Biosimilar strategic implementation at a large health system

Disclaimer In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose This article highlights one health system’s response to the market influx of biosimilars with the establishment of a process for formulary review and selection of preferred agents and support for therapeutic interchanges. Summary Through assessment of available literature, insurance payor coverage, and manufacturer-anticipated approvals of biosimilars, a strategic stance was developed to guide biosimilar order preparation, review, adoption, and implementation. The electronic medical record (EMR) is prepared for biosimilar implementation at least 6 to 12 months ahead of anticipated formulary review. The review includes assessment of a class (reference product and available biosimilars) after at least 2 biosimilars become available. Key health-system departments and clinicians are enlisted to support review of clinical, safety, and economic implications. Implementation of a preferred product relies on standard education, formulary availability, and staff awareness to address any perceived patient safety concerns and gather provider support. The standard steps developed now apply to all future biosimilar reviews, adoption plans, and ongoing monitoring. Barriers evaluated include changes in payor coverage and challenges in preparation of the EMR for future biosimilars, meeting precertification team education needs, and providing operational support for pharmacy inventory. Conclusion To date, use of 5 preferred biosimilar products has led to significant cost savings to the institution, and the process has been endorsed by providers. The institution’s successes can be attributed to clear communication with stakeholders and the development of a deliberate process, led by a multidisciplinary leadership team, for managing formulary, safety, and operational barriers in a thoughtful and systematic manner.

Complex analysis and monitoring of the environment based on earth sensing data

We study a problem of complex analysis and monitoring of the environment based on Earth Sensing Data, with the emphasis on the use of hyperspectral images (HSI), and propose a solution based on developing algorithmic procedures for HSI processing and storage. HSI is considered as a two-dimensional field of pixel signatures. Methods are proposed for evaluating the similarity of a HSI pixel signature with a reference signature, via simple alignment transformations: identical; amplitude scaling; shift along y-axis; and a combination of the last two. A clustering / recognition method with self-learning is proposed, which determines values of the transformation parameters that ensure the alignment of the current pixel signature with the reference signature. Similarity with the reference is determined by a standard deviation value. A HSI compression method with controlled losses has been proposed. The method forms a basis via accumulating reference signatures and represents the rest of the signatures by parameters matching them with the already detected class-reference signature. In an experiment with the GSI f100520t01p00-12 data of the AVIRIS spectrometer, the method provided a 2 % loss and compression coefficients of the original HSI ranging from 43 to 165 for various types of alignment transformation, while not requiring archiving and thus maintaining active access to the HSI and using the list of references as an analogue of the HSI palette. An algorithm for the formation of dense groups of detectable objects (for example, oil spots) and their nonconvex contouring, controlled by 4 parameters, is proposed. A pilot version of the concept of geographic information system (GIS) and an appropriate database management system (DBMS) was built and implemented, which provides monitoring and is based on the prioritized processing and storage of the HSI, which serve as a data source for the system. A laboratory complex with new algorithms for processing and storing the GSE is introduced into the structure of the system.

Various Response Functions in Lattice Domes Reliability Via Analytical Integration and Finite Element Method

The main aim of this work is to verify an influence of the response function type in direct symbolic derivation of the probabilistic moments and coefficients of the structural state variables of axisymmetric spherical steel dome structures. The second purpose is to compare four various types of domes (ribbed, Schwedler, geodesic as well as diamatic) in the context of time-independent reliability assessment in the presence of an uncertainty in the structural steel Young modulus. We have considered various analytical response functions to approximate fundamental eigenfrequencies, critical load multiplier, global extreme vertical and horizontal displacements as well as local deformations. Particular values of the reliability indices calculated here can be of further assistance in the reliability assessment by comparing the minimal one with its counterpart given in the Eurocode depending upon the durability class, reference period and the given limit state type.

Validation of Direct Beam Irradiance Measurements From Rotating Shadowband Irradiometers in a Region With Different Atmospheric Conditions

Rotating shadowband irradiometers (RSIs) are a common type of radiation sensors for measurement of direct normal irradiance (DNI) at remote sites where daily maintenance of the instruments is not feasible or practicable. Their primordial lower accuracy due to systematic deviations of the photodiode response can be improved significantly with a thorough calibration of each RSI against high precision sensors and application of suitable corrections on the raw data. With different available correction functions for the systematic errors, RSI data coincide with first class reference sensors within 2–3% root mean square deviation (RMSD) for 10 min averages of DNI and meet the annual irradiation sum within 1.5%. Such comparisons of RSI data to reference irradiances have only been published for a small number of sites. To endorse the credibility of RSI measurements, it has to be shown that these accuracies derived for certain locations are also valid at other sites with differing atmospheric conditions. Therefore, a parallel measurement campaign with six RSIs and a reference station with first class and secondary standard instrumentation has been performed in the in the extreme climate of the United Arab Emirates (UAE). The results of this comparison are presented in this paper. The stated empiric accuracy could be validated and confirmed for the UAE.

ANALISIS FAKTOR-FAKTOR YANG MEMPENGARUHI KEPUTUSAN NASABAH UNTUK MENYIMPAN DANA PADA BANK SYARI’AH DI KOTA PURWOKERTO (Studi pada BRI Syariah dan Bank Muammalat Cabang Purwokerto)

This study was conducted to analyze the factors that influence a client's decision to deposit funds in Islamic banks. In this study, the data used is primary data by questionnaire to customers of BRI Syariah and bank Muammalat Purwokerto with a sample of 156 reaponden. In the sampling method, the author uses purposive sampling method. The analysis used in this study using validity and reliability test, classic assumption test, multiple regression analysis, and hypothesis testing F-test, t-test and the coefficient of determination (R2). The results showed that the characteristic variable bank, syariah factors, social class, reference groups, the role of family factors, factors perceived marketing stimuli simultaneously have a positive impact on the customer's decision to save in Islamic banks. Partial test results can be concluded that social class variables and variable marketing stimuli have a positive effect but not significant, while the variable characteristics of the bank, syariah factors, reference groups and family roles positive and significant impact on customer decisions. Concluded that all six variables are able to explain the customer's decision amounted to 44.5% (adjusted R-square value), while the remaining 55.5% is explained by other factors beyond the research Keyword: Factor analysis, the customer's decision, Islamic banks

Polyphasic characterization of Stigonema dinghuense, sp. nov. (Cyanophyceae, Nostocophycidae, Stigonemaceae), from Dinghu Mountain, south China

Polyphasic taxonomic studies have been largely conducted at genus/species levels in cyanobacteria, leading to the description of numerous cyanobacterial genera and species. The present study describes a new cyanobacterial species Stigonema dinghuense, sp. nov. Song et Li based on the combination of morphological, genetic, and ecological evidences. This new species was collected from a wet rocky wall in Dinghu Mountain, Guangdong Province, China. Stigonema dinghuense was morphologically similar to Stigonema mamillosum, the type species of the genus, however, Stigonema dinghuense grew on the rocky wall in subtropical region and the type species Stigonema mamillosum inhabited in subfrigid and frigid zones, reflecting a relatively large difference in ecology. 16S rRNA sequences based phylogeny revealed that all the Stigonema species/strains reported so far, including S. dinghuense, grouped into a monophyletic cluster. Phylogenetic analyses based on 16S rRNA, nifH and rbcLX gene sequences yielded the congruent support for the monophyly of heterocytous cyanobacteria. The true branching cyanobacteria (formerly Stigonematales) were separated into four major groups, three of which intermixed with Scytonemataceae.

1D BAR CODE READING ON CAMERA PHONES

The availability of camera phones provides people with a mobile platform for decoding bar codes, whereas conventional scanners lack mobility. However, using a normal camera phone in such applications is challenging due to the out-of-focus problem. In this paper, we present the research effort on the bar code reading algorithms using a VGA camera phone, NOKIA 7650. EAN-13, a widely used 1D bar code standard, is taken as an example to show the efficiency of the method. A wavelet-based bar code region location and knowledge-based bar code segmentation scheme is applied to extract bar code characters from poor-quality images. All the segmented bar code characters are input to the recognition engine, and based on the recognition distance, the bar code character string with the smallest total distance is output as the final recognition result of the bar code. In order to train an efficient recognition engine, the modified Generalized Learning Vector Quantization (GLVQ) method is designed for optimizing a feature extraction matrix and the class reference vectors. 19 584 samples segmented from more than 1000 bar code images captured by NOKIA 7650 are involved in the training process. Testing on 292 bar code images taken by the same phone, the correct recognition rate of the entire bar code set reaches 85.62%. We are confident that auto focus or macro modes on camera phones will bring the presented method into real world mobile use.

Paternal ages below or above 35 years old are associated with a different risk of schizophrenia in the offspring

BackgroundA link between older age of fatherhood and an increased risk of schizophrenia was detected in 1958. Since then, 10 studies attempted to replicate this result with different methods, on samples with different origins, using different age classes. Defining a cut-off at which the risk is significantly increased in the offspring could have an important impact on public health.MethodsA meta-analysis (Meta Win®) was performed, assessing the mean effect size for each age class, taking into account the difference in age class references, and the study design.ResultsAn increased risk is detected when paternal age is below 20 (compared to 20–24), over 35 (compared to below 35), 39 (compared to less than 30), and 54 years old (compared to less than 25). Interestingly, 35 years appears nevertheless to be the lowest cut-off where the OR is always above 1, whatever the age class reference, and the smallest value where offspring of fathers below or above this age have a significantly different risk of schizophrenia.ConclusionNo threshold can be precisely defined, but convergent elements indicate ages below or above 35 years. Using homogeneous age ranges in future studies could help to clarify a precise threshold.