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Lecteur Multimédia
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Publications
125 Toward the Translation of Rectal Intensity Modulated Brachytherapy for Feasibility and Safety Studies
256 Patient-Specific Pre-Treatment Nuclei Size Distribution is of Significance for Post Radiation Therapy Locoregional Recurrence and Survival Outcomes
Impact of a vaccine passport on first-dose COVID-19 vaccine coverage by age and area-level social determinants in the Canadian provinces of Québec and Ontario: an interrupted time series analysis
In Canada, all provinces implemented vaccine passports in 2021 to increase vaccine uptake and reduce transmission in non-essential indoor sp… (voir plus)aces. We evaluate the impact of vaccine passport policies on first-dose COVID-19 vaccination coverage by age, area-level income and proportion racialized.
We performed interrupted time-series analyses using vaccine registry data linked to census information in Québec and Ontario (20.5 million people ≥12 years; unit of analysis: dissemination area). We fit negative binomial regressions to weekly first-dose vaccination, using a natural spline to capture pre-announcement trends, adjusting for baseline vaccination coverage (start: July 3
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; end: October 23
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Québec, November 13
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Ontario). We obtain counterfactual vaccination rates and coverage, and estimated vaccine passports’ impact on vaccination coverage (absolute) and new vaccinations (relative).
In both provinces, pre-announcement first-dose vaccination coverage was 82% (≥12 years). The announcement resulted in estimated increases in vaccination coverage of 0.9 percentage points (p.p.;95%CI:0.4-1.2) in Québec and 0.7 p.p. (95%CI:0.5-0.8) in Ontario. In relative terms, these increases correspond to 23% (95%CI:10-36%) and 19% (95%CI:15-22%) more vaccinations. The impact was larger among people aged 12-39 (1-2 p.p.). There was little variability in the absolute impact by area-level income or proportion racialized in either province.
In the context of high baseline vaccine coverage across two provinces, the announcement of vaccine passports led to a small impact on first-dose coverage, with little impact on reducing economic and racial inequities in vaccine coverage. Findings suggest the need for other policies to further increase vaccination coverage among lower-income and more racialized neighbourhoods and communities.
Vaccine passport policies increased COVID-19 vaccination coverage by approximately 1 percentage point (19 to 23% increase in vaccinations) in Québec and Ontario, Canada.
Although vaccine passport policies increased vaccination coverage, absolute gains were limited in the context of high prior vaccine coverage.
Vaccine passports had little impact on reducing economic and racial inequities in vaccine coverage.
In bioelectronic medicine, neuromodulation therapies induce neural signals to the brain or organs modifying their function. Stimulation devi… (voir plus)ces, capable of triggering exogenous neural signals using electrical wave forms, require a complex and multi-dimensional parameter space in order to control such wave forms. Determining the best combination of parameters (wave form optimization, or dosing) for treating a particular patient’s illness is therefore challenging. Comprehensive parameter searching for an optimal stimulation effect is often infeasible in a clinical setting, due to the size of the parameter space. Restricting this space, however, may lead to sub-optimal therapeutic results, reduced responder rates, and adverse effects.
As an alternative to a full parameter search, we present a flexible machine learning, data acquisition and processing framework for optimizing neural stimulation parameters requiring as few steps as possible using Bayesian optimization. Such optimization builds a model of the neural and physiological responses to stimulations enabling it to optimize stimulation parameters and to provide estimates of the accuracy of the response model. The vagus nerve innervates, among other thoracic and visceral organs, the heart, thus controlling heart rate and is therefore ideal for demonstrating the effectiveness of our approach.
Main results.
The efficacy of our optimization approach was first evaluated on simulated neural responses, then applied to vagus nerve stimulation intraoperatively in porcine subjects. Optimization converged quickly on parameters achieving target heart rates and optimizing neural B-fibre activations despite high intersubject variability.
An optimized stimulation waveform was achieved in real time with far fewer stimulations than required by alternative optimization strategies, thus minimizing exposure to side effects. Uncertainty estimates helped avoiding stimulations outside a safe range. Our approach shows that a complex set of neural stimulation parameters can be optimized in real-time for a patient to achieve a personalized precision dosing.