Impact of in-house specialty pharmacy on access to novel androgen axis inhibitors in men with advanced prostate cancer

Introduction: Novel androgen axis inhibitors are standard of care treatments in advanced prostate cancer. The billed amounts for these medications are often very high, which may create significant financial toxicity for patients and lead to delays in treatment. Our institution implemented an in-house specialty pharmacy in 2014, that provides these medications and evaluates copay assistance options for all patients. We evaluated the program’s impact on out of pocket cost (OOP) and turnaround time (TAT). Methods: We reviewed available internal specialty pharmacy records to identify prescriptions for abiraterone or enzalutamide filled between 1/1/17 and 12/31/18. Payments were stratified by primary payment (amount reimbursed by the patient’s prescription plan based on the benefit’s design) and copayment assistance. Turnaround times (TAT) in business days were stratified by prescriptions requiring intervention (prior authorization, copayment assistance, or insufficient inventory) and clean prescriptions (those requiring no intervention). Results: One thousand four hundred seventeen prescriptions for 175 unique patients requiring abiraterone (n=869, 61.3%) or enzalutamide (n=548, 38.7%) were filled through the institution’s specialty pharmacy. The average amount paid by primary payer was $9,492.96 for a 30 day supply (range:$3,382.48-$12,939.84). Average quoted copay was$577.53 (range $3.08-$10,560.39). 64% of patients received copayment assistance. Average OOP cost per prescription after co-pay assistance was $100.83 (range$0-$8556.64). Three patients declined treatment due to cost (1.7% of overall). Average TAT was 2.98 days for clean prescriptions and 3.36 days for prescriptions needing intervention (p=0.055). Discussion: OOP cost varied significantly based on plan design and copayment assistance eligibility. The majority of patients received copayment assistance, which markedly reduced OOP cost. Cost rarely precluded access to treatment. TAT was not significantly prolonged for prescriptions requiring intervention. Further studies to determine impact of pharmacy type on access to specialty medications are indicated

Global Sentry: NASA/USRA high altitude reconnaissance aircraft design, volume 2

The Global Sentry is a high altitude reconnaissance aircraft design for the NASA/USRA design project. The Global Sentry uses proven technologies, light-weight composites, and meets the R.F.P. requirements. The mission requirements for the Global Sentry are described. The configuration option is discussed and a description of the final design is given. Preliminary sizing analyses and the mass properties of the design are presented. The aerodynamic features of the Global Sentry are described along with the stability and control characteristics designed into the flight control system. The performance characteristics are discussed as is the propulsion installation and system layout. The Global Sentry structural design is examined, including a wing structural analysis. The cockpit, controls and display layouts are covered. Manufacturing is covered and the life cost estimation. Reliability is discussed. Conclusions about the current Global Sentry design are presented, along with suggested areas for future engineering work

An Eccentric Hot Jupiter Orbiting the Subgiant HD 185269

We report the detection of a Jupiter-mass planet in a 6.838 day orbit around the 1.28 solar mass subgiant HD 185269. The eccentricity of HD 185269b (e = 0.30) is unusually large compared to other planets within 0.1 AU of their stars. Photometric observations demonstrate that the star is constant to +/-0.0001 mag on the radial velocity period, strengthening our interpretation of a planetary companion. This planet was detected as part of our radial velocity survey of evolved stars located on the subgiant branch of the H-R diagram--also known as the Hertzsprung Gap. These stars, which have masses between 1.2 and 2.5 solar masses, play an important role in the investigation of the frequency of extrasolar planets as a function of stellar mass.Comment: 18 pages, 4 figures, 3 tables, ApJ in press (scheduled for Dec 2006, v652n2

Characterization of rigor mortis of longissimus dorsi and triceps brachii muscles of male cattle carcasses

In this work, six bovine carcasses butchered in a slaughterhouse in Rio de Janeiro State, Brazil (SIE 504) were studied and temperature, pH, sarcomere length in different periods after slaughter (1, 5, 8, 12, 15 and24 h) of the longissimus dorsi (LD) and triceps brachii (TB) muscles as well as the shear force (meat tenderness) and colour were evaluated, aiming at characterizing the rigor mortis in the meat during industrial processing. Data statistic treatment demonstrated that carcass temperature and pH decreased gradually during the industrial chilling. The chilly room temperature varied from 10.2 to 4.0°C, the mean initial temperature of longissimus dorsi was 34.03°C and the final one was 7.12°C; the mean initial temperature of Triceps brachii was 39.00°C and the final one was 6.42°C. The mean initial pH of Longissimus dorsi was 6.47 and the final one was 5.46; the mean initial pH of Triceps brachii was 6.66 and the final one was 5.54. The smallest sarcomere size obtained in both muscles occurred at 12 h post mortem, and the sarcomere lengths were 1.44 and 1.41 μm, respectively. As for the colour parameters, the b* value presented higher correlation with the ultimate pH. The absence of cold shortening and the non-occurrence of dark firm and dry (DFD) meat indicate better quality of the meat analyzed.Keywords: Bovine carcass, muscles, rigor morti

A factorization method for elliptic BVP

International audienceThe technique of space invariant embedding, applied to a second order boundary value problem de ned in a cylindrical domain, gives rise to a system of uncoupled rst order initial value problems that includes a non-linear Riccati equation on a unbounded functional operator. We present a method to justify this equation that uses a parabolic regularization of the original problem