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2021 ◽  
pp. 100188
Author(s):  
Aline Métris ◽  
Paul Barrett ◽  
Laura Price ◽  
Silvia Klamert ◽  
Judith Fernandez-Piquer

2021 ◽  
Author(s):  
Zita Hubler ◽  
Xiao Song ◽  
Cameron Norris ◽  
Mehul Jani ◽  
David Alouani ◽  
...  

ABSTRACTObjectivesEmerging SARS-CoV-2 variant strains can be associated with increased transmissibility, more severe disease, and reduced effectiveness of treatments. To improve the availability of regional variant surveillance, we describe a variant genotyping system that is rapid, accurate, adaptable, and able to detect new low-level variants built with existing hospital infrastructure.MethodsWe use a tiered high-throughput SARS-CoV-2 screening program to characterizes variants in a supra-regional health system over 76 days. Combining targeted qPCR and selective sequencing, we screen positive SARS-CoV-2 samples from all hospitals within our health care system for genotyping dominant and emerging variants.ResultsThe median turnaround for genotyping was two days using the high-throughput qPCR-based screen, allowing us to rapidly characterize the emerging Delta variant. In our population, the Delta variant is associated with a lower CT value, lower age at infection, and increased vaccine breakthrough cases. Detection of low-level and potentially emerging variants highlights the utility of a tiered approach.ConclusionsThese findings underscore the need for fast, low-cost, high-throughput monitoring of regional viral sequences as the pandemic unfolds and the emergence of SARS-CoV-2 variants increases. Combing qPCR-based screening with selective sequencing allows for rapid genotyping of variants and dynamic system improvement.Key messagesA tiered approach that uses qPCR-based screening to identify dominant variants and sequencing for unique variants maximizes throughput, turnaround time, and information gleaned from each sample.In our population, the Delta variant became dominant in less than a month and is associated with lower CT, lower age at infection, and increased breakthrough cases.We identified low-level variants, including the variant of interest B.1.621 and a Delta variant with an E484K mutation in our population using existing hospital infrastructure.


2021 ◽  
Vol 7 ◽  
pp. 100063
Author(s):  
Caroline J. Burke ◽  
James Hardy ◽  
Eric D. Isaacs
Keyword(s):  

2021 ◽  
pp. 003452372110348
Author(s):  
Tim Corcoran ◽  
Matthew Krehl Edward Thomas

Global implementation of School-Wide Positive Behaviour Support (SWPBS) has grown considerably over the last forty years. SWPBS seeks to provide a multi-tiered approach to strategically frame integrated actions responding to matters of wellbeing, discipline and punishment in schools using Evidence-Based Interventions (EBIs). In this respect, EBIs rely on what are presumed to be value-free, reliably generated data which direct the selection, implementation and monitoring of SWPBS in schools. The paper begins by exploring how SWPBS is understood via implementation science. Following an outline of standard SWPBS EBI practice, discussion turns to instead consider this work as Evidence-Making Interventions (EMIs). To do so, first we outline how our before-the-fact anticipations influence relationships and disciplinary actions as they are realised in schools through EBIs. Our focus then turns to explain how SWPBS interventions, using multi-tiered systems of support and technology as examples, might be understood and enacted differently if engaged as EMIs. In conclusion, school-based relationships are subsequently reconsidered as a confluence of human (teachers and students) and non-human (data and policy) liaisons always and already subject to each other’s next move.


2021 ◽  
Vol 09 (08) ◽  
pp. E1188-E1195 ◽  
Author(s):  
Philip Berry ◽  
Sreelakshmi Kotha ◽  
Giovanni Tritto ◽  
Sabina DeMartino

Abstract Background and study aims Patient safety incidents (PSIs) in endoscopy, although infrequent, can lead to significant morbidity or mortality. There is no commonly agreed strategy to investigate PSIs. We describe a three-tiered approach to investigation to facilitate appropriate action, shared learning, and timely disclosure to patients as mandated in the UK health system by the Duty of Candor (DoC). Methods PSIs were identified prospectively over a 3-year, 7-month period in a large teaching hospital. Level of investigation was agreed by a group of three senior clinicians. Levels of investigation comprised: 1) rapid desktop review; 2) departmental “mini-root cause analysis” (mini-RCA, developed internally); and 3) hospital-level RCA or mortality review. Results Of 63006 procedures there were 73 reported cases of significant harm. Eleven resulted in death. Thirty PSIs were related to hepatobiliary endoscopy, 17 to lower gastrointestinal endoscopy, and 26 to upper gastrointestinal endoscopy. Hospital-level RCA was performed in six cases, mini-RCA/mortality review in 14, and 53 were examined by the endoscopy lead. Findings were presented in an endoscopy user group (EUG) meeting. There was learning in relation to informed consent, pre-procedural radiology reviews, pre-procedural treatment, escalation planning, teamwork and communication, preparation of equipment, and recognition of delayed complications. Open and honest communication with patients and relatives was facilitated. Conclusions The introduction of an endoscopy-tailored investigation tool, the mini-RCA, as part of a three-tiered approach, facilitated investigation, appropriate action, learning, and disclosure after PSIs.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Charlie Young ◽  
Annie Kwan ◽  
Lisa Yepez ◽  
Meghan McCarty ◽  
Amanda Chan ◽  
...  

Abstract Background Since the early descriptions of large series of accessory atrioventricular pathway ablations in adults and adolescents over 20 years ago, there have been limited published reports based on more recent experiences of large referral centers. We aimed to characterize accessory pathway distribution and features in a large community-based population that influence ablation outcomes using a tiered approach to ablation. Methods Retrospective analysis of 289 patients (age 14–81) who underwent accessory ablation from 2015–2019 was performed. Pathways were categorized into anteroseptal, left freewall, posteroseptal, and right freewall locations. We analyzed patient and pathway features to identify factors associated with prolonged procedure time parameters. Results Initial ablation success rate was 94.7% with long-term success rate of 93.4% and median follow-up of 931 days. Accessory pathways were in left freewall (61.6%), posteroseptal (24.6%), right freewall (9.6%), and anteroseptal (4.3%) locations. Procedure outcome was dependent on pathway location. Acute success was highest for left freewall pathways (97.1%) with lowest case times (144 ± 68 min) and fluoroscopy times (15 ± 19 min). Longest procedure time parameters were seen with anteroseptal, left anterolateral, epicardial-coronary sinus, and right anterolateral pathway ablations. Conclusions In this community-based adult and adolescent population, majority of the accessory pathways are in the left freewall and posteroseptal region and tend to be more easily ablated. A tiered approach with initial use of standard ablation equipment before the deployment of more advance tools, such as irrigated tips and 3D mapping, is cost effective without sacrificing overall efficacy.


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