Factors Influencing the Healthcare Workers' Willingness to Receive the COVID-19 Booster Dose in Tuscany (Italy).

BACKGROUND: The World Health Organization has defined vaccine hesitancy as behavior influenced by several factors, including trust in the vaccine itself or its provider or the perceived need for vaccination. The aim of this study was to investigate the factors influencing the willingness to receive the COVID-19 vaccine among the employees and healthcare professionals of the Central Tuscany Local Health Authority (CT-LHA) in Italy. METHODS: From July to October 2022, a cross-sectional study was conducted. An online questionnaire was administered to 7000 employees of the CT-LHA. The questionnaire analyzed the factors that influenced receiving the booster dose of the COVID-19 vaccine. The sample was stratified by gender, age, type of occupation (healthcare or non-healthcare workers), and seniority. Incomplete questionnaires were excluded. A chi-squared test was performed through STATA. The significance level was set at 95%. RESULTS: Of the questionnaires administered, 1885 (26.9%) questionnaires were eligible for the study. In the previous vaccination campaign, the healthcare workers (HCWs) considered the vaccine used by CT-LHA as safe, in contrast to non-healthcare workers (N-HCWs), who considered it less secure (p < 0.05). The HCWs showed a higher propensity for vaccine safety to receive the booster dose than N-HCWs. N-HCWs appeared to be less affected by an updated booster dose than HCWs (p < 0.05). CONCLUSIONS: The factors studied appear to influence HCWs differently from N-HCWs. Both HCWs and N-HCWs would choose an upgraded mRNA vaccine for the booster dose.

Quantum-Classical Hybrid Systems and Ehrenfest's Theorem.

The conceptual analysis of quantum mechanics brings to light that a theory inherently consistent with observations should be able to describe both quantum and classical systems, i.e., quantum-classical hybrids. For example, the orthodox interpretation of measurements requires the transient creation of quantum-classical hybrids. Despite its limitations in defining the classical limit, Ehrenfest's theorem makes the simplest contact between quantum and classical mechanics. Here, we generalized the Ehrenfest theorem to bipartite quantum systems. To study quantum-classical hybrids, we employed a formalism based on operator-valued Wigner functions and quantum-classical brackets. We used this approach to derive the form of the Ehrenfest theorem for quantum-classical hybrids. We found that the time variation of the average energy of each component of the bipartite system is equal to the average of the symmetrized quantum dissipated power in both the quantum and the quantum-classical case. We expect that these theoretical results will be useful both to analyze quantum-classical hybrids and to develop self-consistent numerical algorithms for Ehrenfest-type simulations.

A Quantum-Classical Model of Brain Dynamics.

The study of the human psyche has elucidated a bipartite structure of logic reflecting the quantum-classical nature of the world. Accordingly, we posited an approach toward studying the brain by means of the quantum-classical dynamics of a mixed Weyl symbol. The mixed Weyl symbol can be used to describe brain processes at the microscopic level and, when averaged over an appropriate ensemble, can provide a link to the results of measurements made at the meso and macro scale. Within this approach, quantum variables (such as, for example, nuclear and electron spins, dipole momenta of particles or molecules, tunneling degrees of freedom, and so on) can be represented by spinors, whereas the electromagnetic fields and phonon modes can be treated either classically or semi-classically in phase space by also considering quantum zero-point fluctuations. Quantum zero-point effects can be incorporated into numerical simulations by controlling the temperature of each field mode via coupling to a dedicated Nosé-Hoover chain thermostat. The temperature of each thermostat was chosen in order to reproduce quantum statistics in the canonical ensemble. In this first paper, we introduce a general quantum-classical Hamiltonian model that can be tailored to study physical processes at the interface between the quantum and the classical world in the brain. While the approach is discussed in detail, numerical calculations are not reported in the present paper, but they are planned for future work. Our theory of brain dynamics subsumes some compatible aspects of three well-known quantum approaches to brain dynamics, namely the electromagnetic field theory approach, the orchestrated objective reduction theory, and the dissipative quantum model of the brain. All three models are reviewed.

Non-Invasive Brain Stimulation for the Modulation of Aggressive Behavior-A Systematic Review of Randomized Sham-Controlled Studies.

INTRO: Aggressive behavior represents a significant public health issue, with relevant social, political, and security implications. Non-invasive brain stimulation (NIBS) techniques may modulate aggressive behavior through stimulation of the prefrontal cortex. AIMS: To review research on the effectiveness of NIBS to alter aggression, discuss the main findings and potential limitations, consider the specifics of the techniques and protocols employed, and discuss clinical implications. METHODS: A systematic review of the literature available in the PubMed database was carried out, and 17 randomized sham-controlled studies investigating the effectiveness of NIBS techniques on aggression were included. Exclusion criteria included reviews, meta-analyses, and articles not referring to the subject of interest or not addressing cognitive and emotional modulation aims. CONCLUSIONS: The reviewed data provide promising evidence for the beneficial effects of tDCS, conventional rTMS, and cTBS on aggression in healthy adults, forensic, and clinical samples. The specific stimulation target is a key factor for the success of stimulation on aggression modulation. rTMS and cTBS showed opposite effects on aggression compared with tDCS. However, due to the heterogeneity of stimulation protocols, experimental designs, and samples, we cannot exclude other factors that may play a confounding role.

Superradiant Quantum Phase Transition for an Exactly Solvable Two-Qubit Spin-Boson Model.

A spin-boson-like model with two interacting qubits is analysed. The model turns out to be exactly solvable since it is characterized by the exchange symmetry between the two spins. The explicit expressions of eigenstates and eigenenergies make it possible to analytically unveil the occurrence of first-order quantum phase transitions. The latter are physically relevant since they are characterized by abrupt changes in the two-spin subsystem concurrence, in the net spin magnetization and in the mean photon number.

Invariant-Parameterized Exact Evolution Operator for SU(2) Systems with Time-Dependent Hamiltonian.

We report the step-by-step construction of the exact, closed and explicit expression for the evolution operator U(t) of a localized and isolated qubit in an arbitrary time-dependent field, which for concreteness we assume to be a magnetic field. Our approach is based on the existence of two independent dynamical invariants that enter the expression of SU(2) by means of two strictly related time-dependent, real or complex, parameters. The usefulness of our approach is demonstrated by exactly solving the quantum dynamics of a qubit subject to a controllable time-dependent field that can be realized in the laboratory. We further discuss possible applications to any SU(2) model, as well as the applicability of our method to realistic physical scenarios with different symmetry properties.

Predictors of poor outcome in tocilizumab treated patients with Sars-CoV-2 related severe respiratory failure: A multicentre real world study.

INTRODUCTION: Despite Tocilizumab is now recognized as a concrete therapeutic option in patients with severe SARS-CoV-2 related respiratory failure, literature lacks about factors influencing the response to it in this context. Therefore, the aim of our study was to provide evidence about predictors of poor outcome in Tocilizumab treated patients in the real-world practice. MATERIALS AND METHODS: We retrospectively analyzed clinical, laboratory and chest computer tomography (CCT) data of patients firstly admitted in non Intensive Care Units (ICU) and suffering from severe respiratory failure, who were treated with the IL-6 antagonist Tocilizumab. We compared patients who died and/or required admission to ICU with oro-tracheal intubation (OTI) with those who did not. RESULTS: Two hundreds and eighty-seven patients (29.9% females) with mean age ± SD 64.1 ± 12.6 years were the study population. In-hospital mortality was 18.8%, while the composite endpoint in-hospital mortality and/or ICU admission with OTI occurred in 23.7%. At univariate analysis, patients who died and/or were admitted to ICU with OTI were significantly older and co-morbid, had significantly higher values of creatinine, C-reactive protein (CRP) and procalcitonin and lower lymphocytes count, PaO2/FiO2 ratio (P/F) and room air pulsossimetry oxygen saturation (RAO2S) at hospital admission. Computed tomography ground glass opacities (CT-GGO) involving the pulmonary surface ≥ 50% were found in 55.4% of patients who died and/or were admitted to ICU with OTI and in 21.5% of patients who did not (p=0.0001). At multivariate analysis, age ≥ 65 years (OR 17.3, 95% CI: 3.7-81.0), procalcitonin ≥ 0.14 (OR 9.9, 95%CI: 1.7-56.1), RAO2S ≤ 90% (OR 4.6, 95%CI: 1.2-17.0) and CCT-GGO involvement ≥ 50% (OR 5.1, 95%CI: 1.2-21.0) were independent risk factors associated with death and/or ICU admission with OTI. CONCLUSION: Tocilizumab has shown to improve outcome in patients with severe respiratory failure associated to SARS-CoV-2 related pneumonia. In our multicentre study focusing on Tocilizumab treated severe COVID-19 patients, age ≥ 65 years, procalcitonin ≥ 0.14 ng/mL, RAO2S ≤ 90% and CCT-GGO involvement ≥ 50% were independent factors associated with poor outcome.

Symmetry-Induced Emergence of a Pseudo-Qutrit in the Dipolar Coupling of Two Qubits.

We investigate a system of two identical and distinguishable spins 1/2, with a direct magnetic dipole-dipole interaction, in an external magnetic field. Constraining the hyperfine tensor to exhibit axial symmetry generates the notable symmetry properties of the corresponding Hamiltonian model. In fact, we show that the reduction of the anisotropy induces the invariance of the Hamiltonian in the 3×3 subspace of the Hilbert space of the two spins in which S^2 invariably assumes its highest eigenvalue of 2. By means of appropriate mapping, it is then possible to choose initial density matrices of the two-spin system that evolve in such a way as to exactly simulate the time evolution of a pseudo-qutrit, in the sense that the the actual two-spin system nests the subdynamics of a qutrit regardless of the strength of the magnetic field. The occurrence of this dynamic similitude is investigated using two types of representation for the initial density matrix of the two spins. We show that the qutrit state emerges when the initial polarizations and probability vectors of the two spins are equal to each other. Further restrictions on the components of the probability vectors are reported and discussed.

Evolution of a Non-Hermitian Quantum Single-Molecule Junction at Constant Temperature.

This work concerns the theoretical description of the quantum dynamics of molecular junctions with thermal fluctuations and probability losses. To this end, we propose a theory for describing non-Hermitian quantum systems embedded in constant-temperature environments. Along the lines discussed in [A. Sergi et al., Symmetry 10 518 (2018)], we adopt the operator-valued Wigner formulation of quantum mechanics (wherein the density matrix depends on the points of the Wigner phase space associated to the system) and derive a non-linear equation of motion. Moreover, we introduce a model for a non-Hermitian quantum single-molecule junction (nHQSMJ). In this model the leads are mapped to a tunneling two-level system, which is in turn coupled to a harmonic mode (i.e., the molecule). A decay operator acting on the two-level system describes phenomenologically probability losses. Finally, the temperature of the molecule is controlled by means of a Nosé-Hoover chain thermostat. A numerical study of the quantum dynamics of this toy model at different temperatures is reported. We find that the combined action of probability losses and thermal fluctuations assists quantum transport through the molecular junction. The possibility that the formalism here presented can be extended to treat both more quantum states (∼10) and many more classical modes or atomic particles (∼103-105) is highlighted.

Two-Qubit Entanglement Generation through Non-Hermitian Hamiltonians Induced by Repeated Measurements on an Ancilla.

In contrast to classical systems, actual implementation of non-Hermitian Hamiltonian dynamics for quantum systems is a challenge because the processes of energy gain and dissipation are based on the underlying Hermitian system-environment dynamics, which are trace preserving. Recently, a scheme for engineering non-Hermitian Hamiltonians as a result of repetitive measurements on an ancillary qubit has been proposed. The induced conditional dynamics of the main system is described by the effective non-Hermitian Hamiltonian arising from the procedure. In this paper, we demonstrate the effectiveness of such a protocol by applying it to physically relevant multi-spin models, showing that the effective non-Hermitian Hamiltonian drives the system to a maximally entangled stationary state. In addition, we report a new recipe to construct a physical scenario where the quantum dynamics of a physical system represented by a given non-Hermitian Hamiltonian model may be simulated. The physical implications and the broad scope potential applications of such a scheme are highlighted.

Mortality after hip fracture in the elderly: The role of a multidisciplinary approach and time to surgery in a retrospective observational study on 23,973 patients.

BACKGROUND: Since most hip fractures occur in fragile patients, an important step forward in the treatment may be a co-managed, multidisciplinary treatment approach with orthopaedic surgeons and geriatricians. This multidisciplinary care model (MCM) is implemented in some Tuscan hospitals, while in hospitals with the usual care model (UCM) medical consultation is required only as deemed necessary by the admitting surgeon. The primary aim of this study was to assess the effect of the MCM on 30-day mortality, compared with the UCM. METHODS: A retrospective study was conducted on patients with main diagnosis of hip fracture, as reported in the hospital admission discharge reports, aged 65 years and older, who underwent surgery in Tuscan hospitals from 2010 to 2013. A multilevel logistic regression model was performed to assess the effect of the MCM vs the UCM. The Charlson Comorbidity Index (CCI) was used as a proxy for case mix complexity. RESULTS: 23,973 patients were included: 23% men and 77% women; the mean age was 83.5 years. The multilevel analysis showed that mortality was significantly higher in the UCM, after adjusting for gender, age, comorbidity and timing of surgery (OR=1.32; 95% CI 1.09-1.59; p=0.004). Surgical delay was not significantly associated with higher mortality rates. CONCLUSIONS: A co-managed approach to hip fracture, with orthopaedic surgeons and geriatricians, offers a multidisciplinary pathway for the elderly and leads to a reduction in mortality after hip fracture surgery.

Filtering schemes in the quantum-classical Liouville approach to nonadiabatic dynamics.

We study a number of filtering schemes for the reduction of the statistical error in nonadiabatic calculations by means of the quantum-classical Liouville equation. In particular, we focus on a scheme based on setting a threshold value on the sampling weights, so that when the threshold is overcome the value of the weight is reset, and on another approach which prunes the ensemble of the allowed nonadiabatic transitions according to a generalized sampling probability. Both methods have advantages and drawbacks, however, their combination drastically improves the performance of an algorithm known as the sequential short-time step propagation [MacKernan et al., J. Phys: Condens. Matter 14, 9069 (2002)], which is derived from a simple first order expansion of the quantum-classical propagator. Such an algorithm together with the combined filtering procedures produce results that compare very well with those obtained by means of numerically accurate path integral quantum calculations for the spin-boson model, even for intermediate and strong coupling regimes.

Communication: quantum dynamics in classical spin baths.

A formalism for studying the dynamics of quantum systems embedded in classical spin baths is introduced. The theory is based on generalized antisymmetric brackets and predicts the presence of open-path off-diagonal geometric phases in the evolution of the density matrix. The weak coupling limit of the equation can be integrated by standard algorithms and provides a non-Markovian approach to the computer simulation of quantum systems in classical spin environments. It is expected that the theory and numerical schemes presented here have a wide applicability.

Transient behavior of a model fluid under applied shear.

We study the transient behavior of a model fluid composed by soft repulsive spheres subjected to a planar uniform shear. To this aim, we use a dynamical non-equilibrium molecular dynamics method originally developed by Ciccotti and Jacucci [Phys. Rev. Lett. 35, 789 (1975)] and recently applied to the study of the transient regimes in various fluid systems. We show that the dynamical method allows one to study the transient behavior of the viscous time-dependent response over a wide range of applied shear rates, provided that a temperature control is enforced on the system. In this study, we adopt in particular the configurational thermostat of Braga and Travis [J. Chem. Phys. 123, 134101 (2005)]. The initial behavior of the dynamical response to a θ-like perturbation is characterized by a rapid increase, culminating in a pronounced peak, later relaxing to a plateau value. The latter positively reproduces the values of the viscosity observed in standard steady-state non-equilibrium molecular dynamics.

Sampling of quantum dynamics at long time.

The principle of energy conservation leads to a generalized choice of transition probability in a piecewise adiabatic representation of quantum(-classical) dynamics. Significant improvement (almost an order of magnitude, depending on the parameters of the calculation) over previous schemes is achieved. Perspectives for theoretical calculations in coherent many-body systems are opened.

Bulgac-Kusnezov-Nosé-Hoover thermostats.

In this paper, we formulate Bulgac-Kusnezov constant temperature dynamics in phase space by means of non-Hamiltonian brackets. Two generalized versions of the dynamics are similarly defined, one where the Bulgac-Kusnezov demons are globally controlled by means of a single additional Nosé variable, and another where each demon is coupled to an independent Nosé-Hoover thermostat. Numerically stable and efficient measure-preserving time-reversible algorithms are derived in a systematic way for each case. The chaotic properties of the different phase space flows are numerically illustrated through the paradigmatic example of the one-dimensional harmonic oscillator. It is found that, while the simple Bulgac-Kusnezov thermostat is apparently not ergodic, both of the Nosé-Hoover controlled dynamics sample the canonical distribution correctly.

Quantum-classical dynamics of wave fields.

An approach to the quantum-classical mechanics of phase space dependent operators, which has been proposed recently, is remodeled as a formalism for wave fields. Such wave fields obey a system of coupled nonlinear equations that can be written by means of a suitable non-Hamiltonian bracket. As an example, the theory is applied to the relaxation dynamics of the spin-boson model. In the adiabatic limit, a good agreement with calculations performed by the operator approach is obtained. Moreover, the theory proposed in this paper can take nonadiabatic effects into account without resorting to surface-hopping approximations. Hence, the results obtained follow qualitatively those of previous surface-hopping calculations and increase by a factor of (at least) 2, the time length over which nonadiabatic dynamics can be propagated with small statistical errors. Moreover, it is worth to note that the dynamics of quantum-classical wave fields proposed here is a straightforward non-Hamiltonian generalization of the formalism for nonlinear quantum mechanics that Weinberg introduced recently.

Freezing a single distal motion in dihydrofolate reductase.

Constraining a single motion between distal residues separated by approximately 28 A in hybrid quantum/classical molecular dynamics simulations is found to increase the free energy barrier for hydride transfer in dihydrofolate reductase by approximately 3 kcal/mol. Our analysis indicates that a single distal constraint alters equilibrium motions throughout the enzyme on a wide range of time scales. This alteration of the conformational sampling of the entire system is sufficient to significantly increase the free energy barrier and decrease the rate of hydride transfer. Despite the changes in conformational sampling introduced by the constraint, the system assumes a similar transition state conformation with a donor-acceptor distance of approximately 2.72 A to enable the hydride transfer reaction. The modified thermal sampling leads to a substantial increase in the average donor-acceptor distance for the reactant state, however, thereby decreasing the probability of sampling the transition state conformations with the shorter distances required for hydride transfer. These simulations indicate that fast thermal fluctuations of the enzyme, substrate, and cofactor lead to conformational sampling of configurations that facilitate hydride transfer. The fast thermal motions are in equilibrium as the reaction progresses along the collective reaction coordinate, and the overall average equilibrium conformational changes occur on the slower time scale measured experimentally. Recent single molecule experiments suggest that at least some of these thermally averaged equilibrium conformational changes occur on the millisecond time scale of the hydride transfer reaction. Thus, introducing a constraint that modifies the conformational sampling of an enzyme could significantly impact its catalytic activity.

Statistical mechanics of quantum-classical systems with holonomic constraints.

The statistical mechanics of quantum-classical systems with holonomic constraints is formulated rigorously by unifying the classical Dirac bracket and the quantum-classical bracket in matrix form. The resulting Dirac quantum-classical theory, which conserves the holonomic constraints exactly, is then used to formulate time evolution and statistical mechanics. The correct momentum-jump approximation for constrained systems arises naturally from this formalism. Finally, in analogy with what was found in the classical case, it is shown that the rigorous linear-response function of constrained quantum-classical systems contains nontrivial additional terms which are absent in the response of unconstrained systems.

Phase space flows for non-Hamiltonian systems with constraints.

In this paper, non-Hamiltonian systems with holonomic constraints are treated by a generalization of Dirac's formalism. Non-Hamiltonian phase space flows can be described by generalized antisymmetric brackets or by general Liouville operators which cannot be derived from brackets. Both situations are treated. In the first case, a Nosé-Dirac bracket is introduced as an example. In the second one, Dirac's recipe for projecting out constrained variables from time translation operators is generalized and then applied to non-Hamiltonian linear response. Dirac's formalism avoids spurious terms in the response function of constrained systems. However, corrections coming from phase space measure must be considered for general perturbations.