Impact of a clinical pharmacist's intervention on pneumococcal vaccination in a population of at- risk hospitalized patients: The IP-VAC study

OBJECTIVES

The aim of this study was to evaluate the impact of clinical pharmacist intervention on compliance with pneumococcal vaccination (PV) recommendations in hospitalized patients.

METHODS

This was a prospective, single-center, before-and-after study conducted in 2019-2020. Patients had to be over 18 years of age, at risk of pneumococcal infection, and with no PV. No changes were made in the observational phase. During the interventional phase, the clinical pharmacist discussed a prescription for preventive PV and a mention in the discharge letter. A pharmaceutical consultation sensitized the patient to the interest of PV. The clinical pharmacist ensured that a complete vaccination protocol would be carried out by the retail pharmacist within 3 months of hospitalization.

RESULTS

One hundred and sixty-seven (167) patients were included. In the observational phase, 2.3% of patients received a complete vaccination protocol after discharge from primary care. The rate increased to 63.8% after the clinical pharmacist's intervention (p < 0.001). Vaccines were prescribed by hospital physicians in 97.5% of cases, while 40% of discharge letters included the indication for PV.

CONCLUSION

The clinical pharmacist's intervention led to delivery of a complete PV protocol after discharge for over half the patients. This study demonstrated the feasibility of a pharmaceutical intervention to promote PV in hospital activities.

Skill trade-offs promote persistent individual differences and specialized tactics

Individuals generally differ in their ability to perform challenging behaviours, but the causes of such variability remain incompletely understood. Because animals can usually use different behavioural tactics to achieve their goals, we might expect individual differences in skill to be maintained when the available tactics require different abilities to perform well. To explore this idea, I used the producer-scrounger (PS) paradigm, which considers interactions between foragers that may either invest effort in searching for resources (i.e. produce) or exploit others' discoveries (i.e. scrounge). Specifically, I tested whether individual differences in cognitive traits (i.e. the ability to find food) might result from a trade-off with competitiveness (i.e. the ability to steal food) that would exert disruptive selection pressure and, as such, might explain the coexistence of condition-dependent foraging tactics. If individuals differ in their competitiveness, with strong contestants being better able to monopolize food resources (and hence to scrounge), the model predicts that strong and weak competitors should rely more on scrounging and producing, respectively, especially when the finder's advantage is low. These findings indicate that the existence of individual differences in competitive abilities may be sufficient to explain short-term individual foraging tactic specialization. Yet, the degree of behavioural specialization is expected to depend on both the social and ecological context. Furthermore, persistent phenotypic differences, that are necessary for stable individual specialization, require the existence of a trade-off between competitive abilities that enable greater success as scroungers and cognitive abilities that are associated with better efficiency to detect and/or capture prey and, as such, enable greater success as producers. Therefore, this study further highlights the importance of considering the existence of alternative tactics to measure and predict the evolution of traits, including cognitive traits, within populations.

Predation and parasitism as determinants of animal personalities

Within the same population, proactive (i.e. bolder, more exploratory, active and aggressive) and reactive (i.e. more timid, less exploratory, less active and more passive) individuals could be hypothetically maintained due a trade-off between foraging and vigilance behaviours, provided that both phenotypes differ in their state (e.g. metabolic rates, body condition or energetic needs). Yet, recent findings indicate that among-individual variation in intrinsic state can explain only a small proportion of variation in behaviour, meaning that other mechanisms, such as the presence of trophically transmitted parasites, might contribute to maintaining inter-individual behavioural differences. Empirical evidence, indeed, suggests strong relationships between certain animal personality traits and parasitic load within host populations. However, the direction of causation between these traits remains unclear: are different behaviours in infected hosts in contrast to uninfected ones the result of manipulation by parasites to increase host predation, or are some personalities inherently more susceptible to infection than others? To better understand the role of parasites in shaping behavioural differences within host populations and examine to what extent parasite manipulation and/or intrinsic differences in parasite susceptibility contribute to maintaining behavioural differences, we used a simulation approach and analyzed the change in the frequencies of proactive and reactive individuals over time under different predation and starvation scenarios, when individual phenotype either affected a host's risk of infection or not. We found that in the absence of parasites, predation pressure strongly affected the expression of host personality, but the trade-off between foraging and vigilance behaviours alone could not explain the maintenance of inter-individual behavioural differences without temporal variation in predation pressure. By contrast, in the presence of parasites, the two host phenotypes could coexist within populations even when individuals experienced no temporal variations in predation risk, but only when proactive and reactive hosts were equally susceptible to parasitism. Our findings thus indicate that parasites can play an important role in maintaining genetic diversity in their host populations in addition to generating behavioural differences though manipulation.

MR Imaging Correlates for Molecular and Mutational Analyses in Children with Diffuse Intrinsic Pontine Glioma

BACKGROUND AND PURPOSE

Recent advances in molecular techniques have characterized distinct subtypes of diffuse intrinsic pontine gliomas. Our aim was the identification of MR imaging correlates of these subtypes.

MATERIALS AND METHODS

Initial MRIs from subjects with diffuse intrinsic pontine gliomas recruited for a prospective clinical trial before treatment were analyzed. Retrospective imaging analyses included FLAIR/T2 tumor volume, tumor volume enhancing, the presence of cyst and/or necrosis, median, mean, mode, skewness, kurtosis of ADC tumor volume based on FLAIR, and enhancement at baseline. Molecular subgroups based on EGFR and MGMT mutations were established. Histone mutations were also determined (H3F3A, HIST1H3B, HIST1H3C). Univariate Cox proportional hazards regression was used to test the association of imaging predictors with overall and progression-free survival. Wilcoxon rank sum, Kruskal-Wallis, and Fisher exact tests were used to compare imaging measures among groups.

RESULTS

Fifty patients had biopsy and MR imaging. The median age at trial registration was 6 years (range, 3.3-17.5 years); 52% were female. On the basis of immunohistochemical results, 48 patients were assigned to 1 of 4 subgroups: 28 in MGMT-/epidermal growth factor receptor (EGFR)-, 14 in MGMT-/EGFR+, 3 in MGMT+/EGFR-, and 3 in MGMT+/EGFR+. Twenty-three patients had histone mutations in H3F3A, 8 in HIST1H3B, and 3 in HIST1H3C. Enhancing tumor volume was near-significantly different across molecular subgroups (P = .04), after accounting for the false discovery rate. Tumor volume enhancing, median, mode, skewness, and kurtosis ADC T2-FLAIR/T2 were significantly different (P ≤ .048) between patients with H3F3A and HIST1H3B/C mutations.

CONCLUSIONS

MR imaging features including enhancement and ADC histogram parameters are correlated with molecular subgroups and mutations in children with diffuse intrinsic pontine gliomas.

Consequences of multiple simultaneous opportunities to exploit others' efforts on free riding

Individuals within a group do not all act in the same way: Typically, the investors (or producers) put efforts into producing resources while the free riders (or scroungers) benefit from these resources without contributing. In behavioral ecology, the prevalence of free riders can be predicted by a well-known game-theoretical model-the producer-scrounger (PS) model-where group members have the options to either search for resources (producers) or exploit the efforts of others (scroungers). The PS model has received some empirical support, but its predictions, surprisingly, are based on the strict assumption that only one resource can be exploited at a time. Yet, multiple simultaneous opportunities to exploit others' efforts should frequently occur in nature. Here, we combine analytic and simulation approaches to explore the effect of multiple simultaneous scrounging opportunities on tactic use. Our analyses demonstrate that scrounging rates should increase with the number of simultaneous opportunities. As such, the amount and spatial distribution (i.e., clumped vs. dispersed) of resources as well as the risk of predation are key predictors of scrounging behavior. Because scroungers contribute to reducing the speed of resource exploitation, the model proposed here has direct relevance to the exploitation and sustainability of renewable resources.

[Risk of Infection Following Implant of Artificial Penile Nodule, Bouglous or Dominos: A Case Report in French Guiana]

Implant of artificial penile nodule (APN) is a socio-cultural practice, linked to penitentiary environment in French Guiana. Physicians are often unfamiliar with its existence. Although serious complications remain low regarding the high prevalence of this practice, urgent cares could be required. Indeed, implant of nodule can have functional sequelae, and sometimes life-threatening consequences, especially if infection occurs and spreads. We have reported the case of a 23-year-old male who presented an infection of the penis after the implant of two APN. Removal of the nodules associated with oral antibiotics was needed. We also present CT-scan images of another patient, as an example of fortuitous discovery of these nodules. We finally discuss the various complications already described in literature.

Why are some personalities less plastic?

Individuals from the same population typically show consistent differences in behavioural traits that are frequently associated with differences in contextual plasticity. Yet such a correlation might arise either because some individuals are better able than others to detect environmental changes or because the benefits of being plastic are condition-dependent. To discriminate between these two competing hypotheses, I developed an individual-based model that simulates a population in which individuals of varying fighting ability compete by pairwise interactions using either the fixed hawk (aggressive) or dove (peaceful) strategies or a conditional assessment strategy. As anticipated, the model predicts that only individuals with low (and/or intermediate) fighting ability should use the assessment strategy, giving rise to a negative (or dome-shaped) relationship between aggressiveness and plasticity. The proportion of plastic individuals, however, should be affected not only by the environmental conditions in which individuals live but also by the mechanism that would maintain variation in the traits that determine the benefits of plasticity. In particular, if individual differences in fighting ability may be eroded by natural selection, it predicts that ecological conditions that cause assortative interactions (e.g. high predation risks) would contribute in maintaining variation among individuals in their fighting ability, thereby favouring greater plasticity.

Adaptation of a microbead assay for the easy evaluation of traditional anti-sickling medicines: application to DREPANOSTAT and FACA

CONTEXT

Sickle cell disease is a common inherited blood disorder affecting millions of people worldwide. Due to lack of progress in drug discovery for a suitable treatment, sufferers often turn to traditional medicines that take advantage of the plant extracts activity used by traditional healers.

OBJECTIVE

This study optimizes an anti-sickling screening test to identify preparations capable of reverting sickle cells back to the morphology of normal red blood cells. We focused on the miniaturization and practicability of the assay, so that it can be adapted to the laboratory conditions commonly found in less developed countries.

MATERIALS AND METHODS

We tested two traditional anti-sickling herbal medicines, FACA^® and DREPANOSTAT^®, composed of Zanthoxylum zanthoxyloides (Lam.) Zepern. & Timler (Rutaceae) and Calotropis procera (Aiton) Dryand. (Apocynaceae) at screening concentrations of hydroethanol extracts from 0.2 to 1 mg/mL. Potential bioactive molecules present in the extracts were profiled using Ultra High Performance Liquid Chromatography coupled with High Resolution Mass Spectrometry (UHPLC-HRMS/MS) method, identified through HRMS, MS/MS spectra and in silico fragmentation tools.

RESULTS

Hydroethanol extracts of FACA^® and DREPANOSTAT^® showed low anti-sickling activity, inhibiting less than 10% of the sickling process. The UHPLC-HRMS/MS profiles identified 28 compounds (18 in FACA^® and 15 in DREPANOSTAT^®, including common compounds) among which l-phenylalanine is already described as potential anti-sickling agent. When used as positive control, 7 mg/mL phenylalanine reduced the sickled RBC to 52%.

DISCUSSION AND CONCLUSIONS

This assay has been optimized for the easy screening of plant extracts or extracted compounds from bioassay guided fractionation, valuable to laboratories from less developed countries.

Are some individuals generally more behaviorally plastic than others? An experiment with sailfin mollies

Individuals within the same population generally differ among each other not only in their behavioral traits but also in their level of behavioral plasticity (i.e., in their propensity to modify their behavior in response to changing conditions). If the proximate factors underlying individual differences in behavioral plasticity were the same for any measure of plasticity, as commonly assumed, one would expect plasticity to be repeatable across behaviors and contexts. However, this assumption remains largely untested. Here, we conducted an experiment with sailfin mollies (Poecilia latipinna) whose behavioral plasticity was estimated both as the change in their personality traits or mating behavior across a social gradient and using their performance on a reversal-learning task. We found that the correlations between pairwise measures of plasticity were weak and non-significant, thus indicating that the most plastic individuals were not the same in all the tests. This finding might arise because either individuals adjust the magnitude of their behavioral responses depending on the benefits of plasticity, and/or individuals expressing high behavioral plasticity in one context are limited by neural and/or physiological constraints in the amount of plasticity they can express in other contexts. Because the repeatability of behavioral plasticity may have important evolutionary consequences, additional studies are needed to assess the importance of trade-offs between conflicting selection pressures on the maintenance of intra-individual variation in behavioral plasticity.

Abstract P1-09-11: A phase Ib study of oral administration of lucitanib in combination with fulvestrant in patients with HR+ metastatic breast cancer (mBC)

FGFR1 amplification could mediate resistance to endocrine therapy and FGFR1 inhibition reverses this resistance. This phase Ib seeks to evaluate whether the combination of lucitanib, a potent FGFR/VEGFR/PDFGR inhibitor, in combination with fulvestrant, an endocrine agent, reverses resistance to fulvestrant.

Eligible patients for this study were postmenopausal with ER+/HER2- mBC and have relapsed during or after treatment with fulvestrant. There were 2 parts in the study: a dose allocation to assess the tolerability of the combination in terms of DLTs and MTD using a modified Continual Reassessment Method (mCRM) [part I] and a dose expansion, with patients assigned to 2 different cohorts based on FGFR amplification, to further evaluate the tolerability of the combination and to identify the recommended phase II dose (RP2D) [part II]. Surrogate target hitting biomarkers were also dosed at baseline and on-treatment. The sponsor decided to halt the clinical development in mBC indication and the study was prematurely terminated after 18 patients (15 in part I and 3 in part II). The presentation will focus on these 18 patients.

Patients had ECOG PS 0 or 1 and median number of previous treatments in metastatic setting was 3. Two doses of lucitanib (10mg daily n=9 and 12.5mg daily n=6) in combination with 500 mg/month of fulvestrant were tested in part I. At the 10mg dose level, one patient experienced a DLT (grade 3 hypertension). Based on global lucitanib development program data, it was decided to start Part II with lucitanib 10mg daily. The most common related grade ≥3 toxicities occurring in more than 10% of patients were hypertension (78%) and asthenia (22%). All patients required at least one dose interruption mainly for toxicities, while 13 patients (72%) required at least a dose reduction for toxicities. Thirteen patients (72%) withdrew from the study for disease progression, 3 (17%) for adverse events (at 10mg) and 2 (11%) for non-medical reasons. Three patients achieved a confirmed partial response (as per RECIST v1.1), one at 10mg and two at 12.5mg. About 55% of the patients experienced clinical benefit with a median duration of the benefit of 39.6 weeks and a maximun duration of the benefit of 79.1 weeks for 1 patient (PR at Cycle 4). Biomarker modulations were consistent with lucitanib mode of action; targeting VEGFRs (significant increase of VEGFA, IL8, PlGF) and FGFR1 (significant increase of FGF23).

The combination is feasible but requires close patient monitoring and intensive management of adverse events. Those are in line with the anti-angiogenic activity of lucitanib.

  10mg (N=12)12.5mg (N=6)All (N=18)Objective Response Rate (ORR)n(%) 11 (8.3)2 (33.3)3 (16.7) 95% CI 3[1.5;35.4][9.7;70.0][5.8;39.2]Clinical Benefit Rate (CBR)n(%) 24 (33.3)6 (100.0)10 (55.6) 95% CI 3[13.8;61.0][61.0;100.0][33.7;75.4]Duration of Clinical Benefitmedian (weeks)28.171.339.6 95% CI 3[27.9; 32.7][29.1; 79.1][27.9; 79.1]1: CR or PR 2: CR or PR or stabilization (SD or NonCR/NonPD) &gt;24 weeks or at end of cycle 6 3: 95% Wilson method of Confidence interval of the estimate

Citation Format: Campone M, Bachelot T, Penault-Llorca F, Pallis A, Agrapart V, Pierrat M-J, Poirot C, Paux G, Dubois F, Xuereb L, Robert R, Andre F. A phase Ib study of oral administration of lucitanib in combination with fulvestrant in patients with HR+ metastatic breast cancer (mBC) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-09-11.

Symmetry Breaking in Photonic Crystals: On-Demand Dispersion from Flatband to Dirac Cones

We demonstrate that symmetry breaking opens a new degree of freedom to tailor energy-momentum dispersion in photonic crystals. Using a general theoretical framework in two illustrative practical structures, we show that breaking symmetry enables an on-demand tuning of the local density of states of the same photonic band from zero (Dirac cone dispersion) to infinity (flatband dispersion), as well as any constant density over an adjustable spectral range. As a proof of concept, we demonstrate experimentally the transformation of the very same photonic band from a conventional quadratic shape to a Dirac dispersion, a flatband dispersion, and a multivalley one. This transition is achieved by finely tuning the vertical symmetry breaking of the photonic structures. Our results provide an unprecedented degree of freedom for optical dispersion engineering in planar integrated photonic devices.

Impulsiveness does not prevent cooperation from emerging but reduces its occurrence: an experiment with zebra finches

Reciprocal altruism, the most probable mechanism for cooperation among unrelated individuals, can be modelled as a Prisoner's Dilemma. This game predicts that cooperation should evolve whenever the players, who expect to interact repeatedly, make choices contingent to their partner's behaviour. Experimental evidence, however, indicates that reciprocity is rare among animals. One reason for this would be that animals are very impulsive compared to humans. Several studies have reported that temporal discounting (that is, strong preferences for immediate benefits) has indeed a negative impact on the occurrence of cooperation. Yet, the role of impulsive action, another facet of impulsiveness, remains unexplored. Here, we conducted a laboratory experiment in which male and female zebra finches (Taenyopigia guttata) were paired assortatively with respect to their level of impulsive action and then played an alternating Prisoner's Dilemma. As anticipated, we found that self-controlled pairs achieved high levels of cooperation by using a Generous Tit-for-Tat strategy, while impulsive birds that cooperated at a lower level, chose to cooperate with a fixed probability. If the inability of impulsive individuals to use reactive strategies are due to their reduced working memory capacity, thus our findings might contribute to explaining interspecific differences in cooperative behaviour.