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Health impact and cost-effectiveness of COVID-19 booster vaccination strategies in the early post-Omicron era:a dynamic modelling study
No full textIntroduction Following widespread exposure to Omicron variants, SARS-CoV-2 has transitioned to endemic circulation. Populations now have diverse infection and vaccination histories, resulting in heterogeneous immune landscapes. Careful consideration of the value of ongoing vaccination is required through the post-Omicron phase of COVID-19 management to minimise disease burden. We demonstrate the utility of a modelling approach to address this question, supporting recommendations for targeted vaccine use across different country settings. Methods We integrated immunological, transmission, clinical and cost-effectiveness models and simulated populations with different characteristics and immune landscapes over the early post-Omicron period. We calculated the expected number of infections, hospitalisations and deaths for different vaccine scenarios. Costs (from a healthcare perspective) were estimated for exemplar country income-level groupings in the Western Pacific Region using pandemic-era vaccine prices and healthcare-seeking behaviour assumptions. We assessed the impact and cost-effectiveness of targeted vaccination strategies. Results are reported as incremental costs and disability-adjusted life years averted compared with no additional vaccination. Parameter and stochastic uncertainty were captured through scenario and sensitivity analysis. Results Across different population demographics and income levels, we consistently found that annual elder-targeted boosting strategies are most likely to be cost-effective or cost-saving (>75% probability of being cost-effective among older, high-income settings; >50% probability of being cost-effective in younger, middle-income settings), while paediatric programmes are unlikely to be cost-effective. Results remained broadly consistent while accounting for uncertainties in the epidemiological and economic models, although they were sensitive to the cost of home-based care and vaccination. Use of pandemic-era vaccine prices may underestimate current vaccine prices available in upper-middle-income and high-income settings, potentially overestimating the cost-effectiveness of boosting in these settings. Half-yearly boosting may only be cost-effective in higher income settings with older population demographics and higher cost-effectiveness thresholds. Conclusion Competing health priorities and resource constraints mean COVID-19 vaccine allocation needs to be carefully considered in context. These results, reflecting modelling conducted on the early post-Omicron period, demonstrate the value of continued booster vaccinations to protect against severe COVID-19 disease outcomes across high-income and middle-income settings and show that the biggest health gains relative to vaccine costs are achieved by targeting older age groups.</p
Cortical connectivity, local dynamics and stability correlates of global conscious states
No full textWaking levels of human consciousness are known to be supported by the integrity of complex structures and processes in the brain, yet how they are exactly regulated by neurobiological mechanisms remains uncertain. Here a space-time-resolved inference-based framework is applied to estimate the neurophysiological variables of a whole-cortex model and analyze the neural mechanism correlates of global consciousness by way of a correlation analysis between behavioural and neural variable time-series. Using magnetoencephalography (MEG) data from 15 participants under Xenon-induced anesthesia, interconnected neural mass models (NMMs) were developed and time-evolving regional neurophysiological variables and inter-regional connectivity strengths were inferred from the data. Analyses revealed significant correlations between consciousness levels and inter-regional connectivity, particularly in posterior parietal, occipital, and prefrontal regions. Moreover, results support a parietal, rather than frontal, network backbone to facilitate global consciousness. Regional-level analyses further identified correlates of consciousness within the posterior parietal and occipital regions. Lastly, reductions in consciousness were linked to stabilized cortical dynamics, reflected by changes in the eigenmodes of the system. This framework provides a novel, inference-based approach to investigating consciousness, offering a time-resolved perspective on neural mechanism correlates during altered states.</p
Treating comorbidities in heart failure:tackling the hidden burden
No full textMost patients with heart failure also have comorbidities that require clinical attention. Comprehensive care should optimise guideline-directed medical therapy while addressing these comorbidities. Recent advances in management include sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, finerenone, intravenous iron and vaccinations. GPs are well placed to deliver holistic, patient-centred care to patients with heart failure
Analytics of self-regulated learning strategies and scaffolding:Associations with learning performance
No full textSelf-regulated learning (SRL) encapsulates learners' abilities to control, monitor, and regulate cognitive and metacognitive processes such as motivation, emotion, and learning strategies. A crucial element of SRL proficiency lies in learners' capacity to plan and implement effective learning strategies. As such, extensive academic research has been devoted to understanding the impact of learning strategies on learning performance, and the role of instructional methods (including real-time scaffolding) in amplifying students' ability to adopt effective learning strategies. However, while numerous studies have focused on learning strategies and SRL scaffolding, few have investigated their interplay in field settings, particularly examining learning strategy use at the single task level and its dynamic interaction with scaffolding in enhancing learning outcomes. Hence, we carried out a field experiment in which learners were randomly assigned to one of three scaffolding conditions (control, fixed, and adaptive scaffolding) and asked to complete an essay writing assignment in a computer-based learning environment (CBLE). Learning log data were subsequently collected and analyzed. The findings demonstrate that learning strategies could successfully forecast learning performance as gauged by the essay score, yet neither fixed nor adaptive scaffolding individually proved effective in enhancing learning performance. Intriguingly, the study revealed that the effectiveness of adaptive scaffolding in fostering learning performance varied depending on the learning strategies employed by learners. These findings offer valuable insights for the future design of scaffolding, particularly highlighting that the adaptability of scaffolding can be enriched by taking into account learners' adopted learning strategies.</p
Income-related inequalities in future health prospects
No full textMeasuring health disparities is key to monitoring health systems, but hitherto disparities in the individual risk people face about their future health has been neglected. This paper integrates individual health risk into income-related health inequality measurement. We develop a rank dependent health inequality index that considers inequalities in each individual's expected future health and the dispersion of their future health prospects. It is useful when a social planner wants to account for risk averse preferences in the assessment of income-related inequalities of future health prospects. The empirical application using Australian longitudinal data highlights that neglecting individual risk underestimates income-related inequalities in future health prospects since the poor not only face worse expected future health, but also faced greater dispersion in their future health prospects compared to the rich.</p
Decomposing identification gains and evaluating instrument identification power for partially identified average treatment effects
No full textAbstract.: In this article, we synthesize and review existing results on the roles of instrumental variables (IVs) in average treatment effect (ATE) partial identification analysis. We provide a novel decomposition of identification gains in ATE bounds and offer insights for understanding the complex role of IVs in conjunction with model features and covariates. An empirical example of childbearing and women’s labor supply, with two IVs of ‘twins’ and ‘same-sex siblings’, demonstrates that ‘twins’ has significantly greater identification power than ‘same-sex siblings’, and the identification power of both IVs is heterogeneous across covariates. Our analysis can also be useful in IV selection in future program experiment designs.</p
Governing University Living Labs for sustainability transformations:insights from 18 international case studies
No full textIn recent years, scholarly debate has grown around a perceived gap between societal impact rhetoric and the support structures for interdisciplinary and applied research, education, and innovation in universities. University Living Labs (UniLLs) provide a window into this relationship as they transcend disciplinary boundaries and linear modes of engagement to enable real-world experimentation and learning in response to societal challenges such as sustainable development. However, few studies examine the institutional contexts in which UniLLs operate, thus limiting our understanding of universities’ capacity for sustainability experimentation. This study examines how the institutional structures, cultures, and practices of universities enable or constrain the governance of sustainability-oriented UniLLs. Our study is grounded in the practical work of organising and conducting UniLLs, drawing on interviews with 39 academics and practitioners involved in UniLLs at 18 universities in Australia, Brazil, Canada, Germany, France, The Netherlands, Singapore, the UK, and the USA. Our research findings demonstrate that (1) UniLLs are enabled by the institutionalisation of sustainable development agendas, and the relational and discursive work of key university staff. (2) UniLLs are often limited in scope and longevity by a project logic and work against entrenched academic and operational organising structures and corporate logics. (3) Some UniLLs overcome these barriers by leveraging institutional power and mobilising resources to embed UniLL governance in university-wide structures. We present practical enabling processes for institutionalising UniLLs in universities demonstrated by the cases and reflect on the university governance paradigm for advancing a transformative impact agenda.</p
Testing for approximate measurement invariance of instructional quality in the Teaching and Learning International Survey (TALIS) 2018
No full textThis study investigates how consistently instructional quality is measured among secondary school teachers across 47 countries and economies using the TALIS 2018 teacher data (N = 127,607). We use two methods: the conventional approach (multiple group confirmatory factor analysis) and alignment optimization to test the comparability of instructional quality in an international large-scale survey. The results show that while basic (configural) and structural (metric) consistency is present, full comparability (scalar invariance) is not achieved using the conventional method. However, the alignment optimization method reveals partial comparability across countries. These findings imply that while comparisons of instructional quality can be made across most countries, caution is needed when interpreting results in certain cases. This study highlights the importance of testing measurement invariance in cross-national education research.</p
Trusted Emplaced Futures
No full textSet in a contemporary context of global uncertainties characterised by the climate crisis, pandemic and increasing technological automation, I consider how we might engage with this increasingly urgent situation by working towards trusted, emplaced futures. This I propose requires not simply a business-as-usual analysis, but rather a dramatic shift. This involves acknowledging uncertainty as a generative facet of place, and understanding what is familiar and trusted in the everyday as fundamental to trusted futures where we feel confident in the circumstances, environments and relationships in which we find ourselves. I discuss concepts of place, futures and uncertainty, how the concept of trust can be engaged to express and analyse experiential dimensions of futures, and draw on examples from recent ethnographic futures research. I continue my call for new social science research forward which engages the conceptual, methodological and practical required for social scientists to participate in constituting futures alongside other disciplines and stakeholders.</p
The safety actions of surfers in Victoria, Australia:assessing the impact of water safety and first aid training
No full textRecreational surfers in Victoria, Australia were surveyed every four weeks for 128 weeks about their beach safety actions when surfing. While previous studies have explored rescues performed by surfers over their surfing career/lifetime, this study is the first to provide data on safety action that incorporates a ‘per event’ denominator of exposure (safety action per 100 surfs). Victorian surfers reported giving safety advice, first aid and assistance in the water at average rates of 11.6, 0.4 and 1.1 times per 100 surfs respectively. We found that surfers with a board rescue qualification provided beach safety advice on average 3.1 more times per 100 surfs (29 % more often) and first aid 0.4 more times per 100 surfs than (or 3 times the rate of) surfers without this qualification. The difference between the rate of assistance provided by surfers with and without board rescue and first aid qualifications were not statistically significant. We estimate that surfers may provide safety advice up to 739,209 times, first aid 25,490 times and assistance 70,097 times per year in Victoria. The economic value of lives saved by survey respondents through surfer assistance in the water is estimated to be 3.8 billion (2023 AUD). Results confirm the importance of the safety actions of surfers to other beachgoers and point to the positive impact of board rescue training and qualifications on surfer beach safety actions.</p