Interleukin (IL)-2, a T-cell cytokine used to treat malignant melanoma, can induce profound depression. To determine whether pretreatment with the antidepressant escitalopram could reduce IL-2-induced neuroendocrine, immune, and neurobehavioral changes, 20 patients with Stage IV melanoma were randomized to either placebo or the serotonin reuptake inhibitor, escitalopram (ESC) 10-20 mg/day, 2 weeks before, and during IL-2 treatment (720 000 units/kg Q8 h  5 days (1 cycle) every 3 weeks  4 cycles). Generalized estimation equations were used to examine HPA axis activity (plasma ACTH and cortisol), immune activation (plasma IL-6), and depressive symptoms (Hamilton Depression Rating Scale (HDRS) score). Tolerance of IL-2 treatment (concomitant medications required) and adherence (number of IL-2 doses received) were also assessed. Both the groups (ESC (n ¼ 9), placebo (n ¼ 11)) exhibited significant IL-2-induced increases in plasma cortisol, IL-6, and depressive symptoms (po0.05), as well as a temporal trend for increases in plasma ACTH (p ¼ 0.054); the effects of age and treatment were not significant. Higher plasma ACTH concentrations were associated with higher depressive symptoms during cycles 1-3 of IL-2 therapy (po0.01). Although ESC had no significant effects on ACTH, cortisol, IL-6, tolerance of, or adherence to IL-2, ESC treatment was associated with lower depressive symptoms, ie, a maximal difference of B3 points on the HDRS, which, though not statistically significant (in part, due to small sample size), represents a clinically significant difference according to the National Institute for Health and Clinical Excellence guidelines. A larger sample size will establish whether antidepressant pretreatment can prevent IL-2-induced neurobehavioral changes.

OBJECTIVES: We evaluated the safety and efficacy of a test-to-stay program for unvaccinated students and staff who experienced an unmasked, in-school exposure to someone with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Serial testing instead of quarantine was offered to asymptomatic contacts. We measured secondary and tertiary transmission rates within participating schools and in-school days preserved for participants. METHODS: Participating staff or students from universally masked districts in North Carolina underwent rapid antigen testing at set intervals up to 7 days after known exposure. Collected data included location or setting of exposure, participant symptoms, and school absences up to 14 days after enrollment. Outcomes included tertiary transmission, secondary transmission, and school days saved among test-to-stay participants. A prespecified interim safety analysis occurred after 1 month of enrollment. RESULTS: We enrolled 367 participants and completed 14-day follow-up on all participants for this analysis. Nearly all (215 of 238, 90%) exposure encounters involved an unmasked index case and an unmasked close contact, with most (353 of 366, 96%) occurring indoors, during lunch (137 of 357, 39%) or athletics (45 of 357, 13%). Secondary attack rate was 1.7% (95% confidence interval: 0.6%–4.7%) based on 883 SARS-CoV-2 serial rapid antigen tests with results from 357 participants; no tertiary cases were identified, and 1628 (92%) school days were saved through test-to-stay program implementation out of 1764 days potentially missed. CONCLUSION: After unmasked in-school exposure to SARS-CoV-2, even in a mostly unvaccinated population, a test-to-stay strategy is a safe alternative to quarantine.

Substantivity of sunscreen formulations is affected by the wash-out rate of ultraviolet-absorber and -reflector compounds in water. Water-resistance of sunscreen formulations is currently determined according to a standardized European Cosmetic Toiletry and Perfumery Association (COLIPA) protocol, encompassing the determination of a minimal erythemal dose before and after a defined immersion step in water. It can be supposed that the higher the wettability of a treated skin area, the higher is the wash-out rate of sunscreen compounds. This present report addresses the validity of determining the wettability of treated skin alone as a measure for the water-resistance of sunscreen products. The report addresses the robustness, accuracy and congruence of a recently developed wettability test, based on the measurement of the contact angle (CA) of a sessile water drop on treated skin areas. Contact angle data of 66 sunscreen formulations are compared with the corresponding results of 81 water-resistance tests, using the sun protection factor (SPF)/immersion/SPF method. Sunscreen products tested by the CA method were applied to the skin of the volar forearm of test subjects at a defined dose and drying-time, using a standardized application and recording device. Contact angles between a sessile water drop and skin were recorded by a Charge-Coupled Device (CCD) camera and subjected to automatic contour analysis. Taking the SPF/immersion/SPF method as gold standard, accuracy parameters of the CA method were determined. By using an appropriate cut-off level of CAs, the CA method has a specificity and positive-predictive value of 100%, and turns out to be a reliable screening method to identify water-resistant formulations. Based on our findings, those formulations that give CAs above 30 degrees may be categorized water-proof without further testing by the COLIPA water-resistance method.

OBJECTIVES: Masking is an essential coronavirus 2019 mitigation tool assisting in the safe return of kindergarten through 12th grade children and staff to in-person instruction; however, masking adherence, compliance evaluation methods, and potential consequences of surveillance are currently unknown. We describe two school districts' approaches to promote in-school masking and the consequent impact on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) secondary transmission. METHODS: Two North Carolina school districts developed surveillance programs with daily vs. weekly interventions to monitor in-school masking adherence. Safety teams recorded the proportion of students and staff appropriately wearing masks and provided real-time education after observation of improper masking. Primary infections, within-school transmission, and county-level SARS-CoV-2 infection rates were assessed. RESULTS: Proper mask use was high in both intervention groups and districts. There were variations by grade level, with lower rates in elementary schools, and proper adherence being higher in the weekly surveillance group. Rates of secondary transmission were low in both districts with surveillance programs, regardless of intervention frequency. CONCLUSIONS: Masking surveillance interventions are effective at ensuring appropriate masking at all school levels. Creating a culture of safety within schools led by local leadership is important and a feasible opportunity for school districts with return to in-person school. In our study of schools with high masking adherence, secondary transmission was low.

Formal mentoring relationships socialize Doctor of Philosophy (PhD) students to their current and future roles as nursing scholars. Despite formal mentoring, some students may desire or benefit from additional mentoring in an informal setting. Informal mentoring complements the one-to-one relationship students develop with a primary faculty mentor or dissertation chair. This manuscript describes the development, implementation, and evaluation of a student-driven, peer mentorship model, titled Partnership for Development. This small group, peer mentorship model was implemented in a PhD program at a School of Nursing during an academic year. Five student peer facilitators organized a total of 32 PhD students, 2 post-doctoral associates, and invited 5 faculty to participate. Data includes pre- and post-implementation surveys completed by the students and peer facilitator field notes. Student reported post-participation benefits included: getting to know faculty in an informal setting (n = 6), socializing with students from other cohorts (n = 6), and obtaining a sense of camaraderie with other PhD students (n = 5). We recommend peer mentorship for other PhD programs as a way to socialize PhD students into the role of nurse scientist and assist students during their tenure as a PhD student.

OBJECTIVES We evaluated the impact of a test-to-stay (TTS) program on within-school transmission and missed school days in optionally masked kindergarten through 12th grade schools during a period of high community severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. METHODS Close contacts of those with confirmed SARS-CoV-2 infection were eligible for enrollment in the TTS program if exposure to a non-household contact occurred between 11/29/2021 and 01/28/2022. Consented participants avoided school exclusion if they remained asymptomatic and rapid antigen testing at pre-specified intervals remained negative. Primary outcomes included within-school tertiary attack rate (test positivity among close contacts of positive TTS participants) and school days saved among TTS participants. We estimated the number of additional school-acquired cases resulting from TTS and eliminating school exclusion. RESULTS A total of 1675 participants tested positive or received at least one negative test between days 5 and 7, and completed follow-up; 92% were students and 91% were exposed to an unmasked primary case. We identified 201 positive cases. We observed a tertiary attack rate of 10% (95% CI 6–19%) and 7,272 (89%) of potentially missed days were saved through TTS implementation. We estimated one additional school-acquired case for every 21 TTS participants remaining in school buildings during the entire study period. CONCLUSIONS Even in the setting of high community transmission, a TTS strategy resulted in substantial reduction in missed school days in optionally masked schools.

Background Alterations in cognitive/affective functioning are among the most challenging side effects experienced by 80% of patients with metastatic melanoma and metastatic renal cell carcinoma undergoing high-dose Interleukin-2 (IL-2) therapy. Objective The purpose of this literature review is to describe what is known about IL-2—induced cognitive/affective symptoms, their prevalence and level of severity, and synthesize findings to determine areas for future research to address symptom management challenges. This review describes the IL-2 patient experience, and the pathophysiology leading to these changes. Methods An online electronic search using PubMed was performed to identify relevant literature published between 1992 and 2015. Of the original 113 manuscripts, information was extracted from nine articles regarding cognitive symptoms, affective symptoms, sample size, research design, reliability and validity. Results Our review suggests that the trajectories, breadth and depth of cognitive/affective symptoms have yet to be described. Despite intervention studies designed to address the psychosocial complications of IL-2, an understanding of the level of altered cognitive/affective symptoms experienced by IL-2 patients remains unclear. Conclusion Our literature review reveals a lack of standardization when assessing, reporting and managing cognitive/affective symptoms. Patients/family members have reported cognitive/affective symptoms to be the most alarming and difficult symptoms, yet these symptoms are not adequately screened for and patients were not informed about potential changes. Implications for Practice Assessing patients for cognitive/affective alterations is important to reduce anxiety while improving outcomes. Education about the illness trajectory (what to expect during/after treatment) can help care partners/patients set realistic shared expectations, and increase coping.

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening testing is a recommended mitigation strategy for schools, although few descriptions of program implementation are available. Methods Kindergarten through 12th grade (K–12) students and staff practicing universal masking during the delta and omicron variant waves from 5 schools in Durham, North Carolina and 8 in Kansas City, Missouri participated; Durham’s program was structured as a public health initiative facilitated by school staff, and Kansas City’s as a research study facilitated by a research team. Tests included school-based rapid antigen or polymerase chain reaction testing, at-home rapid antigen testing, and off-site nucleic acid amplification testing. Results We performed nearly 5,700 screening tests on more than 1,600 K–12 school students and staff members. The total cost for the Durham testing program in 5 public charter K–12 schools, each with 500–1000 students, was $246,587 and approximately 752 hours per semester; cost per test was $70 and cost per positive result was $7,076. The total cost for the Kansas City program in 8 public K–12 schools was $292,591 and required approximately 537 hours in personnel time for school-based testing; cost per test was $132 and cost per positive result was $4,818. SARS-CoV-2 positivity rates were generally lower (0–16.16%) than rates in the community (2.7–36.47%) throughout all testing weeks. Conclusions and Relevance Voluntary screening testing programs in K–12 schools are costly and rarely detect asymptomatic positive persons, particularly in universally masked settings.