Dutch public health professionals' perspectives and needs regarding citizen involvement in COVID-19 contact tracing through digital support tools: an exploratory qualitative study.

BACKGROUND: Contact tracing (CT) is an important, but resource-intensive tool to control outbreaks of communicable diseases. Under pandemic circumstances, public health services may not have sufficient resources at their disposal to effectively facilitate CT. This may be addressed by giving cases and their contact persons more autonomy and responsibility in the execution of CT by public health professionals, through digital contact tracing support tools (DCTS-tools). However, the application of this approach has not yet been systematically investigated from the perspective of public health practice. Therefore, we investigated public health professionals' perspectives and needs regarding involving cases and contact persons in CT for COVID-19 through DCTS-tools. METHODS: Between October 2020 and February 2021, we conducted online semi-structured interviews (N = 17) with Dutch public health professionals to explore their perspectives and needs regarding the involvement of cases and contact persons in CT for COVID-19 through DCTS-tools, in the contact identification, notification, and monitoring stages of the CT-process. Interviews were audio recorded and transcribed verbatim. A thematic analysis was performed. RESULTS: Four main themes related to Dutch public health professionals' perspectives and needs regarding involving cases and contact persons in CT for COVID-19 through DCTS-tools emerged from the data: 'Distinct characteristics of CT with DCTS-tools'; 'Anticipated benefits and challenges of CT for COVID-19 with DCTS- tools'; 'Circumstances in CT for COVID-19 that permit or constrain the application of DCTS-tools'; and 'Public health professionals' needs regarding the development and application of DCTS-tools for CT'. Public health professionals seem to have a positive attitude towards involving cases and contact persons through DCTS-tools. Public health professionals' (positive) attitudes seem conditional on the circumstances under which CT is performed, and the fulfilment of their needs in the development and application of DCTS-tools. CONCLUSIONS: Dutch public health professionals seem positive towards involving cases and contact persons in CT for COVID-19 through DCTS-tools. Through adequate implementation of DCTS-tools in the CT-process, anticipated challenges can be overcome. Future research should investigate the perspectives and needs of cases and contact persons regarding DCTS-tools, and the application of DCTS-tools in practice.

Factors affecting the uptake of vaccination by the elderly in Western society.

OBJECTIVE: To present the results of a literature review on factors related to vaccine uptake by elderly persons. METHODS: A systematic literature search was performed using Medline, Embase, and SciSearch to collect all publications available on factors related to vaccine uptake from 1966 until October 2012 for West European and North American societies. In total, 1001 articles were identified and 60 were included in the review. RESULTS: We identified six main themes that influence the willingness to be vaccinated: 1) attitudes and beliefs regarding vaccination in general including positive and negative attitudes and beliefs; 2) perceived risk and severity including knowledge, perceived susceptibility and severity and personal experience; 3) vaccine characteristics including side-effects, effectiveness, content of the vaccine and knowledge; 4) advice and information including influence of the healthcare worker and relatives and the information source and format; 5) general health-related behavior including previous vaccinations, visiting GP or senior center and other preventive behaviors; and 6) accessibility and affordability including logistics, combinations of vaccines and costs. CONCLUSION: The most important factors related to vaccine uptake are people's attitudes and beliefs regarding vaccination (especially their negative attitudes), recommendations of healthcare workers, side effects and effectiveness of the vaccine, and perceived susceptibility.

Prevalence and determinants associated with healthcare-associated infections in long-term care facilities (HALT) in the Netherlands, May to June 2010.

HAIs (healthcare-associated infections) are likely to become an increasing public health problem. Therefore, a point-prevalence study called HALT (Healthcare-associated infections in long-term-care facilities) was set up by the European Centre for Disease Prevention and Control to determine the prevalence, antibiotic use and determinants associated with HAIs. In the Netherlands, 10 nursing homes (in total 1,429 elderly residents) participated in the study between May and June 2010. Risk and protective factors were determined by calculating relative risks (RRs) and performing multilevel Poisson regression. An overall infection prevalence of 2.8% was found and 3.5% of the residents used antibiotics. Residents' characteristics such as the presence of pressure wounds (RR: 2.58; 95% CI:1.04-6.39) and other wounds (RR: 5.70; 95% CI: 2.99-10.86) were risk factors for an HAI, whereas being male (RR: 0.43; 95% CI: 0.21-0.91) was protective. Nursing home characteristics, such as the percentage of shared rooms ( ≥ 2%) (RR: 0.49; 95% CI: 0.39-0.62) and percentage of incontinent residents (≥ 3%) (RR: 0.72; 95% CI: 0.61-0.85) were protective determinants in a multivariate analysis. Special attention is therefore needed for female residents and residents with pressure and other wounds for the prevention of HAIs in Dutch nursing homes.

Vaccine preferences and acceptance of older adults.

BACKGROUND: Expanding vaccination programs for the older population might be important as older adults are becoming a larger proportion of the general population. The aim of this study is to determine the relative importance of vaccine and disease specific characteristics and acceptance for Dutch older adults, including pneumococcal disease, herpes zoster, pertussis vaccination, and influenza vaccination. METHODS: A discrete choice experiment was conducted to generate choice data that was analyzed using a mixed multinomial logit statistical model. RESULTS: Important factors that were associated with vaccination acceptance in older adults are high mortality risk of the infectious disease, high susceptibility of getting the infectious disease, and high vaccine effectiveness. Age, influenza vaccination in 2013 and self-perceived health score were identified as personal factors that affect vaccine preference. Potential vaccination rates of older adults were estimated at 68.1% for pneumococcal vaccination, 58.1% for herpes zoster vaccination, 53.9% for pertussis vaccination and 54.3% for influenza vaccination. For persons aged 50-65, potential vaccination rates were estimated at 58.1% for pneumococcal vaccination, 49.5% for herpes zoster vaccination, 43.9% for pertussis vaccination and 42.2% for influenza vaccination. For persons aged 65 and older, these were respectively 76.2%, 67.5%, 57.5% and 65.5%. DISCUSSION: Our results suggest that older adults are most likely to accept pneumococcal vaccination of the four vaccines. Information provision accompanied with the implementation of a new vaccine has to be tailored for the individual and the vaccine it concerns. Special attention is needed to ensure high uptake among persons aged 50-65years.

Lack of Cross-Resistance of Imazaquin-Resistant Xanthium strumarium Acetolactate Synthase to Flumetsulam and Chlorimuron.

Acetolactate synthase (ALS) was isolated from a field population of cocklebur (Xanthium strumarium) that developed resistance to the herbicide Scepter following three consecutive years of application. The active ingredient of Scepter, imazaquin, gave an inhibitor concentration required to produce 50% inhibition of the enzyme activity that was more than 300 times greater for the resistant enzyme than for the wild-type cocklebur ALS. Tests with flumetsulam and chlorimuron show that the resistant ALS was not cross-resistant to these two other classes of ALS inhibitors.

Therapeutic drug monitoring for the treatment of psychiatric disorders. Clinical use and cost effectiveness.

Pharmacokinetic monitoring is not routine in the treatment of psychiatric disorders, although subtherapeutic or toxic plasma concentrations of psychotropic agents can result from standard doses because of interindividual variability of drug metabolism. Therapeutic plasma concentrations have been established for several of the tricyclic antidepressants and for lithium, as well as for carbamazepine and valproic acid (valproate sodium). Despite difficulties in extrapolating from concentration-effect research, therapeutic concentrations have also been determined for some antipsychotic drugs, in particular haloperidol and clozapine. Clinicians can use therapeutic drug monitoring to optimise dosage decisions with psychotropic drugs, in order to maximise efficacy and prevent toxicity, especially when individuals are nonresponsive to treatment or vulnerable to adverse reactions with standard doses because age, disease states or drug interactions complicate therapy. Although evidence from controlled-outcome studies is unavailable, TDM-assisted psychiatric treatment is potentially useful and cost effective, particularly when applied by clinicians who are knowledgeable of pharmacokinetics and who are aware of the limitations of laboratory findings.

Influences of acculturation and musical sophistication on perception of musical interval patterns.

Influences of acculturation and musical sophistication on music perception were examined. Judgments for mistuning were obtained for Ss differing in musical sophistication who listened to a melody that was based on interval patterns from Western and Javanese musical scales. Less musically sophisticated Ss' judgments were better for Western than Javanese patterns. Musicians' thresholds did not differ across Western and Javanese patterns. Differences in judgments across scales are accountable to acculturation through listening exposure and musical sophistication gained through formal experience.

An event-based analysis of the coordination of early infant vocalizations and facial actions.

This study used an event-based approach to provide empirical evidence regarding the nature of coordination in 3- and 6-month-old infants. Vocalizations and facial actions of 12 normally developing infants interacting with their caregivers were coded. Coded vocalizations and facial actions were considered coordinated when they temporally overlapped. Results indicate that infants coordinated their vocalizations and facial actions more than expected by chance. Coordinated events were governed by 2 sequence patterns. When 2 communicative events were temporally associated across modalities, 1 event tended to be completely embedded within the other, and vocalizations tended to end before facial actions. This study provides new information about how infant communication is structured, confirms results from other coordination studies, and describes a new method for analysis of event-based data.

[Determining the effectiveness of percutaneous cava filters: experimental studies]. / Bestimmung der Effektivität perkutaner Kavafilter: Experimentelle Untersuchungen.

PURPOSE: In vitro clot-trapping capacity of 16 different caval filters should be evaluated under varying experimental conditions. MATERIAL AND METHODS: In a flow model simulating in vivo conditions (soft latex tube, dextran solution at 37 degrees C, pulsatile flow at a mean rate of 3 1/min) the efficiency of 16 caval filters was evaluated in horizontal and vertical position by using 640 or 1280 clots/filter (8 sizes). Non-self centering filters were tested in centric and in tilted position. RESULTS: Efficiency of optimally centered caval filters varied between 97.8 and 69.4%. The largest thrombi were captured by all optimal centered filters. A change from vertical to horizontal position of the flow model resulted in a variation of filter efficiency by about 4.8%. Efficiency of non-self centering filters decreased significantly when placed in a tilted position (mean decrease 15.5%; range 2.7%-37.7%) resulting in a deterioration of the capture rate by as much as 43.2%. CONCLUSION: Under optimal study conditions efficiency of all evaluated caval filters was high. Tilting of caval filters resulted in a significant efficiency decrease.

Late onset canonical babbling: a possible early marker of abnormal development.

By their 10th month of life, typically developing infants produce canonical babbling, which includes the well-formed syllables required for meaningful speech. Research suggests that emerging speech or language-related disorders might be associated with late onset of canonical babbling. Onset of canonical babbling was investigated for 1,536 high-risk infants, at about 10-months corrected age. Parental report by open-ended questionnaire was found to be an efficient method for ascertaining babbling status. Although delays were infrequent, they were often associated with genetic, neurological, anatomical, and/or physiological abnormalities. Over half the cases of late canonical babbling were not, at the time they were discovered associated with prior significant medical diagnoses. Late canonical-babbling onset may be a predictor of later developmental disabilities, including problems in speech, language, and reading.

FFT-based digital tactile vocoder system for real-time use.

A microprocessor-based real-time digital vibrotactile vocoder system has been developed to train the deaf and for artificial hearing research. The system is composed of a microcomputer module with a digital signal processor, interface units and an attenuator/driver circuit. Live or digitised (stored or synthetic) speech is presented to the skin spectrally through a belt housing eight or 16 vibrators. Speech is processed in real time using a fast Fourier transform. The system is also capable of presenting any arbitrary spatiotemporal pattern on the skin for artificial hearing experiments. A preliminary experiment with a deaf subject indicates that the system is potentially an effective device for artificial hearing.

Pre-clinical evaluation of a novel, pneumatic, ventricular assist device (Medos HIA-VAD) under pathophysiological conditions.

To evaluate a new cardiac assist system, the Medos HIA-VAD, we studied the effects of mechanical unloading on regional and global myocardial dysfunction. As a model for the regional temporary contractile dysfunction we chose an anesthetized, open chest preparation in sheep. We occluded the diagonal coronary artery for 15 minutes and reperfused for 90 minutes. Hemodynamic parameters and wall thickening were monitored. Unloading with the 60-ml Medos HIA-VAD was performed either during ischemia (group II) or during reperfusion (group III). The recovery of non-uniformity indicated by post-ejection wall thickening was significantly faster (p < 0.05) in both groups if compared to the non-assisted group (group I) (all groups n = 4). Recovery of systolic wall thickening in the postischemic region in group I was only 76 +/- 12%, while it was 103 +/- 11% and 92 +/- 11% in groups II and III, respectively (p < 0.05). In a canine model of global left ventricular failure, we occluded the left anterior descending coronary artery for 20 min, and after 5 minutes of reperfusion, the circumflex artery for 45 min (group I, n = 5). After 5 min of CX occlusion in group II we performed assisted circulation for 90 min with the 10-ml (n = 5) and the 25-ml (n = 5) Medos HIA-VAD. In group I, no dog survived, in group II, all survived 4 hours of reperfusion (n = 10). Lactate at the end of the experiment was 1.1 +/- 0.9 mmol/L (10-ml, and 1.1 +/- 0.2 mmol/L (25-ml) (p > 0.05 vs. base line). We conclude that the Medos HIA-VAD is a reliable assist device that enhances myocardial recovery and allows sufficient peripheral circulation in the case of cardiogenic shock.

Compact mock loops of the systemic and pulmonary circulation for blood pump testing.

Mock loops are an important tool for in vitro investigations of artificial blood pumps. The simple windkessel, throttle, and atrium principle was used for the mock loop design presented. The components of the systemic and the pulmonary mock loop were designed according to calculated numerical simulation parameters. The loops offer a compact design and simple handling. For simulating biventricular assist or total artificial heart (TAH), both loops can be coupled correspondingly. The numerical simulation and the first results with the loops show very good similarity to physiological data of systemic and pulmonary circulation. The measurements of pump characteristics are significant for quantitative comparison of different pump sizes and types, or driving systems.

Assessment techniques to evaluate tactual aids for hearing-impaired subjects.

In order to optimize the use of tactual aids for the deaf, it is important to have a battery of assessments to determine the potential contribution of the aids to acoustic perception and speech identification. We have designed such a battery to be used with young hearing-impaired children. The tasks were developed so that they could be implemented with standard audiometric equipment and applied to subjects of varying age and to different types of tactual aids. Illustrative results from four profoundly hearing-impaired children showed that tactual vocoders allowed detection of high frequencies that were not available to the subjects through aided audition. In most cases with these subjects, performance on simple detection and discrimination tasks showed facilitative effects with tactual vocoders. Facilitative effects were further evidenced in more complex phonemic identification tasks for all subjects. The tasks can be used to determine possible benefits of tactual aids for individual hearing-impaired children.

Speech perception by congenitally deaf subjects using an electrocutaneous vocoder.

Two congenitally profoundly deaf adults were trained to perceive words through the Tacticon 1600 electrocutaneous vocoder, an artificial hearing prosthesis. The subjects learned to identify 50 words during 47 hours (Subject One) and 41 hours (Subject Two) of training, with a 41.6 percent rate of success across all sessions. Both subjects showed consistent error patterns during the training phase. Analysis of these error patterns suggested that they were employing word identification strategies based on some general aspects of tactual patterns. Specific characteristics of the tactual patterns that they appeared to be using included: syllable number, tactual locus of word ending, direction of pattern movement, and position of bursts (/t/, /k/, /d/, for example). Following training, the subjects were tested for their abilities to integrate tactual and aided-auditory cues in word identification. Three conditions of aided-audition alone (A), tactual vocoder alone (TV), and aided-audition with tactual vocoder (TV + A) were used. The stimulus-word list for this phase consisted of the 50 words acquired in tactual vocoder training, and 50 "tactually-new" words, i.e., words that had not been presented to them in tactual vocoder training sessions. They correctly identified 93 percent (Subject One) and 56 percent (Subject Two) more trials in the TV + A condition than in the A condition. Tactually-new vocabulary was correctly identified 78 percent (Subject One) and 50 percent (Subject Two) more often when sensory modalities were combined, than when only aided-audition was used. Subjects identified tactually-new vocabulary better than chance in the TV condition.

The effects of vocoder filter configuration on tactual perception of speech.

Perception of synthetic speech continua through the sense of touch and audition was compared utilizing a 32-channel spectrally-oriented electrocutaneous vocoder display and standard auditory psychophysical procedures. Perception of a consonantal and a vocalic continuum was evaluated utilizing three vocoder filter configurations: logarithmic, linear, and average (geometric mean of logarithmic and linear). Results indicated a close correspondence between tactual and auditory discrimination and identification for the vowel (/a/-/e/) and the consonant (/sta/-/sa/) continuum regardless of the filter characteristics.

Classification of audiograms by sequential testing: reliability and validity of an automated behavioral hearing screening algorithm.

In 1990, CAST (classification of audiograms by sequential testing) was proposed and developed as an automated, innovative approach to screening infant hearing using a modified Bayesian method. The method generated a four-frequency audiogram in a minimal number of test trials using VRA (visual reinforcement audiometry) techniques. Computer simulations were used to explore the properties (efficiency and accuracy) of the paradigm. The current work is designed to further test the utility of the paradigm with human infants and young children. Accordingly, infants and children between 6 months and 2 years of age were screened for hearing loss. The algorithm's efficacy was studied with respect to validity and reliability. Validity was evaluated by comparing CAST results with tympanometric data and outcomes of staircase-based testing. Test-retest reliability was also assessed. Results indicate that CAST is a valid, efficient, reliable, and potentially cost-effective screening method.

Automated electrophysiologic hearing testing using a threshold-seeking algorithm.

The efficacy of utilizing an automated algorithm to identify auditory brainstem responses (ABR) was studied. A microcomputer-based threshold-seeking algorithm utilizing click-evoked ABR was developed to determine evoked-response thresholds for automated hearing screening. The software consists of an evoked-response recognizer unit, which determines the presence or absence of a response, and a threshold-tracking unit, which controls the click intensity in order to track the threshold. The response recognizer is based upon correlation methods. Threshold tracking is accomplished using a Parameter Estimation by Sequential Testing (PEST) procedure, which is commonly used to study psychophysical properties of the auditory system. Sound level is automatically adjusted, based on the results of the recognizer and the threshold tracker. Test results were generally obtained in less than 15 minutes per ear. The results of the automated procedure correlate very highly with expert judgments of ABR threshold and show good test-retest reliability, suggesting that automated procedures are viable alternatives to traditional testing methods.

Is acute cholecystitis a contraindication for laparoscopic cholecystectomy?

Two-hundred and ninety-four patients underwent laparoscopic cholecystectomy between May 1993 and April 1997 in the Clinical and Surgical Gastrointestinal Unit at Santa Casa Hospital of Porto Alegre. Of all, 47 were operated on for acute cholecystitis (AC). The mean age was 47.1 years, 70.2% were females and 29.8% were males. The mean operative time was 142.8 minutes. Routine intraoperative cholangiography was successfully done in 38 (80.8%) and conversion was necessary in 3 (6.4%). All patients received prophylactic antibiotics for 24 hours. No intraoperative or postoperative complications were detected. The results in this series showed that laparoscopic cholecystectomy is a possible and safe technique for the treatment of the AC.

Is age a risk factor for esophagectomy?

In recent years, the number of elderly patients with esophageal cancer as well as the number submitted for esophageal resection has been increasing. With respect to nutritional and pulmonary evaluations, surgical staging, and mortality, 37 patients over the age of 65 who underwent esophagectomy and simultaneous reconstruction were analyzed. This group was compared statistically with a group of 162 patients younger than 65 to determine whether age was a factor influencing treatment and outcome. There was no statistical difference between the groups relating to the described variables. Age should not be a limiting factor when it comes to offering an aggressive surgical approach for the esophageal cancer patient aged 65 or more. This approach can be performed as safely in older patients as it is in younger patients, with similar incidence of mortality.