The vaccine hesitancy continuum among hesitant adopters of the COVID-19 vaccine

Vaccination is a strategy for mitigating the impact of coronavirus disease 2019 (COVID-19) at both the individual and population levels. Vaccine hesitancy is identified as a significant threat to global health by the World Health Organization (WHO). Vaccine hesitancy has been theorized as a continuum encompassing a range of attitudes, beliefs, emotional orientations, ideologies, and health-seeking behaviors. Individuals who received the COVID-19 vaccine but also indicated some level of hesitancy about vaccination, or "hesitant adopters," remain an understudied group. This study uses a qualitative descriptive design to understand motivations to receive the COVID-19 vaccine among hesitant adopters at various self-reported levels of hesitancy. We conducted interviews with hesitant adopters (n = 49) to analyze the elements of vaccine hesitancy corresponding to reported levels of COVID-19 vaccine hesitancy (i.e., "little hesitant," "somewhat hesitant," and "very hesitant"). Concerns about side effects are shared across the continuum but are articulated differently at each level of hesitancy. The "little hesitant" relate fears of side effects to their health and a lack of clear information to inform their health decision making, whereas the "very hesitant" articulate the risks of side effects within the frame of conspiracies related to the development, approval, and economics of the COVID-19 vaccine. Additionally, conspiracy theories generally increase in salience across the continuum, with the "very hesitant" reporting conspiracy theories as the most salient element of vaccine hesitancy. This research presents opportunities for developing targeted interventions for different levels of vaccine hesitancy.

Developing a new syndromic surveillance system for the London 2012 Olympic and Paralympic Games

Syndromic surveillance is vital for monitoring public health during mass gatherings. The London 2012 Olympic and Paralympic Games represents a major challenge to health protection services and community surveillance. In response to this challenge the Health Protection Agency has developed a new syndromic surveillance system that monitors daily general practitioner out-of-hours and unscheduled care attendances. This new national system will fill a gap identified in the existing general practice-based syndromic surveillance systems by providing surveillance capability of general practice activity during evenings/nights, over weekends and public holidays. The system will complement and supplement the existing tele-health phone line, general practitioner and emergency department syndromic surveillance systems. This new national system will contribute to improving public health reassurance, especially to meet the challenges of the London 2012 Olympic and Paralympic Games.

Flexible dosing of adjunctive zonisamide in the treatment of adult partial-onset seizures: a non-comparative, open-label study (ZEUS)

OBJECTIVES

To assess the efficacy and tolerability of zonisamide in a study allowing flexible dosing in a more diverse and less refractory population than assessed in randomized controlled trials.

METHODS

This 19-week, non-comparative study of adjunctive zonisamide included 281 adults who had at least four partial-onset seizures within 8 weeks on one or two antiepileptic drugs. Alterations to zonisamide doses were allowed after titration, except during two fixed-dose periods (weeks 10-13 and 16-19).

RESULTS

At the end of the second fixed-dose period (median dose 300 mg/day), the median reduction in monthly seizure frequency was 33.3-41.1%; > or =50% responder rate was 40.9-44.2%; and seizure freedom rate was 15.0-15.9%, depending on the analysis used. The most common adverse events were fatigue (16.7%) and somnolence (15.3%).

CONCLUSIONS

Zonisamide demonstrated efficacy in a setting more reflective of clinical practice and was generally well tolerated.

Altered venous function and deep venous thrombosis following proximal femoral fracture

The effect of surgery for femoral neck fracture on lower limb venous blood flow and its relationship to deep vein thrombosis was investigated in 179 patients. Blood flow was measured using strain gauge plethysmography before surgery, in the 1st week after surgery, and at 6 week review. There was a significant reduction in both venous outflow and venous capacitance, affecting both fractured and non-fractured legs but significantly greater in the fractured leg. Venous function remained significantly impaired in both lower limbs 6 weeks after surgery. There was a significant correlation between the reduction in venous function and the development of deep vein thrombosis.

Changes in coagulability as measured by thrombelastography following surgery for proximal femoral fracture

The effect of surgery for femoral neck fracture on whole blood coagulation and the relationship of altered coagulation to deep venous thrombosis were investigated in 250 patients. Whole blood coagulation was measured using thrombelastography preoperatively, in the early postoperative period and at 6-week review. Significant hypercoagulability was demonstrated after surgery and persisted to 6-week review. A significant correlation between hypercoagulability and the development of deep venous thrombosis is demonstrated. Hypercoagulability is shown to be a major factor in thrombosis formation following proximal femoral neck fracture surgery.

Intra-arterial digital subtraction angiography of the spinal cord

Digital subtraction angiography (DSA) of the spinal cord was performed in 6 patients using selective intra-arterial injections of contrast material. Two arteriovenous malformations of the spinal cord, 1 dural fistula, and 1 case of multiple hemangioblastomas were studied. Contrast and spatial resolution were satisfactory for defining normal and abnormal vascularity while reducing examination time, contrast dosage, patient discomfort, and film cost. The only significant limitation was misregistration artifacts seen on lateral views encompassing the diaphragm.

Opacification of epidural venous plexus and dura in evaluation of cervical nerve roots: CT technique

Thin-section computed tomography (CT) after bolus high-volume, intravenous contrast enhancement of the cervical epidural and intervertebral foraminal venous plexus was undertaken in eight patients. Visualization of exiting cervical nerve root by opacification of the surrounding intervertebral plexus was evaluated in 38 foramina. Visualization was judged as excellent in 77% and good in 21%. Thus the nerves were seen satisfactorily in all but one foramen. As the CT scan parallels the long axis of the cervical roots as they pass through the intervertebral foramen, anatomic delineation of the root out to the level of the vertebral artery is excellent. A local widening of the root, which was thought to represent the dorsal root ganglion, was seen in most foramina examined. Excellent filling of the epidural plexus was seen in seven of eight subjects; good opacification was seen in the other subject. In no instance did the study fail to satisfactorily fill the epidural plexus in the cervical vertebral canal. This technique appears to be an excellent method for evaluating the cervical nerve roots and the epidural space.

Examination of the extracranial carotid bifurcation by thin-section dynamic CT: direct visualization of intimal atheroma in man (Part 2)

Examination of the extracranial carotid bifurcation by thin-section computed tomographic (CT) scans after bolus, high-volume contrast enhancement allowed detection of more disease than did arteriograms in six of eight consecutive patients with transient ischemic attacks. In four patients this was on the clinical side of the lesion; in two the disease was in the asymptomatic carotid artery. One patient appeared to show a carotid ulcer; the ulcer was detected on CT. However, at surgery and subsequent histology, the surface of the lesion was endothelialized. The carotid CT examination is performed in the scanner "dead time" between unenhanced and enhanced head CT scans using the same contrast material for both studies. The examinations covers 3-3.6 cm of the carotid bifurcation region. Thin-section CT of the extracranial carotid arteries is a noninvasive examination that on preliminary evaluations appears to have sensitivity at least equal to that of carotid angiography in the detection of intimal disease.

Magnetic resonance imaging of the spinal cord and canal: potentials and limitations

Preliminary experience with magnetic resonance imaging (MRI) of the spinal cord and canal in 17 patients indicates considerable promise in the diagnosis of neoplastic, degenerative, and congenital lesions. The ability to image the cord directly rather than indirectly as in myelography, the absence of bone artifact as in computed tomography, and the multiplanar capabilities indicate that MRI will be the procedure of choice in the examination of the spinal cord. Current limitations include partial-volume effects due to slice thickness and the inability to perform contiguous sections when using multiplanar techniques. The relative increase in signal from cerebrospinal fluid with long TR and TE sequences in spin-echo imaging may result in less sensitivity than in the brain for detection of cord edema and/or infarction.

Nuclear magnetic resonance imaging of syringomyelia

Five patients with syringomyelia were examined with a 3.5 kG nuclear magnetic resonance (NMR) imager. Syrinx cavities were visualized in all five cases, and image quality compared favorably with metrizamide computed tomography (CT). Axial images were optimal for identifying syrinx cavities, and sagittal views were useful in providing an overview of cord morphology and in examining the craniocervical junction. Inversion-recovery images were less valuable than the spin-echo sequences. By varying spin-echo imaging parameters, tissue relaxation times could be determined and the fluid nature of the syrinx cavities confirmed. This limited study suggests that NMR may challenge the current role of CT in the diagnostic workup of syringomyelia.

Cryptic vascular malformations involving the brainstem

Six patients with angiographically cryptic vascular malformations involving the brainstem were examined with computed tomography (CT). The clinical and CT findings of cryptic vascular malformations of the brainstem are described and distinguished from those of brainstem glioma and multiple sclerosis. Calcification within a brainstem lesion that displays relatively little mass effect and shows little contrast enhancement, particularly when associated with a long history of waxing and waning brainstem symptoms, should suggest a vascular malformation.

Simplified and accurate CT-guided needle biopsy of central nervous system lesions

✓ Computerized tomography-directed needle biopsy of intracranial lesions, when correctly performed, offers a high diagnostic yield for both benign and malignant lesions, with relative safety. The simple method described stresses how careful positioning of the patient simplifies the mechanics of the procedure. This non-stereotaxic approach has wide application.

An intraventricular arachnoid cyst

The computed tomographic appearance and the differential diagnosis in a case of unusual congenital intraventricular arachnoid cyst are presented.