scholarly journals Reflecting on the Advantages of Longitudinal Integrated Clerkships and COVID-19

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Kyle Geiger ◽  
Jamie Bowman ◽  
Dawn DeWitt
Keyword(s):  
Clinical Activity ◽  
Clinical Experiences ◽  
Specific Knowledge ◽  
Global Pandemic ◽  
Seamless Transition ◽  
Longitudinal Integrated Clerkships ◽  
Specific Assessment ◽  
Longitudinal Integrated Clerkship ◽  
Integrated Approaches ◽  
To Receive

The emergence of Coronavirus Disease 2019 (COVID-19) has dramatically changed the landscape of medical education. The global pandemic highlighted advantages of specific curricular frameworks.  Longitudinal, integrated approaches may avoid some of the educational consequences seen in traditional models. This viewpoint highlights the advantages of a longitudinal integrated clerkship during the COVID-19 outbreak. These advantages include a relatively even exposure to multiple specialties, discipline specific assessment information despite an early truncation of clinical activity, and a seamless transition to ongoing integrated online learning, as a single integrated virtual clerkship model for an entire class. Notably, the longitudinal integrated clerkship avoided consequences seen in traditional clerkships such as missing entire rotations positioned in March-June 2020 and therefore, clerkship grades. The longitudinal clerkship allowed for students to receive discipline specific grades in all core specialties based on assessment of individual skills (direct observation and assessment of skills such as physical exam and history) versus discipline specific knowledge (subject exams). In addition, there are advantages of pre-existing relationships with preceptors and patients that could facilitate engagement in ongoing contact during virtual clerkships and opportunistic clinical experiences when it is safe for students to re-engage in clinical activities.

Synthetic and semi-synthetic drugs as promising therapeutic option for the treatment of COVID-19

2020 ◽  
Vol 20 ◽  
Author(s):  
Ekta Shirbhate ◽  
Preeti Patel ◽  
Vijay K Patel ◽  
Ravichandran Veerasamy ◽  
Prabodh C Sharma ◽  
...  
Keyword(s):  
Therapeutic Option ◽  
Antiviral Treatment ◽  
The Novel ◽  
Clinical Experiences ◽  
Synthetic Compounds ◽  
Synthetic Drugs ◽  
Global Pandemic ◽  
The World ◽  
Novel Coronavirus

: The novel coronavirus disease-19 (COVID-19), a global pandemic that emerged from Wuhan, China has today travelled all around the world, so far 216 countries or territories with 21,732,472 people infected and 770,866 deaths globally (as per WHO COVID-19 update dated August 18, 2020). Continuous efforts are being made to repurpose the existing drugs and develop vaccines for combating this infection. Despite, to date, no certified antiviral treatment or vaccine prevails. Although, few candidates have displayed their efficacy in in vitro studies and are being repurposed for COVID-19 treatment. This article summarizes synthetic and semi-synthetic compounds displaying potent activity in their clinical experiences or studies against COVID-19 and also focuses on mode of action of drugs being repositioned against COVID-19.

Neuroprotective Effect of Reduced Glutathione on Oxaliplatin-Based Chemotherapy in Advanced Colorectal Cancer: A Randomized, Double-Blind, Placebo-Controlled Trial

2002 ◽  
Vol 20 (16) ◽  
pp. 3478-3483 ◽  
Author(s):  
Stefano Cascinu ◽  
Vincenzo Catalano ◽  
Luigi Cordella ◽  
Roberto Labianca ◽  
Paolo Giordani ◽  
...  
Keyword(s):  
Saline Solution ◽  
Neuroprotective Effect ◽  
Controlled Trial ◽  
Sensory Nerve ◽  
Clinical Activity ◽  
Double Blind ◽  
Double Blind Placebo ◽  
To Receive ◽  
Infusion Period ◽  
Toxicity Criteria

PURPOSE: We performed a randomized, double-blind, placebo-controlled trial to assess the efficacy of glutathione (GSH) in the prevention of oxaliplatin-induced neurotoxicity. PATIENTS AND METHODS: Fifty-two patients treated with a bimonthly oxaliplatin-based regimen were randomized to receive GSH (1,500 mg/m2 over a 15-minute infusion period before oxaliplatin) or normal saline solution. Clinical neurologic evaluation and electrophysiologic investigations were performed at baseline and after four (oxaliplatin dose, 400 mg/m2), eight (oxaliplatin dose, 800 mg/m2), and 12 (oxaliplatin dose, 1,200 mg/m2) cycles of treatment. RESULTS: At the fourth cycle, seven patients showed clinically evident neuropathy in the GSH arm, whereas 11 patients in the placebo arm did. After the eighth cycle, nine of 21 assessable patients in the GSH arm suffered from neurotoxicity compared with 15 of 19 in the placebo arm. With regard to grade 2 to 4 National Cancer Institute common toxicity criteria, 11 patients experienced neuropathy in the placebo arm compared with only two patients in the GSH arm (P = .003). After 12 cycles, grade 2 to 4 neurotoxicity was observed in three patients in the GSH arm and in eight patients in the placebo arm (P = .004). The neurophysiologic investigations (sural sensory nerve conduction) showed a statistically significant reduction of the values in the placebo arm but not in the GSH arm. The response rate was 26.9% in the GSH arm and 23.1% in the placebo arm, showing no reduction in activity of oxaliplatin. CONCLUSION: This study provides evidence that GSH is a promising drug for the prevention of oxaliplatin-induced neuropathy, and that it does not reduce the clinical activity of oxaliplatin.

Effect of ipilimumab at 10 mg/kg on disease control in patients (pts) with M1c-stage melanoma in relation to baseline lactate dehydrogenase (LDH) levels

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9041-9041
Author(s):  
M. Smylie ◽  
S. Francis ◽  
B. Neyns ◽  
M. Maio ◽  
D. Minor ◽  
...  
Keyword(s):  
Disease Control ◽  
Phase Ii ◽  
Cytotoxic T Lymphocyte ◽  
Stage Iv ◽  
Tumor Burden ◽  
Clinical Activity ◽  
Melanoma Metastasis ◽  
Phase Ii Studies ◽  
Similar Disease ◽  
To Receive

9041 Background: Ipilimumab, a fully human, anti-cytotoxic T-lymphocyte antigen-4 monoclonal antibody, enhances antitumor immunity. Ipilimumab is clinically active in advanced melanoma, with a 1-year survival rate of ∼50% in Phase II studies (Wolchok et al. CRI-CVC annual meeting 2008. Oral presentation). Serum LDH level is an independent prognostic factor for malignant melanoma, and is strongly predictive of reduced survival in stage IV disease (Bedikian et al. J Clin Oncol. 2006;24:4738–4745.). This analysis evaluated the association between baseline LDH levels and disease control (stable or reduced measurable tumor burden) in previously treated pts with M1c-stage melanoma (metastasis to vital organs other than the lungs) who received ipilimumab in 2 recently completed Phase II studies (CA184008 and 022). Methods: Ipilimumab at 10 mg/kg was given every 3 weeks (Q3W) × 4; eligible pts could continue to receive ipilimumab Q12W beginning at Week 24. In study 022, pts were randomized to receive ipilimumab induction dosing at 0.3, 3.0, or 10 mg/kg Q3W × 4; study 008 was a single- arm trial of ipilimumab at 10 mg/kg. Disease control data were pooled from the 2 Phase II studies for pts treated with ipilimumab at 10 mg/kg and stratified by normal and elevated (>1× upper normal limit [UNL]) LDH levels. Elevated LDH was not capped. Results: For 227 pts treated at 10 mg/kg, 123 had M1c-stage disease: 42 had normal LDH and 81 had LDH >1 × UNL (of which 32 had LDH 2 × UNL). Among these 123 pts, 17/81 (21.0%) [95% CI 12.7–31.5] with elevated LDH levels experienced disease control, whereas 12/42 (28.6%) [95% CI 15.7–44.6] with LDH levels at or below the UNL experienced disease control. Conclusions: Our data show that ipilimumab exerts similar disease control in pts with normal and elevated LDH levels. Ipilimumab therefore appears to have clinical activity in the form of disease control in pts with a very poor prognosis, i.e., M1c-stage melanoma and elevated LDH levels. [Table: see text]

Subgroup analyses of METEOR, a randomized phase 3 trial of cabozantinib versus everolimus in patients (pts) with advanced renal cell carcinoma (RCC).

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 499-499 ◽  
Author(s):  
Bernard J. Escudier ◽  
Robert J. Motzer ◽  
Thomas Powles ◽  
Nizar M. Tannir ◽  
Ian D. Davis ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Tyrosine Kinases ◽  
Clear Cell ◽  
Clinical Activity ◽  
Time To Progression ◽  
Phase 3 ◽  
Subgroup Analyses ◽  
Baseline Characteristics ◽  
To Receive ◽  
Clinical Trial Information

499 Background: Cabozantinib (C) inhibits tyrosine kinases including VEGFRs, MET, and AXL. The METEOR phase 3 trial (NCT01865747) met its primary endpoint of significant improvement in PFS with C versus everolimus (E) in pts with advanced clear cell RCC and prior exposure to VEGFR TKIs (7.4 mo median PFS [C] vs 3.8 mo [E], HR = 0.58, 95% CI, 0.45 to 0.75; p < 0.001). The improvement in PFS was accompanied by a significant improvement in ORR and a trend for improved OS at an interim analysis. Safety profiles of C and E in this trial were similar to prior experience with each drug in this pt population. This analysis further evaluates PFS and ORR across pt subgroups. Methods: Pts had advanced RCC with clear cell component, measurable disease per RECIST 1.1, KPS ≥ 70%, and were stratified by MSKCC prognostic criteria and number of prior VEGFR TKIs. Pts must have progressed during treatment or within 6 months of the last dose of their most recent VEGFR TKI. 658 pts were randomized 1:1 to receive C (60 mg QD) or E (10 mg QD). The primary endpoint was PFS among the first 375 pts randomized. ORR was a secondary endpoint. Results: In the PFS group, 187 pts were randomized to C and 188 to E. 73% pts had 1 and 27% pts ≥ 2 prior VEGFR TKIs; 43% pts had favorable, 41% intermediate, and 15% poor risk by MSKCC criteria. Across multiple subgroups defined by baseline characteristics, PFS HRs favored C over E. PFS HRs were similar for subgroups defined by prior number of TKIs (HR = 0.56 [1 prior] and 0.67 [ ≥ 2 prior]), and showed higher activity of C over E in pts with fewer MSKCC risk factors (HR = 0.54 [0 factors], 0.56 [1 factor], 0.84 [ ≥ 2 factors]) or with metastases in various organs (HR = 0.47 [lung mets], 0.53 [liver mets], 0.50 [bone mets]). Detailed analysis of the clinical activity of C and E (PFS and ORR) across pt subgroups will be presented, including treatment duration with first VEGFR TKI ( < or ≥ 6mo), receipt of prior anti-PD1/PDL1 agents, time to progression after most recent TKI ( < or ≥ 3mo), and frequency/location of metastases. Conclusions: The METEOR trial met its primary endpoint of improved PFS, and subgroup analyses of the endpoints PFS and ORR generally favored C over E in patients with advanced RCC. Clinical trial information: NCT01865747.

scholarly journals Deaths from Covid-19: Who are the forgotten victims?

2020 ◽  
Author(s):  
Kieran F. Docherty ◽  
Jawad H Butt ◽  
Rudolf A. de Boer ◽  
Pooja Dewan ◽  
Lars Køber ◽  
...  
Keyword(s):  
New York ◽  
The Netherlands ◽  
New York State ◽  
Population Based ◽  
Clinical Activity ◽  
National Agency ◽  
England And Wales ◽  
York State ◽  
Global Pandemic ◽  
Excess Deaths

AbstractBackgroundWith the spreading global pandemic of coronavirus disease 2019 (Covid-19) there has been disruption to normal clinical activity in response to the increased demand on health services. There are reports of a reduction in non-Covid-19 emergency presentations. Consequentially, there are concerns that deaths from non-Covid-19 causes could increase. We examined recent reported population-based mortality rates, compared with expected rates, and compared any excess in deaths with the number of deaths attributed to Covid-19.MethodsNational agency and death registration reports were searched for numbers of deaths attributed to Covid-19 and overall mortality that had been publicly reported by 22 April 2020. Data on the number of deaths attributed to Covid-19, the total number of deaths registered in the population and the historical average over at least 3 years were collected. Data were available for 3 Northern European countries (England & Wales, Scotland and the Netherlands) and New York State, United States of America.FindingsThere was an increase in observed, compared with expected, mortality in Scotland (+73%), England and Wales (+49%), the Netherlands (+65%) and New York state (+34%). Of these deaths, only 65% in Scotland, 68 % in England and Wales, 49% in the Netherlands and 73% in New York state were attributed to Covid-19 leaving a number of excess deaths not attributed to Covid-19.InterpretationA substantial proportion of excess deaths observed during the current COVID-19 pandemic are not attributed to COVID-19 and may represent an excess of deaths due to other causes.FundingNone

The GAIN-C study (BP25438): Randomized phase II trial of RG7160 (GA201) plus FOLFIRI, compared to cetuximab plus FOLFIRI or FOLFIRI alone in second-line KRAS wild type (WT) or mutant metastatic colorectal cancer (mCRC).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. TPS3637-TPS3637 ◽  
Author(s):  
Andres Cervantes-Ruiperez ◽  
Ben Markman ◽  
Salvatore Siena ◽  
Carles Pericay ◽  
Giuseppe Aprile ◽  
...  
Keyword(s):  
Single Agent ◽  
Objective Response ◽  
Predictive Biomarkers ◽  
Progression Free Survival ◽  
Primary Objective ◽  
Clinical Activity ◽  
Tumor Biopsy ◽  
Egfr Expression ◽  
To Receive

TPS3637 Background: GA201 is a novel, dual-acting, humanized, glycoengineered IgG1 anti-EGFR monoclonal antibody, with enhanced antibody-dependent cellular cytotoxicity (ADCC) activity in combination with signal inhibition. GA201 demonstrates significantly enhanced in vitro/vivo activity compared to cetuximab (cet) both as a single agent and in combination with irinotecan, in both KRAS mutant and BRAF mutant models and promising clinical activity in ph I and neo-adjuvant trials (Paz Ares et al, JCO 2011) including KRAS mutant mCRC. A randomized ph II program was launched: one study in NSCLC and GAIN-C in mCRC (NCT01326000), which is presented here. Methods: Main inclusion criteria are progression on 1L containing oxaliplatin, ECOG 0-1, and adequate hematological and liver function. Main exclusion criteria: prior anti-EGFR treatment. A total of 160 patients in 2L mCRC (stratified for EGFR expression, disease progression before or after 6 months after starting 1L, prior treatment with bevacizumab Y vs N) will be randomized to receive either GA201 (day 1, 8 of cycle 1 then q2W) or cet (qW) + FOLFIRI q2W (KRAS WT) or to receive GA201+ FOLFIRI or FOLFIRI alone (KRAS mutant). Collection of archival tumor plus a mandatory fresh tumor biopsy at baseline were implemented because ph I data showed that EGFR expression is not concordant between the two specimen types and to optimize assessment of potential immune related biomarkers. The fresh tumor biopsy will be centrally analyzed for EGFR (immunohistochemistry) and KRAS status. Primary objective is progression free survival; secondary endpoints are to define objective response rates, the safety profile, pharmacokinetics and pharmacodynamics. A comprehensive biomarker program (blood and tumor), mainly immune-phenotyping, immunohistochemistry in tumor samples (Ventana) and immune functional tests (including adaptive responses) were set up to investigate potential predictive biomarkers and the mode of action of GA201. Study is ongoing worldwide in 9 countries with the safety run-in phase completed in Nov 2011. Recruitment is planned to be completed by end of April 2012.

Patients with undetectable PSA 2 years after docetaxel for metastatic castration sensitive prostate cancer (mCSPC).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e17044-e17044
Author(s):  
Mohammad O. Atiq ◽  
Shruti Gandhy ◽  
Fatima Karzai ◽  
Marijo Bilusic ◽  
Lisa M. Cordes ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Treatment Options ◽  
High Volume ◽  
Clinical Activity ◽  
Castration Resistant Prostate Cancer ◽  
Therapeutic Cancer Vaccine ◽  
Volume Group ◽  
Low Volume ◽  
To Receive

e17044 Background: Patients with mCPSC have multiple treatment options to combine with androgen deprivation therapy (ADT) including docetaxel, abiraterone, enzalutamide and apalutamide, all of which have demonstrated a survival advantage. While oral anti-androgens are administered daily until progression but are less toxic, docetaxel has more upfront side effects. One of the advantages of using docetaxel is that the 6-cycle regimen (over approximately 4 months) potentially affords patients a respite from daily therapies thereafter. Furthermore, docetaxel may be more cost-effective. In this prospective study, mCSPC patients were treated with docetaxel and Prostvac, a therapeutic cancer vaccine. Since this study was initiated, Prostvac did not demonstrate independent clinical activity in a phase 3 trial in metastatic castration resistant prostate cancer. Nonetheless, this study provides an opportunity to evaluate responses to docetaxel-based therapy in mCSPC. Methods: Eligible patients included those with mCSPC and ECOG of ≤ 2. All patients were treated with docetaxel and were planned to receive 75mg/m2 for 6 cycles within 4 months of starting ADT, as per the CHAARTED regimen. Patients were randomized to receive Prostvac prior to, concurrent with or after docetaxel. Patients were restaged annually with CT and Tc99 bone scan. The study was powered to evaluate immunologic responses, which is ongoing. For the purposes of this analysis, all patients were analyzed as one group and long-term PSA responses were evaluated. Results: The study enrolled 73 patients. Age range was 41-86 with a median of 63 years. Race distribution was 71.6% White, 20.3% Black, 4.1% other, and 4.1% unknown. Gleason scores were 6 (4.1%), 7 (21.6%), and 8-10 (68.9%), with 5.4% being unknown. Median pre-ADT PSA was 34.75 ng/mL. Low-volume disease represented 41.1% of patients and high-volume was 58.9%. After 2 years from the start of ADT, 22% of all patients had PSA values of ≤ 0.2 ng/mL. This included 37% of the low-volume group and 12% of the high-volume group. Three years from the start of ADT, 14% of all patients had PSA values ≤ 0.2 ng/mL (20% of the low-volume group, 9% of the high-volume group). Conclusions: These data highlight long-term outcomes of 6 cycles of docetaxel for men with mCSPC. Although there are concerns about the short-term toxicity of docetaxel, there is potential for prolonged stable disease after ̃4 months of chemotherapy that allows these patients to defer additional oral anti-androgen therapy for years in some patients. The proportions of patients presented here are an underestimate of those who could continue to be monitored for slowly rising, but low PSAs, before starting the next line of therapy. Additional research is required to determine the optimal therapeutic sequence for men diagnosed with mCSPC and long-term implications for quality of life and cost-effectiveness. Clinical trial information: NCT02649855.

Editorial

2008 ◽  
Vol 7 (2) ◽  
pp. 62-62
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
British Society ◽  
Editorial Team ◽  
Clinical Activity ◽  
Acute Medicine ◽  
Acute Medical Unit ◽  
The Future ◽  
The Subject ◽  
Level Of Training ◽  
Areas Of Interest ◽  
To Receive

Whether acute medicine registrars should have the opportunity to acquire a procedural skill during their training has been the subject of considerable debate over recent years. The issue often dominates discussion amongst trainees and trainers alike at national meetings; exchanges are frequently heated and prolonged, highlighting the strength of feeling on all sides regarding the challenges which this creates. So the inclusion of three articles relating to this subject within this edition of Acute Medicine is not in any way disproportionate. In the past, much of the debate has centred on the concept of the ‘Sanity Session’ – the idea being that specialist acute physicians might need some clinical activity outside the acute arena to help prevent ‘burnout’. The three articles in this edition focus more specifi – cally on the issue of bedside investigation in the clinical setting. Many of us will recognise the scenario of the acutely unwell, hypotensive patient, for whom an urgent echocardiogram or ultrasound would enable great strides towards a diagnosis. Extracting a radiologist or cardiologist from their respective departments often requires a talent for negotiation of which a member of the Diplomatic Corps would be proud. Access to the equipment and possession of the necessary skills to undertake such procedures at the bedside would be a great asset for any Acute Medical Unit. While some units are undoubtedly already making great strides in this direction, this often results from the enthusiasm of individuals, many of whom have been trained in other specialities before moving to Acute Medicine. The statement from the British Society of Echocardiography on p95 should be viewed as an important step in identifying a level of training in which is feasible for trainees in acute medicine. The Royal College of Radiologists has also recently produced recommendations for training in ultrasound, which is described in detail by John Lorains; Mark Mallet also highlights some of the practical challenges which may arise in establishing an acute medical ultrasound service. Readers of this journal may note a slight change in the format, with fewer ‘commissioned’ review articles than in previous editions. The editorial team has been pleased to receive an increased number of unsolicited articles over recent months, which has facilitated this change. As the speciality continues to develop, a larger number of research-orientated papers are also beginning to fi lter through, which will be included over future editions. This increased number of submissions requires that a more rigorous review process is introduced. This will require an expanded team of editorial referees in the future. If any reader is interested in volunteering to help in this way, I would be grateful if you could email me at the address on this page, indicating your areas of interest and expertise. In addition any feedback from readers regarding the future format of the journal would be most welcome. I am also keen to establish a ‘correspondence’ section for future editions, so if any of the articles in this edition have raised your heckles, or reminded you of similar experiences which you wish to share, I would be delighted to receive these.

scholarly journals Glucocorticoids Should Be Used With Caution in Patients With SARS-CoV-2

2021 ◽  
Vol 8 ◽  
Author(s):  
Yong Guo ◽  
Yan Chen ◽  
Yingchuan Li
Keyword(s):  
Clinical Practice ◽  
Severe Acute Respiratory Syndrome ◽  
Clinical Experiences ◽  
Glucocorticoid Treatment ◽  
Global Pandemic

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global pandemic, and the use of glucocorticoids in clinical practice is controversial. Our clinical experiences with glucocorticoid treatment suggested that, while use was effective in some cases, in other cases, glucocorticoid were ineffective and even resulted in immunosuppression that could lead to deterioration. Therefore, glucocorticoids should be used with caution in patients with SARS-CoV-2.

scholarly journals COVID-19 Vaccine Perceptions and Differences by Sex, Age, and Education in 1,367 Community Adults in Ontario

2021 ◽  
Vol 9 ◽  
Author(s):  
Sabrina K. Syan ◽  
Mahmood R. Gohari ◽  
Emily E. Levitt ◽  
Kyla Belisario ◽  
Jessica Gillard ◽  
...  
Keyword(s):  
Side Effects ◽  
Vaccine Safety ◽  
Bachelor's Degree ◽  
Vaccine Uptake ◽  
Vaccine Hesitancy ◽  
Online Assessment ◽  
Cross Sectional ◽  
Global Pandemic ◽  
To Receive

Background: COVID-19 is a global pandemic and vaccination efforts may be impeded by vaccine hesitancy. The present study examined willingness to receive a COVID-19 vaccine, the associated reasons for willingness/unwillingness, and vaccine safety perceptions in a cross-sectional assessment of community adults in Ontario.Methods: One thousand three hundred sixty seven individuals (60.6% female, mean age = 37.5%) participated in this study between January 15, 2021 and February 15, 2021. Perceptions of vaccine safety and reasons for willingness/unwillingness to receive the COVID-19 vaccine were investigated using an online assessment. Perceptions were investigated in general and by age, sex and education using analysis of variance.Results: Overall, 82.8% of the sample reported they were willing to receive a COVID-19 vaccine and 17.2% reported they were unwilling. The three most common reasons for unwillingness were long-term side effects (65.5%), immediate side effects (60.5%), and lack of trust in the vaccine (55.2%). Vaccine willingness significantly differed by sex and education level, with female participants and those with less than a bachelor's degree being more likely to report unwillingness. Perception of COVID-19 vaccine safety was significantly lower (−10.3%) than vaccines in general and differed by age, sex and education, with females, older adults, and individuals with less than a bachelor's degree reporting lower perceived COVID-19 vaccine safety.Conclusion: In this sample of community adults, the COVID-19 vaccine hesitancy rate was less than one in five individuals, but with higher rates in population subgroups. Targeting public health messaging to females and individuals with less than bachelor's degree, and addressing concerns about long-term and immediate side effects may increase vaccine uptake.

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