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.

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.

International collaboration to address common problems in health care: processes, practicalities and power.

This article reports on an international collaborative study into the management of chronic leg ulcers by nurses working in the community in Kronoberg, Sweden and the East Riding and Hull, UK. The management of leg ulcers like many other services provided by nurses working in the community is one that is growing out of community need, often without matching resources. This article reports on some of the processes that were involved and some of the practical considerations that were faced and addressed in formulating and conducting an international collaborative study. The article also explores the 'power' international collaboration brings to the research enterprise.

Design of delay elements in a binary optical true-time-delay device that uses a White cell.

A White-cell-based binary optical true-time-delay device has two parts: the controller, or switching engine, and the delay elements. Here we discuss in detail the design of both glass blocks and lens trains as delay elements. Glass blocks can be used in our design for delays ranging from one to a few hundred picoseconds. Lens trains are suitable for longer delays. We also analyze the loss associated with each design and give design limits.

Motion direction, speed and orientation in binocular matching.

The spatial differences between the images seen by the two eyes, called binocular disparities, can be used to recover the volumetric (three-dimensional) aspects of a scene. The computation of disparity depends upon the correct identification of corresponding features in the two images. Understanding what image features are used by the brain to solve this matching problem is one of the main issues in stereoscopic vision. Many cortical neurons in visual areas V1 (ref. 2), MT (refs 3, 4) and MST (refs 5, 6) that are tuned to binocular disparity are also tuned to orientation, motion direction and speed. Although psychophysical work has shown that motion direction can facilitate binocular matching, the psychophysical literature on the role of orientation is mixed, and it has been argued that speed differences are ineffective in aiding correspondence. Here we use a different psychophysical paradigm to show that the visual system uses similarities in orientation, motion direction and speed to achieve binocular correspondence. These results indicate that cells that multiplex orientation, motion direction, speed and binocular disparity may help to solve the binocular matching problem.

Occlusion junctions do not improve stereoacuity.

Occlusion geometry gives rise to interocular shifts in the positions of binocularly viewed contour junctions. Since these shifts do not give rise to normal binocular disparities, they have been called 'pseudodisparities'. Previous work has shown that the unmatched contour segments of a partially occluded contour at occlusion junctions can be used to recover the geometry of the occluding surface through the construction of 'illusory' contours. Here, experiments were performed to determine whether such junction shifts could enhance stereoscopic depth detection when the relative disparity between the contours was below threshold. Our results showed that stereoscopic depth detection does not improve when pseudodisparity is present. We conclude that the visual system is less sensitive to pseudodisparity than to conventional disparity information. We suggest that the primary role of pseudodisparity is to overcome conditions of camouflage.

Determining spatial modes of lasers with spatial coherence measurements.

We explain a technique that extracts both the structure and the modal weights of spatial modes of lasers by analyzing the spatial coherence of the beam. This is the first time, to our knowledge, that an experimental method is being used to measure arbitrary forms of the spatial modes. We applied this method to an edge-emitting Fabry-Perot semiconductor laser with a stripe width of 5 mum and extracted fundamental and first-order lateral modes with relative power weights of 96.2% and 3.8%. There was a single transverse mode.

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.

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.

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.

Isolation and characterization of a mutant protoporphyrinogen oxidase gene from Chlamydomonas reinhardtii conferring resistance to porphyric herbicides.

In plant and algal cells, inhibition of the enzyme protoporphyrinogen oxidase (Protox) by the N-phenyl heterocyclic herbicide S-23142 causes massive protoporphyrin IX accumulation, resulting in membrane deterioration and cell lethality in the light. We have identified a 40.4 kb genomic fragment encoding S-23142 resistance by using transformation to screen an indexed cosmid library made from nuclear DNA of the dominant rs-3 mutant of Chlamydomonas reinhardtii. A 10.0 kb HindIII subclone (Hind10) of this insert yields a high frequency of herbicide-resistant transformants, consistent with frequent non-homologous integration of the complete RS-3 gene. A 3.4 kb XhoI subfragment (Xho3.4) yields rare herbicide-resistant transformants, suggestive of homologous integration of a portion of the coding sequence containing the mutation. Molecular and genetic analysis of the transformants localized the rs-3 mutation conferring S-23142 resistance to the Xho3.4 fragment, which was found to contain five putative exons encoding a protein with identity to the C-terminus of the A rabidopsis Protox enzyme. A cDNA clone containing a 1698 bp ORF that encodes a 563 amino acid peptide with 51% and 53% identity to Arabidopsis and tobacco Protox I, respectively, was isolated from a wild-type C. reinhardtii library. Comparison of the wild-type cDNA sequence with the putative exon sequences present in the mutant Xho3.4 fragment revealed a G-->A change at 291 in the first putative exon, resulting in a Val-->Met substitution at a conserved position equivalent to Val-389 of the wild-type C. reinhardtii cDNA. A sequence comparison of genomic Hind10 fragments from C. reinhardtii rs-3 and its wild-type progenitor CC-407 showed this G-->A change at the equivalent position (5751) within exon 10.

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.

Robustness of spatial-coherence multiplexing under receiver misalignment.

It has been shown previously that the spatial coherence of a source can be modulated and demodulated; hence it can be used as the basis for a new dimension of multiplexing in high-speed optical communication links. We address the sensitivity of such a system to misalignments of the receiver with respect to the beam and examine how changing transverse modes affect the spatial coherence in the lateral direction. Specifically, we show that such a system is surprisingly robust for both lateral offsets, in which the receiver is not properly aligned on the beam center, and rotational offsets, in which the receiver is tilted with respect to the plane of the spatial coherence modulation. The presence of higher-order transverse modes or changes in the transverse-mode structure are also shown to have little effect on the system operation.

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.