Health care workers' influenza vaccination: motivations and mandatory mask policy

Background Vaccination of health care workers (HCW) against seasonal influenza (SI) is recommended but vaccination rate rarely reach >30%. Vaccination coverage against 2009 pandemic influenza (PI) was 52% in our hospital, whilst a new policy requiring unvaccinated HCW to wear a mask during patient care duties was enforced. Aims To investigate the determinants of this higher vaccination acceptance for PI and to look for an association with the new mask-wearing policy. Methods A retrospective cohort study, involving HCW of three critical departments of a 1023-bed, tertiary-care university hospital in Switzerland. Self-reported 2009-10 SI and 2009 PI vaccination statuses, reasons and demographic data were collected through a literature-based questionnaire. Descriptive statistics, uni- and multivariate analyses were then performed. Results There were 472 respondents with a response rate of 54%. Self-reported vaccination acceptance was 64% for PI and 53% for SI. PI vaccination acceptance was associated with being vaccinated against SI (OR 9.5; 95% CI 5.5-16.4), being a physician (OR 7.7; 95% CI 3.1-19.1) and feeling uncomfortable wearing a mask (OR 1.7; 95% CI 1.0-2.8). Main motives for refusing vaccination were: preference for wearing a surgical mask (80% for PI, not applicable for SI) and concerns about vaccine safety (64%, 50%) and efficacy (44%, 35%). Conclusions The new mask-wearing policy was a motivation for vaccination but also offered an alternative to non-compliant HCW. Concerns about vaccine safety and efficiency and self-interest of health care workers are still main determinants for influenza vaccination acceptance. Better incentives are needed to encourage vaccination amongst non-physician HC

Adult native septic arthritis: a review of 10 years of experience and lessons for empirical antibiotic therapy.

Objectives To review the epidemiology of native septic arthritis to establish local guidelines for empirical antibiotic therapy as part of an antibiotic stewardship programme. Methods We conducted a 10 year retrospective study based on positive synovial fluid cultures and discharge diagnosis of septic arthritis in adult patients. Microbiology results and medical records were reviewed. Results Between 1999 and 2008, we identified 233 episodes of septic arthritis. The predominant causative pathogens were methicillin-susceptible Staphylococcus aureus (MSSA) and streptococci (respectively, 44.6% and 14.2% of cases). Only 11 cases (4.7%) of methicillin-resistant S. aureus (MRSA) arthritis were diagnosed, among which 5 (45.5%) occurred in known carriers. For large-joint infections, amoxicillin/clavulanate or cefuroxime would have been appropriate in 84.5% of cases. MRSA and Mycobacterium tuberculosis would have been the most frequent pathogens that would not have been covered. In contrast, amoxicillin/clavulanate would have been appropriate for only 75.3% of small-joint infections (82.6% if diabetics are excluded). MRSA and Pseudomonas aeruginosa would have been the main pathogens not covered. Piperacillin/tazobactam would have been appropriate in 93.8% of cases (P < 0.01 versus amoxicillin/clavulanate). This statistically significant advantage is lost after exclusion of diabetics (P = 0.19). Conclusions Amoxicillin/clavulanate or cefuroxime would be adequate for empirical coverage of large-joint septic arthritis in our area. A broad-spectrum antibiotic would be significantly superior for small-joint infections in diabetics. Systematic coverage of MRSA is not justified, but should be considered for known carriers. These recommendations are applicable to our local setting. They might also apply to hospitals sharing the same epidemiology

TLEP: A High-Performance Circular e+e- Collider to Study the Higgs Boson

The recent discovery of a light Higgs boson has opened up considerable interest in circular e+e- Higgs factories around the world. We report on the progress of the TLEP concept since last year. TLEP is an e+e- circular collider capable of very high luminosities in a wide centre-of-mass (ECM) spectrum from 90 to 350 GeV. TLEP could be housed in a new 80 to 100 km tunnel in the Geneva region. The design can be adapted to different ring circumference (e.g. LEP3 in the 27 km LHC tunnel). TLEP is an ideal complementary machine to the LHC thanks to high luminosity, exquisite determination of ECM and the possibility of four interaction points, both for precision measurements of the Higgs boson properties and for precision tests of the closure of the Standard Model from the Z pole to the top threshold.Comment: Contribution to IPAC13, 12-17 May 2013, Shanghai, Chin

Prevalence and economic cost of malnutrition in Italy: A systematic review and metanalysis from the Italian Society of Artificial Nutrition and Metabolism (SINPE)

Objectives: Disease-related malnutrition (DRM) is a major public health issue with dramatic consequences on outcomes. However, in Italy a comprehensive and updated overview on national prevalence, in both the adult and pediatric populations, and its burden on the health care environment, is missing. The aim of this systematic literature review and meta-analysis was to identify and summarize the available evidence regarding the prevalence of DRM in Italy from pediatric to adult and older ages, and to project its global costs on the health care system. Methods: We performed a systematic literature search for articles on epidemiology of DRM in Italy published up to June 2021. Studies reporting data on the prevalence of DRM in community-dwelling individuals with chronic diseases, nursing home patients, and hospitalized patients (medical, surgery, and oncology patients), were selected for inclusion. Methodological quality of the studies was assessed by two independent reviewers using published criteria. An epidemiologic meta-analysis to obtain an aggregate estimate of prevalence of DRM was performed and a model for estimating the cost of illness, based on the application of epidemiologic results to official national hospitalization data, and attribution of relevant unit costs in the national context was constructed. Results: Sixty-seven studies reporting on the prevalence of DRM in Italian populations were included in the final selection; meta-analytical pooling yields mean prevalence estimates of about 50% and 30% in adult and pediatric hospitalized populations, respectively, with even higher findings for residents of long-term care facilities. Modeled projections of DRM-attributable yearly economic effects on the Italian health care system exceed 10 billion € in base case analysis, with the most optimistic estimate still exceeding 2.5 billion €. Conclusion: Although comparable in magnitude to data from previous studies in analogous international settings, the diffusion and effects of DRM in the Italian setting is impressive. Increased awareness of these data and proactive fostering of clinical nutrition services are warranted, as prompt identification and treatment of malnutrition have been shown to effectively improve clinical and economic results

Water birth: is the water an additional reservoir for group B streptococcus?

Objective: Water birth became popular in the last years, despite the fact that many questions like the risk of infection for the newborn remain unanswered. Group B streptococcal (GBS) infections in the newborn remain a challenge in obstetrics and neonatology. Method: We conducted a prospective trial to study the impact of water birth on the colonization rate of the bath water and, more importantly, the GBS-colonization rate of the newborn. Result: After water birth the bath water was significantly more often colonized with GBS than after immersion followed by a delivery in bed. The newborns, however, showed no difference in GBS colonization and there was even a trend towards less GBS colonization of the newborn after a water delivery. Conclusion: Regarding GBS colonization of the newborn during water birth there might be a wash out effect, which protects the children during the deliver

Antibiotic consumption in nursing homes of the Canton of Vaud: trends over the years 2009 - 2014

Background & Objectives: Excessive use of antibiotics in nursing homes was reported in several studies1-3. Surveillance of their use in nursing homes is essential to plan interventions fostering an appropriate use and to measure the impact of these interventions. The aims of the study were to describe the antibiotic consumption in nursing homes of the Canton of Vaud and to examine whether the antibiotic consumption was correlated to the urinary catheter use and to methicillin-resistant Staphylococcus aureus (MRSA) colonization. Methods: Data on the use of systemic antibiotics (class J01 of WHO Anatomical Therapeutic Chemical (ATC) system, 2015) were collected from the community pharmacies' annual invoice data including 13 nursing homes in 2009. The number of nursing homes in the database increased to 67 in 2014, representing 46% of all nursing homes of the Canton of Vaud and 54% of the available beds. Aggregated data were converted into defined daily doses (DDD) and antibiotic consumption expressed in number of defined daily doses per 1000 beds and per day (DDD/1000B/D). Proportion of urinary catheter use and MRSA colonization data were provided through a point prevalence study. Results: The total consumption of systemic antibiotics was 52.2 DDD/1000B/D in 2009 and 48.3 in 2014. Beta-lactam antibacterials other than penicillins, macrolides and other antibacterials (including nitrofurantoin) consumption increased resp. by 80%, 45% and 187% between 2009 and 2014, while the use of sulfonamides and trimethoprim decreased by 41%. Penicillin and quinolone use remained relatively stable between 2009 and 2014. Amoxicillin and clavulanic acid (oral) was the most common antibiotic prescribed (31% of the total use), followed by ciprofloxacin (oral) (20%) and nitrofurantoin (10%). Among nursing homes, we reported a large variation in antibiotic consumption from 6.8 to 164.6 DDD/1000B/D in 2014. No correlation was found between global antibiotic consumption and urinary catheter use and between quinolone consumption and proportion of MRSA in 2010 and 2011 (p>0.05). Discussion & Conclusions: This study is the first that analyzes longitudinal data of antibiotic consumption in nursing homes of the Canton of Vaud. The findings suggest that a large variation in antibiotic consumption exists among nursing homes. Thus, antibiotic stewardship programs should be implemented to promote a more accurate use

Urban wastewater treatment in african countries: Evidence from the hydroaid initiative

This study is based on the evidence collected during the “Technical e-Learning Course on Wastewater Treatment”, an international training project developed in 2020 in Italy by the Hydroaid Association, in collaboration with Turin Polytechnic. This work intended to address the sustainability of urban sanitation in various African countries, which the world of international cooperation has been looking at in recent years with growing interest. A comparative analysis of the current strategies and technological solutions was conducted. Data and information reported by the project participants were elaborated and verified. Four African countries—Benin, Egypt, Ethiopia, and Malawi—were considered and two relevant case studies among those proposed by the participants were presented. Starting from this analysis, significant elements about the status and coverage of wastewater management were extracted and reported. The analysis of existing wastewater treatment plants (WWTPs) allowed evaluating their design features and current status of operation. Considerations about the environmental, economic, social, and technical sustainability of wastewater treatment and management were finally reported. Conducting such an analysis provided support in identifying the best practices and the most recurrent problems linked to the various African contexts, which need to be considered for a complete definition of the planning strategy for accessible, efficient, and sustainable sanitation infrastructures

Optimized hybrid ensemble learning approaches applied to very short-term load forecasting

The significance of accurate short-term load forecasting (STLF) for modern power systems’ efficient and secure operation is paramount. This task is intricate due to cyclicity, non-stationarity, seasonality, and nonlinear power consumption time series data characteristics. The rise of data accessibility in the power industry has paved the way for machine learning (ML) models, which show the potential to enhance STLF accuracy. This paper presents a novel hybrid ML model combining Gradient Boosting Regressor (GBR), Extreme Gradient Boosting (XGBoost), k-Nearest Neighbors (kNN), and Support Vector Regression (SVR), examining both standalone and integrated, coupled with signal decomposition techniques like STL, EMD, EEMD, CEEMDAN, and EWT. Through Automated Machine Learning (AutoML), these models are integrated and their hyperparameters optimized, predicting each load signal component using data from two sources: The National Operator of Electric System (ONS) and the Independent System Operators New England (ISO-NE), boosting prediction capacity. For the 2019 ONS dataset, combining EWT and XGBoost yielded the best results for very short-term load forecasting (VSTLF) with an RMSE of 1,931.8 MW, MAE of 1,564.9 MW, and MAPE of 2.54%. These findings highlight the necessity for diverse approaches to each VSTLF problem, emphasizing the adaptability and strength of ML models combined with signal decomposition techniques