metoclopramide (Gimoti / EVK 001 / EVK001)

Cost-effectiveness of nasal adrenaline in the treatment of anaphylaxis.

Nasser Shuaib S, Bottazzi Luca L, Lang Andrea A, Skou Rebecca R et al.

Nasal adrenaline spray is a novel needle-free alternative for the emergency treatment of anaphylaxis. Evidence on its cost-effectiveness versus adrenaline auto-injectors (AAIs) is currently limited. This analysis evaluates the cost-effectiveness of the nasal adrenaline spray versus an AAI in individuals ≥ 30 kg (approximately 8 years of age) at risk of all-cause anaphylaxis in the United Kingdom (UK). A de novo Markov cohort model was developed for the UK setting from a societal perspective over a lifetime horizon. Four health states captured the risks and consequences of anaphylaxis. Clinical inputs included the probability of initial and recurrent anaphylactic episodes, adrenaline carriage, whether used, administration accuracy and needle-related administration errors. Costs included product acquisition, training, emergency care, hospitalization, needle-related administration errors, and productivity loss. Outcomes were quality-adjusted life years (QALYs), with costs and benefits discounted at 3.5% annually. The impact of uncertainty was assessed using deterministic and probabilistic sensitivity analyses. In the base case, the nasal adrenaline spray was dominant versus the AAI, yielding 0.26 additional QALYs at a lower cost (-£681). Cost differences were mainly driven by product acquisition, hospitalization rates and productivity loss. Results were robust across scenario analyses but were sensitive to assumptions about adrenaline carriage and use. In the UK, the nasal adrenaline spray may be a cost-effective alternative to AAIs, largely due to assumed higher carriage and greater likelihood of use during anaphylactic episodes. Further real-world evidence is needed to validate these assumptions and their impact on cost-effectiveness.

Correction: CHEK1 and circCHEK1_246aa evoke chromosomal instability and induce bone lesion formation in multiple myeloma.

Gu Chunyan C, Wang Wang W, Tang Xiaozhu X, Xu Tingting T et al.

Variable fluid mechanics explain why static efficacy tests overestimate sanitizer performance against Listeria.

Jiao Yang Y, Baker Jakob J, Slaughter Calvin C, Daeschel Devin D et al.

Pathogen cross-contamination during food production is primarily controlled through environmental sanitation. However, sanitizer efficacy is often studied in bench-scale experiments that poorly approximate the fluid dynamics of sanitization and limit our understanding of commercial sanitization efficacy. This study paired computational fluid dynamics estimates of shear stress with experimental measurements of Listeria innocua reduction on stainless steel following treatment with 100 ppm hypochlorite sanitizer. At the pilot scale, sanitizer spray manually applied by researchers achieved a 2.6 ± 0.4 log CFU/surface reduction; however, microbial reduction from manual operation of sanitizer spray equipment differed significantly between researchers (P < 0.05). Microbial reduction varied by location following stationary, bench-scale spray application of sanitizer for 3 s. The greatest reduction was at the point of sanitizer spray impingement (7.5 ± 0.5 log CFU/surface) and directly adjacent to the impingement point (6.4 ± 0.7 log CFU/surface), where shear stress was the highest. Significantly less microbial reduction (0.4 ± 0.1 log CFU/surface) occurred where shear stress was lowest in the fluid film of sanitizer running down from the impingement point (P < 0.05). Static submersion of inoculated coupons in sanitizer for 3 s resulted in a log reduction of 2.3 ± 0.1 log CFU/surface. Discrepancies between bench-scale spraying, pilot-scale spraying, and submerged coupons demonstrate the need for sanitizer efficacy testing under realistic conditions to better estimate the risk reduction achieved through sanitation programs.IMPORTANCESanitation is critical for controlling pathogen cross-contamination during food production. These findings highlight the limitations of traditional approaches to sanitizer efficacy testing, not because they are invalid, but because they do not reflect the level of microbial reduction typically achieved in application. We demonstrate that these differences in outcomes are attributable to fluid dynamics and exposure, which are not well approximated in submerged coupon experiments. Accurate estimation of microbial reduction from sanitizer application is needed to guide food safety policy decisions. For example, overestimation of the risk reduction conferred by sanitizer treatment may result in food safety policies that neglect other sources of microbial reduction within sanitation programs.

Variability of oral-nasal balance characteristics in children with cleft lip and palate over time.

Bressmann Tim T, Stevens Kyle K

The accurate assessment of oral-nasal balance disorders in children with cleft lip and palate is a perennial problem in Speech-Language Pathology. Nasalance scores obtained with a nasometer can contribute to the diagnosis of oral-nasal balance disorders. The present study investigated how consistent such classifications are over time. Twenty-seven children with cleft lip and palate were recorded six times with a nasometer headset over the course of an orthodontic palatal expansion treatment. Nasalance scores were considered hypernasal when they were higher than 30% for a non-nasal sentence and hyponasal when they were below 50% for a nasal sentence. Based on the nasalance scores, normal nasalance was found in 42.6%, hyponasality in 34.0%, and hypernasality in 23.5% of 162 sound recordings. Only 7/ 27 (25.9%) of the children had the same nasalance-based classification over the six sessions. The others demonstrated variability that straddled two adjacent categories in 15/ 27 (55.6%) of cases and all three categories in 5/ 27 (18.5%) of cases. While clinicians may wish to assign a permanent oral-nasal balance classification to their patients, the study demonstrated that a subset may show unexpected variability over time. More research is needed to establish whether it would be beneficial in some cases to explore this potential for variability before long-term decisions about a patient's clinical management are made.