Market Access Analysis of Biologics and Small-Molecule Inhibitors for Inflammatory Bowel Disease Among US Health Insurance Policies.

BACKGROUND AND AIMS:Treatment pathways for ulcerative colitis (UC) and Crohn's disease (CD) are shifting to a more individualized, risk-stratified approach. The perception is that insurance policies may not have implemented this paradigm shift, particularly regarding access to newer agents. We evaluated patient access to advanced therapies by analyzing policy information from the Managed Markets Insight and Technology database. METHODS:Coverage status as of December 2018 for all US lives was queried for adalimumab, infliximab, infliximab-dyyb, tofacitinib, ustekinumab, and vedolizumab by indication (UC and/or CD) and medical or pharmacy coverage benefit. Coverage status was classified by the number of biologic steps before access to specified drug as "No Biologic," "1 Prior Biologic," "2+ Prior Biologics," "Not Covered." Unknown lives were excluded from the analyses. RESULTS:Coverage analysis was available for approximately 302 million lives under each medical and pharmacy benefit. Our analysis indicates that approximately half of covered lives had access to all agents (except tofacitinib) as first-line therapy; two-thirds had access after one biologic exposure. Among newer agents, vedolizumab had the widest coverage. For indications of UC and CD, 81% of known lives had access to vedolizumab with no prior biologic exposure required ("No Biologic"), 95% after "No Biologic" + "1 prior Biologic." Geographic variations were identified for coverage patterns. CONCLUSIONS:This US-based healthcare policy analysis points to an increased access to advanced therapies for UC and CD. An individualized, risk-stratified treatment approach integrating advanced therapies, including those recently approved, into treatment pathways for UC and CD is feasible

An investigation of the RWPE prostate derived family of cell lines using FTIR spectroscopy

Interest in developing robust, quicker and easier diagnostic tests for cancer has lead to an increased use of Fourier transform infrared (FTIR) spectroscopy to meet that need. In this study we present the use of different experimental modes of infrared spectroscopy to investigate the RWPE human prostate epithelial cell line family which are derived from the same source but differ in their mode of transformation and their mode of invasive phenotype. Importantly, analysis of the infrared spectra obtained using different experimental modes of infrared spectroscopy produces similar results. The RWPE family of cell lines can be separated into groups based upon the method of cell transformation rather than the resulting invasiveness/aggressiveness of the cell line. The study also demonstrates the possibility of using a genetic algorithm as a possible standardised pre-processing step and raises the important question of the usefulness of cell lines to create a biochemical model of prostate cancer progression

Children, family and the state : revisiting public and private realms

The state is often viewed as part of the impersonal public sphere in opposition to the private family as a locus of warmth and intimacy. In recent years this modernist dichotomy has been challenged by theoretical and institutional trends which have altered the relationship between state and family. This paper explores changes to both elements of the dichotomy that challenge this relationship: a more fragmented family structure and more individualised and networked support for children. It will also examine two new elements that further disrupt any clear mapping between state/family and public/private dichotomies: the third party role of the child in family/state affairs and children's application of virtual technology that locates the private within new cultural and social spaces. The paper concludes by examining the rise of the 'individual child' hitherto hidden within the family/state dichotomy and the implications this has for intergenerational relations at personal and institutional levels

Regeneration in gap models: priority issues for studying forest responses to climate change

Recruitment algorithms in forest gap models are examined with particular regard to their suitability for simulating forest ecosystem responses to a changing climate. The traditional formulation of recruitment is found limiting in three areas. First, the aggregation of different regeneration stages (seed production, dispersal, storage, germination and seedling establishment) is likely to result in less accurate predictions of responses as compared to treating each stage separately. Second, the relatedassumptions that seeds of all species are uniformly available and that environmental conditions are homogeneous, are likely to cause overestimates of future species diversity and forest migration rates. Third, interactions between herbivores (ungulates and insect pests) and forest vegetation are a big unknown with potentially serious impacts in many regions. Possible strategies for developing better gap model representations for the climate-sensitive aspects of each of these key areas are discussed. A working example of a relatively new model that addresses some of these limitations is also presented for each case. We conclude that better models of regeneration processes are desirable for predicting effects of climate change, but that it is presently impossible to determine what improvements can be expected without carrying out rigorous tests for each new formulation

Christopher Lasch's the culture of narcissism the failure of a critique of psychological politics

Christopher Lasch's bestseller The Culture of Narcissism had, beyond doubt, a significant impact-it was even read in the White House. Today it is not only still frequently taught and referenced, there are also still empirical studies conducted which try to verify Lasch's assertion of the preponderance of the narcissistic personality. This paper re-reads the book as a critique of psychologization processes, and this allows us to discern, besides the flaws in Lasch's approach, a fundamental insight which goes largely unnoticed by both Lasch's opponents and his proponents. Following this, the article will situate subjectivity within the matrix of psychology, science, psychoanalysis, and politics. In this way a critique of contemporary forms of psychologization-psychologization under globalization, as it were-is made possible

Anti-Nirvana: crime, culture and instrumentalism in the age of insecurity

‘Anti-Nirvana’ explores the relationship between consumer culture, media and criminal motivations. It has appeared consistently on the list of the top-ten most-read articles in this award-winning international journal, and it mounts a serious neo-Freudian challenge to the predominant naturalistic notion of ‘resistance’ at the heart of liberal criminology and media studies. It is also cited in the Oxford Handbook of Criminology and other criminology texts as a persuasive argument in support of the theory that criminality amongst young people is strongly linked to the acquisitive values of consumerism and the images of possessive individualism that dominate mass media

From ‘Young Women’ to ‘Female Adolescents’:Dutch Advice Literature during the Long Nineteenth Century

In late eighteenth-century Europe, there was a rapid expansion in the publication of advice books directed at young adult women. Based on an examination of conduct books published in the Netherlands, this chapter traces the changing format of the genre from the last quarter of the eighteenth century through to the early decades of the twentieth century. It explores how women pedagogues in the nineteenth century developed new ways of advising young women that gave readers greater control over their life choices. In the early twentieth century, the emerging social sciences drew attention to the physical and emotional changes involved in female adolescence, prescribing for the young woman strict forms of behaviour

Early respiratory viral infections in infants with cystic fibrosis

This article is made available for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.Background Viral infections contribute to morbidity in cystic fibrosis (CF), but the impact of respiratory viruses on the development of airway disease is poorly understood. Methods Infants with CF identified by newborn screening were enrolled prior to 4 months of age to participate in a prospective observational study at 4 centers. Clinical data were collected at clinic visits and weekly phone calls. Multiplex PCR assays were performed on nasopharyngeal swabs to detect respiratory viruses during routine visits and when symptomatic. Participants underwent bronchoscopy with bronchoalveolar lavage (BAL) and a subset underwent pulmonary function testing. We present findings through 8.5 months of life. Results Seventy infants were enrolled, mean age 3.1 ± 0.8 months. Rhinovirus was the most prevalent virus (66%), followed by parainfluenza (19%), and coronavirus (16%). Participants had a median of 1.5 viral positive swabs (range 0–10). Past viral infection was associated with elevated neutrophil concentrations and bacterial isolates in BAL fluid, including recovery of classic CF bacterial pathogens. When antibiotics were prescribed for respiratory-related indications, viruses were identified in 52% of those instances. Conclusions Early viral infections were associated with greater neutrophilic inflammation and bacterial pathogens. Early viral infections appear to contribute to initiation of lower airway inflammation in infants with CF. Antibiotics were commonly prescribed in the setting of a viral infection. Future investigations examining longitudinal relationships between viral infections, airway microbiome, and antibiotic use will allow us to elucidate the interplay between these factors in young children with CF

'We don't learn democracy, we live it!' : consulting the pupil voice in Scottish schools

As the education for citizenship agenda continues to impact on schools, there is a need to begin the discussion around examining the kind of initiatives that can push it forward. In Scotland the proposals should, it is argued, permeate the curriculum throughout the school. Yet there is the fear that the responsibility of all can become the responsibility of none. This paper examines, through case study research carried out by the authors, initiatives in schools designed to take forward the citizenship agenda in the light of children's rights. The first two relate to firstly the impact of pupil councils in primary schools and secondly the impact of discussing controversial issues in the primary classroom. The third outlines the impact on values and dispositions of developing more participatory, democratic practice in the classroom. The paper concludes by calling for both more initiatives of this type and more evaluation of their worth