Challenges recruiting to a proof-of-concept pharmaceutical trial for a rare disease: The trigeminal neuralgia experience

Background: This study aimed to describe recruitment challenges encountered during a phase IIa study of vixotrigine, a state and use-dependent Nav1.7 channel blocker, in individuals with trigeminal neuralgia. Methods: This was an international, multicenter, placebo-controlled, randomized withdrawal study that included a 7-day run-in period, a 21-day open-label phase, and a 28-day double-blind phase in which patients (planned n = 30) were randomized to vixotrigine or placebo. Before recruitment, all antiepileptic drugs had to be stopped, except for gabapentin or pregabalin. After the trial, patients returned to their original medications. Patient recruitment was expanded beyond the original five planned (core) centers in order to meet target enrollment (total recruiting sites N = 25). Core sites contributed data related to patient identification for study participation (prescreening data). Data related to screening failures and study withdrawal were also analyzed using descriptive statistics. Results: Approximately half (322/636; 50.6%) of the patients who were prescreened at core sites were considered eligible for the study and 56/322 (17.4%) were screened. Of those considered eligible, 26/322 (8.1%) enrolled in the study and 6/322 (1.9%) completed the study. In total, 125 patients were screened across all study sites and 67/125 (53.6%) were enrolled. At prescreening, reasons for noneligibility varied by site and were most commonly diagnosis change (78/314; 24.8%), age > 80 years (75/314; 23.9%), language/distance/mobility (61/314; 19.4%), and noncardiac medical problems (53/314; 16.9%). At screening, frequently cited reasons for noneligibility included failure based on electrocardiogram, insufficient pain, and diagnosis change. Conclusions: Factors contributing to recruitment challenges encountered in this study included diagnosis changes, anxiety over treatment changes, and issues relating to distance, language, and mobility. Wherever possible, future studies should be designed to address these challenges. Trial registration: ClinicalTrials.gov, NCT01540630. EudraCT, 2010-023963-16. 07 Aug 2015

Treatment Options for Vestibular Migraine

Although vestibular migraine is a common cause of vertigo, affecting approximately 1% of the Western world's population, it remains widely under-recognized and is under-diagnosed. Diagnostic criteria for vestibular migraine were recently published in collaboration with the International Headache Society and the Bárány-Society. Trials investigating the treatment of vestibular migraine are sparse but some are now underway. This review focuses on the treatments options available for vestibular migraine, based on the existing evidence base where available. Regarding acute treatments, there are two randomized controlled trials that provide evidence for the use of triptans (zolmitriptan and rizatriptan) for the management of vestibular migraine attacks. For prophylactic treatment, the evidence base is largely non-existent, since the only multicenter randomized placebo-controlled trial testing metoprolol versus placebo is still underway. Consequently, the treatment recommendations for the prophylactic treatment of vestibular migraine are mainly based on expert opinion and the treatments guidelines for migraine with and without aura

Initial coupling and reaction progression of directly deposited biradical graphene nanoribbon monomers on iodine-passivated versus pristine Ag(111)

The development of widely applicable methods for the synthesis of C-C-bonded nanostructures on inert and insulating surfaces is a challenging yet rewarding milestone in the field of on-surface synthesis. This would enable studies of nearly unperturbed covalent nanostructures with unique electronic properties as graphene nanoribbons (GNR) and π-conjugated 2D polymers. The prevalent Ullmann-type couplings are almost exclusively carried out on metal surfaces to lower the temperature required for initial dehalogenation well below the desorption threshold. To overcome the necessity for the activation of monomers on the target surface, we employ a recently developed Radical Deposition Source (RaDeS) for the direct deposition of radicals onto inert surfaces for subsequent coupling by addition reactions. The radicals are generated en route by indirect deposition of halogenated precursors through a heated reactive tube, where the dehalogenation reaction proceeds. Here, we use the ditopic 6,11-diiodo-1,2,3,4-tetraphenyltriphenylene (DITTP) precursor that afforded chevron-like GNR on Au(111) via the usual two-staged reaction comprised of monomer-coupling into covalent polymers and subsequent formation of an extended GNR by intramolecular cyclodehydrogenation (CDH). As a model system for inert surfaces, we use Ag(111) passivated with a closed monolayer of chemisorbed iodine that behaves in an inert manner with respect to dehalogenation reactions and facilitates the progressive coupling of radicals into extended covalent structures. We deposit the DITTP-derived biradicals onto both iodine-passivated and pristine Ag(111) surfaces. While on the passivated surface, we directly observe the formation of covalent polymers, on pristine Ag(111) organometallic intermediates emerge instead. This has decisive consequences for the further progression of the reaction: heating the organometallic chain directly on Ag(111) results in complete desorption, whereas the covalent polymer on iodine-passivated Ag(111) can be transformed into the GNR. Yet, the respective CDH proceeds directly on Ag(111) after thermal desorption of the iodine passivation. Accordingly, future work is aimed at the further development of approaches for the complete synthesis of GNR on inert surfaces

Toward Citizen Centricity: Leveraging the Citizens Academy to Foster Inclusive, Sustainable, and Generative Civic Engagement in Midland, MI

This service learning project aims to utilize positive psychology research to foster inclusive, sustainable, and generative civic engagement among residents of Midland, Michigan. We conceptualize civic engagement as an outgrowth of social capital, and we leverage the constructs of mattering, fairness, belonging, and bridging to offer positive interventions aimed at increasing Midland’s social capital. Specifically, we propose several changes to evolve the city government’s existing educational civic leadership program called the Citizens Academy. First, we suggest adjusting the academy’s recruitment process to expand access and inclusion by increasing the number and diversity of participants. Second, we introduce a more participatory and citizen-centered approach to the program content that builds on Midland’s four strategic pillars as a guiding framework. We offer four positive psychology-based exercises to be interwoven into the Citizens Academy curriculum: Strengths and Values, Community Exploration Guide, Citizen-to-Citizen Coaching, and Storytelling. Third, we recommend a Civic Engagement Scale as a simple tool to measure initial outcomes. It is our hope that this service learning project will serve not only as an initial catalyst for Midland’s goal of increasing civic engagement, but as a model for other cities and communities looking to utilize the science of positive psychology to effect large-scale change

The healing pattern of osteoid osteomas on computed tomography and magnetic resonance imaging after thermocoagulation

Objective To compare the healing pattern of osteoid osteomas on computed tomography (CT) and magnetic resonance imaging (MRI) after successful and unsuccessful thermocoagulation. Materials and methods Eighty-six patients were examined by CT and 18 patients by dynamic gadolinium-enhanced MRI before and after thermocoagulation for osteoid osteoma. Thermocoagulation was successful in 73% (63/86) and unsuccessful in 27% (23/86) of patients followed by CT. Thermocoagulation was successful in 72% (13/18) of patients followed by MRI. After treatment, the healing of the nidus on CT was evaluated using different healing patterns (complete ossification, minimal nidus rest, decreased size, unchanged size or thermonecrosis). On MRI the presence of reactive changes (joint effusion, "oedema-like" changes of bone marrow and soft tissue oedema) and the delay time (between arterial and nidus enhancement) were assessed and compared before and after thermocoagulation. Results Complete ossification or a minimal nidus rest was observed on CT in 58% (16/28) of treatment successes (with > 12 months follow-up), but not in treatment failures. "Oedema-like" changes of bone marrow and/or soft tissue oedema were seen on MR in all patients before thermocoagulation and in all treatment failures. However, residual "oedema-like" changes of bone marrow were also found in 69% (9/13) of treatment successes. An increased delay time was observed in 62% (8/13) of treatment successes and in 1/5 of treatment failures. Conclusion Complete, or almost complete, ossification of the treated nidus on CT correlated with successful treatment. Absence of this ossification pattern, however, did not correlate with treatment failure. CT could not be used to identify the activity of the nidus following treatment. The value of MR parameters to assess residual activity of the nidus was limited in this study

Textile sensors for stab and cut detection

Manufacturers are aiming for more flexible and lightweight protective clothing to increase wearing comfort. A cardigan with a knitted stab-resistant inlay and an alarm system is presented. The stab-resistant inlay is based on a multilayer ultra-high molecular weight poly ethylene (UHMW-PE) fabric. Stab resistance was evaluated according to the standard of the Association of Test Laboratories for Bullet, Stab or Pike Resistant Materials and Construction Standard (VPAM 2011). Furthermore sensors for the detection of cuts and pressure were integrated. Both sensors can trigger alarms if the wearer is attacked. Normal pressure occurring through leaning on a wall or sitting is filtered out and does not trigger an alarm

HV/HR-CMOS sensors for the ATLAS upgrade—concepts and test chip results

In order to extend its discovery potential, the Large Hadron Collider (LHC) will have a major upgrade (Phase II Upgrade) scheduled for 2022. The LHC after the upgrade, called High-Luminosity LHC (HL-LHC), will operate at a nominal leveled instantaneous luminosity of 5× 1034 cm−2 s−1, more than twice the expected Phase I . The new Inner Tracker needs to cope with this extremely high luminosity. Therefore it requires higher granularity, reduced material budget and increased radiation hardness of all components. A new pixel detector based on High Voltage CMOS (HVCMOS) technology targeting the upgraded ATLAS pixel detector is under study. The main advantages of the HVCMOS technology are its potential for low material budget, use of possible cheaper interconnection technologies, reduced pixel size and lower cost with respect to traditional hybrid pixel detector. Several first prototypes were produced and characterized within ATLAS upgrade R&D effort, to explore the performance and radiation hardness of this technology. In this paper, an overview of the HVCMOS sensor concepts is given. Laboratory tests and irradiation tests of two technologies, HVCMOS AMS and HVCMOS GF, are also given