The use of the EVITA algorithm for clinical assessment of novel agents used in prostate cancer, metastatic melanoma, and systemic lupus erythematosus.

PURPOSE: Existing health technology assessment methods can be time-consuming and complicated to use in practice. EValuation of pharmaceutical Innovations with regard to Therapeutic Advantage (EVITA) is a recently developed drug assessment strategy that provides a detailed and clinically relevant evaluation of new agents compared to standard therapies. We therefore sought to use EVITA to evaluate eight novel agents recently introduced to clinical practice or in late-stage trials for the treatment of prostate cancer, metastatic melanoma, or systemic lupus erythematosus (SLE). METHODS: Eight agents (abiraterone, enzalutamide, sipuleucel-T, Prostvac, radium 223, ipilimumab, vemurafenib, and belimumab) were selected for study using the EVITA algorithm. A comprehensive literature search was performed to find clinical trial data, which were then classified using the EVITA protocol. EVITA was also compared to results from health technology assessments (HTAs) or reimbursement decisions. RESULTS: The EVITA scores for the eight drugs ranged from 5.5 to 9: all the selected agents are therefore classed as 'recommended' and are likely to produce a therapeutic advantage. In particular, vemurafenib is likely to be highly beneficial to patients with metastatic melanoma and radium 223 to patients with metastatic prostate cancer affecting the bone. The EVITA results were generally concordant with HTAs. CONCLUSIONS: All the agents show favourable EVITA scores and are therefore recommended for clinical practice. EVITA is an easy-to-use tool that provides clinical context to the assessment of newly introduced agents and can be easily used by non-specialists.

Use of multitracers for the study of water mixing in the Paraíba do Sul River estuary.

Multitracers were used to study water mixing in the Paraíba do Sul River estuary region in August 2007 (dry season) and March 2008 (rainy season) and to evaluate the reach of the river plume in the direction of the open ocean. Two sampling campaigns were carried out, each in a different season. Based on these results, it was possible to conclude that the multitracers used in this study (salinity, Si, Ba and U, as well as the radium isotopes 223Ra, 224Ra, 226Ra and 228Ra) presented satisfactory results toward defining the plume reach and determining the residence time and water-mixing processes in the estuary. A strong correlation was observed between tracers and the distance to the coast. During the low river water discharge period, the riverine water took about 10 days to reach open ocean waters (salinity approximately 35). During the rainy period this value decreased to 6 days. Based on the radium results, it was possible to calculate diffusion coefficients (K(h)) of 23 km(2) d(-1) and 38 km(2) d(-1) for 224Ra and 223Ra, respectively, during the dry season (winter). Values of 65 km(2) d(-1) and 68 km(2) d(-1) for 223Ra and 224Ra, respectively, were found for the rainy period (summer).

Radiation protection at an aviation museum.

The U.S. Nuclear Regulatory Commission (U.S. NRC) will soon publish a proposed amendment to its rules that will classify the naturally occurring isotope Ra as "byproduct material" subject to its regulatory control. One of the uses of radium in the first half of the twentieth century was as a source of energy that would make certain consumer products "glow in the dark." In addition to wristwatches and other timepieces, this form of self-luminescence was widely used on aircraft instruments. There have been a number of facilities where large numbers of such instruments were stored and leakage of this isotope occurred. Subsequent decontamination of these areas, including expensive disposal of the radioactive waste, was required. We were asked to evaluate the potential hazards of aircraft and aircraft instruments at a museum in New York City, specifically the decommissioned aircraft carrier USS Intrepid. We present the results of our investigation and discuss the implications as they relate to the proposed new U.S. NRC regulations and compatibility issues with State regulations.

Concurrent determination of 224Ra, 226Ra, 228Ra, and unsupported 212Pb in a single analysis for drinking water and wastewater: dissolved and suspended fractions.

A technique has been developed for the measurement of 224Ra, 226Ra, 228Ra, and unsupported 2t2Pb concurrently in a single analysis. The procedure can be applied to both drinking water and wastewater, including the dissolved and suspended fractions of a sample. For drinking water samples, using 3-L aliquots, the radium isotopes are isolated by a fast PbSO4 co-precipitation and then quantified by gamma-ray spectroscopy. The radium isotopes 224Ra, 226Ra, and 228Ra are measured through their gamma-ray-emitting decay products, 212Pb, 214Pb (and/or 214Bi), and 228Ac, respectively. Because of the short half-life of 224Ra (T1/2 = 3.66 d), the precipitate should be counted within 4 d of the sample collection date. In case the measurement of unsupported 212Pb (T1/2 = 10.64 h) is required, the gamma-ray analysis should be initiated as soon as possible, preferably on the same day of collection. The counting is repeated after about 21 d to ensure the 226Ra progeny are in equilibrium with their parent. At this point, the 228Ac equilibration with its 228Ra parent is already established. In the case of samples containing suspended materials, an aliquot of sample is filtered and then the filtrate is treated as described above for drinking water samples. The suspended fraction of sample, collected on the filter, is directly analyzed by gamma-ray spectroscopy with no further chemical separation. Aliquots of de-ionized water spiked with various radium standards were analyzed to check the accuracy and precision of the method. In addition, analysis results of actual samples using this method were compared with the ones performed using U.S. Environmental Protection Agency-approved procedures, and the measured values were in close agreement. This method simplifies the analytical procedures and reduces the labor while achieving the precision, accuracy, and minimum detection concentration requirements of EPA's Regulations.

Non-destructive determination of 224Ra, 226Ra and 228Ra concentrations in drinking water by gamma spectroscopy.

The U.S. Environmental Protection Agency mandates that drinking water showing gross alpha-activity greater than 0.19 Bq L(-1) should be analyzed for radium, a known human carcinogen. The recommended testing methods are intricate and laborious. The method reported in this paper is a direct, non-destructive gamma-spectroscopic method for the determination of 224Ra, 226Ra, and 228Ra, the three radium isotopes of environmental concern in drinking water. Large-volume Marinelli beakers (4.1-L capacity), especially designed for measuring radioactive gases, in conjunction with a low-background, high-efficiency (131%) germanium detector were used in this work. It was first established that radon, the gaseous decay product of radium, and its progeny are quantitatively retained in this Marinelli beaker. The 224Ra, 226Ra, and 228Ra activity concentrations are determined from the equilibrium activities of their progeny: 212Pb, 214Pb (214Bi), and 228Ac; and the gamma-lines used in the analysis are 238.6, 351.9 (and 609.2), and 911.2 keV, respectively. The 224Ra activity is determined from the first 1,000-min measurement performed after expulsion of radon from the sample. The 226Ra activity is determined from the second, 2,400-min measurement, made 3 to 5 d later, and the 228Ra activity is determined from either the first or the second measurement, depending on its concentration level. The method's minimum detectable activities are 0.017 Bq L(-1), 0.020 Bq L(-1), and 0.027 Bq L(-1) for 224Ra, 226Ra, and 228Ra, respectively, when measured under radioactive equilibrium. These limits are well within the National Primary Drinking Water Regulations required limit of 0.037 Bq L(-1) for 226Ra and for 228Ra. The precision and accuracy of the method, evaluated using the U.S. Environmental Protection Agency and the Environmental Resource Associates' quality control samples, were found to be within acceptable limits.