Does additional monitoring status increase the reporting of adverse drug reactions? An interrupted time series analysis of EudraVigilance data:An interrupted time series analysis of EudraVigilance data

Purpose: To evaluate the impact of including a medicine in the list of medicinal products subject to additional monitoring (AM) on the reporting of adverse drug reactions (ADRs) in the european economic area (EEA).Methods: Interrupted time series using the monthly number of EEA ADR reports in EudraVigilance during 12 months before and after the addition to AM list. The main outcome was the change (%) in reporting of ADRs with step change as the a priori impact model. Further time series analysis was performed using Joinpoint Regression.Results: The analysis included 11 active substances. No significant immediate (step change) increase of reporting was identified for any product at time of addition to AM list. We identified a significant gradual increase of ADR reporting after addition to AM list (slope change) for two out of five new products—boceprevir (10% per month, 95% confidence interval (CI) 3%–18%) and denosumab-Xgeva (13% per month, 95% CI 4%–22%). No change was identified for Prolia, another denosumab-containing product not subject to AM. No significant increase was identified for any product included in the AM list due to the requirement to conduct a PASS. Conversely, a gradual decrease in reporting was identified for natalizumab (−5% per month; 95% CI −10% to −1%), rivaroxaban (−5%; −8 to −3%), and varenicline (−16%; −21 to −10%). The results were corroborated by the Joinpoint analyses, which yielded similar results.Conclusions: We identified limited evidence that reporting of ADRs increased modestly and gradually for some new products and not for products with PASS requirement.</p

Variation in cold hardiness and carbohydrate concentration from dormancy induction to bud burst among provenances of three European oak species

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Phase-field crystal modelling of crystal nucleation, heteroepitaxy and patterning

We apply a simple dynamical density functional theory, the phase-field-crystal (PFC) model, to describe homogeneous and heterogeneous crystal nucleation in 2d monodisperse colloidal systems and crystal nucleation in highly compressed Fe liquid. External periodic potentials are used to approximate inert crystalline substrates in addressing heterogeneous nucleation. In agreement with experiments in 2d colloids, the PFC model predicts that in 2d supersaturated liquids, crystalline freezing starts with homogeneous crystal nucleation without the occurrence of the hexatic phase. At extreme supersaturations crystal nucleation happens after the appearance of an amorphous precursor phase both in 2d and 3d. We demonstrate that contrary to expectations based on the classical nucleation theory, corners are not necessarily favourable places for crystal nucleation. Finally, we show that adding external potential terms to the free energy, the PFC theory can be used to model colloid patterning experiments.Comment: 21 pages, 16 figure

A theoretical model to elucidate the elusive concept ‘voice' for interpreters

This paper is an attempt to elucidate the concept of voice for interpreters in relation to the equally elusive concept pleasant voice for interpreters. The point of departure is that the concept voice for interpreting has to do with the physical properties of a speaker’s voice, which may lead to the effect that a speaker’s voice is heard as pleasant or unpleasant by a listener, depending on how a speaker uses or deploys these physical properties. The paper employs an interdisciplinary approach to reviewing relevant literature and shows that for better interpreter education and interpreting assessment, there is a need to unravel, and unify existing understandings of the concept voice. A new definition is therefore proposed. The new definition consists of a cluster of suprasegmental features resulted from supralaryngeal and laryngeal activities and incorporates in what are traditionally known as fluency features in interpreting. The paper goes on to discuss the potential benefits and implications of the newly proposed definition for both interpreter training and interpreting studies

EU-funded initiatives for real world evidence: descriptive analysis of their characteristics and relevance for regulatory decision-making.

INTRODUCTION: A review of European Union (EU)-funded initiatives linked to 'Real World Evidence' (RWE) was performed to determine whether their outputs could be used for the generation of real-world data able to support the European Medicines Agency (EMA)'s regulatory decision-making on medicines. METHOD: The initiatives were identified from publicly available websites. Their topics were categorised into five areas: 'Data source', 'Methodology', 'Governance model', 'Analytical model' and 'Infrastructure'. To assess their immediate relevance for medicines evaluation, their therapeutic areas were compared with the products recommended for EU approval in 2016 and those included in the EMA pharmaceutical business pipeline. RESULTS: Of 171 originally identified EU-funded initiatives, 65 were selected based on their primary and secondary objectives (35 'Data source' initiatives, 15 'Methodology', 10 'Governance model', 17 'Analytical model' and 25 'Infrastructure'). These 65 initiatives received over 734 million Euros of public funding. At the time of evaluation, the published outputs of the 40 completed initiatives did not always match their original objectives. Overall, public information was limited, data access was not explicit and their sustainability was unclear. The topics matched 8 of 14 therapeutic areas of the products recommended for approval in 2016 and 8 of 15 therapeutic areas in the 2017-2019 pharmaceutical business pipeline. Haematology, gastroenterology or cardiovascular systems were poorly represented. CONCLUSIONS: This landscape of EU-funded initiatives linked to RWE which started before 31 December 2016 highlighted that the immediate utilisation of their outputs to support regulatory decision-making is limited, often due to insufficient available information and to discrepancies between outputs and objectives. Furthermore, the restricted sustainability of the initiatives impacts on their downstream utility. Multiple projects focussing on the same therapeutic areas increase the likelihood of duplication of both efforts and resources. These issues contribute to gaps in generating RWE for medicines and diminish returns on the public funds invested.The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors

Imposed registries within the European postmarketing surveillance system: Extended analysis and lessons learned for regulators

Purpose: Building on previous research, we examined whether delayed study start and low patient accrual rates found in 31 postauthorization registry-based studies requested by European Medicines Agency (EMA) are maintained after 2 additional years of follow-up. Method: The registries identified in the previous EMA study and the same methodology were used. The follow-up was extended from June 2015 to November 2017. The information available for the following variables was updated: marketing authorization status, study and registry status, study end date, planned duration, number of patients planned to be enrolled, and actual patients enrolled. Data were collected from several nonpublic in-house sources such as the study protocols, interim and final study reports, risk management plans, and periodic safety update reports. Results: As of November 2017, 10 (32.2%) studies were finalized (vs. 9.7% as of June 2015), 14 (45.2%) were still ongoing (vs. 64.5%). Four of the ongoing studies had patients' accrual lower than 50%. Six of the finalized studies had a delayed completion, with a median delay of 3 years. As of November 2017, the median patients' accrual percentages were 24% for ongoing studies (vs. 8.5%) and 101% for finalized studies (vs. 24%). Conclusion: Overall, the rate of recruitment and timely finalization were improved after 2 years of additional follow-up but show that further work is needed to facilitate use of registry data for regulatory purposes, a work that has started via the EMA registry initiative

Patient Registries: An Underused Resource for Medicines Evaluation: Operational proposals for increasing the use of patient registries in regulatory assessments

IntroductionPatient registries, 'organised systems that use observational methods to collect uniform data on a population defined by a particular disease, condition, or exposure, and that is followed over time', are potentially valuable sources of data for supporting regulatory decision-making, especially for products to treat rare diseases. Nevertheless, patient registries are greatly underused in regulatory assessments. Reasons include heterogeneity in registry design and in the data collected, even across registries for the same disease, as well as unreliable data quality and data sharing impediments. The Patient Registries Initiative was established by the European Medicines Agency in 2015 to support registries in collecting data suitable to contribute to regulatory assessments, especially post-authorisation safety and effectiveness studies.MethodsWe conducted a qualitative synthesis of the published observations and recommendations from an initiative-led multi-stakeholder consultation and four disease-specific patient registry workshops. We identified the primary factors facilitating the use of registry data in regulatory assessments. We generated proposals on operational measures needed from stakeholders including registry holders, patients, healthcare professionals, regulators, marketing authorisation applicants and holders, and health technology assessment bodies for implementing these.ResultsTen factors were identified as facilitating registry use for supporting regulatory assessments of medicinal products. Proposals on operational measures needed for implementation were categorised according to three themes: (1) nature of the data collected and registry quality assurance processes; (2) registry governance, informed consent, data protection and sharing; and (3) stakeholder communication and planning of benefit-risk assessments.ConclusionsThese are the first explicit proposals, from a regulatory perspective, on operational methods for increasing the use of patient registries in medicines regulation. They apply to registry holders, patients, regulators, marketing authorisation holders/applicants and healthcare stakeholders broadly, and their implementation would greatly facilitate the use of these valuable data sources in regulatory decision-making

Search for {\eta}'(958)-nucleus bound states by (p,d) reaction at GSI and FAIR

The mass of the {\eta}' meson is theoretically expected to be reduced at finite density, which indicates the existence of {\eta}'-nucleus bound states. To investigate these states, we perform missing-mass spectroscopy for the (p, d) reaction near the {\eta}' production threshold. The overview of the experimental situation is given and the current status is discussed.Comment: 6 pages, 3 figures; talk at II Symposium on applied nuclear physics and innovative technologies, September 24th - 27th, 2014, Jagiellonian University, Krak\'ow Poland; to appear in Acta Physica Polonica