Initial Weeks Research Articles

Association between initial clozapine titration and pneumonia risk among patients with schizophrenia in a Korean tertiary hospital

Pneumonia is a significant adverse drug reaction (ADR) associated with clozapine, characterized by high mortality and potential linkage with other inflammatory responses. Despite the critical nature, research regarding the development of pneumonia during initial clozapine titration remains limited. This retrospective study included 1408 Korean inpatients with schizophrenia spectrum disorders. Data were collected from January 2000 to January 2023. Pneumonia developed in 3.5 % of patients within 8 weeks of clozapine initiation. Patients who developed pneumonia were taking a greater number and higher dose of antipsychotics at baseline (2.14 vs. 1.58, p < 0.001; 25.64 vs. 19.34, p = 0.012). The average onset occurred 17.24 days after initiation, on an average dose of 151.28 mg/day. Titration was either paused or slowed in most of these patients, with no reported fatalities. The types of pneumonia included aspiration pneumonia, mycoplasma pneumonia, bronchopneumonia, and COVID-19 pneumonia. Myocarditis, drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, and urinary tract infections were also identified. Logistic regression analysis revealed that a greater number of concomitant antipsychotics (odds ratio [OR] = 1.59, p = 0.027) and concomitant benzodiazepine use (OR = 2.33, p = 0.005) at baseline were associated with an increased risk of pneumonia. Overall, pneumonia development during clozapine titration is linked with other inflammatory ADRs, suggesting a shared immunological mechanism. Close monitoring is recommended, especially for patients taking multiple antipsychotics and benzodiazepines. Further studies involving repeated measures of clozapine concentrations at trough and steady state, along with a more detailed description of pneumonia types, are warranted.

Neutrophil-to-lymphocyte ratio is associated with stroke progression and functional outcome in patients with ischemic stroke.

The objective of the present research was to examine the correlation between the neutrophil-to-lymphocyte ratio (NLR) and stroke progression (SP) as well as the functional outcome following an ischemic stroke (IS). The current study was conducted as prospective observational research. A cohort of 341 participants diagnosed with IS was included in the study from March 2019 to August 2021. This study's primary measure of interest was the occurrence of SP within the initial week following hospital admission. The secondary outcome was functional status 3 months after IS as measured by a modified Rankin scale score. The association between NLR with SP, and poor functional outcomes was examined using multivariate logistic regression. The predictive value of NLR for SP and poor functional outcomes was evaluated using the receiver operating characteristic (ROC) curve. Among the 341 enrolled patients, 56 (16.4%) had SP, and 285 (83.6%) had no SP. The results of the multivariate logistic regression analysis demonstrated that the existence of diabetes mellitus and the NLR were independently associated with SP and poor functional outcomes. The area under the ROC curve of NLR in predicting poor functional outcome was 0.6117 (95% confidence interval, .5341-.6893, p=.0032), and the optimal cut-off point was 4.2139. The sensitivity and specificity of NLR in predicting poor functional outcomes were 52.7% and 72.0%, respectively. Patients with acute IS exhibited a very high incidence of SP. NLR may be a valuable prognostic indicator in clinical practice because it was independently associated with SP and a poor functional outcome.

92 Trends in COVID-19 Vaccination Coverage among Children &amp;lt;5 Years of Age in Canada

Abstract Introduction/Background COVID-19 vaccinations for those aged 6 months to 5 years were announced in the summer of 2022. Specifically, Moderna Spikevax and Pfizer-BioNTech Comirnaty were authorized on July 14, 2022, and September 9, 2022, respectively. Given that this was the last age group to become eligible for vaccination against COVID-19, promoting and measuring vaccination coverage in this vulnerable population is of public health significance. Objectives This analysis describes and compares the trend in vaccination coverage (VC) over the initial weeks of eligibility in those 0-17 years old. Design/Methods Data were obtained from the Canadian COVID-19 Vaccination Coverage Surveillance System and were analyzed to describe and compare VC of those &amp;lt;5, 5-11, and 12-17-year-olds over the first 16 weeks of eligibility. VC is defined as the percent of the population that have received at least 1 dose of a COVID-19 vaccine. Results Sixteen weeks after those &amp;lt;5 years became eligible for vaccination, coverage was 10.9% in those aged 2-4 and 6.3% in those aged &amp;lt;2. Compared to other paediatric age groups, VC in those &amp;lt;5 is markedly lower, where, after 16 weeks of eligibility, coverage in those aged 5–11 was 54.4% and 81.5% in those 12-17. There was an immediate spike in coverage for both 5–11-year-olds and 12–17-year-olds over the first 4 weeks following eligibility, where VC was 40.1% and 63.3%, respectively. A similar increase was not observed 4 weeks following eligibility in those aged &amp;lt;5, where VC was 7.4% in those aged 2-4 and 4.0% in those &amp;lt;2. The weekly increase in VC decreased more rapidly as age groups decreased; weekly increase in VC slowed to less than 1% in 28 weeks, 20 weeks, and 16 weeks after eligibility in those aged 12-17, 5-11, and &amp;lt;5, respectively. Conclusion These data suggest that VC over time in the &amp;lt;5 population has been slow and has not followed the trajectory of other paediatric populations, when compared to the 5-11 and 12-17 age groups. Reasons for this may include but are not limited to parents and guardians’ knowledge, attitudes, and beliefs toward getting their infant children vaccinated, as well as pandemic fatigue, as eligibility for the infant population occurred after the other paediatric age groups.

Switching from intravenous vancomycin to oral antibiotics reduces adverse events in a retrospective cohort of outpatients with orthopedic infections.

Vancomycin is frequently used for prolonged courses in treating osteoarticular infections despite a high rate of adverse drug events (ADE). The objective of this study was to evaluate the safety and effectiveness of transitioning to oral therapy compared to continuing parenteral vancomycin in patients with orthopedic infections. We conducted a single-center, retrospective cohort study of patients with orthopedic infections discharged on parenteral vancomycin with a planned duration of at least four weeks. We compared rates of ADE while on vancomycin to rates of ADE after switching to an oral regimen. As a secondary analysis, we compared unplanned hospital readmission within 60 days and treatment failure at one year between patients who were transitioned to oral antibiotics within four weeks of vancomycin initiation and those that were not. Two hundred twenty-eight patients met inclusion criteria. Vancomycin was associated with significantly greater toxicity compared to oral regimens. Fifty-one patients had an adverse event while on vancomycin (5.87 ADE per 1000 patient-days) while 9 patients had an adverse event on oral therapy (1.49 ADE per 1000 patient-days) (Rate difference 4.39 per 1000 patient days, 95% CI: 2.52 to 6.26 events per 1000 patient-days). In proportional hazards analysis, transition to an oral antibiotic regimen was independently associated with a lower rate of ADE (aHR 0.12, 95% CI: 0.02-0.86). Forty-one patients (18%) were transitioned to oral therapy within four weeks; these patients did not have an increased rate of unplanned readmission (12.2% vs 17.1%) or treatment failure (17.1% vs 21.9%). Patients transitioned to oral therapy within 4 weeks of discharge had significantly fewer adverse events and similar incidences of one-year treatment failure compared to patients maintained on parenteral vancomycin. Substituting oral antibiotics for parenteral vancomycin is a potential strategy to minimize vancomycin toxicity during the treatment of orthopedic infections.

Neoadjuvant nivolumab + palbociclib + anastrozole for oestrogen receptor-positive/human epidermal growth factor receptor 2-negative primary breast cancer: Results from CheckMate 7A8

BackgroundPreclinical data suggest synergistic activity with the combination of programmed death-1 and cyclin-dependent kinase 4/6 blockade in oestrogen receptor-positive/human epidermal growth factor 2-negative (ER+/HER2–) breast cancer. The noncomparative phase 1b/2 CheckMate 7A8 study (NCT04075604) evaluated neoadjuvant treatment with nivolumab, palbociclib, and anastrozole in patients with ER+/HER2− breast cancer. Here, we report outcomes from the safety run-in phase. MethodsPatients with histologically confirmed, untreated ER+/HER2− breast cancer, primary tumour ≥2 cm, ECOG performance status ≤1, and eligible for post-treatment surgery received nivolumab 480 mg intravenously every 4 weeks, palbociclib 125 mg or 100 mg orally once daily for 3 weeks per cycle, and anastrozole 1 mg orally once daily for five 4-week cycles, or until disease progression. The primary endpoint was the proportion of patients with dose-limiting toxicities (DLTs) within 4 weeks of treatment initiation. ResultsAt safety data review, 21 patients were treated (palbociclib 125-mg group: n = 9; palbociclib 100-mg group: n = 12). DLTs were reported in 2 (22.2%) and 0 patients in the palbociclib 125-mg and 100-mg groups, respectively. Across both groups, 9 patients discontinued treatment due to toxicity (grade 3/4 hepatic adverse events [n = 6], grade 3 febrile neutropaenia [n = 1], grade 1 pneumonitis [n = 1], and grade 3 rash and grade 2 immune-mediated pneumonitis [n = 1]). Consequently, the study was closed early. ConclusionsNeoadjuvant treatment with nivolumab, palbociclib, and anastrozole showed a high incidence of grade 3/4 hepatotoxicity and treatment discontinuation, indicating that this combination should not be further pursued for treatment of primary ER+/HER2− breast cancer.

Time‐intensity data analysis in terms of R‐index measures transformed from menopause rating scale data collected in a longitudinal menopause tablet perceptual efficacy study

AbstractA 12‐week longitudinal study with 247 US menopausal women was undertaken to investigate the perceptual efficacy of a tablet formulated with an extract of Siberian rhubarb to provide relief from menopausal symptoms. The 5‐point menopause rating scale (MRS) (0 = none; 1 = mild; 2 = moderate; 3 = severe; 4 = extremely severe) was used to measure symptom intensity. The MRS scale, an ordinal categorical scale, was transformed into an R‐index, a ratio scale, using the frequencies of the MRS categories. Symptom relief was compared to an initial week baseline measure; defined as R‐index = 0.5. An index, A.RDEX, which is based on area under the R‐index curve (AUC) in the range of 0–84 days was used to measure percentage efficacy of symptom relief. Results show that symptom relief occurs through the first 17 days in terms of R‐index = 0.64 for the total score and improves with continued use, reaching an A.RDEX = 0.42 by 84 days, suggesting about 42% relief considering all 11 MRS attributes.Practical ApplicationsMRS ratings data can be transformed into an R‐index using MRS category frequencies at an initial week and a subsequent week. Functional data analysis for R‐index values provides an advanced statistical model for analysis of perceptual differences throughout longitudinal studies that can examine MRS attribute effects over time. R codes are developed and provided in the paper to transform MRS data into R‐index measures and to conduct functional data analysis for R‐index measures obtained from different time points (weeks or days).

Pollen sources and time of pollination for hand pollination affect biochemical and organoleptic attributes of sugar apple (Annona squamosa L.) cv. Arka Sahan

The present investigation aimed to know the effect of different pollen sources and time of pollination for hand pollination on biochemical and organoleptic properties in sugar apple cv. Arka Sahan. For the study, a total 130 flowers of cv. Arka Sahan were hand pollinated with three different pollen sources, such as Balanagar, Raydurg and APK-Ca 1 at three different times in the July. It was found that pollen source and timing significantly affected fruit quality attributes and organoleptic traits. Fruits of T1 (first pollination with Balanagar) exhibited maximum pulp weight, fruit weight and seeds per fruit. The biochemical traits such as higher total soluble solids (32.33 ºBrix), lower titratable acidity (TA) (0.25%), higher total sugar (TS) (25.55%), reducing sugar (RS) (22.75%) and non-reducing sugar (NRS) (2.66 %) were also reported in T1. Likewise, higher ascorbic acid (AA) (27.87 mg/100g) and minimum total phenols content (TPC) (66.76 ?g GAE/100g) were also obtained in T1 yielded fruits compared to the naturally pollinated (control). Evaluation of organoleptic revealed that pollen source and pollination time also affected the sweetness, sourness aroma, grittiness and overall acceptability (8.62) of pulp. Results of organoleptic evaluation revealed that pollen sources and pollination times also affected the sweetness, sourness, aroma, grittiness and overall acceptability (8.62) of the fruit pulp. Hence, Balanagar could be used as an effective pollen source for hand pollination in Arka Sahan during initial weeks of July to get higher quality and acceptability of the sugar apple fruits.

Diaspora governance during the pandemic: the case of Turkey

ABSTRACT The COVID-19 pandemic’s effect on migration has been substantial, with border closures leading to the panic mobility of those returning home across the globe while sending states mobilized their resources to bring the citizens abroad back. In the case of Turkey, during the initial weeks of the COVID-19 pandemic, state diaspora institutions like Presidency for Turks Abroad and Related Communities (YTB) offered distance support, consulates helped funerals and managed the charter flights for rescuing infected ‘emigrants.’ By analysing Turkey’s diaspora policies and actions during the initial weeks of the pandemic, this article questions the types of instruments that are produced by Turkey in reaching out to citizens abroad during the crisis time and the extent of the differences in the pre-crisis diaspora governance. This article shows that Turkey’s diaspora governance during the pandemic aimed to strengthen its embracing perspective, connecting with co-ethnic emigrants and their descendants with nationalist and protectionist motivations. The article provides insights into a better understanding of home state-diaspora relations in times of crisis.

A hyperthermic seizure unleashes a surge of spreading depolarizations in Scn1a-deficient mice.

Spreading depolarization (SD) is a massive wave of cellular depolarization that slowly migrates across the brain gray matter. Cortical SD is frequently generated following brain injury, while less is understood about its potential contribution to genetic disorders of hyperexcitability, such as SCN1A-deficient epilepsy, in which febrile seizure often contributes to disease initiation. Here we report that spontaneous SD waves are predominant EEG abnormalities in the Scn1a-deficient mouse (Scn1a+/R1407X) and undergo sustained intensification following a single hyperthermic seizure. Chronic DC-band EEG recording detected spontaneous SDs, seizures, and seizure-SD complexes in Scn1a+/R1407X mice but not WT littermates. The SD events were infrequent, while a single hyperthermia-induced seizure robustly increased SD frequency over 4-fold during the initial postictal week. This prolonged neurological aftermath could be suppressed by memantine administration. Video, electromyogram, and EEG spectral analysis revealed distinct neurobehavioral patterns; individual seizures were associated with increased motor activities, while SDs were generally associated with immobility. We also identified a stereotypic SD prodrome, detectable over a minute before the onset of the DC potential shift, characterized by increased motor activity and bilateral EEG frequency changes. Our study suggests that cortical SD is a pathological manifestation in SCN1A-deficient epileptic encephalopathy.

Abstract P1098: Molecular Maturation Of Engrafted Human Pluripotent Stem Cell-derived Cardiomyocytes

The transplantation of human pluripotent stem cell derived cardiomyocytes (hPSC-CMs) represents an attractive strategy to regenerate myocardium lost following injury and mitigate the pathological remodeling that ultimately leads to heart failure. However, in vitro hPSC-CMs have an immature phenotype that likely contributes to the transient arrhythmias observed during the initial weeks following hPSC-CM transplantation in large-animal models, hindering safe translation into the clinic. We hypothesized that maturational changes in hPSC-CMs in vivo facilitate the improved electrophysiological behavior of graft tissue observed at later time-points. Because the changing phenotype of hPSC-CM graft tissue remains largely unexplored, we used single nucleus RNA sequencing to evaluate the transcriptional dynamics and cell population heterogeneity of hPSC-CMs prior to transplantation and at 2- and 8-weeks following transplantation in a guinea pig cardiac cryoinjury model (n=3). We used methods based on the sorting of nuclei labeled by a genetically-encoded fluorescent reporter to enrich the proportion of human nuclei sequenced from the graft site and created a comprehensive atlas (&amp;gt; 20,000 cells) of host and graft cells present at the implantation site at both time-points. We identified an upregulation of genes involved in intracellular calcium handling, AMPK, and cAMP signaling pathways, as well as a metabolic shift in engrafted hPSC-CMs that we speculate supports their growth and enhanced electrophysiological function. Our study includes a comprehensive description of the temporal changes in hPSC-CM graft tissue at the single-cell resolution and provides unique insights into how these cells adapt to the injured heart environment and mature in vivo.

THE ROLE OF PARIJATA PATRA KASHAYA IN THE MANAGEMENT OF KATI SHOOLA AND JANU SANDHIGATA VATA: A CASE STUDY

Musculo skeletal disorders are a huge medical burden globally; multimodal analgesia and surgical procedures are the options for treatment in contemporary science. In Ayurveda, Acharya Charaka stated in the context of Anukta Vikara, the vitiated Vata reaches a region, causes Shoola (~ pain), Stambha (~ stiffness), Supti (~ numbness), etc. in that particular region. Kati shula and Janu Sandhigata Vata are among such conditions which can be equated with musculoskeletal disorders. A 47-year-old female patient with low back ache and bilateral knee joint osteoarthritis was treated conservatively with fresh Parijata Patra Kashaya. During treatment, improvement was seen in the initial weeks. By the end of 10 weeks, the treatment protocol was found to be significantly effective in symptomatic and assessment profiles as in NRS scale, SLR, and Lumbar range of movement. Hence, in the initial stages of the condition, Parijata Patra Kashaya would be a better choice against multimodal analgesics.

Leadership in times of crisis: Ontario teachers’ perspectives of system leaders during the COVID-19 pandemic

ABSTRACT Systemic disruptions and uncertainties resulting from the prolonged COVID-19 pandemic have put extraordinary pressure on system-level educational leadership worldwide. Despite often being seen as drivers of thinking and change, system leaders had few, if any, precedents to draw from on how to lead effectively through such crises. This paper examines Ontario secondary school teachers’ (N = 17) perspectives on system-level educational leadership during the initial weeks of the COVID-19 pandemic and considers how these perspectives can inform future approaches to leading school systems through such uncertainty and disruption. Drawing on prolonged semi-structured interviews, six leverage points for systemic change are discussed: actors and elements, feedback, relationships and power, structures and roles, goals, and the overarching paradigm for teaching and learning.

Factors associated with 30-day in-hospital mortality in critically ill adult patients receiving extracorporeal membrane oxygenation: A retrospective cohort study

ObjectiveTo identify factors associated with the 30-day in-hospital mortality rate among adult patients requiring extracorporeal membrane oxygenation (ECMO) in intensive care units. Research MethodologyRetrospective cohort study including 148 patients who underwent ECMO for at least 48 h between March 2010 and August 2021. The patients were divided into survivors and non-survivors based on their 30-day in-hospital survival. We obtained the sociodemographic information and pre- and post-ECMO data from electronic medical records. Kaplan–Meier survival curves and Multivariate Cox proportional hazards regression were used to analyse the data. SettingA tertiary-care university hospital in South Korea. Main Outcome MeasuresThe 30-day in-hospital mortality rate was the principal outcome measure. ResultsThe 30-day in-hospital mortality rate was 49.3% (n = 73). Kaplan–Meier analysis demonstrated that the duration of ECMO support in the 50th percentile of surviving patients was 13 days. Multivariable Cox regression analysis showed that new-onset renal failure, lower mean arterial pressure, and ECMO weaning failure were associated with an increased 30-day in-hospital mortality risk among patients who received ECMO. Subgroup analysis also revealed a significant association between weaning failure and 30-day in-hospital mortality after adjusting for covariates in patients undergoing veno-arterial ECMO. ConclusionClose monitoring of post-ECMO renal function and mean arterial pressure is required to minimize the risk of 30-day in-hospital mortality, especially in adults within the first two weeks of ECMO initiation. Moreover, the success of ECMO weaning should be optimized by collaboration within the ECMO team. Implications for Clinical PracticeCritical care nurses should pay close attention to patients’ response to weaning trials as well as alternations in renal function and mean arterial pressure during ECMO support. Furthermore, developing nursing care guidelines for adult patients receiving ECMO and standardized training programs for nurses in intensive care, are required in Korea.

Therapeutic dilemmas: cognitive enhancers and risk of falling in older adults—a clinical review

Key summary pointsAimTo summarize the falls-related risks of cognitive enhancing medications used to treat neurodegenerative conditions. To assist the clinician in considering the appropriateness of prescribing a cognitive enhancer in an older person at risk of falls and explore the factors that should be considered when reviewing the ongoing use of these medications.FindingsCognitive enhancer use is associated with multiple fall-related side effects, particularly in the initial weeks of administration and up-titration. Acetylcholinesterase inhibitors and memantine differ in their fall-related side effect profiles. Cognitive enhancers can contribute to falls through precipitating cardiac, sleep, neurological (e.g. seizure), extrapyramidal, bladder and/or neuro-psychiatric side effects. Cognitive enhancers should be subject to frequent medication review, including appropriate treatment indication and occurrence of side effects. Several suggested guidelines exist to aid deprescribing decisions, however, these are based on a relatively small number of focused clinical trials.MessageAn individualised approach should be taken when considering whether cognitive enhancer therapy is still appropriate in older adults at risk of falling. Clinicians should consider the plethora of risks associated with (de-) prescribing these medications.

Psilocybin therapy: A novel approach to treating depression

Psilocybin therapy: A novel approach to treating depression

In this Issue.

In this Issue.

Improved Media Formulations for Primary Cell Cultures Derived from a Colonial Urochordate.

The cultivation of marine invertebrate cells in vitro has garnered significant attention due to the availability of diverse cell types and cellular potentialities in comparison to vertebrates and particularly in response to the demand for a multitude of applications. While cells in the colonial urochordate Botryllus schlosseri have a very high potential for omnipotent differentiation, no proliferating cell line has been established in Botryllus, with results indicating that cell divisions cease 24-72 h post initiation. This research assessed how various Botryllus blood cell types respond to in vitro conditions by utilizing five different refinements of cell culture media (TGM1-TGM5). During the initial week of culture, there was a noticeable medium-dependent increase in the proliferation and viability of distinct blood cell types. Within less than one month from initiation, we developed medium-specific primary cultures, a discovery that supports larger efforts to develop cell type-specific cultures. Specific cell types were easily distinguished and classified based on their natural fluorescence properties using confocal microscopy. These results are in agreement with recent advances in marine invertebrate cell cultures, demonstrating the significance of optimized nutrient media for cell culture development and for cell selection.

Belumosudil Impacts Immunosuppression Pharmacokinetics in Patients with Chronic Graft-versus-Host Disease

Belumosudil (BEL) is a novel Rho-associated coiled-coil containing protein kinase 2 (ROCK2) inhibitor approved for the treatment of chronic graft-versus-host disease (cGVHD) in patients who have failed 2 or more prior lines of systemic therapy. Although the pharmacokinetic effects of BEL on other immunosuppressive (IS) agents have not been clinically evaluated, in vitro data indicate that BEL may have possible interactions with drugs with a narrow therapeutic index used to treat cGVHD, such as tacrolimus, sirolimus, and cyclosporine, through cytochrome P450 (CYP3A) and p-glycoprotein interactions. Further evaluation of these potential interactions is warranted to optimize the safety and effectiveness of these medications when combined with BEL. In this study, we investigated the potential effects of BEL on sirolimus and tacrolimus levels when used concurrently by assessing changes in IS levels after the addition of BEL. This retrospective single-center study of patients who started BEL while on tacrolimus and/or sirolimus between February 1, 2019, to February 1, 2023, included patients who had IS levels measured at baseline prior to starting BEL and at least 1 subsequent IS measurement to assess changes over time. The primary endpoint was the concentration-dose (C/D) ratio analyzed before and after the addition of BEL. Secondary endpoints included the incidence of IS levels outside of the therapeutic range (subtherapeutic or supratherapeutic) and mean dosage changes over time. Thirty-seven patients met our eligibility criteria and were included in this analysis. Patients taking sirolimus (n = 30) or tacrolimus (n = 16) concurrently with BEL had a statistically significant increase in the C/D ratio (sirolimus recipients, 160% [P < .001]; tacrolimus recipients, 113% [P = .013]) between the pre-BEL and final post-BEL assessments. The C/D ratios for both tacrolimus and sirolimus recipients continued to increase at several time points after initiation of BEL, indicating that multiple drug dosage adjustments may be required. After BEL initiation, 19% of tacrolimus levels and 57% of sirolimus levels were supratherapeutic. Despite dosage adjustments, 27% of tacrolimus levels were supratherapeutic at both the second and third assessments after starting BEL, and 28% and 30% of sirolimus levels were supratherapeutic at these 2 time points, respectively. All 12 of the patients who discontinued BEL during the study period (100%) showed a return to their baseline C/D ratio, confirming that the C/D ratio change can be attributed to BEL. The impact of BEL on IS levels is clinically significant, warranting dosage adjustments of concurrent medications. A significant number of patients taking sirolimus with BEL had levels >15 ng/mL during the study period, indicating a potential risk for toxicity if this interaction is unmonitored. We recommend empiric dose reductions of 25% for tacrolimus and 25% to 50% for sirolimus when adding BEL, as well as close monitoring of IS levels during the initial weeks of BEL therapy. Future studies are warranted to better describe the impact of BEL on patients taking CYP3A inhibitors.

Foraging Duration and Intensity of &lt;i&gt;Apis mellifera&lt;/i&gt; L.

An experiment was conducted in the apiary of Uttar Banga Krishi Viswavidyalaya, Pundibari during 2019. For study, six strong Apis mellifera L. colonies of similar strength were used. A positive and significant correlation of temperature (maximum and minimum) and relative humidity (minimum) with the foraging duration was found. During the cooler months both foraging duration and foraging intensity was minimum and increased later on. Foraging activity was highly affected by rainfall. The mean foraging duration of foragers throughout the year was 11.85± 1.79 hrs/ day. The 25 th standard week was recorded with maximum foraging duration, viz. 14.22 hrs. Foraging intensity was low during initial hours but increased in later hours. Foraging intensity was very less in initial weeks and very high in 10 th to 25 th standard weeks at all the three intervals.

Development and Feasibility of a Group Tele-Exercise Program for Individuals With Spinal Cord Injury.

More than 50% of individuals with spinal cord injury (SCI) report no regular exercise due to numerous barriers to participation. Tele-exercise services offer viable solutions to reduce barriers. However, limited evidence for SCI-specific tele-exercise programs is available. The purpose of this study was to evaluate the feasibility of a synchronous group tele-exercise program designed for individuals with SCI. Explanatory sequential mixed-methods design assessed feasibility of a synchronous 2-month biweekly group tele-exercise program for individuals with SCI. Numeric measures of feasibility were first collected (recruitment rate, sample features, retention, attendance), followed by postprogram interviews with participants. Thematic analysis of experiential feedback elaborated on numeric findings. Eleven volunteers (ages = 49.5 ± 16.7 years) with SCI (range: 2.7-33.0 years) enrolled within 2 weeks of recruitment initiation. Retention was 100% retention at program completion. Median number of live classes attended per participant was 10 (62.5%). Participants described that attendance and satisfaction were facilitated by program-specific features including coinstruction by instructors with SCI-specific knowledge and lived experience, as well as group structure. Participants reported increased exercise knowledge, confidence, and motivation. This study demonstrated feasibility of a synchronous group tele-exercise class for individuals with SCI. Key features facilitating participation include class length, frequency, coleadership by individuals familiar with SCI and exercise instruction, and group motivation. These findings begin to examine a viable tele-service strategy that could be employed as a bridge among rehabilitation specialists, community fitness instructors, and clients with SCI to increase physical activity access and behavior.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A442).