First record of a structural infestation by the bird flea Dasypsyllus gallinulae perpinnatus (Siphonaptera: Ceratophyllidae) in the San Francisco Bay Area, California, USA

Herein we present the first-known case report of a structural infestation by the bird flea (Dasypsyllus gallinulae perpinnatus) (Dale 1878) in the United States. In March of 2023, the San Mateo County Mosquito and Vector Control District was contacted by a resident in South San Francisco, CA who reported the presence of fleas inside their condominium. The resident had 2 dogs who were on oral flea medication and only 1 inhabitant out of 4 reported receiving flea bites. The front walkway, backyard, and garage were flagged and a small passerine nest was removed from a fire alarm bell in the front walkway. A total of 31 fleas (13 males, 18 females) were collected by flagging from the front entryway underneath the nest. One female flea was collected from the backyard, and 20 (9 males, 11 females) were collected by the resident from inside the house. A total of 387 fleas (163 males, 224 females) were collected from the nest of a small passerine. All life stages (egg, larvae, pupae, and adult) were observed within the nest. Additional parasites in the nest included bird lice and larval western black-legged ticks (Ixodes pacificus, Cooley and Kohls 1943). Research should be conducted into whether bird fleas are capable of transmitting avian pathogens to humans and this information should be communicated to healthcare providers as part of a One Health approach. Additionally, resources to aid in species-level flea identification should be made accessible to pest control operators as this will aid the development of targeted treatments as part of an integrated pest management plan.

Materials Imaging and Dynamics (MID) instrument at the European X-ray Free-Electron Laser Facility

The Materials Imaging and Dynamics (MID) instrument at the European X-ray Free-Electron Laser (EuXFEL) facility is described. EuXFEL is the first hard X-ray free-electron laser operating in the MHz repetition range which provides novel science opportunities. The aim of MID is to enable studies of nano-structured materials, liquids, and soft- and hard-condensed matter using the bright X-ray beams generated by EuXFEL. Particular emphasis is on studies of structure and dynamics in materials by coherent scattering and imaging using hard X-rays. Commission of MID started at the end of 2018 and first experiments were performed in 2019.

Efficacy of piperacillin in combination with novel β-lactamase inhibitor IID572 against β-lactamase-producing strains of Enterobacteriaceae and Staphylococcus aureus in murine neutropenic thigh infection models

OBJECTIVES

The neutropenic murine thigh infection model was used to assess the effectiveness of IID572, a novel β-lactamase inhibitor, in rescuing piperacillin activity against bacterial strains expressing various β-lactamase enzymes.

METHODS

Mice (n = 4/group) were inoculated with Enterobacteriaceae or Staphylococcus aureus bacterial strains expressing a range of β-lactamases via intramuscular injection. Two hours after bacterial inoculation, subcutaneous treatment with piperacillin/IID572 or piperacillin/tazobactam every 3 h was initiated. Animals were euthanized via CO2 24 h after the start of therapy and bacterial cfu (log10 cfu) per thigh was determined, and the static dose was calculated.

RESULTS

In a dose-dependent manner, piperacillin/IID572 reduced the thigh bacterial burden in models established with Enterobacteriaceae producing class A, C and D β-lactamases (e.g. ESBLs, KPC, CMY-2 and OXA-48). Piperacillin/IID572 was also efficacious against MSSA strains, including one producing β-lactamase. Static doses of piperacillin/IID572 were calculable from animals infected with all strains tested and the calculated static doses ranged from 195 to 4612 mg/kg/day piperacillin, the active component in the combination. Of the 13 strains investigated, a 1 log10 bacterial reduction was achieved for 9 isolates and a 2 log10 reduction was achieved for 3 isolates; piperacillin/tazobactam was not efficacious against 6 of the 13 isolates tested.

CONCLUSIONS

In contrast to tazobactam, IID572 was able to rescue piperacillin efficacy in murine thigh infection models established with β-lactamase-producing strains of Enterobacteriaceae and S. aureus, including those expressing ESBLs or serine carbapenemases.

0494 Ability to Discontinue Chronic Hypnotic Use: An Update

Introduction

Physicians prescribing hypnotics remain concerned regarding patient’s inability to discontinue hypnotics after chronic use. That concern has never been directly tested in a controlled prospective study using self-administration choice procedures. This is an update on results from an on-going “blinded” clinical trial in which insomnia subjects are instructed to stop taking their study medication after 6 months of nightly use.

Methods

DSM-V diagnosed insomnia subjects, aged 23-61 yrs, (n=31, 26 females), with disturbed sleep (i.e., polysomnographic sleep efficiency of ≤85%), no other sleep disorder, unstable medical or psychiatric diseases or drug dependency completed the trial. Participants were randomized to zolpidem XR (12.5 mg), eszopiclone (3 mg), or placebo nightly for 6 months (blinded groups A: n=11, B: n=9, C: n=11). After 6 months, nightly use, over a 2-week choice period, they were instructed to discontinue hypnotic use, but if necessary, to self-administer either 1, 2, or 3 capsules of their assigned medication (zolpidem XR 6.25 mg, 6.25 mg, placebo; eszopiclone 2 mg, 1 mg, placebo as capsules 1, 2 and 3 respectively; or 3 placebos).

Results

The number of capsules taken declined from week 1 to 2 (p< .001). Over the 2 weeks 15 participants took 0 (48%), 12 ≤ 6 (39%) and 4 ≥10 total capsules (1 each took 42, 19, 13, and 10). Among those taking capsules, most took one capsule per night and 6 took > 1 capsule. Those 4 taking ≥ 10 were younger (p<.05), but did not differ in screening sleep efficiency or blinded treatment group. Importantly 1 subject took every capsule available.

Conclusion

The majority (87%) of the participants discontinued 6-month nightly hypnotic use (i.e. took ≤ 6 total capsules) and among those taking capsules the rate declined from week 1 to 2. Age may help identify the few with difficulty discontinuing.

Support

NIDA, grant#: R01DA038177 awarded to Dr. Roehrs

0007 Daytime Sleep in Night Shift Workers: Quantifying the Role of Circadian Misalignment

Introduction

Circadian misalignment is commonly cited as a culprit of daytime sleep disturbances in night shift workers; however, the specific impact and magnitude that circadian misalignment has on daytime sleep has not been well-characterized in larger samples of night shift workers.

Methods

Participants included fixed-night shift workers (n=52, ages 18–50) who completed an 8-hour daytime polysomnography (PSG) in the lab following a night shift. Measures of sleep disturbances included: difficulty falling asleep (sleep onset latency [SOL], latency to persistent sleep [LPS]), difficulty staying asleep (sleep efficiency [SE], wake after sleep onset [WASO]), and sleep duration (total sleep time [TST]). Melatonin samples were collected hourly for 24 hours under dim light (<10 lux) and used to determine dim light melatonin offset (DLMOff). Circadian misalignment (CM) was calculated as the time difference between bedtime and DLMOff (higher values represented sleeping after DLMOff), and correlated with PSG sleep variables.

Results

CM was significantly associated with difficulty staying asleep (WASO: r=0.48, p<0.001; SE: r=-0.45, p<0.001), and sleep duration (TST: r=-0.38, p<0.01). Specifically, every 3 hours of CM on average added 19.2 minutes of WASO and reduced TST by 15 minutes. In contrast, CM was not significantly correlated with sleep onset difficulties (SOL: r=-0.27; LPS: r=-0.02).

Conclusion

These data suggest that circadian misalignment in shift workers may be a better predictor of difficulties staying asleep and sleep duration during the day relative to difficulties falling asleep. Because longer work hours (10–12 hours) are common in night shift worker, it may be that sleep initiation difficulties associated with circadian misalignment is masked by elevated fatigue or an increased homeostatic drive from prolonged wakefulness. These results may help guide decisions about the magnitude of phase shifts required (e.g., with light therapy) for the desired improvement in daytime sleep.

Support

Support for this study was provided to PC by the NHLBI (K23HL138166)

0497 Rebound Insomnia During Discontinuation of Chronic Hypnotic Use

Introduction

Rebound insomnia refers to worsened sleep relative to baseline on 1-2 nights after discontinuation of active hypnotic medication. Rebound is typically assessed using a placebo substitution. We assessed rebound in an on-going “blinded” clinical trial in which people with insomnia are instructed to discontinue their study medication (i.e., no-pill) after 6 months of nightly use.

Methods

DSM-V diagnosed people with insomnia (n=31, 26 females), aged 26-61 yrs, with a polysomnographic sleep efficiency of ≤85%, no other sleep disorders, unstable medical or psychiatric diseases or drug dependency completed the clinical trial. Participants were randomized to zolpidem XR (12.5 mg), eszopiclone (3 mg) or placebo nightly for 6 months (blinded groups A: n=11, B: n=9, C: n=11). After 6 months, over a 2-week choice period, they were given the instruction to discontinue their nightly hypnotic use with an opportunity, if necessary, to self-administer either 1, 2, or 3 capsules of their assigned medication (zolpidem XR 6.25 mg, 6.25 mg, placebo; eszopiclone 2 mg, 1 mg, placebo as capsules 1, 2 and 3 respectively; or 3 placebos). On baseline and the14 discontinuation nights, sleep was recorded and scored by actigraphy for sleep efficiency (SE), sleep latency (LAT) and wake after sleep onset (WASO).

Results

Relative to the baseline night, on the first discontinuation night there was no difference in SE, LAT, and WASO. Fifteen subjects stopped taking study medication when told to discontinue and 16 subjects took study medication on one night or more. While not differing on baseline or night 1, on night 14 the last study night the medication users had a lower SE (75.9 vs 87.7 %, p<.0.004) and a longer LAT (61.5 vs 14.5 min, p<0.05).

Conclusion

Difficulty discontinuing hypnotic use is not specifically related to rebound insomnia. We reported in a companion abstract those with insomnia and hyperarousal, defined by MSLT, are those with difficulty discontinuing hypnotic use and as shown here slept poorly on the last study night.

Support

NIDA, grant#: R01DA038177 awarded to Dr. Roehrs

0492 Sleep and Hyperarousal: Inability to Discontinue Chronic Hypnotic Use

Introduction

Inability to discontinue chronic hypnotic use by people with insomnia remains a clinical concern. Sleep and hyperarousal was examined in an on-going “blinded” clinical trial in which people with insomnia are instructed to discontinue their study medication after 6 months of nightly use.

Methods

DSM-V diagnosed people with insomnia (n=31, 26 females), aged 23-61 yrs, with a polysomnographic sleep efficiency (SE) of ≤85% on a 8-hr polysomnogram, no other sleep disorders, unstable medical or psychiatric diseases or drug dependency have completed the clinical trial. Participants were randomized to zolpidem XR (12.5 mg), eszopiclone (3 mg) or placebo nightly for 6 months (blinded groups A: n=11, B: n=9, C: n=11). After 6 months, over a 2-week choice period, they were given the instruction to discontinue their nightly hypnotic use with an opportunity, if necessary, to self-administer either 1, 2, or 3 capsules of their assigned medication (zolpidem XR 6.25 mg as capsule 1, 6.25 mg as capsule 2, placebo as capsule 3; eszopiclone 2 mg, 1 mg, and placebo as capsules 1, 2 and 3 respectively; or 3 placebos.

Results

Fifteen subjects stopped taking study medication when told to discontinue. The other 16 subjects who took study medication (users) had longer MSLT (a measure of hyperarousal) sleep latency (16.2 vs 8.3 min) than non-users (p<.001) at baseline. At baseline users and non-users had similarly disturbed nocturnal sleep: SE 73.4 vs 73.9 %, with sleep latencies of 54 vs 40 min and wake time after sleep onset of 90 vs 104 min.

Conclusion

Hyperarousal, defined by MSLT and high diurnal urinary cortisol levels, has been found in some people with insomnia. High MSLTs were previously associated with dose escalation in a chronic zolpidem use study. These emerging data would suggest high MSLT may also be predictive of difficulty discontinuing hypnotic use.

Support

NIDA, grant#: R01DA038177 awarded to Dr. Roehrs

0521 Daridorexant (ACT-541468), A Dual Orexin Receptor Antagonist for the Treatment of Insomnia Disorder: Double Blind, Randomized, Phase 3 Studies for Efficacy and Safety in Adult and Elderly Patients

Introduction

Daridorexant, a potent and selective orally administered dual orexin receptor antagonist (DORA), has shown dose-dependent efficacy and is well tolerated with minimal residual next-morning effects in two phase 2 studies in adult and elderly subjects with insomnia disorder. Following the favorable phase 2 results, clinical development was pursued with two pivotal phase 3 multi-center, double-blind, randomized, placebo-controlled studies to further assess efficacy and safety in adult and elderly subjects with insomnia disorder. Long-term safety and tolerability are being further evaluated in a double-blind placebo-controlled extension study.

Methods

Each of the pivotal studies include ~900 patients (~40% ≥65y), randomized 1:1:1 to one of two daridorexant arms or placebo. The studies differ in dose only (10 or 25 mg [NCT03545191], 25 or 50 mg [NCT03575104]). Both report objective primary outcomes at 1 and 3 months based on PSG (WASO and LSP). Secondary endpoints include self-reported nighttime benefit with Total Sleep Time (sTST), and daytime benefit using the validated Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ). The patients undergo screening (7-13 d) and run-in (7-18 d) periods establishing eligibility and baseline, a 3-month double-blind treatment period, followed by a placebo run-out (7 d) to evaluate rebound insomnia and withdrawal effects and a 30-day safety follow-up. Additionally, subjects completing treatment could enroll in the 40-week double-blinded placebo-controlled extension trial [NCT03679884] to assess long-term safety.

Results

Enrollment in NCT03575104 (25/50 mg) was successfully completed and involves 76 sites across 10 countries; expected completion March 2020. Recruitment to study NCT03545191 (10/25 mg) is advanced; completion expected June 2020.

Conclusion

The comprehensive daridorexant phase 3 program includes 3 dose levels and replication of objective and subjective measurements at 1 and 3 months, while assessing self-reported nighttime benefit, and benefit during the day with a validated PRO instrument, as well as safety in insomnia disorder.

Support

Medical writing Randall Watson, (Idorsia). These studies were sponsored by Idorsia Pharmaceuticals Ltd.

0006 The Role of Stress in Sleep in Night Shift Workers: Going Beyond Circadian Misalignment

Introduction

Despite a growing need for nighttime work, few studies have characterized the causes of sleep disturbance in night shift workers beyond circadian misalignment. Recent research suggest that high sleep reactivity to stress (a predisposition for sleep disturbance due to stress) may also lead to sleep difficulties in shift workers. This study investigated if sleep reactivity is an independent predictor of daytime sleep disturbances after controlling for circadian phase.

Methods

Night shift workers (N= 48) completed an 8 hour polysomnography (PSG) during the daytime following a night shift (9am - 4pm). Circadian phase was measured using melatonin assays of saliva samples collected over 24 hours under dim light (<10 lux; Dim Light Melatonin Onset [DLMO]). Sleep reactivity was measured using the Ford Insomnia Response to Stress Test (FIRST). Linear regressions were conducted with PSG sleep parameters as outcome variables: difficulty falling asleep (Sleep Onset Latency [SOL] and Latency to Persistent Sleep [LPS]), difficulty staying asleep (Wake After Sleep Onset [WASO]), and sleep duration (Total Sleep Time [TST]). FIRST was tested as a predictor controlling for DLMO.

Results

After controlling for circadian phase, higher FIRST scores was associated with more difficulty staying asleep (WASO: t[45]=4.059, p<0.001) and shorter sleep duration (TST: t[45] = -4.403, p<0.0001), but not predictive of difficulty falling asleep (SOL: p>0.05). However, higher FIRST scores did predict a longer latency to persistent sleep (LPS: t[45]=2.272, p<0.05).

Conclusion

These results suggest that sleep reactivity to stress and circadian misalignment are independent processes that are both associated with disrupted daytime sleep in night shift workers. Given that night shift work can also cause psychosocial stress, treatments focused on circadian misalignment alone may not be sufficient. Our study highlights the need to consider sleep reactivity in the clinical management of shift work disorder.

Support

Support for this study was provided to PC by NHLBI (K23HL138166).

0496 Self-Reported Sleep During Discontinuation of Chronic Hypnotic Use

Introduction

Inability to discontinue chronic hypnotic use by people with insomnia remains a clinical concern. Self-reported sleep in an on-going “blinded” clinical trial in which people with insomnia are instructed to discontinue their study medication after 6 months of nightly use was examined and compared to objective actigraphic recordings of their sleep.

Methods

DSM-V diagnosed people with insomnia (n=31, 26 females), aged 26-61 yrs, with a polysomnographic sleep efficiency of ≤85%, no other sleep disorders, unstable medical or psychiatric diseases or drug dependency completed the clinical trial. Participants were randomized to zolpidem XR (12.5 mg), eszopiclone (3 mg) or placebo nightly for 6 months (blinded groups A: n=11, B: n=9, C: n=11). After 6 months, over a 2-week choice period, they were given the instruction to discontinue their nightly hypnotic use with an opportunity, if necessary, to self-administer either 1, 2, or 3 capsules of their assigned medication (zolpidem XR 6.25 mg, 6.25 mg, placebo; eszopiclone 2 mg, 1 mg, placebo as capsules 1, 2 and 3 respectively; or 3 placebos). On post-sleep questionnaires they reported sleep latency (LAT), wake after sleep onset (WASO), and sleep quality (Q:1-5; best - worst).

Results

15 subjects stopped taking study medication when told to discontinue. The 16 subjects who took study medication had shorter LAT on nights they took capsules then on nights they did not (31 vs 38 min, p<.03), less WASO (22 vs 44 min, p<.02) and better Q (2.3 vs 3.2, p<.002). In contrast, actigraphic recordings of sleep showed no differences in LAT, WASO, or SE.

Conclusion

For subjects who took study medication during the nights they were instructed to discontinue, they reported better sleep than on the nights they used no medication, although objectively their sleep did not differ.

Support

NIDA, grant#: R01DA038177 awarded to Dr. Roehrs

0203 To and From the Night Shift: Risky On-the-Road Driving in Night Shift Workers

Introduction

Drowsy driving is a common occupational hazard for night shift workers (NSWs). While sleep loss is commonly identified as the primary culprit of drowsy driving, another critical factor to consider is circadian phase. However, the role of circadian phase in driving safety has not been well characterized in NSWs. This study examined if dim light melatonin offset (DLMOff, i.e. the cessation of melatonin secretion) is also a relevant phase marker of susceptibility to four different subtypes of risky on-the-road driving behaviors.

Methods

On-the-road driving was monitored over 8 weeks via a mobile application that tracked risky driving behaviors using accelerometer and GPS data from cell phones (N=15; 3052 total driving events recorded). Risky driving behaviors included: 1) frequency of hard-braking events, 2) frequency of aggressive-acceleration events, 3) duration of excessive-speeding, and 4) duration of phone-usage. At week 2, participants spent 24 hours in-lab where hourly saliva samples were collected and assayed for melatonin, and DLMOff was calculated. Phase angle of driving events relative to DLMOff was used as the predictor in nested mixed-effects regressions, with risky driving behaviors as the outcome variables.

Results

The most common occurrences of risky driving were phone-usage and hard-braking. On average, NSWs had 46.7% and 42.0% of driving events with at least one occurrence of phone-usage and hard-braking, respectively. Rates of aggressive-acceleration and speeding were 24.4% and 20.4%. Positive phase angles (i.e. driving after DLMOff) were associated with reduced rates of hard-braking and aggressive-acceleration, but not of phone-usage and excessive-speeding. Specifically, rates of hard-braking and aggressive-acceleration decreased by 4.5% (p<.01) and 3.4% (p=.05) every two hours following DLMOff, respectively.

Conclusion

The study suggests DLMOff appears to be an important variable for predicting accident risk in NSWs. If replicated, circadian phase should be considered in recommendations to increase occupational health and safety of NSWs.

Support

Support for this study was provided to PC by NHLBI (K23HL138166).

0465 Association Between Physical or Sexual Abuse and Sleep Reactivity in Patients with Insomnia

Introduction

Physical and sexual abuse are common and have demonstrated associations with insomnia. A common factor predisposing individuals to the development of insomnia is sleep reactivity, yet no studies have determined the relationship between sleep reactivity and physical and/or sexual abuse.

Methods

Patients with DSM-5 insomnia disorder (N = 658; 519 F; mean age = 45.03) participated in an online randomized controlled trial of behavioral treatment of insomnia. Participants completed the Insomnia Severity Index (ISI), Ford Insomnia Response to Stress Test (FIRST), and demographic information at baseline. Abuse history was assessed with a single 4-choice item asking participants if they had a history of physical or sexual abuse. One-way analysis of variance was used to determine the level of sleep reactivity in each of the 4 abuse groups (none, physical, sexual, both) controlling for insomnia (ISI). Post-hoc analyses also compared differences in self-reported difficulties falling and staying asleep.

Results

Compared to those with no abuse history (n = 465), patients who reported both physical and sexual abuse (n = 50) had significantly elevated FIRST scores (p < .001). Results remained significant after controlling for severity of insomnia, age, and gender. Post-hoc analyses showed group differences in sleep onset latency but not wake after sleep onset.

Conclusion

Combined physical and sexual abuse are associated with higher levels of sleep reactivity to stress, and that the effects may be most prominent for difficulties falling asleep and not sleep maintenance. Prospective studies are needed to determine the potential effects of abuse on sleep reactivity, and whether sensitization of the sleep system to stress constitutes an etiological pathway in the development of insomnia disorder in survivors of abuse. Future work should also investigate potential overlapping biological markers of abuse and sleep reactivity.

Support

This study was funded by the Robert Wood Johnson Foundation (PI: Drake).

0470 A Randomized Controlled Trial of Digital Cognitive Behavioral Therapy for Insomnia in Pregnant Women

Introduction

Over half of pregnant women experience clinical insomnia, which is linked to perinatal depression and cognitive-emotional dysregulation. Despite high rates of prenatal insomnia and known maternal consequences, efficacious insomnia treatment options for this population are woefully scant. Early evidence from randomized controlled trials (RCTs) support the efficacy of face-to-face cognitive-behavioral therapy for insomnia (CBTI) for prenatal insomnia. Yet, as many patients are unable to access this specialist-driven care, a critical need exists to increase its accessibility. This RCT examined the efficacy digital CBTI via mobile health app in pregnant women with insomnia.

Methods

Single-site RCT. Ninety-one pregnant women (29.03±4.16 years) nearing/entering the third trimester who screened positive for clinical insomnia on the Insomnia Severity Index (ISI) were randomized to digital CBTI or digital sleep education control. Blinded assessments were performed before treatment, after treatment (during pregnancy), and 6 weeks after childbirth. The ISI, Pittsburgh Sleep Quality Index (PSQI), Edinburgh Postnatal Depression Scale (EPDS), and Pre-Sleep Arousal Scale’s Cognitive factor (PSAS-C) served as study outcomes.

Results

From pre to posttreatment, CBTI patients reported reductions in ISI (-4.91 points, p<.001) and PSQI (-2.98 points, p<.001) and increases in nightly sleep duration by 32 minutes. Sleep symptoms did not change during pregnancy in the control group. After childbirth, CBTI patients, relative to controls, slept longer by 40 minutes per night (p=.01) and reported better sleep maintenance. No pre or postnatal treatment effects on depression or cognitive arousal were observed.

Conclusion

Digital CBTI improves sleep quality and increases sleep duration during pregnancy and after childbirth. Digitally delivered interventions have potential to improve the health of new and expectant mothers, but CBTI likely needs to be tailored for perinatal patients to optimize outcomes.

Support

This study was funded by the American Academy of Sleep Medicine (198-FP-18, PI: Kalmbach).

Pharmacokinetics and pharmacodynamics of the novel monobactam LYS228 in a neutropenic murine thigh model of infection

Objectives

The neutropenic murine thigh infection model and a dose-fractionation approach were used to determine the pharmacokinetic/pharmacodynamic (PK/PD) relationship of LYS228, a novel monobactam antibiotic with activity against Enterobacteriaceae including carbapenem-resistant strains.

Methods

Mice (n = 4 per group) were inoculated with Enterobacteriaceae strains via intramuscular injection. Two hours post-bacterial inoculation, treatment with LYS228 was initiated. Animals were euthanized with CO2 24 h after the start of therapy and bacterial counts (log10 cfu) per thigh were determined. PK parameters were calculated using free (f) plasma drug levels.

Results

Following a dose-fractionation study, non-linear regression analysis determined that the predominant PK/PD parameter associated with antibacterial efficacy of LYS228 was the percentage of the dosing interval that free drug concentrations remained above the MIC (%fT>MIC). In a dose-dependent manner, LYS228 reduced the thigh bacterial burden in models established with Enterobacteriaceae producing β-lactamase enzymes of all classes (e.g. ESBLs, NDM-1, KPC, CMY-2 and OXA-48). The range of the calculated static dose was 86-649 mg/kg/day for the isolates tested, and the magnitude of the driver of efficacy was 37-83 %fT>MIC. %fT>MIC was confirmed as the parameter predominantly driving efficacy as evidenced by a strong coefficient of determination (r2 = 0.68). Neutrophils had minimal impact on the effect of LYS228 in the murine thigh infection model.

Conclusions

LYS228 is efficacious in murine thigh infection models using β-lactamase-producing strains of Enterobacteriaceae, including those expressing metallo-β-lactamases, ESBLs and serine carbapenemases, with the PK/PD driver of efficacy identified as %T>MIC.

How representative are insomnia clinical trials?

OBJECTIVES

To address the question of how representative subjects studied in hypnotic clinical trials are of the broader insomnia population, this study assessed initial contact rates and reasons for inclusion and exclusion during recruitment to an efficacy trial and to a safety trial of Food & Drug Administration (FDA) approved hypnotics.

METHODS

Otherwise heathy persons meeting Diagnostic Statistical Manual, Fourth Edition, Revised (DSM-IVR) criteria for insomnia were recruited. In one study, persons 32-65 yrs, were invited to a 12 month trial of nightly use of zolpidem or placebo. In the other, persons 21-64 yrs with driver's licenses were recruited to test the effects of a hypnotic on live on-the-road driving ability. In both studies screening was conducted through an initial telephone interview followed by a clinic visit.

RESULTS

In the United States (US) study 13% (n = 410) of 3180 initial contacts and in the Netherlands (NL) study 67% (n = 53) of the 79 initial contacts proceeded to the clinic visit. Of those at clinic 25% of US and 37% of NL participants failed to meet additional insomnia criteria. Mental health exclusions accounted for 24% of US and 23% of NL participants and medical problems accounted for 23% of US and 9% NL exclusions. Finally 20% of US and 26% of NL participants were excluded for drug use/abuse histories. After all screening 4% of the initial US contacts and 0% of the NL contacts entered the study.

CONCLUSIONS

These data suggest persons entering insomnia hypnotic clinical trials are a highly selected sample that is unlikely to be representative of the broad insomnia population or the population of potential medication users.

Development of a hard X-ray split-and-delay line and performance simulations for two-color pump-probe experiments at the European XFEL

A hard X-ray Split-and-Delay Line (SDL) under construction for the Materials Imaging and Dynamics station at the European X-Ray Free-Electron Laser (XFEL) is presented. This device aims at providing pairs of X-ray pulses with a variable time delay ranging from -10 ps to 800 ps in a photon energy range from 5 to 10 keV for photon correlation and X-ray pump-probe experiments. A custom designed mechanical motion system including active feedback control ensures that the high demands for stability and accuracy can be met and the design goals achieved. Using special radiation configurations of the European XFEL's SASE-2 undulator (SASE: Self-Amplified Spontaneous Emission), two-color hard x-ray pump-probe schemes with varying photon energy separations have been proposed. Simulations indicate that more than 10⁹ photons on the sample per pulse-pair and up to about 10% photon energy separation can be achieved in the hard X-ray region using the SDL.

Prevalence and Seasonality of Fleas Associated With California Ground Squirrels and the Potential Risk of Tularemia in an Outdoor Non-Human Primate Research Facility

Ectoparasites at primate research centers may be difficult to control, e.g. without exposing non-human primates (NHPs) to toxicants, but their impact on NHP health is poorly understood. In 2010, there was an epizootic of tularemia at the California National Primate Research Center (CNPRC) in Yolo County, California that resulted in 20 confirmed and suspect clinical cases in outdoors housed rhesus macaques (Macaca mulatta [Zimmermann]) and a 53% seroprevalence in the southern section of the colony. We studied ectoparasite burdens at the CNPRC in order to understand possible conditions at the time of the epizootic and provide data for the management of ectoparasites for the future. In 2015, we recorded 52 California ground squirrel (Otospermophilus beecheyi [Richardson]) burrow systems in the southern colony and collected 560 fleas. The largest number of fleas (n = 184) was collected in October and the most common species were Hoplopsyllus anomalus (Baker) (n = 331), Oropsylla montana (Baker) (n = 158), Echidnophaga gallinacea (Westwood) (n = 60), and Ctenocephalides felis (Bouché) (n = 11), all of which are opportunistically anthropophilic. Free, non-host-associated fleas included 12 H. anomalus, 9 C. felis, 6 O. Montana, and 1 E. gallinacea. We collected 1 H. anomalus from a rhesus macaque. Our results suggest a high potential for the rapid spread of zoonotic infectious diseases via flea transmission in primate facilities with ground squirrels and that flea control measures should be given a high priority.

Rodent-Pika Parasite Spillover in Western North America

Competition during the Cenozoic expansion of the Rodentia may have contributed to ecological niche reduction of pikas, which are now increasingly under threat as their habitat degrades under global climate change, while some rodents expand their ranges and overlap with pikas. Range overlap carries the possibility of disease spillover. Contemporary North American pikas are cold-adapted and relegated primarily to alpine environments where they subsist on relatively low-quality herbaceous diet. Yet their evolutionary ancestors were distributed geographically even into the subtropics. Here we examine historical and contemporary records of fleas on pikas (Ochotona princeps) from sites at different elevations in the Sierra Nevada and Rocky Mountains and the Pacific Northwest. We calculated indices of diversity from each site and spillover fraction, i.e., the proportion of fleas on pikas that have a preference for rodents. Across this range there are four pika specialist flea species, with no more than two of these per site, and 18 characteristically rodent flea species. Diversity is greatest in the Pacific Northwest and lowest in Montana. Rodent flea spillover onto pikas declines with elevation in the Rocky Mountains. These data provide evidence that rodents and pikas interact enough to allow considerable parasite spillover, and which could be exacerbated as pikas are increasingly stressed by climate change at lower elevations some rodent species expand up-elevation in the face of increasing global warming. With global climate change, both biotic and abiotic niche shrinkage demand our attention.