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

STS-9 BET products

The final products generated for the STS-9, which landed on December 8, 1983 are reported. The trajectory reconstruction utilized an anchor epoch of GMT corresponding to an initial altitude of h 356 kft, selected in view of the limited tracking coverage available. The final state utilized IMU2 measurements and was based on processing radar tracking from six C-bands and a single S-band station, plus six photo-theodolite cameras in the vicinity of Runway 17 at Edwards Air Force Base. The final atmosphere (FLAIR9/UN=581199C) was based on a composite of the remote measured data and the 1978 Air Force Reference Atmosphere model. The Extended BET is available as STS9BET/UN=274885C. The AEROBET and MMLE input files created are discussed. Plots of the more relevant parameters from the AEROBET (reel number NL0624) are included. Input parameters, final residual plots, a trajectory listing, and data archival information are defined

More Than Peer Production: Fanfiction Communities as Sites of Distributed Mentoring

From Harry Potter to American Horror Story, fanfiction is extremely popular among young people. Sites such as Fanfiction.net host millions of stories, with thousands more posted each day. Enthusiasts are sharing their writing and reading stories written by others. Exactly how does a generation known more for videogame expertise than long-form writing become so engaged in reading and writing in these communities? Via a nine-month ethnographic investigation of fanfiction communities that included participant observation, interviews, a thematic analysis of 4,500 reader reviews and an in-depth case study of a discussion group, we found that members of fanfiction communities spontaneously mentor each other in open forums, and that this mentoring builds upon previous interactions in a way that is distinct from traditional forms of mentoring and made possible by the affordances of networked publics. This work extends and develops the theory of distributed mentoring. Our findings illustrate how distributed mentoring supports fanfiction authors as they work to develop their writing skills. We believe distributed mentoring holds potential for supporting learning in a variety of formal and informal learning environments

Characterisation of a pucBA deletion mutant from Rhodopseudomonas palustris lacking all but the pucBAd genes

Rhodopseudomonas palustris is a species of purple photosynthetic bacteria that has a multigene family of puc genes that encode the alpha and beta apoproteins, which form the LH2 complexes. A genetic dissection strategy has been adopted in order to try and understand which spectroscopic form of LH2 these different genes produce. This paper presents a characterisation of one of the deletion mutants generated in this program, the pucBAd only mutant. This mutant produces an unusual spectroscopic form of LH2 that only has a single large NIR absorption band at 800 nm. Spectroscopic and pigment analyses on this complex suggest that it has basically a similar overall structure as that of the wild-type HL LH2 complex. The mutant has the unique phenotype where the mutant LH2 complex is only produced when cells are grown at LL. At HL the mutant only produces the LH1-RC core complex

Draft Genome Sequence of Rhodococcus sp. Strain ATCC 49988, a Quinoline-Degrading Bacterium.

We report here the 4.9-Mb genome sequence of a quinoline-degrading bacterium, Rhodococcus sp. strain ATCC 49988. The draft genome data will enable the identification of genes and future genetic modification to enhance traits relevant to heteroaromatic compound degradation

Final STS-11 (41-B) best estimate trajectory products: Development and results from the first Cape landing

The STS-11 (41-B) postflight data processing is completed and the results published. The final reconstructed entry trajectory is presented. The various atmospheric sources available for this flight are discussed. Aerodynamic Best Estimate of Trajectory BET generation and plots from this file are presented. A definition of the major maneuvers effected is given. Physical constants, including spacecraft mass properties; final residuals from the reconstruction process; trajectory parameter listings; and an archival section are included

Vertebrate Natural History Notes from Arkansas, 2018

Because meaningful observations of natural history are not always part of larger studies, important pieces of information often are unreported. Small details, however, can fill gaps in understanding and lead to interesting questions about ecological relationships or environmental change. We have compiled recent important observations of distribution, deformities, and foods of various vertebrates, observations of winter activity of a woodchuck (Marmota monax) and winter torpor of a hoary bat (Lasiurus cinereus), and also report a very unusual case of bilateral gynandromorphism in a Cardinal (Cardinalis cardinalis). These unique observations continue to add immensely to the growth of knowledge of the biology of vertebrates in Arkansas