The objective of this study was to determine the patterns of regulatory noncompliance, as identified by the U.S. Food and Drug Administration (FDA), and their effects on meta-analyses. In order to achieve these objective, three studies were undertaken: analysis of citations issued by FDA Investigators at the conclusion of an inspection; analysis of regulatory actions taken by the FDA towards clinical researchers based on the observations cited by FDA Investigators; and sensitivity analysis of meta-analyses based on the Agency’s determination of research misconduct, primarily the falsification of data. FDA Investigator citations were analyzed using Chi-Square analysis based on geographic location of the inspection, type of inspection, and type of violation. Temporal changes in the number of inspections and the violations cited were analyzed using bivariate Poisson regression models. Bonferroni correction was employed for temporal changes across the time period analyzed. Regulatory actions taken by the agency were analyzed via Chi-Square or Fisher’s exact test based on changes identified in previous publications, temporal changes, and differences between regulatory action types. Sensitivity analysis of meta-analyses identified through a systematic review were assessed both qualitatively and quantitatively for the effects of including publications of apixaban trials with significant FDA regulatory action, i.e. the comparison of odds ratio point estimate, upper and lower 95% confidence interval, both before and after consideration of falsified data. Under the FDA’s Bioresearch Monitoring program from 2007-2015, the number of inspections increased, but the rate of citation issuance per inspection decreased. One third of the violations were related to adherence to investigational procedures followed by informed consent violations and violations involving study records. During this same time period, 194 clinical researchers received a regulatory action based on FDA’s review of inspection results. Since 2007, rates of significant deviations had decreased. Lack of researcher supervision and submission of false information were cited more frequently for disqualification proceedings. A systematic review found 99 statistical analyses from 22 different meta-analyses available for sensitivity analyses. Nearly one-third resulted in a change in the conclusions reported in the originally published statistical analyses. In approximately the last decade, the number of violations cited during inspections under the Bioresearch Monitoring program has decreased; however, significant improvements can continue to be made regarding adherence to study procedures, the consenting of human subjects, and creation of adequate and accurate study documentation. Disqualification of clinical researchers is more likely to occur when researchers fail to supervise a clinical trial or false information is submitted to the FDA. Falsified data can make its way into the exploding field of meta-analyses, a study method that provides a concise and compelling method for the dissemination of medical intervention knowledge; however, this method can be highly unstable and can provide biased results. A robust sensitivity analysis that considers data quality from available sources can help ensure calculations of the best estimates.

FDA decisions and late-stage clinical trial results regarding new pharmaceutical approvals can cause extreme moves in the share price of small biopharmaceutical companies. Throughout the clinical trial process, many potential investors are exposed to market-moving information before such information is made available to the investing public. An investor who wished to profit from advance knowledge about clinical trial results may use the publicly traded options markets in order to increase leverage and maximize profits. This research examined options data surrounding the public release of information pertaining to the efficacy of clinical trials and approval decisions made by the FDA. Events were identified for small pharmaceutical companies with fewer than three currently approved drugs in an attempt to isolate the effect of individual clinical trial and FDA-related events on the share price of the underlying company. Option data were analyzed using logistic regression models in an attempt to predict phase II and III clinical trial outcome results and FDA new drug approval decisions. Implied volatility, open interest, and option contract delta values were the primary independent variables used to predict positive or negative event outcomes. The dichotomized version of a predictor variable designed to estimate total investment exposure incorporating open interest, option contract delta values, and the underlying stock price was a significant predictor of negative pharmaceutical related events. However, none of ii the variables examined in this research were significant predictors of positive drug research related events. The estimated total investment exposure variable used in this research can be applied to the prediction of future clinical trial and FDA decision related events when this predictor variable shows a negative signal. Additional research would help confirm this finding by increasing the sample size of events that potentially follow the same pattern as those examined in this research. / text

The use of ADF as internal Marker of duodenal digesta flow was evaluated, for this the intestinal degradability of fiber was studied. Four Holstein calves (156± 33 kg), fitted with duodenal cannula T simple, and one calve fitted on the rumen, fed diet base with black oat and supplement, was used. Seven feeds were weighted on the polyester bags (7x5,5cm; 25μm) and treated at different ruminal incubation times (12, 24, 36 and 48 hours). After the respective incubations times, the bags were introduced in the duodenum of animals, recovered on the faeces and analyzed. The means of fiber fraction obtained posruminally and on the samples recovered on the faeces, were significantly different (P<0,05). The percent difference was 6,44, 2,07 e 0,90% on DM basis, for NDF, ADF and ADL, respectively. The disappearance of ADL indicated loss of particles through the pores of the bags, thereby the means were corrected for the loss of ADL, improving the regression coefficients and intercept of the regression equations, demonstrating the potential of using the ADF as an internal marker of digesta flow in ruminants. Additionally, was evaluated the duodenal digesta flow on cattle, with different markers. The means obtained from the ADF and ADL were similar, 2,025 and 2,135 kgDM/day, respectively. The n-alkanes presented low fecal recovery (C31= 63,3%; C32=46,7% e C33=75,6%), this may have contributed to the high variability of the results obtained from the n-alkanes. The n-alkane C32 overestimated the duodenal flow of DM, 3,855 kgDM/day. The ADF was useful for to measure the duodenal digesta flow, even small loss was detected, this did not prejudice the assessment. The ADF was efficient for measure digesta flow of DM, differently of the n-alkanes that overestimated (C32) and presented high variability (C31, C32 and C33). / Este estudo foi conduzido com o objetivo de avaliar o potencial do uso de componentes da fibra como marcadores internos e alcanos na estimativa do fluxo duodenal em bovinos. Para tanto foi avaliada a degradabilidade intestinal das frações fibrosas de diferentes alimentos. Foram utilizados quatro bovinos da raça holandesa dotados de cânula tipo T simples no duodeno e um bovino dotado de fistula ruminal, com dieta a base de Aveia Preta e concentrados (60:40). Foram conduzidos ensaios com sete diferentes alimentos, estes sendo submetidos a diferentes tempos de incubação ruminal, (12, 24, 36 e 48 horas). Por meio da técnica dos saquinhos móveis, foi avaliada a degradação intestinal dos alimentos. As médias das frações fibrosas obtidas pós-ruminalmente e recuperadas nas fezes diferiram significativamente de FDN, FDA e LDA (P<0,05). O desaparecimento em percentual da MS foi de 6,44, 2,07 e 0,90%, para FDN, FDA e LDA, respectivamente. No entanto a análise de regressão linear indicou altos coeficientes de determinação para todos os tempos de incubação. O desaparecimento em proporção de FDA e LDA foram estatisticamente iguais em todos os tempos de incubação (P>0,05), indicando perda de partículas pelos poros dos saquinhos. A correção dos teores de FDA, pela perda de LDA não afetou os coeficientes de determinação que permaneceram elevados. A estimativa do fluxo de duodenal de MS com a FDA e a LDA foram similares, 2,025 e 2,135 kgMS/dia, respectivamente. Os n-alcanos apresentaram baixa recuperação fecal (C31= 63,3%; C32=46,7% e C33=75,6%),o que pode ter contribuído para alta variabilidade dos resultados. O C32 superestimou os valores de fluxo duodenal de MS, sendo que fluxo médio obtido pelo C32, corrigido pela excreção fecal do alcano, foi de 3,855 kgMS/dia, enquanto o observado com o FDA foi de 2,065kgMS/dia e 2,135 kgMS/dia com base no LDA. O FDA foi eficiente para medir o fluxo duodenal de MS, , diferentemente do n-alcano dosado, o C32, que superestimou este parâmetro e, como C31 e C33, apresentou resultados com alta variabilidade.

Liberação transdérmica de fármacos apresenta várias vantagens na terapêutica quando comparada com administração oral ou parenteral. Não existe até o momento nenhum método previsto na Farmacopéia Brasileira para realizar testes de liberação de fármacos em adesivos transdérmicos, outros compêndios oficiais como Farmacopéia Americana, Britânica e Européia, descrevem o aparato de pás sobre disco, o cilindro rotatório e o suporte recíproco. Atualmente a literatura descreve diversos tipos de células de difusão para liberação transdérmica das quais a célula de difusão de Franz tem sido a mais empregada tanto para adesivos transdérmicos como formas semi-sólidas, utilizada no desenvolvimento farmacotécnico, caracterização biofarmacêutica e controle de qualidade. A proposta deste estudo tem por objetivo estipular critérios para a escolha mais adequada do equipamento e metodologias in vitro na avaliação da liberação transdérmicas de fármacos, utilizando a nicotina como fármaco modelo. Para tal, foram empregados ensaios in vitro de liberação e retenção cutânea utilizando métodos de pás sobre disco e método de célula de difusão de Franz modificada em sistema estático e fluxo contínuo. A validação dos fatores que influenciam a taxa de liberação in vitro da nicotina foram fundamentais para escolha do meio receptor, escolha da velocidade de agitação que promoveu mais semelhança no perfil de liberação em diferentes equipamentos assim como a escolha da membrana biológica mais adequada para o método proposto. Os resultados mais promissores foram selecionados para os ensaios in vitro de liberação, permeação e retenção cutânea. Os dados de liberação, tanto em quantidades de nicotina liberada como seu fluxo, demonstraram semelhança no uso de diferentes equipamentos, indicando possíveis intercambialidades entre os métodos propostos para liberação de nicotina transdérmica. Ensaios in vitro de permeação cutânea em célula de difusão vertical de Franz não demonstraram diferenças significativas em diferentes modelos de membranas biológicas utilizadas, as quais foram pele de orelha de porco, pele de camundongo sem pelo e pele de cobra cascavel hidratada por 24 horas. A quantidade de nicotina permeada em até 8 horas, assim como o fluxo de permeação foram significativamente menor para o método de pás sobre disco (FDA) quando comparado com os resultados obtidos utilizando célula de difusão vertical de Franz tanto em sistema estático com em fluxo contínuo. Estes resultados podem estar relacionados com a estrutura física do equipamento de célula de difusão vertical de Franz, uma vez que oferece um sistema oclusivo, dificultando o contato do adesivo com o meio receptor. Desta forma, os resultados deste projeto podem indicar o uso da célula de difusão vertical de Franz para ensaios in vitro de liberação e permeação cutânea da nicotina em formas farmacêuticas transdérmicas, podendo ser aplicado em pesquisas de desenvolvimento de formulações, controle da qualidade e testes de Equivalência Farmacêutica para produtos genéricos. Os resultados desta pesquisa apresentam-se podem ter importante influência nas discussões em torno dos medicamentos genéricos no Brasil, bem como na elaboração de diretrizes para testes de Equivalência Farmacêutica e Controle de Qualidade de medicamentos transdérmicos. Poderão ainda fornecer dados para indicações de protocolos para Farmacopéia Brasileira e pesquisa científica em torno dos sistemas de liberação transdérmicas de fármacos. / The aim of this work was to compare in vitro release and permeation of nicotine from transdermal patch (TDS) using three different methods such as, FDA paddle method and both Vertical Diffusion Cell (VCD) static and continuous flux. We evaluated different kinds of membrane (hairless mouse, porcine ear skin and snake skin), different composition and pH of acceptor phases (0.01N isotonic phosphate buffer pH 7.4 (± 0.2), water, and HCL 0.025N), agitation of acceptor phase and batches of the transdermal patches. Profiles of release and permeation from all methods evaluated were linked statistically using linear regression and one-way ANOVA nonparametric assay. The 0.01N isotonic phosphate buffer pH 7.4 (± 0.2) improved greater release rate of nicotine than those obtained using HCL and water as acceptor phase. Cumulative released and permeated amounts of nicotine were almost equal for all methods evaluated and there is not significantly different (one-way ANOVA p 0.05) were observed after 8 h. However nicotine permeated fluxes (J) after 8 h were significantly higher using VDC than those obtained using FDA paddle method. Cumulative permeated amounts (reported to the effective surface area of the cells) were overestimated when skin permeation experiments were prolonged to 12 h, indicating that the actual diffusion surface area of NiQuitinTM exceeded the effective diffusion surface area of the cells. Reducing the trimmed TDS surface area led not only to a reduction of the cumulative permeated amounts, but also to a reduction of the flux at 12 h. In order to evaluate the edge effect on drug release flux studies were performed using static VDC. In vitro penetration studies using different membranes showed not significantly difference for ear pig skin, hairless mouse and snake skin at 8 h. However data obtained without membrane were about 1.25 times smaller than those obtained with biological membranes. These results demonstrated that NiQuitinTM TDS had dependent release of membrane at 8 h of permeation. In conclusion there is not significantly different for in vitro release and permeation amounts of nicotine from NiQuitinTM using VDC and FDA method. In term of release efficiency all methods released up to 80% of nicotine after 8 h. The results suggested the use of VDC as potential method to evaluate both in vitro release and skin permeation of nicotine in transdermal patches.

Retinitis Pigmentosa (RP) is an incurable inherited retinal degeneration affecting approximately 1 in 4,000 individuals globally. The aim of this dissertation was to identify drugs that can help patients suffering from the disease. To accomplish this goal, the zebrafish was utilized as a model for RP to perform <i>in vivo</i> drug screening. The zebrafish RP model expresses a human rhodopsin transgene which contains a premature stop codon at position 344 (<i>Tg</i>(<i>rho:Hsa.RH1_Q344X</i>)). This zebrafish model exhibits significant rod photoreceptor degeneration beginning at 7 days post fertilization (dpf). To assess the visual consequence of this rod degeneration the zebrafish behavior visual motor response (VMR) was assayed under scotopic conditions. The Q344X RP model larvae displayed a deficit in this VMR in response to a scotopic light offset. This deficit in behavior was utilized to perform a drug screen to identify compounds that could ameliorate the deficient Q344X VMR. The ENZO SCREEN-WELL® REDOX library was chosen to be screened since oxidative stress may increase RP progression in a non-specific manner. From this library, a β-blocker, carvedilol, was identified as a compound that improved the Q344X VMR behavior. This drug was also able to increase rod number in the Q344X retina. Carvedilol was shown to be capable of working directly on rods by demonstrating that the drug can signal through the adrenergic pathway in the rod-like human Y79 cell line. Since carvedilol is an FDA-approved drug, this screening paradigm was utilized to screen the Selleckchem FDA-approved library to identify more drugs that can potentially be repurposed to treat RP like carvedilol. Additionally, this scotopic VMR assay was used to demonstrate that it can identify behavioral deficits in the P23H RP model zebrafish<i> (Tg</i>(<i>rho:Hsa.RH1_P23H</i>)). This dissertation work provides a potential FDA-approved drug for RP treatment and sets the foundation for future drug screening to identify more drugs to treat different forms of RP.

La presente investigación tuvo como objetivo principal determinar los factores que influyeron en las exportaciones de la leche evaporada con partida arancelaria 0402911000 hacia el mercado de los Estados Unidos durante el periodo 2008-2018. La metodología que se usó para el estudio fue de tipo descriptiva, con diseño no experimental, con un corte longitudinal y con un enfoque mixto al intervenir variables cualitativas y cuantitativas, tales como las medidas sanitarias y fitosanitarias, el valor FOB y la producción. El principal resultado en el enfoque cualitativo fue el grado de influencia de las exigentes medidas sanitarias que impactó en el desempeño de las exportaciones al mercado estadounidense, debido a que, las normas norteamericanas difieren de las normas internacionales. Por otro lado, en el enfoque cuantitativo, el hallazgo en la competitividad del valor FOB ha favorecido las exportaciones hacia el mercado estadounidense. Sin embargo, en la producción, pese a que se cuenta con la materia prima necesaria para abastecer mercados internacionales, la falta de apoyo por parte del Estado para orientar a los productores es la causa de fondo del porque no se ha llegado a la competitividad esperada. La población de estudio está conformada por 16 gerentes y jefes de las empresas Gloria y Nestlé; En donde se aplicó entrevistas semiestructuradas a expertos como instrumento de recolección de datos. El estudio pretende responder si las normas de etiquetado son una barrera al comercio, y si la competitividad del valor FOB y la producción contribuye a las exportaciones. / The main objective of this investigation was to determine the factors that influenced the evaporated milk exports tariff heading 0402911000 to the United States market during the period 2008-2018. The methodology used for the study was descriptive, with a non-experimental design, with a longitudinal section and with a mixed approach, involving qualitative and quantitative variables, such as sanitary and phytosanitary measures, FOB value production. The main result in the qualitative approach was the degree of influence of the demanding sanitary measures that had and impact of the performance of exports to the US market, because the North American standards differ from the international standards. On the other hand, in the quantitative approach, the finding in the competitiveness of the FOB value has favored exports to the US market. However, in production, despite having the raw material necessary to supply international markets, the lack of support from the State to guide producers is the root cause of why the expected competitiveness has not been reached. The study population is made up of 16 managers and heads of the companies Gloria and Nestle; Where semi-structure interviews with experts were applied as an instrument for data collection. The study aims to answer whether labeling rules are a barrier to trade, and whether the competitiveness of FOB value and production contributes to exports. / Tesis

<p>Bacteriophages are viruses that infect and kill bacteria. They are the most abundant organism on the planet and the largest source of untapped genetic information. Every year, more bacteriophages are isolated from the environment, purified, and sequenced. Once sequenced, their genomes are annotated to determine the location and putative function of each gene expressed by the phage. Phages have been used in the past for genetic engineering and new research is being done into how they can be used for the treatment of disease, water safety, agriculture, and food safety. </p> <p>Despite the influx of sequenced bacteriophages, a majority of the genes annotated are hypothetical proteins, also known as No Known Function (NKF) proteins. They are expressed by the phages, but research has not identified a possible function. Wet lab research into the functions of the hundreds of NKF phages genes would be costly and could take years. Bioinformatics methods could be used to determine putative functions and functional categories for these hypothetical proteins. A new bioinformatics method using algorithms such as Domain Assignments, Hidden Markov Models, Structure Prediction, Sub-Cellular Localization, and iterative algorithms is proposed here. This new method was tested on the bacteriophage genome PotatoSplit and dropped the number of NKF genes from 57 to 40. A total of 17 new functions were found. The functional class was identified for an additional six proteins, though no specific functions were named. Structure Prediction and Simulations were tested with a focus on two NKF proteins within lytic phages and both returned possible functional categories with high confidence.</p> <p>Additionally, this research focuses on the possibility of phage therapy and FDA regulation. A database of phage proteins was built and tested using R Statistical Analysis to determine proteins significant to phage infecting <i>M. tuberculosis</i> and to the lytic cycle of phages. The statistical methods were also tested on both pharmaceutical products recalled by the FDA between 2012 and 2018 to determine ingredients/manufacturing steps that could affect product quality and on the FDA Adverse Event Reporting System (FAERS) data to determine if AERs could be used to judge the quality of a product. Many significant excipients/manufacturing steps were identified and used to score products on their quality. The AERs were evaluated on two case studies with mixed results. </p>

More than one-third of the U.S. citizens (over 70 million people) and 16% of children are classified as obese and are at risk of many diseases including heart disease. Research indicates that 65% of Americans over the age of twenty years old are considered overweight. To address this public health issue, the U.S. Food & Drug Administration has proposed new nutritional guidelines for restaurant menus. Thus, the current study investigated the preferences of quick service restaurant (QSR) industry consumers with reference to the newly proposed U.S. Food and Drug Administration regulations. This study includes development and redesigning of drive thru menus to comply with the FDA guidelines. A 3x2 factorial design experiment was conducted using real drive thru menus from three major national restaurant chains. The control group consisted of normal drive thru menus obtained from national restaurant chains, and the experimental group was comprised of two sets of pre-tested experimental menus complying with the FDA guidelines. The first set of experimental menus includes presentation of calorie information for all menu items offered. The second set of experimental menus includes color coded calorie specific menu categories (low, regular and high). A set of research hypotheses were developed and data was collected from heavy users of QSR units using Qualtrics software. The collected data were analyzed using SPSS. The obtained results indicated that the QSR menus designed to comply with the FDA’s guidelines do not result in loss of revenues as commonly feared by the restaurant industry. But interestingly the second set of experiment menus with color coded nutritional categories (low, regular, high) have led to increased consumer patronage and consumers’ willingness to pay. In iv addition, color coded nutritional menus were preferred over FDA suggested menus designs. The results from the current study are of significant importance to the QSR industry as they strive to comply with the new nutrition guidelines of FDA for drive thru menus

The value proposition of Personalized Medicine is to deliver the “right drug, to the right patient, at the right time”. Companion diagnostics is the required tool for Personalized Medicine used to aid clinical decision making with the aim to identify patients who are most suitable for a given treatment approach and to avoid adverse effects. However, even 16 years after the first co-approval of a therapeutic drug and an associated diagnostic test (trastuzumab (Herceptin1) from Genentech and the HercepTest1 from Dako), the co-development and co-approval of drug-diagnostic pairs is a challenging task.This study has the aim to identify major challenges for diagnostics companies when developing and commercializing companion diagnostics. This is achieved by (1) a literature research and (2) an empirical case study in form of interviews with diagnostics companies. The collected data is analyzed and discussed with focus on current regulatory and reimbursement frameworks in the USA and European Union. The co-development strategies and business models of companion diagnostics developers are identified.The conclusion of this study is that the major hurdles for companion diagnostics development and commercialization are gaps in scientific evidence and lacking regulatory guidelines for co-development and clinical biomarker studies. Companion diagnostics commercialization is further challenged by poor reimbursement levels. The main strategy of diagnostics companies to address these challenges is the demonstration of a beneficial outcome for patients in form of clinical studies. Small companies with limited resources for clinical research receive funding from academic research grants, patient support groups, pharmaceutical industry, and governmental Innovation agencies.Finally the formation of a new “pharma-diagnostics” sectoral innovation system as a result of the emerging paradigm of stratified medicine has been proposed.

Breast cancer is the most common cancer in women worldwide and the solid tumor type for which the highest number of drugs have been approved to date. This study examines new drug approvals for breast cancer by the United States Food and Drug Administration (FDA) and the European Medicines Agency (EMA), based on an analysis of regulatory documents from both agencies for the period from 1995 to 2018. Of the 29 breast cancer drugs approved over this time span, 17 received positive decisions from both the FDA and EMA, including all drugs licensed after 2008. Nineteen of the 25 FDA-approved drugs, but none of the EMA approvals, benefited from special regulatory pathways (such as fast track, breakthrough therapy, or priority review). In the U.S.A., four accelerated approvals were granted (of which one, for bevacizumab, was later revoked), while only two drugs received provisional approvals following EMA review. New breast cancer drugs were approved approximately twelve months earlier in the United States than in Europe. These results suggest that a broader use of special regulatory pathways by EMA could help to accelerate access to novel drugs for European breast cancer patients.