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SG-APSIC1035: Prospective safety surveillance study of ACAM2000 smallpox vaccine in deployed military personnel
- Kevin Yeo, Daniel Gordon, Lori Perry, Ilfra Raymond-Loher, Nita Tati, Kevin Yeo, Grace Lin, Gina DiPietro, Alex Selmani, Michael Decker
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S1 / February 2023
- Published online by Cambridge University Press:
- 16 March 2023, p. s10
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- Article
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- You have access Access
- Open access
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Objectives: We compared rates of myopericarditis adverse events and evaluated potential risk factors of development. We compared rates of dermatological–neurological adverse events (severe and serious) with other adverse events in a specific population of deployed US military personnel who received or did not receive ACAM2000 vaccine (ie, Vaccinia smallpox live vaccine). Methods: Up to 20,000 military personnel recipients were enrolled in a prospective observational cohort study: up to 15,000 ACAM2000 recipients in cohort 1 and up to 5,000 military personnel who were eligible for ACAM2000 vaccination but were not vaccinated due to recent vaccination or characteristics of their contacts in cohort 2. Enrollment was at a 3:1 ratio, respectively. Serum specimens and data were collected at the initial visit and 10 days later (cf, window of 6–17 days). Study participants with evidence, either clinical or laboratory, of possible myopericarditis were referred to a blinded independent review committee for further evaluation and adjudication. The primary analysis was logistic regression with adjudicated myopericarditis as the dependent variable and age, sex, race, and exercise regimen as the independent variables. Results: Initial data and serum specimens were obtained from 14,667 participants (cohort 1, N = 10,825; cohort 2, N = 3,842). According to protocol, 2 visits were completed by 12,110 participants (cohort 1, N = 8,945; cohort 2, N = 3,165), and 125 participants (cohort 1, N = 111; cohort 2, N = 14) were referred for myopericarditis adjudication, of whom 1 had confirmed myocarditis, 5 had suspected myocarditis, 1 had suspected pericarditis, and 54 (cohort 1, N = 44; cohort 2, N = 10) had subclinical myopericarditis. The unadjusted myopericarditis rates were 5.7 per 1,000 (95% CI, 4.3–7.5) for cohort 1 and 3.2 per 1,000 (95% CI, 1.7–5.8) for cohort 2. The unadjusted and adjusted odds ratios for myopericarditis for cohort 1 and cohort 2 were 1.8 (95% CI, 0.9–3.6) and 1.3 (95% CI, 0.6–2.6), respectively. At least 1 serious adverse event was experienced by 117 participants (1.1%) in cohort 1 and 13 (0.3%) in cohort 2. No serious and severe neurological or dermatological adverse events were reported. Conclusions: ACAM2000 vaccination was associated with a modest but nonsignificant increase in the risk of myopericarditis in this prudently screened, young and healthy service-member population. The adjusted OR was 1.3 and the unadjusted OR was 1.8. Overall, all but 7 cases were subclinical. Citation: Faix DJ, Gordon DM, Perry LN, et al. Prospective safety surveillance study of ACAM2000 smallpox vaccine in deploying military personnel. Vaccine 2020;38:7323–7330.
8 - War and Games in Swift’s Battle of the Books and Gulliver’s Travels
- Edited by James William Daems, Holly Faith Nelson
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- Book:
- Games and War in Early Modern English Literature
- Published by:
- Amsterdam University Press
- Published online:
- 21 November 2020
- Print publication:
- 15 August 2019, pp 161-178
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Summary
Abstract
Swift's work demonstrates an extensive critique of the efficacy of war, war games, and politics. His satires often portray the ineffectual preparation for war provided by war-gaming and interrogate the orthodox belief in the socio-political correlation between military prowess and political stability. This chapter argues that, in The Battle of the Books and Gulliver's Travels, Swift systematically dismantles the abstract reasoning of war-gaming. He relentlessly critiques, in particular, the philosophical and linguistic abstractions of Leibniz, Descartes, Bacon, and the Royal Society by revealing the consequences of accepting games as factual scenarios rather than theoretical models, an error that results in the physical and moral depredations of actual warfare.
Keywords: language machines in early modern literature; early modern science and language; early modern scientific method; Ancients and Moderns debate
In the Second Voyage of Gulliver's Travels, a curious exchange takes place when the giant king of Brobdingnag quizzes Gulliver on the habits of his countrymen, alluding to the dangerous pastime of ‘Gaming’, a question that mirrors widespread British concerns about the economic and social costs of gambling across the kingdom. However, the conventional moral stance of the question misleads Jonathan Swift's readers, for Gulliver replies with a jeremiad against political violence, revolution, and war:
He was perfectly astonished with the historical Account I gave him of our Affairs during the last Century; protesting it was only an Heap of Conspiracies, Rebellions, Murders, Massacres, Revolutions, Banishments; the very worst Effect that Avarice, Faction, Hypocrisy, Perfidiousness, Cruelty, Rage, Madness, Hatred, Envy, Lust, Malice, and Ambition could produce.
Swift's rhetorical shift from gaming to seventeenth-century wars reveals his disdain for traditional correlations between war games, military success, and political leadership. His satires of war-gaming in The Battle of the Books (1697/1704) and Gulliver's Travels (1725) expose flaws in game design, the limitations of war games for preparing leaders of real wars, and the logical fallacy of valuing military success amongst those charged with maintaining political stability.
Intellectual gaming in general, and war-gaming in particular, requires an abstract semiotic reasoning, in which sign and signified develop increasingly symbolic relationships. While all mammals engage in mock combat as a form of play, only humans engage in abstract games of war in which symbolic relationships are accorded equal meaning and value to actual combat scenarios.