Are influenza surveillance data useful for mapping presentations?

Geographical information system (GIS) based on mappings of influenza data are rare (http://www.b3e.jussieu.fr.80/sentiweb/fr) and influenza data are commonly aggregated for rather large areas (http://www.eiss.org, http://oms2b3e.jussieu.fr/FluNet). The most limiting factors for the use of morbidity-data from practices in GIS-based mappings are differences which are not related to morbidity. These differences may be due to consultation behaviour, interpretation of the case definition, age distribution of patients and other reasons. In order to reduce the impact of these non-morbidity related differences on the interpretation, the data of many practices are usually pooled and consequently rather large areas are presented. Extracting and harmonising the signals for increased morbidity from practices is a presupposition for mapping with a sufficient geographical resolution. The possibility to harmonise by reducing those confounding differences on a practice level is investigated. Different harmonisation methods were applied to data from Germany where acute respiratory infections (ARI) per consultations are registered and from The Netherlands were influenza like illnesses (ILI) per population are registered. The harmonisation of the indices between countries was achieved by scaling them in relation to the level of the index representative for the peak activity during a usual influenza epidemic. The Kriging method is applied as a means of spatial prediction for the influenza data. The preliminary results are discussed with respect to resulting mappings.     

Vaccine presentations and delivery technologies--what does the future hold?

There is an urgent need to change the presentations and delivery technologies of current vaccines. Until recently, these factors had not been key criteria in the selection of vaccines for program use. Recent and current changes in the field of vaccines and their delivery lead the authors to postulate that a major paradigm shift will take place over the next decade to revolutionize vaccine presentation and delivery in national immunization programs. The programmatic needs for certain vaccine presentations will increasingly dictate elements of vaccine development and manufacture. Over the next decade, an inexorable drift towards firstly, single-dose preparations, and secondly, delivery technologies other than the conventional needle and syringes is anticipated. A unified system capable of delivering multiple antigens as a single dose is urgently needed; however, changing the status quo of vaccine manufacture is not easy. The market predominantly produces vaccines delivered by needle and syringe. Profits for manufacturers from sales to developing countries are marginal at best, and there is little financial incentive to change. Global leaders will need to take bold decisions and begin demanding vaccines which have a presentation that lends them to safer, more practical delivery systems. If a strong enough case can be made to restructure the vaccine manufacturing industry, either through market forces, global bodies, such as the World Health Organization and the United Nations Children's Fund, or both, a dramatic change could be brought about that will make vaccine delivery simpler and safer. A globally coordinated approach to funding research and the introduction of a multiple-antigen, single-dose delivery system is urgently needed. The needs are clear, and this review argues that if the case is presented strongly enough, the resources will be found.     

Peer-review for selection of oral presentations for conferences: Are we reliable?

IntroductionAlthough peer-review for journal submission, grant-applications and conference submissions has been called ‘a counter- stone of science’, and even ‘the gold standard for evaluating scientific merit’, publications on this topic remain scares.Research that has investigated peer-review reveals several issues and criticisms concerning bias, poor quality review, unreliability and inefficiency. The most important weakness of the peer review process is the inconsistency between reviewers leading to inadequate inter-rater reliability.Aim of the paperTo report the reliability of ratings for a large international conference and to suggest possible solutions to overcome the problem.MethodsIn 2016 during the International Conference on Communication in Healthcare, organized by EACH: International Association for Communication in Healthcare, a calibration exercise was proposed and feedback was reported back to the participants of the exercise.ResultsMost abstracts, as well as most peer-reviewers, receive and give scores around the median. Contrary to the general assumption that there are high and low scorers, in this group only 3 peer-reviewers could be identified with a high mean, while 7 has a low mean score. Only 2 reviewers gave only high ratings (4 and 5). Of the eight abstracts included in this exercise, only one abstract received a high mean score and one a low mean score. Nevertheless, both these abstracts received both low and high scores; all other abstracts received all possible scores.DiscussionPeer-review of submissions for conferences are, in accordance with the literature, unreliable. New and creative methods will be needed to give the participants of a conference what they really deserve: a more reliable selection of the best abstracts.Practice implicationsMore raters per abstract improves the inter-rater reliability; training of reviewers could be helpful; providing feedback to reviewers can lead to less inter-rater disagreement; fostering negative peer-review (rejecting the inappropriate submissions) rather than a positive (accepting the best) could be fruitful for selecting abstracts for conferences.     

The learning effects of different presentations of worked examples on medical students’ breaking-bad-news skills: A randomized and blinded field trial

Objectives

Effective instructional approaches are needed to enable undergraduates to optimally prepare for the limited training time they receive with simulated patients (SPs). This study examines the learning effects of different presentation formats of a worked example on student SP communication.

Encephalitic syndrome and anosmia in COVID‐19: Do these clinical presentations really reflect SARS‐CoV‐2 neurotropism? A theory based on the review of 25 COVID‐19 cases

Since the discovery of coronavirus disease 2019 (COVID‐19), a disease caused by the new coronavirus severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), the pathology showed different faces. There is an increasing number of cases described as (meningo)encephalitis although evidence often lacks. Anosmia, another atypical form of COVID‐19, has been considered as testimony of the potential of neuroinvasiveness of SARS‐CoV‐2, though this hypothesis remains highly speculative. We did a review of the cases reported as brain injury caused by SARS‐CoV‐2. Over 98 papers found, 21 were analyzed. Only four publications provided evidence of the presence of SARS‐CoV‐2 within the central nervous system (CNS). When facing acute neurological abnormalities during an infectious episode it is often difficult to disentangle neurological symptoms induced by the brain infection and those due to the impact of host immune response on the CNS. Cytokines release can disturb neural cells functioning and can have in the most severe cases vascular and cytotoxic effects. An inappropriate immune response can lead to the production of auto‐antibodies directed toward CNS components. In the case of proven SARS‐CoV‐2 brain invasion, the main hypothesis found in the literature focus on a neural pathway, especially the direct route via the nasal cavity, although the virus is likely to reach the CNS using other routes. Our ability to come up with hypotheses about the mechanisms by which the virus might interact with the CNS may help to keep in mind that all neurological symptoms observed during COVID‐19 do not always rely on CNS viral invasion.