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Background: Factors contributing to the spread of SARS-CoV-2 outside the acute care hospital setting have been described in detail. However, data concerning risk factors for nosocomial SARS-CoV-2 infections in hospitalized patients remain scarce. To close this research gap and inform targeted measures for the prevention of nosocomial SARS-CoV-2 infections, we analyzed nosocomial SARS-CoV-2 cases in our hospital during a defined time period. Methods: Data on nosocomial SARS-CoV-2 infections in hospitalized patients that occurred between May 2020 and January 2021 at Charité university hospital in Berlin, Germany, were retrospectively gathered. A SARS-CoV-2 infection was considered nosocomial if the patient was admitted with a negative SARS-CoV-2 reverse transcription polymerase chain reaction test and subsequently tested positive on day five or later. As the incubation period of SARS-CoV-2 can be longer than five days, we defined a subgroup of "definite" nosocomial SARS-CoV-2 cases, with a negative test on admission and a positive test after day 10, for which we conducted a matched case–control study with a one to one ratio of cases and controls. We employed a multivariable logistic regression model to identify factors significantly increasing the likelihood of nosocomial SARS-CoV-2 infections. Results: A total of 170 patients with a nosocomial SARS-CoV-2 infection were identified. The majority of nosocomial SARS-CoV-2 patients (n = 157, 92%) had been treated at wards that reported an outbreak of nosocomial SARS-CoV-2 cases during their stay or up to 14 days later. For 76 patients with definite nosocomial SARS-CoV-2 infections, controls for the case–control study were matched. For this subgroup, the multivariable logistic regression analysis revealed documented contact to SARS-CoV-2 cases (odds ratio: 23.4 (95% confidence interval: 4.6–117.7)) and presence at a ward that experienced a SARS-CoV-2 outbreak (odds ratio: 15.9 (95% confidence interval: 2.5–100.8)) to be the principal risk factors for nosocomial SARS-CoV-2 infection. Conclusions: With known contact to SARS-CoV-2 cases and outbreak association revealed as the primary risk factors, our findings confirm known causes of SARS-CoV-2 infections and demonstrate that these also apply to the acute care hospital setting. This underscores the importance of rapidly identifying exposed patients and taking adequate preventive measures. [ABSTRACT FROM AUTHOR]

The mode of action of ribavirin is not completely understood. Ribavirin monotherapy has a measurable antiviral effect, which shows great variability. It might lead to an earlier steady state of plasma concentration and therefore enhance the effect of following combination treatment. The aim of this study was to evaluate the antiviral effect of ribavirin priming and its influence on sustained virologic response after combination treatment in a group of patients with different hepatitis C virus ( HCV) types with or without prior treatment experience. Retrospective analysis of 75 patients (37 treatment naïve, 20 prior relapse, 16 prior nonresponse, genotype 1 present in 60 patients) from five centres who received ribavirin priming as part of an individual strategy in order to improve treatment outcome. All patients received ribavirin monotherapy with a mean dose of 14.5 mg kg−1 body weight for a mean of 28 days. After ribavirin priming, dual combination treatment with pegylated interferon alfa and ribavirin was started. The mean HCV RNA decline after ribavirin priming was 0.6 log10 IU mL−1 ( P<.001). The initial viral decline depended on HCV type and previous treatment status being highest among prior relapsers (0.8 log10 IU mL−1; P=.002) and HCV type 2/3 (1.2 log10 IU mL−1; P=.05) and lowest among those with prior nonresponse (0.3 log10 IU mL−1, P=.01). IFNL4 (formerly IL28B) genotype for rs12979860 and IFNL3 genotype rs8099917 did not influence the initial viral decline. The study demonstrates a significant variability in the viral dynamics and antiviral efficacy of ribavirin monotherapy, which is mainly influenced by prior treatment status. The fact that the lowest response pattern was observed in prior nonresponder patients to pegylated interferon alfa plus ribavirin combination therapy can be taken as a hint that not only the individual interferon, but also the ribavirin sensitivity contributes significantly to the nonresponsive state. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including the arts and health practice in Denmark, role of objects in supporting older people with dementia, and community music therapy.

An interview with Kjell Austin, project manager of Nordic Ministers of Culture is presented. Austin states that culture and health is developing in Nordic countries. Austin notes that arts and culture will still be given priority on their own terms. Austin mentions the number of projects and activities taking place at national, regional, and local levels in Nordic countries.

Objective To evaluate a proposed natural language processing (NLP) and machine-learning based automated method to risk stratify abdominal pain patients by analyzing the content of the electronic health record (EHR). Methods We analyzed the EHRs of a random sample of 2100 pediatric emergency department (ED) patients with abdominal pain, including all with a final diagnosis of appendicitis. We developed an automated system to extract relevant elements from ED physician notes and lab values and to automatically assign a risk category for acute appendicitis (high, equivocal, or low), based on the Pediatric Appendicitis Score. We evaluated the performance of the system against a manually created gold standard (chart reviews by ED physicians) for recall, specificity, and precision. Results The system achieved an average F-measure of 0.867 (0.869 recall and 0.863 precision) for risk classification, which was comparable to physician experts. Recall/precision were 0.897/0.952 in the low- risk category, 0.855/0.886 in the high-risk category, and 0.854/0.766 in the equivocal-risk category. The information that the system required as input to achieve high F-measure was available within the first 4 h of the ED visit. Conclusions Automated appendicitis risk categorization based on EHR content, including information from clinical notes, shows comparable performance to physician chart reviewers as measured by their inter-annotator agreement and represents a promising new approach for computerized decision support to promote application of evidence-based medicine at the point of care. [ABSTRACT FROM AUTHOR]

Background & Aims: Genetic variations near the interferon lambda 3 gene (IFNL3, IL28B) are the most powerful predictors for sustained virologic response (SVR) in patients with chronic hepatitis C virus (HCV) infection, compared to other biochemical or histological baseline parameters. We evaluated whether the interplay of both IFNL3 polymorphisms rs12979860 and rs8099917 together with non-genetic clinical factors contributes to the predictive role of these genetic variants. Methods: The cohort comprised 1,402 patients of European descent with chronic HCV type 1 infection. 1,298 patients received interferon-based antiviral therapy, and 719 (55%) achieved SVR. The IFNL3 polymorphisms were genotyped by polymerase chain reaction and melting curve analysis. Results: A significant correlation was found between the IFNL3 polymorphisms and biochemical as well as virologic predictors of treatment outcome such as ALT, GGT, cholesterol, and HCV RNA levels. In multivariate regression analysis, IFLN3 SNPs, HCV RNA levels, and the GGT/ALT ratio were independent predictors of SVR. Dependent on the GGT/ALT ratio and on the HCV RNA concentration, significant variations in the likelihood for achieving SVR were observed in both, carriers of the responder as well as non-responder alleles. Conclusions: Our data support a clear association between IFNL3 genotypes and baseline parameters known to impact interferon responsiveness. Improved treatment outcome prediction was achieved when these predictors were considered in combination with the IFNL3 genotype. [ABSTRACT FROM AUTHOR]

. Incomplete suppression of hepatitis C virus (HCV) replication with persistence of minimal viremia (partial virologic response) leading to treatment failure can be observed in a significant proportion of HCV type 1-infected patients during antiviral therapy. Recently, high-dose intravenous silibinin has demonstrated strong antiviral activity against HCV. We were therefore interested in whether patients with partial virologic response can be rescued by the on-treatment addition of a short-term course of high-dose intravenous silibinin infusions. Twenty patients who failed to achieve a complete virologic response to different interferon-based regimens qualified for the rescue strategy and received 1400 mg/day silibinin infusions on two consecutive days. Complete viral suppression (below the limit of detection <6 IU/mL, TMA assay) could be induced in 13 of 20 patients within the first week after the short-term silibinin infusion, and all but one of them also remained HCV RNA negative during the subsequent follow-up period on continued peginterferon plus ribavirin treatment. In the remaining seven patients, no complete suppression could be achieved although four showed a significant HCV RNA reduction in response to silibinin. Silibinin infusions were generally well tolerated, and activation of abdominal peristalsis with nausea, diarrhoea and vomiting were the most prominent side effects. Of the twelve patients who exhibited a durable response to peginterferon and ribavirin treatment, three achieved an SVR, two achieved a week 12 SVR and four suffered a viral relapse. Three patients could not complete the assigned antiviral treatment with peginterferon alpha and ribavirin for nonvirological reasons. Short-term administration of high-dose intravenous silibinin might be an interesting approach to rescue patients with ongoing minimal residual viremia while on interferon-based therapy. These preliminary findings may stimulate further studies to evaluate more refined therapeutic strategies. [ABSTRACT FROM AUTHOR]

Deconstructing the Toolkit explores the current desire for toolkits that promise failsafe structures to facilitate creative success. The paper examines this cultural phenomenon within the context of the risk-averse workplace—with particular focus on the NHS. The writers draw on Derrida and deconstructionism to reflect upon the principles of creativity and the possibilities for being creative within the workplace. Through reference to The Extra Mile project facilitated by Open Art, the paper examines the importance of engaging with an aesthetic of creativity and embracing a more holistic approach to the problems and potential of the creative process. [ABSTRACT FROM AUTHOR]

This paper is drafted as an overview of the process of the Creativity in Health and Care workshop programme the themes arising from the project. It is intended as an introduction to the special edition and the notion of creativity that is being explored. [ABSTRACT FROM AUTHOR]

Limiting or eliminating work-related musculoskeletal disorders (WRMSDs) is a goal of many employers. Understanding risk factors associated with WRMSDs assists workers in avoiding these factors. The purposes of this study were to determine employees' awareness of risk factors of WRMSDs and their knowledge for avoiding such risks and to evaluate the effectiveness of injury prevention of WRMSD education by an occupational therapist. Sixty-one employees (both supervisors and employees) at a university animal research laboratory participated. They were given a pre-test survey before the injury prevention education. They were next provided with an hour's training and then given a post-test survey. There was statistical significance with four of the five items on the test instrument when comparing the pre-test and the post-test results. This demonstrates knowledge gained from the training. The conclusion supported injury prevention training from an occupational therapist on risk factors associated with WRMSDs and employers should consider such training. [ABSTRACT FROM AUTHOR]

Migration of groundwater contamination from beneath the Hanford Site into the Columbia River creates a need for in situ 90Sr monitoring. The prototype monitor discussed here was designed for deployment downwell and provides near-real-time determination of the 90Sr concentration in a two-liter groundwater sample. This manuscript discusses the design, construction and preliminary results for a prototype monitor. Calibration and testing results of the as-built system show qualitative agreement between simulated predictions and experimental results. Downwell and laboratory tests demonstrate a sensitivity to 90Sr at concentrations below 8 pCi/l (0.3 Bq/1) at a 90% confidence level in measurement times of less than four hours. [ABSTRACT FROM AUTHOR]

The search for neutrinoless double beta decay in 76Ge has driven the need for ultra-low background Ge detectors shielded by electroformed copper of ultra-high radiopurity (<0.1 μBq/kg). Although electrodeposition processes are almost sophisticated enough to produce copper of this purity, to date there are no methods sensitive enough to assay it. Inductively coupled plasma mass spectrometry (ICP/MS) can detect thorium and uranium at femtogram levels, however, this assay is hindered by high copper concentrations in the sample. Electrodeposition of copper samples removes copper from the solution while selectively concentrating thorium and uranium contaminants to be assayed by ICP/MS. Spiking 232Th and 238U into the plating bath simulates low purity copper and allows for the calculation of the electrochemical rejection rate of thorium and uranium in the electroplating system. This rejection value will help to model plating bath chemistry. [ABSTRACT FROM AUTHOR]

For life insurance companies, the challenge of the new century is to maintain profitability and market share in a rapidly changing business environment, manifested by increased competition and changes to insurance products required by the market. In order to meet these challenges, the Western-Southern Life Insurance Company (WSL) decided to automate their insurance policy application process and reengineer the underwriting process. Their main objectives were to reduce the cost of underwriting, reduce application cycle time and streamline the underwriting process. The result was a business intelligence application known as Intelligent New Business. [ABSTRACT FROM AUTHOR]

The Majorana project, a next-generation76Ge neutrinoless double-beta decay experiment being undertaken by a large international collaboration, has the goal of measuring the neutrinoless double-beta decay rate by observing monochromatic events at 2039 keV in 500 kg of isotopically enriched76Ge gamma-ray spectrometers. In order to achieve the desired sensitivity limit, the background in the 2037-2041 keV region must be reduced to<1 event per year in the entire germanium array. The effects of various background reduction techniques, and the combination thereof, to produce a huge76Ge spectrometer array with virtually zero background are discussed. [ABSTRACT FROM AUTHOR]

An online monitor has been designed, built, and tested that is capable of measuring the residual transuranic concentrations in processed high-level wastes with a detection limit of 370 Bq/ml (10 nCi/ml) in less than six hours. The monitor measures the (α,n) neutrons in the presence of gamma-ray fields up to 1 Sv/h (100 R/h). The optimum design was determined by Monte Carlo modeling and then tempered with practical engineering and cost considerations. A multiplicity counter is used in data acquisition to reject the large fraction of coincident and highly variable cosmic-ray-engendered background events and results in anS/Nratio ~1. [ABSTRACT FROM AUTHOR]

The proposed Majorana double-beta decay experiment is based on an array of segmented intrinsic Ge detectors with a total mass of 500 kg of Ge isotopically enriched to 86% in 76Ge. A discussion is given of background reduction by material selection, detector segmentation, pulse shape analysis, and electroformation of copper parts and granularity. Predictions of the experimental sensitivity are given. For an experimental running time of 10 years over the construction and operation of the Majorana setup, a sensitivity of T1/20ν ∼ 4 × 1027 yr is predicted. This corresponds to 〈mν〉 ∼ 0.003–0.004 eV according to recent QRPA and RQRPA matrix element calculations.© 2004 MAIK “Nauka / Interperiodica”. [ABSTRACT FROM AUTHOR]

We comment on the recent claim for the experimental observation of neutrinoless doublebeta decay. We discuss several limitations in the analysis provided in that paper and conclude that there is no basis for the presented claim. [ABSTRACT FROM AUTHOR]

A pilot plant is being designed at the U. S. Department of Energy's Savannah River Site (SRS) to demonstrate the removal of 90Sr, 137Cs, and transuranics from a high-level liquid waste stream prior to encapsulation in a Saltstone Facility. In-line monitors are required to determine the concentration of all radionuclides on this processed waste stream. Calibration standards containing 60Co, 137Cs, and 90Sr were prepared and counted. Efficiency curves were generated. Strontium-90 is readily observable above the system background in the calibration standard count, and is observable at less than 3 nCi/ml in a mixed solution having the maximum allowable concentration of all other activities present in the proposed SRS effluent stream. [ABSTRACT FROM AUTHOR]

More than 15 years ago the presence of 210Pb activity in lead was found to create significant background in a low-background radiation detection spectrometer. Shortly thereafter, 210Po alpha particles emitted from the surface of a solder joint were directly observed with this spectrometer. Antiquity lead was used to eliminate these sources of radioactivity. The experiments leading up to these “discoveries” are described. The magnitude of the effect of 210Pb in lead on the experiment is discussed. The sensitivities of various techniques for measuring 210Pb in lead are compared, and a practical limit for alpha activity in lead is proposed. [ABSTRACT FROM AUTHOR]

The International Germanium Experiment (IGEX) has now analyzed 117 mol yr of data from its isotopically enriched (86% [sup 76]Ge) germanium detectors. Applying pulse shape discrimination (PSD) to the more recent data, the lower bound on the half-life for neutrinoless double-beta decay of [sup 76]Ge is deduced: T[sub ½](0v) > 1.57 x 10[sup 25] yr (90% C.L.). This corresponds to an upper bound on the Majorana neutrino mass parameter, 〈m[sub v]〉, between 0.33 eV and 1.35 eV depending on the choice of theoretical nuclear matrix elements used in the analysis. [ABSTRACT FROM AUTHOR]

A pilot search for the excitation of [sup 73]Ge to the first excited state at 13.26 keV by spin-dependent interactions of Weakly Interacting Massive Particles (WIMPs) was performed. The first experimental results have been analyzed with a new method. The background for these reactions is ≤0.0012 events/(keV kg([sup 73]Ge) d). Although there is no theory for E2 excitations by WIMPs, this very large suppression of the background may promise an enlarged version of this experiment to be competitive. It is appropriate to propose an experiment with several kg of enriched [sup 73]Ge detectors based on these results. [ABSTRACT FROM AUTHOR]