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Influenza vaccination coverage among persons ages six months and older in the Vaccine Safety Datalink in the 2017–18 through 2022–23 influenza seasons
•We present influenza vaccination coverage in populations of > 12 million people.•Coverage peaked in 2019–20, then decreased each year to a low of 40.3% in 2022–23.•Coverage among children ages 6 months-17 years decreased 23.7 % from 2019 to 2022–23.•Persistent disparities in coverage were seen by sex, age, and race and ethnicity.
In the United States, annual vaccination against seasonal influenza is recommended for all people ages ≥ 6 months. Vaccination coverage assessments can identify populations less protected from influenza morbidity and mortality and help to tailor vaccination efforts. Within the Vaccine Safety Datalink population ages ≥ 6 months, we report influenza vaccination coverage for the 2017–18 through 2022–23 seasons.
Across eight health systems, we identified influenza vaccines administered from August 1 through March 31 for each season using electronic health records linked to immunization registries. Crude vaccination coverage was described for each season, overall and by self-reported sex; age group; self-reported race and ethnicity; and number of separate categories of diagnoses associated with increased risk of severe illness and complications from influenza (hereafter referred to as high-risk conditions). High-risk conditions were assessed using ICD-10-CM diagnosis codes assigned in the year preceding each influenza season.
Among individual cohorts of more than 12 million individuals each season, overall influenza vaccination coverage increased from 41.9 % in the 2017–18 season to a peak of 46.2 % in 2019–20, prior to declaration of the COVID-19 pandemic. Coverage declined over the next three seasons, coincident with widespread SARS-CoV-2 circulation, to a low of 40.3 % in the 2022–23 season. In each of the six seasons, coverage was lowest among males, 18–49-year-olds, non-Hispanic Black people, and those with no high-risk conditions. While decreases in coverage were present in all age groups, the declines were most substantial among children: 2022–23 season coverage for children ages six months through 8 years and 9–17 years was 24.5 % and 22.4 % (14 and 10 absolute percentage points), respectively, less than peak coverage achieved in the 2019–20 season.
Crude influenza vaccination coverage increased from 2017 to 18 through 2019–20, then decreased to the lowest level in the 2022–23 season. In this insured population, we identified persistent disparities in influenza vaccination coverage by sex, age, and race and ethnicity. The overall low coverage, disparities in coverage, and recent decreases in coverage are significant public health concerns.
Journal Article
Validated respiratory drug deposition predictions from 2D and 3D medical images with statistical shape models and convolutional neural networks
For the one billion sufferers of respiratory disease, managing their disease with inhalers crucially influences their quality of life. Generic treatment plans could be improved with the aid of computational models that account for patient-specific features such as breathing pattern, lung pathology and morphology. Therefore, we aim to develop and validate an automated computational framework for patient-specific deposition modelling. To that end, an image processing approach is proposed that could produce 3D patient respiratory geometries from 2D chest X-rays and 3D CT images. We evaluated the airway and lung morphology produced by our image processing framework, and assessed deposition compared to in vivo data. The 2D-to-3D image processing reproduces airway diameter to 9% median error compared to ground truth segmentations, but is sensitive to outliers of up to 33% due to lung outline noise. Predicted regional deposition gave 5% median error compared to in vivo measurements. The proposed framework is capable of providing patient-specific deposition measurements for varying treatments, to determine which treatment would best satisfy the needs imposed by each patient (such as disease and lung/airway morphology). Integration of patient-specific modelling into clinical practice as an additional decision-making tool could optimise treatment plans and lower the burden of respiratory diseases.
Journal Article
Dark destiny
\"It's the meeting of the trinities, as the six aforementioned heroes must save DC's Dark Trinity--Red Hood, Artemis and Bizarro! As these three antiheroes are sacrificed into the depths of the Pandora Pits by Circe and Ra's al Ghul, will Superman, Batman and Wonder Woman be able to save their demonically possessed allies?\"-- Provided by publisher.
Book
Unravelling the role of electrocardiogram changes and ejection fraction in ischaemic stroke outcomes
Stroke, a prevailing global cause of mortality, is witnessing a surge in incidences, particularly in lower-income countries. However, existing guidelines fail to adequately address the impact of electrocardiogram (ECG) changes and ejection fraction on the outcomes of ischaemic stroke, as well as the management of stroke-heart syndrome.
Existing literature underscores a strong link between ischaemic stroke and subsequent cardiac manifestations, hinting at their potential as prognostic indicators for adverse stroke outcomes. Post-ischaemic stroke ECG changes correlate with heightened heart disease risks, emphasising the need for post-stroke ECG monitoring. Recommendations include the use of direct oral anticoagulants and warfarin within 14 days of stroke for atrial fibrillation and thrombolytics for other ischaemic strokes. Conflicting findings exist on the prognostic significance of lower left ventricular ejection fraction (LVEF) post-ischaemic stroke, with some studies indicating poorer outcomes. Currently, LVEF does not significantly impact managing ischaemic stroke patients, but anticoagulation may be considered. Stroke-heart syndrome, a rare post-stroke complication, lacks clear understanding and guidelines for physicians.
ECG changes emerge as potential stroke outcome predictors, with ongoing debate on the utility of lower LVEF. While an ABC approach shows some efficacy for stroke-heart syndrome, additional research is crucial to unravel its ambiguous physiology and clarify these uncertainties.
Journal Article
Morphological analysis of cold-water coral skeletons for evaluating in silico mechanical models of reef-scale crumbling
The structural complexity of cold-water corals is threatened by ocean acidification. Increased porosity and thinning in structurally critical parts of the reef framework may lead to rapid physical collapse on an ecosystem scale, reducing their potential for biodiversity support. Understanding the structural-mechanical relationships of reef-forming corals is important to enable the use of in silico mechanical models as predictive tools that allow us to determine risk and timescales of reef collapse. Here, we analyze morphological variations of the branching architecture of the cold-water coral species Lophelia pertusa to advance mechanical in silico models based on their skeletal structure. We identified a critical size of five interbranch lengths that allows using homogenized finite element models to analyze mechanical competence. At smaller length scales, mechanical surrogate models need to explicitly account for the statistical morphological differences in the skeletal structure. We showed large morphological variations between fragments of L. pertusa colonies and branches, as well as dead and live skeletal fragments which are driven by growth and adaptation to environmental stressors, with no clear branching-specific patterns. Future in silico mechanical models should statistically model these variations to be used as monitoring tools for predicting risk of cold-water coral reefs crumbling.
Journal Article
Resident Development via Progress Testing and Test-Marking: An Innovation and Program Evaluation
Since 2008, the McMaster University Royal College Emergency Medicine residency training program has run practice Short Answer Question (SAQ) examinations to help residents test their knowledge and gain practice in answering exam-style questions. However, marking this type of SAQ exam is time-consuming.
To help address this problem, we require that senior residents help mark at least one exam per year alongside faculty members. Examinees' identities are kept anonymous by assigning a random number to each resident, which is only decoded after marking. Aggregation of marks is done by faculty only. The senior residents and faculty members all share sequential marking of each question. Each question is reviewed, and exemplar \"best practice\" answers are discussed. As novel/unusual answers appear, instantaneous fact-checking (via textbooks, or the internet) and discussions occur allowing for real-time modification to the answer keys as needed.
A total of 22 out of 37 residents (post graduate year 1 to post graduate year 5 (PGY1 to PGY5)) participated in a recent program evaluation focus group. This evaluation showed that residents feel quite positive about this process. With the anonymization process, residents do not object to their colleagues seeing and marking their answers. Senior residents have found this process informative and have felt that this process helps them gain insight into better \"examsmanship.\"
Involving residents in marking short-answer exams is acceptable and perceived as useful experience for improving exam-taking skills. More studies of similar innovations would be required to determine to what extent this may be the case.
Journal Article
Accuracy of the Actigraph wGT3x-BT for step counting during inpatient spinal cord rehabilitation
Study designCross-sectional.Objectives(1) Assess the accuracy of the Actigraph wGT3x-BT accelerometer to count steps taken by inpatients with incomplete spinal cord injury (iSCI) in physical therapy (PT) sessions and self-directed activities, and (2) compare the number of steps/min taken in PT sessions to that in self-directed activities during inpatient rehabilitation.SettingInpatient spinal cord injury rehabilitation.MethodsSeventeen individuals with subacute motor iSCI were observed for up to 45-min of both PT and self-directed activities, during which steps were simultaneously tracked by the Actigraph wGT3x-BT and a researcher using a hand tally counter. Accuracy was evaluated with an intraclass correlation coefficient (ICC) for the entire PT session and self-directed activities, as well as for periods of walking.ResultsThere was excellent agreement between the Actigraph wGT3x-BT and manually counted steps for entire PT sessions (ICC = 0.86) and walking periods (PT walking, ICC = 0.99; self-directed walking, ICC = 0.99). There was poor agreement for entire self-directed sessions (ICC = 0.15). Visual analysis of Bland–Altman plots supported these findings. Participants took more steps/min in PT sessions compared to self-directed activities (p = 0.023).ConclusionThe Actigraph wGT3x-BT accurately counts steps during PT sessions and walking periods in individuals with subacute motor iSCI. Clinically, this may enable physical therapists to track walking repetitions during inpatient rehabilitation more effortlessly.
Journal Article