Effects of congressional modernization laws on public access to innovative medical device technologies

The Federal Food and Drug Administration (FDA) and the Centers for Medicare and Medicaid (CMS) play key roles in making Class III, medical devices available to the public, and they are required by law to meet statutory deadlines for applications under review. Historically, both agencies have failed to meet their respective statutory requirements. Since these failures affect patient access and may adversely impact public health, Congress has enacted several “modernization” laws. However, the effectiveness of these modernization laws has not been adequately studied or established for Class III medical devices. ^ The aim of this research study was, therefore, to analyze how these modernization laws may have affected public access to medical devices. Two questions were addressed: (1) How have the FDA modernization laws affected the time to approval for medical device premarket approval applications (PMAs)? (2) How has the CMS modernization law affected the time to approval for national coverage decisions (NCDs)? The data for this research study were collected from publicly available databases for the period January 1, 1995, through December 31, 2008. These dates were selected to ensure that a sufficient period of time was captured to measure pre- and post-modernization effects on time to approval. All records containing original PMAs were obtained from the FDA database, and all records containing NCDs were obtained from the CMS database. Source documents, including FDA premarket approval letters and CMS national coverage decision memoranda, were reviewed to obtain additional data not found in the search results. Analyses were conducted to determine the effects of the pre- and post-modernization laws on time to approval. Secondary analyses of FDA subcategories were conducted to uncover any causal factors that might explain differences in time to approval and to compare with the primary trends. The primary analysis showed that the FDA modernization laws of 1997 and 2002 initially reduced PMA time to approval; after the 2002 modernization law, the time to approval began increasing and continued to increase through December 2008. The non-combined, subcategory approval trends were similar to the primary analysis trends. The combined, subcategory analysis showed no clear trends with the exception of non-implantable devices, for which time to approval trended down after 1997. The CMS modernization law of 2003 reduced NCD time to approval, a trend that continued through December 2008. This study also showed that approximately 86% of PMA devices do not receive NCDs. ^ As a result of this research study, recommendations are offered to help resolve statutory non-compliance and access issues, as follows: (1) Authorities should examine underlying causal factors for the observed trends; (2) Process improvements should be made to better coordinate FDA and CMS activities to include sharing data, reducing duplication, and establishing clear criteria for “safe and effective” and “reasonable and necessary”; (3) A common identifier should be established to allow tracking and trending of applications between FDA and CMS databases; (4) Statutory requirements may need to be revised; and (5) An investigation should be undertaken to determine why NCDs are not issued for the majority of PMAs. Any process improvements should be made without creating additional safety risks and adversely impacting public health. Finally, additional studies are needed to fully characterize and better understand the trends identified in this research study.^

Perchlorate remediation technologies: A systematic review of solely biodegradation versus a combination of ion-exchange and biodegradation technologies

A systematic review was performed in order to evaluate perchlorate remediation technologies. The two included technologies were ion-exchange concerted with biodegradation and solely biodegradation. A meta-analysis was completed and subsequently, a regression model was formed to conduct a degradation rate analysis and to depict the association between rate and various dependent variables (salinity/sali, nitrate concentration/nitc and carbon source concentration/csou). The outcome of the model analysis suggested that salt concentration did have an effect on the degradation rate in the ion-exchange process and that with a salt concentration greater than or equal to 18.6 g/L, the biodegradation process will produce a greater reduction of perchlorate than ion-exchange concerted with biodegradation. However, when a t-test examined the difference in perchlorate degradation rate between the two cleanup methods, there was no significant difference seen (p=0.7351, α = 0.05).^

NOVEL THERAPEUTIC TARGETS IDENTIFIED BY HIGH-THROUGHPUT TECHNOLOGIES FOR TRIPLE-NEGATIVE BREAST CANCER

Triple-negative breast cancers (TNBC) are characterized by the lack of or reduced expression of the estrogen and progesterone receptors, and normal expression of the human epidermal growth factor receptor 2. The lack of a well-characterized target for treatment leaves only systemic chemotherapy as the mainstay of treatment. Approximately 60-70% of patients are chemosensitive, while the remaining majority does not respond. Targeted therapies that take advantage of the unique molecular perturbations found in triple-negative breast cancer are needed. The genes that are frequently amplified or overexpressed represent potential therapeutic targets for triple-negative breast cancer. The purpose of this study was to identify and validate novel therapeutic targets for triple-negative breast cancers. 681 genes showed consistent and highly significant overexpression in TNBC compared to receptor-positive cancers in 2 data sets. For two genes, 3 of the 4 siRNAs showed preferential growth inhibition in TNBC cells. These two genes were the low density lipoprotein receptor-related protein 8 (LRP8) and very low-density lipoprotein receptor (VLDLR). Exposure to their cognate ligands, reelin and apolipoprotein E isoform 4 (ApoE4), stimulated the growth of TNBC cells in vitro. Suppression of the expression of either LRP8 or VLDLR or exposure to RAP (an inhibitor of ligand binding to LRP8 and VLDLR) abolished this ligand-induced proliferation. High-throughput protein and metabolic arrays revealed that ApoE4 stimulation rescued TNBC cells from serum-starvation induced up-regulation of genes involved in lipid biosynthesis, increased protein expression of oncogenes involved in the MAPK/ERK and DNA repair pathways, and reduced the serum-starvation induction of biochemicals involved in oxidative stress response and glycolytic metabolism. shLRP8 MDA-MB-231 xenografts had reduced tumor volume, in comparison to parental and shCON xenografts. These results indicate that LRP8-APOE signaling confers survival advantages to TNBC tumors under reduced nutrient conditions and during cellular environmental stress. We revealed that the LRP8-APOE receptor-ligand system is overexpressed in human TNBC. We also demonstrated that this receptor system mediates a strong growth promoting and survival function in TNBC cells in vitro and helps to sustain the growth of MDA-MD-231 xenografts. We propose that inhibitors of LRP8-APOE signaling may be clinically useful therapeutic agents for triple-negative breast cancer.

Adriaan Rademaker, Sophrosyne and the Rhetoric of Self-Restraint. Polysemy and Persuasive Use an Ancient Greek Value Term

Fil: Saravia de Grossi, María Inés. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.

Adriaan Rademaker, Sophrosyne and the Rhetoric of Self-Restraint. Polysemy and Persuasive Use an Ancient Greek Value Term

Fil: Saravia de Grossi, María Inés. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.

International Regulation of Emerging Technologies: Global Ideologies and Local Headaches

This paper begins to address the international regulation of emerging technologies taking an approach that includes the co-production of technologies and the nature of wicked problems. Both the development of technologies over time, the role of science in regulation, and results from case studies in the regulation of biotechnologies are discusses. Biotechnology, nanotechnology and synthetic biology receive the most attention.

An export strategy and technology networks in the Republic of Korea

In Korea, trade with Japan has had a deficit since the normalization of Japan-Korea diplomatic relations in 1965. Korea’s trade balance with Japan has remained in deficit since then, although Korean companies have become bigger compared to Japanese companies. My hypothesis is that the problem has been caused because Korea introduced technologies from Japan. However, in recent years Korean companies could not introduce technologies through technical cooperation with Japan like in the 1990s. In addition, the Korean government seemed to encourage domestic production for import substitution. Nevertheless, the deficit has continued. I thought it necessary to check my hypothesis in order to discover whether or not it was persuasive.

Learning&Information Technologies Cartography

Nowadays, many researches focus their efforts in studies and applications on the Learning area. However, there is a lack of a reference system that permits to know the positioning and the existing links between Learning and Information Technologies. This paper proposes a Cartography where explains the relationships between the elements that compose the Learning Theories and Information Technologies, considering the own features of the learner and the Information Technologies Properties. This intersection will allow us to know what Information Technologies Properties promote Learning Futures.

Heart Failure Monitoring System Based on Wearable and Information Technologies

In Europe, Cardiovascular Diseases (CVD) are the leading source of death, causing 45% of all deceases. Besides, Heart Failure, the paradigm of CVD, mainly affects people older than 65. In the current aging society, the European MyHeart Project was created, whose mission is to empower citizens to fight CVD by leading a preventive lifestyle and being able to be diagnosed at an early stage. This paper presents the development of a Heart Failure Management System, based on daily monitoring of Vital Body Signals, with wearable and mobile technologies, for the continuous assessment of this chronic disease. The System makes use of the latest technologies for monitoring heart condition, both with wearable garments (e.g. for measuring ECG and Respiration); and portable devices (such as Weight Scale and Blood Pressure Cuff) both with Bluetooth capabilities

An Analysis of the Impact of 2.0 Tools and Technologies on Organizational Processes

In this paper, the authors present results from a study on the usage rate of 2.0 tools and technologies among Spanish enterprises. The main objective of the study is to analyze, from the perceptions of executives, the influence of social software tools on a set of business processes. This analysis has been made using two graphic tools: the “2.0 Success Matrix” and the “Tool’s Footprint”. Both the review of literature and the empirical work have lead to important findings and conclusions.

Comparison of CO2 From Coal Capture Processes and Valorisation Technologies

Coal is the most plentiful and evenly distributed fossil fuel worldwide. Based on current production, it is estimated that the reserves will last approximately 130 years. Its use worldwide has been increasing, mainly due to consumption by emerging countries. CO2 emissions generated by combustion and the repercussions of such on climate change support the view that it could no longer be used. CO2 capture may be the solution to continue using it, which would cater for the growing energy demand worldwide. The aim of this study is to compare different processes concerning CO2 capture that may be economically viable, ultimately showing that coal, a fossil energy source widely distributed around the world, can, as a result of using different CO2 capture processes, be used as a clean source of electricity. Hence, in places where geological hurdles may render the costs of CO2 storage considerably higher, since it might have to travel far, coal may be used for other purposes, thus valorising CO2 within the industrial sector. This research is focused on the technical and economic comparison of the most relevant CO2 capture projects designed in Spain using different existing technologies. The oxyfuel project in Ciuden (Leon, Spain), the IGCC Elcogas, precombustion CO2-capture project (Puertollano, Spain) and the postcombustion project in Carboneras (Almeria, Spain) will be analyzed in order to assess the options available to valorise captured CO2. Valorising captured CO2 may be an adequate solution in areas where, although CO2 capture is still possible, storage is not equally so, thus generating a further benefit. The possible uses of CO2 will be assessed in vegetable growing greenhouses, harnessing CO2 in vegetable life cycles. This will also be used in growing algae for subsequent biodiesel production. Both CO2 capture and valorising will eventually lead to the clean use of coal, which will thus enhance the level of self-supply, aiding the development of electric vehicles, which require large amounts of electricity, as well as improve the level of energy autonomy in countries around the world. Another type of fuel, biodiesel, will also be obtained, without this affecting international food prices.

Infrastructure and Workflow for the Formal Evaluation of Semantic Search Technologies

This paper describes an infrastructure for the automated evaluation of semantic technologies and, in particular, semantic search technologies. For this purpose, we present an evaluation framework which follows a service-oriented approach for evaluating semantic technologies and uses the Business Process Execution Language (BPEL) to define evaluation workflows that can be executed by process engines. This framework supports a variety of evaluations, from different semantic areas, including search, and is extendible to new evaluations. We show how BPEL addresses this diversity as well as how it is used to solve specific challenges such as heterogeneity, error handling and reuse