Examining the patient and caregiver experience with diazepam nasal spray for seizure clusters: Results from an exit survey of a phase 3, open-label, repeat-dose safety study

BACKGROUND: Ideal rescue treatments for acute treatment of seizure clusters should be easy to administer, so it is important to assess user perceptions of these treatments. Diazepam nasal spray is designed to have a rapid, noninvasive, and socially acceptable route of administration. Patient and caregiver (including care partner) responses to surveys from a phase 3 safety study of diazepam nasal spray are reported. METHODS: The study enrolled patients aged 6-65 years with seizure clusters. Surveys distributed to patients and caregivers at study end, completion, or discontinuation collected data on comfort using diazepam nasal spray outside the home, timing of administration and return to their usual selves, and comfort of use compared with rectal diazepam. Safety was assessed. RESULTS: Of 175 patients enrolled at the October 31, 2019, interim cutoff, 158 received diazepam nasal spray. Sixty-seven (42.4%) patients and 84 (53.2%) caregivers responded to the surveys (including 35 matched pairs). Most patients (78.8%, 52/66) responded that they were very comfortable doing activities outside the home with diazepam nasal spray available; 59.4% of patients returned to their usual selves within an hour of administration. Twenty-seven (40.3%) of these patients reported self-administration, 48% doing so at the first sign of a seizure. Administration of diazepam nasal spray was rated extremely or very easy by 93.8% of caregivers. Safety profile was consistent with diazepam rectal gel; no patient discontinued owing to treatment-emergent adverse events. Nasal discomfort was typically mild and transient. Among patients who had used diazepam rectal gel, most were not at all comfortable using it outside the home (86.7%) or at home (64.5%) compared with diazepam nasal spray, whereas caregivers reported that diazepam rectal gel was not at all easy to use compared with diazepam nasal spray. CONCLUSIONS: This survey from the phase 3 safety study of diazepam nasal spray shows that patients and caregivers were satisfied with, and more comfortable using, diazepam nasal spray than rectal diazepam in public. NCT02721069

Preparing Postbaccalaureates for Entry and Success in Biomedical PhD Programs

Certain racial and ethnic groups, individuals with disabilities, and those from low socioeconomic backgrounds remain underrepresented (UR) in the biomedical sciences. This underrepresentation becomes more extreme at each higher education stage. To support UR scholars during the critical transition from baccalaureate to PhD, we established an intensive, 1-yr postbaccalaureate training program. We hypothesized that this intervention would strengthen each participant’s competitiveness for leading PhD programs and build a foundation of skills and self-efficacy important for success during and after graduate school. Scholar critical analysis skills, lab technique knowledge, and Graduate Record Examination scores all improved significantly during the program. Scholars reported significant confidence growth in 21 of 24 categories related to success in research careers. In 5 yr, 91% (41/45) of scholars transitioned directly into PhD programs. Importantly, 40% (18/45) of participating postbaccalaureate scholars had previously been declined acceptance into graduate school; however, 17/18 of these scholars directly entered competitive PhD programs following our training program. Alumni reported they were “extremely well” prepared for graduate school, and 95% (39/41) are currently making progress to graduation with a PhD. In conclusion, we report a model for postbaccalaureate training that could be replicated to increase participation and success among UR scholars in the biomedical sciences

Automated Inadvertent Intruder Application

The Environmental Analysis and Performance Modeling group of Savannah River National Laboratory (SRNL) conducts performance assessments of the Savannah River Site (SRS) low-level waste facilities to meet the requirements of DOE Order 435.1. These performance assessments, which result in limits on the amounts of radiological substances that can be placed in the waste disposal facilities, consider numerous potential exposure pathways that could occur in the future. One set of exposure scenarios, known as inadvertent intruder analysis, considers the impact on hypothetical individuals who are assumed to inadvertently intrude onto the waste disposal site. Inadvertent intruder analysis considers three distinct scenarios for exposure referred to as the agriculture scenario, the resident scenario, and the post-drilling scenario. Each of these scenarios has specific exposure pathways that contribute to the overall dose for the scenario. For the inadvertent intruder analysis, the calculation of dose for the exposure pathways is a relatively straightforward algebraic calculation that utilizes dose conversion factors. Prior to 2004, these calculations were performed using an Excel spreadsheet. However, design checks of the spreadsheet calculations revealed that errors could be introduced inadvertently when copying spreadsheet formulas cell by cell and finding these errors was tedious and time consuming. This weakness led to the specification of functional requirements to create a software application that would automate the calculations for inadvertent intruder analysis using a controlled source of input parameters. This software application, named the Automated Inadvertent Intruder Application, has undergone rigorous testing of the internal calculations and meets software QA requirements. The Automated Inadvertent Intruder Application was intended to replace the previous spreadsheet analyses with an automated application that was verified to produce the same calculations and results. The application was extended to calculate full decay chains for a given parent so that an intruder calculation could be performed without any input from transport calculations, i.e. the intruder analysis was decoupled from groundwater analysis. Once this full decay chain capability was in place, the application was extended to perform a transient calculation of the dose to an intruder over a specified time range, from which the maximum dose in time was determined. Use of the transient calculation to find the maximum dose in time was a significant step forward in automating and simplifying the inadvertent intruder analysis

RCT Testing Bystander Effectiveness to Reduce Violence

Introduction: Bystander-based programs have shown promise to reduce interpersonal violence at colleges, yet limited rigorous evaluations have addressed bystander intervention effectiveness in high schools. This study evaluated the Green Dot bystander intervention to reduce sexual violence and related forms of interpersonal violence in 26 high schools over 5 years. Design: A cluster RCT was conducted. Setting/participants: Kentucky high schools were randomized to intervention or control (wait list) conditions. Intervention: Green Dot−trained educators conducted schoolwide presentations and recruited student popular opinion leaders to receive bystander training in intervention schools beginning in Year 1. Main outcome measures: The primary outcome was sexual violence perpetration, and related forms of interpersonal violence victimization and perpetration were also measured using anonymous student surveys collected at baseline and annually from 2010 to 2014. Because the school was the unit of analysis, violence measures were aggregated by school and year and school-level counts were provided. Results: A total of 89,707 students completed surveys. The primary, as randomized, analyses conducted in 2014–2016 included linear mixed models and generalized estimating equations to examine the condition−time interaction on violence outcomes. Slopes of school-level totals of sexual violence perpetration (condition−time, p \u3c 0.001) and victimization (condition−time, p \u3c 0.001) were different over time. During Years 3–4, when Green Dot was fully implemented, the mean number of sexual violent events prevented by the intervention was 120 in Intervention Year 3 and 88 in Year 4. For Year 3, prevalence rate ratios for sexual violence perpetration in the intervention relative to control schools were 0.83 (95% CI=0.70, 0.99) in Year 3 and 0.79 (95% CI=0.67, 0.94) in Year 4. Similar patterns were observed for sexual violence victimization, sexual harassment, stalking, and dating violence perpetration and victimization. Conclusions: Implementation of Green Dot in Kentucky high schools significantly decreased not only sexual violence perpetration but also other forms of interpersonal violence perpetration and victimization

Integrated pest management strategies for cabbage stem flea beetle (Psylliodes chrysocephala) in oilseed rape

Oilseed rape (OSR) is the second largest source of vegetable oil globally and the most important biofuel feedstock in the European Union (EU) but production of this important crop is threatened by a small insect; Psylliodes chrysocepaha – the cabbage stem flea beetle (CSFB). The EU ban on use of neonicotinoid seed treatments and resistance of CSFB to pyrethroid insecticides have left farmers with limited control options resulting in drastic reductions in production. Integrated pest management (IPM) may offer a solution. We review the lifecycle of CSFB and the current options available, or in the research pipeline, for the eight IPM principles of the EU Sustainable Use of Pesticides Directive (Directive-2009/128/EC). A full IPM strategy for CSFB barely exists. Although there are a range of preventative measures these require scientific validation; critically, resistant/tolerant OSR cultivars are not yet available. Existing monitoring methods are time consuming and there are no commercial models to enable decision support based on predictions migration timing or population size. Available thresholds are not based on physiological tolerances of the plant making it hard to adapt them to changing market prices for the crop and costs of control. Non-synthetic alternatives tested and registered for use against CSFB are lacking, making resistance management impossible. CSFB control is therefore dependent upon conservation biocontrol. Natural enemies of CSFB are present, but quantification of their effects is needed and habitat management strategies to exploit their potential. Although some EU countries have local initiatives to reduce insecticide use and encourage use of ‘greener’ alternatives, there is no formal process for ranking these and little information available to help farmers make choices. We summarise the main knowledge gaps and future research needed to improve measures for CSFB control and to facilitate development of a full IPM strategy for this pest -and sustainable oilseeds production

An Interactive Internet-Based Continuing Education Course on Sexually Transmitted Diseases for Physicians and Midwives in Peru

Clinicians in developing countries have had limited access to continuing education (CE) outside major cities, and CE strategies have had limited impact on sustainable change in performance. New educational tools could improve CE accessibility and effectiveness.The objective of this study was to evaluate an interactive Internet-based CE course on Sexually Transmitted Diseases (STDs) management for clinicians in Peru. Participants included physicians and midwives in private practice drawn from a census of 10 Peruvian cities. The CE included a three-hour workshop for improving Internet skills, followed by a 22-hour online course on STD-syndrome-management, with subsequent educational support. The course used case-based clinical vignettes tailored to local STD problems. Knowledge and reported practices on STD management were assessed before, immediately after and at four months after completion of the course. Statistical analysis included parametric tests-linear regression multivariate analysis, paired t-test and repeated measures ANOVA using SPSS 14.0. Of 1,071 eligible clinicians, 510 agreed to participate, as did an additional 132 public sector clinicians. Of these 642 participants, 619 (96.4%) completed the course, and 596 (96.3%) took the four-month follow-up evaluation. Physician and midwife scores improved from 64.2% correct answers on the pre-test to 77.9% correct on the four-month follow-up test (p<0.001). Most participants (95%) found the online course useful for their work needs. Self reported STD management practices did not change.Among physicians and midwives in Peru, an Internet-based CE course was feasible, acceptable with high participation rates, and led to sustained improvement in knowledge at four months. Further studies are needed to test it as a model for improving the training of physicians, midwives, and other health care providers

Modelling the factors affecting the spatiotemporal distribution of cabbage stem flea beetle (Psylliodes chrysocephala) larvae in winter oilseed rape (Brassica napus) in the UK

BACKGROUND Cabbage stem flea beetle (CSFB; Psylliodes chrysocephala L.) management in oilseed rape (Brassica napus L.) has become an urgent issue in the absence of permitted and effective insecticides. Understanding the meteorological and management factors affecting their population dynamics has become critical to the development of pest management strategies. RESULTS The spatio-temporal changes in CSFB larval populations were assessed both in autumn and spring, in the UK from 2003 to 2017 (a period encompassing pre-and post-neonicotinoid insecticide restriction). After the neonicotinoid ban in 2013, the number of larvae both in autumn and spring increased 10-fold in the UK. When neonicotinoids were available, later sown crops contained fewer larvae than early sown crops, and bigger fields had fewer larvae than smaller fields, whereas after the ban, bigger fields tended to have more larvae than smaller fields. Wet and mild/hot Septembers were related with higher numbers of larvae when neonicotinoids were available and with lower larval numbers after the neonicotinoid ban. Low temperatures in December and January combined with high rainfall were related with high numbers of larvae in spring both before and after the neonicotinoid ban. CONCLUSION This study will help to produce decision support systems that allow future predictions of regional CSFB population changes and will help growers and consultants to adjust their management methods to reduce the risk of high infestations

Exploratory Use of Microaerosol Decontamination Technology (PAEROSOL) in Enclosed, Unoccupied Hospital Setting

The goal of this study was to validate the previously observed high biological kill performance of PAEROSOL, a semi-dry, micro-aerosol decontamination technology, against common HAI in a non-human subject trial within a hospital setting of Madigan Army Medical Center (MAMC) on Joint Base Lewis-McChord in Tacoma, Washington. In addition to validating the disinfecting efficacy of PAEROSOL, the objectives of the trial included a demonstration of PAEROSOL environmental safety, (i.e., impact to hospital interior materials and electronic equipment exposed during testing) and PAEROSOL parameters optimization for future deployment

Exploratory Use of Microaerosol Decontamination Technology (PAEROSOL) in Enclosed, Unoccupied Hospital Setting

The goal of this study was to validate the previously observed high biological kill performance of PAEROSOL, a semi-dry, micro-aerosol decontamination technology, against common HAI in a non-human subject trial within a hospital setting of Madigan Army Medical Center (MAMC) on Joint Base Lewis-McChord in Tacoma, Washington. In addition to validating the disinfecting efficacy of PAEROSOL, the objectives of the trial included a demonstration of PAEROSOL environmental safety, (i.e., impact to hospital interior materials and electronic equipment exposed during testing) and PAEROSOL parameters optimization for future deployment

Impact of an Educational Intervention Designed to Reduce Unnecessary Recall during Screening Mammography

To describe the impact of a tailored web based educational program designed to reduce excessive screening mammography recall