A new dedicated clinic for HCWs' counseling and vaccination: experience of an academic hospital

Abstract Issue Despite low healthcare workers (HCWs) vaccination coverage being a risk for hospital outbreaks, vaccine hesitancy is not unusual among HCWs. In Italy vaccinations are strongly recommended for HCWs, but there are few occasions for a dedicated counseling. Aim of the study is to evaluate the effectiveness of a new vaccination service in the academic hospital of Udine (northern Italy) in tackling vaccine hesitancy among HCWs. Description of the problem Available data on HCWs specific antibody titers revealed that in high-risk units, 25% of HCWs were certainly unprotected for at least 1/6 of the vaccine preventable diseases (VPDs): measles, rubella, mumps, varicella, pertussis, hepatitis B; only varicella coverage reached the herd immunity target. Periodic occupational health visit was the only moment to screen for VPDs protection and suggest vaccination, but the following inconvenient procedure of HCWs contacting the vaccination office outside the hospital, often lead to delays or loss. In order to improve vaccination adherence, since June 2019 a dedicated clinic has been set up inside the hospital, making vaccination counseling and administration available every two weeks, with appointments directly given by the occupational doctor. Results From June 2019 to February 2020, a total of 362 appointments were booked for the dedicated vaccination clinic, 69.7% of which actually took place as 252 HCWs actually accessed the service. Hours dedicated to the service activity were 76 hours, distributed over 19 days. Administered vaccination were 322, including 107 MMR (measles, rubella, mumps), 4 MMRV (MMR+varicella), 20 varicella, 64 hepatitis B, 127 DTPa (diphtheria, tetanus, pertussis). Lessons Making the access to vaccination more convenient in term of service location within the hospital and giving the appointment when performing the occupational health visit seems to be helpful in filling the VPDs protection among HCWs gap. Key messages Monitoring immunological status of HCWs and promoting vaccination at occupational health visit would sustain herd immunity protection for susceptible individuals in healthcare settings. The dedicated hospital vaccination clinic and the effective procedure of giving the appointment during the occupational health visit could be helpful in improving HCWs vaccine adherence

In vitro optimization and comparison of CT angiography versus radial cardiovascular magnetic resonance for the quantification of cross-sectional areas and coronary endothelial function.

Our objectives were first to determine the optimal coronary computed tomography angiography (CTA) protocol for the quantification and detection of simulated coronary artery cross-sectional area (CSA) differences in vitro, and secondly to quantitatively compare the performance of the optimized CTA protocol with a previously validated radial coronary cardiovascular magnetic resonance (CMR) technique. 256-multidetector CTA and radial coronary CMR were used to obtain images of a custom in vitro resolution phantom simulating a range of physiological responses of coronary arteries to stress. CSAs were automatically quantified and compared with known nominal values to determine the accuracy, precision, signal-to-noise ratio (SNR), and circularity of CSA measurements, as well as the limit of detection (LOD) of CSA differences. Various iodine concentrations, radiation dose levels, tube potentials, and iterative image reconstruction algorithms (ASiR-V) were investigated to determine the optimal CTA protocol. The performance of the optimized CTA protocol was then compared with a radial coronary CMR method previously developed for endothelial function assessment under both static and moving conditions. The iodine concentration, dose level, tube potential, and reconstruction algorithm all had significant effects (all p < 0.001) on the accuracy, precision, LOD, SNR, and circularity of CSA measurements with CTA. The best precision, LOD, SNR, and circularity with CTA were achieved with 6% iodine, 20 mGy, 100 kVp, and 90% ASiR-V. Compared with the optimized CTA protocol under static conditions, radial coronary CMR was less accurate (- 0.91 ± 0.13 mm <sup>2</sup> vs. -0.35 ± 0.04 mm <sup>2</sup> , p < 0.001), but more precise (0.08 ± 0.02 mm <sup>2</sup> vs. 0.21 ± 0.02 mm <sup>2</sup> , p < 0.001), and enabled the detection of significantly smaller CSA differences (0.16 ± 0.06 mm <sup>2</sup> vs. 0.52 ± 0.04 mm <sup>2</sup> ; p < 0.001; corresponding to CSA percentage differences of 2.3 ± 0.8% vs. 7.4 ± 0.6% for a 3-mm baseline diameter). The same results held true under moving conditions as CSA measurements with CMR were less affected by motion. Radial coronary CMR was more precise and outperformed CTA for the specific task of detecting small CSA differences in vitro, and was able to reliably identify CSA changes an order of magnitude smaller than those reported for healthy physiological vasomotor responses of proximal coronary arteries. However, CTA yielded more accurate CSA measurements, which may prove useful in other clinical scenarios, such as coronary artery stenosis assessment

In vitro optimization and comparison of CT angiography versus radial cardiovascular magnetic resonance for the quantification of cross-sectional areas and coronary endothelial function.

Our objectives were first to determine the optimal coronary computed tomography angiography (CTA) protocol for the quantification and detection of simulated coronary artery cross-sectional area (CSA) differences in vitro, and secondly to quantitatively compare the performance of the optimized CTA protocol with a previously validated radial coronary cardiovascular magnetic resonance (CMR) technique. 256-multidetector CTA and radial coronary CMR were used to obtain images of a custom in vitro resolution phantom simulating a range of physiological responses of coronary arteries to stress. CSAs were automatically quantified and compared with known nominal values to determine the accuracy, precision, signal-to-noise ratio (SNR), and circularity of CSA measurements, as well as the limit of detection (LOD) of CSA differences. Various iodine concentrations, radiation dose levels, tube potentials, and iterative image reconstruction algorithms (ASiR-V) were investigated to determine the optimal CTA protocol. The performance of the optimized CTA protocol was then compared with a radial coronary CMR method previously developed for endothelial function assessment under both static and moving conditions. The iodine concentration, dose level, tube potential, and reconstruction algorithm all had significant effects (all p < 0.001) on the accuracy, precision, LOD, SNR, and circularity of CSA measurements with CTA. The best precision, LOD, SNR, and circularity with CTA were achieved with 6% iodine, 20 mGy, 100 kVp, and 90% ASiR-V. Compared with the optimized CTA protocol under static conditions, radial coronary CMR was less accurate (- 0.91 ± 0.13 mm <sup>2</sup> vs. -0.35 ± 0.04 mm <sup>2</sup> , p < 0.001), but more precise (0.08 ± 0.02 mm <sup>2</sup> vs. 0.21 ± 0.02 mm <sup>2</sup> , p < 0.001), and enabled the detection of significantly smaller CSA differences (0.16 ± 0.06 mm <sup>2</sup> vs. 0.52 ± 0.04 mm <sup>2</sup> ; p < 0.001; corresponding to CSA percentage differences of 2.3 ± 0.8% vs. 7.4 ± 0.6% for a 3-mm baseline diameter). The same results held true under moving conditions as CSA measurements with CMR were less affected by motion. Radial coronary CMR was more precise and outperformed CTA for the specific task of detecting small CSA differences in vitro, and was able to reliably identify CSA changes an order of magnitude smaller than those reported for healthy physiological vasomotor responses of proximal coronary arteries. However, CTA yielded more accurate CSA measurements, which may prove useful in other clinical scenarios, such as coronary artery stenosis assessment

Automatic and Data Driven Pitch Contour Manipulation with Functional Data Analysis

Contains fulltext : 86524.pdf (author's version ) (Open Access)Creating stimuli for perceptual experiments in intonation research involves manipulation of pitch contours extracted from spoken utterances. Difficulties arise when changes in the contour shape need to be applied globally and smoothly in the whole pitch curve. Moreover, it is hard to relate a gradual modification in some contour trait to its perceptual counterpart. In this paper we propose a novel approach to stimuli manipulation that is based on an extension of Principal Component Analysis (PCA). Starting from a corpus of pitch curves a parametric description of the principal variation in the curve set is obtained. This allows to locate clusters in this parameter space that are related to linguistic categories. The search for pitch curves with desired perceptual characteristics is carried out by choosing convenient point locations with respect to the relevant clusters. We illustrate this approach in a case study on question/ statement opposition in Neapolitan Italian

Oöcyte markets: global tissue economies and women’s reproductive work in embryonic stem cell research

Somatic Cell Nuclear Transfer (SCNT) research, otherwise known as therapeutic cloning, requires large numbers of research oöcytes, placing pressure on an already limited supply. In the UK, Canada, Australia, Singapore and most of Western Europe, oöcytes are made available through modestly reimbursed donation, and, due to the onerous nature of donation, the existing demand for reproductive oöcytes far outstrips availability. SCNT research will place this system under even greater pressure. This paper investigates the growth in a global market for oöcytes, where transnational IVF clinics broker sales between generally poor, female vendors and wealthy purchasers, beyond the borders of national regulation, and with little in the way of clinical or bioethical scrutiny. It considers the possible impact that SCNT research will have on this global market, and suggests some ways to improve the protection, security and power of vendors

Automatic and Data Driven Pitch Contour Manipulation with Functional Data Analysis

Creating stimuli for perceptual experiments in intonation research involves manipulation of pitch contours extracted from spoken utterances. Difficulties arise when changes in the contour shape need to be applied globally and smoothly in the whole pitch curve. Moreover, it is hard to relate a gradual modification in some contour trait to its perceptual counterpart. In this paper we propose a novel approach to stimuli manipulation that is based on an extension of Principal Component Analysis (PCA). Starting from a corpus of pitch curves a parametric description of the principal variation in the curve set is obtained. This allows to locate clusters in this parameter space that are related to linguistic categories. The search for pitch curves with desired perceptual characteristics is carried out by choosing convenient point locations with respect to the relevant clusters. We illustrate this approach in a case study on question/ statement opposition in Neapolitan Italian

Educational programmes and sharps injuries in health care workers.

BACKGROUND: Sharps injuries in health care personnel still represent a significant problem worldwide. Many studies show a reduction in sharps injuries following the introduction and use of different protection devices, but few studies focus on the role of training programmes in the prevention of such injuries. AIMS: To analyse the influence of training programmes on sharps injuries in health care workers (HCW). METHODS: The study was carried out in a 350-bed university hospital in north-eastern Italy with 700 HCW. Training courses on biological risk for physicians, nurses, ancillary operators and laboratory technicians have been in place since 1998. Data on all sharps injuries reported by HCW between 1998 and 2006 were analysed together with information on HCW who attended the training courses. RESULTS: Between 1998 and 2006, there was a reduction in the incidence of sharps injuries from 11 to 4% (P < 0.01). During the same period, the number of trained HCW increased from 26 to 69% (P < 0.01). Trained personnel had a statistically significant lower relative risk (RR) for injury with RR = 0.06 (95% CI 0.02-0.18). CONCLUSIONS: A continuous educational effort for HCW leads to a reduction of sharps injuries