Predictors of COVID-19 Vaccine Confidence: Findings from Slums of Four Major Metro Cities of India

There are limited studies on COVID vaccine confidence at the household level in urban slums, which are at high risk of COVID-19 transmission due to overcrowding and poor living conditions. The objective was to understand the reasons influencing COVID-19 vaccine confidence, in terms of barriers and enablers faced by communities in urban slums and informal settlements in four major metro cities in India. A mixed method approach was adopted, where in field studies were conducted during April–May 2021. First, a survey of at least 50 subjects was conducted among residents of informal urban settlements who had not taken any dose of the COVID-19 vaccine in Mumbai, Bengaluru, Kolkata and Delhi; second, a short interview with five subjects who had taken at least one dose of the vaccine in each of the four cities to understand the factors that contributed to positive behaviour and, finally, an in-depth interview of at least 3 key informants in each city to ascertain the vaccination pattern in the communities. The reasons were grouped under contextual, individual/group and vaccine/vaccination specific issues. The most frequent reason (27.7%) was the uncertainty of getting the vaccine. The findings show the need for increasing effectiveness of awareness campaigns, accessibility and the convenience of vaccination, especially among vulnerable groups, to increase the uptake.

Analysis of Calculation Methods Currently Practised at V4 Agricultural Holdings

This paper assesses calculation methods in the Visegrad 4 countries (Czech Republic, Hungary, Poland and Slovakia) and, based thereon, recommends and considers activity-based costing (ABC) in the agricultural sector, while evaluating manager knowledge of ABC as an appropriate alternative to outdated, “conventional” methods of calculating costs that are used in practice. It was found that a majority of agricultural holdings in the V4 are currently using conventional cost calculation methods and the most frequent reason for their failure to incorporate ABC is low awareness among managers. Farms and agricultural holdings that have introduced ABC and utilise it to assign their costs evaluate its benefits highly positively, in particular, ABC’s more accurate identification of costs, mainly overheads; more effective cost management and the accuracy of price estimates. From this analysis and assessment, introduction of ABC is recommended for companies in order to obtain the different benefits associated with the method. Successfully implementing ABC leads to a number of advantages, especially in the inevitable decision-making agricultural holdings face about high overhead costs. From the information obtained, managers at agricultural holdings have little information, in most cases, about ABC as an appropriate alternative to the outdated “conventional” cost estimate methods practised today. It is therefore important to work on raising managers' awareness of new approaches to costing by publishing scientific articles with specific examples from practice, pointing out the advantage of the ABC method, especially with high overheads, which are almost the rule in agricultural holdings.

Understanding constipation in adults

Constipation is a common problem which can affect any age and ethnicity and is a frequent reason for patients to seek advice from health professionals. Margaret Perry looks at the risk factors, patient management and potential complications Constipation is a common problem which can affect any age and any ethnicity and is a frequent reason for patients to seek advice from health professionals. Symptoms can vary widely from mild to severe and can impact on quality of life. Given the frequency of its occurrence, it is very likely that nurses and non-medical prescribers will be asked for advice by patients. This article will therefore look at risk factors, patient management and potential complications and hopes to provide useful information for any clinicians who may be approached for advice and guidance in dealing with this condition.

Bacillus cereus as a Major Cause of Discarded Pasteurized Human Banked Milk: A Single Human Milk Bank Experience

A systematic study, performed from 2017–2020 looked at the rate of positive post-pasteurization B. cereus findings, the quantity of B. cereus in pasteurized banked human milk (PBM), and the rate of B. cereus toxicogenic isolates from PBM. During the study period, 6815.71 L (30,943 tested bottles) of PBM were tested, with an average amount per year of 1703.93 L (7736 tested bottles). The PBM discard rate per year due to bacterial contamination varied between 8.7–10.0% and contamination with B. cereus was the most frequent reason. The total number of B. cereus positive tests was 2739 and the proportion of its positivity from all positive tests was between 56.7–66.6%. The prevalence of B. cereus positive tests rose significantly in the summer months. The production of enterotoxin was found in 3 of the 20 tested samples (15.0%). The B. cereus CFU-quantities in the PBM were below 10 CFU/mL in 80% of cases (16 of 20 samples tested). The quantitative data can be used in the risk assessment of cold storage of PBM at temperatures above zero and manipulation of PBM prior to its administration.

Abstract 13237: Motivations and Barriers to Join an Automated External Defibrillator Network: A Nationwide Survey

Introduction: Since 2007, citizens have been able to register an automated external defibrillator (AED) with the Danish AED Network, which holds >23,000 AEDs (394 AEDs/100,000 inhabitants) linked directly to the Emergency Medical Dispatch Centers. In 2019, 60.8% of sold AEDs were registered in the network. This study aimed to identify motivations and barriers for registration with the nationwide Danish AED Network. Methods: A cross-sectional survey among owners of newly registered AEDs in the Danish AED Network was carried out from September 2017 to December 2020. Each month, 30-50 random AED-owners participated. The survey included items on motivations and barriers to join the AED network and items on AED accessibility. Results: In total, 1,540 AED-owners were included (25.3 % of newly registered in the period (n=6087)). The time from AED-purchase to AED-registration was “<1week” in 25.7%, “<1month” in 23.4%, “1month-1year” in 28.6%, “>1year” in 20.4%, and “Do not know” in 1.9%. Knowledge about the AED network is illustrated in Figure 1. Over half of the AED-owners registered their AED because they felt it was a ‘good cause’ (64.0%), followed by ‘registering upon request’ (20.6%), and ‘after a first aid course’ (5.5%). Of newly registered AEDs, 73.8% (n=1137) were 24/7-accessible. The most frequent reason for choosing limited AED accessibility (AED placed indoors/not available 24/7, n=403) was “greater expenses” (26.8%), whereas “fear of theft/vandalism” only accounted for 12.4%. Conclusion: Among AED-owners registering their AED to the Danish AED Network, most heard about the registry through word of mouth, registered their AED within the first year of purchase, and registered primarily because they felt it was a good cause. Most newly registered AEDs were 24/7-accessible. The biggest expressed barrier to AED accessibility was increased expenses whereas fear of theft or vandalism was a minor issue.

A case report of an unfurled appendix - embryological perspective

Appendicitis is a very common clinical condition requiring immediate attention. Long appendix is a frequent reason for inflammation. Very often the size and position of the appendix varies. The differential development of the caecum is responsible for the different positions of the appendix. Adequate knowledge about the presence of such unusual variations is a must for clinical surgeons. We are reporting one of the longest appendices seen during routine cadaveric dissection in south India which was just over 20 cm in length with the embryological basis.

ANALYSIS OF THE PLATELET HEMOSTASIS AMONG PREGNANT WOMEN WITH IMMUNE THROMBOCYTOPENIA

Relevance: Thrombocytopenia is a common hematological problem that accompanies pregnancy. From 5% to 12% of pregnancies are complicated by thrombocytopenia. Gestational thrombocytopenia is the leading cause of complications (70-85%). Immune thrombocytopenia (ITP) is the most frequent reason among pre-pregnancy causes of thrombocytopenia and is responsible for 1-4% of all thrombocytopenia cases during pregnancy. Investigation of the functional potential of the thrombocyte link of hemostasis in conditions of a reduced number of thrombocytes is relevant. The purpose of the study was to analyze the platelet link of hemostasis in pregnant women with ITP of varying severity by the method of light aggregometry. Materials and Methods: Eighty-eight women with gestational and 28 with immune thrombocytopenia were undergoing treatment and delivery at the Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine (Kyiv, Ukraine) from September 2018 to February 2021. The platelet link of hemostasis was studied in a group of women with immune thrombocytopenia; six (21.4%) of them had severe thrombocytopenia. Results: In mild and moderate immune thrombocytopenia, we noted a decrease in spontaneous and induced platelet aggregation; in severe immune thrombocytopenia, there was no spontaneous and a decreased induced platelet aggregation. This indicated a reduced potential of platelets to perform their direct function – the formation of a thrombus. Conclusion: Immune thrombocytopenia accounts for most pre-pregnancy conditions causing thrombocytopenia in pregnant women. Light aggregometry is a relevant and indicative way to analyze the aggregative ability of platelets. A multidisciplinary team consisting of an obstetrician-gynecologist, hematologist, anesthesiologist, and neonatologist should be involved in the management of such cases to provide effective obstetric care for this category of pregnant women. Risks for the mother and the fetus/newborn should be assessed throughout the pregnancy, considering clinical and laboratory aspects. Delivery of pregnant women with severe thrombocytopenia should be managed at institutions providing the highest level of obstetric and gynecological care.

Applicability of the medication level variability index (MLVI) in adult hepatic transplantation and association with graft rejection rates

Introduction: Calculation of the Tacrolimus variation index by using the MLVI (Medication Level Variability Index) is set in pediatric liver transplant patients, and it is useful in controlling treatment adherence by associating MLVI values > 2.5 to acute graft liver rejection. Purpose: To verify the association between MLVI values and rejection in adult liver transplant patients. Methods: A retrospective cohort study including liver transplant patients over 18 years of age from December 2012 to December 2017 using orally tacrolimus. For MLVI calculation, tacrolimus serum level outpatient samples were used after 1 year of transplantation. Results: A total of 125 patients were transplanted, of which 86 met criteria for inclusion in the study. The most frequent reason for transplantation was C virus infection (55.8%, n = 48). Rejection was identified in 18.6% of patients (n = 16). The mean MLVI among rejection and nonrejection patients was 2.5 and 2.1 respectively (RR = 0.95, CI: 0.4-2.1, p = 0.57). The frequency of non-immunological complications was 56.2% (n = 9) in patients with rejection versus 62.8% (n = 44) in patients without rejection, most of them with recurrence of virus C (56,8%, n = 25). Conclusion: Although the mean value of MLVI was higher in patients with rejection, our data showed no statistical difference between both groups, which differs from previous studies in pediatric patients. A higher number of nonimmune complications were observed in patients without rejection. The findings suggest that new MLVI cutoffs should be explored in the adult population.

The influence of bearing surfaces on revisions due to dislocations in total hip arthroplasty

Introduction Recurrent dislocations are still the most frequent reason for revision in total hip arthroplasty (THA). The impact of bearing surfaces on dislocations is still controversial. We hypothesized that: (1) bearing surfaces influence the revisions due to dislocations; (2) ceramic-on-ceramic reduced the revisions for dislocations in adjusted models; (3) Delta-on-Delta bearings reduced the revisions for dislocations in comparison to surfaces with cross-linked polyethylene. Materials and methods The regional arthroplasty registry was enquired about bearing surfaces and revisions for dislocations and instability. Unadjusted and adjusted rates were provided, including sex, age (<65 years or ≥65 years), head diameter (≤28 mm or >28 mm; <36 mm or ≥36 mm) as variables. 44,065 THAs were included. Results The rate of revisions for dislocations was significantly lower in ceramic-on-ceramic and metal-on-metal bearings (unadjusted rates). After adjusting for age, sex, and head size (36 and 28 mm), hard-on-hard bearings were protective (p < 0.05): ceramic-on-ceramic had a lower risk of revisions due to dislocation than ceramic-on-polyethylene (HR 1.6, 95% CI 1.2–2.2 p = 0.0009). The rate of revisions for dislocation was similar in bearings with cross-linked polyethylene and Delta-on-Delta articulations, in unadjusted and adjusted models. Conclusion Bearings with conventional polyethylene were more predisposed to dislocations. Currently adopted bearings exerted no significant influence on revisions due to dislocations. These findings could be primarily related to wear, but due to the time distribution, soft tissue envelopes and surface tension may also play a role. Pre-clinical biomechanical evaluations and prospective matched cohort studies are required to draw definitive conclusions.

421 USE OF BIOABSORBABLE MESH TO REINFORCE HIATAL CLOSURE—EARLY RESULTS

The hiatoplasty is one of the keypoints of hiatal hernia surgery. Reherniation is known to be a frequent reason for recurrence and reoperation. Biodegradable materials for reinforcement have been. shown in some series to reduce these outcomes with very low risks of mesh-related complications. Long term reports, however, have shown conflicting results. This may be because meshes have been used in complicated cases, in which other variables can be involved in unfavourable outcomes. Methods Based on the safe profile of absorbable meshes, we have used meshes to reinforce the hiatoplasty in patients with theoretical higher risks of hernia recurrence. Twenty four patients were operated using bioabsorbable mesh (Gore Bio A®), implanted as an onlay inverted C over a completely closed hiatus. Two surgeons were responsible for all the surgeries. There were 16 (66,6%) women and 8 (33,3%) men. The main reasons for using a mesh were: primary large hiatal hernias (4 cm or more)—14 cases; redo hiatal hernias—8 cases; increased abdominal pressure—2 cases. Results All surgeries were performed between April 2018 and January 2020. Meshes were fixed to the diaphragm using absorbable sutures, fibrin sealant or cyanoacrylate. In all cases, a Nissen fundoplication was performed. There were no conversions. Two (8,3%) patients complained of troublesome dysphagia requiring intervention. One had to be operated within the first 48 hours after surgery: 2 stitches of the hiatus were removed and the fundoplication was converted into a Toupet. The other patient was submitted to endoscopic dilatation and still referes mild dysphagia. In a short follow up period (1–19 months), 23 patients (95,8%) are asymptomatic. Conclusion The use of bioabsorbable mesh in the hiatus is safe and have shown good symptomatic outcomes in the short follow up period. Objective results and longer follow up are needed to see if additional reinforcement of hiatoplasty contributes to reduce recurrence and reoperation rates.