Modeling Respiratory Syncytial Virus Adult Vaccination in the United States With a Dynamic Transmission Model

BACKGROUND

Respiratory syncytial virus (RSV) is shown to cause substantial morbidity, hospitalization, and mortality in infants and older adults. Population-level modeling of RSV allows to estimate the full burden of disease and the potential epidemiological impact of novel prophylactics.

METHODS

We modeled the RSV epidemiology in the United States across all ages using a deterministic compartmental transmission model. Population-level symptomatic RSV acute respiratory tract infection (ARI) cases were projected across different natural history scenarios with and without vaccination of adults aged ≥60 years. The impact of vaccine efficacy against ARIs, infectiousness and vaccine coverage on ARI incidence were assessed. The impact on medical attendance, hospitalization, complications, death, and other outcomes was also derived.

RESULTS

Without a vaccine, we project 17.5-22.6 million symptomatic RSV ARI cases annually in adults aged ≥18 years in the US, with 3.6-4.8 million/year occurring in adults aged ≥60 years. Modeling indicates that up to 2.0 million symptomatic RSV-ARI cases could be prevented annually in ≥60-year-olds with a hypothetical vaccine (70% vaccine efficacy against symptomatic ARI and 60% vaccine coverage) and that up to 0.69 million/year could be prevented in the nonvaccinated population, assuming 50% vaccine impact on infectiousness.

CONCLUSIONS

The model provides estimated burden of RSV in the US across all age groups, with substantial burden projected specifically in older adults. Vaccination of adults aged ≥60 years could significantly reduce the burden of disease in this population, with additional indirect effect in adults aged <60 years due to reduced transmissibility.

A case report of ventricular septal defect complicating transcatheter aortic valve implant for aortic regurgitation: novel complication and technical considerations

Background

Transcatheter aortic valve implantation (TAVI) has proven efficacy in the treatment of aortic stenosis (AS). Understandably, there is increasing enthusiasm for its use to treat aortic regurgitation (AR). However, there are significant anatomical differences between AS and AR which make TAVI for AR more complex.

Case summary

We present the case of technically challenging TAVI for severe AR, which was complicated by a traumatic ventricular septal defect (VSD) that required percutaneous closure. To our knowledge, this is the first published case of VSD post-TAVI for AR.

Discussion

This unanticipated complication highlights anatomical differences between TAVI use in AS and AR. Lack of aortic valve calcification and excessive annular compliance made stable deployment of a self-expanding valve extremely challenging. Despite device oversizing, repeated embolization of the prosthesis into the left ventricular outflow tract traumatized the interventricular septum.

Environmental risk factors associated with ANCA associated vasculitis: A systematic mapping review

BACKGROUND

Anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) is a rare multi-system autoimmune disease, characterised by a pauci-immune necrotising small-vessel vasculitis, with a relapsing and remitting course. Like many autoimmune diseases, the exact aetiology of AAV, and the factors that influence relapse are unknown. Evidence suggests a complex interaction of polygenic genetic susceptibility, epigenetic influences and environmental triggers. This systematic mapping review focuses on the environmental risk factors associated with AAV. The aim was to identify gaps in the literature, thus informing further research.

METHODS

Articles that examined any environmental risk factor in AAV disease activity (new onset disease or relapse) were included. Studies had to make explicit reference to AAV, which includes the 3 clinico-pathological phenotypes (GPA, MPA and EGPA), rather than isolated ANCA-positivity. All articles identified were English-language, full manuscripts involving adult humans (>16 years). There was no restriction on publication date and all study designs, except single case reports, were included. The systematic search was performed on 9th December 2019, using the following databases: EMBASE, Medline (Ovid), Cochrane Library, CINAHL and Web of Science.

RESULTS

The search yielded a total of 2375 articles. 307 duplicates were removed, resulting in the title and abstract of 2068 articles for screening. Of these, 1809 were excluded. Thus, 259 remained for full-text review, of which 181 were excluded. 78 articles were included in this review. The most notable findings support the role of various pollutants - primarily silica and other environmental antigens released during natural disasters and through farming. Assorted geoepidemiological triggers were also identified including seasonality and latitude-dependent factors such as UV radiation. Finally, infection was tightly associated, but the exact microorganism(s) is not clear - Staphylococcus aureus is the most presently convincing.

CONCLUSION

The precise aetiology of AAV has yet to be elucidated. It is likely that different triggers, and the degree to which they influence disease activity, vary by subgroup (e.g. ANCA subtype, geographic region). There is a need for more interoperable disease registries to facilitate international collaboration and hence large-scale epidemiological studies, with novel analytical techniques.

Low Density Granulocytes in ANCA Vasculitis Are Heterogenous and Hypo-Responsive to Anti-Myeloperoxidase Antibodies

Low Density Granulocytes (LDGs), which appear in the peripheral blood mononuclear cell layer of density-separated blood, are seen in cancer, sepsis, autoimmunity, and pregnancy. Their significance in ANCA vasculitis (AAV) is little understood. As these cells bear the autoantigens associated with this condition and have been found to undergo spontaneous NETosis in other diseases, we hypothesized that they were key drivers of vascular inflammation. We found that LDGs comprise a 3-fold higher fraction of total granulocytes in active vs. remission AAV and disease controls. They are heterogeneous, split between cells displaying mature (75%), and immature (25%) phenotypes. Surprisingly, LDGs (unlike normal density granulocytes) are hyporesponsive to anti-myeloperoxidase antibody stimulation, despite expressing myeloperoxidase on their surface. They are characterized by reduced CD16, CD88, and CD10 expression, higher LOX-1 expression and immature nuclear morphology. Reduced CD16 expression is like that observed in the LDG population in umbilical cord blood and in granulocytes of humanized mice treated with G-CSF. LDGs in AAV are thus a mixed population of mature and immature neutrophils. Their poor response to anti-MPO stimulation suggests that, rather than being a primary driver of AAV pathogenesis, LDGs display characteristics consistent with generic emergency granulopoiesis responders in the context of acute inflammation.

Attribution of Age-Discrepant Couples

An attempt was made to determine how dating couples widely discrepant in age are perceived. In the first study, 40 male and 40 female college students were asked to read a vignette where the older protagonists were described as either wealthy or had an average income. Sex was also manipulated so that the male was older in half (he conditions and younger for the other half. A second study with 30 older females as subjects utilized two vignettes with the older protagonists being male in half the conditions and female in the other half. Results indicated that sex and age of subjects were significantly related to how age-discrepant couples are perceived by these two groups. Role salience and role identification are influential.

Cost analysis of Down syndrome screening in advanced maternal age

OBJECTIVE

To analyze the potential cost and efficacy of Down syndrome screening in the population with advanced maternal age.

METHODS

Three screening methods defining Down syndrome risk for women with advanced maternal age were analyzed: advanced maternal age; advanced maternal age and maternal serum triple screen; and advanced maternal age, maternal serum triple screen and genetic sonogram. Costs for all tests and procedures were estimated. Procedure-related loss for amniocentesis was assumed to be 1:200. Efficacy was defined as: number of amniocenteses performed, number of Down syndrome cases detected, procedure-related losses, Down syndrome cases detected per fetal loss, cost per Down syndrome case detected and total cost of screening.

RESULTS

In 1999 in the USA, there were 530,610 women with advanced maternal age at 16 weeks' gestation carrying an estimated 4,043 fetuses with Down syndrome. Screening by maternal age alone would result in the 100% detection of Down syndrome cases, but would require over 530,000 amniocenteses and result in 2,653 procedure-related losses. Combining age with serum screen and genetic sonogram would detect 97.6% of Down syndrome cases, but would require only 119,791 amniocenteses and result in 599 procedure-related losses. The projected cost per Down syndrome case detected using age screening is 219,109 dollars versus 155,992 dollars using serum screen and genetic sonogram.

CONCLUSIONS

The combination of advanced maternal age, maternal serum screen and genetic sonogram would result in the fewest procedure-related losses and lowest cost per Down syndrome case detected.

Pulmonary function subsequent to expiratory muscle fatigue in healthy humans

One of the mechanisms proposed to explain the decrement in pulmonary function often seen after exercise is fatigue of the expiratory muscles. To test the hypothesis that expiratory muscle fatigue alters lung function, several indices of pulmonary function were measured before and after expiratory muscle fatigue was induced by expiratory loaded breathing. Eight subjects completed a fatigue trial (EF) in which expiratory threshold loaded breathing was performed at an initial resistance equal to 80 % of their maximal expiratory pressure (MEP), at a respiratory rate of 13 bpm, and a duty cycle (T(I)/T(Tot)) of 0.33. MEP was taken at predefined intervals throughout the loaded breathing protocol, and loaded breathing was discontinued when MEP was less than 80 % of each subject's pre EF trial MEP (T(Lim)). FVC, FEV(1.0), FEF(25 %), FEF(25-75 %), and maximal inspiratory and expiratory pressures (MIP and MEP) were taken prior to, immediately after, and at 5, 10, and 15 min post fatigue. On a separate day a control trial (CON) was performed that was identical to each subjects EF trial with the exception that no expiratory load was utilized. At T(Lim) MEP was significantly reduced (p < 0.001) by 23.5 % from the pre-expiratory loaded breathing value (183.1 +/- 39.56 to 140.13 +/- 30.45 mmHg), whereas it remained unchanged during the CON trial (191.06 +/- 44.18 to 188.06 +/- 43.50 mmHg). FVC measured prior to and immediately after T(Lim) remained unchanged following both the EF (5349.45 +/- 1130.8 to 5387.43 +/- 1139.92 mL) and CON trials (5287.75 +/- 1220.29 and 5352.78 +/- 1191.30 mL). These results suggest that any expiratory muscle fatigue developed during exercise by itself does not result in altered pulmonary function. However, any interactions between expiratory muscle fatigue and other consequences of exercise that may alter lung function cannot be ruled out.

Perception of Unethical Behavior in an Attorney as a Function of Sex of Observer and Transgressor

This study investigated the notion that competent women in traditionally male-dominated professions are often the victims of erroneous stereotypes and are judged to be less deserving than men of praise, promotions, and raises. In addition, the role of ethical versus unethical practices is examined in the context of the above issues, with a further manipulation of guilt versus innocence. Results indicate that sex biases persist but in a more complex and less generalized fashion. Sex differences regarding ethical standards appear negligible, emerging primarily in complex interactions. Ethical behavior elicited more favorable descriptions and higher ratings for remuneration and confidence. Yet, when guilty, male and female subjects alike showed a significant preference for procuring the unethical lawyer's services. Possible explanations for the various findings are discussed and suggestions for research proffered.

Employees' Perception of Group Job Satisfaction

Utilizing the interview method of job satisfaction, the survey was conducted within a communications firm. As part of the survey employees from seven departments were asked to indicate their over-all job satisfaction and their estimates of the job satisfaction of their co-workers. For the entire sample of 136 employees a significant underestimation of co-workers' satisfaction was indicated. Six of the seven departments showed a significant underestimation while the remaining one, although nonsignificant, was in the same direction. Results are discussed in terms of differences in attributional processes of actors and observers. Ramifications of misperception of co-workers' satisfaction are discussed as well as importance of dissemination of results of job satisfaction surveys throughout the organization.

Information Processing as a Function of Perceptual Reactance

Undergraduate women were divided into 20 augmenters and 20 reducers at the median of 3.7 according to Petrie's method. Reducers recalled simple stimuli better than augmenters whether time was long or short. There were no differences for complex stimuli.

Perceptual reactance and task performance

57 female subjects participated in a study in which perceptual reactance was assessed by the kinesthetic figural aftereffects test. Subjects identified as augmenters were quicker than reducers on a disjunctive reaction time task and a significant interactive effect was found on a paired-associate task. Augmenters performed better on a similar list while reducers were more effective on a dissimilar list.

The errant spouse: a study in person perception

College students rated protagonists of vignettes involved in extra-marital affairs in two separate studies. In the first study, where the affair resulted in the errant spouse falling in love, both the husband and wife were perceived more favorably when they cheated than when they were being cheated. The results of the second study, where the affair did not involve love, were opposite from those of the first. The cheating spouse was viewed negatively. No significant differences were found between married and unmarried subjects' perceptions. Results indicated that the motivation for an extramarital affair may be crucial in evaluation. Implications of perceived competence of the spouse were considered.

Perceptual reactance and melanic density

Following assessment of eye color, a total of 108 college students (33 males and 75 females) estimated changes in sizes of standardized blocks while blindfolded. Subjects were classfied as perceptual augmenters, moderates or reducers as a function of their overestimation, accurate estimation, or underestimation, respectively, of the sizes of the blocks. A significant interaction of gender by perceptual reactance appeared, with augmenting males being rated the most dark-eyed and augmenting females being rated the most light-eyed. Interpretation of the findings was made in terms of attention to relevant cues.