Influence of health literacy on acceptance of influenza and pertussis vaccinations: a cross-sectional study among Spanish pregnant women.

OBJECTIVES: Immunisations against influenza and Bordetella pertussis infection are recommended to pregnant women in Valencia (Spain), yet vaccination rates remain low. Health literacy (HL) appears as a crucial factor in vaccination decision-making. We explored the relation between HL of pregnant women and decisions to receive influenza and pertussis immunisations. SETTING: University hospital in Valencia (Spain). PARTICIPANTS: 119 women who gave birth at a hospital in Valencia (Spain) between November 2015 and May 2016. Women in the immediate postpartum period (more than 27 weeks of gestation), between November 2015 and May 2016 were included in the study. Women with impairments, language barriers or illiteracy which prevented completion of the questionnaires, or those who were under 18 years were excluded from enrolment. PRIMARY AND SECONDARY OUTCOME MEASURES: HL level; influenza and pertussis immunisation rate; reasons for rejection of vaccination. RESULTS: 119 participants were included (mean age 32.3±5.5 years, 52% primiparous, 95% full-term deliveries). A higher education level was associated with Short Assessment of Health Literacy for Spanish Adults _50 (adjusted R2=0.22, p=0.014) and Newest Vital Sign (adjusted R2=0.258, p=0.001) scores. Depending on the scale, 56%-85% of participants had adequate HL. 52% (62/119) and 94% (112/119) of women received influenza and pertussis immunisation, respectively. Women rejecting influenza vaccine had a higher HL level (measured by SALHSA_50 tool) than those accepting it (Kruskal-Wallis test p=0.022). 24% of women who declined influenza vaccination felt the vaccine was unnecessary, and 23% claimed to have insufficient information. CONCLUSIONS: Influenza vaccination rate was suboptimal in our study. Women with high HL were more likely to decline immunisation. Information from professionals needs to match patients' HL levels to reduce negative perceptions of vaccination

An Efficient, Highly Flexible Multi-Channel Digital Downconverter Architecture

In this innovation, a digital downconverter has been created that produces a large (16 or greater) number of output channels of smaller bandwidths. Additionally, this design has the flexibility to tune each channel independently to anywhere in the input bandwidth to cover a wide range of output bandwidths (from 32 MHz down to 1 kHz). Both the flexibility in channel frequency selection and the more than four orders of magnitude range in output bandwidths (decimation rates from 32 to 640,000) presented significant challenges to be solved. The solution involved breaking the digital downconversion process into a two-stage process. The first stage is a 2 oversampled filter bank that divides the whole input bandwidth as a real input signal into seven overlapping, contiguous channels represented with complex samples. Using the symmetry of the sine and cosine functions in a similar way to that of an FFT (fast Fourier transform), this downconversion is very efficient and gives seven channels fixed in frequency. An arbitrary number of smaller bandwidth channels can be formed from second-stage downconverters placed after the first stage of downconversion. Because of the overlapping of the first stage, there is no gap in coverage of the entire input bandwidth. The input to any of the second-stage downconverting channels has a multiplexer that chooses one of the seven wideband channels from the first stage. These second-stage downconverters take up fewer resources because they operate at lower bandwidths than doing the entire downconversion process from the input bandwidth for each independent channel. These second-stage downconverters are each independent with fine frequency control tuning, providing extreme flexibility in positioning the center frequency of a downconverted channel. Finally, these second-stage downconverters have flexible decimation factors over four orders of magnitude The algorithm was developed to run in an FPGA (field programmable gate array) at input data sampling rates of up to 1,280 MHz. The current implementation takes a 1,280-MHz real input, and first breaks it up into seven 160-MHz complex channels, each spaced 80 MHz apart. The eighth channel at baseband was not required for this implementation, and led to more optimization. Afterwards, 16 second stage narrow band channels with independently tunable center frequencies and bandwidth settings are implemented A future implementation in a larger Xilinx FPGA will hold up to 32 independent second-stage channels

X/Ka Celestial Frame Improvements: Vision to Reality

In order to extend the International Celestial Reference Frame from its S/X-band (2.3/8.4 GHz) basis to a complementary frame at X/Ka-band (8.4/32 GHz), we began in mid-2005 an ongoing series of X/Ka observations using NASA s Deep Space Network (DSN) radio telescopes. Over the course of 47 sessions, we have detected 351 extra-galactic radio sources covering the full 24 hours of right ascension and declinations down to -45 degrees. Angular source position accuracy is at the part-per-billion level. We developed an error budget which shows that the main errors arise from limited sensitivity, mismodeling of the troposphere, uncalibrated instrumental effects, and the lack of a southern baseline. Recent work has improved sensitivity by improving pointing calibrations and by increasing the data rate four-fold. Troposphere calibration has been demonstrated at the mm-level. Construction of instrumental phase calibrators and new digital baseband filtering electronics began in recent months. We will discuss the expected effect of these improvements on the X/Ka frame

Determinants of seasonal influenza vaccination in pregnant women in Valencia, Spain

Background: In most countries the coverage of seasonal influenza vaccination in pregnant women is low. We investigated the acceptance, reasons for rejection and professional involvement related to vaccine information in pregnant women in Valencia, Spain. Methods: Observational retrospective study in 200 pregnant women, 100 vaccinated and 100 unvaccinated, were interviewed during the 2014/2015 vaccination campaign. Electronic medical records, immunization registry and telephone interviews were used to determine reasons for vaccination and immunization rejection. Results: 40.5% of pregnant women in the health department were vaccinated. The midwife was identified as source of information for 89% of women. The vaccine was rejected due to low perceptions of risk of influenza infection (23%), lack of information (19%), considering the vaccine as superfluous (16%), close proximity of delivery date (13%) and fear of side effects (12%). Conclusion: Pregnant women in Spain declined to be vaccinated due to under-estimation of the risk of contracting or being harmed by influenza, and lack of information. Interventions aiming to optimize vaccination coverage should include information addressing the safety and effectiveness of the current vaccine together with improved professional training and motivation

Probing magnetism in 2D van der Waals crystalline insulators via electron tunneling

Magnetic insulators are a key resource for next-generation spintronic and topological devices. The family of layered metal halides promises varied magnetic states including ultrathin insulating multiferroics, spin liquids, and ferromagnets, but device-oriented characterization methods are needed to unlock their potential. Here, we report tunneling through the layered magnetic insulator CrI3 as a function of temperature and applied magnetic field. We electrically detect the magnetic ground state and inter-layer coupling and observe a field-induced metamagnetic transition. The metamagnetic transition results in magnetoresistances of 95%, 300%, and 550% for bilayer, trilayer, and tetralayer CrI3 barriers, respectively. We further measure inelastic tunneling spectra for our junctions, unveiling a rich spectrum consistent with collective magnetic excitations (magnons) in CrI3.This work was supported by the Center for Integrated Quantum Materials under NSF grant DMR-1231319 as well as the Gordon and Betty Moore Foundation’s EPiQS Initiative through Grant GBMF4541 to PJH. Device fabrication has been partly supported by the Center for Excitonics, an Energy Frontier Research Center funded by the U.S. Department of Energy (DOE), Office of Basic Energy Sciences (BES) under Award Number DESC0001088. DRK acknowledges partial support by the NSF Graduate Research Fellowship Program (GRFP) under Grant No. 1122374. JLL acknowledges financial support from the ETH Zurich Postdoctoral Fellowship program. DS acknowledges the Marie Curie Cofund program at INL. JFR thanks support from PTDC/FIS-NAN/3668/2014. Growth of hexagonal boron nitride crystals at NIMS was supported by the Elemental Strategy Initiative conducted by the MEXT, Japan and JSPS KAKENHI Grant Numbers JP15K21722 and JP25106006. Work done at Ames Laboratory (PCC and SM) was supported by the DOE BES Division of Materials Sciences and Engineering. Ames Laboratory is operated for the DOE by Iowa State University under Contract No. DE-AC02-07CH11358. SM was funded by the Gordon and Betty Moore Foundation’s EPiQS Initiative through Grant GBMF4411

Protection and consolidation of stone heritage by self-inoculation with indigenous carbonatogenic bacterial communities

Enhanced salt weathering resulting from global warming and increasing environmental pollution is endangering the survival of stone monuments and artworks. To mitigate the effects of these deleterious processes, numerous conservation treatments have been applied that, however, show limited efficacy. Here we present a novel, environmentally friendly, bacterial self-inoculation approach for the conservation of stone, based on the isolation of an indigenous community of carbonatogenic bacteria from salt damaged stone, followed by their culture and re-application back onto the same stone. This method results in an effective consolidation and protection due to the formation of an abundant and exceptionally strong hybrid cement consisting of nanostructured bacterial CaCO3 and bacterially derived organics, and the passivating effect of bacterial exopolymeric substances (EPS) covering the substrate. The fact that the isolated and identified bacterial community is common to many stone artworks may enable worldwide application of this novel conservation methodology.This work was supported by the Spanish Government (Grants MAT2012-37584, CGL2012-35992 and CGL2015-70642-R), the Junta de Andalucía through Proyecto de excelencia RNM-3493 and Project P11-RNM-7550, the Research Groups BIO 103 and RNM-179, and the University of Granada (Unidad Científica de Excelencia UCE-PP2016-05). Additional funds were provided by the Molecular Foundry (Lawrence Berkeley National Laboratory, LBNL, University of California, Berkeley, CA) for a research stay of M.S. (project #1451; User Agreement No. NPUSR009206)

Clinical Outcomes of a Zika Virus Mother-Child Pair Cohort in Spain

BACKGROUND: Zika virus (ZIKV) infection has been associated with congenital microcephaly and other neurodevelopmental abnormalities. There is little published research on the effect of maternal ZIKV infection in a non-endemic European region. We aimed to describe the outcomes of pregnant travelers diagnosed as ZIKV-infected in Spain, and their exposed children. METHODS: This prospective observational cohort study of nine referral hospitals enrolled pregnant women (PW) who travelled to endemic areas during their pregnancy or the two previous months, or those whose sexual partners visited endemic areas in the previous 6 months. Infants of ZIKV-infected mothers were followed for about two years. RESULTS: ZIKV infection was diagnosed in 163 PW; 112 (70%) were asymptomatic and 24 (14.7%) were confirmed cases. Among 143 infants, 14 (9.8%) had adverse outcomes during follow-up; three had a congenital Zika syndrome (CZS), and 11 other potential Zika-related outcomes. The overall incidence of CZS was 2.1% (95%CI: 0.4-6.0%), but among infants born to ZIKV-confirmed mothers, this increased to 15.8% (95%CI: 3.4-39.6%). CONCLUSIONS: A nearly 10% overall risk of neurologic and hearing adverse outcomes was found in ZIKV-exposed children born to a ZIKV-infected traveler PW. Longer-term follow-up of these children is needed to assess whether there are any later-onset manifestations

Impact of the COVID-19 Pandemic on a Cancer Fast-Track Programme

Introduction: The COVID-19 pandemic has disrupted many aspects of clinical practice in oncology, particularly regarding early cancer diagnosis, sparking public health concerns that possible delays could increase the proportion of patients diagnosed at advanced stages. In 2009, a cancer fast-track program (CFP) was implemented at the Clinico-Malvarrosa Health Department in Valencia, Spain with the aim of shortening waiting times between suspected cancer symptoms, diagnosis and therapy initiation. Objectives: The study aimed to explore the effects of the COVID-19 pandemic on our cancer diagnosis fast-track program. Methods: The program workflow (patients included and time periods) was analysed from the beginning of the state of alarm on March 16th, 2020 until March 15th, 2021. Data was compared with data from the same period of time from the year before (2019). Results: During the pandemic year, 975 suspected cancer cases were submitted to the CFP. The number of submissions only decreased during times of highest COVID-19 incidence and stricter lockdown, and overall, referrals were slightly higher than in the previous 2 years. Cancer diagnosis was confirmed in 197 (24.1%) cases, among which 33% were urological, 23% breast, 16% gastrointestinal and 9% lung cancer. The median time from referral to specialist appointment was 13 days and diagnosis was reached at a median of 18 days. In confirmed cancer cases, treatment was started at around 30 days from time of diagnosis. In total, 61% of cancer disease was detected at early stage, 20% at locally advanced stage, and 19% at advanced stage, displaying time frames and case proportions similar to pre-pandemic years. Conclusions: Our program has been able to maintain normal flow and efficacy despite the challenges of the current pandemic, and has proven a reliable tool to help primary care physicians referring suspected cancer patients.S