Effectiveness of a Pharmacist-Directed Tdap Immunization Program for a University Campus

Background/Objectives: Despite a slight increase in Tdap immunization rates, the total numbers are still low among adults. The purpose of this study is to determine the impact of a pharmacist-directed immunization program. The primary objective was to assess the increase in vaccination rates among the subjects indicated to receive the Tdap vaccine. The secondary objective was to assess changes in pre and post vaccine knowledge scores.Methods: Employees enrolled in the pharmacist-directed employee wellness clinic on a university campus in Ohio were screened forTdap vaccination at the annual employee health fair during Fall of 2016. Results were cross-referenced with the state vaccination database. Subjects were recruited via email to an educational program. Indicated patients were asked to schedule an appointment with a pharmacist. Assessment data on the educational program was collected before the presentation and after the appointment when the vaccine was administered. The efficacy endpoint for the primary objective was a 20% increase in baseline vaccination rates.Results: Of the 198 subjects recruited, a total of 54 received Tdap vaccination. The baseline vaccination rate of the study populationwas 37.4% and increased by 27.2% after the intervention to a total vaccination rate of 64.6% (p< 0.001). Six knowledge assessmentswere utilized for the secondary objective; however, these results did not show significance.Conclusions: A pharmacist-directed Tdap immunization program is effective at increasing vaccination rates. Even though the changein education assessment data proved more observational, the education provided will empower subjects to make informed healthcaredecisions

Are genetic risk factors for psychosis also associated with dimension-specific psychotic experiences in adolescence?

Psychosis has been hypothesised to be a continuously distributed quantitative phenotype and disorders such as schizophrenia and bipolar disorder represent its extreme manifestations. Evidence suggests that common genetic variants play an important role in liability to both schizophrenia and bipolar disorder. Here we tested the hypothesis that these common variants would also influence psychotic experiences measured dimensionally in adolescents in the general population. Our aim was to test whether schizophrenia and bipolar disorder polygenic risk scores (PRS), as well as specific single nucleotide polymorphisms (SNPs) previously identified as risk variants for schizophrenia, were associated with adolescent dimension-specific psychotic experiences. Self-reported Paranoia, Hallucinations, Cognitive Disorganisation, Grandiosity, Anhedonia, and Parent-rated Negative Symptoms, as measured by the Specific Psychotic Experiences Questionnaire (SPEQ), were assessed in a community sample of 2,152 16-year-olds. Polygenic risk scores were calculated using estimates of the log of odds ratios from the Psychiatric Genomics Consortium GWAS stage-1 mega-analysis of schizophrenia and bipolar disorder. The polygenic risk analyses yielded no significant associations between schizophrenia and bipolar disorder PRS and the SPEQ measures. The analyses on the 28 individual SNPs previously associated with schizophrenia found that two SNPs in TCF4 returned a significant association with the SPEQ Paranoia dimension, rs17512836 (p-value=2.57x10-4) and rs9960767 (p-value=6.23x10-4). Replication in an independent sample of 16-year-olds (N=3,427) assessed using the Psychotic-Like Symptoms Questionnaire (PLIKS-Q), a composite measure of multiple positive psychotic experiences, failed to yield significant results. Future research with PRS derived from larger samples, as well as larger adolescent validation samples, would improve the predictive power to test these hypotheses further. The challenges of relating adult clinical diagnostic constructs such as schizophrenia to adolescent psychotic experiences at a genetic level are discussed

Anterior pericardial tracheoplasty for long-segment tracheal stenosis: Long-term outcomes

ObjectiveAlthough several techniques have been described for the treatment of tracheal stenosis, including slide tracheoplasty, tracheal autograft, rib grafting, and use of a pericardial patch, the optimal repair remains controversial because of a lack of long-term follow-up data. The purpose of this study is to examine the long-term results of anterior pericardial tracheoplasty.MethodsTo assess the long-term outcomes of patients who underwent repair of tracheal stenosis with anterior pericardial tracheoplasty, we reviewed the case histories of 26 consecutive patients (1984–present). All but 5 had long-segment tracheal stenosis with more than 10 complete tracheal rings. Twenty-one had significant cardiac disease, and 10 had their cardiac lesions repaired at the time of their tracheoplasty. The median age was 6 months (range, 2 days–25 years). All patients underwent anterior pericardial tracheoplasty through a median sternotomy during normothermic cardiopulmonary bypass. We have previously described our tracheoplasty technique. An average of 14 tracheal rings (range, 5–22) was divided anteriorly, and a patch of fresh autologous pericardium was used to enlarge the trachea to 1.5 times the predicted diameter for age and weight.ResultsThere were 3 hospital deaths (at 1, 2, and 7 months, respectively) and 2 late deaths (at 2 and 13 years postoperatively, respectively). No deaths were related to airway obstruction. Two survivors required tracheostomy postoperatively, one after formation of granulation tissue and stenosis and the other after failure to wean from mechanical ventilation. All survivors remain asymptomatic, with minimal to no evidence of airway obstruction. Median follow-up is 11 years (range, 3 months–22 years).ConclusionAnterior pericardial tracheoplasty for tracheal stenosis provides excellent results in the majority of patients at long-term follow-up

Three-dimensional analysis of AP600 standard plant shield building roof

The AP600 passive containment vessel is surrounded by a concrete cylindrical shell covered with a truncated conical roof. This roof supports the passive containment cooling system (PCS) annular tank, shield plate and other nonstructural attachments. When the shield building is subjected to different loading combinations as defined in the Standard Review Plan (SRP), some of the sections in the shield building could experience forces in excess of their design values. This report summarized the three-dimensional finite element analysis that was conducted to review the adequacy of the proposed Westinghouse shield building design. The ANSYS finite element software was utilized to analyze the Shield Building Roof (SBR) under dead, snow, wind, thermal and seismic loadings. A three-dimensional model that included a portion of the shield building cylindrical shell, the conical roof and its attachments, the eccentricities at the cone-cylinder connection and at the compression ring and the PCS tank was developed. Mesh sensitivity studies were conducted to select appropriate element size in the cylinder, cone, near air intakes and in the vicinity of the eccentricities. Also, a study was carried out to correctly idealize the water-structure interaction in the PCS tank. Response spectrum analysis was used to calculate the internal forces at different sections in the SBR under Safe Shutdown Earthquake (SSE). Forty-nine structural modes and twenty sloshing modes were used. Two horizontal components of the SSE together with a vertical component were used. Modal stress resultants were combined taking into account the effects of closely spaced modes. The three earthquake directions were combined by the Square Root of the Sum Squares method. Two load combinations were studied. The load combination that included dead, snow, fluid, thermal and seismic loads was selected to be the most critical. Interaction diagrams for critical sections were developed and used to check the design adequacy. The results demonstrated that provided area of steal on each face of several sections of the AP600 SBR was inadequate. This was also noticed when comparing the total provided area of steel per section, i.e., the area of steel on both faces. The discrepancy between Westinghouse results and these reported herein could have resulted from the different finite element mesh sizes and the assumption used in Westinghouse design

Schizophrenia Gene Networks and Pathways and Their Applications for Novel Candidate Gene Selection

Background Schizophrenia (SZ) is a heritable, complex mental disorder. We have seen limited success in finding causal genes for schizophrenia from numerous conventional studies. Protein interaction network and pathway-based analysis may provide us an alternative and effective approach to investigating the molecular mechanisms of schizophrenia. Methodology/Principal Findings We selected a list of schizophrenia candidate genes (SZGenes) using a multi-dimensional evidence-based approach. The global network properties of proteins encoded by these SZGenes were explored in the context of the human protein interactome while local network properties were investigated by comparing SZ-specific and cancer-specific networks that were extracted from the human interactome. Relative to cancer genes, we observed that SZGenes tend to have an intermediate degree and an intermediate efficiency on a perturbation spreading throughout the human interactome. This suggested that schizophrenia might have different pathological mechanisms from cancer even though both are complex diseases. We conducted pathway analysis using Ingenuity System and constructed the first schizophrenia molecular network (SMN) based on protein interaction networks, pathways and literature survey. We identified 24 pathways overrepresented in SZGenes and examined their interactions and crosstalk. We observed that these pathways were related to neurodevelopment, immune system, and retinoic X receptor (RXR). Our examination of SMN revealed that schizophrenia is a dynamic process caused by dysregulation of the multiple pathways. Finally, we applied the network/pathway approach to identify novel candidate genes, some of which could be verified by experiments. Conclusions/Significance This study provides the first comprehensive review of the network and pathway characteristics of schizophrenia candidate genes. Our preliminary results suggest that this systems biology approach might prove promising for selection of candidate genes for complex diseases. Our findings have important implications for the molecular mechanisms for schizophrenia and, potentially, other psychiatric disorders

DISTMIX: direct imputation of summary statistics for unmeasured SNPs from mixed ethnicity cohorts

Motivation: To increase the signal resolution for large-scale meta-analyses of genome-wide association studies, genotypes at unmeasured single nucleotide polymorphisms (SNPs) are commonly imputed using large multi-ethnic reference panels. However, the ever increasing size and ethnic diversity of both reference panels and cohorts makes genotype imputation computationally challenging for moderately sized computer clusters. Moreover, genotype imputation requires subject-level genetic data, which unlike summary statistics provided by virtually all studies, is not publicly available. While there are much less demanding methods which avoid the genotype imputation step by directly imputing SNP statistics, e.g. Directly Imputing summary STatistics (DIST) proposed by our group, their implicit assumptions make them applicable only to ethnically homogeneous cohorts. Results: To decrease computational and access requirements for the analysis of cosmopolitan cohorts, we propose DISTMIX, which extends DIST capabilities to the analysis of mixed ethnicity cohorts. The method uses a relevant reference panel to directly impute unmeasured SNP statistics based only on statistics at measured SNPs and estimated/user-specified ethnic proportions. Simulations show that the proposed method adequately controls the Type I error rates. The 1000 Genomes panel imputation of summary statistics from the ethnically diverse Psychiatric Genetic Consortium Schizophrenia Phase 2 suggests that, when compared to genotype imputation methods, DISTMIX offers comparable imputation accuracy for only a fraction of computational resources

Comprehensive Gene-Based Association Study of a Chromosome 20 Linked Region Implicates Novel Risk Loci for Depressive Symptoms in Psychotic Illness

Background Prior genomewide scans of schizophrenia support evidence of linkage to regions of chromosome 20. However, association analyses have yet to provide support for any etiologically relevant variants. Methods We analyzed 2988 LD-tagging single nucleotide polymorphisms (SNPs) in 327 genes on chromosome 20, to test for association with schizophrenia in 270 Irish high-density families (ISHDSF, N = 270 families, 1408 subjects). These SNPs were genotyped using an Illumina iSelect genotyping array which employs the Infinium assay. Given a previous report of novel linkage with chromosome 20p using latent classes of psychotic illness in this sample, association analysis was also conducted for each of five factor-derived scores based on the Operational Criteria Checklist for Psychotic Illness (delusions, hallucinations, mania, depression, and negative symptoms). Tests of association were conducted using the PDTPHASE and QPDTPHASE packages of UNPHASED. Empirical estimates of gene-wise significance were obtained by adaptive permutation of a) the smallest observed P-value and b) the threshold-truncated product of P-values for each locus. Results While no single variant was significant after LD-corrected Bonferroni-correction, our gene-dropping analyses identified loci which exceeded empirical significance criteria for both gene-based tests. Namely, R3HDML and C20orf39 are significantly associated with depressive symptoms of schizophrenia (PempP-value and truncated-product methods, respectively. Conclusions Using a gene-based approach to family-based association, R3HDML and C20orf39 were found to be significantly associated with clinical dimensions of schizophrenia. These findings demonstrate the efficacy of gene-based analysis and support previous evidence that chromosome 20 may harbor schizophrenia susceptibility or modifier loci

PVP2005-71322 INTRODUCTION OF THE ELEMENT INTERACTION TECHNIQUE FOR WELDING ANALYSIS AND SIMULATION

ABSTRACT The residual stresses generated due to welding in pressure components may have several harmful effects such as decrease in the resistance to cycling load and corrosive environments. The analysis of the welding process has been developed extensively in 2D and 3D. The element movement technique has been shown to be very effective in simulating the filler material deposition leading to a reduction in the analysis time. However, when attempted for wider fields of applications, it had some limitations, especially when moving the elements towards the base-plate. In this paper, the element interaction technique is introduced utilizing the concepts of both the element movement and element birth techniques. The new technique is verified versus the currently developed procedures. In this technique, the elements of the weld pool are held in place in contact with the elements of the base-plate and the interaction is made to be a function of time. This gave several flexibilities in modeling the welding process. Hence, the technique is then used to analyze simple fillet welding of a plate and circumferential butt-welding of a pipe. INTRODUCTION The residual stresses generated during welding vary with the change in the welding parameters depending on the procedure of the joining process. Many researches have been done to investigate the residual stress for specific problem. Due to the complexity of the different applications, several assumptions and approximations, such as reducing the model from 3D to 2D, are made to facilitate the analysis. These approximations help mainly in reducing modeling efforts and analysis time. The element birth technique has been used in simulating metal deposition in both 3D and 2D models. Brown and Song [1] have used the technique in an axisymmetric simulation of a fillet-weld of ringstiffened cylinder. Wilkening and Snow [2] have also solved an axisymmetric simulation of a two-pass butt-weld of a cylinder using the element birth technique. Also, for a plate, they assumed that the through thickness variation of the residual stress is insignificant, so they modeled a single-pass butt-weld of plate using 2D plane model of the plate. Bouchard et a

Neural processing of criticism and positive comments from relatives in individuals with schizotypal personality traits

Objectives. High negative expressed emotion by family members towards schizophrenia patients increases the risk of subsequent relapse. The study aimed to determine whether individuals with high schizotypy (HS) and low schizotypy (LS) would differ in activation of brain areas involved in cognitive control when listening to relative criticism