Estimating averted illnesses from influenza vaccination for children and pregnant women - El Salvador, Panama, and Peru, 2011-2018.

BACKGROUND: Estimating the burden of disease averted by vaccination can assist policymakers to implement, adjust, and communicate the value of vaccination programs. Demonstrating the use of a newly available modeling tool, we estimated the burden of influenza illnesses averted by seasonal influenza vaccination in El Salvador, Panama, and Peru during 2011-2017 among two influenza vaccine target populations: children aged 6-23 months and pregnant women. METHODS: We derived model inputs, including incidence, vaccine coverage, vaccine effectiveness, and multipliers from publicly available country-level influenza surveillance data and cohort studies. We also estimated changes in illnesses averted when countries' vaccine coverage was achieved using four different vaccine deployment strategies. RESULTS: Among children aged 6-23 months, influenza vaccination averted an estimated cumulative 2,161 hospitalizations, 81,907 medically-attended illnesses, and 126,987 overall illnesses during the study period, with a prevented fraction ranging from 0.3 % to 12.5 %. Among pregnant women, influenza vaccination averted an estimated cumulative 173 hospitalizations, 6,122 medically attended illnesses, and 16,412 overall illnesses, with a prevented fraction ranging from 0.2 % to 10.9 %. Compared to an influenza vaccine campaign with equal vaccine distribution during March-June, scenarios in which total cumulative coverage was achieved in March and April consistently resulted in the greatest increase in averted illness (23 %-3,129 % increase among young children and 22 %-3,260 % increase among pregnant women). DISCUSSION: Influenza vaccination campaigns in El Salvador, Panama, and Peru conducted between 2011 and 2018 prevented hundreds to thousands of influenza-associated hospitalizations and illnesses in young children and pregnant women. Existing vaccination programs could prevent additional illnesses, using the same number of vaccines, by achieving the highest possible coverage within the first two months of an influenza vaccine campaign.

WHO's Investigations and Studies, Unity Studies: A global initiative creating equitable opportunities for enhanced surveillance, operational research, capacity building, and global knowledge sharing.

The World Health Organization's Unity Studies global initiative provides a generic preparedness and readiness framework for conducting detailed investigations and epidemiological studies critical for the early and ongoing assessment of emerging respiratory pathogens of pandemic potential. During the COVID-19 pandemic, the initiative produced standardized investigation protocols and supported Member States to generate robust and comparable data to inform public health decision making. The subsequent iteration of the initiative is being implemented to develop revised and new investigation protocols, implementation toolkits and work to build a sustainable global network of sites, enabling the global community to be better prepared for the next emerging respiratory pathogen with epidemic or pandemic potential.

Biogenic Ag2O nanoparticles with "Hoja Santa" (Piper auritum) extract: characterization and biological capabilities.

The 'sacred leaf' or "Hoja Santa" (Piper auritum Kunth) has a great value for Mexican culture and has gained popularity worldwide for its excellent properties from culinary to remedies. To contribute to its heritage, in this project we proposed the green synthesis of silver oxide nanoparticles (Ag2O NPs) using an extract of "Hoja Santa" (Piper auritum) as a reducing and stabilizing agent. The synthesized Ag2O NPs were characterized by UV-Visible spectroscopy (plasmon located at 405 nm), X-ray diffraction (XRD) (particle size diameter of 10 nm), scanning electron microscopy (SEM) (particle size diameter of 13.62 ± 4.61 nm), and Fourier-transform infrared spectroscopy (FTIR) (functional groups from "Hoja Santa" attached to nanoparticles). Antioxidant capacity was evaluated using DPPH, ABTS and FRAP methods. Furthermore, the antimicrobial activity of NPs against a panel of clinically relevant bacterial strains, including both Gram-positive (Staphylococcus aureus) and Gram-negative bacteria (Salmonella Enteritidis and Escherichia coli O157:H7), was over 90% at concentrations of 200 µg/mL. Additionally, we assessed the antibiofilm activity of the NPs against Pseudomonas aeruginosa (reaching 98% of biofilm destruction at 800 µg/mL), as biofilm formation plays a crucial role in bacterial resistance and chronic infections. Moreover, we investigated the impact of Ag2O NPs on immune cell viability, respiratory burst, and phagocytic activity to understand their effects on the immune system.

DyMnO3: Synthesis, Characterization and Evaluation of Its Photocatalytic Activity in the Visible Spectrum.

DyMnO3 is a p-type semiconductor oxide with two crystal systems, orthorhombic and hexagonal. This material highlights its ferroelectric and ferromagnetic properties, which have been the subject of numerous studies. Nevertheless, its photocatalytic activity has been less explored. In this work, the photocatalytic activity of DyMnO3 is evaluated through the photodegradation of MG dye. For the synthesis of this oxide, a novel and effective method was used: polymer-decomposition. The synthesized powders contain an orthorhombic phase, with a range of absorbances from 300 to 500 nm and a band gap energy of 2.4 eV. It is also highlighted that, when using this synthesis method, some of the main diffraction lines related to the orthorhombic phase appear at 100 °C. Regarding its photocatalytic activity, it was evaluated under visible light (λ = 405 nm), reaching a photodegradation of approximately 88% in a period of 30 min. Photocurrent tests reveal a charge carrier separation (e-,h+) at a 405 nm wavelength. The main reactive oxygen species (ROS) involved in the photodegradation process were radicals, OH•, and photo-holes (h+). These results stand out because it is the first time that the photodegradation capability of this oxide in the visible spectrum has been evaluated.

Tannic acid-layered hydroxide salt hybrid: assessment of antibiofilm formation and foodborne pathogen growth inhibition.

Pathogenic bacteria in food are a public health problem worldwide. Polyphenolic bioactive compounds with antimicrobial activity and antioxidant capacity represent a tangible alternative to overcome this problem. To preserve the biological functions of phenolic compounds such as tannic acid, which has been described to possess antioxidant and antimicrobial activity, this study describes the synthesis of a zinc nanohydroxide to stabilize its properties. Characterization by XRD, FT-IR, SEM, DLS, and UV-vis evidenced the presence of tannic acid in the nanohybrid TA-Zn-LHS which was further confirmed by DPPH, ABTS and FRAP antioxidant activity techniques. Bacterial growth inhibition of Escherichia coli ATCC 8739, Salmonella Enteritidis, and Staphylococcus aureus ATCC 25923 was over 80% at 50 mg/mL of the TA-Zn-LHS and over 90% with Zn-LHS. Antibiofilm evaluation of these same strains showed biofilm formation inhibition > 90% and > 80% for Zn-LHS and TA-Zn-LHS, respectively. The toxicity evaluation of the materials in Artemia salina showed a classification of the materials as non-toxic to slightly toxic in concentrations up to 1 mg/mL. These results allow us to introduce a new nanohybrid useful for food safety with safe biological functions.

Development, characterization, and immunomodulation performance of spray-dried Moringa oleifera seed extract in Longfin yellowtail Seriola rivoliana.

Moringa oleifera is one of the most promising plants in aquaculture because it improves the health status, zootechnical parameters and resistance against diseases. This research evaluates the physicochemical, antioxidant values of spray-dried Moringa oleifera seed extract microencapsulates obtained at 140 and 180 °C with whey protein concentrate (WPC) and maltodextrin (MD) as wall materials in two different proportions: WPC 100% and WPC-MD (3:1). Also, immune response of peripheral blood leukocytes (PBL) of Longfin yellowtail Seriola rivoliana stimulated with spray-dried Moringa oleifera seed for 24 h was assessed. The physicochemical parameters show that the recovery yield for all the treatments was of 65% and microencapsulates demonstrated to be stable in the physicochemical tests with low solubilization times and protection against humidity. For WPC-MD (3:1)/140 °C, bioactive compound retention and antioxidant potential were higher than in other combinations. The immunological test show that any treatments was non-cytotoxic against peripheral blood leukocytes. WPC-MD (3:1)/140 °C treatment enhanced immune parameters as phagocytosis, respiratory burst, myeloperoxidase activities and nitric oxide production. Immune related genes as IL-1ß and TNF-α were up-regulated in those stimulated leukocytes with WPC-MD (3:1)/140 °C. The results suggest that this combination may be a good alternative for animal health as a medicinal and immunostimulant additive.

Determining the Photoelectrical Behavior and Photocatalytic Activity of an h-YMnO3 New Type of Obelisk-like Perovskite in the Degradation of Malachite Green Dye.

YMnO3 is a P-type semiconductor with a perovskite-type structure (ABO3). It presents two crystalline systems: rhombohedral and hexagonal, the latter being the most stable and studied. In the hexagonal system, Mn3+ ions are coordinated by five oxygen ions forming a trigonal bipyramid, and the Y3+ ions are coordinated by five oxygen ions. This arrangement favors its ferroelectric and ferromagnetic properties, which have been widely studied since 1963. However, applications based on their optical properties have yet to be explored. This work evaluates the photoelectric response and the photocatalytic activity of yttrium manganite in visible spectrum wavelengths. To conduct this, a rod-obelisk-shaped yttrium manganite with a reduced indirect bandgap value of 1.43 eV in its hexagonal phase was synthesized through the precipitation method. The synthesized yttrium manganite was elucidated by solid-state techniques, such as DRX, XPS, and UV-vis. It was non-toxic as shown by the 100% leukocyte viability of mice BALB/c.

[Assessment of the in vitro effect of intra and extracellular extracts of Lactobacillus against genotoxicity and oxidative stress caused by acrylamide]. / Evaluación del efecto in vitro de extractos intra y extracelulares de Lactobacillus contra la genotoxicidad y el estrés oxidativo causado por la acrilamida.

Introduction: Introduction: acrylamide is formed by the Maillard reaction and is found in many food products subjected to thermal processes, generating genotoxicity and DNA damage. Studies have reported that lactobacilli have the ability to generate compounds with antioxidant, antigenotoxic and antimutagenic activity, which is why the present work aims to evaluate the effect of Lactobacillus strains and their intra and extracellular extracts against genotoxicity and oxidative stress as caused by acrylamide. Methods: a strain of Lactobacillus casei Shirota and a strain of Lactobacillus reuteri NRRL B-14171 were used, both were cultured in MRS broth and subjected to mechanical and enzymatic treatments to obtain extra and intracellular extracts. Lymphocytes were cultured in RPMI medium. Lipid peroxidation was evaluated by TBARS and the antioxidant capacity was measured in the extra and intracellular extracts with the ABTS technique, also using a strain of Saccharomyces cerevisiae RC 212 as a model. The reduction of lipid peroxidation in lymphocytes was measured by TBARS and the reduction of genotoxicity by reducing the formation of micronuclei in lymphocytes. Results: both strains evaluated, as well as their intra and extracellular extracts, showed the ability to counteract oxidative stress and genotoxicity caused by acrylamide. Conclusion: the results found suggest that the use of intra and extracellular extracts of both strains could be an alternative to reduce the effects of genotoxicity and oxidative stress caused by acrylamide without the need for a viable structure.

Introducción: Introducción: la acrilamida se forma mediante la reacción de Maillard, por lo que se encuentra en muchos productos alimenticios sometidos a procesos térmicos, generando genotoxicidad y daños al ADN. Los estudios han reportado que los lactobacilos tienen la capacidad de generar compuestos con actividad antioxidante, antigenotóxica y antimutagénica, y es por esto que el presente trabajo pretende evaluar el efecto de cepas de Lactobacillus y sus extractos intra y extracelulares contra la genotoxicidad y el estrés oxidativo causado por la acrilamida. Métodos: se empleó una cepa de Lactobacillus casei Shirota y una cepa de Lactobacillus reuteri NRRL B-14171. Ambas fueron cultivadas en caldo MRS y sometidas a tratamientos mecánicos y enzimáticos para obtener los extractos extra e intracelulares. Los linfocitos fueron cultivados en medio RPMI, la peroxidación lipídica se evaluó por TBARS y la capacidad antioxidante se midió en los extractos extra e intracelulares con la técnica ABTS, empleando además una cepa de Saccharomyces cerevisiae RC 212 como modelo. La reducción de la peroxidación lipídica en los linfocitos se midió por TBARS y la reducción de la genotoxicidad mediante la reducción de la formación de micronúcleos en los linfocitos. Resultados: ambas cepas evaluadas, así como sus extractos intra y extracelulares, mostraron capacidad de contrarrestar el estrés oxidativo y la genotoxicidad causada por la acrilamida. Conclusión: los resultados encontrados, sugieren que el empleo de extractos intra y extracelulares de ambas cepas podría ser una alternativa para reducir los efectos de genotoxicidad y estrés oxidativo causados por la acrilamida sin la necesidad de requerir una estructura viable.

Hospitalizações e óbitos associados à influenza no Brasil: uma estimativa da incidência no período de 2010 a 2016 / Influenza burden of disease in Brazil 2010 to 2016

Objetivo: Estimar a incidência de hospitalizações e óbitos associados à influenza no Brasil de 2010 a 2016. Método: Foram utilizados registros de altas hospitalares e óbitos pelos códigos CID J09-J18, dados de vigilância laboratorial de influenza e projeções censitárias populacionais ajustadas pelo percentual de usuários de serviços públicos de saúde. Foi realizada meta-análise para determinar as incidências de hospitalizações e óbitos por faixa etária nas cinco regiões geográficas do Brasil. Resultados: As estimativas foram de 645.661 hospitalizações e 160.089 óbitos por influenza, de 2010 a 2016. As maiores incidências de internação ocorreram em idosos com ≥65 anos (258,6/100.000) e crianças <5 anos (180,1/100.000), enquanto os óbitos se destacaram entre os indivíduos de ≥65 anos (142,9/100.000) e de 50 a 64 anos (22,1/100.000). Foram encontradas diferenças regionais, com as taxas mais elevadas nas regiões Centro-Oeste, Sudeste e Sul. Conclusão: A carga da influenza no Brasil é preocupante, com elevado número de hospitalizações e óbitos pela doença. As diferenças regionais e de faixa etária fornecem evidências para apoiar a política de vacinação e o aprimoramento do sistema de vigilância da influenza.

Human lactoferrin from breast milk: characterization by HPLC and its in vitro antibiofilm performance.

Preterm infants are at high risk of infection due to opportunistic bacteria as Pseudomonas aeruginosa, causing infections among infants in neonatal intensive care units. Human lactoferrin (hLf) is a multifunctional protein and one of the most abundant in breast milk, and plays an important role in prevention of different infections in neonates. This work offers a strategy to obtain a lyophilisate of purified lactoferrin from breast milk. In addition, a reliable HPLC method for quantification of lactoferrin with a linear quantification range of 0.040-0.140 mg/mL with selectivity, accuracy and repeatability, is described. Lyophilized hLf was obtained by purification through a heparin affinity column followed by ultrafiltration with a 30 kDa membrane. The final solution was lyophilized and the product was analyzed using HPLC method, recovering about 70% of initial lactoferrin in the sample. This molecule was elucidated through FTIR spectroscopy and SDS-PAGE electrophoresis. In addition, the capacity against biofilm formation of P. aeruginosa was demonstrated with 75% of inhibition at 6 mg/mL. These results suggest that lyophilized hLf can be obtained by purification of breast milk and that it can provide antibiofilm activity against P. aeruginosa.

Knowledge, attitudes, and practices regarding seasonal influenza vaccination during pregnancy in Costa Rica: A mixed-methods study.

BACKGROUND: Influenza increases stillbirth risk, morbidity and mortality in pregnant women. Vaccination protects pregnant women against severe disease and indirectly protects their infants, but coverage among pregnant women remains low worldwide. We aimed to describe knowledge, attitudes, and practices (KAP) regarding seasonal influenza vaccination among postpartum women and prenatal care physicians in Costa Rica. METHODS: We conducted cross-sectional KAP surveys to women one to three days after childbirth at Costa Rican Social Security Fund maternity hospitals, and obstetricians and general practitioners who provided prenatal care in 2017. Principal components analysis, multiple imputation, and logistic regression were used to examine associations between influenza vaccination and demographics, prenatal care, and sources of information-separately for postpartum women and physicians. We also held two focus groups of six healthcare workers each to further describe vaccination KAP. RESULTS: We surveyed 642 postpartum women and 146 physicians in maternity hospitals in five Costa Rican provinces of whom 85.5 % (95 % CI: 82.6 %-88.0 %) and 57.9 % (95 % CI: 49.6 %-65.7 %) were vaccinated for influenza, respectively. Factors associated with influenza vaccination for postpartum women included tetanus vaccination (aOR: 3.62, 95 % CI: 1.89-6.92); received vaccination recommendations from clinicians during prenatal check-ups (aOR: 3.39, 95 % CI: 2.06-5.59); had other children in household vaccinated for influenza (aOR: 2.25, 95 % CI: 1.08-4.68); and secondary/university education (aOR: 0.15-0.31) with no formal education as reference. For postpartum women, reasons for vaccination were perceived benefits for mother and infant, whereas not being offered vaccines was most cited for non-vaccination. Most prenatal care physicians recommended influenza vaccines during prenatal check-ups but believed vaccination causes flu-like symptoms. CONCLUSION: Vaccination campaigns and provisions of free vaccines effectively increased knowledge and coverage among women in Costa Rica. To improve access, women should be offered vaccines during prenatal care appointments. Educating healthcare workers about vaccine benefits for themselves and patients is needed to mitigate safety concerns.

Nanohybrid of Thymol and 2D Simonkolleite Enhances Inhibition of Bacterial Growth, Biofilm Formation, and Free Radicals.

Due to the current concerns against opportunistic pathogens and the challenge of antimicrobial resistance worldwide, alternatives to control pathogen growth are required. In this sense, this work offers a new nanohybrid composed of zinc-layered hydroxide salt (Simonkolleite) and thymol for preventing bacterial growth. Materials were characterized with XRD diffraction, FTIR and UV-Vis spectra, SEM microscopy, and dynamic light scattering. It was confirmed that the Simonkolleite structure was obtained, and thymol was adsorbed on the hydroxide in a web-like manner, with a concentration of 0.863 mg thymol/mg of ZnLHS. Absorption kinetics was described with non-linear models, and a pseudo-second-order equation was the best fit. The antibacterial test was conducted against Escherichia coli O157:H7 and Staphylococcus aureus strains, producing inhibition halos of 21 and 24 mm, respectively, with a 10 mg/mL solution of thymol-ZnLHS. Moreover, biofilm formation of Pseudomonas aeruginosa inhibition was tested, with over 90% inhibition. Nanohybrids exhibited antioxidant activity with ABTS and DPPH evaluations, confirming the presence of the biomolecule in the inorganic matrix. These results can be used to develop a thymol protection vehicle for applications in food, pharmaceutics, odontology, or biomedical industries.

Self-medication and ILI etiologies among individuals presenting at pharmacies with influenza-like illness: Guatemala City, 2018 influenza season.

OBJECTIVES: We aimed to characterize the proportion of clients presenting to community pharmacies with influenza-like illness (ILI) and the severity of their illness; the proportion with detectable influenza A, influenza B, and other pathogens (i.e., parainfluenza I, II, and III, adenovirus, respiratory syncytial virus, human metapneumovirus); and to describe their self-medication practices. METHODS: A cross-sectional study was conducted in six pharmacies in Guatemala City. Study personnel collected nasopharyngeal and oropharyngeal swabs from participants who met the ILI case definition and who were self-medicating for the current episode. Participants were tested for influenza A and B and other pathogens using real-time RT-PCR. Participants' ILI-associated self-medication practices were documented using a questionnaire. RESULTS: Of all patients entering the pharmacy during peak hours who responded to a screening survey (n = 18,016) 6% (n = 1029) self-reported ILI symptoms, of which 45% (n = 470/1029) met the study case definition of ILI. Thirty-one percent (148/470) met inclusion criteria, of which 87% (130/148) accepted participation and were enrolled in the study. Among 130 participants, nearly half tested positive for viral infection (n = 55, 42.3%) and belonged to groups at low risk for complications from influenza. The prevalence of influenza A was 29% (n = 35). Thirteen percent of the study population (n = 17) tested positive for a respiratory virus other than influenza. Sixty-four percent of participants (n = 83) reported interest in receiving influenza vaccination if it were to become available in the pharmacy. Medications purchased included symptom-relieving multi-ingredient cold medications (n = 43/100, 43%), nonsteroidal anti-inflammatory drugs (n = 23, 23%), and antibiotics (n = 16, 16%). Antibiotic use was essentially equal among antibiotic users regardless of viral status. The broad-spectrum antibiotics ceftriaxone and azithromycin were the most common antibiotics purchased. CONCLUSIONS: During a typical influenza season, a relatively low proportion of all pharmacy visitors were experiencing influenza symptoms. A high proportion of clients presenting to pharmacies with ILI tested positive for a respiratory virus. Programs that guide appropriate use of antibiotics in this population are needed and become increasingly important during pandemics caused by respiratory viral pathogens.

Influenza A virus circulation in backyard animals in the Pacific coast of Guatemala, 2013-2014.

Due to their documented epidemiological relevance as hosts for influenza A viruses (IAV), humans, poultry and pigs in backyard production systems (BPS) within wetlands could be key to the emergence of novel IAV variants able to transmit between humans or animals. To better understand the circulation of IAV at the human-animal interface of BPS within wetlands, we studied IAV in backyard duck flocks and pig herds in the Pacific Coast of Guatemala. From April 2013 to October 2014, we estimated the monthly IAV per cent seropositive and viral positive flocks and herds in two resource-limited communities. We detected antibodies in sera against the IAV nucleoprotein through ELISA. We also detected IAV viral RNA in respiratory (ducks and pigs) and cloacal (ducks) swabs through rRT-PCR directed at the matrix gene. We attempted viral isolation in eggs or MDCK cells followed by sequencing from swabs positive for IAV. During our study period, IAV seropositivity in duck flocks was 38%, and viral positivity was 23% (n = 86 BPS sampled). IAV seropositivity in pig herds was 42%, and viral positivity was 20% (n = 90 BPS sampled). Both flocks and herds had detectable antibodies against IAV mostly year-round, and IAV was detected in several months. We isolated an H3N2 virus from one pig sampled at the end of 2013. Standard nucleotide BLAST searches indicate that the isolated virus was similar to seasonal viruses circulating in humans, suggesting human-to-pig transmission. Our data show concurrent circulation of IAV in multiple species of poultry and pigs that were commingled in rudimentary conditions in proximity to humans, but no significant risk factors could be identified.

Estimating the impact of the COVID-19 pandemic on diagnosis and survival of five cancers in Chile from 2020 to 2030: a simulation-based analysis.

BACKGROUND: The COVID-19 pandemic has strained health system capacity worldwide due to a surge of hospital admissions, while mitigation measures have simultaneously reduced patients' access to health care, affecting the diagnosis and treatment of other diseases such as cancer. We estimated the impact of delayed diagnosis on cancer outcomes in Chile using a novel modelling approach to inform policies and planning to mitigate the forthcoming cancer-related health impacts of the pandemic in Chile. METHODS: We developed a microsimulation model of five cancers in Chile (breast, cervix, colorectal, prostate, and stomach) for which reliable data were available, which simulates cancer incidence and progression in a nationally representative virtual population, as well as stage-specific cancer detection and survival probabilities. We calibrated the model to empirical data on monthly detected cases, as well as stage at diagnosis and 5-year net survival. We accounted for the impact of COVID-19 on excess mortality and cancer detection by month during the pandemic, and projected diagnosed cancer cases and outcomes of stage at diagnosis and survival up to 2030. For comparison, we simulated a no COVID-19 scenario in which the impacts of COVID-19 on excess mortality and cancer detection were removed. FINDINGS: Our modelling showed a sharp decrease in the number of diagnosed cancer cases during the COVID-19 pandemic, with a large projected short-term increase in future diagnosed cases. Due to the projected backlog in diagnosis, we estimated that in 2021 there will be an extra 3198 cases (95% uncertainty interval [UI] 1356-5017) diagnosed among the five modelled cancers, an increase of nearly 14% compared with the no COVID-19 scenario, falling to a projected 10% increase in 2022 with 2674 extra cases (1318-4032) diagnosed. As a result of delayed diagnosis, we found a worse stage distribution for detected cancers in 2020-22, which is estimated to lead to 3542 excess cancer deaths (95% UI 2236-4816) in 2022-30, compared with the no COVID-19 scenario, among the five modelled cancers, most of which (3299 deaths, 2151-4431) are projected to occur before 2025. INTERPRETATION: In addition to a large projected surge in diagnosed cancer cases, we found that delays in diagnosis will result in worse cancer stage at presentation, leading to worse survival outcomes. These findings can help to inform surge capacity planning and highlight the importance of ensuring appropriate health system capacity levels to detect and care for the increased cancer cases in the coming years, while maintaining the timeliness and quality of cancer care. Potential delays in treatment and adverse impacts on quality of care, which were not considered in this model, are likely to contribute to even more excess deaths from cancer than projected. FUNDING: Harvard TH Chan School of Public Health. TRANSLATIONS: For the Spanish and Portuguese translations of the abstract see Supplementary Materials section.

Knowledge, attitudes, and practices for the use of seasonal influenza vaccination, healthcare workers, Costa Rica.

INTRODUCTION: Annual seasonal influenza vaccination in healthcare workers prevents nosocomial transmission to patients, coworkers, and visitors, and reduces absenteeism. This study aimed to describe knowledge, attitudes, and practices (KAP) of seasonal influenza vaccine among public healthcare workers attending patients in Costa Rica. METHODOLOGY: We conducted a cross-sectional survey of healthcare personnel attending patients in public hospitals in 2017-2018. Frequency distributions of demographics, vaccination KAP, sources of information, clinical manifestations and reasons for non-vaccination were reported. Logistic regression was used to analyze associations between exposures of interest (demographics, sources of information, knowledge, attitudes towards vaccination) and self-reported influenza vaccination. RESULTS: We surveyed 747 healthcare workers in 2017-2018. Of 706 participants who knew their vaccination status, 55.7% were vaccinated for seasonal influenza. Only 20.7% of participants knew the influenza vaccine was an inactivated virus, and 94.6% believed the vaccine causes flu-like symptoms. Factors associated with current influenza vaccination were vaccination in previous year (aOR: 8.13; 95% CI: 5.65-11.71) and believed influenza vaccination may be harmful (aOR: 0.62; 95% CI: 0.44-0.89). Reasons for non-vaccination included fear of adverse effects and access limitations. CONCLUSIONS: Suboptimal influenza vaccination among healthcare workers may be attributed to misconceptions about the vaccine and limited engagement strategies focusing on healthcare workers. Appropriate interventions are needed to increase healthcare worker vaccination rates and improve their knowledge and beneficence, which would improve patient safety in hospitals.

Sensorless Speed Estimation for the Diagnosis of Induction Motors via MCSA. Review and Commercial Devices Analysis.

Sensorless speed estimation has been extensively studied for its use in control schemes. Nevertheless, it is also a key step when applying Motor Current Signature Analysis to induction motor diagnosis: accurate speed estimation is vital to locate fault harmonics, and prevent false positives and false negatives, as shown at the beginning of the paper through a real industrial case. Unfortunately, existing sensorless speed estimation techniques either do not provide enough precision for this purpose or have limited applicability. Currently, this is preventing Industry 4.0 from having a precise and automatic system to monitor the motor condition. Despite its importance, there is no research published reviewing this topic. To fill this gap, this paper investigates, from both theoretical background and an industrial application perspective, the reasons behind these problems. Therefore, the families of sensorless speed estimation techniques, mainly conceived for sensorless control, are here reviewed and thoroughly analyzed from the perspective of their use for diagnosis. Moreover, the algorithms implemented in the two leading commercial diagnostic devices are analyzed using real examples from a database of industrial measurements belonging to 79 induction motors. The analysis and discussion through the paper are synthesized to summarize the lacks and weaknesses of the industry application of these methods, which helps to highlight the open problems, challenges and research prospects, showing the direction in which research efforts have to be made to solve this important problem.

Seismic and Aseismic Fault Slip During the Initiation Phase of the 2017 M W = 6.9 Valparaíso Earthquake.

Transient deformation associated with foreshocks activity has been observed before large earthquakes, suggesting the occurrence of a detectable preseismic slow slip during the initiation phase. A critical issue consists in discriminating the relative contributions from seismic and aseismic fault slip during the preparation phase of large earthquakes. We focus on the April-May 2017 Valparaíso earthquake sequence, which involved a M W  = 6.9 earthquake preceded by intense foreshock activity. To assess the relative contribution of seismic and aseismic slip, we compare surface displacement predicted from foreshocks source models with transient motion measured prior to the mainshock. The comparison between observed and predicted displacements shows that only half of the total displacement can be explained by the contribution of foreshocks. This result suggests the presence of aseismic pre-slip during an initiation phase preceding the mainshock.

Knowledge, attitudes, and practices of seasonal influenza vaccination in healthcare workers, Honduras.

BACKGROUND: Seasonal influenza is a highly contagious vaccine-preventable disease that may cause high morbidity and mortality in susceptible populations. Healthcare workers are a priority group for seasonal influenza vaccination to protect them from contracting influenza and prevent nosocomial transmission to patients. This study aimed to evaluate knowledge, attitudes, and practices (KAP) of seasonal influenza vaccination among healthcare workers in Honduras. METHOD: From August 24 to October 21, 2018, we conducted a cross-sectional KAP survey regarding seasonal influenza vaccination to a random sample of healthcare workers who attended patients in hospitals of the Ministry of Health of Honduras (SESAL) and Honduran Social Security Institute (IHSS). We reported frequency distributions of demographics, vaccination KAP, sources of information, and reasons for non-vaccination. We used principal components factor analysis to create knowledge and attitude scores. We used linear regression to analyze associations between demographics and sources of information about the influenza vaccine, and knowledge and attitude scores. We used logistic regression to analyze associations between demographics, sources of information, knowledge scores, and attitude scores, and influenza vaccination. RESULT: We surveyed 947 healthcare workers who attended patients in 13 SESAL hospitals and two IHSS hospitals. Only 4.6% of participants knew the seasonal influenza vaccine was composed of inactivated viruses, 94.7% believed vaccination causes flu-like symptoms, and 52.0% were vaccinated for influenza in 2018. Knowledge scores were lower for nursing assistants and other healthcare professionals compared to doctors, and higher for healthcare workers who attended a healthcare facility training (P-values≤0.030). Attitude scores were higher for healthcare workers who attended ≥11 patients per day having ≤10 patients per day as reference, self-reported influenza vaccination in previous year, and cited trainings and informal information at the healthcare facility as sources of information for influenza vaccination (P-values≤0.030). Factors associated with self-reported vaccination were self-reported influenza vaccination in previous year (aOR: 7.61; 95% CI: 5.24-11.04), attitude score (aOR: 1.14; 95% CI: 1.07-1.21), and worked in a SESAL hospital (aOR: 1.73; 95% CI: 1.12-2.68) having IHSS as reference. CONCLUSION: Although influenza vaccination is required by law in Honduras and available for free in public health centers, coverage of healthcare workers in 2018 was half that reported in 2017. Lower coverage may be attributed to misconceptions of vaccination side effects.

Workflow optimization in a clinical laboratory using Lean management principles in the pre-analytical phase.

BACKGROUND: The application of the Lean methodology in clinical laboratories can improve workflow and user satisfaction through the efficient delivery of analytical results. The purpose of this study was to optimise delivery times of the test results at a clinical laboratory, using Lean management principles in the pre-analytical phase. METHODS: A prospective study with a quasi-experimental design was implemented. Staff functions were restructured and sample flows were modified. Delivery times of clinical results (glucose and haematocrit; 6648 data) from the Medicine and Adult Emergency services for years 2017 and 2018 were compared. RESULTS: A reduction (p < 0.05) in turnaround times in the delivery of glucose test results at the adult emergency service was observed (84 to 73 min, 13%, pre and post). In addition, there was a non-significant reduction in the turnaround times for glucose (Medicine) and haematocrit in both services. In the analytical and post-analytical phase (not intervened), an increase in turnaround times was observed in some cases. CONCLUSIONS: Other studies have indicated that the application of the Lean methodology in clinical laboratories improves workflow, increasing effectiveness and efficiency. This study showed an improvement in the delivery time of test results (glucose - Emergency), giving rise to a culture of cooperation and continuous improvement. It would, however, be essential to address the management model integrating the analytical and post-analytical phases.