Cost-benefit evaluation of routine influenza immunisation in people 65-74 years of age

OBJECTIVES: To determine the cost-effectiveness of influenza vaccination in people aged 65-74 years in the absence of co-morbidity. DESIGN: Primary research: randomised controlled trial. SETTING: Primary care. PARTICIPANTS: People without risk factors for influenza or contraindications to vaccination were identified from 20 general practitioner (GP) practices in Liverpool in September 1999 and invited to participate in the study. There were 5875/9727 (60.4%) people aged 65-74 years identified as potentially eligible and, of these, 729 (12%) were randomised. INTERVENTION: Participants were randomised to receive either influenza vaccine or placebo (ratio 3:1), with all individuals receiving pneumococcal vaccine unless administered in the previous 10 years. Of the 729 people randomised, 552 received vaccine and 177 received placebo; 726 individuals were administered pneumococcal vaccine. MAIN OUTCOME MEASURES AND METHODOLOGY OF ECONOMIC EVALUATION: GP attendance with influenza-like illness (ILI) or pneumonia (primary outcome measure); or any respiratory symptoms; hospitalisation with a respiratory illness; death; participant self-reported ILI; quality of life (QoL) measures at 2, 4 and 6 months post-study vaccination; adverse reactions 3 days after vaccination. A cost-effectiveness analysis was undertaken to identify the incremental cost associated with the avoidance of episodes of influenza in the vaccination population and an impact model was used to extrapolate the cost-effectiveness results obtained from the trial to assess their generalisability throughout the NHS. RESULTS: In England and Wales, weekly consultations for influenza and ILI remained at baseline levels (less than 50 per 100,000 population) until week 50/1999 and then increased rapidly, peaking during week 2/2000 with a rate of 231/100,000. This rate fell within the range of 'higher than expected seasonal activity' of 200-400/100,000. Rates then quickly declined, returning to baseline levels by week 5/2000. The predominant circulating strain during this period was influenza A (H3N2). Five (0.9%) people in the vaccine group were diagnosed by their GP with an ILI compared to two (1.1%) in the placebo group [relative risk (RR), 0.8; 95% confidence interval (CI) = 0.16 to 4.1]. No participants were diagnosed with pneumonia by their GP and there were no hospitalisations for respiratory illness in either group. Significantly fewer vaccinated individuals self-reported a single ILI (4.6% vs 8.9%, RR, 0.51; 95% CI for RR, 0.28 to 0.96). There was no significant difference in any of the QoL measurements over time between the two groups. Reported systemic side-effects showed no significant differences between groups. Local side-effects occurred with a significantly increased incidence in the vaccine group (11.3% vs 5.1%, p = 0.02). Each GP consultation avoided by vaccination was estimated from trial data to generate a net NHS cost of 174 pounds. CONCLUSIONS: No difference was seen between groups for the primary outcome measure, although the trial was underpowered to demonstrate a true difference. Vaccination had no significant effect on any of the QoL measures used, although vaccinated individuals were less likely to self-report ILI. The analysis did not suggest that influenza vaccination in healthy people aged 65-74 years would lead to lower NHS costs. Future research should look at ways to maximise vaccine uptake in people at greatest risk from influenza and also the level of vaccine protection afforded to people from different age and socio-economic populations.

Morphological and fecundity traits of Culex mosquitoes caught in gravid traps in urban and rural Berkshire, UK

Culex pipiens s.l. is one of the primary vectors of West Nile Virus in the USA and Continental Europe. The seasonal abundance and eco-behavioural characteristics of the typical form, Cx. pipiens pipiens, make it a key putative vector in Britain. Surveillance of Culex larvae and adults is essential to detect any changes to spatial and seasonal activity or morphological traits that may increase the risk of disease transmission. Here we report the use of the modified Reiter gravid box trap, which is commonly used in the USA but scarcely used in the UK, to assess its suitability as a tool for British female Culex mosquito surveillance. Trapping was carried out at 110 sites in urban and rural gardens in Berkshire in May, July and September 2013. We tested if reproductively active adult female Culex are more abundant in urban than rural gardens and if wing characteristic traits and egg raft size are influenced by location and seasonal variations. Gravid traps were highly selective for Culex mosquitoes, on average catching significantly more per trap in urban gardens (32.4 ± 6.2) than rural gardens (19.3 ± 4.0) and more in July than in May or September. The majority of females were caught alive in a good condition. Wing lengths were measured as an indicator of size. Females flying in September were significantly smaller than females in May or July. Further non-significant differences in morphology and fecundity between urban and rural populations were found that should be explored further across the seasons.

Seasonal forecasts of tropical cyclone activity in a high-atmospheric-resolution coupled prediction system

Seasonal forecast skill of the basinwide and regional tropical cyclone (TC) activity in an experimental coupled prediction system based on the ECMWF System 4 is assessed. As part of a collaboration between the Center for Ocean–Land–Atmosphere Studies (COLA) and the ECMWF called Project Minerva, the system is integrated at the atmospheric horizontal spectral resolutions of T319, T639, and T1279. Seven-month hindcasts starting from 1 May for the years 1980–2011 are produced at all three resolutions with at least 15 ensemble members. The Minerva system demonstrates statistically significant skill for retrospective forecasts of TC frequency and accumulated cyclone energy (ACE) in the North Atlantic (NA), eastern North Pacific (EP), and western North Pacific. While the highest scores overall are achieved in the North Pacific, the skill in the NA appears to be limited by an overly strong influence of the tropical Pacific variability. Higher model resolution improves skill scores for the ACE and, to a lesser extent, the TC frequency, even though the influence of large-scale climate variations on these TC activity measures is largely independent of resolution changes. The biggest gain occurs in transition from T319 to T639. Significant skill in regional TC forecasts is achieved over broad areas of the Northern Hemisphere. The highest-resolution hindcasts exhibit additional locations with skill in the NA and EP, including land-adjacent areas. The feasibility of regional intensity forecasts is assessed. In the presence of the coupled model biases, the benefits of high resolution for seasonal TC forecasting may be underestimated.

Seasonal deposition of Holocene banded sediments in the Severn Estuary Levels (southwest Britain): palynological and sedimentological evidence

Banded sediments outcrop widely in the intertidal zone of the Severn Estuary and have been suggested, on the basis of textural analysis, to have formed in response to seasonal variations in sea temperature and windiness (Holocene, 14 (2004) 536). Here palynological and sedimentological analyses of banded sediments of mid-Holocene date from Gold Cliff, on the Welsh side of the Severn Estuary, are combined to test and further develop the hypothesis of seasonal deposition. Pollen percentage and concentration data are presented from a short sequence of bands to establish whether textural variations in the bands coincide with variations in pollen content reflecting seasonal flowering patterns. It is shown that fine-grained band parts contain higher total pollen concentrations, and a higher proportion of pollen from late spring- to summer-flowering plants, than coarse-grained band parts. Pollen in the coarser deposits appears primarily to reflect deposition from the buffering `reservoir' of suspended pollen in the estuarine water-body and from rivers, when there is little pollen in the air in winter, while the finer sediments contain pollen deposited from the atmosphere during the flowering season, superimposed on these `background' sources. The potential of such deposits for refining chronologies and identifying seasonality of coastal processes is noted, and the results of charcoal particle analysis of the bands presented as an example of how they have the potential to shed light on seasonal and annual patterns of human activity. (C) 2004 Elsevier Ltd. All rights reserved.

Are cold winters in Europe associated with low solar activity?

Solar activity during the current sunspot minimum has fallen to levels unknown since the start of the 20th century. The Maunder minimum (about 1650–1700) was a prolonged episode of low solar activity which coincided with more severe winters in the United Kingdom and continental Europe. Motivated by recent relatively cold winters in the UK, we investigate the possible connection with solar activity. We identify regionally anomalous cold winters by detrending the Central England temperature (CET) record using reconstructions of the northern hemisphere mean temperature. We show that cold winter excursions from the hemispheric trend occur more commonly in the UK during low solar activity, consistent with the solar influence on the occurrence of persistent blocking events in the eastern Atlantic. We stress that this is a regional and seasonal effect relating to European winters and not a global effect. Average solar activity has declined rapidly since 1985 and cosmogenic isotopes suggest an 8% chance of a return to Maunder minimum conditions within the next 50 years (Lockwood 2010 Proc. R. Soc. A 466 303–29): the results presented here indicate that, despite hemispheric warming, the UK and Europe could experience more cold winters than during recent decades.

Activity patterns of urban red foxes (Vulpes vulpes) reduce the risk of traffic-induced mortality

Traffic collisions can be a major source of mortality in wild populations, and animals may be expected to exhibit behavioral mechanisms that reduce the risk associated with crossing roads. Animals living in urban areas in particular have to negotiate very dense road networks, often with high levels of traffic flow. We examined traffic-related mortality of red foxes (Vulpes vulpes) in the city of Bristol, UK, and the extent to which roads affected fox activity by comparing real and randomly generated patterns of movement. There were significant seasonal differences in the number of traffic-related fox deaths for different age and sex classes; peaks were associated with periods when individuals were likely to be moving through unfamiliar terrain and would have had to cross major roads. Mortality rates per unit road length increased with road magnitude. The number of roads crossed by foxes and the rate at which roads were crossed per hour of activity increased after midnight when traffic flow was lower. Adults and juveniles crossed 17% and 30% fewer roads, respectively, than expected from randomly generated movement. This highly mobile species appeared to reduce the mortality risk of minor category roads by changing its activity patterns, but it remained vulnerable to the effects of larger roads with higher traffic flows during periods associated with extraterritorial movements.

Movements, activity patterns and home range of a female brown bear (Ursus arctos, L.) in the Rodopi Mountain Range, Greece

Movements and activity patterns of an adult radio-tagged female brown bear accompanied by her cubs were documented for the first time in Rodopi area (NE Greece) from August 2000 to July 2002. Average daily movements were 2.45 +/- 2.26 SD km, (range 0.15-8.5 km). The longest daily range could be related to human disturbance (hunting activity). The longest seasonal distance (211 km), during Summer 2001 coincided with the dissolution of the family. With cubs, the female was more active during daytime (73 % of all radio-readings) than when solitary (28 %). The female switched to a more crepuscular behaviour, after separation from the yearling (July 2001). According to pooled data from 924 activity - recording sessions, during the whole monitoring period, the female was almost twice as active during day time while rearing cubs (51 % active) than when solitary (23 %). The autumn and early winter home range size of the family was larger (280 km(2)) than after the separation from the cubs (59 km(2)). During the family group phase, home range size varied from 258 km(2) in autumn to 40 km(2) in winter (average denning period lasted 107 days : December 2000-March 2001). The bear hibernated in the Bulgarian part of the Rodopi Range during winters of 2001 and 2002.

Seasonal 'fall out' of sessile macro-fauna from submarine cliffs: quantification, causes and implications

Submarine cliffs are typically crowded with sessile organisms, most of which are ultimately exported downwards. Here we report a 24 month study of benthic fauna dropping from such cliffs at sites of differing cliff angle and flow rates at Lough Hyne Marine Nature Reserve, Co. Cork, Ireland. The magnitude of 'fall out' material collected in capture nets was highly seasonal and composed of sessile and mobile elements. Sponges, ascidians, cnidarians, polychaetes, bryozoans and barnacles dominated the sessile forms. The remainder (mobile fauna) were scavengers and predators such as asteroid echinoderms, gastropod molluscs and malacostracan crustaceans. These were probably migrants targeting fallen sessile organisms. 'Fall out' material (including mobile forms) increased between May and August in both years. This increase in 'fall out' material was correlated with wrasse abundance at the cliffs (with a one month lag period). The activities of the wrasse on the cliffs (feeding, nest building and territory defence) were considered responsible for the majority of 'fall out' material, with natural mortality and the activity of other large mobile organisms (e.g. crustaceans) also being triplicated. Current flow rate and cliff profile were important in amount of 'fall out' material collected. In low current situations export of fallen material was vertical, while both horizontal and vertical export was associated with moderate to high current environments. Higher 'fall out' was associated with overhanging than vertical cliff surfaces. The 'fall out' of marine organisms in low current situations is likely to provide ail important source of nutrition in close proximity to the cliff, in an otherwise impoverished soft sediment habitat. However, in high current areas material will be exported some distance from the source, with final settlement again occurring in soft sediment habitats (as current speed decreases).

The signature of ENSO in the Northern Hemisphere midlatitude seasonal mean flow and high-frequency intraseasonal variability

The impact of pronounced positive and negative sea surface temperature (STT) anomalies in the tropical Pacific associated with the El Niño/Southern Oscillation (ENSO) phenomenon on the atmospheric circulation in the Northern Hemisphere extratropics during the boreal winter season is investigated. This includes both the impact on the seasonal mean flow and on the intraseasonal variability on synoptic time scales. Moreover, the interaction between the transient fluctuations on these times scales and the mean circulation is examined. Both data from an ensemble of five simulations with the ECHAM3 atmospheric general circulation model at a horizontal resolution of T42 each covering the period from 1979 through 1992 and operational analyses from ECMWF for the corresponding period are examined. In each of the simulations observed SSTs for the period of investigation are given as lower boundary forcing, but different atmospheric initial conditions are prescribed. The simulations with ECHAM3 reveal a distinct impact of the pronounced SST-anomalies in the tropical Pacific on the atmospheric circulation in the Northern Hemisphere extratropics during El Niño as well as during La Niña events. These changes in the atmospheric circulation, which are found to be highly significant in the Pacific/North American as well as in the Atlantic/European region, are consistent with the essential results obtained from the analyses. The pronounced SST-anomalies in the tropical Pacific lead to changes in the mean circulation, which are characterized by typical circulation patterns. These changes in the mean circulation are accompanied by marked variations of the activity of the transient fluctuations on synoptic time scales, that are changes in both the kinetic energy on these time scales and the atmospheric transports of momentum and heat accomplished by the short baroclinic waves. The synoptic disturbances, on the other hand, play also an important role in controlling the changes in the mean circulation associated with the ENSO phenomenon. They maintain these typical circulation patterns via barotropic, but counteract them via baroclinic processes. The hypothesis of an impact of the ENSO phenomenon in the Atlantic/European region can be supported. As the determining factor the intensification (reduction) of the Aleutian low and the simultaneous reduction (intensification) of the Icelandic low during El Niño and during La Niña events respectively, is identified. The changes in the intensity of the Aleutian low during the ENSO-events are accompanied by an alteration of the transport of momentum caused by the short baroclinic waves over the North American continent in such a way that the changes in the intensity of the Icelandic low during El Niño as well as during La Niña events are maintained.

Wave activity in the tropical tropopause layer in seven reanalysis and four chemistry climate model data sets

Sub-seasonal variability including equatorial waves significantly influence the dehydration and transport processes in the tropical tropopause layer (TTL). This study investigates the wave activity in the TTL in 7 reanalysis data sets (RAs; NCEP1, NCEP2, ERA40, ERA-Interim, JRA25, MERRA, and CFSR) and 4 chemistry climate models (CCMs; CCSRNIES, CMAM, MRI, and WACCM) using the zonal wave number-frequency spectral analysis method with equatorially symmetric-antisymmetric decomposition. Analyses are made for temperature and horizontal winds at 100 hPa in the RAs and CCMs and for outgoing longwave radiation (OLR), which is a proxy for convective activity that generates tropopause-level disturbances, in satellite data and the CCMs. Particular focus is placed on equatorial Kelvin waves, mixed Rossby-gravity (MRG) waves, and the Madden-Julian Oscillation (MJO). The wave activity is defined as the variance, i.e., the power spectral density integrated in a particular zonal wave number-frequency region. It is found that the TTL wave activities show significant difference among the RAs, ranging from ∼0.7 (for NCEP1 and NCEP2) to ∼1.4 (for ERA-Interim, MERRA, and CFSR) with respect to the averages from the RAs. The TTL activities in the CCMs lie generally within the range of those in the RAs, with a few exceptions. However, the spectral features in OLR for all the CCMs are very different from those in the observations, and the OLR wave activities are too low for CCSRNIES, CMAM, and MRI. It is concluded that the broad range of wave activity found in the different RAs decreases our confidence in their validity and in particular their value for validation of CCM performance in the TTL, thereby limiting our quantitative understanding of the dehydration and transport processes in the TTL.

MODIS-based vegetation index has sufficient sensitivity to indicate stand-level intra-seasonal climatic stress in oak and beech forests

Context: Variation in photosynthetic activity of trees induced by climatic stress can be effectively evaluated using remote sensing data. Although adverse effects of climate on temperate forests have been subjected to increased scrutiny, the suitability of remote sensing imagery for identification of drought stress in such forests has not been explored fully. Aim: To evaluate the sensitivity of MODIS-based vegetation index to heat and drought stress in temperate forests, and explore the differences in stress response of oaks and beech. Methods: We identified 8 oak and 13 beech pure and mature stands, each covering between 4 and 13 MODIS pixels. For each pixel, we extracted a time series of MODIS NDVI from 2000 to 2010. We identified all sequences of continuous unseasonal NDVI decline to be used as the response variable indicative of environmental stress. Neural Networks-based regression modelling was then applied to identify the climatic variables that best explain observed NDVI declines. Results: Tested variables explained 84–97% of the variation in NDVI, whilst air temperature-related climate extremes were found to be the most influential. Beech showed a linear response to the most influential climatic predictors, while oak responded in a unimodal pattern suggesting a better coping mechanism. Conclusions: MODIS NDVI has proved sufficiently sensitive as a stand-level indicator of climatic stress acting upon temperate broadleaf forests, leading to its potential use in predicting drought stress from meteorological observations and improving parameterisation of forest stress indices.