Dengue Risk among Visitors to Hawaii during an Outbreak

Despite the high rates of dengue in many tropical destinations frequented by tourists, limited information is available on the risk for infection among short-term visitors. We retrospectively surveyed 4,000 persons who arrived in Hawaii during the peak of the 2001–2002 dengue outbreak and collected follow-up serologic test results for those reporting denguelike illness. Of 3,064 visitors who responded, 94 (3%) experienced a denguelike illness either during their trip or within 14 days of departure; 34 of these persons were seen by a physician, and 2 were hospitalized. Twenty-seven visitors with denguelike illness provided a serum specimen; all specimens were negative for anti-dengue immunoglobulin G antibodies. The point estimate of dengue incidence was zero infections per 358 person-days of exposure with an upper 95% confidence limit of 3.0 cases per person-year. Thus, the risk for dengue infection for visitors to Hawaii during the outbreak was low

Comfort Measures Orders and Hospital Transfers: Insights From the OPTIMISTIC Demonstration Project

Context Nursing facility residents and their families may identify “comfort measures” as their overall goal of care, yet some hospital transfers still occur. Objectives Describe nursing facility residents with comfort measures and their hospital transfers. Methods Mixed methods, including root cause analyses of transfers by registered nurses and interviews with a subset of health care providers and family members involved in transfers. Participants were residents in 19 central Indiana facilities with comfort measures orders who experienced unplanned transfers to the hospital between January 1, 2015 and June 30, 2016. Project demographic and clinical characteristics of the residents were obtained from the Minimum Data Set 3.0. Interviews were conducted with stakeholders involved in transfer decisions. Participants were prompted to reflect on reasons for the transfer and outcomes. Interviews were transcribed and coded using qualitative descriptive methods. Results Residents with comfort measures orders (n = 177) experienced 204 transfers. Most events were assessed as unavoidable (77%). Communication among staff, or between staff and the resident/family, primary care provider, or hospital was the most frequently noted area needing improvement (59.5%). In interviews, participants (n = 11) highlighted multiple issues, including judgments about whether decisions were “good” or “bad,” and factors that were important to decision-making, including communication, nursing facility capabilities, clinical situation, and goals of care. Conclusion Most transfers of residents with comfort measures orders were considered unavoidable. Nonetheless, we identified several opportunities for improving care processes, including communication and addressing acute changes in status

Quantum correlations between the light and kilogram-mass mirrors of LIGO

Measurement of minuscule forces and displacements with ever greater precision encounters a limit imposed by a pillar of quantum mechanics: the Heisenberg uncertainty principle. A limit to the precision with which the position of an object can be measured continuously is known as the standard quantum limit (SQL) [1–4]. When light is used as the probe, the SQL arises from the balance between the uncertainties of photon radiation pressure imposed on the object and of the photon number in the photoelectric detection. The only possibility surpassing the SQL is via correlations within the position/momentum uncertainty of the object and the photon number/phase uncertainty of the light it reflects [5]. Here, we experimentally prove the theoretical prediction that this type of quantum correlation is naturally produced in the Laser Interferometer Gravitational-wave Observatory (LIGO). Our measurements show that the quantum mechanical uncertainties in the phases of the 200 kW laser beams and in the positions of the 40 kg mirrors of the Advanced LIGO detectors yield a joint quantum uncertainty a factor of 1.4 (3 dB) below the SQL. We anticipate that quantum correlations will not only improve gravitational wave (GW) observatories but all types of measurements in future

LIGO’s quantum response to squeezed states

Gravitational wave interferometers achieve their profound sensitivity by combining a Michelson interferometer with optical cavities, suspended masses, and now, squeezed quantum states of light. These states modify the measurement process of the LIGO, VIRGO and GEO600 interferometers to reduce the quantum noise that masks astrophysical signals; thus, improvements to squeezing are essential to further expand our gravitational view of the Universe. Further reducing quantum noise will require both lowering decoherence from losses as well more sophisticated manipulations to counter the quantum back-action from radiation pressure. Both tasks require fully understanding the physical interactions between squeezed light and the many components of km-scale interferometers. To this end, data from both LIGO observatories in observing run three are expressed using frequency-dependent metrics to analyze each detector’s quantum response to squeezed states. The response metrics are derived and used to concisely describe physical mechanisms behind squeezing’s simultaneous interaction with transverse-mode selective optical cavities and the quantum radiation pressure noise of suspended mirrors. These metrics and related analysis are broadly applicable for cavity-enhanced optomechanics experiments that incorporate external squeezing, and—for the first time—give physical descriptions of every feature so far observed in the quantum noise of the LIGO detectors

High precision optical cavity length and width measurements using double modulation

We use doubly phase modulated light to measure both the length and the linewidth of an optical resonator with high precision. The first modulation is at RF frequencies and is set near a multiple of the free spectral range, whereas the second modulation is at audio frequencies to eliminate offset errors at DC. The light in transmission or in reflection of the optical resonator is demodulated while sweeping the RF frequency over the optical resonance. We derive expressions for the demodulated power in transmission, and show that the zero crossings of the demodulated signal in transmission serve as a precise measure of the cavity linewidth at half maximum intensity. We demonstrate the technique on two resonant cavities, with lengths 16 m and a 4 km, and achieve an absolute length accuracy as low as 70 ppb. The cavity width for the 16 m cavity was determined with an accuracy of approximately 6000 ppm. Through an analysis of the systematic errors we show that this result could be substantially improved with the reduction of technical sources of uncertainty

Point Absorber Limits to Future Gravitational-Wave Detectors

High-quality optical resonant cavities require low optical loss, typically on the scale of parts per million. However, unintended micron-scale contaminants on the resonator mirrors that absorb the light circulating in the cavity can deform the surface thermoelastically, and thus increase losses by scattering light out of the resonant mode. The point absorber effect is a limiting factor in some highpower cavity experiments, for example, the Advanced LIGO gravitational wave detector. In this Letter, we present a general approach to the point absorber effect from first principles and simulate its contribution to the increased scattering. The achievable circulating power in current and future gravitational-wave detectors is calculated statistically given different point absorber configurations. Our formulation is further confirmed experimentally in comparison with the scattered power in the arm cavity of Advanced LIGO measured by in-situ photodiodes. The understanding presented here provides an important tool in the global effort to design future gravitational wave detectors that support high optical power, and thus reduce quantum noise

Pandemic (H1N1) 2009 influenza community transmission was established in one Australian state when the virus was first identified in North America

BACKGROUND In mid-June 2009 the State of Victoria in Australia appeared to have the highest notification rate of pandemic (H1N1) 2009 influenza in the world. We hypothesise that this was because community transmission of pandemic influenza was already well established in Victoria at the time testing for the novel virus commenced. In contrast, this was not true for the pandemic in other parts of Australia, including Western Australia (WA). METHODS We used data from detailed case follow-up of patients with confirmed infection in Victoria and WA to demonstrate the difference in the pandemic curve in two Australian states on opposite sides of the continent. We modelled the pandemic in both states, using a susceptible-infected-removed model with Bayesian inference accounting for imported cases. RESULTS Epidemic transmission occurred earlier in Victoria and later in WA. Only 5% of the first 100 Victorian cases were not locally acquired and three of these were brothers in one family. By contrast, 53% of the first 102 cases in WA were associated with importation from Victoria. Using plausible model input data, estimation of the effective reproductive number for the Victorian epidemic required us to invoke an earlier date for commencement of transmission to explain the observed data. This was not required in modelling the epidemic in WA. CONCLUSION Strong circumstantial evidence, supported by modelling, suggests community transmission of pandemic influenza was well established in Victoria, but not in WA, at the time testing for the novel virus commenced in Australia. The virus is likely to have entered Victoria and already become established around the time it was first identified in the US and Mexico

Environmental Noise in Advanced LIGO Detectors

The sensitivity of the advanced LIGO detectors to gravitational waves can be affected by environmental disturbances external to the detectors themselves. Since the transition from the former initial LIGO phase, many improvements have been made to the equipment and techniques used to investigate these environmental effects. These methods have aided in tracking down and mitigating noise sources throughout the first three observing runs of the advanced detector era, keeping the ambient contribution of environmental noise below the background noise levels of the detectors. In this paper we describe the methods used and how they have led to the mitigation of noise sources, the role that environmental monitoring has played in the validation of gravitational wave events, and plans for future observing runs

LIGO detector characterization in the second and third observing runs

The characterization of the Advanced LIGO detectors in the second and third observing runs has increased the sensitivity of the instruments, allowing for a higher number of detectable gravitational-wave signals, and provided confirmation of all observed gravitational-wave events. In this work, we present the methods used to characterize the LIGO detectors and curate the publicly available datasets, including the LIGO strain data and data quality products. We describe the essential role of these datasets in LIGO–Virgo Collaboration analyses of gravitational-waves from both transient and persistent sources and include details on the provenance of these datasets in order to support analyses of LIGO data by the broader community. Finally, we explain anticipated changes in the role of detector characterization and current efforts to prepare for the high rate of gravitational-wave alerts and events in future observing runs

Improving Nursing Facility Care Through an Innovative Payment Demonstration Project: Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care Phase 2

Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) is a 2‐phase Center for Medicare and Medicaid Innovations demonstration project now testing a novel Medicare Part B payment model for nursing facilities and practitioners in 40 Indiana nursing facilities. The new payment codes are intended to promote high‐quality care in place for acutely ill long‐stay residents. The focus of the initiative is to reduce hospitalizations through the diagnosis and on‐site management of 6 common acute clinical conditions (linked to a majority of potentially avoidable hospitalizations of nursing facility residents1): pneumonia, urinary tract infection, skin infection, heart failure, chronic obstructive pulmonary disease or asthma, and dehydration. This article describes the OPTIMISTIC Phase 2 model design, nursing facility and practitioner recruitment and training, and early experiences implementing new Medicare payment codes for nursing facilities and practitioners. Lessons learned from the OPTIMISTIC experience may be useful to others engaged in multicomponent quality improvement initiatives