Comparative analysis of US real-world dosing patterns and direct infusion-related costs for matched cohorts of rheumatoid arthritis patients treated with infliximab or intravenous golimumab.

Purpose: The objectives of this study were to evaluate and compare treatment patterns and infusion-related health care resource expenditures for rheumatoid arthritis (RA) patients initiating golimumab for intravenous use (GLM-IV) and infliximab (IFX) therapy and to assess cost implications from the commercial perspective. Methods: Adult RA patients with a new episode of GLM-IV or IFX treatment between January 1, 2014 and March 31, 2016 were identified from MarketScan databases and evaluated for maintenance infusion intervals and related costs of treatment. IFX and GLM-IV patients were matched 1:1 on index medication treatment duration, gender, payer type, prior biologic use, and post-index methotrexate use. Paid amounts for drugs and associated administration costs were applied to treatment group dosing patterns. Results: Final matched treatment groups included 547 GLM-IV and 547 IFX patients (mean age = 55-56 years). Mean (SD) follow-up was 609 (161) days for GLM-IV and 613 (163) days for IFX. Treatment duration was 396 (240) days for GLM-IV and 397 (239) days for IFX. Overall, 80% of GLM-IV and 39% of IFX maintenance infusions were given approximately every 8 weeks; and 6% of GLM-IV and 53% of IFX maintenance infusions occurred more frequently than every 8 weeks (P\u3c0.001). When weighting of the maintenance infusion interval was applied, the mean number of induction plus maintenance infusions during the first year of treatment was estimated at 7.03 for GLM-IV and 9.48 for IFX. From the commercial perspective, drug plus administration costs per infusion were $5,846 for GLM-IV and$5,444 for IFX with total annual cost of therapy for GLM-IV patients costing $10,507 less than that for IFX patients in the first year and$6,774 less than that for IFX patients in subsequent years. Conclusion: Annual GLM-IV drug plus administration costs for commercial health plans were significantly less than IFX in RA patients due to differences in real-world dosing and administration. © 2019 Ellis et al

Edward Wild: Advocate of simplification and an organised profession in colonial Australia

As far as can be established, Edward Wild\u27s book, Bookkeeping by Double Entry Made Easy, was the second book on accounting to be published in Australia. Apart from the presentation of his simplified system of double entry bookkeeping, Wild advocated the establishment of an organised Australian accounting profession in his book. This paper examines the life and career of Wild and describes and analyses the content of his book. The book is placed within the local Victorian context. Possible influences on Wild\u27s writing are examined and the possible influence of Wild on later developments in Australian accounting is addressed

Pancreatectomy for non-pancreatic malignancies results in improved survival after R0 resection

<p>Abstract</p> <p>Background</p> <p>Pancreatectomy has a high morbidity but remains the only chance of cure for pancreatic cancer. Its efficacy for non-pancreatic malignancies is less clear. We reviewed our experience with pancreatectomy for non-pancreatic malignancies to determine outcomes and identify predictors of survival.</p> <p>Patients and methods</p> <p>The records of patients who underwent pancreatectomy for non-pancreatic malignancies between 1990 and 2005 were reviewed. Survival curves were constructed using the Kaplan-Meier method and compared using log-rank analysis. Cox proportional hazards was used to identify predictors of survival.</p> <p>Results</p> <p>29 patients (18 M/11 F) with a mean age of 59.9 years (range 29–86) underwent pancreatectomy for non-pancreatic malignancies. 19 (66%) primary malignancies were GI in origin. Most operations were undertaken with curative intent (76%), whereas the remainder was for symptom palliation. Pancreatectomy was completed for metastatic disease in 7 patients (24%) or en bloc to achieve negative margins in 22 patients (76%). Complete (i.e., R0) resection was achieved in 17 (59%). Perioperative mortality was 3%. Median follow-up was 15 months (range 7–172). Median overall survival was 12 months with 1-year survival of 48%. Significant predictors of improved survival by univariate analysis were R0 resection, non-GI primary, and pancreatic metastasectomy (vs. en bloc resection). Only R0 resection was predictive of long-term survival by multivariate analysis (median 21 months vs. 6).</p> <p>Conclusion</p> <p>Pancreatic resection for non-pancreatic malignancies can be completed with minimal mortality. However, incomplete resection results in poor overall survival. Pancreatectomy for non-pancreatic malignancies should only be undertaken if complete resection is possible.</p

A systematic review of platinum and taxane resistance from bench to clinic: an inverse relationship

We undertook a systematic review of the pre-clinical and clinical literature for studies investigating the relationship between platinum and taxane resistance. Medline was searched for (1) cell models of acquired drug resistance reporting platinum and taxane sensitivities and (2) clinical trials of platinum or taxane salvage therapy in ovarian cancer. One hundred and thirty-seven models of acquired drug resistance were identified. 68.1% of cisplatin-resistant cells were sensitive to paclitaxel and 66.7% of paclitaxel-resistant cells were sensitive to cisplatin. A similar inverse pattern was observed for cisplatin vs. docetaxel, carboplatin vs. paclitaxel and carboplatin vs. docetaxel. These associations were independent of cancer type, agents used to develop resistance and reported mechanisms of resistance. Sixty-five eligible clinical trials of paclitaxel-based salvage after platinum therapy were identified. Studies of single agent paclitaxel in platinum-resistant ovarian cancer where patients had previously recieved paclitaxel had a pooled response rate of 35.3%, n=232, compared to 22% in paclitaxel naïve patients n=1918 (p<0.01, Chi-squared). Suggesting that pre-treatment with paclitaxel may improve the response of salvage paclitaxel therapy. The response rate to paclitaxel/platinum combination regimens in platinum-sensitive ovarian cancer was 79.5%, n=88 compared to 49.4%, n=85 for paclitaxel combined with other agents (p<0.001, Chi-squared), suggesting a positive interaction between taxanes and platinum. Therefore, the inverse relationship between platinum and taxanes resistance seen in cell models is mirrored in the clinical response to these agents in ovarian cancer. An understanding of the cellular and molecular mechanisms responsible would be valuable in predicting response to salvage chemotherapy and may identify new therapeutic targets

Critical experiential education : integrating critical pedagogy, social justice education, and experiential education to re-imagine teaching and learning

This dissertation examines the lived experiences of teachers, students, and administrators at a public charter school based on progressive philosophies such as experiential education, restorative justice, and social justice. Through a qualitative constructivist grounded theory approach, this research discusses the ways that experiential education influences the teaching and learning at this school. Interviews and observations were utilized to gain a more thorough understanding of the ways in which these progressive pedagogies are enacted. Experiential education provides a co-created and student-centered learning environment that prepares students for lives as citizens of local and global communities. As a philosophy, experiential education can be utilized to help make meaning of experiences and motivate future actions. Central to this project is the proposal of a new frame for critical experiential education that intentionally integrates social justice education, critical pedagogy, and experiential education. The creation of this frame attempts to put these seemingly disparate fields into conversation with one another thereby intertwining the elements of each such that the gaps found amongst them can be filled. The value of this work is the ability to create a more robust and comprehensive understanding and implementation of a frame of critical experiential education that is intentionally grounded in aspects of power, justice, context, history, and identity in order to recognize and encourage future action towards the alleviation of oppression in all its forms

Predicting high anger intensity using ecological momentary assessment and wearable-derived physiological data in a trauma-affected sample

Background: Digital technologies offer tremendous potential to predict dysregulated mood and behavior within an individual's environment, and in doing so can support the development of new digital health interventions. However, no prediction models have been built in trauma-exposed populations that leverage real-world data.Objective: This project aimed to determine if wearable-derived physiological data can predict anger intensity in trauma-exposed adults.Method: Heart rate variability (i.e. a commercial wearable stress score) was combined with ecological momentary assessment (EMA) data collected over 10 days (n = 84). Five summary measures from stress scores collected 10 min prior to each EMA were selected using factor analysis of 24 candidates.Results: A high area under the receiver operating curve (AUC) was found for a logistic mixed effects model including these measures as predictors, ranging 0.761 (95% CI:0.569-0.921) to 0.899 (95% CI:0.784-0.980) across cross-validation methods.Conclusions: While the predictive performance may be overly optimistic due to the outcome prevalence (13.8%) and requires replication with larger datasets, our promising findings have significant methodological and clinical implications for researchers looking to build novel prediction and treatment approaches to respond to posttraumatic mental health

Complex pleural empyema can be safely treated with vacuum-assisted closure

<p>Abstract</p> <p>Objective</p> <p>For patients with postoperative pleural empyema, open window thoracostomy (OWT) is often necessary to prevent sepsis. Vacuum-assisted closure (VAC) is a well-known therapeutic option in wound treatment. The efficacy and safety of intrathoracal VAC therapy, especially in patients with pleural empyema with bronchial stump insufficiency or remain lung, has not yet been investigated.</p> <p>Methods</p> <p>Between October 2009 and July 2010, eight consecutive patients (mean age of 66.1 years) with multimorbidity received an OWT with VAC for the treatment of postoperative or recurrent pleural empyema. Two of them had a bronchial stump insufficiency (BPF).</p> <p>Results</p> <p>VAC therapy ensured local control of the empyema and control of sepsis. The continuous suction up to 125 mm Hg cleaned the wound and thoracic cavity and supported the rapid healing. Additionally, installation of a stable vacuum was possible in the two patients with BPF. The smaller bronchus stump fistula closed spontaneously due to the VAC therapy, but the larger remained open.</p> <p>The direct contact of the VAC sponge did not create any air leak or bleeding from the lung or the mediastinal structures. The VAC therapy allowed a better re-expansion of remaining lung.</p> <p>One patient died in the late postoperative period (day 47 p.o.) of multiorgan failure. In three cases, VAC therapy was continued in an outpatient service, and in four patients, the OWT was treated with conventional wound care. After a mean time of three months, the chest wall was closed in five of seven cases. However, two patients rejected the closure of the OWT. After a follow-up at 7.7 months, neither recurrent pleural empyema nor BPF was observed.</p> <p>Conclusion</p> <p>VAC therapy was effective and safe in the treatment of complicated pleural empyema. The presence of smaller bronchial stump fistula and of residual lung tissue are not a contraindication for VAC therapy.</p