Gender differences and influenza-associated mortality in hospitalized influenza A patients during the 2018/19 season.

BACKGROUND: In this study we analyzed gender differences in the clinical presentation of patients with molecular confirmed influenza A. Additionally, we tried to identify predictors of influenza-associated mortality. MATERIALS/METHODS: In this prospective observational multi-center-study we included all influenza-positive patients ≥ 18 years who were hospitalized and treated on flu-isolation-wards in three hospitals in Vienna during the 2018/19 influenza season. Diagnoses were made via Cobas® Liat® POCT. RESULTS: 490 Patients (48.8% female) tested positive for influenza A. Female patients were older (median age 76 years vs. 70 years, p < 0.001). Male patients had a higher rate of chronic liver disease in history (8.8% vs. 2.9%, p = 0.006), myositis (11.7% vs. 3.1%, p < 0.001) and ICU admissions (9.6% vs. 4.6%, p = 0.03). The in-hospital mortality rate was 4.3% and increased to 9.5% during the 90-day follow-up period. Female patients > 75 years had a significantly higher in-hospital mortality rate than ≤ 75-year-old females (9.2% vs. 1.7%, p = 0.019). This effect was not observed in male patients (5.4% vs. 1.9%, p = ns). Age > 75 years (OR 5.49, 95% CI 1.10-27.43), acute heart failure (OR 3.56, 95% CI 1.03-12.05) and ICU admission (OR 6.1, 95% CI 0.98-37.91) were predictors for in-hospital mortality for female patients, while any malignancy (OR 9.4, 95% CI 1.90-46.54) and ICU admission (OR 7.05, 95% CI 1.44-34.55) were predictors in male patients. CONCLUSIONS: Gender is associated with differences in clinical presentation and complications of influenza A virus infection. Women with acute heart failure or aged > 75 years have an increased risk of influenza associated in-hospital mortality, while ICU admission and any malignancy are predictors for male patients. Mortality rates in patients > 75 years are 5-10 times higher compared to their non-hospitalized influenza-negative Austrian counterparts.

Evidence against solar influence on nuclear decay constants.

The hypothesis that proximity to the Sun causes variation of decay constants at permille level has been tested and disproved. Repeated activity measurements of mono-radionuclide sources were performed over periods from 200 days up to four decades at 14 laboratories across the globe. Residuals from the exponential nuclear decay curves were inspected for annual oscillations. Systematic deviations from a purely exponential decay curve differ from one data set to another and are attributable to instabilities in the instrumentation and measurement conditions. The most stable activity measurements of alpha, beta-minus, electron capture, and beta-plus decaying sources set an upper limit of 0.0006% to 0.008% to the amplitude of annual oscillations in the decay rate. Oscillations in phase with Earth's orbital distance to the Sun could not be observed within a 10-6 to 10-5 range of precision. There are also no apparent modulations over periods of weeks or months. Consequently, there is no indication of a natural impediment against sub-permille accuracy in half-life determinations, renormalisation of activity to a distant reference date, application of nuclear dating for archaeology, geo- and cosmochronology, nor in establishing the SI unit becquerel and seeking international equivalence of activity standards.

A new large-area 2pi proportional counting system at NIST.

A new large-area gas flow multi-wire proportional counter has been developed to replace the large-area counting system that is currently in use at the National Institute of Standards and Technology (NIST) and several Department of Defense counting facilities for calibrating large-area alpha and beta sources. The current systems are over 20 years old and part replacement is very difficult. The new systems have been built using specifications that will improve on the current systems and allow collecting data at pressures up to 0.2MPa. The ability to operate at higher pressures will increase the beta efficiency of the counter and lead to improved precision in the final measured results. Comparison of the results from the old and new systems is presented for both alpha and beta sources.

Calibration of HPGe gamma-ray detectors for measurement of radioactive noble gas sources.

Measurements of radioactive noble gases are routinely made with gamma-ray spectrometers. This work describes the calibration of high purity germanium detectors provided by the full-energy-peak efficiency as a function of the gamma-ray energy. A comparison of measured efficiency values with a new, simplified method based on a direct mathematical method is given here.

Development of gamma-ray emitting test sources for portal monitors.

A new set of gamma-ray emitting test sources was designed by the National Institute of Standards and Technology (NIST) for testing of radiation portal monitors for homeland security applications. This paper provides a description of the construction and characterization of these new sources that were designed and built to meet the American National Standard Institute (ANSI) N42.35-2004 and N42.38 standards' requirements.

Test of radiation detectors used in homeland security applications.

This work was performed as part of the National Institute of Standards and Technology (NIST) program to support the development of the new American National Standards Institute (ANSI) standards N42.32-2003 and N42.33-2003 for hand-held detectors, and personal electronic dosimeters, as well as to support the Office of Law Enforcement Standards (OLES) and the Department of Homeland Security (DHS) in testing these types of detectors for their use by first responders. These instruments are required to operate over a photon energy range of 60 keV to 1.33 MeV and over a wide range of air-kerma rates. The performance and response of various radiation detectors, purchased by the NIST, was recorded when placed in 60Co, 137Cs, and x-ray beams at different air-kerma rates. The measurements described in this report were performed at the NIST x-ray and gamma-ray radiation calibration facilities. The instruments' response (exposure or dose rate readings) shows strong energy dependence but almost no dependence to different air-kerma rates. The data here reported provide a benchmark in support of current protocols that are being developed for radiation detection instrumentation used in homeland security applications. A future plan is to test these devices, plus other commercially available detectors, against ANSI standards N42.32-2003 and N42.33-2003.

Gamma-ray emitting test sources for Portal Monitors used for homeland security.

The National Institute of Standards and Technology developed a new set of test sources for testing of portal monitors against the ANSI standard N42.35-2004. The design and source specifications are provided in this work.

A new experimental determination of the dose calibrator setting for 188Re.

UNLABELLED: Accurate activity measurements of radionuclides using commercial dose calibrators requires that the correct dial setting (or calibration factor) be applied. The dose calibrator setting for the medical radionuclide 188Re (as 188ReO4-) has been determined experimentally using solution sources prepared and calibrated at the National Institute of Standards and Technology (NIST). METHODS: The specific activity of two sources (in units of MBq/g) in the standard 5-mL NIST ampoule and in a 5-mL SoloPak dose vial were calibrated using 4pibeta liquid scintillation counting with 3H-standard efficiency tracing and gamma-ray/bremmstrahlung counting in the NIST "4pi" gamma ionization chamber on gravimetrically related sources. RESULTS: The newly determined settings for the NIST Capintec CRC-12 dose calibrator are (631+/-4) x 10 and (621+/-3) x 10 for the respective ampoule and dose vial geometries with an expanded (at a presumed 95% confidence level) uncertainty of 0.4%-0.5% in the activity determination. The setting for the dose vial geometry was independently confirmed using a Capintec CRC-15R at Cedars-Sinai Medical Center using sources calibrated against a NIST standard. CONCLUSION: These new settings result in activity readings 28%-30% lower than those obtained using the previously recommended setting of 496 x 10. This discrepancy most likely results from underestimating the total radiation yield from 188Re decay when calculating the dose calibrator response. This study emphasizes the need for experimental determinations of dose calibrator settings in the geometry in which the measurements will be performed.

Cardiac volumetry. Comparison of echoplanar and conventional cine-magnetic resonance data-acquisition strategies.

RATIONALE AND OBJECTIVES: Ejection fraction (EF) measurements obtained using conventional cine-magnetic resonance imaging (MRI) are accurate but time-consuming. With echoplanar imaging (EPI), these data can be acquired much faster. In this study, EF and cardiac output (CO) measurements based on EPI data are compared with those measurements based on cine-MRI images. METHODS: Twelve subjects were examined on a 1.5-T imager equipped with a special EPI gradient system. The entire heart was imaged with contiguous axial 10-mm sections using cine-MRI and EPI techniques. With cine-MRI, 20 frames were acquired over 256 cardiac cycles; with EPI, 24 frames were obtained over four RR intervals using an electrocardiogram-triggered four-shot acquisition strategy. Ejection fraction and CO were calculated based on the summation of the individual end-systolic and end-diastolic volumes. Ejection fraction and CO measurements based on the two different data sets were compared. RESULTS: Multishot EPI was 50 times faster than cine-MRI. The short acquisition time permitted breath-hold imaging. The high temporal (16 to 24 frames/RR interval) and spatial resolution (1.56 x 1.56 mm in plane) of the multishot EPI images enabled delineation of the ventricular lumen at end-systole and end-diastole in a fashion similar to cine-MRI. Echoplanar imaging EF and CO measurements correlated well with cine-MRI EF measurements, with correlation coefficients of 0.96 and 0.94, respectively. The 95% confidence interval of the EF measurement differences between the two techniques was narrow, ranging from -5.2 to 5.7 EF percentage points. CONCLUSIONS: Accurate volumetric EF and CO measurements are possible based on ultrafast multishot EPI data sets as part of an integrated MRI-based cardiac evaluation.

Comprehensive Review and Critical Evaluation of the Half-Life of Tritium.

As part of the preparation and calibration of three new National Institute of Standards and Technology (NIST) tritiated-water radioactivity Standard Reference Materials (SRMs), we have performed a comprehensive review and critical evaluation of the half-life of tritium (hydrogen-3). Twenty three experimentally-determined values of the half-life of tritium, reported between 1936 and 2000, were found. Six of these values were updated by later values. Two values were limits. Two values were deemed to be outliers. The 13 remaining values were evaluated in several ways. The results are compared with the results of other recent evaluations and all are found to be in good agreement. Our final recommended value for the half-life of tritium is the average of the adopted values from the four most recent evaluations, (4500 ± 8) d, where 8 d corresponds to one standard uncertainty.

Evaluation of Handheld Radionuclide Identifiers.

Characterization of commercially available instruments for measurement and identification of unknown radionuclides was carried out in support of the development and testing of the American National Standards Institute (ANSI) standard, N42.34, "Performance Criteria for Hand-held Instruments for the Detection and Identification of Radionuclides." Measurements were based on the performance of the devices, i.e., the capability of the detectors to ensure a correct radionuclide identification in a given time interval for various radioactive sources.

Construction and Calibration of the NIST Large-Area-Source X-Ray Counting System.

This paper describes the construction and calibration of the NIST large area x-ray counting system. 238Pu sources 8 in (20.32 cm) by 5 in (12.70 cm) thick, emitting L x rays in the range of 12-20 keV are calibrated for total emission rate and also for rate through a centrally located 3 in (7.63 cm) diameter aperture. Alpha particle emission rates are obtained using the known x-ray to alpha particle abundances. The sources will be used to calibrate alpha-particle surface monitors.

The NIST Primary Radon-222 Measurement System.

Within the United States, the national standard for radon measurements is embodied in a primary radon measurement system that has been maintained for over 50 years to accurately measure radon (222Rn) against international and national radium (226Ra) standards. In turn, all of the radon measurements made at the National Institute of Standards and Technology (NIST) and the radon transfer calibration standards and calibration services provided by NIST are directly related to this national radon standard. This primary radon measurement system consists of pulse ionization chambers and ancillary gas handling and gas purification equipment. The system is currently undergoing a significant upgrading and expansion which will replace the extant outdated system.

An International Marine-Atmospheric 222Rn Measurement Intercomparison in Bermuda Part I: NIST Calibration and Methodology for Standardized Sample Additions.

As part of an international 222Rn measurement intercomparison conducted at Bermuda in October 1991, NIST provided standardized sample additions of known, but undisclosed ("blind") 222Rn concentrations that could be related to U.S. national standards. The standardized sample additions were obtained with a calibrated 226Ra source and a specially-designed manifold used to obtain well-known dilution factors from simultaneous flow-rate measurements. The additions were introduced over sampling periods of several hours (typically 4 h) into a common streamline on a sampling tower used by the participating laboratories for their measurements. The standardized 222Rn activity concentrations for the intercomparison ranged from approximately 2.5 Bq · m-3 to 35 Bq · m-3 (of which the lower end of this range approached concentration levels for ambient Bermudian air) and had overall uncertainties, approximating a 3 standard deviation uncertainty interval, of about 6 % to 13 %. This paper describes the calibration and methodology for the standardized sample additions.

An International Marine-Atmospheric 222Rn Measurement Intercomparison in Bermuda Part II: Results for the Participating Laboratories.

As part of an international measurement intercomparison of instruments used to measure atmospheric 222Rn, four participating laboratories made nearly simultaneous measurements of 222Rn activity concentration in commonly sampled, ambient air over approximately a 2 week period, and three of these four laboratories participated in the measurement comparison of 14 introduced samples with known, but undisclosed ("blind") 222Rn activity concentration. The exercise was conducted in Bermuda in October 1991. The 222Rn activity concentrations in ambient Bermudian air over the course of the intercomparison ranged from a few hundredths of a Bq · m-3 to about 2 Bq · m-3, while the standardized sample additions covered a range from approximately 2.5 Bq · m-3 to 35 Bq · m-3. The overall uncertainty in the latter concentrations was in the general range of 10 %, approximating a 3 standard deviation uncertainty interval. The results of the intercomparison indicated that two of the laboratories were within very good agreement with the standard additions, and almost within expected statistical variations. These same two laboratories, however, at lower ambient concentrations, exhibited a systematic difference with an averaged offset of roughly 0.3 Bq · m-3. The third laboratory participating in the measurement of standardized sample additions was systematically low by about 65 % to 70 %, with respect to the standard addition which was also confirmed in their ambient air concentration measurements. The fourth laboratory, participating in only the ambient measurement part of the intercomparison, was also systematically low by at least 40 % with respect to the first two laboratories.

Half-life measurements at the National Institute of Standards and Technology.

For nearly half a century the half-lives of many radionuclides have been measured with increasing precision. The results of these measurements for many long-lived radionuclides, such as 60Co, 137Cs, 85Kr, 133Ba, 207Bi, 152Eu, 154Eu, and 155Eu, have been updated recently by the Radioactivity Group of NIST. These long-lived radionuclides are used extensively to calibrate various nuclear counting and monitoring systems. The long-term precision of these calibrations can be greatly affected by the uncertainties in the calibrant half-lives. Results for the half-lives of many radionuclides measured over the last four decades are tabulated. In addition, values of the half-lives of several short-lived radionuclides used in nuclear medicine are addressed, which are critical in determining the correct dosage given in patient treatment, are addressed. Comparisons with the recommended values from the International Atomic Energy Agency Coordinated Research Program and the Evaluated Nuclear Structure Data File from Brookhaven National Laboratory are presented and any apparent disagreements noted.

Ionization chamber measurements of the half-lives of 24Na, 42K, 76As and 198Au.

Samples of 24Na, 42K, 76As and 198Au were produced by irradiation in the National Institute of Standards and Technology (NIST) reactor, and examined for impurities before and after measurement. Half-life measurements were carried out in the NIST 4pigamma pressurized ionization chamber. The results are compared to presently accepted values and previous NIST measurements.

The standardization of 177Lu by 4pibeta liquid scintillation spectrometry with 3H-standard efficiency tracing.

Solutions containing the potential radiotherapy radionuclide 177Lu have been standardized at the National Institute of Standards and Technology (NIST) by 4pibeta liquid scintillation (LS) counting with 3H-standard efficiency tracing using the CIEMAT/NIST method. Confirmatory measurements were made with 4pi NaI(TI) gamma-ray spectrometry. Activity determinations were made on 4 solutions over the course of 10 months with an expanded (k = 2) uncertainty on the activity of 0.8%. Half-life measurements were carried out using the NIST "4pi" gamma ionization chamber (IC) and LS counting and gave a new value of 6.65+/-0.01 d, which is shorter than the current ENSDF-recommended value by 1.3%. Impurity analyses were performed by high-purity germanium (HPGe) gamma-ray spectrometry and indicated only the presence of 177mLu at a level of 0.02% that of the 177Lu as of the respective reference times for the four solutions. Calibration factors for the NIST IC and Vinten 671 ionization chambers were developed, as were dial settings for the NIST-maintained Capintec CRC-12.

Establishment of transfer standard for holmium-166-DOTMP.

The measurement of 166Ho, both as a chloride solution and as [166Ho]-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetramethylenephoonic acid (DOTMP), was examined for four models of radionuclide calibrators: Capintec CRC-35R (two chambers), Capintec 712MX, AtomLab 100 (two chambers), and a Capintec CRC-12. Holmium-166 chloride was measured as 16 ml in 20-ml glass dose vials. Diagnostic imaging level [166Ho]DOTMP solutions, nominally 400 MBqg(-1), were measured as 12 ml in 20-ml dose vials. Finally, therapeutic level [166Ho]DOTMP solutions, nominally 9GBqg(-1), were measured as aliquots of 100-500 microl in sealed plastic vials of 10-ml saline. Single calibration factors for each instrument manufacturer are recommended for 12-16-ml of either solution in 20-ml glass dose vials, (673+/-9) x 10 and 72.7+/-0.7, for the Capintec and AtomLab models, respectively. Calibration factors recommended for the therapeutic dose geometry are (706+/-6) x 10 and 68.7+/-1.3, for the Capintec and AtomLab models, respectively. The calibration factors recommended for an NIST 5-ml ampoule are (686+/-5) x 10 and 70.9+/-0.4 for the Capintec and AtomLab models, respectively.