Influenza Vaccination Coverage Rates in Germany: A Population-Based Cross-Sectional Analysis of the Seasons 2002/2003 and 2003/2004

Abstract : Background and Purpose: : Influenza continues to be a considerable health problem in Europe. Vaccination is the only preventive measure, reducing mortality and morbidity of influenza in all age groups. The objectives of this survey were to assess the level of influenza vaccination coverage in the 2002/2003 season compared with the 2003/2004 season in Germany, to understand the driving forces and barriers to vaccination, and to determine vaccination intentions for the following winter. Methods: : The authors conducted a random-sampling, telephone-based household survey among noninstitutionalized individuals representative of the population aged ≥ 14. The surveys for 2002/2003 and 2003/2004 used the same questionnaire and were subsequently pooled. Four target groups were determined for analysis: (1) persons aged ≥ 60; (2) people working in the medical field; (3) persons suffering from chronic illness; and (4) a group composed of persons aged ≥ 60 or working in the medical field or suffering from a chronic illness. Results: : The overall sample consisted of 4,011 people. The influenza vaccination coverage rate in Germany increased from 22.3% in 2002/2003 to 25.1% in 2003/2004. This increase is not significant. The most frequent reasons for being vaccinated given by vaccinees were: influenza considered to be a serious illness, which people wanted to avoid (90.1%), having received advice from the family doctor or nurse to be vaccinated (71.3%), and not wanting to infect family and friends (70.4%). Reasons for not being vaccinated mentioned by people who have never been vaccinated were: thinking about it, however, not being vaccinated in the end (47.7%), not expecting to catch influenza (43.6%), and not having received a recommendation from the family doctor to be vaccinated (36.6%). Options encouraging influenza vaccination are: recommendation by the family doctor or nurse (66.6%), more available information on the vaccine regarding efficacy and tolerance (54.2%), and more information available about the disease (52.4%). Conclusion: : The vaccination coverage in the 2003/2004 season increased in comparison to the 2002/2003 season, although not significantly. The family doctor is the most important source of encouragement for people to be vaccinated against influenza. It seems that the public would be more likely to be vaccinated if they had more information on the efficacy and tolerance of the vaccine, as well as the disease. It is therefore suggested that family doctors be better informed on influenza vaccine and the disease itself, so that they can actively inform their patients on these topic

Consistent Unanticipated Adaptation for Context-Dependent Applications

Unanticipated adaptation allows context-dependent applications to overcome the limitation of foreseen adaptation by incorporating previously unknown behavior. Introducing this concept in language-based approaches leads to inconsistencies as an object can have different views in different contexts. Existing language-based approaches do not address unanticipated adaptation and its associated run-time inconsistencies. We propose an architecture for unanticipated adaptation at run time based on dynamic instance binding crafted in a loosely manner to asynchronously replace adaptable entities that allow for behavioral changes of objects. To solve inconsistencies, we introduce the notion of transactions at the object level. Transactions guard the changing objects during their execution, ensuring consistent views. This allows for disruption-free, safe updates of adaptable entities by means of consistent unanticipated adaptation

Decentralized Coordination of Dynamic Software Updates in the Internet of Things

Large scale IoT service deployments run on a high number of distributed, interconnected computing nodes comprising sensors, actuators, gateways and cloud infrastructure. Since IoT is a fast growing, dynamic domain, the implementation of software components are subject to frequent changes addressing bug fixes, quality insurance or changed requirements. To ensure the continuous monitoring and control of processes, software updates have to be conducted while the nodes are operating without losing any sensed data or actuator instructions. Current IoT solutions usually support the centralized management and automated deployment of updates but are restricted to broadcasting the updates and local update processes at all nodes. In this paper we propose an update mechanism for IoT deployments that considers dependencies between services across multiple nodes involved in a common service and supports a coordinated update of component instances on distributed nodes. We rely on LyRT on all IoT nodes as the runtime supporting local disruption-minimal software updates. Our proposed middleware layer coordinates updates on a set of distributed nodes. We evaluated our approach using a demand response scenario from the smart grid domain

a prospective cohort study

Background The effects of target temperature management (TTM) on the heart aren’t thoroughly studied yet. Several studies showed the prolongation of various ECG parameters including Tpeak-Tend-time under TTM. Our study’s goal is to evaluate the acute and long-term outcome of these prolongations. Methods In this study we included patients with successful resuscitation after cardiac arrest who were admitted to the Charité Virchow Klinikum Berlin or the Heart and Vascular Centre of the Ruhr University Bochum between February 2006 and July 2013 (Berlin) or May 2014 to November 2015 (Bochum). For analysis, one ECG during TTM was recorded after reaching the target temperature (33–34 °C) or in the first 6 h of TTM. If possible, another ECG was taken after TTM. The patients were being followed until February 2016. Primary endpoint was ventricular arrhythmia during TTM, secondary endpoints were death and hospitalization due to cardiovascular diseases during follow-up. Results One hundred fifty-eight patients were successfully resuscitated in the study period of which 95 patients had usable data (e.g. ECGs without artifacts). During TTM significant changes for different parameters of ventricular de- and repolarization were noted: QRS (103.2 ± 23.7 vs. 95.3 ± 18.1; p = 0.003),QT (405.8 ± 76.4 vs. 373.8 ± 75.0; p = 0.01), QTc (474.9 ± 59.7 vs. 431.0 ± 56.8; p < 0.001), JT (302.8 ± 69.4 vs. 278.5 ± 75.2; p = 0.043), JTc (354.3 ± 60.2 vs. 318.7 ± 59.1; p = 0.001). 13.7% of the patients had ventricular arrhythmias during TTM, however these patients showed no difference regarding their ECG parameters in comparison to those were no ventricular arrhythmias occurred. We were able to follow 69 Patients over an average period of 35 ± 31 months. The 14 (21.5%) patients who died during the follow-up had significant prolongations of the TpTe-time in the ECGs without TTM (103.9 ± 47.2 vs. 75.8 ± 28.6; p = 0.023). Conclusion Our results show a significant prolongation of ventricular repolarization during TH. However, there was no significant difference between the ECG parameters of those who developed a ventricular arrhythmia and those who did not. The temporary prolongation of the repolarization during TTM seems to be less important for the prognosis of the patient. Whereas the prolongation of the repolarization in the basal ECG is associated with a higher mortality in our study

The epidemiological impact of childhood influenza vaccination using live-attenuated influenza vaccine (LAIV) in Germany: predictions of a simulation study

Rose MA, Damm O, Greiner W, et al. The epidemiological impact of childhood influenza vaccination using live-attenuated influenza vaccine (LAIV) in Germany: predictions of a simulation study. BMC Infectious Diseases. 2014;14(1): 40.Background Routine annual influenza vaccination is primarily recommended for all persons aged 60 and above and for people with underlying chronic conditions in Germany. Other countries have already adopted additional childhood influenza immunisation programmes. The objective of this study is to determine the potential epidemiological impact of implementing paediatric influenza vaccination using intranasally administered live-attenuated influenza vaccine (LAIV) in Germany. Methods A deterministic age-structured model is used to simulate the population-level impact of different vaccination strategies on the transmission dynamics of seasonal influenza in Germany. In our base-case analysis, we estimate the effects of adding a LAIV-based immunisation programme targeting children 2 to 17 years of age to the existing influenza vaccination policy. The data used in the model is based on published evidence complemented by expert opinion. Results In our model, additional vaccination of children 2 to 17 years of age with LAIV leads to the prevention of 23.9 million influenza infections and nearly 16 million symptomatic influenza cases within 10 years. This reduction in burden of disease is not restricted to children. About one third of all adult cases can indirectly be prevented by LAIV immunisation of children. Conclusions Our results demonstrate that vaccinating children 2–17 years of age is likely associated with a significant reduction in the burden of paediatric influenza. Furthermore, annual routine childhood vaccination against seasonal influenza is expected to decrease the incidence of influenza among adults and older people due to indirect effects of herd protection. In summary, our model provides data supporting the introduction of a paediatric influenza immunisation programme in Germany

Sun-induced chlorophyll fluorescence and photochemical reflectance index improve remote-sensing gross primary production estimates under varying nutrient availability in a typical Mediterranean savanna ecosystem

Este estudio investiga las diferentes actuaciones de ópticas sobre los índices para estimar la producción primaria bruta (GPP) del estrato herbáceo de una sabana mediterránea con diferente disponibilidad de nitrógeno (N) y de fósforo (P). La fluorescencia de la clorofila inducida por el sol sobre el rendimiento calculado en 760 nm (FY760), escala de índice de reflectancia fotoquímica (sPRI), MERIS terrestre (índice de clorofila MTCI) y el índice de vegetación de diferencia normalizada (NDVI) fueron calculadas desde cerca de la superficie y las mediciones de espectroscopia de campo recolectados se hicieron utilizando espectrómetros de alta resolución espectral, que abarcan las regiones del infrarrojo cercano visible. La GPP fue medida utilizando cámaras de dosel en las mismas localidades muestreadas por los espectrómetros. Hemos probado si la eficiencia del uso de los modelos de luz (LUE) impulsados por cantidades de teledetección (RSMs) pueden hacer un mejor seguimiento de los cambios en la GPP causada por fuentes de nutrientes en comparación con aquellos impulsados exclusivamente por datos meteorológicos (MM). En particular, comparamos los espectáculos de diferentes formulaciones de RSM -basándose en la utilización de FY760 o sPRI como proxy para LUE y NDVI MTCI o como una fracción de la radiación fotosintéticamente activa absorbida (APAR f)- con las clásicas de MM. Los resultados mostraron mayor GPP en la N -parcelas experimentales fertilizadas durante el período de crecimiento. Estas diferencias en la GPP desaparecieron en el período de secado, cuando los efectos de la senescencia enmascarada contiene diferencias de potencial debido a la planta N. Por consiguiente, MTCI estaba estrechamente relacionada con la media de la planta N, contenida a través de tratamientos (r2 D 0:86, p < 0:01), porque estaba mal relacionados con GPP (r2 D 0:45, p < 0:05). Por el contrario sPRI y FY760 se correlacionaban bien con GPP durante todo el período de medición. Los resultados revelaron que la relación entre el GPP y FY760 no es única en los tratamientos, pero no se ve afectada por la disponibilidad de N. Los resultados de un análisis de validación cruzada mostró que el MM (AICcv D 127, MEcv D 0:879) superó a RSM (AICcv D 140, MEcv D 0:8737,) cuando la humedad del suelo fue utilizada para restringir la dinámica estacional de LUE. Sin embargo, el análisis residual demostró que las predicciones de GPP con MM son inexactas cuando no revela explícitamente unas variables climáticas en cambios relacionados con el parámetro de nutrientes LUE. Estos resultados sugieren que RSM es un medio valioso para diagnosticar los efectos inducidos por los nutrientes en la actividad fotosintética.This study investigates the performances of different optical indices to estimate gross primary production (GPP) of herbaceous stratum in a Mediterranean savanna with different nitrogen (N) and phosphorous (P) availability. Sun-induced chlorophyll fluorescence yield computed at 760 nm (Fy760), scaled photochemical reflectance index (sPRI), MERIS terrestrial-chlorophyll index (MTCI) and normalized difference vegetation index (NDVI) were computed from near-surface field spectroscopy measurements collected using high spectral resolution spectrometers covering the visible near-infrared regions. GPP was measured using canopy chambers on the same locations sampled by the spectrometers. We tested whether light-use efficiency (LUE) models driven by remote-sensing quantities (RSMs) can better track changes in GPP caused by nutrient supplies compared to those driven exclusively by meteorological data (MM). Particularly, we compared the performances of different RSM formulations – relying on the use of Fy760 or sPRI as a proxy for LUE and NDVI or MTCI as a fraction of absorbed photosynthetically active radiation (f APAR) – with those of classical MM. Results showed higher GPP in the N-fertilized experimental plots during the growing period. These differences in GPP disappeared in the drying period when senescence effects masked out potential differences due to plant N content. Consequently, although MTCI was closely related to the mean of plant N content across treatments (r2 D 0:86, p < 0:01), it was poorly related to GPP (r2 D 0:45, p < 0:05). On the contrary sPRI and Fy760 correlated well with GPP during the whole measurement period. Results revealed that the relationship between GPP and Fy760 is not unique across treatments, but it is affected by N availability. Results from a cross-validation analysis showed that MM (AICcv D 127, MEcv D 0:879) outperformed RSM (AICcv D 140, MEcv D 0:8737) when soil moisture was used to constrain the seasonal dynamic of LUE. However, residual analyses demonstrated that GPP predictions with MM are inaccurate whenever no climatic variable explicitly reveals nutrient-related changes in the LUE parameter. These results suggest that RSM is a valuable means to diagnose nutrient-induced effects on the photosynthetic activity.Trabajo financiado por: Alexander von Humboldt Foundation y la Max Planck Research AwardpeerReviewe

Environment-sensitivity functions for gross primary productivity in light use efficiency models

The sensitivity of photosynthesis to environmental changes is essential for understanding carbon cycle responses to global climate change and for the development of modeling approaches that explains its spatial and temporal variability. We collected a large variety of published sensitivity functions of gross primary productivity (GPP) to different forcing variables to assess the response of GPP to environmental factors. These include the responses of GPP to temperature; vapor pressure deficit, some of which include the response to atmospheric CO2 concentrations; soil water availability (W); light intensity; and cloudiness. These functions were combined in a full factorial light use efficiency (LUE) model structure, leading to a collection of 5600 distinct LUE models. Each model was optimized against daily GPP and evapotranspiration fluxes from 196 FLUXNET sites and ranked across sites based on a bootstrap approach. The GPP sensitivity to each environmental factor, including CO2 fertilization, was shown to be significant, and that none of the previously published model structures performed as well as the best model selected. From daily and weekly to monthly scales, the best model's median Nash-Sutcliffe model efficiency across sites was 0.73, 0.79 and 0.82, respectively, but poorer at annual scales (0.23), emphasizing the common limitation of current models in describing the interannual variability of GPP. Although the best global model did not match the local best model at each site, the selection was robust across ecosystem types. The contribution of light saturation and cloudiness to GPP was observed across all biomes (from 23% to 43%). Temperature and W dominates GPP and LUE but responses of GPP to temperature and W are lagged in cold and arid ecosystems, respectively. The findings of this study provide a foundation towards more robust LUE-based estimates of global GPP and may provide a benchmark for other empirical GPP products.publishersversionpublishe

Prediction modelling for trauma using comorbidity and 'true' 30-day outcome

BACKGROUND: Prediction models for trauma outcome routinely control for age but there is uncertainty about the need to control for comorbidity and whether the two interact. This paper describes recent revisions to the Trauma Audit and Research Network (TARN) risk adjustment model designed to take account of age and comorbidities. In addition linkage between TARN and the Office of National Statistics (ONS) database allows patient's outcome to be accurately identified up to 30 days after injury. Outcome at discharge within 30 days was previously used. METHODS: Prospectively collected data between 2010 and 2013 from the TARN database were analysed. The data for modelling consisted of 129 786 hospital trauma admissions. Three models were compared using the area under the receiver operating curve (AuROC) for assessing the ability of the models to predict outcome, the Akaike information criteria to measure the quality between models and test for goodness-of-fit and calibration. Model 1 is the current TARN model, Model 2 is Model 1 augmented by a modified Charlson comorbidity index and Model 3 is Model 2 with ONS data on 30 day outcome. RESULTS: The values of the AuROC curve for Model 1 were 0.896 (95% CI 0.893 to 0.899), for Model 2 were 0.904 (0.900 to 0.907) and for Model 3 0.897 (0.896 to 0.902). No significant interaction was found between age and comorbidity in Model 2 or in Model 3. CONCLUSIONS: The new model includes comorbidity and this has improved outcome prediction. There was no interaction between age and comorbidity, suggesting that both independently increase vulnerability to mortality after injury