A lesson from MMR: is choice of vaccine the missing link in promoting vaccine confidence through informed consent?

A recent study suggests that vaccine hesitancy amongst key demographics – including females, younger individuals, and certain ethnic groups – could undermine the pursuit of herd immunity against COVID-19 in the United Kingdom. At the same time, the UK Joint Committee on Vaccination and Immunization (JVCI) indicated that it will not facilitate the choice between available COVID-19 vaccines. This paper reflects upon lessons from the introduction of the UK's combined Measles, Mumps and Rubella (MMR) vaccine strategy of the 1980s when Member of Parliament Miss Julie Kirkbride argued that had parents been allowed to choose between vaccine variants, then the crisis of low herd immunity – and subsequent outbreaks – could have been avoided. This paper explores this argument, as applied to the COVID-19 vaccination strategy, by considering how three key elements of informed consent – disclosure of risk, benefit, and reasonable alternatives – may be employed to tackle vaccine hesitancy and build vaccine confidence.

"it's only when somebody says a tool worked for them that i believe it will work for me": Socio-tecture as a lens for Digital Transformation

Small and Medium sized Businesses (SMBs) make up majority of employment in Africa (around 80%). Understanding the digital transformation that SMBs in Africa went through during the pandemic can play an important role in uncovering how to build solutions that better support the African business and African worker. In this paper we report on findings from a qualitative study with 40 SMBs in Kenya. The study aimed to understand the lived experience of digital transformation, the impacts of COVID-19 on their businesses, and how they responded to such impacts using technology. We found that COVID-prompted digital transformation was reactive and opportunistic, plus social and collective. Moreover, the socialness of business goes way beyond digital transformation, and influences how SMBs in Kenya start, develop and are sustained. In illustrating this, we offer a lens to understanding work and workers of SMBs in Kenya and similar contexts across the globe. © 2022 Owner/Author.

Humoral response to SARS-CoV-2 vaccination among heart transplant recipients aged 18–70 years of age administered two doses of an adenoviral vector (ChAdOx1 nCoV-19) vaccine and a messenger RNA (BNT162b2) booster

28 Figure 1a) Frequency of a detectable antibody response after each vaccination for 80 heart transplant recipients, b) Interval change in anti-spike antibody titres between the 2nd ChAdOx1 nCoV-19 vaccine and the 3rd dose mRNA (BNT162b2) booster vaccine.[Figure omitted. See PDF]Conclusions/ImplicationsHeart transplant recipients who received 2 doses of the ChAdOx1 nCoV-19 viral vector vaccine and a mRNA booster vaccine failed to develop a detectable antibody response in 44% of cases. These findings highlight the importance of maintaining protective measures for transplant recipients, particularly those on more intensive immunosuppressive regimens, both at a personal and public health level, as well as investigating additional strategies to protect this vulnerable patient cohort.

Platformisation of Digital Financial Services (DFS): The Journey of DFS in the Global North and Global South

The digitization of financial transactions in both Global North and Global South has led to considerable shifts in how money is used, understood, and processed by users, banks, and fintechs. This shift from physical cash to digital media, accelerated by the COVID-19 push for digital transactions, has impacted how users perceive and use digital money and opened avenues for more data collection. This diverse panel proposes a discussion to understand the set of opportunities and challenges around the design of digital financial services (DFS) and data-driven decision-making in DFS. We will create a live working document starting before the panel to document the discussion, which develops during and after the panel. This live document will enable community to engage with a broader audience of researchers and industry, outlining processes, methods, and tools that researchers and practitioners have created to work with users to develop new equitable DFS and further exploration. © 2022 Owner/Author.

Appendicitis during the COVID-19 pandemic: To operate or not to operate, that is the question

Background: During the Covid-19 pandemic, non-operative management for acute appendicitis (AA) was implemented in the UK. Aim of this study was to determine the efficacy and outcomes of conservative versus surgical management of AA during the pandemic. Materials & Methods: We conducted an observational study in a tertiary referral centre. Data was collected from patients (≥16 years) with a diagnosis of AA between 1st November 2019 to 10th March 2020 (pre-COVID period) and 10th March 2020 to 5th July 2020 (COVID period). Results: A total of 116 patients in the pre-COVID period were included versus 91 in the COVID period. 43.1% (n=50) of patients pre-COVID were classified as ASA 2 compared to 26.4% (n=24) during the COVID period (p-value =0.042). 72.5% (n=66) of the patients during the COVID period scored as high risk using the Alvarado score compared to 24.1% (n=28) in the pre-COVID period (p-value<0.001).We observed a significant increase in radiological evaluation, 69.8% versus 87.5% of patients had a CT in the pre-COVID and COVID periods respectively (p-value=0.008). 94.9% of patients were managed operatively in the pre-COVID period compared to 60.4% in the COVID period (p-value<0.001). We observed more open appendicectomies (37.3% versus 0.9%;p-value<0.001) during the COVID period compared to the pre-COVID period. More abscess formation and free fluid were found intraoperatively in the COVID period (p-value= 0.021 and 0.023 respectively). Re-attendance rate due to appendicitis-related issues was significantly higher in the COVID period (p=0.027). Conclusion: Radiological diagnosis of AA was more frequent during the COVID period. More conservative management for AA was employed during the COVID-19 pandemic, and for those managed operatively an open approach was preferred. Intra-operative findings were suggestive of delayed presentation during the COVID period without this affecting the length of hospital stay.

Pillcam eso capsule: An alternative diagnostic tool during the covid-19 pandemic. first irish experience

Introduction: The Covid-19 pandemic has led to unprecedented endoscopy practice. At the peak of the pandemic in Ireland, many routine and surveillance endoscopies were deferred, with only urgent procedures prioritised. To allow safe and effective upper gastrointestinal investigations continue, alternative modalities were explored. HSE national guidance document for safe endoscopy in pandemic conditions recommends that alternative non-invasive investigation be considered for all non-urgent referrals for endoscopy. The PillCam ESO® (Given Imaging Ltd., Yoqneam, Israel) offers such an alternative for evaluation of the UGI tract. We conducted a prospective analysis of PillCam ESO® as an alternative diagnostic tool during the Covid-19 pandemic to help tackle the increasing waiting list for gastroscopy at our unit. Aims & Methods: The Aim was to assess if the PillCam ESO can identify important anatomical landmarks as stated in the British Society of Gastroenterology quality standards for upper gastrointestinal endoscopy and if it can effectively identify pathology in the Upper GI Tract. Methods: Patients who fitted our inclusion criteria were prospectively invited to participate into our trial. The three main indications were: 1. Patients with dyspepsia less than 40 years of age with no red flag symptoms, 2. Known cirrhosis to screen for varices, 3. UGI bleeds with a low Blatchford score (≤2). A local protocol for ingestion and series of positional guidelines was developed for the procedure. Ethical approval was granted for this study. Capsule transit time, endoscopic landmarks, and pathology detection were evaluated by two independent endoscopists. Results: 66 exams have been successfully performed in the GI Lab from June 2020 to date without complications. The two frequent indications were dyspepsia (66%) and abdominal pain (24%). IM Metoclopramide was administered in 52% of cases. Complete visualisation of the following major anatomical landmarks was achieved in 100% of cases: Oesophagus, Oesophageal-gastro junction, and Gastric. A full view of the cardia, fundus, greater curve, lesser curve, incisura angularis, antrum, pylorus, and second part of Duodenum was obtained in 99%, 94%, 99%, 97%, 97%, 92%, 91%, and 80% of cases, respectively. D2 intubation was achieved in 80% of cases. The mean capsule transit times was 62 mins (SD 28). A normal exam was reported in 41% of cases. Reflux oesophagitis and gastritis were the most common pathology detected. Adenocarcinoma of the OG junction was detected in 1 case. Conclusion: The PillCam ESO achieves excellent views of the upper GI tract. In selective cases, it is a safe alternative to gastroscopy which may help reduce gastroscopy waiting times.

Management of Upper Gastrointestinal Tract Leaks Using Endoluminal Vacuum Therapy: 10-years’ Experience of a Specialist Esophago-gastric Center

Introduction: Management of upper gastrointestinal (UGI) leaks is challenging, especially in patients with delayed presentation and established sepsis. Endoluminal vacuum therapy (EVT) is an emerging treatment strategy which may reduce morbidity and mortality compared to traditional treatments in this patient group. We report the outcomes for patients with UGI leaks treated with EVT in a tertiary UK hospital over a 10-year period. Methods: Between April 2011 and February 2021, 63 patients with UGI leaks from different causes were treated with EVT using an ad-hoc endoluminal vacuum device (EVD). Information related to treatment and outcome was recorded prospectively. Results: Patients had a median age of 67 years (25-92), and mean Apache II score of 20.7 (6-36) at the time of leak diagnosis. The cause of the leak was anastomotic (n=23;37%), iatrogenic (n=20;32%), spontaneous (n=19;30%), and traumatic (n=1;2%). Forty-seven (75%) leaks were oesophageal, 12 (19%) gastric, 2 (3%) duodenal, and 1 (2%) pharyngeal. The median number of EVD changes required to heal the leak was 9 (1-27), and median length of hospital stay was 31 days (1-196). Successful resolution of the leak occurred in 55 (87%) patients. Eight (13%) patients died during treatment. There were no complications related to insertion of the EVD. Eight (13%) patients had complications during treatment which required further intervention including bleeding (n=4;6%), stroke (n=1;2%), pulmonary embolus (n=1;2%), myocardial infarction (n=1;2%) and COVID-19 (n=1;2%). Conclusion: EVT is safe, and can be used to successfully treat UGI leaks from a disparate range of leak causes in critically unwell patients. Further studies are required to develop a standardized procedure to enable broader adoption of EVT in this group of patients.

Pillcam ESO capsule, an alternative diagnostic tool during the COVID-19 pandemic. firstirish experience

Aims At the peak of the Covid-19 pandemic in Ireland, many routine and surveillance endoscopies were deferred, with onlyurgent procedures prioritised. The PillCam ESO (Given Imaging Ltd., Yoqneam, Israel) is a non-invasive investigation, whichoffers an alternative method of evaluating the UGI tract for non-urgent referrals for endoscopy. A prospective study to assess if the PillCam ESO can identify important anatomical landmarks stated in the British Societyof Gastroenterology quality standards for upper gastrointestinal endoscopy and pathology in the Upper GI Tract. Methods Patients who fitted our inclusion criteria were prospectively invited to participate into our trial. The three main indications were 1;patients with dyspepsia less than 40 years of age with no red flag symptoms, 2;knowncirrhosis to screen for varices, 3;UGI bleeds with a low Blatchford score (≤2). A local protocol for ingestion and series of positional guidelines was developed for the procedure. Endoscopic landmarks, and pathology detection were evaluated by two independent endoscopists. Results 32 exams have been successfully performed from June 2020 to date without complications. The two frequentindications were dyspepsia (66 %) and abdominal pain (19 %). Metoclopramide was administered in 66 % of cases. Visualisation of the following major anatomical landmarks was achieved in 100 % of cases: Oesophagus, oesophageal-gastro junction, greater curve, pylorus. A full view of the cardia, fundus, lesser curve, incisura angularis and antrum was obtained in 97 %, 87 %, 93 %, 97 % and97 % of cases, respectively. D2 intubation was achieved in 90 % of cases. A normal exam was reported in 34 % of cases.Reflux oesophagitis and gastritis were the most common pathology detected. Adenocarcinoma of the OG junction wasdetected in 1 case. Conclusions The PillCam ESO achieves excellent views of the upper GI tract. In selective cases, it is a safe alternative togastroscopy which may help reduce gastroscopy waiting times.