Validation of the Vaccination Confidence Scale: A Brief Measure to Identify Parents at Risk for Refusing Adolescent Vaccines

Objective To validate a brief measure of vaccination confidence using a large, nationally representative sample of parents. Methods We analyzed weighted data from 9018 parents who completed the 2010 National Immunization Survey–Teen, an annual, population-based telephone survey. Parents reported on the immunization history of a 13- to 17-year-old child in their households for vaccines including tetanus, diphtheria, and acellular pertussis (Tdap), meningococcal, and human papillomavirus vaccines. For each vaccine, separate logistic regression models assessed associations between parents\u27 mean scores on the 8-item Vaccination Confidence Scale and vaccine refusal, vaccine delay, and vaccination status. We repeated analyses for the scale\u27s 4-item short form. Results One quarter of parents (24%) reported refusal of any vaccine, with refusal of specific vaccines ranging from 21% for human papillomavirus to 2% for Tdap. Using the full 8-item scale, vaccination confidence was negatively associated with measures of vaccine refusal and positively associated with measures of vaccination status. For example, refusal of any vaccine was more common among parents whose scale scores were medium (odds ratio, 2.08; 95% confidence interval, 1.75–2.47) or low (odds ratio, 4.61; 95% confidence interval, 3.51–6.05) versus high. For the 4-item short form, scores were also consistently associated with vaccine refusal and vaccination status. Vaccination confidence was inconsistently associated with vaccine delay. Conclusions The Vaccination Confidence Scale shows promise as a tool for identifying parents at risk for refusing adolescent vaccines. The scale\u27s short form appears to offer comparable performance

Coxiella burnetii: Intranasal immunizations and axenic media adaptations

Coxiella burnetii is an obligate intracellular pathogen and the causative agent of the zoonotic illness Q fever. With an infectious dose of 1-10 organisms, C. burnetii is one of the most infectious bacteria known. This low infectious dose coupled with its environmental stability and aerosol route of infection has placed it on the Centers for Disease Control and Prevention's Class B Select Agent List, making a vaccine against C. burnetii infection particularly desirable. Formulations of killed whole-cell C. burnetii virulent strains has been shown to be effective when administered intramuscularly, intraperitoneally, and sub-cutaneously, but has not been assessed using an intranasal route of inoculation that would also bring to bear the mucosal immune response. We hypothesized that intranasal immunization would be protective against subsequent challenge with live virulent C. burnetii. Using a guinea pig model, intranasal immunization with either a mixture of killed whole-cell C. burnetii Nine Mile phase I combined with double mutant lethal toxin (DmLT) adjuvant, or a mock immunization of PBS-DmLT. Booster immunizations were administered at 14 and 28 days. Sera was drawn for IgG titers prior to, and at 14, 28, and 56 days following intranasal immunization. Analysis of sera indicates that a robust humoral response is elicited following intranasal immunization. Additionally, immunized guinea pigs that were subsequently challenged with virulent C. burnetii NMI did not develop significant clinical symptoms as measured by fever and weight loss when compared to animals receiving the mock immunization. Studies defining minimal immunization requirements, potential hypersensitivity response, and protective antigen profile using this physiologically relevant exposure route will aid us in defining a protective response to this unusual aerosol acquired pathogen.For the first 80 years following its discovery, C. burnetii could only be grown in a system providing live cells within which it would replicate. The relatively recent advent of cell free media has been a boon for C. burnetii research on many fronts. We noticed when infecting cultured cells using C. burnetii that had been repeatedly passaged in cell free defined acidified citrate cysteine media (ACCM-D), that the infectivity rates were lower than expected based on the number of genomes used to initiate the infection relative to C. burnetii that had been derived from infected cells. Infectious assays comparing C. burnetii from passages 1, 3, 5 and 10 determined that by passage 10 the organism's relative ability to infect cultured cells had decreased 2-logs. We hypothesized that molecular changes were occurring in these early passages that related to the ability of the bacteria to infect or grow within host cells at their normal rate. We initiated a "Reverse Evolution" approach to study the molecular changes that occur following serial passages in axenic media to determine what occurs when the stressors associated with C. burnetii's typically intracellular lifestyle are removed. We found that the concentration of DotA and IcmX, two structural proteins of the Type IVB Secretion System, which is required for intracellular growth, were significantly reduced by passage 10. Mass spec analysis of passages 1, 3, and 5 also demonstrate changes between protein levels in subsequent passages analyzed. Expanded mass spec and RNAseq analysis to include passage 10, along with immunoblot analysis and genome sequencing of both early and longer-term passages will elucidate molecular mechanisms required for C. burnetii's intracellular survival and growth

Measurement of 02 Saturation in Freely Deep Diving Northern Elephant Seals (Mirounga angustirostris) Using a Novel Data Logging Tag

Marine mammals live a life of dual constraints and must balance energetic demands (oxygen consumption) and limited O2 availability while breath-holding. In order to overcome these dual constraints, marine mammals have developed unique physiological traits to cope with their aquatic environment, thereby taking advantage of a unique foraging niche. Extending breath-hold dive time increases the opportunity to obtain nutrients, but it can be energetically costly if marine mammals exceed the threshold for aerobic metabolism. We know relatively little about the physiological mechanisms employed by these animals that allow them to flourish in such an extreme environment. Due to the difficulty obtaining direct physiological measurements, there are gaps in knowledge for the field of diving physiology, particularly in the understanding of muscle perfusion during a dive. In order to improve our understanding of how marine mammals adjust muscle blood flow (oxygen and nutrients) during diving to increase dive time, we developed and tested a tag with oxygen sensors that attempted to measure O2 saturation in the muscle of freely deep-diving elephant seals. The purpose of this part of the study aimed at using an archival tag and implanted sensor system to measure physiological variables in freely deep-diving Northern elephant seals. Following the sensor and data logger development, we set out to test a long-held assumption that oximeter use in marine mammals could be calibrated with terrestrial mammal blood. This was of particular importance to this study as calibrations of the oximeter data loggers in the Northern elephant seal were needed. As part of the ability of marine mammals to prolong apnea for diving, some have modified hemoglobin to change its affinity for oxygen. These polymorphisms alter the affinity for O2, possibly by altering the folding of the protein. Alteration in the quaternary structure may also alter the optical properties of Hb. Oximeters use the change in the optical properties of oxygenated (HbO2) and reduced Hb (HbR) to determine arterial blood O2 saturation. Given the differences in Hb isoformss, the optical properties need to be assessed before conventional veterinary oximeters can be used on marine species. Therefore, the objective of this part of the study was to determine the absorbance spectra of HbO2 and HbR in several species of marine mammals (killer whale, short-finned pilot whale, beluga whale, and northern elephant seals) and compare these against humans. Whole blood samples were opportunistically obtained during routine health assessment, and the Hb was isolated via a series of centrifugation, dialysis, and filtration steps. The isolated Hb was oxygenated or deoxygenated using 5% CO2 in 95% O2 or N2, respectively. Under gas-tight conditions, the HbO2 and HbR samples were placed in a UV-visible light spectrophotometer and the absorption spectra measured from 600 nm to 1000 nm. The absorption spectra were overlaid and compared between species. The results indicate the absorption spectra are similar between humans and the species investigated and the point where absorbance is equal for HbO2 and HbR in all species at ~800 nm. The results of the Hb study allowed the possibility of properly calibrating the oximeter we surgically implanted in the Northern elephant seal. The oximeter sensor contained 3 LEDs in the visible red, near infrared (NIR), and infrared (IR) spectral regions (emitting at red:660, NIR:810, and IR:940 nm, respectively) and a photo detector. The sensor was attached to the external data logger with a thin (2-3 mm diameter) flexible silver (Ag) cable. The external data logger was attached with epoxy to the skin and fur of the seal following implantation of the sensor. In April 2013, 5 northern elephant seals were captured from the Año Nuevo and were instrumented with the oxygen sensor and data logger via aseptic surgical technique. Following implantation of the muscle O2 sensor and attachment of logger and satellite and radio transmitters, the animals were allowed to recover. Every 1-2 hours signs of inflammation, infection, or changes in swimming behavior were documented and none were observed in any seal. After translocation, all of the seals returned to the Año Nuevo rookery. All 5 seals implanted returned to Año Nuevo, had the instrumentation easily and successfully removed, and showed no signs of infection, inflammation or trauma concluding that we were able to develop a surgical technique that minimized the invasiveness of implanting a small sensor into the major swimming muscle of the Northern elephant seal. Free-diving ocean data was collected from the oximeter data logger only from the last two seals implanted, however only 1 out of 5 had oximetry data. Additionally, there was difficulty in calibrating the oximeter/sensor data logger. However, GPS tracks and dive patterns were recorded and analyzed from all 5 seals. All seals were equipped with GPS tags with ARGOS satellite uplink and had similar dive patterns to one another and to previous studies. Furthermore, we were able to obtain data by the end of the field season from one seal out of five indicating that with a few adjustments to the data logger, a second field season may yield a larger sample size and more reliable data

Anticipated regret and health behavior: A meta-analysis.

Risk beliefs are central to most theories of health behavior, yet many unanswered questions remain about an increasingly studied risk construct, anticipated regret. We sought to better understand anticipated regret’s role in motivating health behaviors

Reading Recovery in South Carolina: 2016-2017 State Report

Developed by New Zealand educator Dr. Marie M. Clay, Reading Recovery® is a short-term early intervention for first grade students who have the lowest achievement on measures of literacy outcomes. Students meet individually with a specially trained teacher for 30 minutes each day for a period of 12-20 weeks. The goal during this period is for children to develop a network of reading and writing strategies so they may independently perform within the average range of their class

Comparative Transcriptomics and Genomics from Continuous Axenic Media Growth Identifies

Coxiella burnetii (Cb) is an obligate intracellular pathogen in nature and the causative agent of acute Q fever as well as chronic diseases. In an effort to identify genes and proteins crucial to their normal intracellular growth lifestyle, we applied a Reverse evolution approach where the avirulent Nine Mile Phase II strain of Cb was grown for 67 passages in chemically defined ACCM-D media and gene expression patterns and genome integrity from various passages was compared to passage number one following intracellular growth. Transcriptomic analysis identified a marked downregulation of the structural components of the type 4B secretion system (T4BSS), the general secretory (sec) pathway, as well as 14 out of 118 previously identified genes encoding effector proteins. Additional downregulated pathogenicity determinants genes included several chaperones, LPS, and peptidoglycan biosynthesis. A general marked downregulation of central metabolic pathways was also observed, which was balanced by a marked upregulation of genes encoding transporters. This pattern reflected the richness of the media and diminishing anabolic and ATP-generation needs. Finally, genomic sequencing and comparative genomic analysis demonstrated an extremely low level of mutation across passages, despite the observed Cb gene expression changes following acclimation to axenic media

Parents who refuse or delay HPV vaccine: Differences in vaccination behavior, beliefs, and clinical communication preferences

Background: We sought to estimate the national prevalence of HPV vaccine refusal and delay in a nationally-representative sample of parents of adolescents. We also compared parents who refused versus delayed HPV vaccine in terms of their vaccination beliefs and clinical communication preferences. Methods: In 2014 to 2015, we conducted an online survey of 1,484 US parents who reported on an 11- to 17-year-old child in their household. We used weighted multinomial logistic regression to assess correlates of HPV vaccine refusal and delay. Results: Overall, 28% of parents reported that they had ever “refused or decided not to get” HPV vaccine for their child, and an additional 8% of parents reported that they had “delayed or put off getting” HPV vaccine. Compared to no refusal/delay, refusal was associated with lower confidence in adolescent vaccination (relative risk ratio [RRR] = 0.66, 95% confidence interval [CI], 0.48–0.91), lower perceived HPV vaccine effectiveness (RRR = 0.68, 95% CI, 0.50–0.91), and higher perceived harms (RRR = 3.49, 95% CI, 2.65–4.60). In contrast, delay was associated with needing more information (RRR = 1.76, 95% CI, 1.08–2.85). Most parents rated physicians and information sheets as helpful for making decisions about HPV vaccination, although parents who reported refusal endorsed these resources less often. Conclusions: Our findings suggest that HPV vaccine refusal is common among parents of adolescents and may have increased relative to previous estimates. Because the vaccination beliefs and communication preferences of parents who refuse appear to differ from those who delay, targeted communication strategies may be needed to effectively address HPV vaccine hesitancy

Physician support of HPV vaccination school-entry requirements

School-entry requirements in the US have led to high coverage for several vaccines, but few states and jurisdictions have adopted these policies for human papillomavirus (HPV) vaccination. Because physicians play a key role in advocating for vaccination policies, we assessed physician support of requiring HPV vaccine for school entry and correlates of this support. Participants were a national sample of 775 physicians who provide primary care, including vaccines, to adolescents. Physicians completed an online survey in 2014 that assessed their support for school-entry requirements for HPV vaccination of 11 and 12 y olds. We used multivariable logistic regression to assess correlates of support for these requirements. The majority of physicians (74%) supported some form of school-entry requirements, with or without opt-out provisions. When opt-out provisions were not specified, 47% agreed that laws requiring HPV vaccination for school attendance were a “good idea.” Physicians more often agreed with requirements, without opt-out provisions, if they: had more years in practice (OR=1.49; 95% CI: 1.09-2.04), gave higher quality HPV vaccine recommendations (OR=2.06; 95% CI: 1.45-2.93), believed that having requirements for Tdap, but not HPV, vaccination undermined its importance (OR=3.33; 95% CI: 2.26-4.9), and believed HPV vaccination was as or more important than other adolescent vaccinations (OR=2.30; 95% CI: 1.65-3.18). In conclusion, we found that many physicians supported school-entry requirements for HPV vaccination. More research is needed to investigate the extent to which opt-out provisions might weaken or strengthen physician support of HPV vaccination school-entry requirements

Implementing the WHO caregivers skills training program with caregivers of autistic children via telehealth in rural communities

Background: For families with autistic children living in rural areas, limited access to services partly results from a shortage of providers and extensive travel time. Telehealth brings the possibility of implementing alternative delivery modalities of Parent Mediated Interventions (PMIs) with the potential to decrease barriers to accessing services. This study aimed to evaluate the feasibility and acceptability of implementing the World Health Organization-Caregivers Skills Training program (WHO-CST) via an online, synchronous group format in rural Missouri. Methods: We used a mixed methods design to collect qualitative and quantitative data from caregivers and program facilitators at baseline and the end of the program, following the last home visit. Caregivers of 14 autistic children (3-7 years), residents of rural Missouri, completed nine virtual sessions and four virtual home visits. Results: Four main themes emerged from the focus groups: changes resulting from the WHO-CST, beneficial aspects of the program, advantages and disadvantages of the online format, and challenges to implementing the WHO-CST via telehealth. The most liked activity was the demonstration (36%), and the least liked was the practice with other caregivers. From baseline to week 12, communication skills improved in both frequency (p \u3c 0.05) and impact (p \u3c 0.01), while atypical behaviors decreased (p \u3c 0.01). For caregivers\u27 outcomes, only confidence in skills (p \u3c 0.05) and parental sense of competence (p \u3c 0.05) showed a positive change. Conclusion: Our results support the feasibility of implementing the WHO-CST program via telehealth in a US rural setting. Caregivers found strategies easy to follow, incorporated the program into their family routines, and valued the group meetings that allowed them to connect with other families. A PMI such as the WHO-CST, with cultural and linguistic adaptations and greater accessibility via telehealth-plays an essential role in closing the treatment gap and empowering caregivers of autistic children

Parents' Support for School-Entry Requirements for Human Papillomavirus Vaccination: A National Study

The number of states proposing school-entry requirements for human papillomavirus (HPV) vaccination has increased over the last decade. However, data are currently limited regarding parents' support of such laws. We sought to obtain the first national estimates of parents' support of HPV vaccination school-entry requirements