Vaccine Literacy and Hesitancy among Parents and Legal Guardians of Elementary School-Aged Children in the Midwest (preprint)

Parental refusal of childhood vaccines is a growing public health concern. Numerous reasons exist for this refusal, including religious, personal, and philosophical beliefs, and safety concerns. However, parental refusal of childhood vaccines is not simply an individualized problem for the family; this impacts herd immunity and affects the entire community. To improve vaccination rates among the pediatric population, understanding the thought process and decision-making behind parental opposition and refusal of vaccinations is essential. Using a survey developed to assess attitudes towards recommended childhood vaccines and the COVID-19 vaccine, this study examined the correlation between vaccine literacy and hesitancy among parents and legal guardians of elementary school-aged children in the Midwest. Responses were analyzed using Chi-squared tests on “R” software. Significant negative correlations were found between COVID-19 hesitancy and vaccine literacy, and resistance towards all vaccines and vaccine literacy. No significant negative correlations were found between hesitancy towards all vaccines and vaccine literacy, or hesitancy and literacy among different income and education brackets. Our results suggest that vaccine education may lessen vaccine hesitancy among parents and may be an essential factor in improving vaccination rates among the pediatric population.

COVID-19 infection and 2-year mortality in nursing home residents who survived the first wave of the pandemic (preprint)

Background During the first COVID-19 pandemic wave (1stCoPW), nursing homes (NHs) experienced a high rate of COVID-19 infection and death. Residents who survived the COVID-19 infection may have become frailer. This study aimed to determine the predictive value of having a COVID-19 infection during the 1st CoPW for 2-year mortality in NH residents.Methods This was a retrospective study conducted in three NHs. Residents who had survived the 1st CoPW (March to May 2020) were included. The diagnosis of COVID-19 was based on the results of a positive reverse transcriptase-polymerase chain reaction test. The collected data also included age, sex, length of residence in the NH, disability status, legal guardianship status, nutritional status, need for texture-modified food and hospitalization during lockdown. Nonadjusted and adjusted Cox models were used to analyse factors associated with 2-year post-1st CoPW mortality.Results Among the 315 CoPW1 survivors (72% female, mean age 88 years, 48% with severe disability), 35% presented with COVID-19. Having a history of COVID-19 was not associated with 2-year mortality: hazard ratio (HR) [95% confidence interval] = 0.96 [0.81–1.13], p = 0.62. The factors independently associated with 2-year mortality were older age (for each additional year, HR = 1.05 [1.03–1.08], p < 0.01), severe disability vs moderate or no disability (HR = 1.35 [1.12–1.63], p < 0.01) and severe malnutrition vs no malnutrition (HR = 1.29 [1.04–1.60], p = 0.02).Conclusions Having survived a COVID-19 infection during the 1st CoPW did not affect subsequent 2-year survival in older adults living in NHs, suggesting that most of these residents recovered from the infection without COVID-19-related life-threatening sequelae.

Temporal Analysis of Drifting Hashtags in Textual Data Streams: A Graph-Based Application (preprint)

Social media has played an important role since its emergence. People use the internet to express opinions about anything, making social media platforms a social sensor. Initially supported by Twitter, the hashtags are now in use on several social media platforms. Hashtags are helpful to tag, track, and group posts on similar topics. In this paper, we analyze hashtag drifts over time using concepts from graph analysis and textual data streams using the Girvan-Newman method to uncover hashtag communities in annual snapshots. More specifically, we analyzed the #mybodymychoice hashtag between 2018 and 2022. In addition, we offer insights about some hashtags found in the study. Furthermore, our approach can be useful for monitoring changes over time in opinions and sentiment patterns about an entity on social media. Even though the hashtag #mybodymychoice was initially coupled with women's rights, abortion, and bodily autonomy, we observe that it suffered drifts during the studied period across topics such as drug legalization, vaccination, political protests, war, and civil rights. The year 2021 was the most significant drifting year, in which the communities detected suggest that #mybodymychoice significantly drifted to vaccination and Covid-19-related topics.

Analysis of pathogenic factors of retinopathy of prematurity in Heilongjiang Province (preprint)

Background and purpose Retinopathy of prematurity is a vascular development disorder in immature retinas of premature infants, which is the leading cause of blindness in children worldwide. Because the screening delay may lead to the occurrence of blindness in children, it is particularly important to conduct timely screening for children with high risk factors. Currently, the pathogenesis of ROP may be related to multiple factors such as gestational age and birth weight of premature infants. In this study, the prevalence and risk factors of ROP in Heilongjiang Province were determined through screening for premature infants in the region, aiming to proceed early prevention of the disease. Methods Retrospectively analyzed 714 premature infants admitted to the Ophthalmology Clinic of the Second Affiliated Hospital of Harbin Medical University from January 2016 to February 2022. 12 related factors was recorded including patients’ gender, gestational age, birth weight, oxygen duration, blood transfusions, anemia, neonatal infections, respiratory distress syndrome, maternal feeding way, childbirth way, pregnancy age and parity. The prevalence of ROP and the differences in related factors between ROP patientsand non-ROP patients were found. Results Among 714 premature infants, 188 had ROP of which the incidence is 26.3%，and 61 patients received treatment. There were statistically significance(P<0.05) in gestational age, birth weight, oxygen duration, blood transfusion, anemia, neonatal infection, respiratory distress syndrome and childbirth way between the 188 ROP patients and non-ROP patients in univariate regression analysis. Variables with statistical significance for single factor were selected and conducted by multivariate regression analysis, which showed that gestational age, birth weight, and oxygen duration had remarkable statistical significance(P<0.05) with the occurrence of ROP. Gestational age and birth weight were the protective factors of disease (OR=0.43 and OR=0.8), while oxygen duration was the risk factor of disease (OR=1.02), and the diagnostic value of the model was high (AUC=0.776). five of the 61 patients who received treatment for ROP accepted two treatments, with gestational age < 32 weeks, birth weight < 1500g, and oxygen inhalation time > 20 days. The Kendall grade relative analysis of 188 patients with ROP showed that disease severity was significantly correlated with gestational age, birth weight, oxygen duration, anemia, blood transfusion and respiratory distress syndrome(P<0.05), in which the gestational age, birth weight, anemia, blood transfusion and respiratory distress syndrome were negatively correlated with the severity of the disease, while oxygen duration was positively correlated with severity of the disease. 507 children were screened from 2016 to December 31th in 2019, 138 of which were ROP patients, 36 children were treated (7.1%). Due to the spread of the COVID-19, 207 children were screened after January 1th in 2020, 50 children were ROP patients, and 25 of whom got treatment (12%), 21were treated after 8 weeks of birth or more than 37 weeks of corrected gestational age. Four out of five children who received the second treatment happened after the epidemic, and three of them missed treatment due to the epidemic. Conclusions The gestational age, birth weight and oxygen duration are significantly correlated with the incidence and severity of the disease in premature infants screening of Heilongjiang Province. Premature infants screening and subsequent visit were affected due to the spread of the COVID-19 in the past two years, the proportion of children needed to be cured augmented apparently, therefore, it matters a lot for premature infants to be screened standardly and timely.

United States Marijuana Legalization and Opioid Mortality Trends Before and During the First Year of the COVID-19 Pandemic (preprint)

To determine if marijuana legalization reduced opioid mortality, the U.S. opioid and fentanyl subset death trends during the 2010-2019 decade were compared in states and District of Columbia (D.C.) (jurisdictions) that had implemented marijuana legalization with states that had not. Acceleration of opioid mortality during 2020, first year of the COVID-19 pandemic, was also compared in recreational and medicinal-only legalizing jurisdictions. Joinpoint methodology was applied to Centers for Disease Control and Prevention WONDER data. Trends in legalizing jurisdictions were cumulative aggregates. The overall opioid and fentanyl death rates and percentage of opioid deaths due to fentanyl increased more during 2010-2019 in jurisdictions that legalized marijuana than in those that did not (pairwise comparison p=0.007, 0.05, and 0.006, respectively). By 2019, the opioid and fentanyl death rates were 44% and 50% greater in the legalizing than non-legalizing jurisdictions, respectively. When the COVID-19 pandemic hit in 2020, jurisdictions that implemented recreational marijuana legalization before 2019 had significantly greater increases in both overall opioid and fentanyl death rates than jurisdictions with medicinal-only legalization. For all opioids, the mean (95% confidence interval [CI]) 2019-to-2020 increases were 46.5% (95% CI, 36.6% to 56.3%) and 29.1% (95% CI 20.2% to 37.9%), respectively (p=0.02). For fentanyl, they were 115.6% (95% CI, 80.2% to 151.6%) and 55.4% (95% CI, 31.6% to 79.2%), respectively (p=0.01). Marijuana legalization is correlated with worsening of the U.S. opioid epidemic, and especially during the COVID-19 pandemic with recreational legalization.

A Media Analysis of the COVID-19 Tobacco Sales Ban in South Africa (preprint)

The South African government introduced a nationwide lockdown in March 2020 to mitigate the spread of Covid-19. Among other restrictions, the government banned the sale of tobacco products, which lasted for nearly five months. We performed a Google search using the keywords smok*, puff*, lockdown, tobacco, and cigarette*, for articles published in English from 23 March 2020to 18 December 2020 and analysed 441 online media articles. We identified the main arguments made by proponents and opponents of the tobacco sales ban, which were categorised into themes. Three themes were prominent: medical, legal, and economic/financial. Legal aspects were covered in 48% of articles, followed by economic (34%), and medical aspects (18%). The media was generally ambivalent about the tobacco sales ban during the first five weeks of lockdown. Sentiment then turned against the ban. because the medical rationale was not well communicated by the government, there was limited empirical evidence of a link between smoking and contracting Covid-19, and the sales ban was ineffective, since most smokers still purchased cigarettes. Policy framing in the media plays an important role in how the public receives the policy. Any future tobacco control policy intervention should be well-considered and appropriate cessation support services offered.

Regulating Economic Opportunism in Post-Disaster Markets (preprint)

Markets often falter during crises. Recently, the COVID-19 pandemic and the massive power grid collapse in Texas have caused market failures concerning medical supplies, paper goods, gasoline, electricity, and other necessities. By disrupting standard market conditions, disasters commonly lead to the supply of necessities being outpaced by demand. Some vendors seek to exploit this dynamic, increasing their prices exponentially and shamelessly engaging in disaster profiteering. While nearly every state has enacted anti-price gouging laws that proscribe such practices, these laws differ substantially from each other in what they prohibit and in how vigorously they have been enforced.While anti-pricing gouging statutes have existed for decades, the scale of the market disruptions witnessed in the past few years have put them into the public consciousness like never before. While this publicity has led to coverage in popular media and a surge of interest from scholars, these laws have been severely undertheorized within the legal academy.This Article addresses this gap. It begins by analyzing how states, the federal government, and other nations have regulated price gouging. It then reviews the types of exploitative conduct commercial actors have engaged in during recent disasters and the results of governmental enforcement actions. After reviewing the traditional legal and economic objections to anti-price gouging laws, it establishes the flaws in these arguments. Not only are they shown to be theoretically unsound, but they also are demonstrably undermined by recent qualitative data. It concludes by arguing that the adoption of specific reforms to anti-price gouging laws would help them protect consumers from exploitation while minimizing negative externalities.

Legality Without Liberalism: The Rule of Law and the Environmental Emergency (preprint)

The rule of law is often said to be a liberal ideal, intrinsically associated with the enlightenment and, being necessary for each, supplying the link between liberalism and constitutionalism. In this paper, that idea is challenged. The rule of law, even in its most ‘formal’ conception embraced by Lon Fuller, cannot be severed from an account of law which is thoroughly infused with moral purpose and value. The specific values which inform this principle are often portrayed as confined to action guidance, restraint of state power, and the protection of individual rights. Framed as such, the rule of law often conflicts with the moral and political obligation of political authority to preserve the conditions necessary for the community to survive and flourish. An alternative conception of the rule of law, rooted in the classical legal tradition, sees no conflict here and can thus provide the intellectual framework needed to explain how inaction on behalf of public authority can be as much of a threat to the rule of law as abusive action. With this in mind, the duty upon the state to respond to threats such as climate change or the COVID-19 pandemic is itself best understood as one arising from the requirements of legality. Analysis of state action or inaction in the face of such threats must thus begin with this duty in mind as a constitutive aspect of the rule of law. The threats posed by the environmental emergency are best viewed by reference to the communal underpinnings of the rule of law. The liberal desire to frame all moral issues in the language of individual rights should therefore be resisted. The framework of an individual right to a liveable climate may be the best way for liberal constitutionalism to frame the climate crises, but it is by no means the only way. Indeed, it is a manifestly impoverished attempt to concretise what can only be understood as a threat to the common good itself, grounded within the needs of the global community as a whole.

Is breastfeeding during the Covid-19 pandemic too close for comfort? (preprint)

Purpose This study aims to assess whether Covid-19 has affected breastfeeding rates negatively in the Maltese neonatal population and how breastfeeding services have been impacted by the pandemic. Data was also compared to a nationwide study carried out in 2008 to assess whether any improvements in breastfeeding rates and service have been made. Methods It is a retrospective cohort study which used a questionnaire to obtain its data. The study was carried out in Mater Dei Hospital, the only local government hospital that serves as the main hospital of the island. Data of every birth in Mater Dei Hospital during the period August and September 2019 as well as August and September 2020 was collected and compared. This allowed the comparison of newborns up to 6 months of age prior to the first reported case of COVID-19 on the Maltese (7th March 2020) islands to newborns born during the COVID-19 pandemic. Data of each birth was collected from the Malta Birth Registry. Legal guardians of the child werecontacted via phone and asked to give verbal consent. Only authorised researchers contacted the caregivers. Results A total of 1481 mothers gave birth during August and September 2019 and 2020, of which 734 (50%) were in 2019 and 747 (50%) in 2020. Out of these 235 (32%) caregivers were reached in the pre-covid cohort and 228 (30%) in the covid cohort. During the Covid 19 pandemic mothers-to-be were significantly less likely to be informed of the services offered by Mater Dei Hospital, with 13% being informed of the services compared to 83% of mothers in the pre covid cohort (P<0.000). During the covid-19 pandemic 36% (n=83) of mothers continued breastfeeding until 6 months of age compared to 3% (n=6) pre covid pandemic. Conclusions Despite breastfeeding protocols, ambitions to become a baby friendly hospital and increased staff awareness to breastfeeding the general population is evidently not convinced. Covid-19 did not have a negative impact on the attrition rates in the Maltese population despite poorer health care services, however it did increased breastfeeding rates at 6 months of age. Community services and hospital services need to be improved to improve the poor breastfeeding rate on the Maltese islands. Increased awareness of breastfeeding in the workplace and in public areas would beneficial. Pre and postnatal education in the hospital environment should be enhanced.

Die Transparenz rechtlicher Verbraucherinformationen im Internet. Eine empirische Studie über die wichtigsten Stakeholder. (The Transparency of Legal Consumer Information Online. An Empirical Study of the Most Important Stakeholders) (preprint)

German Abstract: Informationspflichten sind seit Jahrzehnten ein fester Bestandteil des EU-Verbraucherrechts. Durch die stetig steigende Zahl von E-Commerce und Online-Verbraucherverträgen, nicht zuletzt infolge des Lockdown des stationären Einzelhandels während der COVID-19-Pandemie, ist die Bedeutung der Informationspflichten in den letzten Jahren weiter gewachsen. Ihre empirische Erforschung weckt jedoch Zweifel, ob diese Ausbreitung der Informationspflichten sinnvoll ist. Auch sind die Hinweise des europäischen Gesetzgebers, wie transparente Offenlegungen gegenüber Verbraucher/-innen gestaltet sein sollten lediglich auf einem sehr allgemeinen Niveau, so dass sie für konkrete Fälle nur bedingt hilfreich sind. Daher untersuchen wir in diesem Beitrag das Prinzip der Transparenz und seine Verwirklichung im europäischen Verbraucherrecht aus einer interdisziplinären Multi-Stakeholder-Perspektive. Wir stellen die Ergebnisse einer qualitativen empirischen Studie vor, in der wir 75 deutsche Stakeholder von Verbraucherinformationen im Internet befragt haben und geben einen Überblick über die wichtigsten Auffassungen von Richter/-innen, Anwält/-innen, Vertreter/-innen von Verbraucherorganisationen, Politiker/-innen, Unternehmer/-innen und Verbraucher/-innen. Auf dieser Grundlage entwickeln wir empirisch begründete Empfehlungen zur Verbesserung der Transparenz von Verbraucherinformationen im Internet.English Abstract: Information obligations have been an integral part of EU consumer law for decades. Due to the steadily increasing number of e-commerce and online consumer contracts, the importance of information duties has continued to grow in recent years. However, empirical research results raise doubts as to whether this proliferation of information obligations makes sense. Furthermore, the European Commission’s guidance on how disclosures to consumers should be designed to count as transparent is only on a very general level. Thus, it is only of limited help for concrete cases. In this paper we examine the principle of transparency and its realization in European consumer contract law from an interdisciplinary multi-stakeholder perspective. We present the results of a qualitative empirical study in which we interviewed 75 German stakeholders of consumer information on the internet. We give an overview of the most important views of judges, lawyers, representatives of consumer organizations, politicians, entrepreneurs and consumers. On this basis, we develop empirically based recommendations for improving the transparency of online consumer information.

Voices from Behind Bars: Narratives of Under Trial Prisoners in the Indian Justice System (preprint)

The conditions faced by undertrial prisoners in India are often harsh and deplorable. These individuals are incarcerated in overcrowded prisons, often subjected to inhumane treatment and denied basic amenities. Juvenile undertrials are particularly vulnerable in this system. They are often subjected to physical and emotional abuse and are denied access to education and rehabilitation programs. The Covid-19 pandemic has inflamed the circumstance, with undertrial prisoners at a higher risk of infection due to the cramped living conditions. Many prisons have reported outbreaks, leading to a further deterioration of the already dire situation. The deficiency of access to legal aid and the prolonged detention without trial often leads to a sense of hopelessness and despair among undertrial prisoners. This has resulted in a spate of suicides among these individuals, highlighting the urgent need for prison reforms in India.The plight of undertrial prisoners in India is a cause for concern. The government shall take initiative to improve the living conditions in prisons, ensure access to legal aid, and expedite the trial process to prevent the prolonged detention of individuals. Only then can we hope to bring about a more just and equitable society.

Avoiding "COVID Blindness": Advocating Cognitive Bias Teaching in the Context of COVID-19.

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Migrasomes deliver messages from migrating cells (preprint)

Migrasomes are newly discovered extracellular vesicles that can mediate communication between cells. These unique vesicles form exclusively at the rear of migrating cells with the help of a protein called TSPAN4. After they’re left behind, the migrasomes and their contents can be captured by nearby cells and affect the recipient cells’ behavior. They can also serve as “breadcrumb trails” that mark the paths of their migrating parent cells. Migrasomes participate in both health and disease. For example, they can dispose of damaged mitochondria to maintain healthy cells and they help establish left–right patterning in zebrafish embryos by releasing the protein CXCL12 to recruit dorsal forerunner cells (DFCs). However, migrasomes can also deliver molecules that promote tumor growth and metastasis and migrasomes released from platelets promote blood clotting after SARS-CoV-2 infection. Furthermore, migrasomes can facilitate an eye condition called proliferative vitreoretinopathy that leads to retinal detachment and blindness. Better characterization of the contents and roles of migrasomes will help us understand these newly identified vesicles and reveal how they can be leveraged to diagnose and treat diseases.

Different Cases, Different Manifestations of Post-COVID-19 Retinal Artery Occlusion: A Case Series.

Coronavirus disease 2019 (COVID-19) is a procoagulant disease that increases the risk of clinically evident thrombotic complications. Herein we present 3 cases with different retinal artery occlusions that emerged soon after the diagnosis of COVID-19. The first patient had central retinal artery occlusion (CRAO) that resulted in visual loss in one eye. The second patient had inflammatory peripheral retinal artery occlusion, vasculitis, and uveitis which did not affect vision. The third patient presented with CRAO following the progression from orbital cellulitis to orbital apex syndrome. Interestingly, CRAO progressed to internal carotid artery occlusion in this case within days and resulted in monocular visual loss. Variations in the underlying pathophysiology and the characteristics of individual immune responses in patients with COVID-19 may be factors that determine differences in clinical manifestations. This article aims to describe different presentations of COVID-19-related retinal artery occlusions and discuss possible pathophysiological aspects.

The Principles of Legality in Aotearoa New Zealand (preprint)

The principle of legality (POL) may have had a slow start in New Zealand. But a trilogy of Supreme Court decisions in 2021 – D v Police, Fitzgerald v R and Trans-Tasman Resources v Taranaki-Whanganui Conservation Board – as well as a significant case law generated by the Covid-19 pandemic, have ensured the principle’s meteoric rise. Interpretive presumptions protective of basic norms are emerging as a central and perhaps defining feature of contemporary public law in Aotearoa, and are destined to be at the heart of future legal development.It follows that the POL should be a key focus for all public lawyers. The principle is typically taken to mean that if Parliament wishes to infringe basic legal norms it must do so through express statutory language or by necessary implication; general or ambiguous words are insufficient to authorise interferences with fundamental norms.This article unpacks the legality jurisprudence. First, it analyses the ‘triggers’ for the POL. That is, the norms which enliven the interpretive principle. While the POL is traditionally associated with protection of common law rights, the triggers have expanded significantly over time. The article examines four types of trigger: common law rights; principles of the Treaty of Waitangi (and tikanga/Māori customary law); international law; and statutory norms, specifically rights under the New Zealand Bill of Rights Act 1990.The article next examines the legality principle itself. While legal actors often refer to the POL as if it were a monolithic principle, this article demonstrates that there are multiple variants of the principle which are meaningfully different. As such unqualified references to the ‘principle of legality’ are liable to mislead.It is typical for particular areas of law, such as human rights, private law, international law or the Treaty of Waitangi, to be analysed in isolation. But as this article demonstrates, there is significant insight to be gained by setting these different norms, and associated interpretive principles, side-by-side. Doing so causes us to reflect upon variations between these areas, both in relation to selection of trigger norms and the strength of interpretive presumptions, and whether variations are capable of rationalisation.Key recent cases considered include:Ellis v R [2022] NZSC 114Trans-Tasman Resources Ltd v Taranaki-Whanganui Conservation Board [2021] NZSC 127D v Police [2021] NZSC 2Fitzgerald v R [2021] NZSC 131Borrowdale v Director-General of Health [2021] NZCA 520Four Midwives v Minister for Covid-19 Response [2021] NZHC 3064Four Aviation Security Service Employees v Minister for Covid-19 Response [2021] NZHC 3012