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EpiCore was launched in 2013 and is a tool designed to supplement traditional infectious disease surveillance efforts by bringing together human, animal, and environmental experts on a digital platform to provide field-based verification efforts of global public health events1,2. Public health professionals from organizations around the globe, including Ending Pandemics, HealthMap, Geosentinel, MSF-OCBA, ProMED, and EDIS-RSOE, are trained as Moderators and are able to send Requests for Information (RFIs). Moderators utilize nontraditional resources, such as social media and news articles, to identify potential health events. Through EpiCore, moderators send out a RFI to EpiCore members located in a geographic area where a new or known health event is occurring. Health experts who receive the RFI may anonymously respond with information about the health event. A moderator reviews the responses and determines whether the information verifies a new event or updates a known ongoing event. Verified and updated events are summarized and published on the EpiCore public dashboard and shared with WHO EIOS. The study period was January 2020 - July 2022. In the study period, 231 RFIs were sent requesting signals about potential health events;111 of those RFIs received responses with information that allowed moderators to confirm or negate a suspected event, or update a known ongoing event. 82% of those RFIs were responded to within 24 hours. EpiCore is a resource for public health professionals and organizations to supplement traditional infectious disease surveillance efforts. For example, information collected through EpiCore was used to provide timely details on the emerging COVID-19 outbreak in Wuhan, China in January 2020. Additionally, responses to RFIs supported surveillance efforts of the 2022 global monkeypox outbreak. Future efforts include outreach and engagement with existing and new members to expand EpiCore's member base in countries with few to no members. [ FROM AUTHOR] Copyright of International Journal of Infectious Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Intro: The COVID-19 pandemic highlighted a need for an open-source repository of line-list case data for infectious disease surveillance and research efforts. Global.health was launched in January 2020 as a global resource for public health data research. Here, we describe the data and systems underlying the Global.health datasets and summarize the project's 2.5 years of operations and the curation of the COVID-19 and monkeypox repositories. Method(s): The COVID-19 repository is curated daily through an automated system, verified by a team of researchers. The monkeypox dataset is curated manually by a team of researchers, Monday-Friday. Both repositories include metadata fields on demographics, symptomology, disease confirmation date, and others1,2. Data is de-identified and ingested from trusted sources, such as government public health agencies, trusted media outlets, and established openaccess repositories. Finding(s): The Global.health COVID-19 dataset is the largest repository of publicly available validated line-list data in the world, with over 100 million cases from more than 100 countries, including 60+ fields of metadata, comprising over 1 billion unique data points. The monkeypox dataset has over 35,000 data entries, from 100 different countries. 7,325 users accessed the COVID-19 repository and 3,005 accessed the monkeypox repository. Conclusion(s): The Global.health repositories provide verified, de-identified case data for two global outbreaks and are used by CDC, WHO, and other national public health organizations for surveillance and forecasting efforts. The repositories were utilized to share insights into the COVID-19 pandemic and track the monkeypox outbreak using real-time data3-6. We are collaborating with WHO Hub for Pandemic and Epidemic Intelligence to improve coordination, data schemas, and downstream use of data to inform and evaluate public health policy7. Future work will focus on creating a 'turnkey' data system to be used in future outbreaks for quicker infectious disease surveillance.Copyright © 2023
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Background and aims: A global study with equitable participation for cirrhosis and chronic liver disease (CLD) outcomes is needed. We initiated the Chronic Liver disease Evolution And Registry for Events and Decompensation (CLEARED) study to provide this global perspective. Aim to evaluate determinants of inpatient mortality and organ dysfunction in a multi-center worldwide study. Method: We prospectively enrolled pts with CLD/Cirrhosis >18 years without organ transplant or COVID-19 who were admitted non-electively. To maintain equity in outcome analysis, a maximum of 50 pts/site were allowed. Data for admission variables, hospital course, and inpatient outcomes (ICU, death, organ dysfunction [ODF]) were recorded. This was analyzed for death and ODs using significant variables on admission and including World Bank classification of low/middle-income countries (LMIC). A model for in-hospital mortality for all variables during the hospital course, including ODs) was analyzed. Results: 1383 pts (55 ± 13 yrs, 64% men, 39% White, 30% Asian, 10% Hispanic, 9% Black, 12% other) were enrolled from 49 centers (Fig A). 39% were from high-income while the rest were from LMICs. Admission MELDNa 23 (6–40) with history in past 6 months of hospitalizations 51%, infections 25%, HE 32%, AKI 23%, prior LVP 15%, hydrothorax 8% and HCC 4%. Leading etiologies were Alcohol 46% then NASH 23%, HCV 11% and HBV 13%. Most were on lactulose 52%, diuretics 53%, PPI 49% and statins 11%, SBP prophylaxis 16%, beta-blockers 35% and rifaximin 31%. 90% were admitted for liver-related reasons;GI bleed 30%, HE 34%, AKI 33%, electrolyte issues 30%, anasarca 24% and 25% admission infections. In-hospital course: Median LOS was 7 (1–140) days with 25% needing ICU. 15% died in hospital, 3% were transplanted, 46% developed AKI,15% grade 3–4 HE, 14% shock, 13% nosocomial infections and 13% needed ventilation. Logistic Regression: Fig B shows that liver-related/unrelated factors on admission which predicted in-hospital mortality and development of organ dysfunction with MELDNa and Infections being common among all models. Nosocomial infections and organ dysfunctions predicted mortality when all variables were considered. High-income countries had better mortality outcomes likely due to transplant and ICU availability. AUCs were >0.75 (Figure Presented) Conclusion: In this worldwide equitable experience, admission cirrhosis severity and infections are associated with inpatient outcomes, which are greater in low-income settings. Liver-related and unrelated factors and regional variations are important in defining critical care goals and outcome models in inpatients with cirrhosis.