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Huang J, Wang X, Jin Y, Lou G, Yu Z. Trends and prescribing patterns of antimigraine medicines in nine major cities in China from 2018 to 2022: a retrospective prescription analysis. J Headache Pain 2024; 25:62. [PMID: 38654177 PMCID: PMC11036710 DOI: 10.1186/s10194-024-01775-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The objective of this study was to investigate the trends and prescribing patterns of antimigraine medicines in China. METHODS The prescription data of outpatients diagnosed with migraine between 2018 and 2022 were extracted from the Hospital Prescription Analysis Cooperative Project of China. The demographic characteristics of migraine patients, prescription trends, and corresponding expenditures on antimigraine medicines were analyzed. We also investigated prescribing patterns of combination therapy and medicine overuse. RESULTS A total of 32,246 outpatients who were diagnosed with migraine at 103 hospitals were included in this study. There were no significant trend changes in total outpatient visits, migraine prescriptions, or corresponding expenditures during the study period. Of the patients who were prescribed therapeutic medicines, 70.23% received analgesics, and 26.41% received migraine-specific agents. Nonsteroidal anti-inflammatory drugs (NSAIDs; 28.03%), caffeine-containing agents (22.15%), and opioids (16.00%) were the most commonly prescribed analgesics, with corresponding cost proportions of 11.35%, 4.08%, and 19.61%, respectively. Oral triptans (26.12%) were the most commonly prescribed migraine-specific agents and accounted for 62.21% of the total therapeutic expenditures. The proportion of patients receiving analgesic prescriptions increased from 65.25% in 2018 to 75.68% in 2022, and the proportion of patients receiving concomitant triptans decreased from 29.54% in 2018 to 21.55% in 2022 (both P < 0.001). The most frequently prescribed preventive medication classes were calcium channel blockers (CCBs; 51.59%), followed by antidepressants (20.59%) and anticonvulsants (15.82%), which accounted for 21.90%, 34.18%, and 24.15%, respectively, of the total preventive expenditures. Flunarizine (51.41%) was the most commonly prescribed preventive drug. Flupentixol/melitracen (7.53%) was the most commonly prescribed antidepressant. The most commonly prescribed anticonvulsant was topiramate (9.33%), which increased from 6.26% to 12.75% (both P < 0.001). A total of 3.88% of the patients received combined therapy for acute migraine treatment, and 18.63% received combined therapy for prevention. The prescriptions for 69.21% of opioids, 38.53% of caffeine-containing agents, 26.61% of NSAIDs, 13.97% of acetaminophen, and 6.03% of triptans were considered written medicine overuse. CONCLUSIONS Migraine treatment gradually converges toward evidence-based and guideline-recommended treatment. Attention should be given to opioid prescribing, weak evidence-based antidepressant use, and medication overuse in migraine treatment.
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Affiliation(s)
- Jing Huang
- Department of Pharmacy, The First Affiliated Hospital of Ningbo University, Ningbo, 315010, China
| | - Xinwei Wang
- Department of Pharmacy, The First Affiliated Hospital of Ningbo University, Ningbo, 315010, China
| | - Yiyi Jin
- Department of Pharmacy, The First Affiliated Hospital of Ningbo University, Ningbo, 315010, China
| | - Guodong Lou
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3rd East Qingchun Road, Hangzhou, Zhejiang Province, China
| | - Zhenwei Yu
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3rd East Qingchun Road, Hangzhou, Zhejiang Province, China.
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Wang YF, Wang SJ, Huang YH, Chen YT, Yen YC, Shia BC, Tsai CW, Chan HF, Panni T, Dell’Agnello G. Treatment pattern and health care resource utilization for Taiwanese patients with migraine: a population-based study. Front Neurol 2023; 14:1222912. [PMID: 37654430 PMCID: PMC10466390 DOI: 10.3389/fneur.2023.1222912] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/03/2023] [Indexed: 09/02/2023] Open
Abstract
Objectives Given the substantial disease burden, appropriate and effective management of migraine is a public health priority. To gain insights into real-world migraine management practices in Taiwan, current treatment patterns, costs, and health care resource use were assessed. Methods This was a retrospective, longitudinal study using the Taiwan National Health Insurance Research Database. Included patients had an initial diagnosis of migraine (defined using International Classification of Diseases codes) between 1 January 2013 and 31 December 2017. Data analyzed included demographics; the use, number, and type of acute and preventive medications; and drug and medical services costs. Data were stratified according to migraine type (chronic [CM] or episodic [EM] migraine). Results A total of 312,718 patients were included in the analyses: 53,992 (17.3%) had CM and 258,726 (82.7%) had EM. Most patients (81.7%) had used acute and/or preventive medications; acute medications used more frequently than preventive medications (78.0% vs. 20.2%). Acute medications were used by 81.6 and 77.3% of patients with CM and EM, respectively. Commonly used acute medications were acetaminophen (68.8%), ergots (49.4%), and non-steroidal anti-inflammatory drugs (38.4%); the use of triptans (6.0%), tramadol (3.1%), and other opioids (0.2%) was less common. A total of 28.6 and 18.5% of patients with CM and EM, respectively, used preventive medications. Flunarizine (68.9%), propranolol (40.7%), and topiramate (16.0%) were the most commonly used preventive medications. Most patients had used 1-2 acute or preventive medications, with the use of ≥3 acute or preventive medications more common in patients with CM than EM. Average total medical cost per annum was 4,169 New Taiwan Dollars (NTDs) per CM patient and 2,928 NTDs per EM patient, with CM patients having higher costs associated with medical service utilization and acute medication use. Conclusion These real-world data suggest unmet needs for Taiwanese patients with migraine, including under-utilization of preventive medications and greater costs and health care resource use for patients with CM versus EM. These findings provide important information on treatment patterns, cost, and health care resource use for patients with migraine in Taiwan.
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Affiliation(s)
- Yen-Feng Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | - Yung-Tai Chen
- Department of Nephrology, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan
| | - Yu-Chun Yen
- Clinical Information Department, Quality Management Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ben-Chang Shia
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
| | - Ching-Wen Tsai
- Health Data Analytics and Statistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
| | - Hoi-Fong Chan
- Eli Lilly and Company, Indianapolis, IN, United States
| | - Tommaso Panni
- Eli Lilly and Company, Indianapolis, IN, United States
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Jones SK, Korte JE, Wilson D. Hazard of substance abuse onset among adults diagnosed with epilepsy or migraine. Epilepsy Behav 2023; 144:109258. [PMID: 37209553 DOI: 10.1016/j.yebeh.2023.109258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/26/2023] [Accepted: 05/07/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE We investigated adult-onset epilepsy as a risk factor for the development of substance use disorder (SUD) by comparing the rate of SUD diagnosis among adults diagnosed with epilepsy with presumably healthy controls with lower extremity fractures (LEF). For additional comparison, we investigated the risk for adults with migraine only. Epilepsy and migraine are both episodic neurological disorders and migraine is frequently comorbid with epilepsy. METHODS We conducted a time-to-event analysis using a subset of surveillance data of hospital admissions, emergency department visits, and outpatient visits in South Carolina, USA from January 1, 2000, through December 31, 2011. Individuals aged 18 years or older were identified using the International Classification of Disease, 9thRevision Clinical Modification (ICD-9) with a diagnosis of epilepsy (n = 78,547; 52.7% female, mean age 51.3 years), migraine (n = 121,155; 81.5% female, mean age 40.0 years), or LEF (n = 73,911; 55.4% female, mean age 48.7 years). Individuals with SUD diagnosis following epilepsy, migraine, or LEF were identified with ICD-9 codes. We used Cox proportional hazards regression to model the time to SUD diagnosis comparing adults diagnosed with epilepsy, migraine, and LEF, adjusting for insurance payer, age, sex, race/ethnicity, and prior mental health comorbidities. RESULTS Compared to LEF controls, adults with epilepsy were diagnosed with SUD at 2.5 times the rate [HR 2.48 (2.37, 2.60)] and adults with migraine only were diagnosed with SUD at 1.12 times the rate [HR 1.12 (1.06, 1.18)]. We found an interaction between disease diagnosis and insurance payer, with hazard ratios comparing epilepsy to LEF of 4.59, 3.48, 1.97, and 1.44 within the commercial payer, uninsured, Medicaid, and Medicare strata, respectively. SIGNIFICANCE Compared to presumably healthy controls, adults with epilepsy had a substantially higher hazard of SUD, while adults with migraine only showed a small, but significant, increased hazard of SUD.
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Affiliation(s)
- Stephanie K Jones
- Department of Public Health, Baylor University, Waco, TX 76798, USA.
| | - Jeffrey E Korte
- Department of Public Health Sciences, Medical University of South Carolina, Charleston. SC 29425, USA.
| | - Dulaney Wilson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston. SC 29425, USA.
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Guo W, Jin H, Wang Y, Zhu X, Zhang G, Wang T, Fan C, Huang Y. Efficacy and safety of cutting therapy in the treatment of migraine: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e28084. [PMID: 34918662 PMCID: PMC8677987 DOI: 10.1097/md.0000000000028084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Migraine is a chronic paroxysmal neurovascular disease in which pain on one or both sides of the head is the main manifestation and is accompanied by other neurological manifestations. Clinical practice has shown that cutting therapy as a complementary alternative medicine can play a role in relieving migraine attacks. However, there is no consensus on the efficacy of cutting treatment in the treatment of migraine. The aim of this study was to conduct a meta-analysis to systematically evaluate the efficacy and safety of cutting therapy in the treatment of migraine. METHODS First, databases were searched for relevant literature. The main databases we searched were PubMed, the Web of Science, MEDLINE, Embase, Cochrane Library, the Chinese National Knowledge Infrastructure, the Chinese Science Journal Database, Wanfang Data, and the Chinese Biomedical Literature Database. The keywords searched were "cutting treatment," " traditional Chinese medicine cutting treatment," and "migraine." The search was conducted from inception to November 2021. Second, 2 reviewers independently completed the process of study selection, data extraction, risk of bias assessment and data synthesis in strict accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols statement guidelines. Finally, we will use Review Manager Version 5.3 software for meta-analysis. RESULTS This study will provide the most recent evidence related to the treatment of migraine by cutting therapy. CONCLUSION The results of this systematic evaluation will provide an objective evidence-based framework for judging the effectiveness and safety of cutting therapy in the treatment of migraine.
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Affiliation(s)
- Wenping Guo
- Changchun University of Chinese Medicine; Changchun, Jilin, China
| | - Hongguang Jin
- Affiliated Hospital of Changchun University of Traditional Chinese Medicine; Changchun, Jilin, China
| | - Yiqiang Wang
- Affiliated Hospital of Changchun University of Traditional Chinese Medicine; Changchun, Jilin, China
| | - Xing Zhu
- Affiliated Hospital of Changchun University of Traditional Chinese Medicine; Changchun, Jilin, China
| | - Guanwei Zhang
- Changchun University of Chinese Medicine; Changchun, Jilin, China
| | - Te Wang
- Changchun University of Chinese Medicine; Changchun, Jilin, China
| | - Chunhui Fan
- Changchun University of Chinese Medicine; Changchun, Jilin, China
| | - Yongsheng Huang
- Affiliated Hospital of Changchun University of Traditional Chinese Medicine; Changchun, Jilin, China
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Noninvasive vagus nerve stimulation and morphine transiently inhibit trigeminal pain signaling in a chronic headache model. Pain Rep 2020; 5:e881. [PMID: 33364541 PMCID: PMC7752694 DOI: 10.1097/pr9.0000000000000881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 12/02/2022] Open
Abstract
Noninvasive vagus nerve stimulation suppressed persistent trigeminal nociception in a chronic headache model similarly to morphine and may provide a safe, nonaddictive abortive therapy for chronic headache. Introduction: Chronic headache conditions are characterized by persistent sensitization of the trigeminal system, which involves dysfunction of descending pain modulation. We previously reported that noninvasive vagus nerve stimulation (nVNS) inhibits trigeminal nociception in models of episodic migraine through a mechanism involving enhanced serotonergic and GABAergic descending pain signaling. Objectives: The analgesic effectiveness of nVNS and morphine were investigated in an animal model of chronic headache mediated by the combination of the 3 migraine risk factors of neck muscle tension, paradoxical sleep deprivation, and pungent odors. Methods: Sprague–Dawley rats were injected with complete Freund's adjuvant in the trapezius and sleep deprived for 1 night to promote trigeminal sensitization. After 7 days, animals were exposed to a pungent odor, and mechanical nocifensive head withdrawal responses were determined using von Frey filaments. Beginning on day 3 after odor exposure, animals were treated daily with either nVNS or morphine for 7 days. Results: Exposure of animals sensitized by neck inflammation and sleep deprivation to a pungent odor resulted in a prolonged state of trigeminal nociception. Daily administration of nVNS or morphine significantly repressed the nocifensive response; however, cessation resulted in a return to heightened pretreatment nocifensive levels. Conclusions: The combination of reported migraine risk factors promotes a state of sustained trigeminal hypersensitivity characteristic of chronic headache. Daily nVNS was similarly effective as morphine in inhibiting nociception and may represent a safer, opioid-sparing therapeutic option for other chronic pain disorders involving sensitization of the trigeminal system by promoting descending pain modulation.
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Autism and Migraine: An Unexplored Association? Brain Sci 2020; 10:brainsci10090615. [PMID: 32899972 PMCID: PMC7565535 DOI: 10.3390/brainsci10090615] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022] Open
Abstract
Autism spectrum disorder is characterized by neurological, psychiatric and medical comorbidities—some conditions co-occur so frequently that comorbidity in autism is the rule rather than the exception. The most common autism co-occurring conditions are intellectual disability, language disorders, attention-deficit hyperactivity disorder, epilepsy, gastrointestinal problems, sleep disorders, anxiety, depression, obsessive-compulsive disorder, psychotic disorders, oppositional defiant disorder, and eating disorders. They are well known and studied. Migraine is the most common brain disease in the world, but surprisingly only a few studies investigate the comorbidity between autism and migraine. The aim of this narrative review is to explore the literature reports about the comorbidity between autism and migraine and to investigate the common neurotransmitter, immune, anatomical and genetic abnormalities at the base of these two conditions.
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Tseng KS. Considerations in 2017–2018 for the Use of Opioids in Non-terminal Pain. CURRENT ANESTHESIOLOGY REPORTS 2018. [DOI: 10.1007/s40140-018-0289-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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D'Amico D, Sansone E, Grazzi L, Giovannetti AM, Leonardi M, Schiavolin S, Raggi A. Multimorbidity in patients with chronic migraine and medication overuse headache. Acta Neurol Scand 2018; 138:515-522. [PMID: 30107027 DOI: 10.1111/ane.13014] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/01/2018] [Accepted: 08/10/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Patients with chronic migraine (CM) display a considerable amount of comorbidities, particularly psychiatric and cardiovascular, and the presence of multiple comorbidities, that is, the so-called multimorbidity, is a risk factor for migraine chronification or maintenance of CM. Our aim was to address the rate and impact of multimorbidity in patients with CM and medication overuse headache (MOH). MATERIALS & METHODS In a sample of patients with CM attending a structured withdrawal for coexisting MOH, we defined multimorbidity as the presence of two or more conditions in addition to CM-MOH. We compared patients with and without multimorbidity for demographic and clinical variables, quality of life, and disability; we also tested whether patients with multimorbidity had higher likelihood to attend emergency room, relapse into CM, and require further withdrawal treatments by 12 months. RESULTS One hundred and ninety-four patients were enrolled as follows: 61% had at least one comorbidity, the most common being mental (34%), circulatory (18%), and endocrine conditions (13%); 32% were multimorbidity cases. Patients with multimorbidity had higher headaches frequency, older age, lower education and lower employment rates, higher disability and lower QoL. They were more frequently opioids/barbiturates overusers and were more likely to attend ER (OR: 2.36), relapse into CM (OR: 2.19), and undergo another withdrawal (OR: 2.75) by 12 months after discharge, after controlling for age, gender, years of education, and headache frequency. CONCLUSIONS Recognizing multimorbidity in patients with CM-MOH is important to enhance the management of these complex patients, who are at risk of polypharmacy and increased health care utilization.
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Affiliation(s)
- Domenico D'Amico
- Neuroalgology Unit; Fondazione IRCCS Istituto Neurologico Carlo Besta; Milan Italy
| | - Emanuela Sansone
- Neuroalgology Unit; Fondazione IRCCS Istituto Neurologico Carlo Besta; Milan Italy
| | - Licia Grazzi
- Neuroalgology Unit; Fondazione IRCCS Istituto Neurologico Carlo Besta; Milan Italy
| | - Ambra M. Giovannetti
- Unit of Neuroepidemiology; Fondazione IRCCS Istituto Neurologico Carlo Besta; Milan Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit; Fondazione IRCCS Istituto Neurologico Carlo Besta; Milan Italy
| | - Silvia Schiavolin
- Neurology, Public Health and Disability Unit; Fondazione IRCCS Istituto Neurologico Carlo Besta; Milan Italy
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit; Fondazione IRCCS Istituto Neurologico Carlo Besta; Milan Italy
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Ford JH, Jackson J, Milligan G, Cotton S, Ahl J, Aurora SK. A Real-World Analysis of Migraine: A Cross-Sectional Study of Disease Burden and Treatment Patterns. Headache 2017; 57:1532-1544. [PMID: 28984356 DOI: 10.1111/head.13202] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The purpose of this cross-sectional study was to assess the sociodemographics, disease burden, and treatment patterns of patients with episodic and chronic migraine in the United States. BACKGROUND Migraine is a disabling neurological disease that places an enormous burden on patients. METHODS Data were drawn from the Adelphi Migraine United States Disease Specific Programme (index period: January to March 2014). Physicians (N = 150) completed a patient report form on 10 consulting patients with migraine. Episodic migraineurs had ≤14 headache days per month (HDM) and those with chronic migraine had ≥15. Headache-related disability was assessed with the Migraine Disability Assessment (MIDAS) questionnaire. Disability was also compared across subgroups based on the number of HDM (≤3, 4-7, 8-14, and ≥15). RESULTS A total of 1487 patient report forms were completed. Over 70% of the patients were female, 90.8% (n = 1350) were episodic migraineurs, and 9.2% (n = 137) were chronic migraineurs. Acute treatment was prescribed for >90% of the patients, and >50% had a current prescription for preventive treatment. Despite taking acute and/or preventive treatment, 29.2% of episodic migraineurs (including some patients with ≤3 headache days/month) and 73.2% of chronic migraineurs had moderate-to-severe headache-related disability (MIDAS total score ≥11). Preventive treatment was discontinued/switched at least once by 26.4% of episodic migraineurs and by 53.3% of chronic migraineurs. Of those patients (n = 382) who gave collective reasons for discontinuation/switching preventive treatment, over 70% selected lack of efficacy and tolerability/safety. CONCLUSIONS This real-world analysis provides additional support for the unmet medical need for efficacious therapies that reduce migraine frequency and severity, headache-related disability, and have better tolerability for patients with migraine. In addition, further research is needed to better understand the burden of illness among patients with lower migraine frequency, and to implement treatment strategies to prevent progression of the disease.
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Affiliation(s)
| | | | | | - Sarah Cotton
- Adelphi Real World, Adelphi Mill, Bollington, UK
| | - Jonna Ahl
- Eli Lilly and Company, Indianapolis, IN, USA
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