admission. This proportion could already be greater in some parts of the country and may increase if referrals of cases of self-poisoning increase faster than the facilities for their assessment and management. The provision of social work and psychiatric expertise in casualty departments may be one means of preventing unnecessary medical admissions without risk to the patients. Dr Blake's and Dr Bramble's figures do not demonstrate, however, that any advantage would attach to medical teams taking over assessment from psychiatrists except that, by implication, assessments would be completed sooner by staff working on the ward full time. What the figures actually suggest is that if assessment of overdoses were left to house doctors there would be an increase in admissions to psychiatric units (by 19°U), outpatients (by 5O°'), and referrals to social services (by 140o). So for house doctors to assess overdoses would provide no economy for the psychiatric or social services. The study does not tell us what the consequences would have been for the six patients who the psychiatrists would have admitted but to whom the house doctors would have offered outpatient appointments. E J SALTER

Vitamin D deficiency.

正しい方法がわかる臨床基本手技 : from the New England journal of medicine

This paper uses the 1918 influenza pandemic as a natural experiment for testing the fetal origins hypothesis. The pandemic arrived unexpectedly in the fall of 1918 and had largely subsided by January 1919, generating sharp predictions for long‐term effects. Data from the 1960–80 decennial U.S. Census indicate that cohorts in utero during the pandemic displayed reduced educational attainment, increased rates of physical disability, lower income, lower socioeconomic status, and higher transfer payments compared with other birth cohorts. These results indicate that investments in fetal health can increase human capital.

/pdf/is-the-1918-influenza-pandemic-over-long-term-effects-of-in-3d6v4weoop.pdf

Is the 1918 Influenza Pandemic Over? Long‐Term Effects of In Utero Influenza Exposure in the Post‐1940 U.S. Population

This report summarizes the epidemiology of human papillomavirus (HPV) and associated diseases, describes the licensed HPV vaccines, provides updated data from clinical trials and postlicensure safety studies, and compiles recommendations from CDC's Advisory Committee on Immunization Practices (ACIP) for use of HPV vaccines. Persistent infection with oncogenic HPV types can cause cervical cancer in women as well as other anogenital and oropharyngeal cancers in women and men. HPV also causes genital warts. Two HPV vaccines are licensed in the United States. Both are composed of type-specific HPV L1 protein, the major capsid protein of HPV. Expression of the L1 protein using recombinant DNA technology produces noninfectious virus-like particles (VLPs). Quadrivalent HPV vaccine (HPV4) contains four HPV type-specific VLPs prepared from the L1 proteins of HPV 6, 11, 16, and 18. Bivalent HPV vaccine (HPV2) contains two HPV type-specific VLPs prepared from the L1 proteins of HPV 16 and 18. Both vaccines are administered in a 3-dose series. ACIP recommends routine vaccination with HPV4 or HPV2 for females aged 11 or 12 years and with HPV4 for males aged 11 or 12 years. Vaccination also is recommended for females aged 13 through 26 years and for males aged 13 through 21 years who were not vaccinated previously. Males aged 22 through 26 years may be vaccinated. ACIP recommends vaccination of men who have sex with men and immunocompromised persons (including those with HIV infection) through age 26 years if not previously vaccinated. As a compendium of all current recommendations for use of HPV vaccines, information in this report is intended for use by clinicians, vaccination providers, public health officials, and immunization program personnel as a resource. ACIP recommendations are reviewed periodically and are revised as indicated when new information and data become available.

/pdf/human-papillomavirus-vaccination-recommendations-of-the-28czmnevd6.pdf

Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP).

We introduce a general stochastic model for the spread of rumours, and derive mean-field equations that describe the dynamics of the model on complex social networks (in particular, those mediated by the Internet). We use analytical and numerical solutions of these equations to examine the threshold behaviour and dynamics of the model on several models of such networks: random graphs, uncorrelated scale-free networks and scale-free networks with assortative degree correlations. We show that in both homogeneous networks and random graphs the model exhibits a critical threshold in the rumour spreading rate below which a rumour cannot propagate in the system. In the case of scale-free networks, on the other hand, this threshold becomes vanishingly small in the limit of infinite system size. We find that the initial rate at which a rumour spreads is much higher in scale-free networks than in random graphs, and that the rate at which the spreading proceeds on scale-free networks is further increased when assortative degree correlations are introduced. The impact of degree correlations on the final fraction of nodes that ever hears a rumour, however, depends on the interplay between network topology and the rumour spreading rate. Our results show that scale-free social networks are prone to the spreading of rumours, just as they are to the spreading of infections. They are relevant to the spreading dynamics of chain emails, viral advertising and large-scale information dissemination algorithms on the Internet.

/pdf/theory-of-rumour-spreading-in-complex-social-networks-563npwoq6e.pdf

Theory of rumour spreading in complex social networks

Although the 1918 influenza epidemic was a major demographic event in the US and worldwide it has not been the major focus of studies by demographers. Some of its salient features include the enormity of the number of people who were affected; estimates indicate that one-quarter of the American population had clinically recognizable cases of flu during the epidemic. Also noteworthy is the fact that the 1918 influenza epidemic was associated with exceptionally high mortality both qualitatively and quantitatively. This study presents a relevant finding in the reexamination of published statistics on death: that the 1918 influenza had a strong and fairly long-lasting effect on differential mortality by sex diminishing the earlier female advantage. Specifically it is noted that the mechanism posited is a selection effect whereby those with tuberculosis (TB) in 1918 were more likely than others to die of influenza. This possible outcome affected males more than females because TB morbidity disproportionately affected males. However the reduction of the pool of male TB cases lowered the male TB death rate in the 2 years following 1918 thereby bringing males life expectancy closer to the longer female life expectancy.

The 1918 influenza epidemic's effects on sex differentials in mortality in the United States.

Vitamin D is an important micronutrient for health. Hypovitaminosis D is thought to play a role in the seasonality of a number of diseases and adverse health conditions. To refine hypotheses about the links between vitamin D and seasonal diseases, good estimates of the cyclicality of serum vitamin D are necessary. The objective of this study is to describe quantitatively the cyclicality of 25-hydroxyvitamin D (25OHD) in the United States. We provide a statistical analysis with weekly time resolution, in comparison to the quarterly (winter/spring/summer/fall) estimates already in the literature. We analyzed time series data on 25OHD, spanning 287 consecutive weeks. The pooled data set comes from 3.44 million serum samples from the United States. We statistically analyzed the proportion of sera that were vitamin D sufficient, defined as 25OHD [Formula: see text] ng/mL, as a function of date. In the United States, serum 25OHD follows a lagged pattern relative to the astronomical seasons, peaking in late summer (August) and troughing in late winter (February). Airmass, which is a function of solar altitude, fits the 25OHD data very well when lagged by 8 weeks. Serum vitamin D levels can be modeled as a function of date, working through a double-log transformation of minimal solar airmass (easily calculated from solar altitude, retrievable from an online solar altitude/azimuth table).

/pdf/vitamin-d-25ohd-serum-seasonality-in-the-united-states-2q91vjh784.pdf

Vitamin D (25OHD) Serum Seasonality in the United States

https://escholarship.org/content/qt3k8415x2/qt3k8415x2.pdf?t=ng9bxv

The 1918 influenza pandemic hastened the decline of tuberculosis in the United States: An age, period, cohort analysis

Testing the influenza-tuberculosis selective mortality hypothesis with Union Army data.

This paper describes two related epidemic models of rumor transmission in an age-structured population. Rumors share with communicable disease certain basic aspects, which means that formal models of epidemics may be applied to the transmission of rumors. The results show that rumors may become entrenched very quickly and persist for a long time, even when skeptics are modeled to take an active role in trying to convince others that the rumor is false. This is a macrophenomeon, because individuals eventually cease to believe the rumor, but are replaced by new recruits. This replacement of former believers by new ones is an aspect of all the models, but the approach to stability is quicker, and involves smaller chance of extinction, in the model where skeptics actively try to counter the rumor, as opposed to the model where interest is naturally lost by believers. Skeptics hurt their own cause. The result shows that including age, or a variable for which age is a proxy (e.g., experience), can improve model fidelity and yield important insights.

/pdf/the-transmission-and-persistence-of-urban-legends-5eqw61frxw.pdf

Andrew Noymer

Papers

The 1918 influenza epidemic's effects on sex differentials in mortality in the United States.

Vitamin D (25OHD) Serum Seasonality in the United States

The 1918 influenza pandemic hastened the decline of tuberculosis in the United States: An age, period, cohort analysis

Testing the influenza-tuberculosis selective mortality hypothesis with Union Army data.

The transmission and persistence of ‘urban legends’: sociological application of age-structured epidemic models