Translating a Culture of Quality to Clinical Research Conduct: Expanding the Clinical Development Quality Framework

The International Council on Harmonisation E8 Guidance Revision 1 (ICH E8(R1)) calls for creating a Culture of Quality that "values and rewards critical thinking and open, proactive dialogue about what is critical to quality." Across the biopharma landscape, clinical sites, sponsors, and service providers are working to translate this far-reaching guideline into working practices. This manuscript deconstructs key elements that comprise the critical thinking and open, proactive Culture of Quality "enablers." In addition, maturity models are provided so readers can visualize what a Culture of Quality looks like in their clinical research organization. These provide examples of high performing cultures of quality and useful tools for teams or organizations to measure and evolve their respective quality cultures.

Effect of carnitine deprivation on carnitine homeostasis and energy metabolism in mice with systemic carnitine deficiency

BACKGROUND/AIMS

Juvenile visceral steatosis (jvs-/-) mice lack the activity of the carnitine transporter OCTN2 and are dependent on carnitine substitution. The effects of carnitine deprivation on carnitine homeostasis and energy metabolism are not known in jvs-/- mice.

METHODS

jvs-/- mice were studied 3, 6 and 10 days after carnitine deprivation, and compared to jvs-/- mice substituted with carnitine, wild-type (jvs+/+) and jvs+/- mice. Carnitine concentrations were assessed radioenzymatically.

RESULTS

Compared to wild-type mice, carnitine-treated jvs-/- mice had decreased plasma beta-hydroxybutyrate levels and showed hepatic fat accumulation. The carnitine levels in plasma, liver and skeletal muscle were decreased by 58, 16 and 17%, respectively. After ten days of carnitine deprivation, the plasma carnitine concentration had fallen by 87% (to 2.3 mumol/l) and the tissue carnitine levels by approximately 50% compared to carnitine-treated jvs-/- mice. Carnitine deprivation was associated with a further drop in plasma beta-hydroxybutyrate and increased hepatic fat. Skeletal muscle glycogen stores decreased and lactate levels increased with carnitine deprivation, whereas tissue ATP levels were maintained.

CONCLUSIONS

In jvs-/- mice, tissue carnitine stores are more resistant than carnitine plasma concentrations to carnitine deprivation. Metabolic changes (liver steatosis and loss of muscle glycogen stores) appear also early after carnitine deprivation.

Experiences with fetal phonocardiographic telemonitoring and future possibilities

Phonocardiography (PCG) makes possible the examination of some fetal cardiac anomalies which otherwise usually remain undetected during pregnancy. The application of PCG in a telemonitoring system enhances its diagnostic capabilities, allowing long-term measurements even at home. The paper summarizes the intensive fetal monitoring campaign carried out in Hungary during the last three years that yielded useful experience regarding recent and future possibilities of fetal monitoring. Results collected from a large number of measurements suggest that PCG home monitoring may be a suitable screening method for fetal congenital heart diseases, even if surgical intervention in this phase of pregnancy is not easy.

Long-term Phonocardiographic Fetal Home Monitoring for Telemedicine Systems

A novel compact method for fetal home monitoring optimized for long data acquisition time and low communication costs is presented. The method incorporates the preprocessing of disturbed acoustic signal received on the maternal abdomen. The basic idea of the preprocessing is that the detection of the systolic and diastolic sounds takes place on two separated frequency bands with autocorrelation on predicted time intervals. Measurements on 47 selected pregnant women have shown that the use of this method significantly reduces the amount of data to be transferred to the computer centre in the hospital, where only the very disturbed time periods have to be evaluated. Based on this method a new, phonocardiographic fetal telemedicine system can be built without time limitation of measurements.

Two B or not two B? Overview of the rapidly expanding B-box family of proteins

The B-box gene family represents a large number of genes involved in functions such as axial patterning, growth control, differentiation, and transcriptional regulation. These genes possess several conserved motifs that always include a B-box zinc binding motif associated with various other motifs such as the RING zinc finger, an alpha-helical coiled-coil, the rfp or B30.2 motif, propeller domain, and the NHL motif in various combinations. Mutations or rearrangements in several B-box family members are associated with human diseases and cancers such as familial Mediterranean fever (FMF), Optiz/BBB syndrome, acute promyelocytic leukemia, mulibrey nanism, and thyroid carcinomas. This suggests that members of this gene family play important roles in fundamental biological processes. Here we discuss the known members of this rapidly expanding protein family.

[On the way to the secret of Freudian psychoanalysis. From Emmy von N. to "Totem and taboo"]

The authors approach the work of Sigmund Freud by regarding the theory and history of psychoanalysis in terms of a feature that they have in common, namely secrecy. This proclivity towards secrecy, which stands in contradiction to the psychoanalytic principle of total frankness and demystification, is illustrated by a number of examples-the suggestion made by Jones to Ferenczi and Freud in 1911 for the "formation of a secret committee to supervise the development of psychoanalysis"; the censorship practised by Jones in connection with the use of the Freud Archives; and the case history of Emmy von N., where Freud assumes the role of depositary for the memories communicated by his patient under hypnosis and observes strict secrecy about them. The authors give a particularly detailed account of the evidence of the "secret of psychoanalysis" to be traced in Totem and Taboo, which they elucidate with the aid of a reading of Shakespeare's Tempest.

Prevention of acute stress bleeding with sucralfate, antacids, or cimetidine. A controlled study with pirenzepine as a basic medication

In a prospective, controlled, randomized study of a prophylaxis for stress bleeding, 100 high-risk patients in an intensive care unit received, on a daily basis, 1 g of sucralfate every four hours, an antacid every two hours, or 2 g of cimetidine intravenously. All patients also received 50 mg of pirenzepine by intravenous infusion each day. Gastric pH was determined every eight hours. Bleeding was defined as macroscopically visible bleeding. The intragastric pH was less than 4 significantly more often in patients treated with sucralfate than in patients treated with the other agents, but stress bleeding occurred only in patients treated with cimetidine (n = 2) or antacids (n = 2). In the latter two treatment groups, the probability of bleeding correlated with the incidence of pH values below 4. No side effects of sucralfate therapy were observed. The results indicate that prophylactic treatment of stress bleeding with pirenzepine and sucralfate is at least as effective as combined treatment with pirenzepine and cimetidine or antacids.