CDC Advisory Committee Makes New Recommendations for RSV Vaccine

I looked at one slide set for the Respiratory Syncitial Virus (RSV) vaccine. I didn’t watch the meeting. The ACIP Adult RSV Work Group Clinical Considerations powerpoint presentation recommend transitioning away from the shared clinical decision-making (SCDM) component for getting the RSV vaccine.

Slide 4 seems clear:

“All adults aged 75 years and older should get a single dose of RSV vaccination.

All adults aged 60-74 years and with certain chronic medical conditions or other factors that increase the risk of severe RSV disease should receive a single dose of RSV vaccination.

These recommendations would replace the SCDM recommendation, meaning that adults aged 60-74 years without risk factors for severe RSV vaccine, are no longer recommended to receive RSV vaccination.”

Stat News has a report which includes comments on the unanimous vote in favor of the above.

Reminder: CDC ACIP Meeting June 26-28 on Vaccines Including Covid-19 and RSV

Just a reminder about the upcoming CDC ACIP meeting on vaccines, including RSV and Covid-19.

Great Rounding@Iowa Podcast on Preventing & Managing Heat-Related Illness

The Rounding@Iowa podcast has many fascinating and helpful episodes, not the least of which is this one on heat-related illness. The days are getting hotter and we need to pay close attention to what happens in our bodies when exposed to excessive heat.

87: New Treatment Options for Menopause Rounding@IOWA

Join Dr. Clancy and his guests, Drs. Evelyn Ross-Shapiro, Sarah Shaffer, and Emily Walsh, as they discuss the complex set of symptoms and treatment options for those with significant symptoms from menopause.  CME Credit Available:  https://uiowa.cloud-cme.com/course/courseoverview?P=0&EID=81895  Host: Gerard Clancy, MD Senior Associate Dean for External Affairs Professor of Psychiatry and Emergency Medicine University of Iowa Carver College of Medicine Guests: Evelyn RossShapiro, MD, MPH Clinical Assistant Professor of Internal Medicine Clinic Director, LGBTQ Clinic University of Iowa Carver College of Medicine Sarah Shaffer, DO Clinical Associate Professor of Obstetrics and Gynecology Vice Chair for Education, Department of Obstetrics and Gynecology University of Iowa Carver College of Medicine Emily Walsh, PharmD, BCACP Clinical Pharmacy Specialist Iowa Health Care Financial Disclosures:  Dr. Gerard Clancy, his guests, and Rounding@IOWA planning committee members have disclosed no relevant financial relationships. Nurse: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this activity for a maximum of 1.00 ANCC contact hour. Physician: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this enduring material for a maximum of 1.00 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Other Health Care Providers: A certificate of completion will be available after successful completion of the course. (It is the responsibility of licensees to determine if this continuing education activity meets the requirements of their professional licensure board.) References/Resources:   
  1. 87: New Treatment Options for Menopause
  2. 86: Cancer Rates in Iowa
  3. 85: Solutions for Rural Health Workforce Shortages
  4. 84: When to Suspect Atypical Recreational Substances
  5. 83: Hidradenitis Suppurativa

Cicada-Geddon in Eastern Iowa

A couple of days ago I saw one of the many news items about the 17 year (and 13 year) cicadas invading Eastern Iowa this summer.

But I haven’t seen any mention of the sex-crazed, fungus-infected zombie cicadas announced in April.

So, you can relax. Try noise-cancelling headphones.

June CDC ACIP Meeting on Covid and Other Vaccines

There’s an upcoming meeting of the CDC Advisory Committee on Immunization Practices (ACIP) June 26-28, 2024. They’ll discuss the new Covid-19 vaccine and several other vaccines including RSV.

About That Artificial Intelligence…

I’ve got a couple of things to get off my chest about Artificial Intelligence (AI). By now, everyone knows about AI telling people to put hot glue on pizza and whatnot. Sena and I talked to a guy at an electronics store who had nothing but good things to say about AI. I mentioned the hot glue thing and pizza and it didn’t faze him.

I noticed the Psychiatric Times article, “AI in Psychiatry: Things Are Moving Fast.” They mention the tendency for AI to hallucinate and expressed appropriate reservations about its limitations.

And then I found something very interesting about AI and Cribbage. How much does AI know about the game? Turns out not much. Any questions? Don’t expect AI to answer them accurately.

FDA VRBPAC Meeting: Vaccine Targeting Lineage JN.1 for Fall 2024

I didn’t get a chance to watch the June 5th FDA advisory committee meeting on the new vaccine formulation for Covid-19 for this fall. There is a nice summary on the Minnesota CIDRAP (Center for Infectious Disease Research & Policy).

The committee unanimously upvoted the selection of the JN.1 lineage strain (which includes JN.1, KP.2 etc) for Covid vaccines this fall in the U.S.

As usual, Director Dr. Jerry Weir’s slides (summary slides 22-26) provide excellent background and clear discussion.

FDA VRBPAC Meeting on Covid Vaccine for Fall of 2024

The voting question for today’s FDA VRBPAC Meeting on the Covid Vaccine strain for this fall is:

“For the 2024-2025 Formula of COVID-19 vaccines in the U.S., does the
committee recommend a monovalent JN.1-lineage vaccine composition?
Please vote “Yes” or “No” or “Abstain.”

The FDA Selection of the 2024-2025 Formula for COVID-19 vaccines briefing document has a thorough review on the issue.

Svengoolie Movie: The Tingler!”

We saw the 1959 movie “The Tingler” starring Vincent Price on the Svengoolie show last Saturday. Price plays a prison pathologist, Dr. Warren Chapin, who’s trying to scientifically study a parasitic creature called the tingler (tingles up and down your spine means you’re scared right out of your mind!).

It sits on your spine and feeds on fear by clamping down on it, eventually breaking it unless you scream. Then it’ll just let go. However, if you’re mute, scared speechless, or it grabs you by the throat—you’re done. So, the tingler lives on fear, although if you express fear vocally by screaming, you escape it.

OK, so I’m going to spoil the opening scene, which shows a prisoner being dragged to the electric chair, screaming all the way until the executioner throws the switch. When Dr. Chapin does an autopsy, he finds the prisoner’s spine is cracked. He says it wasn’t caused by the electrocution, but by the tingler.

Huh? But the prisoner screamed bloody murder (murder was why he got the death penalty by the way) hardly stopping to take a breath. Shouldn’t that have weakened or killed the tingler? You can find examples of inconsistencies like this in any cheesy movie, but where’s the fun in that?

One web article says the tingler creature was modeled after the velvet worm, which looks pretty creepy. In reality, the velvet worm is harmless to humans, but is a predator of many invertebrates. Just keep telling yourself, “I’m a vertebrate.”

You can watch the full movie on the Internet Archive. The most interesting part of it for me was the use of what was called “acid,” (meaning the hallucinogen LSD) by Dr. Chapin. He wanted to experience and record the actual experience of being scared by the tingler, just to see what it’s like apparently. He mainlines himself with a fairly stiff dose of LSD although I can’t remember how much.

Incidentally, an article in JAMA notes, “Doses of 20μg/kg of body weight are known to have been taken without a lethal outcome.” (Materson BJ, Barrett-Connor E. LSD “Mainlining”: A New Hazard to Health. JAMA. 1967;200(12):1126–1127. doi:10.1001/jama.1967.03120250160025). I don’t know how much Dr. Chapin weighs.

This was about the same time as a lot of people in the U.S. were experimenting with the hallucinogen in various ways, including mainlining it. There are web references to psychiatrists using LSD recreationally (this was when it was legal). Bad trips were and still are common, although there is a growing body of clinical studies that involve using the psychedelics as adjuncts in psychotherapy. It’s not for everybody, although tinglers might have a different opinion.

Anyway, Dr. Chapin has a bad trip, gets really scared of hallucinations and screams. Web articles say that killed his tingler, but I didn’t see it flop out of his mouth.

There you have it. Another really cheesy and fun Svengoolie movie. I’m a vertebrate.

Thoughts on Down Time Activities for Land Survey Technicians

I was just thinking about the old-time land survey crews. When I was getting on the job training as a survey technician, the typical land survey crews were at least 2-3 persons. One rodman, one instrument man, and a crew chief who organized the job, which could be property or construction jobs.

Nowadays, you get by sometimes with one man doing the jobs using a theodolite that measures angles and distances. You don’t always need a physical measuring tape; you can use something they call “total stations.”

It’s cheaper for engineering companies to use one man survey outfits. On the other hand, one disadvantage is the lack of mentoring for learners who want to become land surveyors or civil engineers.

Mentoring from surveyors on the survey back in the day not only taught me such skills as how to throw and wrap a surveyor’s steel tape—it also taught me how to work well with others as a team. Of course, this was transferrable to working on the psychiatry consultation-liaison service in a big hospital as well.

It’s well known that playing cards in the truck while waiting for the rain to stop was an essential skill. I don’t know how they manage downtime nowadays. We didn’t play cards on the consultation service during downtime, partly because we didn’t have much downtime.

Anyway, as I mentioned in a recent post, we played Hearts in the truck on rain days. I always sat in the middle. At the time, I was a terrible card player in general. It was a cutthroat game and I had trouble remembering which cards had been played.

When you consider that the strong suit of engineers and surveyors is math ability, you’d think that survey crews would have figured out a way to play Cribbage during downtime. You can have a Cribbage game with 3 or 4 people although I’ve never played it that way. If there are 3 players, it can still be cutthroat.

The one problem I can see is that, the guy sitting in the middle would have to set the board on his lap. You’d almost need a special, custom-made board which would have a space for placing the cards to keep track of what’s been played. I think that might have made things easier for me.

The other drawback to one man survey crews is that pretty much the only card game you can play is solitaire.