Search

Maryia Zhdanava,1 H Lynn Starr,2 Todor I Totev,3 Patrick Lefebvre,1 Aditi Shah,1 Kristy Sheng,4 Dominic Pilon1 1Analysis Group, Inc., Montréal, QC, Canada; 2Janssen Scientific Affairs, LLC, Titusville, NJ, USA; 3Analysis Group, Inc., Boston, MA, USA; 4Analysis Group, Inc., Menlo Park, CA, USACorrespondence: Maryia Zhdanava, Manager at Analysis Group, Inc, 1190 Avenue des Canadiens-de-Montréal, Suite, 1500, Montréal, QC, H3B 0G7, Canada, Tel +1 514-394-4469, Email Masha.Zhdanava@analysisgroup.comPurpose: To describe changes due to the COVID-19 pandemic in the prescribing of long-acting antipsychotics (LAI) for schizophrenia, patient outcomes, and patient and healthcare provider (HCP) attitudes regarding COVID-19 vaccination in the United States (US).Methods: An anonymous online survey was administered to US-based LAI prescribers with a psychiatry specialty in May 2021. Information on prescriber and clinical practice characteristics, LAI prescribing, patient outcomes, and attitudes toward COVID-19 vaccination was collected and described.Results: Of the 401 LAI prescribers meeting survey criteria, 64.6% reported that LAI prescribing remained unchanged (increase: 19.2%, decrease: 14.0%). The majority did not switch patients from LAIs to oral antipsychotics (OAP; 63.3%) or to LAI formulations with lower frequency of administration (68.1%); most prescribers switched the same number of patients from OAPs to LAIs during the pandemic as in previous practice (65.1%). Half of LAI prescribers (50.1%) reported antipsychotic adherence as unchanged among most patients; 44.6% reported symptom control/relapse frequency as unchanged. Most prescribers believed their patients with schizophrenia should be prioritized for COVID-19 vaccination (74.1%) and encouraged all patients to obtain a COVID-19 vaccine (84.0%). However, 64.1% of prescribers reported hesitancy among some patients about vaccines’ safety; 51.4% reported that some patients were willing to be vaccinated despite the hesitancy, 48.6% indicated that some patients perceived COVID-19 vaccines as safe, effective, and important.Conclusion: LAI prescribing and prescriber-reported antipsychotic adherence in patients with schizophrenia remained largely unchanged approximately one year after the start of COVID-19. Focused efforts to overcome patients’ COVID-19 vaccine hesitancy are warranted.Keywords: adherence, antipsychotics, COVID-19, physician survey, prescribing habits, schizophrenia

Maryia Zhdanava,1 H Lynn Starr,2 Patrick Lefebvre,1 Todor I Totev,3 Aditi Shah,1 Kristy Sheng,4 Dominic Pilon1 1Analysis Group, Inc, Montréal, Quebec, Canada; 2Janssen Scientific Affairs, LLC, Titusville, NJ, USA; 3Analysis Group, Inc, Boston, MA, USA; 4Analysis Group, Inc, Menlo Park, CA, USACorrespondence: Maryia Zhdanava, Analysis Group, Inc, 1190 avenue des Canadiens-de-Montréal, Suite 1500, Montréal, Quebec, H3B 0G7, Canada, Tel +1 514-394-4469, Email Masha.Zhdanava@analysisgroup.comPurpose: To describe factors that enable the routine use of long-acting injectable antipsychotics (LAIs) for appropriate patients in the current clinical practice, including changes in LAI prescribing due to the COVID-19 pandemic and expectations for prescribing in 2021 in the United States (US).Methods: Frequent LAI prescribers recruited from a nationwide panel in 2020 completed an online survey regarding practice characteristics, perspectives on healthcare system conditions enabling routine use of LAIs, and prescribing patterns and changes in patterns during the COVID-19 pandemic.Results: Of 408 prescribers who completed the survey, 77.7% were physicians and 59.1% had ≥ 10 years of psychiatry practice. More than half of frequent prescribers (57.1%) reported treating > 20% of their patients with schizophrenia with LAIs. The American Psychiatric Association (APA) guideline was followed by 64.0% of prescribers. Most prescribers identified poor adherence to antipsychotics as a circumstance when LAIs are recommended (94.9%) and patient/caregiver involvement in treatment decisions as a key factor impacting the decision to prescribe LAIs (97.3%). Most prescribers reported that LAI prescribing rates were unchanged in 2020 (59.8%). Similar proportions of prescribers expected no change (44.1%) or an increase (42.9%) in LAI prescribing rates in 2021. The number of patients followed, cost of treatment, and availability of staff to administer LAIs were the main driving factors identified by prescribers expecting an increase in LAI prescribing rates.Conclusion: LAIs were commonly recommended to patients with poor adherence, and patient/caregiver involvement was an important factor affecting prescribers’ treatment decisions. LAI prescribing rates remained unchanged during the COVID-19 pandemic in 2020.Keywords: COVID-19, healthcare providers, long-acting injectable antipsychotics, prescribing patterns, schizophrenia

Lightning is an important threat to life and properties and its forecast is important for practical applications. We show the performance of a dynamic lightning scheme for the next-day strokes forecast. The prediction is compared against the LINET network, and the forecast period spans one year. Specifically, a total of 162 case studies were selected between 1 March 2020 and 28 February 2021. The events span a wide range of lightning intensity; 69 cases occurred in summer, 46 in fall, 18 in winter, 29 in spring. Three different settings of the lightning scheme are considered to test the sensitivity of the method to the key parameter of charge transferred in 1 second: 0.5*10-4 C (L50), 0.75*10-4 C (L75), and 1.0*10-4 C (L100). The meteorological driver is WRF. Each simulation lasts 36h and the first twelve hours are the spin-up time and are discarded from the analysis. The focus is on the next-day forecast (12-36 h). The horizontal resolution of the simulations is 3 km and 50 unevenly spaced vertical levels extend from the surface to 50 hPa. Lightning is closely related to convection in the atmosphere and model errors in the lightning forecast have two main sources: errors in forecasting the convection and errors in the representation of the electric processes inside the clouds. This makes the lightning forecast a difficult task. Results are discussed for the whole year and for different seasons. Moreover, statistics are presented for the land and sea. LINET strokes are remapped into the WRF 3km grid and then further elaborated for comparison with the strokes forecast. Among the three configurations of the lightning scheme, L75 forecasts accurately the total number of strokes recorded for all the cases, L50 underestimates the strokes and L100 overestimates the strokes. The time-series correlation of daily observed and forecasted strokes is around 0.75 and depends on the season. Qualitative scores (FBIAS, ETS, POD, FAR) computed for the 3km grid and different strokes thresholds have low values and upscaling the model output, by summing the forecast and observed strokes over grids with larger grid spaces (from 6 to 48 km), improves the results. Among the different configurations of the dynamic lightning scheme, L75 performs slightly better. However, L50, L75, and L100 show very similar spatial patterns of predicted strokes. The analysis of the fraction skill score shows that the best lightning forecast is for summer, followed by fall, winter, and spring. This happens for all configurations L50, L75, L100. The lightning forecast performance varies between sea and land; the analysis of the Taylor diagram shows better performance over the land than over the sea. This result shows that the convection is better simulated over the land than over the sea, where the effect of topography, partially represented by the model, may focus the convection on specific areas. The result of this study shows that lightning forecast with the dynamic lightning scheme can be performed with success in Italy; nevertheless, a careful inspection of the forecast performance is necessary for tuning the scheme to the specific purpose.

A teleomorph of the fungus Botryosphaeria rhodina (Berkeley et Curtis) von Arx, (Br) was evaluated as a bioherbicide for control of giant salvinia (Salvinia molesta D.S. Mitchell) under greenhouse conditions and in small-scale field trials. We found that fungal mycelium was highly infective and could be rapidly produced (48+ h) in soy flour-cornmeal liquid media contained in shake flasks or fermenters. A dew period was not required to achieve infection and mortality of inoculated plants. A surfactant (Silwet L-77, a polyalkyleneoxide modified heptamethyl-trisiloxane) incorporated in the fungal formulation was required for Br to infect and kill plants. Infection and mortality occurred rapidly (within 48 h after treatment), and re-growth of treated plants did not occur. In replicated field trials, Br controlled giant salvinia ~95%. Br also infected other plants, such as common salvinia (S. minima Baker), and Azolla filiculoides Lam., as determined in ongoing host range research. However, no symptomatology was observed on several economically important crop species, such as rice (Oryza sativa L.), corn (Zea mays L.), and several woody species such as bald cypress (Taxodium distichum L.) and loblolly pine (Pinus taeda L.) occurring in areas where giant salvina occurs that would be subject to contact with releases of Br. These results suggest that this teleomorph of Botryosphaeria rhodina has potential as a bioherbicide for controlling this onerous aquatic weed.

This study reports the first year of an exemplary program at Garfield High School, Seattle, where a program of occupational skills was instituted as a regular part of the comprehensive school curriculum. First year objectives included efforts to: (1) plan and develop limited operation of vocational-technical programs, (2) establish technical advisory groups in the skill areas, (3) individualize the curriculum, (4) provide inservice training for staff, and (5) enroll one-fourth of the student body or 250 students in an occupational development program. Major accomplishments of these efforts included: (1) More than 130 persons were involved in the initial planning of the program, (2) By September 1970, 14 courses had been initiated and some 300 students enrolled, and (3) Staff development was furthered through two workshops in 1970-1971 for all program staff. A major recommendation of the report is that the middle school area of career orientation and education should be fully developed during the second year program. (JS)

Objective: To compare direct and indirect costs among caregivers of patients with major depressive disorder (MDD) and suicidal ideation and/or suicide attempts (MDSI) versus caregivers of patients with MDD alone versus caregivers of patients without MDD or suicidal ideation and/or suicide attempts (controls). Methods: Cohorts were based on caregivers of adult patients with MDSI, MDD alone, and controls. Patients were identified by Workpartners employer database ICD-9/ICD-10 codes (January 2010 to July 2019) and were spouses or domestic partners of employees (caregivers). Twenty controls and 20 MDD-alone caregivers were matched to each MDSI caregiver on sex, age, and index year. All caregiver-patient pairs had 6 months pre/postindex information and met additional inclusion/exclusion criteria. Patient and caregiver medical and prescription claims and caregiver absenteeism (payment/time) were analyzed. Direct costs (medical, prescription) and indirect costs (absence payments by benefit type) were analyzed using separate, 2-part stepwise regression models and controlling for demographics, job-related variables, region, index year, and Charlson Comorbidity Index score. Results: 570 MDSI caregiver-patient pairs and 11,400 matched MDD-alone and control pairs were identified. MDSI and MDD-alone caregivers had higher medical costs compared with controls ($5,131 and $4,548 versus $3,885, respectively; P

BACKGROUND Schizophrenia is a lifelong illness that requires long-term treatment and caregiving. Family psychoeducation (FP) has been shown to lessen caregiver burden, improve caregiver functioning, and improve outcomes in patients. However, the impact of FP delivered specifically to caregivers on patient outcomes has not been well explored, particularly for early schizophrenia. Furthermore, there is a lack of research examining the benefits of telehealth-based psychoeducation for caregivers on either patient or caregiver outcomes. OBJECTIVE The Family Intervention in Recent-Onset Schizophrenia Treatment (FIRST) study is a randomized controlled trial of patients with schizophrenia spectrum disorders and their caregivers, which is designed to evaluate the effect of telehealth-based, caregiver-focused, study-provided psychoeducation versus usual care (UC) on patient treatment failure (TF). The impact of study-provided psychoeducation on caregiver burden is also investigated. METHODS Eligible patients and their designated caregivers were randomly assigned to either the study-provided psychoeducation (≤16 sessions of telehealth-based psychoeducation over 6 months) or UC group, stratified by antipsychotic treatment (paliperidone palmitate or oral antipsychotic). The major TF events (ie, psychiatric hospitalization or intervention, arrest or incarceration, and suicide attempts) were assessed at 3, 6, and 12 months after baseline. A proportional means model using mean cumulative function was used to assess between-group differences in the mean cumulative number of TF events over 12 months. Caregiver burden was assessed using the Involvement Evaluation Questionnaire and 12-item Short Form Health Survey. RESULTS A total of 148 pairs of participants were enrolled in the study, of whom 96 (64.9%) patients and 94 (63.5%) caregivers completed the 12-month follow-up. The mean number of sessions in the study-provided psychoeducation group was 7.7 (SD 5.9). No differences were observed between the study-provided psychoeducation and UC groups in patient outcomes (rates of TF: 70% vs 67%; P=.90) or measures of caregiver burden (assessment of caregiver distress and physical and mental health). However, post hoc analyses revealed lower relapse rates in patients who received paliperidone palmitate than in those who received oral antipsychotics at all time points. Although the FIRST study did not meet the primary end point, several key lessons were identified to inform future caregiver-focused, telehealth-based FP interventions. Lack of study-provided psychoeducation, focus on caregiver-only intervention, difficulties with enrollment, and caregiver–treatment team coordination may have affected the outcomes of the FIRST study. CONCLUSIONS Key insights from the FIRST study suggest the potential importance of supporting sufficient caregiver engagement; communication between clinicians, patients, and family members regarding treatment plans; and solidifying the relationship between clinicians providing psychoeducation to the caregiver and patient treatment team. CLINICALTRIAL ClinicalTrials.gov NCT02600741; http://clinicaltrials.gov/ct2/show/NCT02600741

Background Schizophrenia is a lifelong illness that requires long-term treatment and caregiving. Family psychoeducation (FP) has been shown to lessen caregiver burden, improve caregiver functioning, and improve outcomes in patients. However, the impact of FP delivered specifically to caregivers on patient outcomes has not been well explored, particularly for early schizophrenia. Furthermore, there is a lack of research examining the benefits of telehealth-based psychoeducation for caregivers on either patient or caregiver outcomes. Objective The Family Intervention in Recent-Onset Schizophrenia Treatment (FIRST) study is a randomized controlled trial of patients with schizophrenia spectrum disorders and their caregivers, which is designed to evaluate the effect of telehealth-based, caregiver-focused, study-provided psychoeducation versus usual care (UC) on patient treatment failure (TF). The impact of study-provided psychoeducation on caregiver burden is also investigated. Methods Eligible patients and their designated caregivers were randomly assigned to either the study-provided psychoeducation (≤16 sessions of telehealth-based psychoeducation over 6 months) or UC group, stratified by antipsychotic treatment (paliperidone palmitate or oral antipsychotic). The major TF events (ie, psychiatric hospitalization or intervention, arrest or incarceration, and suicide attempts) were assessed at 3, 6, and 12 months after baseline. A proportional means model using mean cumulative function was used to assess between-group differences in the mean cumulative number of TF events over 12 months. Caregiver burden was assessed using the Involvement Evaluation Questionnaire and 12-item Short Form Health Survey. Results A total of 148 pairs of participants were enrolled in the study, of whom 96 (64.9%) patients and 94 (63.5%) caregivers completed the 12-month follow-up. The mean number of sessions in the study-provided psychoeducation group was 7.7 (SD 5.9). No differences were observed between the study-provided psychoeducation and UC groups in patient outcomes (rates of TF: 70% vs 67%; P=.90) or measures of caregiver burden (assessment of caregiver distress and physical and mental health). However, post hoc analyses revealed lower relapse rates in patients who received paliperidone palmitate than in those who received oral antipsychotics at all time points. Although the FIRST study did not meet the primary end point, several key lessons were identified to inform future caregiver-focused, telehealth-based FP interventions. Lack of study-provided psychoeducation, focus on caregiver-only intervention, difficulties with enrollment, and caregiver–treatment team coordination may have affected the outcomes of the FIRST study. Conclusions Key insights from the FIRST study suggest the potential importance of supporting sufficient caregiver engagement; communication between clinicians, patients, and family members regarding treatment plans; and solidifying the relationship between clinicians providing psychoeducation to the caregiver and patient treatment team. Trial Registration ClinicalTrials.gov NCT02600741; http://clinicaltrials.gov/ct2/show/NCT02600741