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Uptake of COVID-19 vaccine first doses in UK care homes has been higher among residents compared to staff. We aimed to identify causes of lower COVID-19 vaccine uptake amongst care home staff within Liverpool. An anonymised online survey was distributed to all care home managers, between the 21st and the 29th January 2021. 53 % of 87 care homes responded. The overall COVID-19 vaccination rate was 52.6 % (n = 1119). Reasons, identified by care home managers for staff being unvaccinated included: concerns about lack of vaccine research (37.0 %), staff being off-site during vaccination sessions (36.5 %), pregnancy and fertility concerns (5.6 %), and allergic reactions concerns (3.2 %). Care home managers wanted to tackle vaccine hesitancy through conversations with health professionals, and provision of evidence dispelling vaccine misinformation. Vaccine hesitancy and logistical issues were the main causes for reduced vaccine uptake among care home staff. The former could be addressed by targeted training, and public health communication campaigns to build confidence and acceptance of COVID-19 vaccines., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

Introduction: Care homes have been severely affected by the SARS-CoV-2 pandemic. Rapid antigen testing could identify most SARS-CoV-2 infected staff and visitors before they enter homes. We explored implementation of staff and visitor testing protocols using lateral flow devices (LFDs)., Methods: An evaluation of a SARS-CoV-2 LFD-based testing protocol in 11 care homes in Liverpool, UK, including staff and visitor testing, plus a qualitative exploratory study in nine of these homes. The proportion of pilot homes with outbreaks, and outbreak size, were compared to non-pilot homes in Liverpool. Adherence to testing protocols was evaluated. Fifteen staff were interviewed, and transcript data were thematically coded using an iterative analysis to identify and categorize factors influencing testing implementation., Results: In total, 1,638 LFD rapid tests were performed on 407 staff. Protocol adherence was poor with 8.6% of staff achieving >75% protocol adherence, and 25.3% achieving $\ge$50%. Six care homes had outbreaks during the study. Compared to non-pilot care homes, there was no evidence of significant difference in the proportion of homes with outbreaks, or the size of outbreaks. Qualitative data showed difficulty implementing testing strategies due to excessive work burden. Factors influencing adherence related to test integration and procedural factors, socio-economic factors, cognitive overload and the emotional value of testing., Conclusion: Implementation of staff and visitor care home LFD testing protocols was poorly adhered to and consequently did not reduce the number or scale of COVID-19 outbreaks. More focus is needed on the contextual and behavioural factors that influence protocol adherence., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Aim: To compare, over a 4-year period, a cohort of adult frequent attenders at Christchurch Hospital Emergency Department (Christchurch, New Zealand) who received case management with a cohort who did not., Method: A descriptive prospective cohort study of patients who attended ED 10 or more times during the index period of 1 Nov 2000-31 Oct 2001 was carried out. Each patient had an individual management plan. Attendance patterns were compared with a previous 4-year study of patients without management plans which was performed in the same ED. This study acted as an historical control., Results: 87 patients who met the criteria for frequent attendance were compared with 77 patients in the control group. 10 patients remained frequent users for all 4 years of the study, compared with 9 in the control group. Most patients attended less frequently in the second year, with attendance rates continuing to fall, while a small group continued to make frequent presentations. The percentage of the cohort still attending ED at least once a year in the 4th year was nearly identical in each study (65% in the control and 64% in the intervention group); the percentage of each cohort who remained as frequent attenders, still attending 10 or more times in the 4th year, was identical., Conclusions: This study showed similar rates of attrition in ED attendance between the cohorts with and without management plans. If there were not a 'control' group, the decline in attendance in the study group might have been attributed to the management plans. When attributing changes in attendance patterns to any intervention, it is important to be aware of natural attrition over time.

The present work provides the first information concerning the immunostimulatory activity of trout recombinant interleukin-1 beta (rIL-1beta) in vivo. The predicted rainbow trout mature IL-1beta peptide was produced as a recombinant protein in Escherichia coli. Optimal migration of peritoneal leucocytes and rIL-1beta induced phagocytosis occurred following intraperitoneal injection of 1 microg of the recombinant protein. Moreover, systemic IL-1beta, COX-2 and lysozyme II gene expression was enhanced following >or=1 microg rIL-1beta administration. Finally, resistance to Aeromonas salmonicida, the causative agent of furunculosis, was augmented at early times (2 days) post-injection of 1 microg rIL-1beta.

The present work provides information concerning the immunostimulatory activity of Ergosan, an algal based product, injected intraperitoneally in the rainbow trout (Oncorhynchus mykiss). Ergosan is composed of 0.002% unspecified plant extract, 1% alginic acid from Laminaria digitata, and 98.998% algal based carrier. Migration of leucocytes into the peritoneal cavity was stimulated at doses > or =1 mg ml(-1). A single dose of 1mg significantly augmented the proportion of neutrophils, degree of phagocytosis, respiratory burst activity and expression of interleukin-1beta (IL-1beta), interleukin-8 (IL-8) and one of the two known isoforms of trout tumour necrosis factor-alpha (TNF2) in peritoneal leucocytes at 1 day post-injection. Humoral immune parameters were less responsive to intraperitoneal Ergosan administration, with complement stimulation only evident in the 1mg treated group at 2 days post-injection. Antiprotease and lysozyme activity were unaffected by Ergosan over a 7-day time period at the doses examined.