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Background: The prevalence of exposure to pharmacogenomic medications is well established but little is known about how long patients are exposed to these medications. Aim: Our objective was to describe the amount of exposure to actionable pharmacogenomic medications using patient-level measures among a large nationally representative population using an insurance claims database. Methods: Our retrospective cohort study included adults (18+ years) from the IQVIA PharMetrics® Plus for Academics claims database with incident fills of 72 Clinical Pharmacogenetics Implementation Consortium level A, A/B, or B medications from January 2012 through September 2018. Patient-level outcomes included the proportion of days covered (PDC), number of fills, and average days supplied per fill over a 12-month period. Results: Over 1 million fills of pharmacogenetic medications were identified for 605,355 unique patients. The mean PDC for all medications was 0.21 (SD 0.3), suggesting patients were exposed 21% (77 days) of the year. Medications with the highest PDC (0.55–0.89) included ivacaftor, tamoxifen, clopidogrel, HIV medications, transplant medications, and statins; with the exception of statins, these medications were initiated by fewer patients. Pharmacogenomic medications were filled an average of 2.8 times (SD 3.0, range 1–81) during the year following the medication's initiation, and the average days supplied for each fill was 22.3 days (SD 22.4, range 1–180 days). Conclusion: Patient characteristics associated with more medication exposure were male sex, older age, and comorbid chronic conditions. Prescription fill data provide patient-level exposure metrics that can further our understanding of pharmacogenomic medication utilization and help inform opportunities for pharmacogenomic testing. [ABSTRACT FROM AUTHOR]

The authors examined the relationship between depression, maladaptive perfectionism, and shame. Regression analyses were used to replicate a model in which maladaptive perfectionism was negatively associated with self-esteem and positively associated with symptoms of depression, with self-esteem mediating the effects of maladaptive perfectionism on depressive symptoms. Additional models showed that the path from maladaptive perfectionism to depression was partially mediated by shame, although these paths differed for men and women.

The Feelings, Reactions, and Beliefs Survey (FRBS) was administered to 141 undergraduate students to evaluate differences in Rogerian personality constructs among adaptive, maladaptive, and nonperfectionists. The groups differed significantly on 5 FRBS subscales: Fully Functioning Person, Struggling With Feelings of Inferiority, Openness to Feelings in Relationships, Feeling Ambivalent in Relationships, and Focusing Conscious Attention.

This research examined the relationship between types of perfectionists and differences in post-adolescent intellectual development. University students completed the Almost Perfect Scale-Revised (Slaney, Rice, Mobley, Trippi, & Ashby, 2001) and the Scale of Adult Intellectual Development (Newman & Martin, 1999). The results revealed significant differences in the cognitive complexity and epistemic sophistication obtained by adaptive, maladaptive, and nonperfectionists. Nonperfectionists endorsed a less complex personal epistemology than either maladaptive or adaptive perfectionists, while maladaptive perfectionists demonstrated a more relativistic epistemology than either adaptive perfectionists or nonperfectionists. Implications for college counselors and therapists who encounter individuals broadly labeled as "perfectionists" are discussed. (Contains 3 tables.)

Background Chikungunya virus (CHIKV) is an arbovirus that periodically emerges to cause large epidemics of arthritic disease. Although the robust immunity elicited by live-attenuated virus (LAV) vaccine candidates makes them attractive, CHIKV vaccine development has been hampered by a high threshold for acceptable adverse events. Methods We evaluated the vaccine potential of a recently described LAV, skeletal muscle-restricted virus (SKE), that exhibits diminished replication in skeletal muscle due to insertion of target sequences for skeletal muscle-specific miR-206. We also evaluated whether these target sequences could augment safety of an LAV encoding a known attenuating mutation, E2 G82R. Attenuation of viruses containing these mutations was compared with a double mutant, SKE G82R. Results SKE was attenuated in both immunodeficient and immunocompetent mice and induced a robust neutralizing antibody response, indicating its vaccine potential. However, only SKE G82R elicited diminished swelling in immunocompetent mice at early time points postinoculation, indicating that these mutations synergistically enhance safety of the vaccine candidate. Conclusions These data suggest that restriction of LAV replication in skeletal muscle enhances tolerability of reactogenic vaccine candidates and may improve the rational design of CHIKV vaccines. [ABSTRACT FROM AUTHOR]

Herbert Lindenberger, Situating Opera: Period, Genre, Reception New York: Cambridge University Press, 2010, 313 pp. Herbert Lindenberger's Situating Opera: Period, Genre, Reception, his third book on opera, is part of [...]

A theoretical model is developed to predict the wind-streamflow-driven gas-liquid transfer rate. When wind blows over the stream surface, turbulence is generated at both the air-water interface and the water-bed interface, which is the driving force of the surface renewal movement of water parcels. The total surface renewal rate is considered as the sum of the effective surface renewal rates driven by the turbulence generated at these two interfaces. The gas-liquid transfer rate is formulated as a function of the total surface renewal rate based on the surface renewal theory. The concept of serial resistance, shear velocity, and effective viscous layer play significant roles in the model development. This model correlates the gas-liquid transfer rate with the dynamic fluid parameters such as wind speed and stream velocity. The predictions of this model show good agreement with existing experimental data. This model can be applied to predict the gas-liquid transfer rate in wind-streamflow-driven systems. DOI: 10.1061/(ASCE)0733-9372(2009) 135:8(653) CE Database subject headings: Water resources; Environmental engineering; Mathematical models.