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Individuals with tardive dyskinesia (TD) who completed a long-term study (KINECT 3 or KINECT 4) of valbenazine (40 or 80 mg/day, once-daily for up to 48 weeks followed by 4-week washout) were enrolled in a subsequent study (NCT02736955) that was primarily designed to further evaluate the long-term safety of valbenazine.
Participants were initiated at 40 mg/day (following prior valbenazine washout). At week 4, dosing was escalated to 80 mg/day based on tolerability and clinical assessment of TD; reduction to 40 mg/day was allowed for tolerability. The study was planned for 72 weeks or until termination due to commercial availability of valbenazine. Assessments included the Clinical Global Impression of Severity-TD (CGIS-TD), Patient Satisfaction Questionnaire (PSQ), and treatment-emergent adverse events (TEAEs).
At study termination, 85.7% (138/161) of participants were still active. Four participants had reached week 60, and none reached week 72. The percentage of participants with a CGIS-TD score ≤2 (normal/not ill or borderline ill) increased from study baseline (14.5% [23/159]) to week 48 (64.3% [36/56]). At baseline, 98.8% (158/160) of participants rated their prior valbenazine experience with a PSQ score ≤2 (very satisfied or somewhat satisfied). At week 48, 98.2% (55/56) remained satisfied. Before week 4 (dose escalation), 9.4% of participants had ≥1 TEAE. After week 4, the TEAE incidence was 49.0%. No TEAE occurred in ≥5% of participants during treatment (before or after week 4).
Valbenazine was well-tolerated and persistent improvements in TD were found in adults who received once-daily treatment for >1 year.
Valbenazine is approved for tardive dyskinesia (TD) in adults based on clinical trials that included patients with mood disorders (e.g., bipolar disorder, major depressive disorder). In two long-termphase 3 trials, KINECT 3 (NCT02274558) and KINECT 4 (NCT02405091), sustained TD improvements were found in participants who received once-daily treatment with valbenazine (40 or 80mg). Data from these studies were analyzed post hoc to evaluate changes in psychiatric status of patients with a primary mood disorder.
Data were pooled from participants with mood disorders in KINECT 3 (6-week double-blind, placebo-controlled period; 42-week double-blind extension period; 4-week drug-free washout) and KINECT 4 (48week open-label treatment; 4-week drug-free washout). At screening, patients must have had a Brief Psychiatric Rating Scale total score <50. Mood changes were evaluated after long-term treatment (Week 48) and washout (Week 52) using the Young Mania Rating Scale (YMRS) and Montgomery-Åsberg Depression Rating Scale (MADRS). For each scale, mean changes from baseline in the total score and individual item scores were analyzed descriptively.
Of the 95 participants with a primary mood disorder (40mg , n=32; 80mg , n=63), 59 (62.1%) were diagnosed with bipolar disorder, 32 (33.7%) with major depressive disorder, and 4 (4.2%) with another mood disorder. A majority of all mood participants received concomitant antidepressants (84.2%) and/or antipsychotics (76.8%) during treatment; other common concomitant medications included antiepileptics (47.4%), anxiolytics (38.9%), and anticholinergics (22.1%). Mean YMRS and MADRS total scores in all mood participants indicated mood symptom stability at baseline (YMRS, 2.7; MADRS, 5.9). This stability was maintained during the studies, as indicated by minimal changes from baseline in mean total scores (YMRS: Week 48, 1.0; Week 52, –1.0; MADRS: Week 48, 0.3; Week52,0.9). Changes in individual items on both scales were also small (<±0.3), indicating no clinically significant changes or worsening in specific mood symptoms or domains.
Mood symptom stability was maintained in patients with TD and a primary mood disorder who received up to 48 weeks of treatment with once-daily valbenazine in addition to their psychiatric medication(s).
Funding Acknowledgements: Neurocrine Biosciences, Inc.
Scholars in the fields of instructional development and pedagogy note that learning outcomes can be improved when teachers use “narratives” to communicate how complex processes work or how problems are addressed. In this article, the authors describe a narrative-centered approach to graduate-level instruction in research methodology. This approach is intended to supplement, not replace, conventional graduate seminars in quantitative or qualitative methods. In a series of lectures, scholars reflected on how their published articles originally were framed, the trade-offs that were necessary to advance the investigation, the methodological challenges and non-findings that had to be addressed—but may not have been printed—and the evolution of a piece as it progressed through the peer-review stages. This approach to exposing graduate students to the entirety of the research process is termed Social Science Mechanics: A Look under the Hood at Innovative Research Designs. Surveys used to evaluate the series confirmed that graduate students who attended the presentations found them to be highly engaging and beneficial. Many faculty members also attended and found the lectures to be equally instructive.
Contamination of inanimate surfaces contributes to the transmission of healthcare-associated infection, a phenomenon that is well documented for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). The high rate of skin colonization with these bacteria among healthcare workers increases the risk of cross contamination via high-touch surfaces. Since gram-negative bacteria are believed to survive poorly on surfaces, their role in the transmission of infection has not been investigated as widely. Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) are widespread and endemic in nosocomial settings. Given the increasing prevalence of infections involving ESBL-PE, the role of the environment in ESBL-PE transmission should be explored. This study reports the evaluation of 2 ESBL-PE recovery methods from typical hospital surface materials and their application for recovery of ESBL-PE adjacent to an ESBL-positive patient.
The Kepler Mission was designed to measure the frequency of Earth-like planets in the habitable zone of Sun-like stars. A requirement for determining the underlying planet population from a sample of detected planets is understanding the completeness of that sample—what fraction of the planets that could have been discovered in a given data set were actually detected. Here we describe an experiment designed to address a specific aspect of that question, which is the issue of signal throughput efficiency. We investigate the extent to which the Kepler pipeline preserves transit signals by injecting simulated transit signals into the pixel-level data, processing the modified pixels through the pipeline, and measuring their detection statistics. For the single channel that we examine initially, we inject simulated transit signal trains into the pixel time series of each of the 1801 targets for the 89 days that constitute Quarter 3. For the 1680 that behave as expected in the pipeline, on average we find the strength of the injected signal is recovered at 99.6% of the strength of the original signal. Finally we outline the further work required to characterise the completeness of the Kepler pipeline.
The Kepler Mission simultaneously measures the brightness of more than 150,000 stars every 29.4 minutes primarily for the purpose of transit photometry. Over the course of its 3.5-year primary mission Kepler has observed over 190,000 distinct stars, announcing 2,321 planet candidates, 2,165 eclipsing binaries, and 105 confirmed planets. As Kepler moves into its 4-year extended mission, the total number of transit-like features identified in the light curves has increased to as many as ~18,000. This number of signals has become intractable for human beings to inspect by eye in a thorough and timely fashion. To mitigate this problem we are developing machine learning approaches to perform the task of reviewing the diagnostics for each transit signal candidate to establish a preliminary list of planetary candidates ranked from most credible to least credible. Our preliminary results indicate that random forests can classify potential transiting planet signatures with an accuracy of more than 98.6% as measured by the area under a receiver-operating curve.
Assessments of infectious disease spread in hospitals seldom account for interfacility patient sharing. This is particularly important for pathogens with prolonged incubation periods or carrier states.
We quantified patient sharing among all 32 hospitals in Orange County (OC), California, using hospital discharge data. Same-day transfers between hospitals were considered “direct” transfers, and events in which patients were shared between hospitals after an intervening stay at home or elsewhere were considered “indirect” patient-sharing events. We assessed the frequency of readmissions to another OC hospital within various time points from discharge and examined interhospital sharing of patients with Clostridium difficile infection.
In 2005, OC hospitals had 319,918 admissions. Twenty-nine percent of patients were admitted at least twice, with a median interval between discharge and readmission of 53 days. Of the patients with 2 or more admissions, 75% were admitted to more than 1 hospital. Ninety-four percent of interhospital patient sharing occurred indirectly. When we used 10 shared patients as a measure of potential interhospital exposure, 6 (19%) of 32 hospitals “exposed” more than 50% of all OC hospitals within 6 months, and 17 (53%) exposed more than 50% within 12 months. Hospitals shared 1 or more patient with a median of 28 other hospitals. When we evaluated patients with C. difficile infection, 25% were readmitted within 12 weeks; 41% were readmitted to different hospitals, and less than 30% of these readmissions were direct transfers.
In a large metropolitan county, interhospital patient sharing was a potential avenue for transmission of infectious agents. Indirect sharing with an intervening stay at home or elsewhere composed the bulk of potential exposures and occurred unbeknownst to hospitals.
The lack of frequent real-world opportunities to study preparedness for large-scale public health emergencies has hindered the development of an evidence base to support best practices, performance measures, standards, and other tools needed to assess and improve the nation’s multibillion dollar investment in public health preparedness. In this article, we argue that initial funding priorities for public health systems research on preparedness should focus on using engineering-style methods to identify core preparedness processes, developing novel data sources and measures based on smaller-scale proxy events, and developing performance improvement approaches to support the translation of research into practice within the wide variety of public health systems found in the nation. (Disaster Med Public Health Preparedness. 2008;2:247–250)
The placentas of 68 infants with intrauterine growth restriction (IUGR) were examined for evidence of impaired uteroplacental circulation and compared with those of 65 appropriately grown infants. Infarcts and/or accelerated villous maturation were present in the placentas in 27 (40%) of the infants with IUGR compared with seven (11%) of the infants without IUGR (P<0.001). The infants were followed-up at 4 and 12 months of age and growth parameters recorded. Medical and developmental assessments and neuromotor developmental examinations were also performed. The 23 infants in the IUGR group with placentas with evidence of impaired uteroplacental circulation were compared with the 31 infants with IUGR with normal placentas. There was no difference between the groups in growth, cognitive development, or neuromotor abnormality. It was concluded that IUGR is strongly associated with placental markers of impaired uteroplacental blood flow while it would appear that there is no association between placental pathology and growth or neurodevelopment in the first year.
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