Faster Use and Fewer Failures with Needle-Free Nasal Glucagon Versus Injectable Glucagon in Severe Hypoglycemia Rescue: A Simulation Study.

BACKGROUND: During severe hypoglycemic episodes, people with diabetes depend on others to help with treatment. We compared needle-free nasal glucagon and commercially available injectable glucagon for ease of use by caregivers of people with diabetes and by others in treating simulated episodes of severe hypoglycemia. METHODS: Sixteen instructed caregivers and 15 noninstructed acquaintances administered nasal and injectable glucagon to manikins, simulating unconscious people with diabetes during severe hypoglycemia episodes. RESULTS: With nasal glucagon, 15 caregivers (94%) and 14 acquaintances (93%) administered a full dose (mean time 0.27 and 0.44 min, respectively). One caregiver and one acquaintance did not administer nasal glucagon because they did not fully depress the plunger on the device. Two caregivers deliberately administered both insulin and nasal glucagon, believing that insulin would also help the patient. With injectable glucagon, eight caregivers (50%) injected glucagon (mean time 1.89 min), but only two (13%) administered the full dose. Three acquaintances (20%) injected a partial dose of injectable glucagon (mean time 2.40 min); none gave a full dose. Errors included injecting diluent only, bending the needle, and injecting with an empty syringe. Two caregivers and one acquaintance injected insulin because they confused insulin with injectable glucagon. CONCLUSIONS: More than 90% of participants delivered full doses of nasal glucagon, while 13% and 0% of caregivers and acquaintances delivered full doses of injectable glucagon, indicating that nasal glucagon is easier for nonmedically trained people to administer. Thus, nasal glucagon has the potential to substantially improve treatment for patients experiencing a life-threatening episode of severe hypoglycemia.

Patient and Healthcare Professionals Preference for Brenzys vs. Enbrel Autoinjector for Rheumatoid Arthritis: A Randomized Crossover Simulated-Use Study.

INTRODUCTION: Brenzys was developed as an etanercept biosimilar of Enbrel. The aim of this study was to assess preference and perceived ease of use for the new Brenzys autoinjector compared to the currently available marketed Enbrel MYCLIC autoinjector (Australia) and Enbrel SureClick autoinjector (Canada) for the treatment of rheumatoid arthritis (RA). Because RA affects manual dexterity, ease of use of an autoinjector is a particularly important consideration in developing effective self-delivery of long-term courses of therapy. METHODS: Patients (N = 191) reporting a diagnosis of RA and nurses and rheumatologists (N = 90) with experience managing RA were shown how to use Brenzys and Enbrel autoinjectors (in counterbalanced order between participants), then they used each autoinjector by injecting into a pad simulating skin, and completed a questionnaire. Study sessions took place in Australia and Canada. RESULTS: A binomial test showed that significantly more patients indicated that the Brenzys autoinjector was easier to use than the Enbrel autoinjector (79% reporting Brenzys easier to use; p < 0.001, two-sided, 95% CI [73%, 85%]). In addition, significantly more nurses and rheumatologists with experience managing RA also indicated that the Brenzys autoinjector was easier to use (86%; p < 0.001, two-sided, 95% CI [77%, 92%) and that they would recommend the buttonless Brenzys autoinjector over the Enbrel autoinjector to patients (83%; p < 0.001, two-sided, 95% CI [74%, 90%]). Almost all patients who reported past experience using an Enbrel autoinjector (N = 17) reported on the basis of using the two devices in the study that they would prefer to switch their device to the Brenzys autoinjector rather than continue their course of therapy using the Enbrel autoinjector (16/17, 94%, 95% CI [71%, 100%]). CONCLUSION: On the basis of the study results, the Brenzys autoinjector was rated statistically significantly easier to use, and was overall preferred by patients and healthcare professionals with experience managing RA patients. FUNDING: Merck & Co., Inc.

Positioning patient status monitors in a family waiting room.

OBJECTIVE: To determine where to place patient status displays for family members in the operating room family waiting room at The Children's Hospital of Philadelphia. METHODS: We calculated the percentage of seats from which wall monitors placed in hypothetical positions would be usable. We validated the usability of the new monitors by observing nonemployees' use of monitors in the waiting room 1 week before and 1 week after implementation. RESULTS: Compared to the legacy monitor, the new monitors were observed to be used from more locations within the waiting room and more people were observed to use the new monitors soon after entering the waiting room. CONCLUSIONS: Seemingly trivial decisions like where in a waiting room to place monitors can be informed by careful data collection and the consequences can observably impact communication between hospital staff and family members waiting for loved ones in surgery.

Artificial natural selection: can supplemental feeding domesticate mosquitoes and control mosquito-borne diseases?

A new method is proposed for controlling mosquito-borne diseases. In particular, instead of trying to kill mosquitoes, we suggest provisioning them with food from artificial feeders. Because mosquito populations are frequently limited by ecological factors other than blood meals, such as the availability of egg-laying sites, feeding mosquitoes would not necessarily increase the total number of mosquitoes, but could reduce the number of human-drawn mosquito meals. Like mosquito traps, feeders could divert biting mosquitoes away from people by means of lures, but, after diversion, prevent subsequent human bites by satiating the mosquitoes instead of killing them. Mosquito feeders might reduce the problem of the evolution of resistance to control: in an ecology with mosquito feeders, which provide safe and abundant calories for adult female mosquitoes, there could be selection for preferring (rather than avoiding) feeders, which could eventually lead to a population of feeder-preferring mosquitoes. Artificial feeders also offer the chance to introduce novel elements into the mosquito diet, such as anti- malarial or other anti-parasitic agents. Feeders might directly reduce human bites and harnesses the power of natural selection by selectively favoring feeder-preferring (rather than trap-resistant) mosquitoes.

Behavioral responses to light by headless anesthetized Drosophila melanogaster.

The bodies of decapitated fruit flies are known to retain a variety of functional sensory inputs, processing, and behavioral responses. Here I report a previously undescribed phenomenon: headless bodies can respond to a light presentation with movement, walking, and flight. Headless anesthetized flies also respond to a light presentation with behavior, albeit to a lesser degree. The mechanism underlying the behavioral response of headless flies to light might include extracephalic photoreceptors or thermoreceptors.

Meta-meta-placebo and -curabo: you might get better just by reading this paper.

Three separate but related ideas build on van Deventer's concept of the "meta-placebo" effect in which placebo effects are hypothesized to help patients even when patients know they are receiving a placebo. First, a method is proposed to experimentally validate the meta-placebo effect without lying to experimental subjects. Second, the idea of a meta-placebo is extended to a condition where patients experience many of the elements of placebo treatments that are hypothesized to cause placebo benefits, such as an optimistic prognosis by a doctor, but patients do not actually take a placebo pill: a "curabo effect". The final section proposes that patients might be able to experience enough placebo- and -curabo-related treatment elements to gain a beneficial effect without either a pill or a doctor. Instead, simply having the knowledge that one can derive medical benefit from placebo, meta-placebo, and -curabo treatments, and without medicine, might in itself suffice to cause some to feel better: the hypothesized meta-meta-placebo and -curabo (or "meta-bo," for short) effect.

Representing metarepresentations: is there theory of mind-specific cognition?

What cognitive mechanisms underlie Theory of Mind? Some infer domain-specific Theory of Mind cognition based the pattern of children diagnosed with autism failing the False Belief test but passing the False Photograph test. However, we argue that the False Belief test entails various task demands the False Photograph task does not, including the necessity to represent a higher-order representation (a metarepresentation), thus confounding the inference of domain-specificity. Instead, a general difficulty that affects representations of metarepresentations might account for the seeming domain-specific failure. Here we find that False-Belief failing False-Photograph passing children fail the Meta Photograph test, a new photograph-domain test that requires subjects to represent a metarepresentation. We conclude that people who fail the False Belief test but pass the False Photograph test do not necessarily have a content-specific Theory of Mind deficit. Instead, the general ability to represent representations and metarepresentations might underlie Theory of Mind.

Two new illusions of the tongue.

New illusions resulting from failures in proprioception are described. The Forked Tongue illusion results from weaving the tongue among the prongs of a fork, or from using the prongs of a fork to distort skin on other parts of the body-in these cases, the prongs feel misaligned even though the fork has not bent. The Tongue Twister illusion results from turning the tongue upside down and probing it with a finger or foreign object-the object can be felt to be in the wrong spatial location, opposite to where it actually is on the tongue.

Electrophysiological signatures: magnetoencephalographic studies of the neural correlates of language impairment in autism spectrum disorders.

While magnetoencephalography (MEG) is of increasing utility in the assessment of pediatric patients with seizure disorders, this reflects only a part of the clinical potential of the technology. Beyond epilepsy, a broad range of developmental psychiatric disorders require the spatial and temporal resolution of brain activity offered by MEG. This article reviews the application of MEG in the study of auditory processing as an aspect of language impairment in children. Specifically, the potential application of MEG is elaborated in autism spectrum disorders (ASD), a devastating disorder with prevalence of 1 in 150. Results demonstrate the sensitivity of MEG for detection of abnormalities of auditory processing in ASD ('electrophysiological signatures') and their clinical correlates. These findings offer promise for the comprehensive assessment of developmental neuropsychiatric disorders.