Label Instructions Research Articles

System-Wide, Electronic Health Record-Based Medication Alerts for Appropriate Prescribing of Direct Oral Anticoagulants: Pilot Randomized Controlled Trial.

While direct oral anticoagulants (DOACs) have improved oral anticoagulation management, inappropriate prescribing remains prevalent and leads to adverse drug events. Antithrombotic stewardship programs seek to enhance DOAC prescribing but require scalable and sustainable strategies. We present a pilot, prescriber-level randomized controlled trial to assess the effectiveness of electronic health record (EHR)-based medication alerts in a large health system. The pilot assessed prescriber responses to alerts for initial DOAC prescription errors (apixaban and rivaroxaban). A user-centered, multistage design process informed alert development, emphasizing clear indication, appropriate dosing based on renal function, and drug-drug interactions. Alerts appeared whenever a DOAC was being prescribed in a way that did not follow package label instructions. Clinician responses measured acceptability, accuracy, feasibility, and utilization of the alerts. The study ran from August 1, 2022, through April 30, 2023. Only 1 prescriber requested trial exclusion, demonstrating acceptability. The error rate for false alerts due to incomplete data was 6.6% (16/243). Two scenarios with alert design and/or execution errors occurred but were quickly identified and resolved, underlining the importance of a responsive quality assurance process in EHR-based interventions. Trial feasibility issues related to alert-data capture were identified and resolved. Trial feasibility was also assessed with balanced randomization of prescribers and the inclusion of various alerts across both medications. Assessing utilization, 34.2% (83/243) of the encounters (with 134 prescribers) led to a prescription change. The pilot implementation study demonstrated the acceptability, accuracy, feasibility, and estimates of the utilization of EHR-based medication alerts for DOAC prescriptions and successfully established just-in-time randomization of prescribing clinicians. This pilot study sets the stage for large-scale, randomized implementation evaluations of EHR-based alerts to improve medication safety. ClinicalTrials.gov NCT05351749; https://clinicaltrials.gov/study/NCT05351749.

Subterranean termites (Coptotermes formosanus [Blattodea: Rhinotermitidae]) colonies can readily intercept commercial inground bait stations placed at label-prescribed distance

Abstract The Formosan subterranean termite, Coptotermes formosanus Shiraki, is both an economically impactful pest and a successful invader. One method of subterranean termite control is baiting. According to the label, baits are installed surrounding the structure at a uniform interval distance of ≈3 m. However, homeowners and pest control professionals are often concerned that termites may bypass bait stations and have access to the structure. To address this concern, we experimentally duplicated field conditions using a large planar arena (3.6 m × 1.1 m) to study the optimal distribution of bait stations based on colony-wide foraging activity. We installed 2 bait stations 3 m apart as per label instructions and introduced C. formosanus colonies to allow them to explore the arena by tunneling through the sand. In this real-scale arena, all termite colonies intercepted a bait station in an average of 21 (± 8 SD) days. We assumed that termites could find bait faster if there were more bait stations by overlaying additional hypothetical baits closer than per label instruction, but the improvement was incremental, requiring 4 times more stations (0.45 m interval) to obtain a significant difference. We also revealed the characteristic behavior after intercepting bait stations, termites created a burst of tunnels that radiated from the bait station. These branching tunnels averaged 16 cm in length, suggesting immediate interceptions of additional auxiliary stations placed within 16 cm of an active station. These findings contribute to our understanding on how subterranean termites intercept inground bait stations.

The Invisible Tropical Tuber Crop: Edible Aroids (Araceae) Sold as “Tajer” in the Netherlands

AbstractEdible aroids (plants from the family Araceae) are among the top five most cultivated tuber crops globally, but their consumer acceptance is hindered by acridity. Aroids contain sap that severely irritates the throat and lips if not properly processed. However, no in-depth studies exist on acridity in edible aroids and how to diminish it. We used ethnobotanical methods to document the diversity of edible aroids available in the Dutch marketplace and how consumers handle acridity. We grew corms in a greenhouse to obtain additional morphological information and used flow cytometry to assess ploidy. We collected 73 samples and interviewed 71 people. At least three species, Colocasia esculenta, Xanthosoma violaceum, and Caladium bicolor, were sold under the generic name “tajer.” Different plant parts with various forms of processing were imported from diverse geographic origins and sold mainly to immigrant customers. Interviewees mentioned various processing methods to avoid and reduce acridity. We distinguished nine cultivar groups of Colocasia esculenta and four of Xanthosoma violaceum. Both Colocasia esculenta and Xanthosoma violaceum were also cultivated in Dutch greenhouses. We present the first report on edible aroids cultivation in northern Europe and draw attention to the lack of labeling and cooking instructions.

The effects of pre-harvest glyphosate rate and timing on yield and pre-malt quality of malting barley

The production of barley cultivars with malting and brewing quality characteristics is subject to strict grading and technical standards for the end-use market. Environmental and management factors can significantly alter grain quality, and the qualities required for malting. Crop and kernel uniformity are critical factors where variability can exceed the tolerance for meeting malt quality. A practice to address variations in crop maturity is the application of pre-harvest glyphosate. Pre-harvest glyphosate applications can, however, alter malting characteristics in barley, and, if mis-timed, can also reduce yield. A 4-year study at five locations in Alberta and Saskatchewan from 2013 to 2017 was conducted to determine the effects of pre-harvest glyphosate applications on malting barley characteristics. Glyphosate was applied at 900 and 1125 g ae ha−1 on malting barley cultivars ‘CDC Meredith’ and ‘AC Metcalfe’ malting barley at soft dough, hard dough, and physiological maturity growth stages. Yield reductions of up to 12% were observed from glyphosate applications at soft dough, and yield was maximized with applications at physiological maturity. Glyphosate application, at two rates, reduced percentage plump kernels, but did not affect kernel weight or protein concentration. The growth stage of barley plants did not provide an accurate indicator of seed moisture levels at the time of application, which motivated our conclusion that glyphosate applications can be mistimed by inaccurate indicators. The results motivate our questioning of the utility of pre-harvest glyphosate applications, given the adverse effects to barley yield and quality observed, even when applied according to the label instructions.

Assessing the Risk of Antimicrobial Resistant Enterococcal Infections in Humans Due to Bacitracin Usage in Poultry

Bacitracin is an antimicrobial used in the feed or water of poultry in the U.S. for the prevention, treatment, and control of clostridial diseases such as necrotic enteritis. Concern has been raised that bacitracin can select for antimicrobial-resistant bacteria that can be transmitted to humans and subsequently cause disease that is more difficult to treat because of the resistance. The objective of the present study was to perform a quantitative risk assessment (QRA) to estimate the potential risk in the U.S. of human infection with antimicrobial-resistant Enterococcus faecalis and E. faecium derived from chicken and turkey products as a result of bacitracin usage in U.S. poultry. The modeling approach estimated the annual number of healthcare-associated enterococcal infections in the U.S. that would be resistant to antimicrobial therapy and that would be derived from poultry sources because of bacitracin use in poultry. Parameter estimates were developed to be “maximum risk” to overestimate the risk to humans. While approximately 60% of E. faecalis and E. faecium derived from poultry were predicted to possess bacitracin resistance based on the presence of the bcrABDR gene locus, very few human-derived isolates possessed this trait. Furthermore, no vancomycin or linezolid-resistant strains of E. faecalis or E. faecium were detected in poultry sources between the years 2002 and 2019. The model estimated the number of antimicrobial-resistant E. faecalis and E. faecium cases per year that might resist therapy due to bacitracin use in poultry as 0.86 and 0.14, respectively, which translates to an annual risk estimate for E. faecalis of less than 1 in 350 million and for E. faecium of less than 1 in 2 billion for members of the U.S. population. Even with the use of risk-maximizing assumptions, the results indicate that there is a high probability that the use of bacitracin according to label instructions in U.S. poultry presents a negligible risk to human health.

Food-Drug Effects and Pediatric Drug Development Studies Submitted to the US Food and Drug Administration, 2012-2022.

Food effect (FE) studies characterize food-drug interactions that may alter the efficacy or safety of a drug, but these studies are not conducted in pediatric patients. Pediatric patients have substantial physiologic, anatomic, and dietary differences from adults, which may result in differences in their FE considerations. Therefore, the objective of this study was to identify oral drug products approved for use in pediatric patients aged <6years with an FE observed in adults. Additional objectives were to summarize the therapeutic areas, pharmacokinetic effects, and labeling instructions that resulted from these studies. Publicly available data were searched for products studied in pediatric patients and approved for use by the United States Food and Drug Administration (FDA) from 2012 to 2022. Of the 102 oral drug products approved for use in patients aged <6years, 43 recommended the consideration of food intake in the drug labeling. These included drug products recommended to be taken with food (n = 21, 49%) or without food (n = 14, 33%). Each of the 14 drug products recommended to be taken without food are approved for use in pediatric patients aged <2 years. The products approved for use in pediatric patients aged <2years comprised the highest proportion with area under the plasma concentration-time curve extrapolated to infinity (AUCinf, n=35, 75%) and maximum serum concentration (Cmax, n=45, 80%) affected by food. Close monitoring is warranted during the postapproval period for products identified as having a significant FE in adults and that are approved for use in pediatric patients aged <6years. Promising tools for predicting pediatric FE may include physiologically based pharmacokinetic absorption modeling.

OLDER ADULT MISUSE OF OVER-THE-COUNTER MEDICATIONS: BENEFITS OF A NOVEL PHARMACY-BASED INTERVENTION

Abstract Older adults’ inappropriate use of over-the-counter medications (OTCs) is prevalent and comprises: (1) Drug-Age misuse – medication risks due to advanced age, (2) Drug-Drug misuse – medication interactions, (3) Drug-Disease misuse – contraindications with health conditions, and (4) Drug-Label misuse – deviations from label instructions. Since pharmacies are ubiquitous sources of OTC accessibility and medication safety expertise, a structural redesign of pharmacy aisles (Senior SafeTM) was conceived to mitigate older adult OTC misuse. A central feature of Senior Safe is the use of Stop Signs for high-risk OTCs and Behind-the-Counter Signs (BTC) for particularly high-risk OTCs. Given the signage’s practical importance, this study’ principal aim was to determine whether Senior Safe reduced misuse of Stop Sign/BTC OTCs. Twenty pharmacies from a mid-Western healthcare system were matched and randomly allocated to either control or intervention groups, from which 288 older adults were recruited (ages 65-91). Participants’ reported OTC use for a symptom scenario (pain, sleep, cough/cold/allergy) was evaluated to determine whether it fulfilled the four misuse types. Misuse occurrences between intervention/control sites were compared using multivariate modeling. Drug-Age and Drug-Drug misuse frequencies were significantly lower in intervention sites (Coef.=-1.012, p=.004; Coef.=-1.702, p=.004, respectively), while Drug-Disease and Drug-Label misuse had too few occurrences in intervention sites for statistical comparisons. Also, adults aged 85+ had the greatest likelihood of all misuse types. Senior Safe shows substantial benefit reducing high-risk OTC misuse, which is important particularly for vulnerable adults ages 85-91. Future research should document intervention mechanisms contributing to lower older adult OTC misuse.

Efficacy of afoxolaner or the combination of afoxolaner with milbemycin oxime against Otodectes cynotis in naturally infested dogs

Otodectes cynotis, commonly known as "the ear mite," is a highly contagious ectoparasite and a significant cause of otitis externa in canines. The objective of the current study was to determine the efficacy of the isoxazoline afoxolaner (Nexgard®), and the combination of afoxolaner with milbemycin oxime (Nexgard Spectra®), in dogs naturally infested with O. cynotis. In total, 32 infested client-owned dogs from two different sites in Greece were included. The animals were randomly divided into four equal groups based on their infestation score. Group 1 served as the negative control, group 2 received one oral administration of Nexgard (Day 0), group 3 received two monthly oral administrations of Nexgard (Days 0, 30), and group 4 received two monthly oral administrations of Nexgard Spectra (Days 0, 30), according to label instructions. Otoscopic examinations for mites and observations on debris/cerumen in the ears were carried out on Days 0, 15, 30, and 45. A quantitative assessment of ear mites by ear duct flushing and live mite counts was performed on Day 45. The results demonstrated that a single oral dose of afoxolaner and two monthly doses of afoxolaner or afoxolaner with milbemycin oxime resulted in a 99.9% reduction in live mite counts compared to the untreated control group by Day 45. Additionally, treated dogs showed improved clinical symptoms, such as ear cerumen/debris decrease, while untreated dogs experienced worsening symptoms over the study duration. No adverse events were reported. Overall, these results support the use of afoxolaner-based products to treat O. cynotis infestation in dogs.

A cross-sectional study on stool- and gastrointestinal-related outcomes of Mexican infants consuming different formulae

BackgroundImmaturities present at birth, such as in the gut microbiome and digestive, nervous, and immune system, resolve with time. Nevertheless, this may result in mild digestive symptoms early in life, particularly in formula-fed infants. Formula composition and processing may impact this discomfort. This study therefore aimed to assess stool characteristics and gastrointestinal symptoms of healthy infants fed different formulae.MethodsA multicenter, cross-sectional, observational trial was performed in Mexico between November 2019 and January 2022, where exclusively formula-fed infants (n = 342, aged 1–4 months) were studied in four groups based on their existing formula use. Feeding was continued per practice following label instructions. For 7 days, parents/caregivers were requested to record fecal characteristics, using the Amsterdam Infant Stool Scale, and rate gastrointestinal symptoms. Stool samples were collected to determine pH, dry matter content, and fecal calprotectin levels.ResultsMost infants had a soft/formed stool consistency, although odds for hard stools were different between groups. Gastrointestinal symptom scores revealed significant differences for burping and diarrhea, while other symptoms did not differ between groups. No significant differences between groups were found for stool frequency, dry matter content, and fecal pH. Although calprotectin was within the expected healthy ranges, significant differences among groups were seen. Furthermore, calprotectin significantly correlated with the severity of the gastrointestinal symptoms burping, flatulence, abdominal distension, and diarrhea.ConclusionsDifferences in stool characteristics and specific differences in gastrointestinal symptoms were observed between different formula brand users. This may potentially be explained by the different composition and processing of the formulae, although there are multiple factors that influence the assessed outcomes.Trial registrationThe study was registered in the Netherlands Trial Registry (NL7805), linked to https://trialsearch.who.int/, on 11/06/2019.

Over-the-Counter Drug Consumption: How Consumers Deviate from Label Instructions

Product consumption is an important yet understudied aspect of marketing. Over-the-counter medicines present a unique consumption context because consumers are expected to follow product label instructions. For acetaminophen, a widely consumed over-the-counter drug, the authors study which consumers tend to deviate from the label instructions, why they do so, and the interventions that are most promising to mitigate such deviations. They develop a dynamic structural model of consumption that enables them to investigate the probability of different types of label deviations (e.g., &gt;4 g per day) and drivers of such behaviors. Label deviations are infrequent “tail area” behaviors, and the model uncovers them well. The analysis is based on a unique online consumption diary in which consumers select from two classes of acetaminophen products (single ingredient or a combination of ingredients) to treat their pain or non-pain-related symptoms . Consumers have a higher probability of taking &gt;4 g of acetaminophen when they have multiple symptoms, and a variety of observable factors explain the individual propensity to deviate from the label. The authors propose two interventions—a new label instruction and consumer education—to mitigate the observed label deviations and assess the expected impact of each.

Comparison of the initial and residual speed of Ixodes scapularis kill on dogs treated with a single dose of Bravecto® Chew (25 mg/kg fluralaner) or Simparica TRIO® (1.2 mg/kg sarolaner, 24 µg/kg moxidectin, 5 mg/kg pyrantel)

BackgroundCompliant ectoparasiticide product use is a comprehensive way to control ticks and reduce the risk of tick-borne pathogen transmission to dogs. Because the systemically acting isoxazoline ectoparasiticides require tick attachment for drug delivery, fast speed of kill is essential to minimize tick-borne pathogen transmission risk.MethodsDogs of satisfactory tick-carrying capacity were randomly allocated to treatment groups and administered, per label instructions, Bravecto® Chews (minimum 25 mg/kg fluralaner), Simparica TRIO® (minimum 1.2 mg/kg sarolaner, 24 µg/kg moxidectin, 5 mg/kg pyrantel), or no treatment. Dogs were infested with approximately 50 unfed adult (35 female, 15 male) Ixodes scapularis on Day -2, 21 and 28. Live tick counts were performed at 4, 8, 12 and 24 h post-treatment (Day 0) and post-infestation on Day 21 and 28. Tick control efficacy was determined by comparing live tick means for each product-treated group to the untreated control group and each other at all time points using a linear mixed model. The percent of dogs free of live ticks was analyzed using the Fisher’s exact test for treatment group comparison.ResultsThe untreated control group maintained adequate tick infestations throughout the study. Using geometric means, an existing I. scapularis infestation was controlled by 99.7% and 93.0% 12 h post-treatment and by 100% and 99.5% 24 h post-treatment, for Bravecto® and Simparica TRIO®-treated dogs, respectively. Ixodes scapularis infestations were controlled more quickly for Bravecto®- compared to Simparica TRIO®-treated dogs on Day 21 at 8 h (efficacy 74.0% vs. 0.0%, p = 0.003) and 12 h (efficacy 99.2% vs. 39.4%, p < 0.001) post-infestation and Day 28 at 8 h (efficacy 92.2% vs. 0.0%, p < 0.001) and 12 h (efficacy 99.6% vs. 27.7%, p < 0.001) post-infestation. On Day 28 post-treatment, the efficacy of Bravecto® and Simparica TRIO® to control a new I. scapularis infestation was 100% and 96.6%, respectively, by 24 h post-infestation. Of product-treated dogs, 100% of Bravecto®-treated dogs were free of live ticks by 24 h post-treatment or post-infestation. No treatment-related adverse reactions occurred during the study.ConclusionsIxodes scapularis infestations are controlled more quickly 21 and 28 days post-treatment for dogs administered a single dose of Bravecto® compared to dogs administered a single dose of Simparica TRIO®.Graphical

PSIV-9 Describing the Consumption of Chlortetracycline-Containing Supplement Offered Free-Choice to Commercial Beef Cows on Pasture

Abstract Extensive beef cattle production systems depend on forage as the predominant nutrient source. However, mineral requirements are not always met solely through forage consumption. To maintain optimum animal productivity, beef cattle producers must provide mineral supplementation and free-choice supplements are most common. Free-choice supplement intake by grazing cattle is highly variable and is dictated by season, individual animal preference, supplement palatability and other factors. Variation in supplement intake is problematic for delivering medication such as chlortetracycline (CTC), which is aimed to mitigate the risk of bovine anaplasmosis in beef herds. Research investigating the relationship between individual animal attributes and supplement consumption in extensive settings is limited. Recently, adoption of technology such as a portable, self-contained individual feeding unit (SmartFeed; C-Lock Inc.) into supplementation programs has facilitated unprecedented data collection in grazing cattle. The study objectives were to describe the consumption patterns of a granular CTC-containing supplement and to evaluate the factors contributing to consumption variability by gestating cows on pasture. A total of 103 nonlactating, pregnant, crossbred cows were assigned to this experiment on d -28 and allocated to 1 of 3 pastures equipped with a SmartFeed unit to record individual supplement intake. Cows were offered dried distillers grains for 27 d of acclimation to the units (mean intake of 0.29 kg of supplement/cow daily; 74% of cows) before transition to a commercially available granular mineral supplement containing CTC for 46 d. Supplement was formulated such that a 630 kg cow must consume 113 g/d to receive the label CTC dose (1.1 mg/kg). Cow intake and unit visit frequency data were analyzed using a general linear model (PROC GLM) and differences evaluated using Least Squared Means. The runs test for serial randomness was used to evaluate clustering of feeding and non-feeding events. Feeding and non-feeding events during the 46-d observation period were not randomly distributed (P &amp;lt; 0.01), and the mean number of consecutive days a cow did or did not consume mineral supplement were 1.8 and 5.6 days, respectively. As cow age increased, visits to the feeding unit decreased and total supplement consumption also decreased (P &amp;lt; 0.01). According to supplement label instructions, each cow was expected to consume 5.2 kg of supplement in total over 46 d to receive the total recommended 32.2 g CTC dose. Mean supplement consumption was 40.5 g· cow-1· d-1, providing 0.25 g CTC· cow-1· d-1, and only 1.9% (2/103 cows) consumed enough supplement to receive the recommended dose. Collectively, results indicate that providing a granular free-choice supplement containing CTC is not an effective method of ensuring cows consume an adequate amount of supplement to receive CTC at the label-directed dose and frequency.

An Investigation into Replacement of Washcare Labels with Cost Effective QR Code Labels

We have worked on project an investigation into replacement of wash care labels with cost effective QR code labels. In India the wash care label instructions are not mandatory but recommended by ISO 3758 standards. We need to give the wash care instruction on garment to every customer and it is essential and necessary too. We need follow the wash care instructions and it improves life cycle of garment. Normally in foreign countries gives much priority than India because they are having care instructions mandatory and it is under legal acts. India is a developing country and 2ND highest population country in the world and most of the people (around 65%) under below poverty line and lives in rural areas. But compared to India, developed country peoples are having well economic conditions and they are able to buy the washing machines and afford to clean the garments in washing factories. In India most of the peoples are wash the garments using detergent powders/bars in normal water

Crushing riluzole tablets: evaluation of loss of powder and active principle in a home-simulation experiment

Objective Swallowing difficulties cause patients with amyotrophic lateral sclerosis (ALS) to crush oral medications, falling outside the labeling instructions and entailing some risks. To date, there is no evidence about consequences of crushing riluzole tablets in a home setting. This simulation experiment evaluated the loss of powder and active principle ingredient (API) mimicking the home setting with two alternative crushing methods (A and B). Methods The tests were carried out by 15 volunteers without experience in the preparation of medication. Each volunteer manually crushed 5 tablets with a meat tenderizer (method A) or two spoons pressed against each other (method B). Riluzole was weighed before (W1) and after crushing (W2). Then, a subsample of crushed tablets was analyzed by HPLC to measure API content. The loss of powder was calculated as a percentage of the intact tablet weight, and the loss of API as a percentage of the labeled API content. Results The quantitative analysis showed a mean percentage loss of 6.27% corresponding to a mean (SD) loss of powder of 13(±13) mg. The API loss was directly related to the powder loss: overall the mean percentage of API loss was 8.53% (corresponding to a mean API loss of 4.27 ± 4.50 mg). The difference in powder and API loss was highly statistically significant. Conclusion Crushing riluzole tablets in a simulated home setting determined a significant loss of powder and API. These results support neurologists to evaluate formulations that minimize the need to alter the product and can improve ALS patient journey.

Open label single arm study to assess the implementation of home based daratumumab administration in patients being treated for multiple myeloma.

TPS1609 Background: Multiple myeloma (MM) is an incurable hematologic malignancy that has a high burden of care for patients and their caregivers. Over the last two decades, the treatment landscape for MM has changed dramatically. However, treatment burden with frequent visits to offices and the hospital is high. We need innovative care delivery models to alleviate these burdens. Chemotherapy at home remains uncommon in the US, though models for its use exist globally. In these models, home-based chemotherapy is safe, preferred by patients, and can be administered at lower cost. Herein, we propose a home-based subcutaneous daratumumab and hyaluronidase-fihj (dara) program for patients with MM. We hypothesize that this program will be feasible, reduce patient treatment and financial burden, and improve quality of life. Methods: We designed an open label single arm study to assess the implementation of home administration of dara. The primary objective is to evaluate (n=20) treatment satisfaction of patients, using the Cancer Therapy Satisfaction Questionnaire (CTSQ), when they receive care at home as compared to the standard of care (SOC). Secondary outcomes include evaluating adherence to home delivery, quality of life (EORTC QLQ-30), financial burden (COST survey), safety of home administration, and barriers to home administration. At the end of the study, we will conduct semi-structured interviews to assess patient experience with home administration of chemotherapy. Patients will be eligible for study participation if they have a diagnosis of multiple myeloma, are in the monthly phase of dara treatment and are treated with either monotherapy or in combination with oral agents. All participants who are interested and eligible will be on study for 8 cycles of dara (2 cycles of dara in the infusion center (IC) followed by 4 cycles at home and then 2 cycles in the IC). During the home administration phase, 1-3 days prior, patients will go to a local lab or have at home labs. On day of at home dara, the drug will be mixed and packaged by our pharmacy, and then delivered at room temperature to the patient’s home by our home infusion courier. The patient will take pre-medications 1-3 hours prior to nurse arrival. The nurse arrives, confirm pre-medications were taken. Pre-treatment vitals and post treatment vitals will be obtained. Drug will be administered as per label instructions. At the beginning of each cycle, patient reported outcome surveys and quality of life surveys will be collected. During the home administration phase, details on barriers to maintaining adherence (i.e. issues with storage, delivery, disposal of medication) will be collected. The study opened for enrollment on November 8th, 2022. As of February 1stth 2023, 9 patients have consented and 5 patients are on-treatment. Clinical trial information: NCT05511428 .

The Buzz on Insecticides: A Review of Uses, Molecular Structures, Targets, Adverse Effects, and Alternatives.

Insecticides play a critical role in controlling the spread of insect-borne diseases and preserving crop health. These chemical substances are specifically formulated to kill or manage insect populations. Over the years, various types of insecticides have been developed, including organophosphates, carbamates, pyrethroids, and neonicotinoids, each with unique modes of action, physiological targets, and efficacy. Despite the advantages that insecticides offer, it is imperative to recognize the potential consequences on non-target species, the environment, and human health. It is therefore crucial to follow recommended label instructions and employ integrated pest management practices for the judicious use of insecticides. This review article provides an in-depth examination of the various types of insecticides, including their modes of action, physiological targets, environmental and human health impacts, and alternatives. The aim is to furnish a comprehensive overview of insecticides and to emphasize the significance of responsible and sustainable utilization.

Perceived Environmental Implications of Clothing Maintenance Among Consumers in Gauteng Province, South Africa

In 2018, global fashion produced 2.1 billion tonnes of greenhouse emissions. According to life-cycle assessments (LCA), the use phase in clothing life cycles is the most harmful to the environment. During the use phase, clothing maintenance is associated with high water and energy consumption and is the most polluting stage in the clothing life cycle. In addressing the environmental impact of the clothing and textile industry, the design and manufacturing phases overshadow the clothing maintenance/care phase. As part of their social responsibility, clothing companies do not concern themselves with how sold garments are utilised after purchase. A disconnect emerges between seller and buyer immediately after a garment is bought and leaves the retail environment. As a result, the clothing consumer assumes full responsibility for managing the environmental impacts that characterise the use phase. Yet, most consumers need to be equipped with the knowledge to empower them to understand the ecological implications. This study aims to establish the level of sustainability awareness among young consumers in a major South African university of technology concerning clothing maintenance and to establish whether environmental knowledge translates into sustainable practice. The study applied a quantitative research approach, using semi-structured questionnaires, to gather information related to the ecological impact of washing, drying, and ironing clothing, as well as washing detergents and fabric softeners. The findings show that most participants were aware of 'eco-fashion' as a general term related to environmental welfare but were unaware of how the activities involved in the care of clothing may affect the environment. Some participants demonstrated poor knowledge, and many did not relate clothing-care equipment and products such as detergents and fabric softeners to adverse environmental impacts. Few participants consulted fabric and care label instructions during laundering and ironing to avoid ecological damage. Most participants also did not understand the health and environmental dangers caused by dry cleaning processes. The research concludes that there is a generally low level of sustainability awareness among young consumers of clothing and a low rate of translation of sustainability literacy into sustainable action in the care and maintenance of clothing. The paper recommends that clothing manufacturers and retailers provide consumers with sustainable post-purchase information as part of their environmental responsibility.&#x0D; &#x0D; Received: 13 April 2022 / Accepted: 5 February 2023 / Published: 5 March 2023

Labelling instructions matter in biomedical image analysis

Biomedical image analysis algorithm validation depends on high-quality annotation of reference datasets, for which labelling instructions are key. Despite their importance, their optimization remains largely unexplored. Here we present a systematic study of labelling instructions and their impact on annotation quality in the field. Through comprehensive examination of professional practice and international competitions registered at the Medical Image Computing and Computer Assisted Intervention Society, the largest international society in the biomedical imaging field, we uncovered a discrepancy between annotators’ needs for labelling instructions and their current quality and availability. On the basis of an analysis of 14,040 images annotated by 156 annotators from four professional annotation companies and 708 Amazon Mechanical Turk crowdworkers using instructions with different information density levels, we further found that including exemplary images substantially boosts annotation performance compared with text-only descriptions, while solely extending text descriptions does not. Finally, professional annotators constantly outperform Amazon Mechanical Turk crowdworkers. Our study raises awareness for the need of quality standards in biomedical image analysis labelling instructions.

Medication Dosing Schedules, Medication Knowledge, and Dosing Errors of Adults Taking Complex Drug Regimens.

This study examined how patients take complex medication regimens at home. Participants were primary care patients, 21 years or older, and prescribed three or more medications. Interviews assessed medication dosing schedules, medication knowledge, and dosing errors. Participants (N=441) were middle aged (mean 56.9); the majority were Hispanic/Latino (73.4%), had limited English proficiency (59.0%), and had limited health literacy (89.0%). One in five participants dosed medication five or more times per day, although no participants in the sample had a label instructing them to take medication more than times times daily. On average, participants correctly identified the purpose of 65% of their medications. Half of participants made one or more dosing errors. Less than high school education and a regimen size of six or more medications were independently associated with less medication knowledge, whereas language discordant label instructions were associated with dosing errors. Screening for regimen dosing complication and interventions to simplify dosing schedules are needed.

Chemical control of Septoria lycopersici in vitro as first screening for fungicide efficacy studies

The disease septoriose causes severe defoliation in tomato plants that can reach 100% leaf fall. Consequently, the losses are significant due to the decrease in photoassimilate production and sun scald on tomato fruits. To apply a fungicide the dose used must follow the fungicide label instructions to keep the resistance risk low and comply with current legislation. This work presents in vitro studies of 16 active ingredients (17 commercial products) at the recommended doses to control the tomato septoriose and the molecular identification of 26 Septoria lycopersici isolates performed with the ITS gene. In vitro test was performed at Petri dishes filled with 20 mL of maltextract medium (20 g/L malt extract and 20 g/L agar). 100 µL of spore suspension (105 spores/mL) were spread onto Petri dishes with the Drigalski loop. In their label dose, 10 µL of each fungicide was added at the centre of the Petri dishes to measure the inhibition halo formed. Petri dishes were incubated for 14 days at 25 ºC and 12h of photoperiod. Among the fungicides tested, 14 commercial products formed inhibition halo showing the dose used was able to control the spore germination which indicates efficacy of the fungicide and also an adequate dose to control the pathogen. Only cuprous oxide (1344 mg a.i./L), azoxystrobin (80 mg a.i./L) and thiophanate methyl (490 mg a.i. /L) were unable to prevent spore germination and did not form an inhibition halo. The Septoria isolates were identified as Septoria lycopersici and sequences were deposited at the Genbank. No variation was observed for the species when using ITS region.