scholarly journals Experience of establishing and coordinating a nationwide network for bidirectional intussusception surveillance in India: lessons for multisite research studies

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e046827
Author(s):  
Manoja Kumar Das
Keyword(s):  
Quality Assurance ◽  
Site Selection ◽  
Information Seeking ◽  
Selection Process ◽  
Tertiary Care ◽  
Vaccine Safety ◽  
Secondary Outcome ◽  
Prospective Surveillance ◽  
Surveillance Network ◽  
Nationally Representative

ObjectivesTo document and share the process of establishing the nationally representative multisite surveillance network for intussusception in India, coordination, data management and lessons learnt from the implementation.DesignThis study combined both retrospective and prospective surveillance approaches.Setting19 tertiary care institutions were selected in India considering the geographic representation and public and private mixParticipantsAll children under-2 years of age with intussusceptionPrimary and secondary outcome measuresThe experience of site selection, regulatory approvals, data collection, quality assurance and network coordination were documented.ResultsThe site selection process involved systematic and objective four steps including shortlisting of potential institutions, information seeking and telephonic interaction, site visits and site selection using objective criteria. Out of over 400 hospitals screened across India, 40 potential institutions were shortlisted and information was sought by questionnaire and interaction with investigators. Out of these, 25 institutes were visited and 19 sites were finally selected to participate in the study. The multistep selection process allowed filtering and identification of sites with adequate capacity and motivated investigators. The retrospective surveillance documented 1588 cases (range: 14–652 cases/site) and prospective surveillance recruited 621 cases (range: 5–191 cases/site). The multilayer quality assurance measures monitored and ensured protocol adherence, complete record retrieval and data completeness. The key challenges experienced included time taken for obtaining regulatory and ethical approvals, which delayed completion of the study. Ten sites continued with another multisite vaccine safety surveillance study.ConclusionThe experience and results of this systematic and objective site selection method in India are promising. The systematic multistep site selection and data quality assurance methods presented here are feasible and practical. The lessons from the establishment and coordination of this surveillance network can be useful in planning, selecting the sites and conducting multisite and surveillance studies in India and developing countries.

scholarly journals Development and quality assurance of computer programs for the review of long-term safety analysis

2021 ◽  
Vol 1 ◽  
pp. 171-172
Author(s):  
Jens Eckel ◽  
Martin Navarro ◽  
Stephan Hotzel
Keyword(s):  
Quality Assurance ◽  
Site Selection ◽  
Selection Process ◽  
Data Interpretation ◽  
Computer Programs ◽  
Safety Analysis ◽  
Starting Point ◽  
High Degree ◽  
Modelling Approach

Abstract. During the site selection process, regulated by the Site Selection Act (Standortauswahlgesetz – StandAG), the implementer has to identify adequate siting regions and has to perform long-term safety analysis for these regions. The Federal Office for the Safety of Nuclear Waste Management (Bundesamt für die Sicherheit der nuklearen Entsorgung – BASE) as the responsible federal authority has to review the implementer's long-term safety analysis. To perform this duty in the required depth, it will be necessary to recalculate important aspects of the analysis by means of numerical computer programs. In addition, this will allow assessment of the underlying uncertainties of the implementer's long-term safety analysis from a regulatory point of view. Numerical modelling requires a high degree of quality assurance. Therefore, it is of vital importance that the same problem is modelled with different computer programs and – if possible – by different teams of modelers. This strategy is known as the diverse modelling approach. The goal of this approach is to perform a cross-check of the computer programs in use as well as of the correctness of data handling, data interpretation, and model implementation. Comparing outcomes of different modelling teams also integrates complementary views and approaches, which can be beneficial when dealing with complicated problems. The diverse modelling approach forms the basis of regulatory modelling. It can also be implemented within organizations if more than one code is used to tackle the same task. The diverse modelling approach has been carried out at GRS gGmbH over the past two decades by means of the computer programs, TOUGH2-GRS and MARNIE(2). Both (co-)developed programs are thermohydraulic codes that compute transport phenomena in porous media and can be coupled to geochemical codes, see Navarro (2018) and Navarro et al. (2021) for further details. TOUGH2-GRS and MARNIE(2) were applied in various projects, such as preliminary safety analysis Gorleben (VSG, Vorläufige Sicherheitsanalyse Gorleben), ZIESEL and EVEREST. A recent example for the diverse modelling approach was the use of TOUGH2-GRS and MARNIE for the development of indicators for the safe confinement of radionuclides in a deep geological repository (Navarro et al., 2019). A high degree of quality assurance is also achieved by involving computer programs in benchmarks to compare results among different codes for well-defined problems. For the calculation of THM (thermo-hydraulical-mechanical) processes TOUGH2-GRS has been coupled with the geomechanical computer program FLAC3D and this approach has been used in the benchmark BenVaSim (Seher et al., 2019). In this contribution selected works related to TOUGH2-GRS and MARNIE(2) are presented. From this starting-point, ideas and concepts for the continuation of development and quality assurance of the two computer programs at BASE in the near future are outlined. These works will contribute to strengthen the capabilities of BASE in the independent review process of implementer's long-term safety analysis within the site selection process.

Spontaneous self-affirmation before and during COVID-19: Associations with information-seeking, worry and adherence

2020 ◽  
Author(s):  
Tracy Epton ◽  
Chris Keyworth ◽  
Chris Armitage
Keyword(s):  
Older Adults ◽  
Opposite Direction ◽  
Information Seeking ◽  
Demographic Characteristics ◽  
Brief Interventions ◽  
Adaptive Behaviors ◽  
Uk Government ◽  
Nationally Representative

Objective: To assess the extent of spontaneous self-affirmation pre COVID-19 and during COVID-19 pandemic to identify for whom self-affirmation interventions might be helpful; and the extent to which spontaneous self-affirmation is associated with increased information-seeking, worry and adherence to UK government instructions. Methods: Two large nationally-representative surveys of UK adults were conducted via YouGov in March 2019 (pre COVID-19; N = 10421) and April 2020 (during COVID-19; N = 2252); both surveys measured demographic characteristics and spontaneous self-affirmation. The latter survey included measures of time spent accessing COVID-19 related news, worry about COVID-19 related news and degree of adherence to UK government instructions. Results: Spontaneous self-affirmation was lower before COVID-19 (44%) than it was during the pandemic (57%), although the pattern was in the opposite direction among older adults. Older adults were more likely to spontaneously self-affirm during COVID-19 than pre COVID-19. Greater spontaneous self-affirmation was associated with more time spent accessing news, and greater adherence to UK government instructions, but not media-related worry. Conclusions: The threat of COVID-19 may have triggered greater levels of spontaneous self-affirmation, which could give people the resources they needed to allow them to seek COVID-19-related news and adhere to UK government instructions. Groups lower in spontaneous self-affirmation, such as younger people could be targeted with brief interventions to promote self-affirmation and encourage performance of adaptive behaviors.

Republicans, Not Democrats, Are More Likely to Endorse Anti-Vaccine Misinformation

2021 ◽  
pp. 1532673X2110226
Author(s):  
Matthew Motta
Keyword(s):  
Vaccine Safety ◽  
Health Policies ◽  
Scientific Experts ◽  
Childhood Vaccine ◽  
Nationally Representative ◽  
Childhood Vaccines ◽  
Partisan Identification

Vaccine safety skeptics are often thought to be more likely to self-identify as Democrats (vs. Independents or Republicans). Recent studies, however, suggest that childhood vaccine misinformation is either more common among Republicans, or is uninfluenced by partisan identification (PID). Uncertainty about the partisan underpinnings of vaccine misinformation acceptance is important, as it could complicate efforts to pursue pro-vaccine health policies. I theorize that Republicans should be more likely to endorse anti-vaccine misinformation, as they tend to express more-negative views toward scientific experts. Across six demographically and nationally representative surveys, I find that—while few Americans think that “anti-vaxxers” are more likely to be Republicans than Democrats—Republican PID is significantly associated with the belief that childhood vaccines can cause autism. Consistent with theoretical expectations, effect is strongly mediated by anti-expert attitudes—an effect which supplemental panel analyses suggest is unlikely to be reverse causal.

scholarly journals Profile and outcome of pediatric intussusception: a 5-year experience in a tertiary care center

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Aqeela J. Madan ◽  
Fayza Haider ◽  
Saeed Alhindi
Keyword(s):  
Seasonal Variation ◽  
Success Rate ◽  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Operative Intervention ◽  
Secondary Outcome ◽  
Lead Point ◽  
Pneumatic Reduction ◽  
Tertiary Center

Abstract Background Intussusception is the most frequent cause of bowel obstruction in infants and toddlers; idiopathic intussusception occurs predominantly under the age of 3 and is rare after the age of 6 years; the highest incidence occurs in infants between 4 and 9 months; the gold standard for treatment of intussusception is non-operative reduction. This research will tackle the problem of pediatric intussusception in our center which is the largest tertiary center in our region. The primary outcome is to study the profile of intussusception; the secondary outcome is to assess the success rate of pneumatic reduction in the center’s pediatric population as well as to study the seasonal variation if present. Results During the study period, eighty-six (N=86) cases were identified, from which 10 cases were recurrent intussusception. Seventy-six (N=76) cases were included from the study period. N=68 (89%) were less than 3 years of age, and only N=2 (3%) were above 6 years. Seasonal variation was not significant; N=69 (91%) patients had successful pneumatic reduction under fluoroscopy while thirteen patients N=13 (17%) needed operative intervention. Conclusion Ileocolic intussusception is one of the most common pediatric surgical emergencies that can be successfully managed non-operatively in our institute; 89% of the cases were below 3 years of age, and no seasonal variation was demonstrated. Operative intervention was required in 13 cases with the main reason being lead point. The fact that the pediatric surgeon performs the reduction might have contributed to a high success rate reaching 91% in our center. This study provides a valuable opportunity for future regional data comparisons and pooled data analyses.

scholarly journals POS1225 INFLUENCE OF COLCHICINE PRESCRIPTION IN COVID19-RELATED HOSPITAL ADMISSIONS: A SURVIVAL ANALYSIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 896.2-896
Author(s):  
M. P. Álvarez ◽  
A. Madrid García ◽  
I. Perez-Sancristobal ◽  
J. I. Colomer ◽  
L. León ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Rheumatic Diseases ◽  
Hospital Admissions ◽  
Musculoskeletal Diseases ◽  
Tertiary Care ◽  
Secondary Outcome ◽  
P Value ◽  
Inflammatory Rheumatic Diseases ◽  
Cytokine Storm ◽  
Observation Period

Background:Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), triggers the innate immune system, leading in severe cases, an excessive immune response, which can lead to high levels of pro-inflammatory cytokines promoting a “cytokine storm”.To modulate this exaggerated inflammatory response, several clinical trials with already approved and well-known therapeutic agents that inhibit the inflammatory response, are being carried out. However, none of these drugs seems to achieve the desired results when treating COVID19.Colchicine, a drug often used in the management of patients with Rheumatic and Musculoskeletal diseases (RMDs), is one of the several drugs that are being currently tested for efficacy in COVID19 due to its anti-inflammatory effects.Objectives:To analyze association between colchicine prescription and COVID19-related hospital admissions in patients with Rheumatic and Musculoskeletal diseases (RMDs).Methods:Patients attending a rheumatology outpatient clinic from a tertiary care center in Madrid, Spain, from 1st September 2019 to 29th February 2020 were included.Patients were assigned as exposed or unexposed based on whether they were prescribed with colchicine in their last visit to the clinic during the 6 months before the start of the observation period. Treatment changes during the observation period were also considered. The primary outcome was COVID19-related hospital admissions occurring between March 1st and May 20th, 2020. Secondary outcome included COVID19-related mortality. Several weighting techniques for data balancing, based and non-based on the propensity score, followed by Cox regressions were performed to estimate the association of colchicine prescription on both outcomes.Results:9,379 patients entered in the study, with 406 and 9,002 exposed and unexposed follow-up periods, respectively. Generalized Boosted Models (GBM) and Empirical Balancing Calibration Weighting (EBCW) methods showed the best balance for COVID19-related hospital admissions. Colchicine prescription did not show a statistically significant association after covariable balancing (p-value = 0.195 and 0.059 for GBM and EBCW, respectively). Regarding mortality, the low number of events prevented a success variable balancing and analysis.Conclusion:Colchicine prescription does not play a significant protective or risk role in RMD patients regarding COVID19-related hospital admissions. Our observations could support the maintenance of colchicine prescription in those patients already being treated, as it is not associated with a worse prognosis.References:[1]Fernandez-Gutierrez B. COVID-19 with Pulmonary Involvement. An Autoimmune Disease of Known Cause. Reumatol Clin 2020; 16: 253–254.[2]Coperchini F, Chiovato L, Croce L, et al. The cytokine storm in COVID-19: An overview of the involvement of the chemokine/chemokine-receptor system. Cytokine Growth Factor Rev 2020; 53: 25–32.[3]Shaffer L. 15 drugs being tested to treat COVID-19 and how they would work. Nat Med. Epub ahead of print 15 May 2020. DOI: 10.1038/d41591-020-00019-9.[4]Fernandez-Gutierrez B, Leon L, Madrid A, et al. Hospital admissions in inflammatory rheumatic diseases during the COVID-19 pandemic: incidence and role of disease modifying agents. medRxiv 2020; 2020.05.21.20108696.[5]Freites Nuñez DD, Leon L, Mucientes A, et al. Risk factors for hospital admissions related to COVID-19 in patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2020; 1–7.Disclosure of Interests:None declared

Abstract 15502: Clinical Outcomes in Patients Undergoing Non-cardiac Surgery Within 1 Year of Pci

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Davide Cao ◽  
Matthew A Levin ◽  
Samantha Sartori ◽  
Anastasios Roumeliotis ◽  
Rishi Chandiramani ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Antiplatelet Therapy ◽  
Care Center ◽  
Tertiary Care ◽  
Coronary Intervention ◽  
Secondary Outcome ◽  
Cardiac Events ◽  
Bleeding Events ◽  
Target Vessel Revascularization ◽  
Increased Risk

Introduction: Perioperative cardiovascular events are an important cause of morbidity and mortality associated with non-cardiac surgery (NCS), especially in patients with recent percutaneous coronary intervention (PCI) who require dual antiplatelet therapy. Objective: To illustrate the types and timing of different noncardiac surgeries occurring within 1 year of PCI, and to evaluate the risk of thrombotic and bleeding events according to perioperative antiplatelet management. Methods: All patients undergoing NCS within 1 year of PCI at a tertiary-care center between 2011 and 2018 were included. The primary outcome was major adverse cardiac events (MACE; composite of death, myocardial infarction, stent thrombosis or target vessel revascularization). The key secondary outcome was major bleeding, defined as ≥2 units of blood transfusion. All outcomes were evaluated at 30 days after NCS. Results: A total of 1092 NCS (corresponding to 747 patients) were included and classified by surgical risk (low: 50.9%, intermediate: 38.4%, high: 10.7%) and priority (elective: 88.5%, urgent/emergent: 11.5%). High-risk and urgent/emergent surgeries tended to occur earlier post-PCI compared to low-risk and elective ones ( Figure-A ). The incidence of MACE and bleeding was time-dependent, with an increased risk in surgeries occurring in the first 6 months post-PCI ( Figure-B ). Perioperative antiplatelet cessation occurred in 487 (44.6%) NCS and was more likely for intermediate-risk procedures and after 6 months of PCI. There was no significant association between antiplatelet cessation and cardiac events. Conclusions: Among patients undergoing NCS within 1 year of PCI, the perioperative risk of MACE is inversely related to time from PCI. Preoperative interruption of antiplatelet therapy was observed in less than half of all cases and was not associated with an increased risk of cardiac events.

Understanding Online Conversation about COVID-19 Vaccine on Twitter: Data Mining Approach (Preprint)

2021 ◽  
Author(s):  
Ekaterina Malova
Keyword(s):  
Online Social Networks ◽  
Information Seeking ◽  
Information Dissemination ◽  
Vaccine Development ◽  
Online Communication ◽  
Vaccine Safety ◽  
Interaction Patterns ◽  
Twitter Users ◽  
The Government ◽  
Online Conversation

BACKGROUND Timely vaccination against COVID-19 can prevent a large number of people from getting infected. However, given the disease novelty and fast vaccine development, some people are hesitant to vaccinate. Online social networks like Twitter produce huge amounts of public health information and impact peoples' vaccination decisions. Hence, it is important to understand the conversation around the COVID-19 vaccination through the lens of social media. OBJECTIVE The present study aimed to define the nature of a larger Twitter conversation around the COVID-19 vaccine and explored interaction patterns between Twitter users engaged in such a conversation. METHODS Data collection took place in November 2020 on the wave of the news about the COVID-19 vaccine breakthrough. In total, 9600 Twitter posts were analyzed using a combination of text and network analysis. RESULTS Results of this study show that mixed-emotions reactions and discussions about potential side effects and vaccine safety dominated the online conversation. Twitter was primarily used for two purposes: information dissemination and opinion expression. Overall, the communication network was sparse, non-reciprocal, decentralized, and highly modular. Four main network clusters highlighted different groups of conversation stakeholders. CONCLUSIONS This study provides important insights into public sentiments, information-seeking behaviors, and online communication patterns during a major COVID-19 crisis. Given the popularity of Twitter among different types of communities and its power for rapid information dissemination, it can be an effective tool for vaccination promotion. Thus, it should be actively used to promote safe and effective vaccination through major stakeholders in the government, science, and health sectors.

3D Web Visualization Tool to support HAYABUSA2-MASCOT Landing Site Selection Process

2018 ◽  
Author(s):  
Antoine F. Charpentier ◽  
Vivian Lafaille ◽  
Aurelie Moussi ◽  
Jean Christophe Malapert ◽  
Laurence Lorda ◽  
...  
Keyword(s):  
Site Selection ◽  
Selection Process ◽  
Landing Site ◽  
Visualization Tool ◽  
Web Visualization ◽  
3D Web ◽  
Landing Site Selection
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