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Nosocomial transmission of influenza is a major concern for infection control. We aimed to dissect transmission dynamics of influenza, including asymptomatic transmission events, in acute care.
Prospective surveillance study during 2 influenza seasons.
Volunteer sample of inpatients on medical wards and healthcare workers (HCWs).
Participants provided daily illness diaries and nasal swabs for influenza A and B detection and whole-genome sequencing for phylogenetic analyses. Contacts between study participants were tracked. Secondary influenza attack rates were calculated based on spatial and temporal proximity and phylogenetic evidence for transmission.
In total, 152 HCWs and 542 inpatients were included; 16 HCWs (10.5%) and 19 inpatients (3.5%) tested positive for influenza on 109 study days. Study participants had symptoms of disease on most of the days they tested positive for influenza (83.1% and 91.9% for HCWs and inpatients, respectively). Also, 11(15.5%) of 71 influenza-positive swabs among HCWs and 3 (7.9%) of 38 influenza-positive swabs among inpatients were collected on days without symptoms; 2 (12.5%) of 16 HCWs and 2 (10.5%) of 19 inpatients remained fully asymptomatic. The secondary attack rate was low: we recorded 1 transmission event over 159 contact days (0.6%) that originated from a symptomatic case. No transmission event occurred in 61 monitored days of contacts with asymptomatic influenza-positive individuals.
Influenza in acute care is common, and individuals regularly shed influenza virus without harboring symptoms. Nevertheless, both symptomatic and asymptomatic transmission events proved rare. We suggest that healthcare-associated influenza prevention strategies that are based on preseason vaccination and barrier precautions for symptomatic individuals seem to be effective.
To assess influenza symptoms, adherence to mask use recommendations, absenteesm and presenteeism in acute care healthcare workers (HCWs) during influenza epidemics.
The TransFLUas influenza transmission study in acute healthcare prospectively followed HCWs prospectively over 2 consecutive influenza seasons. Symptom diaries asking for respiratory symptoms and adherence with mask use recommendations were recorded on a daily basis, and study participants provided midturbinate nasal swabs for influenza testing.
In total, 152 HCWs (65.8% nurses and 13.2% physicians) were included: 89.1% of study participants reported at least 1 influenza symptom during their study season and 77.8% suffered from respiratory symptoms. Also, 28.3% of HCW missed at least 1 working day during the study period: 82.6% of these days were missed because of symptoms of influenza illness. Of all participating HCWs, 67.9% worked with symptoms of influenza infection on 8.8% of study days. On 0.3% of study days, symptomatic HCWs were shedding influenza virus while at work. Among HCWs with respiratory symptoms, 74.1% adhered to the policy to wear a mask at work on 59.1% of days with respiratory symptoms.
Respiratory disease is frequent among HCWs and imposes a significant economic burden on hospitals due to the number of working days lost. Presenteesm with respiratory illness, including influenza, is also frequent and poses a risk for patients and staff.
In this prospective cohort of 1,012 Swiss hospital employees, 3 different assays were used to screen serum for SARS-CoV-2 antibodies. Seropositivity was 1%; the positive predictive values of the lateral-flow immunoassay were 64% (IgG) and 13% (IgM). History of fever and myalgia most effectively differentiated seropositive and seronegative participants.
In this paper we comparatively explore three claims concerning the disciplinary character of economics by means of citation analysis. The three claims under study are: (1) economics exhibits strong forms of institutional stratification and, as a byproduct, a rather pronounced internal hierarchy; (2) economists strongly conform to institutional incentives; and (3) modern mainstream economics is a largely self-referential intellectual project mostly inaccessible to disciplinary or paradigmatic outsiders. The validity of these claims is assessed by means of an interdisciplinary comparison of citation patterns aiming to identify peculiar characteristics of economic discourse. In doing so, we emphasize that citation data can always be interpreted in different ways, thereby focusing on the contrast between a “cognitive” and an “evaluative” approach towards citation data.
Bipolar disorder I (BD-I) is defined by episodes of mania, depression and euthymic states. These episodes are among other symptoms characterized by altered reward processing and negative symptoms (NS), in particular apathy. However, the neural correlates of these deficits are not well understood.
We first assessed the severity of NS in 25 euthymic BD-I patients compared with 25 healthy controls (HC) and 27 patients with schizophrenia (SZ). Then, we investigated ventral (VS) and dorsal striatal (DS) activation during reward anticipation in a Monetary Incentive Delayed Task and its association with NS.
In BD-I patients NS were clearly present and the severity of apathy was comparable to SZ patients. Apathy scores in the BD-I group but not in the SZ group correlated with sub-syndromal depression scores. At the neural level, we found significant VS and DS activation in BD-I patients and no group differences with HC or SZ patients. In contrast to patients with SZ, apathy did not correlate with striatal activation during reward anticipation. Explorative whole-brain analyses revealed reduced extra-striatal activation in BD-I patients compared with HC and an association between reduced activation of the inferior frontal gyrus and apathy.
This study found that in BD-I patients apathy is present to an extent comparable to SZ, but is more strongly related to sub-syndromal depressive symptoms. The findings support the view of different pathophysiological mechanisms underlying apathy in the two disorders and suggest that extra-striatal dysfunction may contribute to impaired reward processing and apathy in BD-I.
Despite their importance for mass-balance estimates and the progress in techniques based on optical and thermal satellite imagery, the mapping of debris-covered glacier boundaries remains a challenging task. Manual corrections hamper regular updates. In this study, we present an automatic approach to delineate glacier outlines using interferometrically derived synthetic aperture radar (InSAR) coherence, slope and morphological operations. InSAR coherence detects the temporally decorrelated surface (e.g. glacial extent) irrespective of its surface type and separates it from the highly coherent surrounding areas. We tested the impact of different processing settings, for example resolution, coherence window size and topographic phase removal, on the quality of the generated outlines. We found minor influence of the topographic phase, but a combination of strong multi-looking during interferogram generation and additional averaging during coherence estimation strongly deteriorated the coherence at the glacier edges. We analysed the performance of X-, C- and L- band radar data. The C-band Sentinel-1 data outlined the glacier boundary with the least misclassifications and a type II error of 0.47% compared with Global Land Ice Measurements from Space inventory data. Our study shows the potential of the Sentinel-1 mission together with our automatic processing chain to provide regular updates for land-terminating glaciers on a large scale.
We develop a novel approach for pricing cyber insurance contracts. The considered cyber threats, such as viruses and worms, diffuse in a structured data network. The spread of the cyber infection is modeled by an interacting Markov chain. Conditional on the underlying infection, the occurrence and size of claims are described by a marked point process. We introduce and analyze a new polynomial approximation of claims together with a mean-field approach that allows to compute aggregate expected losses and prices of cyber insurance. Numerical case studies demonstrate the impact of the network topology and indicate that higher order approximations are indispensable for the analysis of non-linear claims.
In this contribution, a design methodology for octave-bandwidth power amplifiers (PA) for 5G communication systems using surface mount dual-flat-no-lead packaged gallium-nitride high-electron-mobility transistor devices is presented. Systematic source- and load-pull simulations have been used to find the optimum impedances across 75% fractional bandwidth for S- (1.9–4.2 GHz) and C-band (3.8–8.4 GHz) PAs. The harmonic impact is considered to improve the output power and efficiency of the PAs. Utilizing the characteristic behavior of the transistors leads to modified optimum fundamental load impedances for the low-frequency range, which have higher gain compared with high-frequency range, and minimize the influence of the higher harmonics. Continuous wave large-signal measurements of the realized S-Band PA show a power added efficiency (PAE) of more than 40% from 1.9–4.2 GHz and a flat power gain of 11 dB while achieving a saturated output power of 10 W. The measured performance of the C-Band PA demonstrates a delivered power between 3.5 and 5 W across the frequency range of 3.8–8.4 GHz. A flat power gain of around 9 ± 0.5 dB with 26–40% PAE is achieved.
For a fast scan-phase satellite radio antenna diversity system a noise correction method is presented for a significant improvement of audio availability at low signal-to-noise ratio (SNR) conditions. An error analysis of the level and phase detection within the diversity system in the presence of noise leads to a correction method based on a priori knowledge of the system's noise floor. This method is described and applied in a hardware example of a satellite digital audio radio services antenna diversity circuit for fast fading conditions. Test drives, which have been performed in real fading scenarios, are described and results are analyzed statistically. Simulations of the scan-phase antenna diversity system show higher signal amplitudes and availabilities. Measurement results of dislocated antennas as well as of a diversity antenna set on a single mounting position are presented. A comparison of a diversity system with noise correction, the same system without noise correction, and a single antenna system with each other is performed. Using this new method in fast multipath fading driving scenarios underneath dense foliage with a low SNR of the antenna signals, a reduction in audio mute time by one order of magnitude compared with single antenna systems is achieved with the diversity system.
We present a novel bonding process for gallium nitride-based electronic devices on diamond heat spreaders. In the proposed technology, GaN devices are transferred from silicon (Si) onto single (SCD) and polycrystalline diamond (PCD) substrates by van der Waals bonding. Load-pull measurements on Si and SCD heat spreaders at 3 GHz and 50 V drain bias show comparable power-added-efficiency and output power (Pout) levels. A thermal analysis of the hybrids was performed by comparison of 2 × 1mm2 AlGaN/GaN Schottky diodes on Si, PCD, and SCD, which exhibit a homogeneous field in the channel in contrast to gated transistors. Significantly different currents are observed due to the temperature dependent mobility in the 2DEG channel. These measurements are supported by a 3D thermal finite element analysis, which suggests a large impact of our transfer technique on the thermal resistance of these devices. In summary, we show a promising new GaN-on-diamond technology for future high-power, microwave GaN device applications.
Epigenetic DNA modifications in genes related to the hypothalamic–pituitary–adrenal (HPA) axis are discussed as a mechanism underlying the association between prenatal depression and altered child HPA activity. In a longitudinal study, DNA methylation changes related to prenatal depressive symptoms were investigated in 167 children aged 6 to 9 years. At six candidate genes, 126 cytosine–guanine dinucleotides were considered without correcting for multiple testing due to the exploratory nature of the study. Further associations with the basal child HPA activity were examined. Children exposed to prenatal depressive symptoms exhibited lower bedtime cortisol (p = .003, ηp2 = 0.07) and a steeper diurnal slope (p = .023, ηp2 = 0.06). For total cortisol release, prenatal exposure was related to lower cortisol release in boys, and higher release in girls. Furthermore, prenatal depressive symptoms were associated with altered methylation in the glucocorticoid receptor gene (NR3C1), the mineralocorticoid receptor gene (NR3C2), and the serotonin receptor gene (SLC6A4), with some sex-specific effects (p = .012–.040, ηp2 = 0.03–0.04). In boys, prenatal depressive symptoms predicted bedtime cortisol mediated by NR3C2 methylation, indirect effect = –0.07, 95% confidence interval [–0.16, –0.02]. Results indicate relations of prenatal depressive symptoms to both child basal HPA activity and DNA methylation, partially fitting a mediation model, with exposed boys and girls being affected differently.
In this review article, we discuss selected developments regarding the role of the equation of state in simulations of core-collapse supernovae. There are no first-principle calculations of the state of matter under supernova conditions since a wide range of conditions is covered, in terms of density, temperature, and isospin asymmetry. Instead, model equation of state are commonly employed in supernova studies. These can be divided into regimes with intrinsically different degrees of freedom: heavy nuclei at low temperatures, inhomogeneous nuclear matter where light and heavy nuclei coexist together with unbound nucleons, and the transition to homogeneous matter at high densities and temperatures. In this article, we discuss each of these phases with particular view on their role in supernova simulations.
Among the myriad of desirable properties discussed in the context of forgetting in Answer Set Programming, strong persistence naturally captures its essence. Recently, it has been shown that it is not always possible to forget a set of atoms from a program while obeying this property, and a precise criterion regarding what can be forgotten has been presented, accompanied by a class of forgetting operators that return the correct result when forgetting is possible. However, it is an open question what to do when we have to forget a set of atoms, but cannot without violating this property. In this paper, we address this issue and investigate three natural alternatives to forget when forgetting without violating strong persistence is not possible, which turn out to correspond to the different possible relaxations of the characterization of strong persistence. Additionally, we discuss their preferable usage, shed light on the relation between forgetting and notions of relativized equivalence established earlier in the context of Answer Set Programming, and present a detailed study on their computational complexity.
Precise therapeutic decision-making is vital in managing out-of-hospital cardiac arrest. We present an interesting approach where suspected pulmonary embolism could be confirmed by early computed tomography in cardiac arrest. Chest compressions were performed automatically by mechanical devices also during the acquisition of computed tomography data and subsequent thrombolysis.
High-fidelity simulators (HFSs) have been shown to prompt critical actions at a level equal to that of trained human actors (HAs) and increase perceived realism in intrahospital mass-casualty incident (MCI) exercises. For unannounced prehospital MCI exercises, however, no data are available about the feasibility of incorporating HFSs. This case report describes the integration of HFSs in such an unannounced prehospital MCI drill with HAs and provides data about the differences concerning triage, treatment, and transport of HFSs and HAs with identical injury patterns. For this purpose, 75 actors and four high-fidelity simulators were subdivided into nine groups defined by a specific injury pattern. Four HFSs and six HAs comprised a group suffering from traumatic brain injury and blunt abdominal trauma. Triage results, times for transport, and number of diagnostic and therapeutic tasks were recorded. Means were compared by t test or one-way ANOVA.
Triage times and results did not differ between actors and simulators. The number of diagnostic (1.25, SD = 0.5 in simulators vs 3.5, SD = 1.05 in HAs; P = .010) and therapeutic tasks (2.0, SD = 1.6 in simulators vs 4.8, SD = 0.4 in HAs; P = .019) were significantly lower in simulators. Due to difficulties in treating and evacuating the casualties from the site of the accident in a timely manner, all simulators died. Possible causal factors and strategies are discussed, with the aim of increasing the utility of simulators in emergency medicine training.
SchulzCM, SkrzypczakM, RaithS, HinzmannD, KrautheimV, HeuserF, MayerV, KreuzerC, HimslM, HollM, LippC, KochsEF, WagnerKJ. High-fidelity Human Patient Simulators Compared with Human Actors in an Unannounced Mass-Casualty Exercise. Prehosp Disaster Med. 2014;29(2):1-7.
Cognitive remediation is a promising pathway for ameliorating cognitive impairment of patients with schizophrenia. Here, we investigate predictors of improvement in problem-solving ability for two different types of cognitive remediation – specific problem-solving training and training of basic cognition. For this purpose we conducted a re-analysis of a randomized controlled trial comparing these two training approaches. The main outcome measure was improvement in problem-solving performance. Correlational analyses were used to assess the contribution of clinical, cognitive and training-related predictors. In the problem-solving training group, impaired pre-training planning ability was associated with stronger improvement. In contrast, in the basic cognition training group antipsychotic medication dose emerged as a negative predictor. These results demonstrate that predictors for successful cognitive remediation depend on the specific intervention. Furthermore, our results suggest that at least in the planning domain patients with impaired performance benefit particularly from a specific intervention. (JINS, 2014, 20, 1–6)