Reporting vaccine complications: what do obstetricians and gynecologists know about the Vaccine Adverse Event Reporting System?

BACKGROUND: Obstetrician-gynecologists are increasingly called upon to be vaccinators as an essential part of a woman's primary and preventive health care. Despite the established safety of vaccines, vaccine adverse events may occur. A national Vaccine Adverse Event Reporting System (VAERS) is a well-established mechanism to track adverse events. However, we hypothesized that many obstetrician-gynecologists are naive to the role and use of VAERS. METHODS: We devised a ten-question survey to a sample of ACOG fellows to assess their knowledge and understanding of VAERS. We performed descriptive and frequency analysis for each of the questions and used one-way analysis of variance for continuous and chi-squared for categorical variables. RESULTS: Of the 1000 fellows who received the survey, 377 responded. Only one respondent answered all nine knowledge questions correctly, and 9.2% of physicians had used VAERS. Older physicians were less familiar with VAERS in general and with the specific objectives of VAERS in particular (χ(2) = 10.7, P = .005). CONCLUSIONS: Obstetrician-gynecologist familiarity with VAERS is lacking. Only when the obstetrician-gynecologist is completely knowledgeable regarding standard vaccine practices, including the availability and use of programs such as VAERS, will providers be functioning as competent and complete vaccinators.

The Src homology domain 3 (SH3) of a yeast type I myosin, Myo5p, binds to verprolin and is required for targeting to sites of actin polarization.

The budding yeast contains two type I myosins, Myo3p and Myo5p, with redundant functions. Deletion of both myosins results in growth defects, loss of actin polarity and polarized cell surface growth, and accumulation of intracellular membranes. Expression of myc-tagged Myo5p in myo3Delta myo5Delta cells fully restores wild-type characteristics. Myo5p is localized as punctate, cortical structures enriched at sites of polarized cell growth. We find that latrunculin-A-induced depolymerization of F-actin results in loss of Myo5p patches. Moreover, incubation of yeast cells at 37 degrees C results in transient depolarization of both Myo5p patches and the actin cytoskeleton. Mutant Myo5 proteins with deletions in nonmotor domains were expressed in myo3Delta myo5Delta cells and the resulting strains were analyzed for Myo5p function. Deletion of the tail homology 2 (TH2) domain, previously implicated in ATP-insensitive actin binding, has no detectable effect on Myo5p function. In contrast, myo3Delta myo5Delta cells expressing mutant Myo5 proteins with deletions of the src homology domain 3 (SH3) or both TH2 and SH3 domains display defects including Myo5p patch depolarization, actin disorganization, and phenotypes associated with actin dysfunction. These findings support a role for the SH3 domain in Myo5p localization and function in budding yeast. The proline-rich protein verprolin (Vrp1p) binds to the SH3 domain of Myo3p or Myo5p in two-hybrid tests, coimmunoprecipitates with Myo5p, and colocalizes with Myo5p. Immunolocalization of the myc-tagged SH3 domain of Myo5p reveals diffuse cytoplasmic staining. Thus, the SH3 domain of Myo5p contributes to but is not sufficient for localization of Myo5p either to patches or to sites of polarized cell growth. Consistent with this, Myo5p patches assemble but do not localize to sites of polarized cell surface growth in a VRP1 deletion mutant. Our studies support a multistep model for Myo5p targeting in yeast. The first step, assembly of Myo5p patches, is dependent upon F-actin, and the second step, polarization of actin patches, requiresVrp1p and the SH3 domain of Myo5p.

Synthetic lethality screen identifies a novel yeast myosin I gene (MYO5): myosin I proteins are required for polarization of the actin cytoskeleton.

The organization of the actin cytoskeleton plays a critical role in cell physiology in motile and nonmotile organisms. Nonetheless, the function of the actin based motor molecules, members of the myosin superfamily, is not well understood. Deletion of MYO3, a yeast gene encoding a "classic" myosin I, has no detectable phenotype. We used a synthetic lethality screen to uncover genes whose functions might overlap with those of MYO3 and identified a second yeast myosin 1 gene, MYO5. MYO5 shows 86 and 62% identity to MYO3 across the motor and non-motor regions. Both genes contain an amino terminal motor domain, a neck region containing two IQ motifs, and a tail domain consisting of a positively charged region, a proline-rich region containing sequences implicated in ATP-insensitive actin binding, and an SH3 domain. Although myo5 deletion mutants have no detectable phenotype, yeast strains deleted for both MYO3 and MYO5 have severe defects in growth and actin cytoskeletal organization. Double deletion mutants also display phenotypes associated with actin disorganization including accumulation of intracellular membranes and vesicles, cell rounding, random bud site selection, sensitivity to high osmotic strength, and low pH as well as defects in chitin and cell wall deposition, invertase secretion, and fluid phase endocytosis. Indirect immunofluorescence studies using epitope-tagged Myo5p indicate that Myo5p is localized at actin patches. These results indicate that MYO3 and MYO5 encode classical myosin I proteins with overlapping functions and suggest a role for Myo3p and Myo5p in organization of the actin cytoskeleton of Saccharomyces cerevisiae.

Chloroplast transformation in Chlamydomonas with high velocity microprojectiles.

Bombardment of three mutants of the chloroplast atpB gene of Chlamydomonas reinhardtii with high-velocity tungsten microprojectiles that were coated with cloned chloroplast DNA carrying the wild-type gene permanently restored the photosynthetic capacity of the algae. In most transformants of one of the mutants, a fragment with a 2.5-kilobase deletion was restored to normal size by a homologous replacement event; in about 25 percent of the transformants the restored restriction fragment was 50 to 100 base pairs smaller or larger than that of wild type. About one-fourth of the transformants of this mutant contained unintegrated donor plasmid when first examined. This plasmid persisted in four different transformants after 65 cell generations of continuous liquid culture but was lost from all transformants maintained on plates of selective medium. The restored wild-type atpB gene remains in all transformants as an integral part of the chloroplast genome and is expressed and inherited normally.

Stereoscopic surface perception.

Physiological, computational, and psychophysical studies of stereopsis have assumed that the perceived surface structure of binocularly viewed images is primarily specified by the pattern of binocular disparities in the two eyes' views. A novel set of stereoscopic phenomena are reported that demonstrate the insufficiency of this view. It is shown that the visual system computes the contrast relationships along depth discontinuities to infer the depth, lightness, and opacity of stereoscopically viewed surfaces. A novel theoretical framework is introduced to explain these results. It is argued that the visual system contains mechanisms that enforce two principles of scene interpretation: a generic view principle that determines qualitative scene geometry, and anchoring principles that determine how image data are quantitatively partitioned between different surface attributes.

Motion-based mechanisms of illusory contour synthesis.

Neurophysiological studies and computational models of illusory contour formation have focused on contour orientation as the underlying determinant of illusory contour shape in both static and moving displays. Here, we report a class of motion-induced illusory contours that demonstrate the existence of novel mechanisms of illusory contour synthesis. In a series of experiments, we show that the velocity of contour terminations and the direction of motion of a partially occluded figure regulate the perceived shape and apparent movement of illusory contours formed from moving image sequences. These results demonstrate the existence of neural mechanisms that reconstruct occlusion relationships from both real and inferred image velocities, in contrast to the static geometric mechanisms that have been the focus of studies to date.

Stereoscopic occlusion junctions.

Portions of surfaces in a binocularly viewed scene may be 'half occluded', that is, visible in only one eye. The human visual system uses zones of half occlusion to help segment the visual scene and infer figure-ground relationships at object boundaries. We developed a quantitative model of the depth-discontinuity cue provided by half occlusion. Half occlusions are revealed by two-dimensional interocular displacements of binocularly viewed occlusion junctions, such as T junctions. We derived a formula relating this two-dimensional displacement, or 'pseudodisparity', to binocular disparities and orientations of occluding and occluded contours. In human psychophysical experiments, perceived depth and contour orientation quantitatively depended on pseudodisparity, as predicted by our model, implying that the visual system senses quantitative variations in interocular junction position to reconstruct occlusion geometry.

Transformation of chloroplast ribosomal RNA genes in Chlamydomonas: molecular and genetic characterization of integration events.

Transformation of chloroplast ribosomal RNA (rRNA) genes in Chlamydomonas has been achieved by the biolistic process using cloned chloroplast DNA fragments carrying mutations that confer antibiotic resistance. The sites of exchange employed during the integration of the donor DNA into the recipient genome have been localized using a combination of antibiotic resistance mutations in the 16S and 23S rRNA genes and restriction fragment length polymorphisms that flank these genes. Complete or nearly complete replacement of a region of the chloroplast genome in the recipient cell by the corresponding sequence from the donor plasmid was the most common integration event. Exchange events between the homologous donor and recipient sequences occurred preferentially near the vector:insert junctions. Insertion of the donor rRNA genes and flanking sequences into one inverted repeat of the recipient genome was followed by intramolecular copy correction so that both copies of the inverted repeat acquired identical sequences. Increased frequencies of rRNA gene transformants were achieved by reducing the copy number of the chloroplast genome in the recipient cells and by decreasing the heterology between donor and recipient DNA sequences flanking the selectable markers. In addition to producing bona fide chloroplast rRNA transformants, the biolistic process induced mutants resistant to low levels of streptomycin, typical of nuclear mutations in Chlamydomonas.

Stereovision: beyond disparity computations.

One of the most powerful sources of information about three-dimensional (3-D) structure is provided by stereovision (or stereopsis). For over a century, theoretical and empirical investigations into this ability have focused on the role of binocular disparity in generating percepts of 3-D structure. Recent work in image segmentation demonstrates that stereovision can cause large changes in perceptual organization that cannot be understood on the basis of binocular disparity alone. It is argued that these phenomena reveal the need for theoretical tools beyond those that have dominated the study of visual perception over the past three decades.

Toward a general theory of stereopsis: binocular matching, occluding contours, and fusion.

Models of stereopsis have focused on developing strategies for identifying common features in the 2 half-images so that disparity may be computed. This emphasis ignores the unpairable features that arise at occluding contours (half-occlusions). Most models treat half-occlusions as noise or outliers that are interpreted after disparity processing is completed. A series of experiments reveal that occlusion relationships are sensed during the earliest stages of binocular processing. The authors hypothesize the existence of receptive field structures that sense the local structure of stereoscopic occlusion relationships to account for these findings. Finally, a simple theoretical framework is presented in which fusion, stereopsis, and occlusion are unified. This theory explains the co-occurrence of stereopsis and diplopia and how half-occlusions escape the suppression characteristic of binocular rivalry.

Energy expenditure and physical performance in overweight women: response to training with and without caloric restriction.

The metabolic effects of exercise training and the influence of a moderate calorie restriction on the training response were examined in overweight women. Ten healthy women, 119% to 141% of desirable weight, completed the 14-week study. After a 2-week stabilization period, in which diets were designed to maintain body weight (BW), five women were assigned to a 12-week experimental program of diet and exercise (D + EX) that included a 50% reduction in energy intake and a program of moderate intensity aerobic exercise 6 days per week. The other five women were assigned to the same daily exercise (EX) and continued to consume the stabilization diet. Periodic measurements of resting metabolic rate (RMR), thermic effect of food (TEF), energy cost of exercise, and predicted maximal aerobic capacity (VO2 max) were obtained, and the respiratory quotient (RQ) was determined during rest and exercise. Body composition was monitored weekly. Tests of strength and anaerobic capacity were conducted. D + EX lost an average of approximately 1.1 kg/wk, which was 67% fat, 33% lean. EX lost approximately 0.5 kg/wk, which was 86% fat, 14% lean. In both groups, the exercise program resulted in an 11% to 13% improvement in VO2 max and an 8% to 16% decrease in energy expenditure at submaximal workloads. The caloric restriction significantly increased fat utilization during exercise. The RMR declined 9% in D + EX, from 1,550 to 1,411 kcal/d, whereas it was maintained in EX, 1,608 to 1,626 kcal/d. The decrease in RMR observed in D + EX was consistent with the loss of fat-free mass (FFM).(ABSTRACT TRUNCATED AT 250 WORDS)

Stereoscopic occlusion and the aperture problem for motion: a new solution.

Recent work has shown that the ability of moving contour terminators to determine the perceived motion of untextured contours is strongly constrained by whether contour terminators are classified as intrinsic (belonging to a moving contour) or extrinsic (belonging to a surface occluding a moving contour). It has also been demonstrated that stereopsis can play a decisive role in this classification. Specifically, Shimojo, Silverman and Nakayama (1989, Vision Research 29, 619-626) argued that the efficacy of stereopsis in classifying moving contour terminators as intrinsic or extrinsic stemmed from the relative depth relationships specified by binocular disparity. Here, evidence is presented which demonstrates that the visual system relies on the presence of unpaired contour terminators to classify stereoscopic contour terminators as extrinsic. The author shows that the tendency to perceive untextured contours translating in a single rectangular aperture in a direction parallel to the longer axis of the aperture (the barberpole illusion) was not abolished by stereoscopic depth differences when the contour terminators were interocularly paired. However, the illusion was abolished when the contours terminators along the longer axis of the aperture were interocularly unpaired. Moreover, contours translated within a square aperture revealed a systematic shift towards the direction of motion signaled by the binocularly paired contour terminators along the horizontal edges of the aperture. These results demonstrate that the classification of stereoscopic contour terminators along an extrinsic-intrinsic dimension results from the presence of local, unpaired contour terminators rather than the relative depth or disparity differences per se, or via the global integration of contour terminators across multiple apertures when multiple apertures are present.

Moderate diet restriction alters the substrate and hormone response to exercise.

Substrate and hormone responses to submaximal exercise were studied in 10 overweight women (119-141% ideal body weight) to learn if a moderately restricted diet would influence the responses. Subjects consumed diets with adequate energy (ADEX), N = 5, or low energy (LDEX)--50% reduction in energy, N = 5. Three times during the 12-wk study, blood was drawn before and immediately following exercise; results were combined since there were no differences between replicates. Postexercise free fatty acids and glycerol increased to 465 +/- 27 mg.l-1 in LDEX but only to 245 +/- 19 mg.l-1 in ADEX. Postexercise insulin increased to 129 +/- 13 pmol.l-1 in LDEX, but did not increase in ADEX. Postexercise growth hormone increased to 10.5 +/- 1.0 microgram.l-1 in ADEX but only to 6.6 +/- 1.0 microgram.l-1 in LDEX. All postexercise increases within diet groups were highly significant (P < 0.0001), and the postexercise responses between diet groups were also different (P < 0.01). Respiratory gas exchange indicated that both groups increased fat utilization during exercise, but diet restriction altered postexercise hormones so that fat mobilization and utilization might be inhibited. The postexercise recovery period should be studied further to determine whether diet restriction results in a sustained altered hormone pattern that would curtail lipolysis and possibly limit body fat loss.

Differential sensitivity of the WMS to the effects of IQ and brain damage.

The sensitivity of the Wechsler Memory Scale with Russell's Revision to the effects of IQ and brain damage was assessed in groups of brain-damaged (N = 64) and nonbrain-damaged (N = 64) subjects. Brain-damaged and nonbrain-damaged subjects were divided into subgroups equated on age and IQ for each of three IQ ranges (80-89, 90-99, 100-109). Some Wechsler Memory Scale subtests were affected only by IQ, others were affected by IQ and brain-damage status, and still others were affected only by brain-damage status. Measures of recall efficiency were most useful in discriminating brain-damaged and nonbrain-damaged subjects. We concluded that specific Wechsler Memory Scale subtests are useful in assessing memory deficits in brain-damaged patients.

Obstetric health care workers' attitudes and beliefs regarding influenza vaccination in pregnancy.

OBJECTIVE: To explore obstetric health care workers' attitudes and beliefs regarding influenza vaccination in pregnancy. METHODS: A survey consisting of 16 multiple-choice questions was administered to nurses, medical and nursing assistants, receptionists, and clinical administrators in obstetric settings. Survey questions addressed general knowledge of influenza and recommendations for vaccination during pregnancy, as well as personal beliefs about the acceptability of the vaccine in the pregnant population. The study was conducted at two sites, Women & Infants Hospital in Providence, RI, and Magee-Women's Hospital in Pittsburgh, PA. Variables were compared by Fisher exact test. RESULTS: Two hundred sixty-seven completed surveys were available for analysis, with a completion rate of 85%. Almost one third of health care workers surveyed do not believe that vaccines are a safe and effective way to decrease infections (31%) and a minority believe that vaccines are safe in pregnancy (36%). Just over half of health care workers know that pregnant women are at increased risk of complications from the flu (56.6%). Only 46% were able to correctly identify influenza symptoms, and only 65% would recommend influenza vaccination to a pregnant woman if indicated. A small percentage would be willing to give an avian influenza vaccine to pregnant women during a pandemic if it had not been tested in pregnancy (12.3%). CONCLUSION: Many obstetric health care workers lack knowledge regarding the safety and importance of influenza vaccination during pregnancy. Misinformed or inadequately informed health care workers may represent a barrier to influenza vaccine coverage of pregnant women. This lack of knowledge among the health care workforce takes on added importance in the setting of the H1N1 2009 swine-origin influenza pandemic. LEVEL OF EVIDENCE: III.

Effects of varying the threshold of alarm systems and workload on human performance.

The purpose of this research was to investigate the effects of varying the threshold of alarm systems and workload on human response to alarm signals and performance on a complex task. A receiver operating characteristic (ROC) curve was selected to reflect the sensitivity of the alarm system. The threshold of the alarm system was manipulated by changing the value of beta along the ROC curve. A total of 84 students participated in experiment 1 and 48 students participated in experiment 2. Participants performed a compensatory-tracking, a resource management and a monitoring task. As expected, results showed that participants responded significantly faster to true alarm signals when they were using the system with the highest threshold under low-workload conditions. Results also indicated that changing the threshold of the alarm system had a significant effect on overall performance and this effect was greater under high-workload conditions. However, contrary to expectations, the highest level of performance was achieved by setting the threshold at a low level. Results from both experiments revealed that the advantage of faster alarm reaction time as a result of increasing the system's threshold was lost because of its increased probability of missed events.

The role of partial occlusion in stereopsis.

Models of stereopsis typically assume that all the information about stereoscopic depth is contained in the disparity field, that is, the positional differences of image features that arise from surfaces visible to both eyes. But such models have difficulty in resolving image regions containing occlusions, because a portion of the occluded surface is visible to only one of the two eyes ('half-occlusions'). Here I present displays revealing an unexpected relationship between interocular differences in image position and occluding contours. The partial occlusion of contours can give rise to both horizontal and vertical image differences that are not disparities. The results show that the visual system interprets these image differences as signalling the presence of occluding contours. Even when a single line segment serves as a binocular target, subjective contours form that can appear both oriented and in depth. These local subjective contours have a strong tendency to interact cooperatively and form global contours not present in the monocular images. These and other findings show that stereoscopic processing actively decomposes vertical and horizontal image differences into disparities and half-occlusions. The two sources of information are complementary: while disparity provides relative depth information about surface features visible to both eyes, half-occlusions provide information to segment the visual world into coherent objects at object boundaries.