Evaluation of discharge prescribing after rescheduling of gabapentin as a controlled substance

Purpose Gabapentin has increasingly been identified as a drug of abuse, especially when used concurrently with opioids. Rescheduling gabapentin as a schedule V controlled substance may strengthen monitoring and prescribing restrictions. The purpose of this study was to characterize the impact of rescheduling gabapentin from a nonscheduled to a schedule V substance in Virginia on discharge prescribing patterns in a health system. Methods This was a retrospective, pre-post, multicenter chart review conducted at 4 sites. Data from 3 months before gabapentin rescheduling (prerescheduling group) and 3 months after gabapentin rescheduling (postrescheduling group) were evaluated. The primary outcome was the percentage of newly prescribed gabapentin prescriptions upon discharge, which was compared between the pre- and postrescheduling groups. Results A similar percentage of gabapentin prescriptions were newly prescribed in the prerescheduling group as compared to the postrescheduling group (55.0% vs 50.0%, P = 0.479). Gabapentin prescribing characteristics did not differ between the groups for new gabapentin prescriptions (n = 55 in the prerescheduling group, n = 50 in the postrescheduling group). Concomitant discharge prescribing of benzodiazepines (5.5% vs 2.0%, P = 0.619) and opioids (45.5% vs 60.0%, P = 0.136) did not differ significantly between the postrescheduling group and prerescheduling group for new gabapentin prescriptions. However, fewer opioid prescriptions exceeded 90 daily morphine milligram equivalents (MME) in the postrescheduling group as compared to the prerescheduling group for new gabapentin prescriptions (36.0% vs 20.0%, P = 0.020). Conclusion Gabapentin prescribing practices did not differ before and after rescheduling of gabapentin as a controlled substance. There was a trend toward dosages with reduced daily MME for concomitant opioid prescriptions after rescheduling. However, additional investigation with larger studies over longer periods of time is needed to discover whether gabapentin rescheduling significantly changes prescribing practices.

Community context matters for bacteria-phage ecology and evolution

Bacteria-phage symbioses are ubiquitous in nature and serve as valuable biological models. Historically, the ecology and evolution of bacteria-phage systems have been studied in either very simple or very complex communities. Although both approaches provide insight, their shortcomings limit our understanding of bacteria and phages in multispecies contexts. To address this gap, here we synthesize the emerging body of bacteria-phage experiments in medium-complexity communities, specifically those that manipulate bacterial community presence. Generally, community presence suppresses both focal bacterial (phage host) and phage densities, while sometimes altering bacteria-phage ecological interactions in diverse ways. Simultaneously, community presence can have an array of evolutionary effects. Sometimes community presence has no effect on the coevolutionary dynamics of bacteria and their associated phages, whereas other times the presence of additional bacterial species constrains bacteria-phage coevolution. At the same time, community context can alter mechanisms of adaptation and interact with the pleiotropic consequences of (co)evolution. Ultimately, these experiments show that community context can have important ecological and evolutionary effects on bacteria-phage systems, but many questions still remain unanswered and ripe for additional investigation.

Expanding the knowledge on a desert sigmodontine rodent in Central Argentina with remarks on its conservation status

The monotypic genus Salinomys (Cricetidae, Sigmodontinae) includes tiny mice with specialist adaptations to desert habitats characteristic of Argentinian shrubland. We report on a population of Salinomys delicatus from Central La Pampa Province, Argentina, representing a 450 km southerly extension to its known distribution. Importantly, this stresses the necessity for further discussion of the validity of its conservation status, recently updated from Data Deficient to Vulnerable. Furthermore, we highlight aspects from its morphology that could help in future proper identification of specimens. Finally, we propose that this species should be retained as Data Deficient pending additional investigation.

Investigative Outcomes of CODIS Matches in Previously Untested Sexual Assault Kits

A 2011 Texas statute required that police agencies submit to the state all unanalyzed sexual assault kits between 1996 and 2011. Cases where a match was made with DNA from an individual or case were returned to local agencies for additional investigation. This article examines outcomes of these cases. Consistent with other studies, we found that the ratio of arrests to all kits submitted was below 1%, and the ratio of arrests to Combined DNA Index System (CODIS) hits was 5.5%. A cost analysis concluded that the cost per court filing was US$132,000. We argue that the small number of arrests was partially due to the age of the cases, based on 8- to 23-year-old crime reports. We further contend that the program could have produced better results if the state had provided funding more quickly for testing and investigations.

Influence of Special Education, ADHD, Autism, and Learning Disorders on ImPACT Validity Scores in High School Athletes

Objective: The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is commonly used to assist with post-concussion return-to-play decisions for athletes. Additional investigation is needed to determine whether embedded indicators used to determine the validity of scores are influenced by the presence of neurodevelopmental disorders (NDs). Method: This study examined standard and novel ImPACT validity indicators in a large sample of high school athletes (n = 33,772) with or without self-reported ND. Results: Overall, 7.1% of athletes’ baselines were judged invalid based on standard ImPACT validity criteria. When analyzed by group (healthy, ND), there were significantly more invalid ImPACT baselines for athletes with an ND diagnosis or special education history (between 9.7% and 54.3% for standard and novel embedded validity criteria) when compared to athletes without NDs. ND history was a significant predictor of invalid baseline performance above and beyond other demographic characteristics (i.e., age, sex, and sport), although it accounted for only a small percentage of variance. Multivariate base rates are presented stratified for age, sex, and ND. Conclusions: These data provide evidence of higher than normal rates of invalid baselines in athletes who report ND (based on both the standard and novel embedded validity indicators). Although ND accounted for a small percentage of variance in the prediction of invalid performance, negative consequences (e.g., extended time out of sports) of incorrect decision-making should be considered for those with neurodevelopmental conditions. Also, reasons for the overall increase noted here, such as decreased motivation, “sandbagging”, or disability-related cognitive deficit, require additional investigation.

BET 1: Can hands-on defibrillation be performed safely?

A review was carried out to see whether hands-on defibrillation could be performed safely. 6 papers presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that hands-on defibrillation has the potential to be performed safely if the rescuer uses appropriate electrical insulating barriers such as polyethylene gloves or class 1 electrical insulating gloves. The safety profile of nitrile gloves is unclear. Since detection of shock was used as a proxy for safety, additional investigation is warranted before hands-on defibrillation becomes common practice.

Building a land statistics, testing database

Although the statistics and land inventory from 2014 up to now have made much progress, the Natural Resources and Environment sector, as well as many production units, have put in application some software and supporting tools such as TK2015, gCadas, VietMap XM, TKDesktop 2019, etc. However, these software are mainly manual or semi-automatic, not organized to comply with database standards, while the control of the additional investigation, data editing, must be manipulated, updated many times, so the application of the above software in reality still faces many difficulties and expensive. In order to effectively and synchronously perform land statistics and inventory, additional studies and proposals for scientific and technological improvement are necessary. This article presents a new approach for the purpose of thorough automation in land statistics and inventory based on proposing effective implementation solutions and building statistical databases and land inventory according to current regulations.

The Characteristics of Feet Center of Pressure Trajectory during Quiet Standing

To investigate the level of bilateral symmetry or asymmetry between right and left foot center of pressure (COP) trajectory in the mediolateral and anteroposterior directions, this study involved 102 participants (54 females and 48 males). Ground reaction forces were measured using two Kistler force plates during two 45-s quiet standing trials. Comparisons of COP trajectory were performed by correlation and scatter plot analysis. Strong and very strong positive correlations (from 0.6 to 1.0) were observed between right and left foot anteroposterior COP displacement trajectory in 91 participants; 11 individuals presented weak or negative correlations. In the mediolateral direction, moderate and strong negative correlations (from −0.5 to −1.0) were observed in 69 participants, weak negative or weak positive correlations in 30 individuals, and three showed strong positive correlations (0.6 to 1.0). Additional investigation is warranted to compare COP trajectories between asymptotic individuals as assessed herein (to determine normative data) and those with foot or leg symptoms to better understand the causes of COP asymmetry and aid clinicians with the diagnosis of posture-related pathologies.

Tendencies of Development of Activities of a Prosecutor in Elimination of Obstacles to Consideration and Resolution of Criminal Cases under the 1864 Charter of Criminal Proceedings

The paper substantiates the relevance of historical experience of the legal regulation in the context of the modern reform of the prosecutor’s work aimed at elimination of obstacles to consideration and resolution of criminal cases with a view to ensure the adoption of a lawful and reasonable decision on the case, which will certainly contribute to the achievement of the objectives of criminal proceedings. The paper investigates the cases of the 19th century when prosecutors returned criminal cases for additional investigation at the pre-trial stage of criminal proceedings. The author has examined the evolution of the goals, objectives and functions of the institution of return of cases by the prosecutor for further investigation in the specified period. The subject of the study amounts to the examination of the institution of additional investigation from the standpoint of its historical genesis. The author focuses on the analysis of the procedure applied to cases returned by the prosecutor for further investigation, the grounds for investigation and ways of correcting the revealed violations. Taking into account the historical experience, the author comes to the conclusion that it is necessary to improve the activity of the prosecutor aimed at eliminating obstacles. The author has formulated and substantiated proposals for modernization of the legal regulation of the procedure under consideration, as the return of the case for additional investigation constitutes a reserve mechanism for achieving the purpose of criminal proceedings that has restorative nature with regard to the legal rights and interests of the participants of criminal proceedings and their compliance with the relevant legal procedure. This procedure is important for making the right decision on the merits. Thus, the purpose of the work is to elucidate the process of formation and functioning of the institution of additional investigation enshrined in the Charter of Criminal Proceedings. To achieve this goal, the basic scientific methods (dialectical method of cognition, method of systematic analysis, deduction and induction, methods of comparisons and analogies, and a number of others) have been used. The main objectives of the study have been achieved on the basis of the comparative legal method. The practical significance of the work is that it justifies the need for legislative unification of legal norms regulating the activities of the prosecutor aimed at removing the obstacles to the consideration and resolution of criminal cases and introduction of appropriate amendments and additions to normative legal acts that would coordinate the procedure for sending cases by the procurator for additional investigation in strict compliance with the fundamental principles of domestic criminal proceedings.

Randomized Phase II Trial of Bevacizumab or Temsirolimus in Combination With Chemotherapy for First Relapse Rhabdomyosarcoma: A Report From the Children’s Oncology Group

PURPOSE The primary aim of this clinical trial was to prioritize bevacizumab or temsirolimus for additional investigation in rhabdomyosarcoma (RMS) when administered in combination with cytotoxic chemotherapy to patients with RMS in first relapse with unfavorable prognosis. PATIENTS AND METHODS Patients were randomly assigned to receive bevacizumab on day 1 or temsirolimus on days 1, 8, and 15 of each 21-day treatment cycle, together with vinorelbine on days 1 and 8, and cyclophosphamide on day 1 for a maximum of 12 cycles. Local tumor control with surgery and/or radiation therapy was permitted after 6 weeks of treatment. The primary end point was event-free survival (EFS). Radiographic response was assessed at 6 weeks. The study had a phase II selection that was design to detect a 15% difference between the two regimens (α = .2; 1-β = 0.8; two sided test). RESULTS Eighty-seven of 100 planned patients were enrolled when the trial was closed after the second interim analysis after 46 events occurred in 68 patients with sufficient follow-up. The O’Brien Fleming boundary at this analysis corresponded to a two-sided P value of .058 with an observed two-sided P value of .003 favoring temsirolimus. The 6-month EFS for the bevacizumab arm was 54.6% (95% CI, 39.8% to 69.3%) and 69.1% (95% CI, 55.1% to 83%) for the temsirolimus arm. Objective response rates were 28% (95% CI, 13.7% to 41.3%) and 47% (95% CI, 31.5% to 63.2%) for the bevacizumab and temsirolimus arms, respectively ( P = .12) and, 28% of patients on bevacizumab and 11% on temsirolimus had progressive disease at 6 weeks. CONCLUSION Patients who received temsirolimus had a superior EFS compared with bevacizumab. Temsirolimus has been selected for additional investigation in newly diagnosed patients with intermediate-risk RMS.