with underlying conditions in England would be cost-saving and likely to offer ROI of £3.1 per £1 invested by generating additional cost savings, from a societal perspective. ◦ Compared to previously published cost-effectiveness analyses from the healthcare system perspective, this societal perspective analysis suggests that cost savings from PCV20 would be 5 times higher.

Currently, the 13-valent pneumococcal conjugate vaccine (PCV13) is administered under a 1+1 (1 primary dose) pediatric schedule in the United Kingdom (UK). Higher-valency PCVs, 15-valent PCV (PCV15), or 20-valent PCV (PCV20) might be considered to expand serotype coverage. We evaluated the cost-effectiveness of PCV20 or PCV15 using either a 2+1 (2 primary doses) or 1+1 schedule for pediatric immunization in the UK. Using a dynamic transmission model, we simulated future disease incidence and costs under PCV13 1+1, PCV20 2+1, PCV20 1+1, PCV15 2+1, and PCV15 1+1 schedules from the UK National Health Service perspective. We prospectively estimated disease cases, direct costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Scenario analyses were performed to estimate the impact of model assumptions and parameter uncertainty. Over a five-year period, PCV20 2+1 averted the most disease cases and gained the most additional QALYs. PCV20 2+1 and 1+1 were dominant (cost-saving and more QALYs gained) compared with PCV15 (2+1 or 1+1) and PCV13 1+1. PCV20 2+1 was cost-effective (GBP 8110/QALY) compared with PCV20 1+1. PCV20 was found cost-saving compared with PCV13 1+1, and PCV20 2+1 was cost-effective compared with PCV20 1+1. Policymakers should consider the reduction in disease cases with PCV20, which may offset vaccination costs.

Background/Objectives: To evaluate the health benefits, costs, and cost-effectiveness of vaccination with bivalent respiratory syncytial virus stabilized prefusion F vaccine (RSVpreF) for the prevention of lower respiratory tract disease caused by respiratory syncytial virus (RSV) in Greek adults 60 years of age and older. Methods: A Markov model was adapted to simulate lifetime risk of health and economic outcomes from the public payer’s perspective over a lifetime horizon. Epidemiology, vaccine effectiveness, utilities, and direct medical costs (EUR, 2024) were obtained from published studies, official sources, and local experts. Model outcomes included the number of medically attended RSV cases, stratified by care setting (i.e., hospital, emergency department [ED], outpatient visits [OV]), and attributable RSV-related deaths, costs, life years (LY), quality-adjusted life-years (QALY), and incremental cost-effectiveness ratios (ICERs) of RSVpreF vaccination compared with no vaccination. Results: The model projected 258,170 hospitalizations, 112,248 ED encounters, 1,201,604 OV, and 25,463 deaths related to RSV in Greek older adults resulting in direct medical costs of EUR 1.6 billion over the lifetime horizon. Assuming RSV vaccination would reach the same coverage rates as pneumococcal and influenza programmes, 18,118 hospitalizations, 7874 ED encounters, 48,079 OV, and 1706 deaths could be prevented over the modelled time horizon. The health benefits associated with RSVpreF contributed to an incremental gain of 10,976 LYs and 7230 QALYs compared with no vaccination. The incremental analysis reported that vaccination with RSVpreF was estimated to be a cost-effective strategy resulting in ICERs of EUR 12,991 per LY gained, EUR 19,723 per QALY gained, and EUR 7870 per hospitalized RSV case avoided compared with no vaccination. Conclusions: Vaccination with RSVpreF was a cost-effective strategy for the prevention of RSV disease in Greek adults over 60 years of age. The introduction of RSV vaccination can improve public health by averting RSV cases and deaths and has the potential to fulfil an unmet medical need.

ObjectivesTo quantify direct costs and healthcare resource utilisation (HCRU) associated with acute COVID-19 in adults in England.DesignPopulation-based retrospective cohort study using Clinical Practice Research Datalink Aurum primary care electronic medical records linked to Hospital Episode Statistics secondary care administrative data.SettingPatients registered to primary care practices in England.Population1 706 368 adults with a positive SARS-CoV-2 PCR or antigen test from August 2020 to January 2022 were included; 13 105 within the hospitalised cohort indexed between August 2020 and March 2021, and 1 693 263 within the primary care cohort indexed between August 2020 and January 2022. Patients with a COVID-19-related hospitalisation within 84 days of a positive test were included in the hospitalised cohort.Main outcome measuresPrimary and secondary care HCRU and associated costs ≤4 weeks following positive COVID-19 test, stratified by age group, risk of severe COVID-19 and immunocompromised status.ResultsAmong the hospitalised cohort, average length of stay, including critical care stays, was longer in older adults. Median healthcare cost per hospitalisation was higher in those aged 75–84 (£8942) and ≥85 years (£8835) than in those aged <50 years (£7703). While few (6.0%) patients in critical care required mechanical ventilation, its use was higher in older adults (50–74 years: 8.3%; <50 years: 4.3%). HCRU and associated costs were often greater in those at higher risk of severe COVID-19 than in the overall cohort, although minimal differences in HCRU were found across the three different high-risk definitions. Among the primary care cohort, general practitioner or nurse consultations were more frequent among older adults and the immunocompromised.ConclusionsCOVID-19-related hospitalisations in older adults, particularly critical care stays, were the primary drivers of high COVID-19 resource use in England. These findings may inform health policy decisions and resource allocation in the prevention and management of COVID-19.

ObjectiveTo create case definitions for confirmed COVID-19 diagnoses, COVID-19 vaccination status and three separate definitions of high risk of severe COVID-19, as well as to assess whether the implementation of these definitions in a cohort reflected the sociodemographic and clinical characteristics of COVID-19 epidemiology in England.DesignRetrospective cohort study.SettingElectronic healthcare records from primary care (Clinical Practice Research Datalink, CPRD) linked to secondary care data (Hospital Episode Statistics) data covering 24% of the population in England.Participants2 271 072 persons aged 1 year and older diagnosed with COVID-19 in CPRD Aurum between 1 August 2020 and 31 January 2022.Main outcome measuresAge, sex and regional distribution of COVID-19 cases and COVID-19 vaccine doses received prior to diagnosis were assessed separately for the cohorts of cases identified in primary care and those hospitalised for COVID-19 (primary diagnosis code of ICD-10 U07.1 ‘COVID-19’). Smoking status, body mass index and Charlson Comorbidity Index were compared for the two cohorts, as well as for three separate definitions of high risk of severe disease used in the UK (National Health Service Highest Risk, PANORAMIC trial eligibility, UK Health Security Agency Clinical Risk prioritisation for vaccination).ResultsCompared with national estimates, CPRD case estimates under-represented older adults in both the primary care (age 65–84: 6% in CPRD vs 9% nationally) and hospitalised (31% vs 40%) cohorts, and over-represented people living in regions with the highest median wealth areas of England (20% primary care and 20% hospital admitted cases in South East vs 15% nationally). The majority of non-hospitalised cases and all hospitalised cases had not completed primary series vaccination. In primary care, persons meeting high-risk definitions were older, more often smokers, overweight or obese, and had higher Charlson Comorbidity Index score.ConclusionsCPRD primary care data are a robust real-world data source and can be used for some COVID-19 research questions, however, limitations of the data availability should be carefully considered. Included in this publication are supplemental files for a total of over 28 000 codes to define each of three definitions of high risk of severe disease.

Hospitals in England experience extremely high levels of bed occupancy in the winter. In these circumstances, vaccine-preventable hospitalisations due to seasonal respiratory infections have a high cost because of the missed opportunity to treat other patients on the waiting list. This paper estimates the number of hospitalisations that current vaccines against influenza, pneumococcal disease (PD), COVID-19, and a hypothetical Respiratory Syncytial Virus (RSV) vaccine, could prevent in the winter among older adults in England. Their costs were quantified using a conventional reference costing method and a novel opportunity costing approach considering the net monetary benefit (NMB) obtained from alternative uses of the hospital beds freed-up by vaccines. The influenza, PD and RSV vaccines could collectively prevent 72,813 bed days and save over £45 million in hospitalisation costs. The COVID-19 vaccine could prevent over 2 million bed days and save £1.3 billion. However, the value of hospital beds freed up by vaccination is likely to be 1.1–2 times larger (£48–93 million for flu, PD and RSV; £1.4–2.8 billion for COVID-19) when quantified in opportunity cost terms. Considering opportunity costs is key to ensuring maximum value is obtained from preventative budgets, as reference costing may significantly underestimate the true value of vaccines.