Rates of nonmedical exemptions from school immunizations are increasing and have been associated with resurfacing clusters of vaccine-preventable diseases, such as measles. Historically, state-level school immunization policies successfully suppressed such diseases. We examined state immunization exemption regulations across the United States. We assessed procedures for exempting schoolchildren and whether exemption rates were associated with the complexity of the procedures. We also analyzed legal definitions of religious objections and state legislatures' recent modifications to exemption policies. We found that states with simpler immunization exemption procedures had nonmedical exemption rates that were more than twice as high as those in states with more-complex procedures. We also found that the stringency of legal definitions of religious exemptions was not associated with exemption procedure complexity. Finally, we found that although there were more attempts by state legislatures to broaden exemptions than to tighten them in 2011-13, only bills tightening exemptions passed. Policy makers seeking to control exemption rates to achieve public health goals should consider tightening nonmedical exemption procedures and should add vaccine education components to the procedures by either mandating or encouraging yearly educational sessions in schools for parents reluctant to have their children vaccinated.

Parathyroid hormone (PTH) elevations are associated with reduced bone mineral density and adverse health outcomes and have been reported in patients with HIV infection. We aimed to examine the impact of vitamin D status and tenofovir (TDF) use on PTH levels among HIV-infected patients receiving combination antiretroviral therapy (cART). Demographics, medication and supplement use, and clinical data, including 25-hydroxyvitamin D [25(OH)D] and PTH, were collected on 45 HIV-infected men on ART. Suboptimal vitamin D status was defined as 25(OH)D < 30 ng/ml. The relationship between antiretroviral agents, suboptimal 25(OH)D, and PTH levels was examined. Among subjects with suboptimal vitamin D status, PTH values greater than or equal to the ULN (87 pg/ml) were more common among TDF users than nonusers: 41% versus 0% ( p ¼ 0.018); and median PTH was higher in TDF users: 80 pg/ml versus 55 pg/ml ( p ¼ 0.02). Among TDF users, PTH was higher in the group with suboptimal 25(OH)D ( p ¼ 0.045). Multivariable linear regression showed that PTH was independently and directly related to TDF use ( p ¼ 0.017) and inversely related to 25(OH)D ( p ¼ 0.017). PTH was not related to the estimated glomerular filtration rate ( p ¼ 0.9). In this cross-sectional study of HIV-infected men on ART, the use of TDF and the level of 25(OH)D were independently associated with PTH levels. Because TDF is a potent and widely used antiretroviral drug, information about cofactors that may exacerbate its side effects is of significant clinical value.

No abstract

This paper describes further efforts aimed at more accurately and objectively determining and quantifying the local, regional and global function of the left ventricle (LV) of the heart from four-dimensional (4D) image data. B y studying the endocardial-epicardial surface properties of LV wall over many temporal frames within a cardiac cycle and over a range of conditions of LV wall abnormalities, we will be able to better understand the physiological processes associated with ischemic heart disease.I n this paper, we will first briefly describe the setup for an in vivo experimental model and the imaging techniques, including the use of implanted imagingopaque markers that will permit us to establish the gold standard against which the validity of our nonznvasive image analysis algorithms can be evaluated, as well as permit us to study the efficacy of using in vivo, image-derived measures of function for predicting regzonal myocardial viability. Then, the shape-based image analysis methods, particularly our new developments in surface triangulation from segmented contour stacks of LV wall, surface curvature estimation, pointwise non-rigid motion tracking, quantitative measures of LV motion and thickening, and 3 0 visualization techniques, will be discussed. Finally, initial experimental results using image sequences from two different modalities will be presented.