Business Days Research Articles

Keeping calm on a busy day\u2014an interpersonal skill home care patients desire in health workers: hermeneutical phenomenological method

BackgroundIn Western countries, many health and social care provisions have been transferred to primary care, and most older patients wish to remain in their own homes for as long as possible. For older patients who live alone, health workers could be their only personal contacts. Hence, health workers’ personal skills affect their relationships with these patients. Accordingly, this study aimed to shed light on the interpersonal skills needed by health workers to establish good relationships with older home care patients and highlight the importance of interpersonal skills training in nursing education.MethodsThis study adopted a hermeneutical phenomenological approach. The qualitative method was used to elicit data on patients’ perspectives. Ten home care patients were interviewed individually in their own homes between December 2019 and January 2020.ResultsDespite individual variations, health workers’ interpersonal skills are of significance with regard to the social well-being of patients living at home. The findings revealed that patients want health workers to be mentally present, congruent in their communications, calm and relaxed during the available time spent with them, and capable of facilitating autonomy.ConclusionsIt is important to present patients’ perspectives to ensure that nursing education is geared towards patients’ best interests.Trial registration numberThe Norwegian Centre for Research Data (NSD): 953937.

Point of Care Molecular Testing: Community-Based Rapid Next-Generation Sequencing to Support Cancer Care.

Purpose: Biomarker data are critical to the delivery of precision cancer care. The average turnaround of next-generation sequencing (NGS) reports is over 2 weeks, and in-house availability is typically limited to academic centers. Lengthy turnaround times for biomarkers can adversely affect outcomes. Traditional workflows involve moving specimens through multiple facilities. This study evaluates the feasibility of rapid comprehensive NGS using the Genexus integrated sequencer and a novel streamlined workflow in a community setting. Methods: A retrospective chart review was performed to assess the early experience and performance characteristics of a novel approach to biomarker testing at a large community center. This approach to NGS included an automated workflow utilizing the Genexus integrated sequencer, validated for clinical use. NGS testing was further integrated within a routine immunohistochemistry (IHC) service, utilizing histotechnologists to perform technical aspects of NGS, with results reported directly by anatomic pathologists. Results: Between October 2020 and October 2021, 578 solid tumor samples underwent genomic profiling. Median turnaround time for biomarker results was 3 business days (IQR: 2–5). Four hundred eighty-one (83%) of the cases were resulted in fewer than 5 business days, and 66 (11%) of the cases were resulted simultaneously with diagnosis. Tumor types included lung cancer (310), melanoma (97), and colorectal carcinoma (68), among others. NGS testing detected key driver alterations at expected prevalence rates: lung EGFR (16%), ALK (3%), RET (1%), melanoma BRAF (43%), colorectal RAS/RAF (67%), among others. Conclusion: This is the first study demonstrating clinical implementation of rapid NGS. This supports the feasibility of automated comprehensive NGS performed and interpreted in parallel with diagnostic histopathology and immunohistochemistry. This novel approach to biomarker testing offers considerable advantages to clinical cancer care.

Data Breach Announcements and Stock Market Reactions: A Matter of Timing?

Although firms’ announcement of data breaches can lead to reputational or operational damages, extant research suggests that stock markets are relatively unresponsive to such announcements. We investigate whether markets’ unresponsiveness can be explained by firms strategically timing the announcement to coincide with busy days in the media, thereby reducing attention and, ultimately, attenuating market reactions. We leverage novel data on data breach announcements in the United States between 2008 and 2018 and create a measure of busyness in the trade press—news pressure—based on the Wall Street Journal. To investigate, we conduct two complementary studies. In Study 1, we employ an instrumental variable approach to assess whether announcements coincide with days of predictably high news pressure. We find that this is the case. On days with a one-standard-deviation-higher predictable news pressure, 4.44% more data breaches are announced (or approximately 19.024 data records). Strategic timing is more prevalent for breaches that are severe, that have firm-internal causes, and that leak healthcare data or credentials. In Study 2, we utilize a stock market event study to assess market reactions conditional on news pressure on the announcement day. We find that data breach announcements are associated with negative market reactions, yet these are attenuated by higher news pressure on the announcement day. If news pressure is on its empirical mean (respectively, one standard deviation above), we estimate a median decline in market capitalization of $347 (respectively, $85) million. We conclude that firms’ strategic timing might explain inconsistent findings in prior work. This paper was accepted by Chris Forman, information systems.

Post-surgical emergency after-hours calls: Prevalence, concerns, and management.

The purpose of this study was to investigate the prevalence, nature, and management of post-surgical emergency after-hours calls in a dental school setting with predoctoral students, graduate students/residents, and faculty providers. A patient chart review (March 2018-February 2020) for post-surgical calls through the emergency after-hours pager system was conducted at the Marquette University School of Dentistry. The total number of surgical procedures, procedure type, the timing of call, operator experience, concern, and recommendation given during the call were documented. During the review period, 83 calls (from 75 patients) were recorded after 8,487 surgical procedures (1% of procedures). Patients called 5.4 ± 0.8 days postoperatively. Procedure type affected call prevalence (p=0.04), with most calls made after extractions (69.9% of all calls; 1% of extractions; 58/5,725), implant placement (6%; 0.9% of implant placements; 5/530) and periodontal plastic surgery (6%; 3.1% of all plastic surgeries; 5/161). The most common concern was pain (72.3%), then swelling (36.1%), bleeding (12%), and infection (9.6%). Operator experience did not affect call prevalence. Recommendations given were next business day follow-up (79.5%), reinforcement of already given postoperative instructions (51.8%), prescription (15.7%), and hospital emergency department (ED) visit (7.2%). Post-surgical emergency after-hours calls in a dental school setting occur within the first postoperative week and are rare, unrelated to operator experience, typically prompted by pain, and rarely resulting in referral to hospital ED. The use of a pager system is adequate for the management of after-hours emergencies and may reduce self-referrals to the hospital ED.

Abstract 34: A Stroke Transition Of Care Intervention With Stroke Nurse Navigator And Early Stroke Clinic Follow-up Reduces Readmissions For Stroke At 12 Months

Introduction: Stroke is a leading cause of disability in the United States, and one in four occur in people who have already had a stroke. Preventable hospital readmissions contribute to the high medical costs of stroke. Transition of care programs have been successful in reducing hospital readmissions in other diseases, but the data on such programs for stroke is mixed. A transition of care program was implemented at a large urban stroke center, utilizing interventions shown to be effective in the literature, with the goal of reducing recurrent strokes and hospital readmissions. Methods: The transition of care program consisted of: two Stroke Nurse Navigators, personalized stroke education in the hospital, two-day phone call reinforcing education and reviewing medications, early follow-up within 7-10 business days with a Stroke Neurologist, and further education on personalized risk factors in the clinic. Baseline data from the year prior to intervention, and each quarter of the three-year project period were obtained on the following measures: Rate of recurrent stroke admissions within one year, all-cause readmission within one year, all-cause readmission within 30 days, patient scheduled for initial follow-up within 7-10 days, compliance with follow up in the stroke clinic, and percent of patients receiving two-day post discharge phone call. Discharge data were reviewed on 949 patients in 2016 (year 0) and on 2,328 patients in the three-year project period (starting in July 2017). Results: The rate of readmission for stroke was 8.5%, 9.0%, 6.6%, and 4.2% for year 0, 1, 2, and 3, respectively. This represents a reduction of 50% from the year prior to the intervention to year 3 of the grant. All-cause readmission remained stable, at 38.9%, 42.6%, 36.6%, and 37.4% for year 0, 1, 2, and 3 respectively. An improvement was seen in process measures: patients scheduled for early follow up in the stroke clinic, adherence to follow-up, and two-day post-discharge phone calls. Conclusions: In conclusion, the transition of care intervention led to a reduction from baseline in readmissions for stroke within one year, but did not impact all cause readmission at one year or 30 days. This is a meaningful outcome for those who have suffered strokes. This program can serve as a model.

Comparison of Health Outcomes Among Patients Admitted on Busy vs Less Busy Days for Hospitalists

Comparison of Health Outcomes Among Patients Admitted on Busy vs Less Busy Days for Hospitalists

Living with severe asthma as a teenager

Living with severe asthma as a teenager

Montana County ends decade‐long contract with MH provider

One of Montana's leading providers of behavioral health services will no longer have an operating contract with Gallatin County as of Feb. 2, the Montana Free Press reported Jan.12. Citing several breaches of its agreement, Gallatin County commissioners and County Attorney Marty Lambert notified Western Montana Mental Health Center in a letter that the agreement would be terminated in 15 business days. “Gallatin County hereby advises all of you that the WMMHC has, on multiple occasions, breached its contractual obligations to the County, including but not limited to, the pro‐visions outlined below,” stated an accompanying Jan. 10 letter addressed to WMMHC Chairperson Levi Anderson. Gallatin County has been paying the WMMHC $29,417.50 monthly to provide a range of services. One is the provision of at least one bed for temporary, involuntary holds at the WMMHC's Hope House in Bozeman for people whose mental health crisis presents a danger to themselves or others. County officials say Hope House has been insufficiently operated at various times in recent years. Ending the more than 10‐year contract, Lambert said, “finally allows us to move forward with the provision of these very important crisis services which have only been sporadically met by Western for quite some time.” The WMMHC's Anderson attributes much of the difficulty at Hope House to low staffing levels exacerbated by the COVID‐19 pandemic — an issue he says is not unique to his organization. “The entire State of Montana is experiencing a drastic workforce shortage and behavioral health providers, WMMHC included, are struggling with workforce,” Anderson said in an email, adding that his organization has had to be “nimble” to modify services during the pandemic. “The Gallatin County Commission and County Attorney are alleging a breach of service based on these pandemic‐related operational challenges that have been experienced by many organizations, including the County themselves.” Lambert said the county does not expect to enter into a new contract with any other behavioral health care provider, which would require issuing a request for proposals to interested organizations, before the WMMHC's contract ends. The county's agreement with Bozeman Health, he said, will provide an emergency resource for people in crisis until the county can find new providers to work with long term.

Temporal profiles of ambient air pollutants and associated health outcomes in two polluted cities of the Middle East.

Dust storms and particulate matters had been increased due to climate change in the Middle East. On the other hand, urbanization and industrialization raised levels of gaseous air pollutants in all big cities. In the current study, air pollution information collected from Environmental Protection Agency of Khuzestan and Tehran containing hourly O3, NO2, CO, SO2, PM10 and PM2.5 concentrations between 2014 and 2015. This study evaluated the air quality of these two cities by Air Quality Index (AQI). As a result, mean concentrations of O3, NO2, PM10 and PM2.5 were higher in Ahvaz than Tehran while Tehran was more pollutant in terms of CO and SO2. Diurnal variations of O3 in weekend were the only trend located above weekday variations along the daytimes. Hourly variations of all pollutants changed with a wider range of concentrations in Ahvaz. Diurnal peaks of all pollutants showed their highest level on Monday as the busiest day in mega city, Tehran with the exception of SO2. PM2.5 was the worst and limiting pollutant for both cities. Accordingly, winter was the most polluted season by 77 and 33μgm-3 in Ahvaz and Tehran, respectively. Number of clean days was significantly lower in Ahvaz (no-day) than mega city, Tehran (<17days). The number of unhealthy days was also presented significantly higher in Ahvaz (>186days). Although, annual PM2.5 concentrations were more in Ahvaz, the higher at-risk population in Tehran caused more health endpoints in the capital of Iran. Consequently, both cities should have their own especial pattern to control air pollution and attributed health damages.

Exploring the Measurement Lab Open Dataset for Internet Performance Evaluation: The German Internet Landscape

The Measurement Lab (MLab) provides a large and open collection of Internet performance measurements. We make use of it to look at the state of the German Internet by a structured analysis, in which we carve out expressive results from the dataset to identify busy hours and days, the impact of server locations and congestion control protocols, and compare Internet service providers. Moreover, we examine the impact of the COVID-19 lockdown in Germany. We observe that only parts of the Internet show a performance degradation at the beginning of the lockdown and that a large impact in performance depends on the network the servers are located in. Furthermore, the evolution of congestion control algorithms is reflected by performance improvements. For our analysis, we focus on the busy hours. From the end-user perspective, this time is of most interest to identify if the network can support challenging services such as video streaming or cloud gaming at these intervals.

Examining the Development of Zen Buddhist Sources in the East Asian Buddhist Countries

It must be stated that there are not sufficient sources to study the theory and the practice of Zen Buddhism for the students and the teachers of Sri Lankan universities, who do their studies in Sinhala language. To fulfil this gap to some extent, this research is carried out. This tradition is named as “Dhyana” in Sanskrit, “Chan” in Chinese, “Son” in Korean, and “Zen” in Japanese. Though this isrecognized as a tradition that refuses books or scriptures, its great teachers have produced many books which are known as the primary sources of Zen Buddhism. The main subject discussed in these sources is the Buddhist meditation systems which developed as “Zen” Buddhism in the East-Asian countries such as China, Korea and Japan. Thus, these sources were written in Chinese, Korean and Japanese languages. One of the main characteristics of these sources is that they try to introduce the path of purification in a simple manner so that the followers can easily practice. This can be seen throughout the Zen Buddhist history, and that knowledge will help the readers to understand how to implement simple Zen Buddhist techniques in their busy day to day life. Hence, the objective of the research is to examine the Zen Buddhist sources and the meditation systems or techniques which are found in them.

Application of Accounting Information Systems at Zakat, Infaq, Sadaqah Institutions in an Effort to Improve Internal Control on Cash Receipts

This study aims to determine the application of accounting information systems at zakat, infaq, shadaqah institutions in an effort to improve internal control on cash receipts at LAZISMU Sidoarjo. This research approach uses a qualitative approach with primary data sources. Data collection was obtained from the results of interviews, observations and documentation. Technical validity of data with triangulation model. The results of the study stated that the application of the accounting information system at LAZISMU, Sidoarjo Regency had used a system from the center, namely the ZISKA software which stands for (Zakat, Infaq, Shadaqah, and Humanity). The advantages of the system are more detailed. However, there are obstacles that occur such as network disturbances and to prevent the risk of data loss, data backup is carried out. To anticipate errors in recording cash receipts, cross checks and evaluations are carried out through meetings. The use of the form or document has been serially numbered printed. Transparent financial reports to the public. Cash deposits to the bank are made every day and are directly deposited on bank business days. In the element of internal control, several weaknesses were found.

A Look Back at the Czechoslovak Family Business Day, which Included a Conference Entitled Family Business, Intergenerational Milestones and Generators of Value

A Look Back at the Czechoslovak Family Business Day, which Included a Conference Entitled Family Business, Intergenerational Milestones and Generators of Value

Metaphors in Newspaper Reports on Nigeria 2005 Banks Recapitalisation

This article investigates metaphors in newspaper reports that border on mergers and acquisitions within the 2005 recapitalisation exercise in Nigeria. It considers conceptual metaphors used in depicting mergers and acquisitions among Nigerian banks and how they are deployed by journalists in shaping readers’ perception of the mergers and acquisitions activities. Data for the study comprise thirty purposively sampled articles on recapitalisation published between year 2004 and 2006, in three selected Nigerian newspapers: Business Day, The Punch and ThisDay, which had relevance, wide circulation and adequate reports on economic issues in Nigeria. Lakoff and Johnson’s (1980) conceptual metaphor theory provides the theoretical perspective for the data analysis. The study reveals two conceptual metaphors: MERGERS AND ACQUISITIONS AS WAR and MERGERS AND ACQUISITIONS AS CONNUBIAL RELATIONS. The metaphors of war influence readers’ perception of the mergers and acquisitions exercise as a corporate management task that is highly indispensable, confrontational and susceptible to aggression considering the appalling state of the Nigeria banking sector and the huge recapitalisation funds required of individual banks. While the connubial metaphors offered readers a perception of an important exercise that entails due process, cooperation, and togetherness in achieving the stipulated recapitalisation funds. Metaphors perform multifarious functions in the construction and comprehension of financial issues. They are not the consequence of genus, but the sequence of motivated cognitive devices used by Nigerian journalists in rendering contemporary Nigerian issues.

Northern Michigan University online campus: A case of digital transformation in higher education

The Northern Michigan University (NMU) online campus, fondly known as the “Global Campus,” is now 5 years old. Launched in 2016, this online and distance education initiative had as its mission to create academic programs that meet students’ learning and service needs “at the same high standard we do for on-campus students” (NMU). This was a kind of organic final step in the journey of digital transformation that began sixteen years before. Nonetheless, how does NMU make a pivot from 117 years of traditional face-to-face learning model to create value and compete in the digital education space? Worse still, when the Covid-19 global pandemic hits in March 2020 and the campus is forced to shut down (mandating all face-to-face teaching and learning, and to transition to online delivery within just two business days and a weekend); how does the university handle this new set of challenges as its online model gets tested in real-time? The story of NMU’s evolution to online education is told by intrinsic and extrinsic factors including declining enrollments due to changing local economics and regional demographics, an old business model now compounded by a global pandemic. This mix of factors would seem to present NMU with both an opportunity to refine its online model and some new challenges to overcome. This evolution also speaks to the importance of having an overarching digital strategy that can drive true digital transformation.

Implementing Electronic Patient-Reported Outcomes for Patients With New Oral Chemotherapy Prescriptions at an Academic Site and a Community Site.

Oral chemotherapy challenges providers' abilities to safely monitor patients' symptoms, adherence, and financial toxicity. COVID-19 has increased the urgency of caring for patients remotely. Collection of electronic patient-reported outcomes (ePROs) has demonstrated efficacy for patients on intravenous chemotherapy, but limited data support their use in oral chemotherapy. We undertook a pilot project to assess the feasibility of implementing an ePRO system for patients starting oral chemotherapy at our cancer center, which includes both an academic site and a community site. Patients initiating oral chemotherapy were asked to participate. A five-question tool was built in REDCap. Concerning responses triggered outreach within one business day. The primary outcome was time to first symptom assessment. For comparison, we used a historical cohort of patients who had been prescribed oral chemotherapies by providers in the same disease groups at the cancer center. Twenty-five of 62 (40%) patients completed ePRO assessments. Fifty historical charts were reviewed. Time to first symptom assessment was 7 days (IQR, 4-14 days) in the historical group compared with 3 days (IQR, 2-4 days) in the ePRO group. Time to clinical action was 14 days (7-35 days) in the historical group compared with 8 days (4-19 days) in the ePRO group. No statistically significant differences were detected in 30-day emergency department visit or hospitalization (12% for both groups) or 90-day emergency department visit or hospitalization rates (historical 28% and ePRO 20%). An ePRO tool monitoring patient concerns about adherence, cost, and toxicities for patients with new oral chemotherapy regimens is feasible and improves time to symptom assessment. Further investigation is needed to improve patient engagement with ePROs and evaluate the long-term impacts for patients on oral chemotherapy.

Analysis of Emergency Healthcare Demand in a Prison.

ObjectiveTo analyze the reasons for seeking emergency medical care amongst prison inmates and their relationship to sociodemographic characteristics.Material and methodAn observational, descriptive and retrospective study was carried out. We collected the sociodemographic variables of inmates and their healthcare needs at the referral hospital over nine years.ResultsA total of 972 hospital visits were included. The most common healthcare needs, in descending order, were multiple trauma, limb problems and dyspnea. Mondays and Wednesdays were found to be the busiest days (P <0.001). The average stay in cases of hospitalization was 6.1 (SD: 4.3) days; patients with nontraumatic healthcare needs required a longer stay. The majority of the inmates native to Africa, Asia and America received emergency healthcare services due to traumatic injuries; by contrast the most common injuries among Europeans were non-traumatic and unrelated to suicide attempts (P <0.001). European inmates were on average 4.2 years older than Africans and 4.7 years older than American inmates (P <0.001).DiscussionThe reasons for seeking emergency care are clearly differentiated according to the inmates’ nationality, one notable outcome was the greater longevity of European internees. These results highlight the importance of understanding healthcare demand within the prison system in order to better address considerations such as prevention, organization and the location of healthcare units.

Classical Hodgkin Lymphoma; Real-World Observations from Physicians, Patients, and Caregivers on the Disease and Its Treatment (CONNECT): Observations of Physicians on Treatment and Interim PET-Adapted Regimens

BackgroundCurrent NCCN guidelines recommend 1 of 3 first-line (1L) regimens for stage III or IV classical Hodgkin lymphoma (cHL): ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine), A+AVD (brentuximab vedotin, doxorubicin, vinblastine, dacarbazine), or escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone); preferred regimens vary by region (e.g., North America vs Europe). The NCCN recommends positron emission tomography/computerized tomography (PET/CT) imaging after cycle 2 (interim PET2) to guide ABVD escalation or de-escalation. We surveyed physicians on their cHL treatment decision-making process and how PET/CT scan access, reimbursement, and comprehension influence their choices as part of CONNECT, the first real-world survey of physicians, patients, and caregivers in cHL.MethodsMedical oncologists, hematologist/oncologists, or hematologists who treat cHL were invited to participate in an Institutional Review Board-approved, 30-minute online anonymous survey. Eligible participants had ≥2 years of practice experience in the United States (US) and treated ≥1 adult (aged ≥18 years) with stage III or IV cHL and ≥1 adult with cHL in the 1L setting within the prior 12 months. Surveys were completed from October 19, 2020-November 16, 2020.ResultsOf 301 participating physicians, 80% were hematologist/oncologists with a median practice duration of 15 years; 62% practiced in community and 38% in academic settings. Participants were located in the US (South, 34%; Northeast, 26%; West, 21%; Midwest, 20%) and spent 90% of their professional time in direct patient care. In the preceding 12 months, participants treated a median (interquartile range) of 16 (7-40) patients with active cHL (stage III [median], 4; stage IV, 5) and 15 (8-40) cHL survivors. When treating cHL, 88% of participants reported giving NCCN guidelines somewhat/significant consideration. Overall, 94% of participants (n=284) reported using a PET/CT combined scan to diagnose/stage cHL, in line with current guideline recommendations. Of these participants, 97% reported typically getting an interim PET/CT scan for stage III or IV cHL with 65% typically getting the scan after cycle 2 (Figure A). Participants reported both escalating and de-escalating treatment based on interim PET/CT results (Figure B) with 61% making decisions after cycle 2. Of participants using a PET/CT scan, 42% reported receiving both a Deauville score and a standardized uptake value (SUV; Figure C) with 62% of participants noting that the Deauville score was the primary system used for reviewing PET/CT results (Figure D). However, 19% of participants reported challenges interpreting PET/CT results. Among participants using a Deauville score (n=209), consensus was limited on what defined a positive scan (≥3, 44%; ≥4, 37%).Challenges obtaining PET/CT scans were reported by 16% of participants using PET/CT scans. However, despite not reporting challenges 55% of participants on average were unable to obtain a PET/CT scan 20% of the time. Of participants using PET/CT scans, 86% reported typically receiving results within 2 business days and 14% within 3-5 business days. Twenty-one percent of participants reported that delays in PET/CT results affected their ability to use a PET-adaptive approach. Forty-nine percent of those using PET/CT scans reported increased difficulty in PET/CT access for stage III or IV cHL due to lack of insurance coverage. In absence of a PET/CT scan, 36% of participants reported using an interim biopsy and 63% an interim CT scan to inform treatment choices. Among all participants, 36% reported increased difficulty in getting patients with cHL access to PET/CT scans due to COVID-19.ConclusionsAlthough participants consider NCCN guidelines when treating cHL, interim PET scans are not universally obtained after cycle 2 for stage III or IV cHL, with 65% of participants who use PET/CT scans obtaining an interim PET scan after cycle 2 for stage III or IV cHL. When PET/CT scans are obtained, Deauville scores are commonly provided; however, there is variability in what is termed a positive or negative Deauville score. Challenges in obtaining PET/CT scans, with increased difficulty during COVID-19, were reported. Also, there are other barriers, such as lack of insurance, that may prohibit the optimal adherence to guidelines on interim PET/CT utilization. [Display omitted] DisclosuresParsons: SeaGen: Consultancy. Yu: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Liu: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Kumar: Seagen, Inc: Consultancy. Fanale: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Flora: Seagen, Inc: Research Funding.

FDA Cleared Companion Diagnostics (CDx) Tests (IDH1, IDH2 and FLT3) for Acute Myeloid Leukemia (AML) Patient Care

Acute myeloid leukemia (AML) is one of the most lethal blood cancers from which nearly 10,000 people die in the United States each year. While therapies for other blood cancers have made some progress, the standard of care for AML, a combination of toxic chemotherapies, has changed very little over the past four decades. In recent years the US Food and Drug Administration (FDA) has been very active in approving targeted therapeutic drugs for AML patients including Midostaurin (Rydapt; 2017) and Gilteritinib (Xospata;2018) for FLT3 mutations; Enasidenib (Idhifa; 2017) for IDH2 mutations and Ivosidenib (Tibsovo; 2018) for IDH1 mutations. Additionally, the Leukemia and Lymphoma Society's Beat AML Master Clinical Trial has shown that waiting for molecular results prior to treatment decision leads to better outcomes. Versiti Blood Center of Wisconsin Diagnostics laboratory which is certified under the Clinical Laboratory Improvement Amendments (CLIA) and qualified to perform high complexity clinical laboratory testing has performed the verification studies and offers two companion diagnostics tests for IDH1 and IDH2 mutations for AML patients. Also, in collaboration with Invivoscribe Inc., the AML patient can be tested for Leukostrat CDx FLT3 mutations assay so that the same AML patient can get three CDx test results leading to available drug therapy treatment decision making by physicians.IDH1CDX Test: IDH1 CDx is indicated as an aid in identifying AML patients with an IDH1 mutation for treatment with ivosidenib (TIBSOVO®). Mutations in codon R132 of IDH1 can be found in 6% to 10% of AML patients. The IDH1 CDx test detects five IDH1 mutations R132H (CAT), R132C (TGT), R132G (GGT), R132S (AGT), and R132L (CTT) using PCR technology with homogeneous real-time fluorescence detection. The assay sensitivity for these five IDH1 mutations is 100% at variant allele frequencies of 2% and higher and 98% or greater at variant allele frequencies of 1% and higher. This test has been approved by the FDA as companion diagnostic device (PMA number P170041).IDH2CDx: IDH2 CDx is indicated as an aid in identifying AML patients with an IDH2 mutation for treatment with IDHIFA® (enasidenib). Mutations in the R140 and R172 codons of IDH2 8% to 19% of AML patients.The IDH2 CDX test detects nine IDH2 mutations (R140Q, R140L, R140G, R140W, R172K, R172M, R172G, R172S, and R172W) using PCR technology with real-time fluorescent detection. The assay sensitivity for these nine IDH2 mutations is 99.8% or greater at variant allele frequencies of 2% and higher or 93.5% or greater at variant allele frequencies of 1% and higher. This test has been approved by the FDA as companion diagnostic device (PMA number P170005).FLT3CDx: The FLT3 Leukostrat® CDx Assay is the FDA approved (PMA number P160040) predictive test for the efficacy of midostaurin (RYDAPT®) therapy in all AML patients, regardless of cytogenetics and efficacy of gilteritinib (XOSPATA ® ) therapy in relapsed or refractory AML patients. FLT3 is one of the most commonly mutated genes in AML with 30% of patients at the time of diagnosis 1. The most prevalent type of FLT3 mutation is an internal tandem duplication (ITD) in the juxtamembrane domain. The second most common mutation type in the FLT3 gene is a tyrosine kinase domain (TKD) point mutation in the codon for an aspartate (D835) or an isoleucine (I836) residue. The LeukoStrat® CDx FLT3 Mutation Assay is a PCR-based, in vitro diagnostic test designed to detect internal tandem duplication (ITD) mutations and the tyrosine kinase domain (TKD) mutations D835 and I836 in genomic DNA extracted from mononuclear cells obtained from peripheral blood or bone marrow aspirates of patients diagnosed with AML. Versiti Blood Center sends the patient specimens to Invivoscribe Inc. where the LeukoStrat® CDx FLT3 Mutation Assay is performed and the interpretive comments are included in the patient report by Versiti.From our experience pathologists and treating physicians want molecular test results as fast as possible, especially for the actionable gene mutations in IDH1, IDH2 and FLT3. The IDH1 CDx, IDH2 CDx and FLT3 CDx tests are highly sensitive and Versiti provides average turn around time of 3 business days which enable rapid decision making on the recently available drug therapies for AML patients. We strongly recommend that the IDH1 CDx, IDH2 CDx and FLT3 CDx tests should be performed on all AML patients for better care. DisclosuresNo relevant conflicts of interest to declare. OffLabel Disclosure:In recent years the US Food and Drug Administration (FDA) approved targeted therapeutic drugs for AML patients including Midostaurin (Rydapt; 2017) and Gilteritinib (Xospata;2018) for FLT3 mutations; Enasidenib (Idhifa; 2017) for IDH2 mutations and Ivosidenib (Tibsovo; 2018) for IDH1 mutations.

Intertemporal imitation behavior of interbank offered rate submissions

This paper addresses a problem that may damage the reliability of an interbank offered rate (IBOR) system. Using evidence from the Shanghai Interbank Offered Rate (SHIBOR), we show that some SHIBOR panel banks imitate peers’ quotes after observing them on the next business day. The strength of the intertemporal behavior can be measured by a “Signed Active-minus-Stationary (SAmS)” index, which significantly predicts SHIBOR changes. Moreover, we find that the consequences of the imitation behavior are not fully perceived and understood by the market, and, as a result, SHIBOR-linked derivatives are mispriced. Our findings suggest that regulators of a poll-based interest rate benchmark should pay attention to the intertemporal imitation of submissions, in addition to bad faith collusion. The SAmS index can be utilized in the quality control of panel bank submissions.