Dalba Got Back? Use of Dalbavancin for the Treatment of Vertebral Osteomyelitis.

Data evaluating dalbavancin use for vertebral osteomyelitis remain limited. In our retrospective cohort, 29 of 34 (85.3%) patients completed their dalbavancin course. Adverse reactions occurred for 6 (17.6%) and infection recurrence in 3 (8.8%) within 90 days. Dalbavancin appears to be safe and well-tolerated for vertebral osteomyelitis.

The hidden cost of dalbavancin: OPAT RN time required in coordination for persons who use drugs.

Background: Serious infections in persons who use drugs (PWUD) are rising. Dalbavancin, due to its extended half-life, offers an alternative treatment for patients in whom standard of care antibiotics are not feasible or practical, allowing for reduced hospital days and the avoidance of central line placement or the use of complex oral regimens. Objectives: We aim to describe the time and effort required for coordination of dalbavancin courses by outpatient registered nurses (RNs) and other outpatient parenteral antimicrobial therapy (OPAT) staff. Design and methods: We conducted a retrospective review of adult patients with documented substance use who received at least one dose of dalbavancin and quantified the number of interventions required by our OPAT RNs and other OPAT staff for coordination of dalbavancin courses. Additionally, detailed data on time spent per intervention were prospectively collected for a 1-month period. Results: A total of 52 patients with 53 dalbavancin courses were included. Most substance use was intravenous. Infectious diagnoses included bone and joint infections (61%) and endocarditis (7%), in addition to skin and soft tissue infections (19%). Infections were most commonly caused by Staphylococcus aureus (62%). RN intervention was required in the coordination of 60% of all courses and in 77% of courses in which at least one outpatient dose was needed. Adverse reactions occurred in one patient (2%) and 90-day readmissions due to infectious complications occurred in two patients (4%). Detailed time analysis was performed for seven consecutive patients, with a total of 179 min spent by OPAT RNs on coordination. Conclusions: The ease of dalbavancin administration does not eliminate the need for extensive RN coordination for successful administration of doses in the outpatient setting for PWUD. This need should be accounted for in program staffing to help increase successful dalbavancin course completion.

An Electronic Information Kiosk for Enhancing Patient Accrual for Cancer Clinical Trials: A Pilot and Feasibility Study.

Introduction Low accrual to clinical trials for solid tumors at our institution led to a review of possible modifiable factors within our control. This led to a pilot project to determine whether improved patient awareness could alter accrual rates to active trials. Methods An information kiosk was located at the patient library on the ground floor of the London Regional Cancer Program. Adult cancer patients were invited to learn more about clinical trials from our research navigator, including specific trials open in our center, and to participate in the study, which involved a brief satisfaction and demographics survey. Results Three hundred and eighty-six (386) patients interacted with the clinical trial information kiosk over the eight weeks it was open. Of these, 32 patients consented and filled out surveys, which indicated an overall positive interaction with the kiosk. Unfortunately, in the time period examined, clinical trial accrual rates appeared to decrease when the pre- and post-kiosk activation periods were compared (44 versus 37 patients accrued to various trials). Conclusion Our pilot study found that the implementation of a clinical trial information kiosk was easy to understand and useful for patients to learn more about clinical trials. Barriers to this patient satisfaction translating into increased accrual rates in our center included suboptimal kiosk location and lack of guidance to the kiosk from clerical staff. High patient satisfaction scores support the potential value of permanent clinical trial information kiosks in our cancer center, but this requires increased attention to visibility, location, and staff education.

Effects of maternal experience on pup-induced activation of maternal neural circuits in virgin mice.

Maternal experience can promote a long-lasting increase in maternal motivation. This maintenance of caregiving behaviors, rather than avoidant or agnostic responses towards young, is advantageous for the survival of subsequent offspring. We have previously reported that maternal motivation is associated with differential immediate early gene expression in central motivation circuits and aversion circuits. Here we ask how these circuits come to differentially respond to infant cues. We used Targeted Recombination in Active Populations (TRAP) to identify cells that respond to pups in maternally hesitant TRAP2;Ai14 virgin female mice. Following an initial 60 min exposure to foster pups, virgin TRAP2;Ai14 mice were injected with 4-hydroxytamoxifen to induce recombination in c-Fos expressing cells and subsequent permanent expression of a red fluorescent reporter. We then examined whether the same cells that encode pup cues are reactivated during maternal memory retrieval two weeks later using c-Fos immunohistochemistry. Whereas initial pup exposure induced c-Fos activation exclusively in the medial preoptic area (MPOA), following repeated experience, c-Fos expression was significantly higher than baseline in multiple regions of maternal and central aversion circuits (e.g., ventral bed nucleus of the stria terminalis, nucleus accumbens, basolateral amygdala, prefrontal cortex, medial amygdala, and ventromedial nucleus of the hypothalamus). Further, cells in many of these sites were significantly reactivated during maternal memory retrieval. These data suggest that cells across both maternal motivation and central aversion circuits are stably responsive to pups and thus may form the cellular representation of maternal memory.

Ethologically relevant repeated acute social stress induces maternal neglect in the lactating female mouse.

Psychosocial stress is a top predictor of peripartum mood disorders in human mothers. In the present study, we developed a novel paradigm testing the effects of direct and vicarious social stress on maternal and mood-related behaviors in B6 mice. Using a novel housing paradigm, we examined the extent to which postpartum dams withdrew from litters following psychosocial stress. Repeated acute direct social stress involved exposing dams to a virgin male mouse for 7 min/day on postpartum days 5-7 during a brief (15-min) mother-pup separation. To remove the effects of direct stress, the vicarious social stress dams were housed in the same vivarium as direct social stressed dams, but without direct exposure to intruders. Control dams were given mock intruder exposure and housed in a separate vivarium room containing breeding mice. All dams experienced pup separation, and maternal care was investigated upon reunion. Direct and vicarious social stress induced significant deficits in maternal care and increased maternal anxiety relative to controls. Although vicarious stress effects were more likely to occur on days when there was acute stress exposure, direct stress sustained maternal deficits 24 h after the final stressor. Together, these data suggest psychosocial stress induces aberrant maternal phenotypes in mice.

Histone deacetylase inhibitor treatment promotes spontaneous caregiving behaviour in non-aggressive virgin male mice.

The majority of mammalian species are uniparental, with the mother solely providing care for young conspecifics, although fathering behaviours can emerge under certain circumstances. For example, a great deal of individual variation in response to young pups has been reported in multiple inbred strains of laboratory male mice. Furthermore, sexual experience and subsequent cohabitation with a female conspecific can induce caregiving responses in otherwise indifferent, fearful or aggressive males. Thus, a highly conserved parental neural circuit is likely present in both sexes; however, the extent to which infants are capable of activating this circuit may vary. In support of this idea, fearful or indifferent responses toward pups in female mice are linked to greater immediate early gene (IEG) expression in a fear/defensive circuit involving the anterior hypothalamus compared to that in an approach/attraction circuit involving the ventral tegmental area. However, experience with infants, particularly in combination with histone deacetylase inhibitor (HDACi) treatment, can reverse this pattern of pup-induced activation of fear/defence circuitry and promote approach behaviour. Thus, HDACi treatment may increase the transcription of primed/poised genes that play a role in the activation and selection of a maternal approach circuit in response to pup stimuli. In the present study, we investigated whether HDACi treatment would impact behavioural response selection and associated IEG expression changes in virgin male mice that are capable of ignoring, attacking or caring for pups. The results obtained indicate that systemic HDACi treatment induces spontaneous caregiving behaviour in non-aggressive male mice and alters the pattern of pup-induced IEG expression across a fear/defensive neural circuit.

Experience-dependent mechanisms in the regulation of parental care.

Maternal behavior is a defining characteristic of mammals, which is regulated by a core, conserved neural circuit. However, mothering behavior is not always a default response to infant conspecifics. For example, initial fearful, fragmented or aggressive responses toward infants in laboratory rats and mice can give way to highly motivated and organized caregiving behaviors following appropriate hormone exposure or repeated experience with infants. Therefore hormonal and/or experiential factors must be involved in determining the extent to which infants access central approach and avoidance neural systems. In this review we describe evidence supporting the idea that infant conspecifics are capable of activating distinct neural pathways to elicit avoidant, aggressive and parental responses from adult rodents. Additionally, we discuss the hypothesis that alterations in transcriptional regulation within the medial preoptic area of the hypothalamus may be a key mechanism of neural plasticity involved in programming the differential sensitivity of these neural pathways.

Histone deacetylase inhibitor treatment induces postpartum-like maternal behavior and immediate early gene expression in the maternal neural pathway in virgin mice.

The peripartum period is associated with the onset of behaviors that shelter, feed and protect young offspring from harm. The neural pathway that regulates caregiving behaviors has been mapped in female rats and is conserved in mice. However, rats rely on late gestational hormones to shift their perception of infant cues from aversive to attractive, whereas laboratory mice are "spontaneously" maternal, but their level of responding depends on experience. For example, pup-naïve virgin female mice readily care for pups in the home cage, but avoid pups in a novel environment. In contrast, pup-experienced virgin mice care for pups in both contexts. Thus, virgin mice rely on experience to shift their perception of infant cues from aversive to attractive in a novel context. We hypothesize that alterations in immediate early gene activation may underlie the experience-driven shift in which neural pathways (fear/avoidance versus maternal/approach) are activated by pups to modulate context-dependent changes in maternal responding. Here we report that the effects of sodium butyrate, a drug that allows for an amplification of experience-induced histone acetylation and gene expression in virgins, are comparable to the natural onset of caregiving behaviors in postpartum mice and induce postpartum-like patterns of immediate early gene expression across brain regions. These data suggest that pups can activate a fear/defensive circuit in mice and experience-driven improvements in caregiving behavior could be regulated in part through decreased activation of this pathway.

Observation of plasmon-phonons in a metamaterial superconductor using inelastic neutron scattering.

A metamaterial approach is capable of drastically increasing the critical temperature, T c , of composite metal-dielectric superconductors as demonstrated by the tripling of T c that was observed in bulk Al-Al2O3 coreshell metamaterials. A theoretical model based on the Maxwell-Garnett approximation provides a microscopic explanation of this effect in terms of electron-electron pairing mediated by a hybrid plasmon-phonon excitation. We report an observation of this excitation in Al-Al2O3 core-shell metamaterials using inelastic neutron scattering. This result provides support for this mechanism of superconductivity in metamaterials.

Titi Monkeys as a Novel Non-Human Primate Model for the Neurobiology of Pair Bonding
.

It is now widely recognized that social bonds are critical to human health and well-being. One of the most important social bonds is the attachment relationship between two adults, known as the pair bond. The pair bond involves many characteristics that are inextricably linked to quality of health, including providing a secure psychological base and acting as a social buffer against stress. The majority of our knowledge about the neurobiology of pair bonding comes from studies of a socially monogamous rodent, the prairie vole (Microtus ochrogaster), and from human imaging studies, which inherently lack control. Here, we first review what is known of the neurobiology of pair bonding from humans and prairie voles. We then present a summary of the studies we have conducted in titi monkeys (Callicebus cupreus)-a species of socially monogamous New World primates. Finally, we construct a neural model based on the location of neuropeptide receptors in the titi monkey brain, as well as the location of neural changes in our imaging studies, with some basic assumptions based on the prairie vole model. In this model, we emphasize the role of visual mating stimuli as well as contributions of the dopaminergic reward system and a strong role for the lateral septum. This model represents an important step in understanding the neurobiology of social bonds in non-human primates, which will in turn facilitate a better understanding of these mechanisms in humans.

Assessment of PGAA capability for low-level measurements of H in Ti alloys.

The accuracy of low-level hydrogen measurements with prompt gamma-ray activation analysis (PGAA) depends on identifying and accounting for all background H signals, including interfering signals. At the cold-neutron (CN)PGAA facility at the NIST Center for Neutron Research, the sources of background H signals were investigated in the context of titanium-based matrices containing low-levels of H (<300 mg H per kg Ti) with the measurements of prepared standards (mixtures of polyvinyl chloride and titanium oxide) and Ti alloy (Ti6Al4V) samples. The sensitivity ratio, defined as the ratio of the H signal to the Ti signal per unit mass ratio of H in Ti, was determined (1) with the measurements of prepared standards and (2) based on partial gamma-ray production cross sections and full-energy detection efficiencies. The resulting calibrations from these two approaches agreed within experimental uncertainty. A series of Ti alloy NIST Standard Reference Materials (SRMs) previously certified for the H content (SRMs 2452, 2453, 2453a, 2454) were used as test cases, with the mass fractions determined based on the sensitivity ratios derived from method 1 and method 2, respectively. The results agreed with the certified values within experimental uncertainties, validating the analysis performed on the new instrument with newly-prepared standards at low H mass fractions (method 1), and with the standard-independent analysis (method 2). Various sample mounting improvements were made to lower the background H signal. Spectral interferences near the H peak were identified as potential sources of bias and as a limiting factor in the detection limit of H in Ti alloy samples.

Statistical Issues in Testing Conformance with the Quantitative Imaging Biomarker Alliance (QIBA) Profile Claims.

A major initiative of the Quantitative Imaging Biomarker Alliance is to develop standards-based documents called "Profiles," which describe one or more technical performance claims for a given imaging modality. The term "actor" denotes any entity (device, software, or person) whose performance must meet certain specifications for the claim to be met. The objective of this paper is to present the statistical issues in testing actors' conformance with the specifications. In particular, we present the general rationale and interpretation of the claims, the minimum requirements for testing whether an actor achieves the performance requirements, the study designs used for testing conformity, and the statistical analysis plan. We use three examples to illustrate the process: apparent diffusion coefficient in solid tumors measured by MRI, change in Perc 15 as a biomarker for the progression of emphysema, and percent change in solid tumor volume by computed tomography as a biomarker for lung cancer progression.

Orexin/Hypocretin-1 Receptor Antagonism Selectively Reduces Cue-Induced Feeding in Sated Rats and Recruits Medial Prefrontal Cortex and Thalamus.

The orexin/hypocretin system is important for reward-seeking behaviors, however less is known about its function in non-homeostatic feeding. Environmental influences, particularly cues for food can stimulate feeding in the absence of hunger and lead to maladaptive overeating behavior. The key components of the neural network that mediates this cue-induced overeating in sated rats include lateral hypothalamus, amygdala, and medial prefrontal cortex (mPFC), yet the neuropharmacological mechanisms within this network remain unknown. The current study investigated a causal role for orexin in cue-driven feeding, and examined the neural substrates through which orexin mediates this effect. Systemic administration of the orexin-1 receptor (OX1R) antagonist SB-334867 had no effect on baseline eating, but significantly reduced cue-driven consumption in sated rats. Complementary neural analysis revealed that decreased cue-induced feeding under SB-334867 increased Fos expression in mPFC and paraventricular thalamus. These results demonstrate that OX1R signaling critically regulates cue-induced feeding, and suggest orexin is acting through prefrontal cortical and thalamic sites to drive eating in the absence of hunger. These findings inform our understanding of how food-associated cues override signals from the body to promote overeating, and indicate OX1R antagonism as a potential pharmacologic target for treatment of disordered eating in humans.