A pragmatic health centre-based evaluation comparing the effectiveness of a PCV13 schedule change from 3+0 to 2+1 in a high pneumococcal carriage and disease burden setting in Malawi: a study protocol

IntroductionStreptococcus pneumoniae (the pneumococcus) is commonly carried as a commensal bacterium in the nasopharynx but can cause life-threatening disease. Transmission occurs by human respiratory droplets and interruption of this process provides herd immunity. A 2017 WHO Consultation on Optimisation of pneumococcal conjugate vaccines (PCV) Impact highlighted a substantial research gap in investigating why the impact of PCV vaccines in low-income countries has been lower than expected. Malawi introduced the 13-valent PCV (PCV13) into the national Expanded Programme of Immunisations in 2011, using a 3+0 (3 primary +0 booster doses) schedule. With evidence of greater impact of a 2+1 (2 primary +1 booster dose) schedule in other settings, including South Africa, Malawi’s National Immunisations Technical Advisory Group is seeking evidence of adequate superiority of a 2+1 schedule to inform vaccine policy.MethodsA pragmatic health centre-based evaluation comparing impact of a PCV13 schedule change from 3+0 to 2+1 in Blantyre district, Malawi. Twenty government health centres will be randomly selected, with ten implementing a 2+1 and 10 to continue with the 3+0 schedule. Health centres implementing 3+0 will serve as the direct comparator in evaluating 2+1 providing superior direct and indirect protection against pneumococcal carriage. Pneumococcal carriage surveys will evaluate carriage prevalence among children 15–24 months, randomised at household level, and schoolgoers 5–10 years of age, randomly selected from school registers. Carriage surveys will be conducted 18 and 33 months following 2+1 implementation.AnalysisThe primary endpoint is powered to detect an effect size of 50% reduction in vaccine serotype (VT) carriage among vaccinated children 15–24 months old, expecting a 14% and 7% VT carriage prevalence in the 3+0 and 2+1 arms, respectively.Ethics and disseminationThe study has been approved by the Malawi College of Medicine Research Ethics Committee (COMREC; Ref: P05.19.2680), the University College London Research Ethics Committee (Ref: 8603.002) and the University of Liverpool Research Ethics Committee (Ref: 5439). The results from this study will be actively disseminated through manuscript publications and conference presentations.Trial registration numberNCT04078997.

Treatment changes in prostate cancer patients on active treatment during the COVID-19 pandemic in a community cancer center in New York City.

e18750 Background: The surge of the SARS coronavirus-2 (COVID-19) pandemic posed great challenges in the oncology community for optimal management of cancer patients. We sought to analyze the treatment changes experienced by the prostate cancer patients in March, April and May 2020 and to compare these treatment decisions to the published guidelines. Methods: We focused on patients currently receiving androgen deprivation therapy (ADT) with leuprolide acetate, and/or oral anti-androgen agents (Androgen receptor axis targeted agent, ARAT), or chemotherapy. Electronic medical records were reviewed, and the oncologists and nurse practitioners were interviewed to understand the decision-making process. Results: Seventy-five patients were included, median age 72 years old (range 47-95). All were taking ADT, and 21 were also taking ARAT, and 3 were also receiving chemotherapy. The incidence and indications for their ADT treatments and schedule changes are shown in the table below. Twenty-seven patients (36%) experienced delays in their ADT treatment, and the percentage of treatment change was similar in categories of metastatic hormone sensitive prostate cancer (mHSPC), metastatic castration resistant cancer (mCRPC), biochemical recurrence as well as stage IVA post surgery. Four patients were receiving neoadjuvant ADT planned prior to definitive radiation, and none had schedule change. One patient with mHSPC and 2 patients with mCRPC continued chemotherapy as planned. One patient declined recommended chemotherapy for mCRPC. Two patients were given q 3 months dose of ADT instead of q 1m, while all the rest were already receiving q3 months dosing. Among the 27 patients who had schedule change, 12 (44.4%) patients had a discussion with their providers first, and 15 patients (55.6%) did not keep their treatment appointment. Conclusions: About one third of patients changed ADT injection schedule with a similar percentage in patients with mHSPC, or mCRPC or Biochemical recurrence, or IVA after surgery. Every 3 months dosing of ADT recommended by NCCN significantly decreases exposure to COVID -19, delaying or skipping treatment was still encountered due to health concern or travel limitations. On the other hand, all patients receiving neoadjuvant ADT, or chemotherapy stayed on schedule. Although NCCN guideline recommended delaying myelosuppressive therapy, palliative chemotherapy for symptomatic, refractory patients may still be a priority.[Table: see text]

Risk Propagation Model and Simulation of Schedule Change in Construction Projects: A Complex Network Approach

Construction schedules play an important role in construction project management. However, during construction activities, risks may arise due to unexpected schedule changes, resulting in the ineffective delivery of projects. This study aims to reveal the law of schedule change risk propagation and to analyze the effects on the risk propagation through numerical simulations. First, construction projects are represented by activity-on-node (AON) networks. A model of risk propagation is then built based on a susceptible-infected (SI) model considering the effects of the nodal characteristics on the propagation process. Next, the model is tested on a real-world project to examine cascading failures with varying parameters. The experimental results demonstrate that the model is effective in identifying the activities most capable of affecting a project schedule and evaluating the impact of schedule change risk propagation. This study will provide a basis for enhancing the robustness of AON networks and controlling the propagation of schedule change risks.

Holistic analysis of the effect on electricity cost in South Africa’s platinum mines when varying shift schedules according to time-of-use tariffs

In the past the cost of electricity was not a significant concern and was not common practice for mining companies to consider peak time-of-use (TOU) tariffs for their shift schedules. It has become more prevalent, as TOU tariffs continue increasing, to consider energy saving important. A study was carried out to analyse the mining operation of a South African deep-level platinum mine in respect of integrated load management, shift changes and TOU schedules. This was achieved by thoroughly analysing energy consumers, mine operational schedules and their interconnectedness. A specific mining system was analysed as a case study and a maximum savings scenario was determined, using the methodology formulated. The maximum savings scenario schedule change resulted in a 1.3% cost reduction. System improvements had an additional potential reduction effect of 8.4%, which was primarily the result of a reduction in compressors’ power consumption. The implications of the proposed schedule adjustments necessitated a realistic scenario. The realistic scenario had an effective financial reduction of 0.7%. The realistic schedule change, however, opened the door for large system operational improvements, which could increase the reduction potential by 7.6%. The study methods described illustrate the potential implications of integrated load management and operational schedule optimisation on the power demand and cost savings in the mining industry, specifically focusing on deep-level platinum mines.