Vaccine Hesitancy: Lessons Learned and Perspectives for a Post-Pandemic Tomorrow

Infectious diseases have always posed a significant threat to mankind, resulting in high mortality and morbidity throughout history [1]. Currently, the burden of communicable diseases still remains very high in all age groups worldwide [2]. Moreover, the current COVID-19 pandemic has once again underlined the tremendous impact of transmittable diseases in terms of public health [1]. From this point of view, vaccines have always represented a fundamental public health tool. Indeed, mass immunization campaigns save millions of lives each year [3]. Furthermore, COVID-19 vaccines are enabling us to overcome the ongoing pandemic. Therefore, it is of utmost importance to promote vaccine uptake and to identify and address barriers for achieving adequate vaccination coverage. Among the obstacles to reaching adequate vaccination coverage, vaccine hesitancy (VH) is rightfully included. VH is defined by SAGE working group as “the delay in acceptance or refusal of vaccination despite the availability of vaccination services”[4] and was included by the World Health Organization (WHO) amongst the major health concerns in 2019 [5]. Going into detail, VH appears to be complex and context specific, varying across time, place and types of vaccines [4]. All these factors have been studied with respect to VH in recent decades and have played a big role during the COVID-19 pandemic and will certainly continue to do so in the post-pandemic future

Patient-reported outcome measures (PROMs) for the quality of care promotion: the case study of prostate cancer surgery.

Gli esiti riferiti dai pazienti (PROMS), sono attualmente diventati tra gli strumenti più utilizzati in tutti i livelli dell’assistenza, e in particolare per le patologie oncologiche. Il cancro della prostata è la diagnosi più comune di tumore maligno e la seconda causa di morte negli uomini. I pazienti possono sviluppare effetti collaterali legati al trattamento di cui l'incontinenza urinaria ne rappresenta uno dei più frequenti e influenzanti maggiormente la qualità della vita. Nella prima parte sperimentale della presente tesi sono stati identificati gli indicatori più importanti di qualità per il cancro alla prostata (proposti dalla comunità scientifica) e ne è stato determinato il loro utilizzo. Successivamente, tramite una raccolta dati sugli esiti funzionali estratti dalle cartelle cliniche informatizzate utilizzando i dati del database Stanford University HealthCare, è stato sviluppato un flusso di estrazione e di data-mining che è stato in grado di catturare la documentazione fornita dai medici sugli esiti più importanti e centrati sul paziente utilizzando note cliniche non strutturate e registrate di routine. Inoltre è stato misurato quanto riferito dai pazienti utilizzando l'indagine EPIC-26 (somministrato in sede di visita oncologica pre e post intervento), un questionario che nel corso degli anni è stato validato ed è attualmente considerato uno dei gold-standard per la valutazione del paziente post-prostatectomia. Il risultato maggiore della attuale comparazione è che quanto viene riferito dai pazienti è altamente concordante con quanto viene riportato dai medici sulle cartelle cliniche elettroniche. Il caso di studio presentato, apre la strada alla possibilità di utilizzare e valutare questo tipo di indicatori in maniera sistematica. I clinici possono riportare nelle cartelle cliniche importanti informazioni riferite dai pazienti, la cui integrazione potrà portare, in futuro, ad una migliore raccolta dei dati sugli esiti patient-centered e ad un effettivo miglioramento della qualità così orientata in tutti i settori della medicina.Patient reported outcome measures (PROMS) have now become among the most used tools at all levels of care, particularly for oncology. Prostate cancer is the most common malignant cancer diagnosis and the second leading cause of death in men. Patients may develop treatment-related side effects of which urinary incontinence is one of the most frequent and most influencing quality of life. In the first experimental part of this thesis the most important quality indicators for prostate cancer (proposed by the scientific community) were identified and their use was determined. In a second stage, through data collection of the functional outcomes extracted from the electronic medical records (using data from the Stanford University HealthCare database), an extraction and data-mining flow that has been able to capture the documentation provided by the physicians on the most important patient-centered outcomes using unstructured and routine recorded clinical notes has been developed. Furthermore, patient reported outcomes were collected using the EPIC-26 survey (administered during the oncological visit before and after surgery), a questionnaire that over the years has become one of the gold-standard for evaluation of the patients undergoing prostatectomy. The main result of the actual comparison is that what is reported by patients is highly consistent with what is reported by doctors on electronic medical records. The presented case study paves the way for the possibility of using and evaluating this type of indicators in a systematic way. Clinicians can report in the medical records important patient reported information, whose integration will lead, in the future, to a better collection of data on patient-centered outcomes and to an effective quality improvement in all medical fields

Predict, diagnose, and treat chronic kidney disease with machine learning: a systematic literature review

Objectives In this systematic review we aimed at assessing how artificial intelligence (AI), including machine learning (ML) techniques have been deployed to predict, diagnose, and treat chronic kidney disease (CKD). We systematically reviewed the available evidence on these innovative techniques to improve CKD diagnosis and patient management.Methods We included English language studies retrieved from PubMed. The review is therefore to be classified as a "rapid review ", since it includes one database only, and has language restrictions; the novelty and importance of the issue make missing relevant papers unlikely. We extracted 16 variables, including: main aim, studied population, data source, sample size, problem type (regression, classification), predictors used, and performance metrics. We followed the Preferred Reporting Items for Systematic Reviews (PRISMA) approach; all main steps were done in duplicate. The review was registered on PROSPERO.ResultsFrom a total of 648 studies initially retrieved, 68 articles met the inclusion criteria.Models, as reported by authors, performed well, but the reported metrics were not homogeneous across articles and therefore direct comparison was not feasible. The most common aim was prediction of prognosis, followed by diagnosis of CKD. Algorithm generalizability, and testing on diverse populations was rarely taken into account. Furthermore, the clinical evaluation and validation of the models/algorithms was perused; only a fraction of the included studies, 6 out of 68, were performed in a clinical context.Conclusions Machine learning is a promising tool for the prediction of risk, diagnosis, and therapy management for CKD patients. Nonetheless, future work is needed to address the interpretability, generalizability, and fairness of the models to ensure the safe application of such technologies in routine clinical practice

Probiotics for Preventing Necrotizing Enterocolitis in Preterm Infants: A Network Meta-Analysis

Background: Recent evidence supports a role of probiotics in preventing necrotizing enterocolitis (NEC) in preterm infants. Methods: A systematic review and network meta-analysis of randomized controlled trials (RCTs) on the role of probiotics in preventing NEC in preterm infants, focusing on the differential effect of type of feeding, was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A random-effects model was used; a subgroup analysis on exclusively human milk (HM)-fed infants vs. infants receiving formula (alone or with HM) was performed. Results: Fifty-one trials were included (10,664 infants, 29 probiotic interventions); 31 studies (19 different probiotic regimens) were suitable for subgroup analysis according to feeding. In the overall analysis, Lactobacillus acidophilus LB revealed the most promising effect for reducing NEC risk (odds ratio (OR), 0.03; 95% credible intervals (CrIs), 0.00\u20130.21). The subgroup analysis showed that Bifidobacterium lactis Bb-12/B94 was associated with a reduced risk of NEC stage 2 in both feeding type populations, with a discrepancy in the relative effect size in favour of exclusively HM-fed infants (OR 0.04; 95% CrIs <0.01\u20130.49 vs. OR 0.32; 95% CrIs 0.10\u20130.36). Conclusions: B. lactis Bb-12/B94 could reduce NEC risk with a different size effect according to feeding type. Of note, most probiotic strains are evaluated in few trials and relatively small populations, and outcome data according to feeding type are not available for all RCTs. Further trials are needed to confirm the present findings

Allogeneic hematopoietic stem cell transplantation for pediatric acute myeloid leukemia in first complete remission: a meta-analysis

Identification of pediatric patients with acute myeloid leukemia (AML) candidates to receive allogeneic hematopoietic stem cell transplantation (allo-HSCT) in first complete remission (CR1) is still a matter of debate. Currently, transplantation is reserved to patients considered at high risk of relapse based on cytogenetics, molecular biology, and minimal residual disease (MRD) assessment. However, no randomized clinical trial exists in the literature comparing transplantation with other types of consolidation therapy. Here, we provide an up-to-date meta-analysis of studies comparing allo-HSCT in CR1 with chemotherapy alone as a post-remission treatment in high-risk pediatric AML. The literature search strategy identified 10 cohorts from 9 studies performing as-treated analysis. The quantitative synthesis showed improved overall survival (OS) (relative risk, 1.15; 95% confidence interval [CI], 1.06-1.24; P = 0.0006) and disease-free survival (relative risk, 1.31; 95% CI, 1.17-1.47; P = 0.0001) in the allo-HSCT group, with increased relapse rate in the chemotherapy group (relative risk, 1.26; 95% CI, 1.07-1.49; P = 0.006). Sensitivity analysis including prospective studies alone and excluding studies that reported the comparison only on intermediate-risk patients confirmed the benefit of allo-HSCT on OS. Further research should focus on individualizing allo-HSCT indications based on molecular stratification and MRD monitoring

Transitions in Xenes between excitonic, topological and trivial insulator phases: influence of screening, band dispersion and external electric field

Using a variational approach, the binding energies $E_b$ of the lowest bound excitons in Xenes under varying electric field are investigated. The internal exciton motion is described both by Dirac electron dispersion and in effective-mass approximation, while the screened electron-hole attraction is modeled by a Rytova-Keldysh potential with a 2D electronic polarizability $\alpha_{2{\rm D}}$. The most important parameters as spin-orbit-induced gap $E_g$, Fermi velocity $v_F$ and $\alpha_{2{\rm D}}$ are taken from ab initio density functional theory calculations. In addition, $\alpha_{2{\rm D}}$ is approximated in two different ways. The relation of $E_b$ and $E_g$ is ruled by the screening. The existence of an excitonic insulator phase with $E_b>E_g$ sensitively depends on the chosen $\alpha_{2{\rm D}}$. The values of $E_g$ and $\alpha_{2{\rm D}}$ are strongly modified by a vertical external electric bias $U$, which defines a transition from the topological into a trivial insulator at $U=E_g/2$, with the exception of plumbene. Within the Dirac approximation, but also within the effective mass description of the kinetic energy, the treatment of screening dominates the appearance or non-appearance of an excitonic insulator phase. Gating does not change the results: the prediction done at zero electric field is confirmed when a vertical electric field is applied. Finally, Many-Body perturbation theory approaches based on the Green's function method, applied to stanene, confirm the absence of an excitonic insulator phase, thus validating our results obtained by ab initio modeling of $\alpha_{2{\rm D}}$

Non-ideal effects on the typical trailing edge shock pattern of ORC turbine blades

Abstract At the trailing edge of supersonic high-pressure turbine vanes, a typical shock pattern, the so-called fish-tail shocks, originates due to the flow rotation imposed by its finite thickness. In addition, shock and shock/fan systems can arise in case of a post-expanded channel design or at off-design conditions. ORC turbine stator blades are particularly prone to this phenomena since they are designed to provide a high outlet Mach number, especially at the first stage. In the close proximity of the saturation curve, near the critical point, molecularly complex organic fluids for ORC applications may exhibit a number of non-ideal gasdynamic effects, including a remarkable dependency of the shock properties on the upstream thermodynamic state of the fluid, at a fixed upstream Mach number. The influence of thermodynamic conditions on the shock pattern is assessed as a function of the flow deviation and compared against the ideal gas case, for which the shock properties depends on the upstream Mach number only. Non-ideal effects are investigated here using siloxane vapor MDM (Octamethyltrisiloxane, C 8 H 24 O 2 Si 3 ), as an exemplary organic fluid. The present results can be arguably extended to most vapors currently employed in ORC applications

Evaluation of feasibility, effectiveness, and sustainability of school-based physical activity “active break” interventions in pre-adolescent and adolescent students: a systematic review

Objective The present systematic review aimed to investigate the impact of school-based physical activity (PA) interventions of “active breaks” on PA levels, classroom behaviour, cognitive functions, and well-being in pre-adolescents and adolescents attending secondary and high school. Methods In March 2021, we performed a systematic research in CINAHL, Cochrane Library, Embase, MedLine, and PsycINFO databases and through grey literature. Quality assessment was performed in accordance with the Cochrane Tool for Quality Assessment for RCTs and the STROBE tool for observational studies. We included studies that investigated classroom PA interventions led by teachers such as active breaks or physically active lessons on PA levels, classroom behaviour, cognitive function, and quality of life in pre-adolescent and adolescent population attending secondary and high school. Synthesis Three studies met the inclusion criteria. Two studies showed a positive effect of active breaks on students’ classroom behaviour and quality of life. One study registered a positive effect in the increase in school PA levels; unfortunately, this effect was not found in the overall levels of PA or in the reduction of sedentary behaviour. All three studies showed the feasibility and acceptability of active breaks intervention in secondary and high school settings. Conclusion This systematic review suggests the potential benefit of this type of intervention integrated in the secondary and high school curriculum on classroom behaviour, school PA levels, and well-being.Objectif La présente revue systématique visait à étudier l’impact des interventions d’activité physique (AP) en milieu scolaire des « pauses actives » sur les niveaux d’AP, le comportement en classe, les fonctions cognitives et le bien-être des préadolescents et des adolescents fréquentant l’école secondaire et le lycée. Méthodes En mars 2021, nous avons effectué une recherche systématique dans les bases de données CINAHL, Cochrane Library, Embase, MedLine, PsycINFO et à travers la littérature grise. L’évaluation de la qualité a été réalisée conformément à l’outil Cochrane d’évaluation de la qualité pour les ECR et à l’outil STROBE pour les études observationnelles. Nous avons inclus les études portant sur les interventions d’AP en classe menées par les enseignants, telles que les pauses actives ou les leçons d’activité physique sur les niveaux d’AP, le comportement en classe, la fonction cognitive et la qualité de vie chez les préadolescents et les adolescents fréquentant l’école secondaire et le lycée. Synthèse Trois études répondaient aux critères d’inclusion. Deux études ont montré un effet positif des pauses actives sur le comportement en classe et la qualité de vie des élèves. Une étude a enregistré un effet positif dans l’augmentation des niveaux d’AP à l’école, malheureusement cet effet n’a pas été trouvé dans les niveaux globaux d’AP ou dans la réduction du comportement sédentaire. Les trois études ont montré la faisabilité et l’acceptabilité de l’intervention des pauses actives dans les écoles secondaires et les lycées. Conclusion Cette revue systématique suggère le bénéfice potentiel de ce type d’intervention intégrée dans le programme scolaire des collèges et lycées sur le comportement en classe, les niveaux d’AP à l’école et le bien-être