Hazard of complex regional pain syndrome following human papillomavirus vaccination among adolescent girls in the United States: a case-cohort analysis of insurance claims data

Objectives: Complex regional pain syndrome (CRPS) cases have followed human papillomavirus (HPV) vaccination, but no causal link has been established. Methods: Using insurance claims, the authors observed unvaccinated 11-year-old girls for CRPS diagnoses. The authors used time-dependent Cox regression to identify health-related CRPS predictors using diagnosis codes. Next, the authors identified HPV vaccinations using procedural codes. HPV vaccination and CRPS predictors were considered time-dependent covariates to estimated adjusted hazard ratios (HR) and 95% confidence intervals (CI) for CRPS, 30, 90, and 180-days post-vaccination. Results: 1,232,572 girls received 563 unique CRPS diagnoses. In a 10% sub-cohort of 123,981 girls accounting for potential confounders and predisposing risk factors (i.e. injury, infection, mental illness, primary care use), CRPS hazard was not significantly elevated 30 days (HR: 0.90, 95% CI: 0.46, 1.73), 90 days (HR: 1.17, 95% CI: 0.83, 1.65), or 180-days post-vaccination (HR: 1.11, 95% CI: 0.83, 1.47). Conclusion: The results support the safety and continued administration of HPV vaccines to adolescents

Mechanism of Fluoride Uptake by Hydroxyapatite from Acidic Fluoride Solutions: I. Theoretical Considerations

A mathematical model for the mechanism of calcium fluoride formation on hydroxyapatite in buffered fluoride solutions is proposed. It takes into account the physical and chemical processes that occur during the reaction. With the model it is possible to evaluate a priori the fluoride uptake potential of fluoride solutions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67263/2/10.1177_00220345700490066601.pd

Classical Cepheids: Yet another version of the Baade-Becker-Wesselink method

We propose a new version of the Baade--Becker--Wesselink technique, which allows one to independently determine the colour excess and the intrinsic colour of a radially pulsating star, in addition to its radius, luminosity, and distance. It is considered to be a generalization of the Balona approach. The method also allows the function F(CI) = BC + 10 log (Teff) for the class of pulsating stars considered to be calibrated. We apply this technique to a number of classical Cepheids with very accurate light and radial-velocity curves and with bona fide membership in open clusters (SZ Tau, CF Cas, U Sgr, DL Cas, GY Sge), and find the results to agree well with the reddening estimates of the host open clusters. The new technique can also be applied to other pulsating variables, e.g. RR Lyrae and RV Tauri.Comment: 6 pages, 2 figures, 1 table; Submitted to Astrophysical Bulletin, 201

Students with global experiences during medical school are more likely to work in settings that focus on the underserved: an observational study from a public U.S. institution

Background: Global health interest has grown among medical students over the past 20 years, and most medical schools offer global health opportunities. Studies suggest that completing global health electives during medical school may increase the likelihood of working with underserved populations in a clinical or research capacity. This study aimed to assess the association of global electives in medical school on subsequently working in global health and with underserved populations in the United States (U.S.), additionally considering students’ interests and experiences prior to medical school. We also examined whether respondents perceived benefits gained from global electives. Methods: We surveyed medical school graduates (classes of 2011-2015) from a large public medical school in the U.S. to describe current practice settings and previous global health experience. We evaluated work, volunteer, and educational experiences preceding medical school, socioeconomic status, race and ethnicity using American Medical College Application Service (AMCAS) data. We assessed the association between students’ backgrounds, completing global health electives in medical school and current work in global health or with underserved populations in the U.S. Results: In the 5 to 8 years post-graduation, 78% of 161 respondents reported work, research, or teaching with a focus on global or underserved U.S. populations. Completing a global health elective during medical school (p = 0.0002) or during residency (p = 0.06) were positively associated with currently working with underserved populations in the U.S. and pre-medical school experiences were marginally associated (p = 0.1). Adjusting for pre-medical school experiences, completing a global health elective during medical school was associated with a 22% greater prevalence of working with an underserved population. Perceived benefits from global electives included improved cultural awareness, language skills, public health and research skills, and ability to practice in technology-limited settings. Conclusion: Medical school graduates who participated in global electives as students were more likely than their peers to pursue careers with underserved populations, independent of experiences prior to medical school. We hypothesize that by offering global health experiences, medical schools can enhance the interests and skills of graduates that will make them more likely and better prepared to work with underserved populations in the U.S. and abroad

Optically induced coherent intra-band dynamics in disordered semiconductors

On the basis of a tight-binding model for a strongly disordered semiconductor with correlated conduction- and valence band disorder a new coherent dynamical intra-band effect is analyzed. For systems that are excited by two, specially designed ultrashort light-pulse sequences delayed by tau relatively to each other echo-like phenomena are predicted to occur. In addition to the inter-band photon echo which shows up at exactly t=2*tau relative to the first pulse, the system responds with two spontaneous intra-band current pulses preceding and following the appearance of the photon echo. The temporal splitting depends on the electron-hole mass ratio. Calculating the population relaxation rate due to Coulomb scattering, it is concluded that the predicted new dynamical effect should be experimentally observable in an interacting and strongly disordered system, such as the Quantum-Coulomb-Glass.Comment: to be published in Physical Review B15 February 200

Patterns of use of recombinant zoster vaccine among commercially-insured immunocompetent and immunocompromised adults 50–64 years old in the United States

Purpose: The Centers for Disease Control and Prevention (CDC) recommends recombinant zoster vaccination (RZV) for adults ≥ 50 years to prevent herpes zoster (HZ) and its sequelae. Initially, no distinct recommendation was made for immunocompromised adults, who experience higher HZ rates and more severe outcomes. We characterized receipt of first RZV dose (initiation) and both doses (completion) over time, and the impact of immune function on RZV uptake among adults aged 50–64 years in the United States. Methods: We identified RZV claims from the IBM MarketScan database between 1/1/2018 and 12/31/2019. We characterized immunocompromised enrollees as having malignancy, HIV, solid organ transplant, primary immunosuppression, or medication-induced immunosuppression using inpatient, outpatient, and prescription claims in the 6 months prior to study start. We evaluated patterns of vaccine uptake by demographic and healthcare access characteristics and immune status. Results: The cumulative incidence of RZV initiation during the study period was 10.0%. Incidence increased with age and number of medical office visits, and was higher among women, urban residents, high-deductible insurance beneficiaries, and those who were immunocompromised compared to immunocompetent. Among immunocompromised adults, RZV initiation was highest among those with HIV and primary immunodeficiencies. Of those who initiated RZV, 89.5% received both doses. RZV completion was highest among those who received the first dose at a pharmacy. Most enrollees (88.6%) who completed RZV vaccination did so within the recommended dosing schedule. Conclusions: RZV uptake was low in the two years since the CDC recommendation, and differed by demographic, healthcare access, and clinical characteristics. Initiation rates were higher among immunocompromised adults compared to immunocompetent adults, despite no CDC recommendation for vaccination in these groups during the study period. The CDC has since recommended RZV for immunocompromised individuals, and our findings may inform efforts to increase RZV uptake in individuals at higher risk of severe disease

United States travelers’ concern about Zika infection and willingness to receive a hypothetical Zika vaccine

The ongoing Zika pandemic has affected many countries that are common travel destinations. We assessed the willingness to receive a prophylactic Zika virus (ZIKV) vaccine, currently under development, among travelers to areas with reported autochthonous ZIKV transmission. We surveyed United States (U.S.) residents aged 18–44 years who had ever heard of ZIKV and planned to travel to Florida and/or Texas (N = 420) or a U.S. territory or foreign country (N = 415) in 2017, using a nationally representative internet panel. Travelers to Florida and/or Texas reported less concern about ZIKV infection than travelers to other destinations (27% versus 36%, P = 0.01). Female sex, Hispanic ethnicity, discussing ZIKV with medical professionals, ZIKV risk perception, and self-efficacy for ZIKV prevention predicted concern about ZIKV infection in both groups. Travelers to Florida and/or Texas (43%) and other destinations (44%) were equally willing to receive a ZIKV vaccine. Hispanic ethnicity, discussing ZIKV with medical professionals, and concern about ZIKV infection predicted vaccine willingness in both groups. Likelihood of using existing ZIKV prevention methods, confidence in the U.S. government to prevent ZIKV spread, self-efficacy for ZIKV prevention, and knowledge about ZIKV symptoms further predicted vaccine willingness in travelers to other destinations. In multivariable analyses, only concern about ZIKV infection was associated with vaccine willingness in both groups (prevalence ratio [95% confidence interval]: Florida and/or Texas: 1.34 [1.06, 1.69]; other: 1.82 [1.44, 2.29]). Targeted communications can educate travelers, particularly travelers who are pregnant or may become pregnant, about ZIKV risk to generate ZIKV vaccine demand

Awareness, Knowledge, and Travel-Related Risk Factors for Zika Virus Among Latinas Attending a Federally Qualified Health Center in Rural North Carolina

BACKGROUND The Zika virus (ZIKV) epidemic that began in 2015 presented a risk for ZIKV infection among persons who traveled to ZIKV-affected countries. Latinas in North Carolina and their sexual partners may be exposed to ZIKV when traveling to these regions.METHODS We administered a cross-sectional survey, measuring ZIKV risk and knowledge, to a convenience sample of 262 reproductive-age Latinas attending a Federally Qualified Health Center in rural North Carolina. We described ZIKV risk and knowledge in the sample, and compared responses between those who were pregnant or recently pregnant, and those who were not pregnant. We further identified factors associated with 1) awareness of ZIKV and 2) high knowledge of ZIKV sequelae and prevention among those who were aware of ZIKV, using log-binomial regression.RESULTS Two-thirds of participants had ever heard of ZIKV, which was positively associated with educational attainment. Most participants aware of ZIKV had moderate/high knowledge of ZIKV transmission (92.5%) and symptoms (73.2%), but knowledge of preventing sexual and congenital transmission was limited. Travel was infrequent among pregnant or recently pregnant participants (5.4%) and their partners (7.1%). Despite low risk for ZIKV infection, participants were willing to practice ZIKV prevention.LIMITATIONS Our study is limited by a lack of generalizability to Latinas in other regions of the country, self-reporting bias, and lack of survey validation as an indicator of English language proficiency.CONCLUSIONS Providers should identify patients likely to become pregnant and travel to high-risk areas, inquire about partner travel history, and offer culturally appropriate ZIKV risk counseling

Supermembranes and Super Matrix Models

We review recent developments in the theory of supermembranes and their relation to matrix models.Comment: Invited lecture presented at the Corfu Workshop, September 20 - 26, 1998, of the TMR Project "Quantum Aspects of Gauge Theories, Supersymmetry and Unification" (ERBFMRXCT96-0045), to appear in the proceedings. Latex 41 p

Heterotic / type I duality and D-brane instantons

We study heterotic/type I duality in d=8,9 uncompactified dimensions. We consider the special (``BPS saturated'') F^4 and R^4 terms in the effective one-loop heterotic action, which are expected to be non-perturbatively exact. Under the standard duality map these translate to tree-level, perturbative and non-perturbative contributions on the type I side. We check agreement with the one-loop open string calculation, and discuss the higher-order perturbative contributions, which arise because of the mild non-holomorphicities of the heterotic elliptic genus. We put the heterotic world-sheet instanton corrections in a form that can be motivated as arising from a D-brane instanton calculation on the type-I side.Comment: latex 23 pages, 3 figures eps included. Final version to appear in Nuclear Physics