Assessment of Human Papillomavirus Vaccination in Primary Care Among Swiss University Students

Importance: Human papillomavirus vaccination coverage rates lie below desired thresholds in Switzerland. Because general practitioners are the main contact for the relatively rare health issues of many Swiss young adults, primary care offers an important opportunity to provide catch-up human papillomavirus vaccination. Objective: To examine the knowledge, experiences, and attitudes of Swiss university students in the context of receiving human papillomavirus vaccination during primary care visits. Design, setting, and participants: This self-administered, cross-sectional, web-based survey study was conducted among students of 3 universities and 1 educational institution for health professions in the Swiss Canton of Zurich. Specific questions about human papillomavirus vaccination experience were directed to respondents who had received at least 1 dose administered by a general practitioner. Responses were collected during 12-week intervals between November 11, 2020, and April 7, 2021, and data were analyzed from August 3 to August 30, 2022. Main outcomes and measures: The primary outcome was whether human papillomavirus vaccination had been administered on the patient's or the general practitioner's initiative. Results: The responses of 5524 participants (median [IQR] age, 23 [21-25] years; 3878 women [70.2%]) were analyzed. The survey completion rate was 90.9% (5524 of 6076 students who consented to participate). A total of 2029 respondents (1792 women [46.2%] and 237 men [14.6%]) reported having received at least 1 human papillomavirus vaccination dose, of whom 740 (36.5%) had received at least 1 dose administered by a general practitioner. Among these, 190 respondents (25.7%) reported that vaccine administration had occurred on their request rather than on their general practitioner's initiative. Among all respondents, 4778 (86.5%) wanted to obtain more information about human papillomavirus vaccination at a general practitioner's office, and 2569 (55.3%) rated acute consultations in general practice as inappropriate for addressing human papillomavirus vaccination. Conclusions and relevance: The findings of this survey study of Swiss university students suggest that primary care shows a high potential for increasing human papillomavirus vaccination coverage rates in Switzerland. However, there was room for improvement in the proactivity of general practitioners, especially with men, and in the attitudes of students toward the appropriateness of acute consultations in general practice for addressing human papillomavirus vaccination

Stochasticity from function -- why the Bayesian brain may need no noise

An increasing body of evidence suggests that the trial-to-trial variability of spiking activity in the brain is not mere noise, but rather the reflection of a sampling-based encoding scheme for probabilistic computing. Since the precise statistical properties of neural activity are important in this context, many models assume an ad-hoc source of well-behaved, explicit noise, either on the input or on the output side of single neuron dynamics, most often assuming an independent Poisson process in either case. However, these assumptions are somewhat problematic: neighboring neurons tend to share receptive fields, rendering both their input and their output correlated; at the same time, neurons are known to behave largely deterministically, as a function of their membrane potential and conductance. We suggest that spiking neural networks may, in fact, have no need for noise to perform sampling-based Bayesian inference. We study analytically the effect of auto- and cross-correlations in functionally Bayesian spiking networks and demonstrate how their effect translates to synaptic interaction strengths, rendering them controllable through synaptic plasticity. This allows even small ensembles of interconnected deterministic spiking networks to simultaneously and co-dependently shape their output activity through learning, enabling them to perform complex Bayesian computation without any need for noise, which we demonstrate in silico, both in classical simulation and in neuromorphic emulation. These results close a gap between the abstract models and the biology of functionally Bayesian spiking networks, effectively reducing the architectural constraints imposed on physical neural substrates required to perform probabilistic computing, be they biological or artificial

Influenza vaccination uptake among at-risk patients in Switzerland-The potential of national claims data for surveillance

BACKGROUND Swiss national surveillance of influenza vaccination uptake rates (VURs) relies on self-reported vaccination status. The aim of this study was to determine VURs among at-risk patients, namely, patients ≥65 of age and adult patients with chronic diseases, using claims data, instead of self-reported measures, to investigate factors of vaccine uptake, and to assess different methodological approaches to conduct vaccination surveillance. METHODS In this retrospective cross-sectional analysis, we determined VURs in three influenza seasons (2015/2016-2017/2018). Medication, diagnosis, or medical services claims were used as triggers to identify patients. For the calculation of VURs in patients with chronic diseases, we identified those by triggers in the given season only (Model 1) and in the given and previous seasons (Model 2). Regression analysis was used to identify factors associated with vaccination status. RESULTS Data from 214,668 individual patients were analyzed. VURs over all seasons ranged from 18.4% to 19.8%. Most patients with chronic diseases were identified with the medication trigger, and we found no clinical significant differences in VURs comparing both models. Having a chronic disease, age, male gender, and regular health care provider visits were associated with increased odds of being vaccinated. CONCLUSIONS VURs were below the recommended thresholds, and our analysis highlighted the need for efforts to increase VURs. We assessed the identification of chronic diseases by medication claims and the calculation of VURs based on data of the given season only as an effective approach to conduct vaccination surveillance. Claims data-based surveillance may complete the national surveillance

Radiation dose optimization in pediatric temporal bone computed tomography: influence of tube tension on image contrast and image quality

Introduction: The purpose of this experimental study was to investigate the effect of tube tension reduction on image contrast and image quality in pediatric temporal bone computed tomography (CT). Methods: Seven lamb heads with infant-equivalent sizes were scanned repeatedly, using four tube tensions from 140 to 80kV while the CT-Dose Index (CTDI) was held constant. Scanning was repeated with four CTDI values from 30 to 3mGy. Image contrast was calculated for the middle ear as the Hounsfield unit (HU) difference between bone and air and for the inner ear as the HU difference between bone and fluid. The influence of tube tension on high-contrast detail delineation was evaluated using a phantom. The subjective image quality of eight middle and inner ear structures was assessed using a 4-point scale (scores 1-2 = insufficient; scores 3-4 = sufficient). Results: Middle and inner ear contrast showed a near linear increase with tube tension reduction (r = −0.94/−0.88) and was highest at 80kV. Tube tension had no influence on spatial resolution. Subjective image quality analysis showed significantly better scoring at lower tube tensions, with highest image quality at 80kV. However, image quality improvement was most relevant for low-dose scans. Conclusions: Image contrast in the temporal bone is significantly higher at low tube tensions, leading to a better subjective image quality. Highest contrast and best quality were found at 80kV. This image quality improvement might be utilized to further reduce the radiation dose in pediatric low-dose CT protocol

Development of smart boulders to monitor mass movements via the Internet of Things: A pilot study in Nepal

Boulder movement can be observed not only in rockfall activity, but also in association with other landslide types such as rockslides, soil slides in colluvium originating from previous rockslides, and debris flows. Large boulders pose a direct threat to life and key infrastructure in terms of amplifying landslide and flood hazards as they move from the slopes to the river network. Despite the hazard they pose, boulders have not been directly targeted as a mean to detect landslide movement or used in dedicated early warning systems. We use an innovative monitoring system to observe boulder movement occurring in different geomorphological settings before reaching the river system. Our study focuses on an area in the upper Bhote Koshi catchment northeast of Kathmandu, where the Araniko highway is subjected to periodic landsliding and floods during the monsoons and was heavily affected by coseismic landslides during the 2015 Gorkha earthquake. In the area, damage by boulders to properties, roads, and other key infrastructure, such as hydropower plants, is observed every year. We embedded trackers in 23 boulders spread between a landslide body and two debris flow channels before the monsoon season of 2019. The trackers, equipped with accelerometers, can detect small angular changes in the orientation of boulders and large forces acting on them. The data can be transmitted in real time via a long-range wide-area network (LoRaWAN®) gateway to a server. Nine of the tagged boulders registered patterns in the accelerometer data compatible with downslope movements. Of these, six lying within the landslide body show small angular changes, indicating a reactivation during the rainfall period and a movement of the landslide mass. Three boulders located in a debris flow channel show sharp changes in orientation, likely corresponding to larger free movements and sudden rotations. This study highlights the fact that this innovative, cost-effective technology can be used to monitor boulders in hazard-prone sites by identifying the onset of potentially hazardous movement in real time and may thus establish the basis for early warning systems, particularly in developing countries where expensive hazard mitigation strategies may be unfeasible

Safety and tolerability of sirolimus treatment in patients with autosomal dominant polycystic kidney disease

Background. We initiated a randomized controlled clinical trial to assess the effect of sirolimus on disease progression in patients affected by autosomal dominant polycystic kidney disease (ADPKD). Here we report the preliminary safety results of the first 6 months of treatment. Method. A total of 25 patients were randomized to sirolimus 2 mg/day and 25 patients to no treatment except standard care. Treatment adherence was monitored electronically. At baseline and at Month 6, laboratory parameters were analysed and the urinary protein profile in 24-h urine collections was determined. Results. Both treatment groups were well balanced for age, sex and renal function. In 94.1 ± 11.4% of the study days, patients in the sirolimus group were exposed to the drug when assuming a therapeutic efficacy duration of 30 h. At Month 6, the mean sirolimus dose and trough level were 1.28 ± 0.71 mg/day and 3.8 ± 1.9 μg/l, respectively. Glomerular (albumin, transferrin, IgG) and tubular (retinol-binding protein, α1-microglobulin) protein excretion remained unchanged. Glomerular filtration rate also did not change significantly. Haematological parameters were similar in both groups, except for a mild reduction of the mean corpuscular volume of erythrocytes in patients receiving sirolimus. Lipid levels were similar in both groups. Adverse events were transient and mild, and no grade 3 or 4 events occurred. The incidence of infections was similar in the sirolimus group (80%) and the standard group (88%). The most common gastrointestinal adverse events were mucositis (72% in the sirolimus group versus 16% in the standard group, P = 0.0001) and diarrhoea (36% in the sirolimus versus 20% in the standard group, P = 0.345). Conclusion. Treatment of ADPKD patients with sirolimus with a dose of 1-2 mg/day is safe and does not cause proteinuria or impairment of GFR. Treatment adherence was excellent. (ClinicalTrials.gov number, NCT00346918.