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MMWR. Morbidity and Mortality Weekly... Mar 2021In December 2020, two COVID-19 vaccines (Pfizer-BioNTech and Moderna) received Emergency Use Authorization from the Food and Drug Administration.* Both vaccines require...
In December 2020, two COVID-19 vaccines (Pfizer-BioNTech and Moderna) received Emergency Use Authorization from the Food and Drug Administration.* Both vaccines require 2 doses for a completed series. The recommended interval between doses is 21 days for Pfizer-BioNTech and 28 days for Moderna; however, up to 42 days between doses is permissible when a delay is unavoidable. Two analyses of COVID-19 vaccine administration data were conducted among persons who initiated the vaccination series during December 14, 2020-February 14, 2021, and whose doses were reported to CDC through February 20, 2021. The first analysis was conducted to determine whether persons who received a first dose and had sufficient time to receive the second dose (i.e., as of February 14, 2021, >25 days from receipt of Pfizer-BioNTech vaccine or >32 days from receipt of Moderna vaccine had elapsed) had received the second dose. A second analysis was conducted among persons who received a second COVID-19 dose by February 14, 2021, to determine whether the dose was received during the recommended dosing interval, which in this study was defined as 17-25 days (Pfizer-BioNTech) and 24-32 days (Moderna) after the first dose. Analyses were stratified by jurisdiction and by demographic characteristics. In the first analysis, among 12,496,258 persons who received the first vaccine dose and for whom sufficient time had elapsed to receive the second dose, 88.0% had completed the series, 8.6% had not received the second dose but remained within the allowable interval (≤42 days since the first dose), and 3.4% had missed the second dose (outside the allowable interval, >42 days since the first dose). The percentage of persons who missed the second dose varied by jurisdiction (range = 0.0%-9.1%) and among demographic groups was highest among non-Hispanic American Indian/Alaska Native (AI/AN) persons (5.1%) and persons aged 16-44 years (4.0%). In the second analysis, among 14,205,768 persons who received a second dose, 95.6% received the dose within the recommended interval, although percentages varied by jurisdiction (range = 79.0%-99.9%). Public health officials should identify and address possible barriers to completing the COVID-19 vaccination series to ensure equitable coverage across communities and maximum health benefits for recipients. Strategies to ensure series completion could include scheduling second-dose appointments at the first-dose administration and sending reminders for second-dose visits.
Topics: Adolescent; Adult; Aged; COVID-19; COVID-19 Vaccines; Female; Health Services Accessibility; Humans; Immunization Schedule; Male; Middle Aged; Time Factors; United States; Vaccination Coverage; Young Adult
PubMed: 33735162
DOI: 10.15585/mmwr.mm7011e2 -
Vaccines Feb 2023Reaching zero-dose (ZD) children, operationally defined as children who have not received a first dose of the diphtheria, tetanus, and pertussis (DTP1) vaccine, is...
Reaching zero-dose (ZD) children, operationally defined as children who have not received a first dose of the diphtheria, tetanus, and pertussis (DTP1) vaccine, is crucial to increase equitable immunisation coverage and access to primary health care. However, little is known about the approaches already taken by countries to improve immunisation equity. We reviewed all Health System Strengthening (HSS) proposals submitted by Gavi-supported countries from 2014 to 2021 inclusively and extracted information on interventions favouring equity. Pro-equity interventions were mapped to an analytical framework representing Gavi 5.0 programmatic guidance on reaching ZD children and missed communities. Data from keyword searches and manual screening were extracted into an Excel database. Open format responses were analysed using inductive and deductive thematic coding. Data analysis was conducted using Excel and R. Of the 56 proposals included, 51 (91%) included at least one pro-equity intervention. The most common interventions were conducting outreach sessions, tailoring the location of service delivery, and partnerships. Many proposals had "bundles" of interventions, most often involving outreach, microplanning and community-level education activities. Nearly half prioritised remote-rural areas and only 30% addressed gender-related barriers to immunisation. The findings can help identify specific interventions on which to focus future evidence syntheses, case studies and implementation research and inform discussions on what may or may not need to change to better reach ZD children and missed communities moving forward.
PubMed: 36851218
DOI: 10.3390/vaccines11020341 -
Vaccines Mar 2023Immunization has one of the highest coverage levels of any health intervention, yet there remain zero-dose children, defined as those who do not receive any routine...
Immunization has one of the highest coverage levels of any health intervention, yet there remain zero-dose children, defined as those who do not receive any routine immunizations. There were 18.2 million zero-dose children in 2021, and as they accounted for over 70% of all underimmunized children, reaching zero-dose children will be essential to meeting ambitious immunization coverage targets by 2030. While certain geographic locations, such as urban slum, remote rural, and conflict-affected settings, may place a child at higher risk of being zero-dose, zero-dose children are found in many places, and understanding the social, political, and economic barriers they face will be key to designing sustainable programs to reach them. This includes gender-related barriers to immunization and, in some countries, barriers related to ethnicity and religion, as well as the unique challenges associated with reaching nomadic, displaced, or migrant populations. Zero-dose children and their families face multiple deprivations related to wealth, education, water and sanitation, nutrition, and access to other health services, and they account for one-third of all child deaths in low- and middle-income countries. Reaching zero-dose children and missed communities is therefore critical to achieving the Sustainable Development Goals commitment to "leave no one behind".
PubMed: 37112693
DOI: 10.3390/vaccines11040781 -
Journal of Medical Signals and Sensors 2023Virtual wedge (VW) is used in radiotherapy to compensate for missing tissues and create a uniform dose distribution in tissues. According to TECDOC-1583 and technical...
BACKGROUND
Virtual wedge (VW) is used in radiotherapy to compensate for missing tissues and create a uniform dose distribution in tissues. According to TECDOC-1583 and technical reports series no. 430, evaluating the dose calculation accuracy is essential for the quality assurance of treatment planning systems (TPSs). In this study, the dose calculation accuracy of the collapsed cone superposition (CCS) algorithm in the postmastectomy radiotherapy of the chest wall for breast cancer was evaluated by comparing the calculated and measured dose in VW fields.
METHODS
Two tangential fields with the typical VW angles were planned using ISOgray TPS in a thorax phantom. The CCS algorithm was used for dose calculation at 6 and 15 MV photon beams. The obtained dose distributions from EBT3 film spaces and TPS were evaluated using the gamma index.
RESULTS
The measured and calculated dose values using VW in a heterogeneous medium with different beam energies were in a good agreement with each other (acceptance rate: 88.0%-93.4%). The calculated and measured data did not differ significantly with an increase/decrease in wedge angle. In addition, the results demonstrated that ISOgray overestimated and underestimated the dose of the soft tissue and lung in the planned volume, respectively.
CONCLUSIONS
According to the results of gamma index analysis, the calculated dose distribution using VW model with the CCS algorithm in a heterogeneous environment was within acceptable limits.
PubMed: 37622042
DOI: 10.4103/jmss.jmss_7_22 -
European Journal of Drug Metabolism and... Sep 2022Nonadherence to levetiracetam (LEV) use can result in subtherapeutic concentrations and increase the risk of the occurrence of seizures. The impact of missing LEV doses...
BACKGROUND AND OBJECTIVE
Nonadherence to levetiracetam (LEV) use can result in subtherapeutic concentrations and increase the risk of the occurrence of seizures. The impact of missing LEV doses on its pharmacokinetics and evidence of the appropriate remedial dose is lacking. This study has determined the influence of missed LEV doses on its pharmacokinetics and has explored the appropriate remedial dosage regimens.
METHODS
Monte Carlo simulation was used to assess the impacts of different remedial dosage regimens on LEV concentrations. Simulated LEV concentrations outside the individual therapeutic range were calculated for the compliance scenario and for each of the remedial dosage regimens. The percentage of deviation from the full compliance scenario was also calculated. The regimen with the lowest percentage of deviation was considered the most appropriate.
RESULTS
The suitable LEV remedial dose varied across the delay times. For one missed dose, a remedial regimen with a regular dose followed by the usual dose was suitable for a delay time of less than 6 h, while a replacement with a regular dose followed by a partial dose appeared to be appropriate for a delay time of 6 h and longer. This was justified based on the concerns of LEV toxicity when the remedial dose is close to the next scheduled dose. For two consecutive missed doses, a remedial dose with one and a half of the regular dose was suitable if the gap between that and the next dose was greater than 6 h.
CONCLUSIONS
The appropriate remedial dosage regimen for one and two consecutive missed doses of LEV have been proposed. These remedial regimens, however, should be applied with clinicians' judgment based on the clinical status of the patients.
Topics: Anticonvulsants; Computer Simulation; Humans; Levetiracetam; Monte Carlo Method; Piracetam; Seizures
PubMed: 35761145
DOI: 10.1007/s13318-022-00774-9 -
American Journal of Obstetrics and... Mar 2018Despite the availability of a safe and efficacious vaccine against human papillomavirus, uptake of the vaccine in the United States is low. Missed clinical opportunities...
BACKGROUND
Despite the availability of a safe and efficacious vaccine against human papillomavirus, uptake of the vaccine in the United States is low. Missed clinical opportunities to recommend and to administer human papillomavirus vaccine are considered one of the most important reasons for its low uptake in adolescents; however, little is known about the frequency or characteristics of missed opportunities in the young adult (18-26 years of age) population.
OBJECTIVE
The objective of the study was to assess both the rates of and the factors associated with missed opportunities for human papillomavirus immunization among young adult women who attended an urban obstetrics and gynecology clinic.
STUDY DESIGN
In this cross-sectional study, medical records were reviewed for all women 18-26 years of age who were underimmunized (<3 doses) and who sought care from Feb. 1, 2013, to January 31, 2014, at an urban, hospital-based obstetrics and gynecology clinic. A missed opportunity for human papillomavirus immunization was defined as a clinic visit at which the patient was eligible to receive the vaccine and a dose was due but not administered. Multivariable logistic regression was used to test associations between sociodemographic variables and missed opportunities.
RESULTS
There were 1670 vaccine-eligible visits by 1241 underimmunized women, with a mean of 1.3 missed opportunities/person. During the study period, 833 of the vaccine eligible women (67.1%) had at least 1 missed opportunity. Overall, the most common types of visits during which a missed opportunity occurred were postpartum visits (17%) or visits for either sexually transmitted disease screening (21%) or contraception (33%). Of the patients with a missed opportunity, 26.5% had a visit at which an injectable medication or a different vaccine was administered. Women who identified their race as black had higher adjusted odds of having a missed opportunity compared with white women (adjusted odds ratio, 1.61 [95% confidence interval, 1.08-2.41], P < .02). Women who reported a non-English- or non-Spanish-preferred language had lower adjusted odds of having a missed opportunity (adjusted odds ratio, 0.25 [95% confidence interval, 0.07-0.87], P = .03). No other patient characteristics assessed in this study were significantly associated with having a missed opportunity.
CONCLUSION
A majority of young-adult women in this study had missed opportunities for human papillomavirus immunization, and significant racial disparity was observed. The greatest frequency of missed opportunities occurred with visits for either contraception or for sexually transmitted disease screening.
Topics: Adolescent; Adult; Black or African American; Contraception; Cross-Sectional Studies; Female; Gynecology; Humans; Language; Obstetrics; Outpatient Clinics, Hospital; Papillomavirus Infections; Papillomavirus Vaccines; Sexually Transmitted Diseases; United States; Vaccination; White People; Young Adult
PubMed: 29223597
DOI: 10.1016/j.ajog.2017.11.602 -
Journal of Thoracic Imaging Nov 2018Lung cancer at its earliest stage is typically manifested on computed tomography as a pulmonary nodule, which could be detected by low-dose multidetector computed... (Review)
Review
Lung cancer at its earliest stage is typically manifested on computed tomography as a pulmonary nodule, which could be detected by low-dose multidetector computed tomography technology and the use of thinner collimation. Within the last 2 decades, computer-aided detection (CAD) of pulmonary nodules has been developed to meet the increasing demand for lung cancer screening computed tomography with a larger set of images per scan. This review introduced the basic techniques and then summarized the up-to-date applications of CAD systems in clinical and research programs and in the low-dose lung cancer screening trials, especially in the detection of small pulmonary nodules and missed lung cancers. Many studies have already shown that the CAD systems could increase the sensitivity and reduce the false-positive rate in the diagnosis of pulmonary nodules, especially for the small and isolated nodules. Further improvements to the current CAD schemes are needed to detect nodules accurately, particularly for subsolid nodules.
Topics: Humans; Image Processing, Computer-Assisted; Lung; Lung Neoplasms; Multiple Pulmonary Nodules; Sensitivity and Specificity; Solitary Pulmonary Nodule; Tomography, X-Ray Computed
PubMed: 30239461
DOI: 10.1097/RTI.0000000000000362 -
Immunotherapy Oct 2023This study aimed to develop a novel dose strategy for subcutaneous immunotherapy to reduce medical waste and financial burdens for patients who are required to restart...
This study aimed to develop a novel dose strategy for subcutaneous immunotherapy to reduce medical waste and financial burdens for patients who are required to restart subcutaneous immunotherapy. A prospective, nonrandomized concurrent controlled trial was performed to assess the safety and advantages of the novel dose-adjustment protocol compared with the conventional one. 76 subjects were grouped to receive novel or conventional dose-adjustment protocols. The injections, visits and time needed to reach the pre-established dose with the novel regimen were decreased. Furthermore, there were no differences in side reactions between the two groups. The novel protocol seemed safe and well tolerated, offering the advantages of time efficiency and reduced healthcare costs.
Topics: Animals; Humans; Allergens; Pyroglyphidae; Prospective Studies; Rhinitis, Allergic; Injections, Subcutaneous; Immunotherapy; Desensitization, Immunologic; Sublingual Immunotherapy
PubMed: 37585664
DOI: 10.2217/imt-2023-0051 -
Medicine and Science in Sports and... Feb 2020While general guidelines (such as CONSORT or Consensus on Exercise Reporting Template) exist to enhance the reporting of exercise interventions in the field of exercise...
PURPOSE
While general guidelines (such as CONSORT or Consensus on Exercise Reporting Template) exist to enhance the reporting of exercise interventions in the field of exercise science, there is inadequate detail facilitating the standardized reporting of resistance training adherence in the oncology setting. The purpose of this study was to apply a novel method to report resistance training dose, adherence, and tolerance in patients with cancer.
METHODS
A total of 47 prostate cancer patients (70.1 ± 8.9 yr, body mass index, 28.6 ± 4.0) with bone metastatic disease completed an exercise program for 12 wk. We assessed traditional metrics of adherence (attendance and loss to follow-up), in addition to novel proposed metrics (exercise-relative dose intensity, dose modification, and exercise interruption). Total training volume in kilograms (repetitions × sets × training load (weight)) was calculated for each patient.
RESULTS
Attendance assessed from traditional metrics was 79.5% ± 17.0% and four patients (9%) were lost to follow-up. The prescribed and actual cumulative total dose of resistance training was 139,886 ± 69,150 kg and 112,835 ± 83,499 kg, respectively, with a mean exercise-relative dose intensity of 77.4% ± 16.6% (range: 19.4% -99.4%). Resistance training was missed (1-2 consecutive sessions) or interrupted (missed ≥3 consecutive sessions) in 41 (87%) and 24 (51%) participants, respectively. Training dose was modified (reduction in sets, repetitions, or weight) in 40 (85%) of patients. Importantly, using attendance as a traditional metric of adherence, these sessions would have all counted as adherence to the protocol.
CONCLUSIONS
Traditional reporting metrics of resistance training in exercise oncology may overestimate exercise adherence. Our proposed metrics to capture resistance training dose, adherence, and tolerance may have important applications for future studies and clinical practice.
Topics: Aged; Bone Neoplasms; Exercise Therapy; Fatigue; Follow-Up Studies; Humans; Male; Middle Aged; Patient Compliance; Prostatic Neoplasms; Resistance Training; Retrospective Studies; Weight Lifting
PubMed: 31436734
DOI: 10.1249/MSS.0000000000002127 -
European Radiology Jul 2023Validation of [F]FDG PET/CT at ultralow-dose (0.37 MBq/kg) and compared to imaging at half-dose (1.85 MBq/kg).
OBJECTIVES
Validation of [F]FDG PET/CT at ultralow-dose (0.37 MBq/kg) and compared to imaging at half-dose (1.85 MBq/kg).
METHODS
This prospective head-to-head intraindividual study compared dynamic and static parameters of ultralow-dose with half-dose [F]FDG total-body PET/CT. In static imaging, the ultralow-dose groups of PET images were denoted ULD5, 60-65 min; ULD8, 60-68 min; ULD10, 60-70 min; and ULD15, 60-75 min. The half-dose group images were reconstructed to 60-61, 60-62, 60-63, and 60-75 min, defined as LD1, LD2, LD3, and LD15, respectively. A 5-point Likert scale was used to subjectively evaluate the quality of static PET images, with a score greater than 3 considered to meet the requirements for clinical diagnosis.
RESULTS
Thirty participants were included in this study, and in terms of kinetic indicators, no special differences were found between the two groups of normal organs and lesions. In static images, those in groups ULD8 and LD2 achieved scores of [Formula: see text] 3.0, meeting the requirements for clinical diagnosis. In static imaging, four lesions were missed in the LD1 group with a lesion detectability of 89.7% (35/39). In the meantime, lesions were not missed in the whole ultra-low dose group (ULD5, ULD8, ULD10, and ULD15) and half-dose groups (LD2 and LD3).
CONCLUSIONS
Compared with half-dose imaging, ultralow-dose [F]FDG total-body PET/CT imaging is clinically feasible, and there was no meaningful difference between the two groups of quantitative and qualitative analysis either dynamic or static images. Total-body PET/CT with ultralow-dose activity, the corresponding acquisition time of 8 min provides acceptable image quality and lesion detection.
TRIAL REGISTRATION
ClinicalTrials.gov identifier: ChiCTR2000036487 KEY POINTS: • A prospective single-center study showed that the total-body PET scanner allows ultralow-dose [F]FDG imaging with acceptable image quality and lesion detectability. • For the participant, radiation exposure can be reduced with ultralow-dose [F]FDG total-body PET/CT imaging.
Topics: Humans; Positron Emission Tomography Computed Tomography; Fluorodeoxyglucose F18; Prospective Studies; Feasibility Studies; Tomography, X-Ray Computed; Positron-Emission Tomography
PubMed: 36688971
DOI: 10.1007/s00330-023-09389-3