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Environmental monitoring (EM) is the cornerstone for the assurance of sterility during aseptic manufacturing. In this study, the EM quality aspects in the radiopharmaceutical cleanrooms of the University Medical Center Groningen (UMCG), The Netherlands, were evaluated. Hereto, data obtained from EM over the period 2010–2022 were analyzed. The data were sorted according to the Good Manufacturing Practice (GMP) classification of the respective premises with their corresponding limits, and frequencies of excursions were determined per location. The frequency of conducted measurements gradually increased between the start and end of the assessed period. There was a trend of increased action limit excursions observed between 2010–2022. We found that EM in grade A areas appeared to be significantly less compliant with GMP specifications than the combined data from all sampled premises at the facility (p < 0.00001; two-sided Fisher’s exact test). A trend was found for reduced action limit excursions for passive air sampling and particle counting, suggesting improved GMP compliance over time for this specific type of EM. The contamination recovery rate (CRR) found for cleanroom conditions, around 10%, was considered sufficient. From this comprehensive data analysis, we learn that, in order to be fully compliant with the requirements set in the recent revision of EU (European Union)-GMP Annex 1 ‘Manufacture of sterile medicinal products’ (in force as of 25 August 2023), strategies to further improve product protection are justified. For example, improved cleaning and disinfection procedures, more efficient working methods as well as optimization of the conditions under which aseptic manufacturing is performed are to be considered.

Summary: Monoclonal antibodies are important cancer medicines. The European Medicines Agency (EMA) approved 48 and the Food and Drug Administration (FDA) 56 anticancer monoclonal antibody-based therapies. Their high prices burden healthcare systems and hamper global drug access. Biosimilars could retain costs and expand the availability of monoclonal antibodies. In Europe, five rituximab biosimilars, six trastuzumab biosimilars, and eight bevacizumab biosimilars are available as anti-cancer drugs. To gain insight into the biosimilar landscape for cancer treatment, we performed a literature search and analysis. In this review, we summarize cancer monoclonal antibodies’ properties crucial for the desired pharmacology and point out sources of variability. The analytical assessment of all EMA-approved bevacizumab biosimilars is highlighted to illustrate this variability. The global landscape of investigational and approved biosimilars is mapped, and the challenges for access to cancer biosimilars are identified.

Immuno-positron emission tomography (immunoPET) enables imaging of specific targets that play a role in targeted therapy and immunotherapy, such as antigens on cell membranes, targets in the disease microenvironment, or immune cells. The most common immunoPET applications use a monoclonal antibody labeled with a relatively long-lived positron emitter such as 89Zr (T1/2 = 78.4 h), but smaller antibody-based constructs labeled with various other positron emitting radionuclides are also being investigated. This molecular imaging technique can thus guide the development of new drugs and may have a pivotal role in selecting patients for a particular therapy. In early phase immunoPET trials, multiple imaging time points are used to examine the time-dependent biodistribution and to determine the optimal imaging time point, which may be several days after tracer injection due to the slow kinetics of larger molecules. Once this has been established, usually only one static scan is performed and semi-quantitative values are reported. However, total PET uptake of a tracer is the sum of specific and nonspecific uptake. In addition, uptake may be affected by other factors such as perfusion, pre-/co-administration of the unlabeled molecule, and the treatment schedule. This article reviews imaging methodologies used in immunoPET studies and is divided into two parts. The first part summarizes the vast majority of clinical immunoPET studies applying semi-quantitative methodologies. The second part focuses on a handful of studies applying pharmacokinetic models and includes preclinical and simulation studies. Finally, the potential and challenges of immunoPET quantification methodologies are discussed within the context of the recent technological advancements provided by long axial field of view PET/CT scanners.

BackgroundDigital transformation (DT) involves integrating digital technologies into organizations to improve productivity, efficiency, and quality. Investing in the workforce's skillsets is essential for successful DT. However, it remains unclear which skillsets are essential.ObjectivesThis study aims to identify and define the essential skillsets needed for exploiting the full potential of DT, and to consolidate the identified skills into a comprehensive framework of DT skills.MethodA systematic literature review was conducted using the PRISMA approach for selecting studies. This led to the selection of 36 articles that were examined using thematic analysis for identifying and consolidating skills into a framework.ResultsThe Digital Transformation Skills Framework (DTSF) was developed, which contains six overarching skillsets and 44 underlying skills. The framework covers key skillsets in the areas of digital work, entrepreneurship, evidence-based work, collaboration, communication, and adaptation.Conclusion and discussionThe DTSF offers a comprehensive understanding of essential skills for today's evolving organizations, addressing a critical gap in existing literature. It is valuable for organizations and HR professionals, serving as a foundation for re- and upskilling initiatives. Ongoing research should expand the framework to include domain-specific DT skills and emerging digital technologies.

BackgroundAdvanced media technologies have become an integral part of people's daily lives, providing them with new tools and environments for the formation and enactment of their identities. To date, the literature acknowledges that media technologies, such as social networking sites, are used to form and enact online identities, and that these platforms can simultaneously pose challenges to individuals' identity work. However, we know little about the precise online identity work strategies that individuals employ in response to the challenges they face over time.ObjectiveThis paper examines the online identity work dynamics of Instagram micro-influencers, for whom social network sites enable and guide them in forming and enacting their online identities on a daily basis. The study was guided by the following research question: what are the challenges that Instagram micro-influencers perceive online and what are the online identity work strategies that they employ in response to these challenges over time?MethodsThis study employs an extreme case approach to rigorously explore the lives of seven micro-influencers on Instagram. We combine in-depth data from narrative interviews, longitudinal data from online autobiographical narratives revealed through the participants' Instagram timelines, and follow-up interviews.ResultsOur analysis revealed three main themes that highlight the challenges that Instagram micro-influencers face online: (1) amplified social expectations, (2) feelings of inauthenticity, and, as a result thereof, (3) psychological distress. We found that these challenges were viewed as catalysts for their online identity work processes. We identified three key online identity work strategies that the Instagram micro-influencers employed in response over time: (1) experimenting with their online identities, followed by either (2) segmenting between their online and offline identities, or (3) adding identities through online multiplicity.ConclusionOur research provides new insights into how individuals may respond to the challenge of managing their online identities over time by engaging in different online identity work strategies. This study highlights the importance of designing online media technologies that enable individuals to cope with online challenges. We emphasize the need to design online spaces for (1) the expression of authentic identities, (2) community building, and (3) online multiplicity.

Stimuli responsive optical materials are attractive for many areas, from healthcare to art design. However, creating intricate color‐changing patterns for visual information is still a challenge. This work describes the preparation of mechanochromic structural colored intricate pictures imprinted in cholesteric liquid crystal elastomers by using a chiral isosorbide molecular photoswitch. The photoswitch contains a photoisomerizable cinnamate moiety and was incorporated in a main chain liquid crystal oligomer with photopolymerizable acrylate end groups. After coating, the structural colored film was irradiated with ultraviolet (UV) light in air causing E/Z isomerization of the cinnamate units leading to a redshift of the structural color of the film. A grayscale photomask was used to spatially control the photoisomerization reaction and imprint colorful pictures such as portraits and landscapes, in the cholesteric liquid crystal films with high resolution. Photopolymerization in a nitrogen atmosphere led to a mechanochromic cholesteric liquid crystal elastomer with striking structural colors that blueshift upon strain. The sharp details of the patterns were preserved even under deformation and the system returned to the initial state upon strain removal. Our work offers a simple photoswitch approach to prepare stimuli responsive optical polymers imprinted with color‐changing pictures of unprecedented complexity. [ABSTRACT FROM AUTHOR]

This paper is the result of the collective work undertaken by a group of Psychological Contract (PC) and Sustainability scholars from around the world, following the 2023 Bi-Annual PC Small Group Conference (Kedge Business School, Bordeaux, France). As part of the conference, scholars engaged in a workshop designed to generate expert guidance on how to aid the PC field to be better aligned with the needs of practice, and thus, impact the creation and maintenance of high-quality and sustainable exchange processes at work. In accordance with accreditation bodies for higher education, research impact is not limited to academic papers alone but also includes practitioners, policymakers, and students in its scope. This paper therefore incorporates elements from an impact measurement tool for higher education in management so as to explore how PC scholars can bolster the beneficial influence of PC knowledge on employment relationships through different stakeholders and means. Accordingly, our proposals for the pursuit of PC impact are organized in three parts: (1) research, (2) practice and society, and (3) students. Further, this paper contributes to the emerging debate on sustainable PCs by developing a construct definition and integrating PCs with an 'ethics of care' perspective. [ABSTRACT FROM AUTHOR]

Abstract [177Lu]Lu-DOTA-NNV003, a radioimmunoconjugate targeting CD37, is developed as novel radioimmunotherapy (RIT) treatment for patients with B cell non-Hodgkin’s lymphoma (NHL). Since patients are at risk for developing hematological toxicities due to CD37 expression on normal B cells, we aimed to develop 89Zr-labeled NNV003 for positron emission tomography (PET) imaging as a surrogate tool to predict [177Lu]Lu-DOTA-NNV003 RIT whole-body distribution and tumor uptake. NNV003 antibody was first radiolabeled with 89Zr. [89Zr]Zr-N-sucDf-NNV003 tumor uptake was evaluated by PET imaging of mice bearing human CD37-expressing REC1 B cell NHL or RAMOS Burkitt’s lymphoma xenograft tumors followed by ex vivo analysis. Finally, CD37-targeting of [89Zr]Zr-N-sucDf-NNV003 and [177Lu]Lu-DOTA-NNV003 RIT were compared. [89Zr]Zr-N-sucDf-NNV003 accumulated in REC1 tumors over time, which was not observed for non-specific, 111In-labeled IgG control molecule. In RAMOS tumor-bearing mice, [89Zr]Zr-N-sucDf-NNV003 tumor uptake was higher than [111In]In-DTPA-IgG at all tested tracer protein doses (10 µg, 25 µg and 100 µg; P

Introduction Unruptured intracranial aneurysms (UIA) are common in the adult population, but only a relatively small proportion will rupture. It is therefore essential to have accurate estimates of rupture risk to target treatment towards those who stand to benefit and avoid exposing patients to the risks of unnecessary treatment. The best available UIA natural history data are the PHASES study. However, this has never been validated and given the known heterogeneity in the populations, methods and biases of the constituent studies, there is a need to do so. There are also many potential predictors not considered in PHASES that require evaluation, and the estimated rupture risk is largely based on short-term follow-up (mostly 1 year). The aims of this study are to: (1) test the accuracy of PHASES in a UK population, (2) evaluate additional predictors of rupture and (3) assess long-term UIA rupture rates.Methods and analysis The Risk of Aneurysm Rupture study is a longitudinal multicentre study that will identify patients with known UIA seen in neurosurgery units. Patients will have baseline demographics and aneurysm characteristics collected by their neurosurgery unit and then a single aggregated national cohort will be linked to databases of hospital admissions and deaths to identify all patients who may have subsequently suffered a subarachnoid haemorrhage. All matched admissions and deaths will be checked against medical records to confirm the diagnosis of aneurysmal subarachnoid haemorrhage. The target sample size is 20 000 patients. The primary outcome will be aneurysm rupture resulting in hospital admission or death. Cox regression models will be built to test each of the study’s aims.Ethics and dissemination Ethical approval has been given by South Central Hampshire A Research Ethics Committee (21SC0064) and Confidentiality Advisory Group support (21CAG0033) provided under Section 251 of the NHS Act 2006. The results will be disseminated in peer-reviewed journals.Trial registration number ISRCTN17658526.

Abstract Elexacaftor/tezacaftor/ivacaftor (ETI) is a cystic fibrosis (CF) transmembrane conductance regulator modulator, which has shown efficacy in CF patients (≥6 years) with ≥1 Phe508del mutation and a minimal function mutation. In October 2019, ETI became available on compassionate use basis for Dutch CF patients with severe lung disease. Our objective was to investigate safety and efficacy of ETI in this patient group in a real‐life setting. A multicenter longitudinal observational study was conducted to examine changes in FEV1, BMI, and adverse events at initiation and 1, 3, 6, and 12 months after starting ETI. The number of exacerbations was recorded in the 12 months before and the 12 months after ETI treatment. Patients eligible for compassionate use had a FEV1

The advent of immune checkpoint inhibitors has reinvigorated the field of immuno-oncology. These monoclonal antibody-based therapies allow the immune system to recognize and eliminate malignant cells. This has resulted in improved survival of patients across several tumor types. However, not all patients respond to immunotherapy therefore predictive biomarkers are important. There are only a few Food and Drug Administration-approved biomarkers to select patients for immunotherapy. These biomarkers do not consider the heterogeneity of tumor characteristics across lesions within a patient. New molecular imaging tracers allow for whole-body visualization with positron emission tomography (PET) of tumor and immune cell characteristics, and drug distribution, which might guide treatment decision making. Here, we summarize recent developments in molecular imaging of immune checkpoint molecules, such as PD-L1, PD-1, CTLA-4, and LAG-3. We discuss several molecular imaging approaches of immune cell subsets and briefly summarize the role of FDG-PET for evaluating cancer immunotherapy. The main focus is on developments in clinical molecular imaging studies, next to preclinical studies of interest given their potential translation to the clinic.

Immuno-positron emission tomography (immunoPET) enables imaging of specific targets that play a role in targeted therapy and immunotherapy, such as antigens on cell membranes, targets in the disease microenvironment, or immune cells. The most common immunoPET applications use a monoclonal antibody labeled with a relatively long-lived positron emitter such as 89Zr (T1/2 = 78.4 h), but smaller antibody-based constructs labeled with various other positron emitting radionuclides are also being investigated. This molecular imaging technique can thus guide the development of new drugs and may have a pivotal role in selecting patients for a particular therapy. In early phase immunoPET trials, multiple imaging time points are used to examine the time-dependent biodistribution and to determine the optimal imaging time point, which may be several days after tracer injection due to the slow kinetics of larger molecules. Once this has been established, usually only one static scan is performed and semi-quantitative values are reported. However, total PET uptake of a tracer is the sum of specific and nonspecific uptake. In addition, uptake may be affected by other factors such as perfusion, pre-/co-administration of the unlabeled molecule, and the treatment schedule. This article reviews imaging methodologies used in immunoPET studies and is divided into two parts. The first part summarizes the vast majority of clinical immunoPET studies applying semi-quantitative methodologies. The second part focuses on a handful of studies applying pharmacokinetic models and includes preclinical and simulation studies. Finally, the potential and challenges of immunoPET quantification methodologies are discussed within the context of the recent technological advancements provided by long axial field of view PET/CT scanners. [ABSTRACT FROM AUTHOR]

Environmental monitoring (EM) is the cornerstone for the assurance of sterility during aseptic manufacturing. In this study, the EM quality aspects in the radiopharmaceutical cleanrooms of the University Medical Center Groningen (UMCG), The Netherlands, were evaluated. Hereto, data obtained from EM over the period 2010–2022 were analyzed. The data were sorted according to the Good Manufacturing Practice (GMP) classification of the respective premises with their corresponding limits, and frequencies of excursions were determined per location. The frequency of conducted measurements gradually increased between the start and end of the assessed period. There was a trend of increased action limit excursions observed between 2010–2022. We found that EM in grade A areas appeared to be significantly less compliant with GMP specifications than the combined data from all sampled premises at the facility (p < 0.00001; two-sided Fisher's exact test). A trend was found for reduced action limit excursions for passive air sampling and particle counting, suggesting improved GMP compliance over time for this specific type of EM. The contamination recovery rate (CRR) found for cleanroom conditions, around 10%, was considered sufficient. From this comprehensive data analysis, we learn that, in order to be fully compliant with the requirements set in the recent revision of EU (European Union)-GMP Annex 1 'Manufacture of sterile medicinal products' (in force as of 25 August 2023), strategies to further improve product protection are justified. For example, improved cleaning and disinfection procedures, more efficient working methods as well as optimization of the conditions under which aseptic manufacturing is performed are to be considered. [ABSTRACT FROM AUTHOR]

Psychological contracts reside in the eye of the beholder and capture the employee-employer exchange relationship. It is a dynamic relationship as employees deliberately manage and change their psychological contract over time. Triggers seem to be the drivers underpinning this dynamism. Yet little is known about how these triggers operate and affect the psychological contract. To address this, we explore triggers and their impact using a 6-week daily diary study (N = 117). We found a linear chain of positive relationships from initial triggers to connectedness of past triggers, to the experience of negative emotions, to the expected reoccurrence of the initial trigger, ultimately disrupting the psychological contract. The findings revealed the dynamic effect of triggers on the employment relationship, not only by exposing the underlying micro-processes, but also by revealing that the impact of triggers can linger for approximately 11 days before leveling off. These findings suggest that the psychological contract may fluctuate on a daily basis due to the influence of triggers. The theoretical implications for understanding the dynamic nature of the psychological contract are discussed in relation to the disruptive role of triggers. [ABSTRACT FROM AUTHOR]

(1) Introduction: Pharmacokinetic boosting of kinase inhibitors can be a strategy to enhance drug exposure and to reduce dose and associated treatment costs. Most kinase inhibitors are predominantly metabolized by CYP3A4, enabling boosting using CYP3A4 inhibition. Kinase inhibitors with food enhanced absorption can be boosted using food optimized intake schedules. The aim of this narrative review is to provide answers to the following questions: Which different boosting strategies can be useful in boosting kinase inhibitors? Which kinase inhibitors are potential candidates for either CYP3A4 or food boosting? Which clinical studies on CYP3A4 or food boosting have been published or are ongoing? (2) Methods: PubMed was searched for boosting studies of kinase inhibitors. (3) Results/Discussion: This review describes 13 studies on exposure boosting of kinase inhibitors. Boosting strategies included cobicistat, ritonavir, itraconazole, ketoconazole, posaconazole, grapefruit juice and food. Clinical trial design for conducting pharmacokinetic boosting trials and risk management is discussed. (4) Conclusion: Pharmacokinetic boosting of kinase inhibitors is a promising, rapidly evolving and already partly proven strategy to increase drug exposure and to potentially reduce treatment costs. Therapeutic drug monitoring can be of added value in guiding boosted regimens.