Demand-Sensitive Candidate Route Generation Algorithm

Demand satisfaction is a key component that reflects the quality of public transit from the passenger’s perspective, whereas cost minimization is considered a main objective of transit agencies. This trade-off between quality and cost turns transit network design into a multiobjective problem in which the interests of passengers and operators conflict. Transit network design involves the determination of various design elements, such as route alignments and stop locations, which are essential to serve transit demand within a particular area. The design of a transit network typically starts with the generation of a set of potential routes through the use of a candidate route generation algorithm. Existing route generation algorithms find the shortest path between a route’s origin and destination. Demand is aggregated without proper attention given to its pattern and distribution along the generated route. Given that demand actually is scattered along the transit route, the aggregate demand assumption is considered a major drawback of existing route generation algorithms. In an attempt to fill the highlighted gap in current practice, this paper presents a novel demand-sensitive candidate route generation algorithm that can address passenger and operator needs in a simple, objective function that aims to maximize route-level ridership. The proposed approach is well suited to small and rural communities and specialized transit services (e.g., flex route, demand responsive service) in which transit demand is dispersed

Epoetin zeta in the management of anemia associated with chronic kidney disease, differential pharmacology and clinical utility

Mary Lynn Davis-Ajami,1 Jun Wu,2 Katherine Downton,3 Emilie Ludeman,3 Virginia Noxon4 1Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, USA; 2South Carolina College of Pharmacy, University of South Carolina, Greenville, SC, USA; 3Health Sciences and Human Services Library, University of Maryland, Baltimore, MD, USA; 4Department of Clinical Pharmacy and Outcomes Science, South Carolina College of Pharmacy, University of South Carolina, Columbia, SC, USA Abstract: Epoetin zeta was granted marketing authorization in October 2007 by the European Medicines Agency as a recombinant human erythropoietin erythropoiesis-stimulating agent to treat symptomatic anemia of renal origin in adult and pediatric patients on hemodialysis and adults on peritoneal dialysis, as well as for symptomatic renal anemia in adult patients with renal insufficiency not yet on dialysis. Currently, epoetin zeta can be administered either subcutaneously or intravenously to correct for hemoglobin concentrations ≤10 g/dL (6.2 mmol/L) or with dose adjustment to maintain hemoglobin levels at desired levels not in excess of 12 g/dL (7.5 mmol/L). This review article focuses on epoetin zeta indications in chronic kidney disease, its use in managing anemia of renal origin, and discusses its pharmacology and clinical utility. Keywords: biosimilar, chronic kidney disease, epoetin alfa, erythropoiesis, renal anemia, Retacrit&reg

Real-world analysis of cost, health care resource utilization, and supportive care in Hodgkin lymphoma patients with frontline failure

Machaon Bonafede,1 Joseph Feliciano,2 Qian Cai,1 Virginia Noxon,1 Nicole Princic,1 Akshara Richhariya,2 David J Straus3,4 1IBM Watson Health, Cambridge, MA, USA; 2Seattle Genetics, Inc., Bothell, WA, USA; 3Memorial Sloan Kettering Cancer Center, New York, NY, USA; 4John P Leonard Department of Medicine, Weill Cornell Medicine, New York, NY, USA Purpose: The purpose of this study was to evaluate the economic burden of frontline failure (FLF) among classical Hodgkin lymphoma (HL) patients during and after treatment.Patients and methods: The population consisted of adult HL patients identified from January 2010 through September 2015 without any other primary cancer prior to HL diagnosis, who also had a frontline (FL) regimen indicative of curative intent. Patients were characterized as FLF (those who restart, switch to any chemotherapy; had a hematopoietic stem cell transplant; or newly initiated radiation therapy [RT] after discontinuing FL) or non-FLF (those not considered as FLF). Direct health care utilization and expenditures were measured over both fixed and variable length follow-up periods and during FL therapy.Results: There were 77 FLF and 602 non-FLF patients who met the final inclusion criteria. FLF and non-FLF patients were demographically similar with mean age 38.5 years and 47.5% females. Average per patient per month (PPPM) costs were significantly higher for FLF patients during all follow-up (US$20,266 vs US$7,772, P<0.05). Annual total expenditures were significantly higher among FLF patients (US$198,388) vs non-FLF patients (US$37,549). FLF (vs non-FLF) patients had a significantly shorter duration of FL therapy (116 vs 131 days, P=0.024) and higher total PPPM expenditures during FL (US$29,040 vs US$16,369, P<0.05). Annual cost varied by failure type with those who failed due to restart incurring the highest cost (US$269,189) and those who switched incurring the lowest cost (US$46,951). FLF patients had a significantly greater utilization in every health care resource category during follow-up.Conclusion: FLF (vs non-FLF) patients utilized substantially more health care resources and incurred a substantially higher economic burden. Over 5 years, FLF patients with at least two lines of treatment were projected to incur US$535,846 of health care costs. Further research is needed to determine optimal treatment that could reduce the risk of progression, need for treatment after FL, and enhance long-term clinical and economic outcomes. Keywords: Hodgkin lymphoma, health care outcomes, treatment failure, administrative claims database, retrospective analysi

Engaging concert hall acoustics is made up of temporal envelope preserving reflections

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