【最近のウォーニングレター】ASTROM通信 241号

ゴールデンウィーク真っ只中ですが、いかがお過ごしでいらっしゃいますか。

さて今回は、FDAがアメリカ国内の製薬会社向けに出したのウォーニングレター2件を、
FDAがどのような点を指摘したかを確認していきたいと思います。
是非、お読みいただければ幸いです。

最近のウォーニングレターの概要  

注:文中のXXはウォーニングレターでマスキングされている文言及び具体的な社名・品名等です。

■Warning Letter 621026■

2021年9月20日~9月24日のユタ州の製造所の査察でみつかった医薬品製造の重大なCGMP違反について発した2022年2月8日付ウォーニングレターには、下記の指摘事項があげられています。

●指摘1

貴社は医薬品の各成分の同一性を検証するために少なくとも1つの試験を実施することを怠った。
また貴社は、適切な間隔で成分の供給者の分析の信頼性をバリデートし確証することを怠った。
<指摘1詳細>
貴社は、入荷した成分を、OTC医薬品の製造に使用する前に適切に試験することを怠った。
さらに貴社は、純度、濃度、品質等の規格に関し、適格性評価のされていない供給者の分析証明書(COA)を信頼した。成分の同一性、純度、濃度、品質の不十分な分析により、貴社は入荷した成分が適切な規格を満たすと保証することを怠った。
例えば貴社は、手指の消毒剤の有効成分でありエタノールを、その色、におい、外観だけで供給者から受け入れ、その後、製造するのに使用した。貴社は使用前にこのエタノールの同一性やメタノールについて試験をしなかった。貴社は、供給者のCOAを信頼し、他の品質特性を1つも試験しなかった。さらに、貴社のエタノールの供給者のCOAは、“医薬品製造の有効成分や医療機器用や消毒剤としての使用を意図したものではない”と述べている。
貴社は回答の中で、日焼け止めと手指の消毒剤を製造するために使用される有効成分に関し同一性試験を実施すると約束した。しかし、貴社の是正処置・予防処置(CAPA)に関して提出された補助文書では、日焼け止めの有効成分の同一性試験のみを対象としている。貴社は、いかに貴社の供給者の試験結果の信頼性を確証し、定期的にバリデートする計画をするかについては対処しなかった。また貴社は貴社のOTC医薬品に使用される成分の同一性を検証するために保管サンプルを試験するとも約束しなかった。
貴社はエタノールを含む医薬品を製造している。メタノールで汚染されたエタノールの使用は、世界中の人の様々な致死的な中毒事件をもたらしている。エタノールを含む医薬品を製造する場合のCGMP要件を満たす助けとして、
FDAのガイダンス文書Policy for Testing of Alcohol(Ethanol) and Isopropyl Alcohol for Methanol, Including During the Public Health Emergency(COVID-19)
を見よ。
この文書への回答の中で、以下の情報を提供せよ:

  • 医薬品製造の有効成分として使用されることを意図していない非医薬品グレードのエタノールの使用に関するリスクアセスメント
    貴社のリスクアセスメントには、貴社の医薬品を回収する具体的な安全性のリスクがあるかどうかの評価を含むべきである。
  • 製造に使用するための成分の入荷した各ロットを試験しリリースするために貴社が使用している化学及び微生物の品質管理の規格
  • 同一性、濃度、品質、純度に関する全ての適切な規格への一致に関し、成分の各ロットを貴社がいかに試験するつもりかの記述
    もし貴社が濃度、品質、純度に関し、成分の各ロットを試験する代わりに、供給者のCOAから得ら れた結果を受け入れるつもりなら、初期のバリデーションと定期的な再バリデーションを通じて、 供給者の分析結果の信頼性をいかに確実に証明するつもりかを明記せよ。
    更に、入荷した各成分について、少なくも1つの特定の同一性試験を常に実施するという約束を含めよ。
  • 各成分の製造業者から得られたCOAの信頼性を評価するために全ての成分を試験して得られた結果のサマリ
    COAのバリデーションプログラムについて述べた貴社の標準操作手順書を含めよ。
  • 貴社が製造した医薬品を試験する契約施設の適格性評価と監督に関する貴社のプログラムのサマリ
  • 成分、容器、蓋の全ての供給者がそれぞれ適格性を評価され、原材料には、適切な使用期限またはリテストの日付が付与されているかどうかを判断するための、貴社の原材料システムの包括的で独立したレビュ
    レビュは、入荷した原材料の管理が、不適切な成分、容器、蓋の使用を防ぐために適切かどうかの判断も含むべきである。

●指摘2

貴社は、ロットが既に出荷されているかどうかに関わらず、ロットや成分の規格に対する説明のつかない不一致や不具合を徹底的に調査することを怠った。
<指摘2詳細>
貴社の、OOSの試験結果の調査は不完全で、結論の科学的な裏付けを含まず、適切なCAPAが不足している。
例えば、SPF30の日焼け止めのロットXXを試験している間に、貴社は、有効成分メラジメートは80.1%、有効成分オクチサレート81.9%(リリース試験規格:それぞれXX%とXX%)の不適合の分析結果を得た。調査中、貴社は、最初の不合格の結果を確認した。それから貴社はラベルのない最終製品の3つの箱の上部、中部、下部から新しいサンプルを収集し、合格の結果を得た。貴社は、COAの合格結果の平均を報告し、製品をリリースした。本格的な調査(例:製造工程)を実施することなく、貴社は、最初の不合格の結果は、製造のはじめに加熱された充填ノズルが、最初のサンプルを充填する際に急冷されたことによるとした。
貴社のCAPAは、“製造の開始時にいくつが廃棄されるか”を作業者と話し合うことだった。貴社は、今後、いかに加熱したノズルの影響を除去または軽減するかについて決定することを怠った。
貴社は回答で “どの程度の手順や工程の変更を文書化する必要があるかを認識していなかった”と述べた。貴社は、適切な根本原因を判断し、再発を防ぐために適切なCAPAを特定し、CAPAの効果を測定するための調査システムをいかに改善するかについて対処していなかったので、貴社の回答は不十分である。
不具合、規格外、傾向外、その他の予期しない結果の取り扱いや、調査の文書化に関する詳細の情報は、FDAのガイダンス文書Investigating Out-of-Specification(OOS) Test Results for Pharmaceutical Production
を見よ。
この文書への回答の中で、以下の情報を提供せよ:

  • 現在アメリカ市場にあり、この文書の日付時点で有効期限内にあるアメリカ向け製品の無効化された全てのOOS(工程内試験、リリース/安定性試験を含む)の結果の回顧的で独立したレビュと、各OOSに関する以下の情報を含む分析の結果を要約したレポート:
    • 無効化されたOOSの結果に関する科学的正当性とエビデンスが決定的または非決定的でも、原因となる試験のエラーを示しているかどうかの判断
    • 決定的に試験の根本原因を確証した調査に関し、論理的根拠を提出し、同じまたは類似の根本原因に対して脆弱な他の全ての試験方法が改善のために特定されていることを保証せよ。
    • 回顧的レビュで、試験の根本原因が非決定的、または、根本原因がないと判明した全てのOOSの結果について、製造の徹底的なレビュ(例:バッチの製造記録、製造手順の妥当性、装置/設備の適合性、原材料のばらつき、工程の能力、逸脱の履歴、苦情の履歴、ロットの不具合の履歴)を含めよ。
      各調査に関し、潜在的な製造の根本原因と、製造作業の改善のサマリを提出せよ。
    • 貴社のOOSの結果の調査システムに関する包括的なレビュと改善計画CAPAには、これに限定されないが、以下の対処を含めよ。
      • 試験の調査の品質部門の監督
      • 有害な試験の管理傾向の特定
      • 試験のばらつきの原因の解決
      • 試験の原因が決定的に特定できない場合はいつでも潜在的な製造の原因の徹底的な調査の開始
      • 各調査とそのCAPAの適切な範囲の決定
      • これら及びその他の改善を含む改訂されたOOSの調査の手順
  • 貴社の逸脱、不一致、苦情、OOSの結果、不具合の調査に関する全てのシステムの包括的で独立 したアセスメント
    このシステムを修正するための詳細なアクションプランを提出せよ。貴社のアクションプランには、これに限定されないが、調査能力、範囲の決定、根本原因の評価、CAPAの効果、品質保証部門の監督、文書化された手順の大幅な改善を含むべきである。調査の全ての段階が適切に実施されることを貴社がいかに保証するつもりかについて説明せよ。
  • 貴社の変更管理システムの包括的で独立したアセスメント
    このアセスメントには、これに限定されないが、変更が理にかなっていて、レビュされ、品質保証 部門 に承認されていることを保証するための手順を含むべきである。貴社の変更管理プログラム は、変更の効果を判断する規定も含むべきである。

●指摘3

貴社は、成分、医薬品の容器、蓋、中間材料、ラベル、医薬品が同一性、濃度、品質、純度の適切な基準に一致していることを保証するために設計された、科学的に妥当で適切な規格、標準、サンプリング計画、テスト手順を含む品質の管理を制定することを怠った。
<指摘3詳細>
貴社には、エタノールベースの手指の消毒剤の製品が出荷のためにリリースされる前に、分析、有効成分の同一性、不純物の限界(例:メタノール)に関する試験をするための分析機器と適切な試験方法が不足していた。製品は、リリースや出荷の前に同一性、濃度、品質、純度に関して試験されなければならない。
さらに、成分として使用される水及びOTC医薬品の中の微生物を検知するために貴社の微生物の試験方法が適切であることを示すことも怠っていた。また、貴社は、最終製品の微生物試験に使用される培地の複数のロットの成長促進試験を実施することも怠っていた。
貴社は、メタノールの含有量について、エタノール原薬を試験する必要性を認識しておらず、貴社の微生物試験手順はまだバリデートしていないと述べた。また、貴社は、分析試験機器の設置と、微生物試験室の設置が保留になっていると述べた。貴社は、貴社の有効成分の同一性または、OTC医薬品の不純物を検証するために保管サンプルを試験することを約束しなかった。
我々は、貴社の回答内で是正箇所として提供されたローション内のオキシベンゾン、オクチノキサート、メラジメート、及び、オクチサレートに関する分析方法01-146.02のバリデーションを評価し、それが不十分であることに気付いた、貴社は、貴社の方法バリデーションのプロトコルに従っておらず、バリデーションの試験実施後はじめて合格基準や製品規格の上限を設定した。貴社は、適切な正確さと精度で各有効成分を定量化する方法の能力を示すために、サンプル母体、分解物、不純物からの干渉の可能性を試験しなかった。最後に、追加の方法バリデーションをせずに、この方法が日焼け止めローション製剤だけでなく、ワックスベースのリップクリームにとっても使用が妥当であるとみなした。
貴社は、正確性、感度、特異性、試験の再現性を保証するために、分析方法と手順を制定し、バリデートまたは検証しなければならない。
FDAが分析方法バリデーションの適切な要素と考える一般原則とアプローチに関し、FDAのガイダンス文書Analytical Procedures and Methods Validation for Drugs and Biologicsを見よ。
この文書への回答の中で、以下の情報を提供せよ:

  • メタノール、ベンゼン、アセタール、アセトアルデヒドと、リリースされ出荷された全ての手指の消毒剤の試験結果
  • 貴社の試験の業務、手順、方法、装置、文書、分析者の能力に関する包括的で独立したアセスメント
    このレビュに基づき、貴社の試験システムを修正し、効果を評価するための詳細な計画を提出せよ。
  • ロットの処遇を判断する前に貴社の医薬品の各ロットの分析に使用される試験方法を含む、化学及び微生物の規格のリスト
    • この文書の日付時点で使用期限内にあるアメリカに出荷された医薬品の全てのロットの品質を判断するために保管サンプルの化学及び微生物の全ての試験を実施するためのアクションプランとタイムライン
    • 各ロットの保管サンプルから得られた全ての結果のサマリ
      それらの試験で基準以下の品質が明らかになった場合、顧客への通知や製品の回収等の迅速な是正処置をとれ。

●指摘4

貴社は、貴社が製造する医薬品が、それが持つとされる同一性、濃度、品質、純度を持っていることを保証するために設計された製造及び工程の管理に関する文書化された手順を制定することを怠った。
<指摘4詳細>
貴社は、貴社の医薬品を製造するために使用されている製造工程を適切にバリデートし、貴社の工程が再現可能で、均一な性質と品質の医薬品を一貫して製造するために管理されていることを示すことを怠った。
プロセスバリデーションは、その工程のライフサイクルを通じて、設計と工程の管理状態の安定性を評価する。製造工程のそれぞれの重要な段階は、適切に設計され、投入原材料、中間材料、最終製品の品質を保証しなければならない。工程の適格性評価の検証は、初期の管理状態が定着しているかどうかを判断する。商品流通前に、工程の適格性評価の検証を成功させる必要がある。その後、貴社が製品のライフサイクルを通じて安定した製造作業を維持していることを保証するために工程性能と製品品質の継続的で慎重な監視が必要である。
貴社は回答で、OTC医薬品の“プロセスバリデーションはまだ行っていない”と述べた。貴社はこの作業を完了するための計画とタイムラインの提出を怠っているので、貴社の回答は不十分である。
FDAがプロセスバリデーションの適切な要素と考える一般原則とアプローチに関する、プロセスバリデーションについての更なる情報については、FDAのガイダンス文書Process Validation : General Principles and Practices を見よ。
この文書への回答の中で、以下の情報を提供せよ:

  • 製品のライフサイクルを通じて管理状態を保証するための、関連する手順も添えた、貴社のバリデー ションプログラムの詳細なサマリ継続的な管理状態を保証するための、工程性能の適格性評価、ロット内及びロット間のばらつきの継続的なモニタリングに関する貴社のプログラムについて述べよ。
  • 貴社の市販されている各医薬品の適切な工程性能適格性評価を実施するためのタイムライン
  • 貴社の工程性能プロトコル、機器及び設備の適格性評価に関する文書化された手順を含めよ。
  • 継続的な管理状態を保証するための、ロット内及びロット間のばらつきの慎重なモニタリングを含む貴社の各製造工程の設計、バリデーション、維持、管理、モニタリングに関する詳細なプログラムを提出せよ。貴社の機器及び装置の適格性評価に関するプログラムも含めよ。

●指摘5

貴社は、医薬品の安定性を評価し、適切な保管条件と使用期限を決めるために安定性試験の結果を使うために設計された文書化された試験プログラムに従うことを怠った。
<指摘5詳細>
貴社は、3年というラベルに表示された使用期間を通じて、貴社の医薬品の化学及び微生物学的特性が許容可能な状態であることを示すための適切な安定性データを持っていない。査察中、貴社は、3年というラベル表示された使用期間は、安定性の検証により裏付けされていると主張した。しかし、査察中、貴社はその検証を提出できなかった。貴社は、適切な安定性のデータなしに、医薬品に付与された使用期間を通じて制定された規格や事前に定められた全ての品質基準を満たすことを保証できない。
貴社は回答の中で、バリデートされた安定性試験を開始するためのリソースを持っていないと述べ、貴社の医薬品に関し安定性の検証を実施する全ての要件を認識していないと述べた。貴社は、ガスクロマトグラフを設置し、機器の適格性を評価したら、適切な使用期限を決めるために各医薬品について安定性の検証を開始すると約束した。この作業を完了させるための計画とタイムラインを提出していないので、貴社の回答は不十分である。
この文書への回答の中で、以下の情報を提供せよ:

  • 貴社の安定性プログラムの妥当性を保証するための包括的で独立したアセスメントとCAPAの計画
    貴社の修正されたプログラムは、これに限定されないが、以下のことを含むべきである:
    • 安定性を示す方法
    • 出荷が許可される前の、販売されている容器密閉システムにおける各医薬品の安定性の研究
    • 使用期間が妥当であるかどうかを判断するために、毎年各製品の代表的なロットがプログラムに追加されるような継続的なプログラム
    • 各段階(タイムポイント)で試験される特性の詳細な定義
  • 改善された安定性プログラムの、これら及びその他の要素を説明する全ての手順

●施設での繰り返しの違反

FDAは2017年に発行されたウォーニングレターDEN-17-07-WL、2020年1月に開催された規制会議、2007年9月、2011年2月、2016年5月、2018年2月、2019年9月に実施された査察で、同様のCGMP違反や査察結果について指摘している。貴社は、回答の中で、指摘された違反や査察結果を修正することを約束していた。繰り返しの不具合は、経営陣の医薬品製造の監督と管理が不十分であることを示している。

●CGMPコンサルタントの推奨

2018年5月8日から5月15日までの前回の査察で、同様のCGMPの査察結果を挙げた。貴社は、回答の中でこれらの査察結果に対する具体的な改善を提案した。繰り返される不具合は、貴社の経営陣の医薬品製造の監督と管理が不十分であることを示している。

●コンサルタントの推奨

貴社は繰り返しの違反の是正を怠っているので、我々は、CGMPの要件を満たすように貴社を支援するために、21 CFR 211.34に規定された適格性のあるコンサルタントを雇うことを強く勧める。貴社のコンサルタントの使用は、CGMPを順守するための貴社の義務を軽減するものではない。貴社の経営陣には、継続的なCGMP順守を保証するために、全ての不備とシステムの欠陥を解決する責任が残る。

●結論

この文書で挙げた違反は、貴社の製造所に存在する違反の包括的なリストでもない。貴社には、違反を調査し、原因を判断し、再発やその他の違反の発生を防止する責任がある。
全ての違反を速やかに是正せよ。この問題への即座の適切な対処の不履行は、制限のない差し押さえ、強制命令を含む、さらなる通知のない制限または法的なアクションにつながるかもしれない。未解決の違反は、他の連邦機関の契約授与も妨げるかもしれない。
違反への対処の不履行は、FDAの輸出証明の発行の差し控えにもつながるかもしれない。全ての違反に完全に対応がされ、我々が貴社のCGMPの遵守を確認するまで、FDAは貴社の医薬品製造業者としての新しい申請やリストの補完の承認を保留するだろう。我々は、貴社が全ての違反に対する是正処置を完了したことを確認するために再査察を行うかもしれない。

出典:https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/yusef-manufacturing-laboratories-llc-621026-02082022

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■CMS#618333■

2021年7月6日~7月28日のカリフォルニア州の製造所の査察でみつかった医薬品製造の重大なCGMP違反について発した2022年3月1日付ウォーニングレターには、下記の指摘事項があげられています。

●指摘1

貴社は、そのロットが既に出荷されたかどうかに関わらず、その規格を満たすために、ロットまたはその成分の説明のつかない不一致や不具合を徹底的に調査することを怠った。
<指摘1詳細>
貴社はOTC医薬品のいくつかのロットに関し、規格外(OOS)の分析結果を調査することを怠った。
例えば、貴社の医薬品XXロットXX内のサリチル酸の分析試験で、1.93%と1.90%(リテスト)を含む結果が明らかになった。この重要な製品の特性に関する貴社の規格は、XX% – XX%だった。
調査のための貴社の品質システムは不十分で、安全で有効な医薬品の一貫した製造を保証していない。
貴社は回答の中で、適切に調査するためのリソースと職員が不足していると述べた。貴社は、より包括的な是正処置と予防処置(CAPA)のプログラムを開発し職員を訓練するつもりであるとも述べた。
貴社の回答は不十分である。貴社は根本原因を判断するために適切に評価し、OOSの結果の影響を評価することを怠った。さらに、貴社は、全ての潜在的な不一致が適切に調査されていることを保証するために使用期限内で、販売された全てのロットの回顧的なレビュを提出しなかった。
この文書への回答の中で、以下の情報を提供せよ:

  • 査察初日の日付から過去3年の、最終的にアメリカに販売されたかどうかにかかわらず、アメリカ向け製品の全ての無効化されたOOS(工程内試験とリリース/安定性試験を含む)の結果の回顧的で独立したレビュと、各OOSについて以下のことを含む、分析結果をまとめたレポート:
    • 無効化されたOOSの結果に関する科学的正当性及びエビデンスが、決定的にまたは決定的でなくても、原因として試験のエラーを示しているかどうかを判断せよ。
    • 最終的に試験を根本原因とした調査について、論理的根拠を提出し、同じまたは類似の根本原因に対して脆弱な他の全ての試験方法が修正のために特定されていることを保証せよ。
    • 回顧的レビュにより、根本原因が決定的でないか、根本原因がないとされた全てのOOSの結果について、製造の徹底的なレビュ(例:バッチ製造記録、製造ステップの妥当性、機器/設備の適合性、原材料のばらつき、工程性能、逸脱の履歴、苦情の履歴、ロットの不具合の履歴)を含めよ。各調査について、潜在的な製造の原因と、製造作業の改善のサマリを提出せよ。
  • 貴社のOOSの結果の調査システムに関する包括的なレビュと修正計画
    CAPAは、これに限定されないが、以下のことへの対処を含むべきである:
    • 試験の調査の品質部門の監督
    • 有害な試験管理の傾向の特定
    • 試験のばらつきの原因の解決
    • 試験の原因が決定的に特定できない場合はいつでも潜在的な製造の原因の徹底的な調査の開始
    • 各調査そのCAPAの適切な範囲の決定
    • これら及びその他の修正を含む、OOS調査手順の改訂
  • 貴社の逸脱、不一致、苦情、OOSの結果、不具合の調査に関する全てのシステムの包括的で独立したアセスメント
    このシステムを修正するための詳細なアクションプランを提出せよ。貴社のアクションプランには、これに限定されないが、調査能力、範囲の決定、根本原因の評価、CAPAの効果、品質保証部門の監督、文書化された手順の大幅な改善を含むべきである。調査の全ての段階が適切に実施されることを貴社がいかに保証するつもりかについて説明せよ。
  • 貴社のCAPAプログラムの独立したアセスメントと修正計画
    プログラムが効果的な根本原因の分析を含み、CAPAの効果を保証し、調査の傾向を分析し、必要に応じてCAPAプログラムを改良し、最終的に品質部門が判断を実施し、経営陣に完全にサポートされているかどうかを評価するレポートを提出せよ。

●指摘2

貴社は、同一性と、純度、濃度、品質に関する全ての文書化された規格への一致について、各成分のサンプルを試験することを怠った。また貴社は、適切な間隔で、貴社の成分供給者の分析試験の信頼性をバリデートし、確証することを怠った。
<指摘2詳細>
貴社は、医薬品XXのロットXXの有効成分であるサリチル酸を含む、貴社の医薬品の製造で使用される成分の各ロットの同一性試験を実施することを怠った。さらに貴社は、成分の仕様と特性に関し、各供給者の分析証明書(COA)の信頼性を確証していなかった。
これは、2013年4月の前回のFDA査察からの繰り返しの指摘である。
適切な試験をしなければ、貴社は、原材料が医薬品の製造に使用する前に適切な規格に一致するという科学的なエビデンスを持っていない。
貴社は回答の中で、純度と同一性に関する成分の試験を含む標準操作手順(SOP)を開発する予定であると述べた。また貴社は、原材料成分の取り扱い方法について技術者を教育する予定であるとも述べた。
貴社の回答は不十分である。貴社は、各成分について適切な受入試験が実施されることを保証する手順の詳細、即ち、COAに対する完全な試験、または、供給者の信頼性に基づいて選択された品質特性(識別以外)に関する制限試験を実施するための適切な正当性を提出することを怠った。また貴社は、ベンダのアンケート以外に、供給者の適格性プログラムのその他の要素について説明をしなかった。さらに、貴社は、全ての品質特性が規格を満たしていることを保証するために、以前、医薬品の成分に使用された保管サンプルを試験するための計画を提出することを怠った。
この文書への回答の中で、以下の情報を提供せよ:

  • 成分、容器、蓋の全ての供給者がそれぞれ適格性評価をされていて、原材料は適切な使用期限またはリテストの日付が付与されているかどうかを判断するための、貴社の原材料システムの包括的で独立したレビュ
    レビュは、不適切な成分、容器、蓋の使用を防ぐために入荷した原材料の管理が適切かどうかの判断も含めるべきである。
  • 製造に使用するための入荷した成分の各ロットを試験しリリースするために使用している化学及び微生物の品質管理の規格
  • 同一性、濃度、品質、純度に関し、全ての適切な規格への一致について、各成分のロットを貴社がいかに試験するかの説明
    もし貴社が各成分のロットの濃度、品質、純度に関するテストを実施する代わりに供給者のCOAの結果を受け入れるつもりなら、初期のバリデーションと定期的な再バリデーションを通じて供給者の結果の信頼性をいかに慎重に確証するつもりかを明記せよ。さらに、入荷した成分の各ロットについて少なくとも1つの特定の同一性試験を常に実施するという約束を含めよ。
  • 各成分の製造業者から得たCOAの信頼性を評価するための、全ての成分の試験から得られた結果のサマリ
    このCOAのバリデーションプログラムを述べた貴社の標準操作手順を含めよ。
  • 貴社が製造した医薬品の試験をする契約施設の適格性評価と監督に関する貴社のプログラムのサマリ

●指摘3

貴社は、貴社が製造した医薬品が、それが持つとされる同一性、濃度、品質、純度を持つことを保証するために設計された製造及び工程管理に関する文書化された手順を制定することを怠った。
<指摘3詳細>
貴社は、貴社のOTC医薬品を製造するために使用される工程をバリデートし、機器の適格性評価を実施することを怠った。具体的には、貴社は、多数のOTC医薬品に関し、適切な工程性能適格性評価(PPQ)を完了していなかった。また、貴社は安定した製造作業と一貫した医薬品の品質を保証するために工程管理をモニタするための厳格で継続的なプログラムを持っていない。また貴社は、調合及び充填装置の性能適格性評価を適切に実施することも怠った。
工程の適切なバリデートと、装置の適格性評価を実施せずに、貴社の製造工程が所定の品質特性を満たす製品を一貫して製造できると示すことはできない。
これは、2013年4月の前回のFDA査察と、2014年1月24日に発行された無題の文書の違反リストからの繰り返しの指摘である。
貴社は回答の中で、包括的な製造と工程管理のプログラムを実装し、貴社の従業員を教育するつもりであると述べた。又貴社は貴社の据付時適格性評価と運転時適格性評価の手順を統合するために性能適格性評価の手順を開発するつもりであるとも述べた。貴社の回答は不十分である。貴社は、新しい手順とプロトコルの詳細を提出することを怠った。また貴社はこれらの計画の実施に関するタイムラインの提出も怠った。
この文書への回答の中で、以下の情報を提出せよ:

  • 製品のライフサイクルを通して管理状態を保証するための関連手順も添えたバリデーションプログラムの詳細なサマリ
    工程の性能適格性評価(PPQ)と、継続的な管理状態を保証するためのロット内及びロット間のばらつきの継続的なモニタリングに関する貴社のプログラムについて述べよ。
  • 販売されている貴社の各医薬品の適切なPPQの実施に関するタイムライン
  • 装置及び設備の適格性評価に関する貴社の工程性能プロトコルと文書化された手順
  • 継続的な管理状態を保証するためのロット内及びロット間のばらつきの慎重なモニタリングを含む、貴社の各製造工程の設計、バリデーション、維持、管理、モニタリングに関する詳細なプログラム
    装置及び設備の適格性評価のためのプログラムも含めよ。
  • 製造工程が適切な規格と製造の標準を一貫して満たすよう、ばらつきの全ての原因を特定し管理するデータ駆動型の科学的に妥当なプログラムが存在することを保証するための医薬品の各工程のアセスメント
    このアセスメントには、これに限定されないが、装置の使用目的への適合性、モニタリング及び試験システムの検知能力の十分性、投入原材料の品質、各製造工程の手順と管理の信頼性の評価を含めよ。

●指摘4

貴社は、公式またはその他の制定された要求を超えて、医薬品の安全性、同一性、濃度、品質、純度を変える誤動作や汚染を防止するために、適切な間隔で機器及び器具を洗浄、維持、医薬品の性質に応じて消毒/滅菌することを怠った。
<指摘4詳細>
貴社は、OTC医薬品と化粧品の両方を製造するために使用される共有装置から汚染物質を除去するために貴社の洗浄及び消毒の業務が十分であると示すことを怠った。例えば、貴社のXXを製造するために使用される装置は、貴社の医薬品XXとXXの製造に使用するのと同じ装置であったが、貴社には洗浄バリデーションの検証が不足していた。
洗浄中の製造装置からの有効成分や残留物の不十分な除去は、貴社の医薬品の交叉汚染につながる可能性がある。
これは、2013年4月の前回のFDA査察と、2014年1月24日に発行された無題の文書の違反リストからの繰り返しの指摘である。
貴社は回答の中で、OTC医薬品製造のために使用される全ての装置の洗浄バリデーションを開発し実施すると述べた。貴社の回答は不十分である。貴社は、バリデーション計画の詳細の提出を怠った。また貴社は、この計画の実施のためのタイムラインも提出しなかった。
この文書への回答の中で、以下の情報を提供せよ:

  • 交叉汚染の危険の範囲を評価するための貴社の洗浄の効果の包括的で独立した回顧的アセスメント
    残留物の特定、不適切に洗浄された可能性のある他の製造装置、交叉汚染された製品が販売のためにリリースされた可能性があるかどうかのアセスメントを含めよ。アセスメントは、洗浄手順と業務の不備を特定し、複数製品の製造に使用される製造装置を網羅せよ。
  • 貴社の洗浄及び消毒プログラムの手順と業務の適切な修正と、完了までのタイムラインを含む、洗浄及び消毒プログラムの回顧的アセスメントに基づくCAPAの計画
    装置の洗浄及び消毒のライフサイクル管理に関する貴社の工程の脆弱性の詳細なサマリを提出せよ。
    洗浄効果の向上、全ての製品と装置のための適切な洗浄及び消毒の継続的な検証の改善、その他の必要な全ての修正を含む、洗浄及び消毒プログラムの改善について述べよ。
  • 貴社の医薬品製造作業におけるワーストケースとして特定された条件を取り入れることに特に重点を置いた貴社の洗浄バリデーションプログラムへの適切な改善
    改善には、これに限定されないが、以下の全てのワーストケースの特定と評価を含むべきである:
    • より高い毒性を持つ医薬品
    • より高い有効性を持つ医薬品
    • 洗浄溶液の中でより低い溶解度の医薬品
    • 洗浄を難しくする特性を持った医薬品
    • 洗浄を最も難しくする拭き取り場所
    • 洗浄前の最大保持時間

さらに、新しい製造装置や新しい製品を導入する前に、貴社の変更管理システムでとられるべき手順を述べよ。

  • 製品、工程、装置の洗浄手順の検討とバリデーションのための適切なプログラムが実施されていることを保証する改訂されたSOPのサマリ

●未承認の新薬と虚偽表示

省略

●品質部門の権限

この文書内の、貴社の査察の履歴と重大な指摘は、貴社の品質部門がその権限と責任を完全に果たしていないことを示している。貴社は、品質部門がその責任を果たし一貫して医薬品の品質を保証するために、適切な権限とリソースを提供しなければならない。

●施設での繰り返しの査察結果と違反

2013年4月5日の前回の査察と、2014年1月24日の無題の文書でFDAは同様のCGMPの査察結果と違反ついて挙げている。貴社は回答の中で、これらの指摘事項と違反について具体的な修正を提案した。繰り返しの不具合は、経営陣の医薬品製造の監督と管理が不十分であることを示している。

●規格外(Out-of-Specification)の結果

不具合、OOS、傾向外、その他の予期しない結果の取扱いと、調査の文書化に関する更なる情報は、FDAのガイダンス文書Investigating OOS Test Results for Pharmaceutical Productionを見よ。

●工程管理

貴社には、安定した製造作業と一貫した医薬品品質を保証するための工程管理のモニタリングのための継続的なプログラムが不足している。FDAが工程のバリデーションの適切な要素と考える一般原則とアプローチに関し、FDAのガイダンス文書Process Validation : General Principles and Practicesを見よ。

●CGMPコンサルタントの推奨

我々が貴社で発見した違反の性質に基づき、また、貴社が繰り返し、違反の是正を怠っていることから、我々はCGMPの要件を満たすように貴社を支援するために、21 CFR 211.34に規定された適格性のあるコンサルタントを雇うことを強く勧める。貴社のコンサルタントの使用は、CGMPを順守するための貴社の義務を軽減するものではない。貴社の経営陣には、継続的なCGMP順守を保証するために、全ての不備とシステムの欠陥を解決する責任が残る。

●結論

この文書で挙げた違反は、貴社の製造所に存在する違反の包括的なリストでもない。貴社には、違反を調査し、原因を判断し、再発やその他の違反の発生を防止する責任がある。
全ての違反を速やかに是正せよ。この問題への即座の適切な対処の不履行は、制限のない差し押さえ、強制命令を含む、さらなる通知のない制限または法的なアクションにつながるかもしれない。未解決の違反は、他の連邦機関の契約授与も妨げるかもしれない。
違反への対処の不履行は、FDAの輸出証明の発行の差し控えにもつながるかもしれない。全ての違反に完全に対応がされ、我々が貴社のCGMPの遵守を確認するまで、FDAは貴社の医薬品製造業者としての新しい申請やリストの補完の承認を保留するだろう。我々は、貴社が全ての違反に対する是正処置を完了したことを確認するために再査察を行うかもしれない。

出典:https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/generitech-corporation-618333-03012022

まとめ

いかがでしたでしょうか。

Out-of-Specificationの調査不足、供給者のCOAの信頼性の検証不足の指摘は、ほぼ毎回登場する内容ですが、皆様の会社ではいかがでしょうか。

  • OOSの根本原因が特定できない場合、どこまで、そして、いつまで調査をするか。
  • 供給者との関係性も含め、いろいろな事情がある中で、供給者の管理をどこまで徹底するか。

この指摘は万国共通の課題のように思います。

話は変わるのですが、今回取り上げた2件とも、FDAの指摘内容に対して、リソースが不足していると回答しているのが印象的でした。
ウォーニングレターの中で、今までこのような回答を見たことがなかったので驚かされました。

弊社サービスのプロス

https://drmarketing.jp/cch/73/640/3/377/501330/ee3281

★ブログ毎日更新中!

◆ PROS.社長の滋養強壮ブログ

◆ プロス橋本のブログ

【発行責任者】

株式会社プロス 『ASTROM通信』担当 橋本奈央子 hashimoto@e-pros.co.jp

※本記事は株式会社プロスの許可を得て転載しております。

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    4. **Breaks:** Symbols used to indicate moments of silence in a piece.

    5. **Time Signature:** Indicates the metric structure of
    a piece.
    6. **Tonality:** Defines the tonality of the piece.

    7. **Volume:** Indications of the volume of the music.

    8. **Articulation:** Instructions on how to perform each note or phrase.

    9. **Pace:** Shows how fast or slow the music should be played.

    10. **Decorations:** Notes or symbols that add expressiveness
    to the music.

    Reading Music Sheets and Scores
    Reading music sheets and scores requires awareness of the
    various parts and signs used.

    Benefits of Learning to Read Music Sheets and Scores
    1. **Enhanced Musical Understanding:** Reading
    music sheets enhances one’s understanding of music theory and
    composition.
    2. **Greater Flexibility:** Musicians who read music can play a wider variety of pieces.

    3. **Improved Interaction:** Musicians who read music can collaborate more effectively.

    4. **Preservation of Music:** Documenting music through scores
    ensures its longevity.
    5. **Personal Fulfillment:** The achievement of reading music brings a sense of personal satisfaction.

    Tips for Beginners
    1. **Keep it Basic:** Start with the basics before tackling more complex compositions.

    2. **Consistent Practice:** Frequent practice is key to mastering music reading.

    3. **Use Resources:** Many resources are available online to help beginners learn to read music.

    4. **Seek Support:** Seek support from others who are also learning to
    read music.
    5. **Stay Persistent:** Stay persistent and don’t get discouraged by challenges.

    Advanced Techniques
    1. **On-the-Spot Playing:** The ability to read and play a piece
    of music on the spot without prior preparation.
    2. **Modulating:** The process of changing the key of a piece of music.

    3. **Building Chords:** Building chords to accompany a musical piece.

    4. **Spontaneous Composition:** Spontaneous composition of music on the spot.

    5. **Personal Expression:** Adding personal expression to the performance of written music.

    Famous Composers and Their Scores
    1. **Ludwig van Beethoven:** Renowned for his profound
    and expressive music.
    2. **Mozart:** Renowned for his musical brilliance and
    creativity.
    3. **Johann Sebastian Bach:** Famous for his intricate and harmonically rich compositions.

    4. **Pyotr Ilyich Tchaikovsky:** Celebrated for his emotional and expressive compositions.

    5. **C. Debussy:** Renowned for his innovative use of
    harmony and texture.

    Digital vs. Traditional Music Scores
    **Pros of Digital Sheets:**
    – Convenience: Available on multiple platforms.

    – Alteration: Flexible for altering and adapting.
    – Storage: Large capacity for storing multiple scores.

    **Pros of Printed Sheets:**
    – Physical Interaction: Physical interaction with the music.

    – Longevity: Durable and long-lasting.
    – Visual Beauty: Holds artistic and historical significance.

    The Role of Technology in Music Scores
    Technology has changed the way we engage with music scores.

    **Digital Sheet Music Apps:** Digital sheet music apps provide convenient platforms for composing and distributing music.

    **Online Libraries:** Online libraries provide access to a wide range of music scores.

    **Interactive Learning Tools:** Technology-based tools provide interactive music learning opportunities.

    Conclusion
    Music sheets and scores are integral to the craft of music.

    Whether you are new or an advanced musician, knowing how to read and work
    with music sheets and scores is essential.

    Embrace the path of exploring music sheets and scores, and unlock
    the potential that lie ahead.

    Music sheets hold a deep history that extends
    over centuries.

    Early Beginnings
    The initial forms of music notation trace back to early societies.

    Ancient Mesopotamians created simple music notation systems to document their musical
    practices.

    The Greek Contribution
    Ancient Greece made notable improvements to music notation.

    Medieval Innovations
    The medieval period saw considerable developments in music notation.

    The Renaissance Era
    The Renaissance brought a rebirth of music, including music notation.

    Baroque and Classical Periods
    During the Classical periods, music notation evolved further, becoming increasingly detailed.

    The Romantic Era
    The Romantic era brought about novel emotional techniques in music notation.

    The Modern Age
    In the 20th century, music notation underwent substantial changes, adopting electronic systems.

    The Digital Revolution
    The arrival of digital music transformed the landscape
    of music notation.

    Key Milestones in Music Notation History
    1. **Primitive Symbols:** Ancient Greek symbols that represented musical concepts.

    2. **Staff Lines:** Invention of the staff and solmization system by Guido d’Arezzo in the 11th century.

    3. **Classical Evolution:** Development of complex notational systems in the Baroque period.

    4. **Romantic Period:** Increased complexity and detail
    in Romantic music notation.
    5. **Contemporary Techniques:** Introduction of graphic scores and
    experimental notation in the 20th century.

    The Role of Music Sheets in Education
    Music sheets serve a crucial role in learning
    music.

    Notable Composers and Their Contributions
    1. **Bach:** Famed for his intricate and precise notation.
    2. **Beethoven:** Advanced the use of expressive dynamics
    in notation.
    3. **Wolfgang Amadeus Mozart:** Perfected the Classical approach to
    elegant and clear notation.
    4. **Frédéric Chopin:** Known for his detailed and expressive piano music notations.

    5. **I. Stravinsky:** Revolutionized 20th-century notation with
    his complex scores.

    Evolution of Music Sheets in the Digital Age
    The digital age has significantly altered the method we create music sheets.

    Future of Music Sheets
    The next era of music sheets foresees exciting developments.

    As technology advances, the methods composers use to compose and share music sheets will so too progress.

    Conclusion
    The history of music sheets is intricate, mirroring the advancement of music
    itself.

    From early marks to modern notations, music sheets have served as a crucial medium for recording and distributing melodies.

    As we move forward, the history of music sheets shall endure, adapting with
    technological progress. }
    Music sheets hold a captivating history that spans across millennia.

    Early Beginnings
    The initial versions of music notation date back to prehistoric times.

    Ancient Egyptians developed rudimentary music notation techniques to preserve their
    musical practices.

    The Greek Contribution
    The Greeks made important contributions to music notation.

    Medieval Innovations
    The medieval period experienced major progress in music notation.

    The Renaissance Era
    Renaissance brought a renewal of music, including music
    notation.

    Baroque and Classical Periods
    During the Baroque periods, music notation advanced further, growing more complex.

    The Romantic Era
    The Romantic era brought about new dynamic techniques in music
    notation.

    The Modern Age
    In the modern era, music notation experienced significant changes,
    integrating digital tools.

    The Digital Revolution
    The advent of computer-based scores transformed the domain of
    music notation.

    Key Milestones in Music Notation History
    1. **Ancient Notations:** Ancient Greek symbols that represented musical concepts.

    2. **Medieval Notation:** Guido d’Arezzo’s revolutionary contributions to music notation.
    3. **Baroque Notation:** Advancements in notational precision during the Renaissance.

    4. **Expressive Notation:** Increased complexity and detail in Romantic music notation.
    5. **Contemporary Techniques:** Introduction of graphic scores and experimental notation in the 20th century.

    The Role of Music Sheets in Education
    Music sheets play a important part in music pedagogy.

    Notable Composers and Their Contributions
    1. **Bach:** Renowned for his elaborate and accurate notation techniques.

    2. **Ludwig van Beethoven:** Advanced the use of expressive dynamics in notation.
    3. **W.A. Mozart:** Excelled in the Classical era’s precise and clear notation.
    4. **F. Chopin:** Known for his detailed and expressive piano music notations.

    5. **I. Stravinsky:** Pioneered 20th-century notational
    innovations.

    Evolution of Music Sheets in the Digital Age
    The digital age has significantly altered the approach we use music sheets.

    Future of Music Sheets
    The next era of music sheets holds intriguing innovations.

    As technology advances, the methods composers use to create
    and publish music sheets will in parallel evolve.

    Conclusion
    The story of music sheets is intricate, reflecting the advancement of music itself.

    From primitive notations to digital scores, music sheets have functioned as
    a crucial tool for preserving and distributing melodies.

    As we move forward, the legacy of music sheets will persist,
    adapting with technological progress.}
    Mastering music sheets is essential for any novice musician. | Understanding how to
    read music sheets is essential for all novice musician. | Understanding the art of reading
    music sheets is crucial for every beginning musicians.}

    What Are Music Sheets?
    Music sheets serve as written down representations of musical notes,
    displaying the tone as well as, pace of a music piece.

    Getting Started with Music Sheets
    Grasping reading music sheets starts with familiarizing yourself with the essential components of musical notation.

    Understanding Musical Notation
    Music notation involves many crucial elements, including the staff,
    clefs, notes, and rhythms.

    The basis in musical notations is this.

    In that musical notation, the staff actually consists of five distinct
    different lines and also four different spaces.

    2. **Clefs
    Clefs denote the actual note on the staff is meant to the five lines
    and spaces. | This clefs indicate the note the actual note
    for each line as well as the different spaces. | Clefs is meant for each
    line and also spaces.}

    {There {are actually|actually are|is} {two|two separate|two distinct} {primary|different|distinct} {clefs|clef|music notes} {used
    in|used in various|used in the} {music|musical} {notation|notes|notations}.
    | There {are actually|actually are|is} {two|two separate|two distinct} {primary|different|distinct} {clefs|musical notes|clef} {used in|used in various|used in the} {notations|music|musical} {of|music} {these notes|these notes}.

  30. Music sheets and scores give the essential assistance for musicians to perform pieces precisely.

    Music sheets and scores show how pieces should be executed.

    Elements of Music Sheets and Scores
    1. **Staff:** The lines and spaces used to notate the pitch and duration of notes.

    2. **Clefs:** Symbols used to denote the pitch range of the notes.

    3. **Tones:** Symbols denoting the pitch and duration of a
    musical sound.
    4. **Rests:** Symbols indicating silence in music.
    5. **Meter:** Indicates the metric structure of a piece.
    6. **Scale:** Defines the tonality of the piece.
    7. **Dynamics:** Symbols showing how loud or soft the music should be played.

    8. **Phrasing:** Instructions on how to perform each note or phrase.

    9. **Tempo:** The speed at which the piece should be performed.

    10. **Decorations:** Symbols showing extra
    notes for decorative purposes.

    Reading Music Sheets and Scores
    Reading music sheets and scores necessitates knowledge of the various components
    and signs used.

    Benefits of Learning to Read Music Sheets and Scores
    1. **Deeper Comprehension:** Improved knowledge of music sheets leads to a better grasp of music
    theory.
    2. **Broader Skill Set:** Being able to read music increases a musician’s versatility.

    3. **Better Communication:** Musicians who read music can collaborate more effectively.

    4. **Documentation:** Documenting music through scores ensures its longevity.

    5. **Satisfaction:** Learning to read music can be a
    deeply fulfilling and rewarding experience.

    Tips for Beginners
    1. **Begin with Basics:** Keep it simple in the beginning to build a strong foundation.
    2. **Consistent Practice:** Regular practice is essential for improvement.

    3. **Use Resources:** Use tools and aids such as
    apps, books, and online tutorials.
    4. **Find a Group:** Joining a music community can provide support and motivation.
    5. **Be Patient:** Learning to read music takes time and effort.

    Advanced Techniques
    1. **Instant Interpretation:** On-the-spot playing
    of music from written notation.
    2. **Modulating:** Altering the key in which music is played.

    3. **Creating Harmonies:** Creating harmonies to complement a primary melody.

    4. **Spontaneous Composition:** Ad-libbing music as it is played.

    5. **Personal Expression:** Bringing personal interpretation to
    the performance of music.

    Famous Composers and Their Scores
    1. **Ludwig van Beethoven:** Renowned for his
    profound and expressive music.
    2. **W. A. Mozart:** Celebrated for his clarity,
    balance, and natural elegance in music.
    3. **Bach:** Known for his masterful use of counterpoint and harmony.

    4. **Pyotr Ilyich Tchaikovsky:** Famous for his richly orchestrated and
    emotive music.
    5. **Debussy:** Famous for his impressionistic and evocative compositions.

    Digital vs. Traditional Music Scores
    **Benefits of Digital Music:**
    – Availability: Easily accessible on various devices.

    – Editing: Flexible for altering and adapting.
    – Storage: Easy to store and organize.

    **Advantages of Traditional Scores:**
    – Hands-On: Engaging tactile experience.
    – Durability: Durable and long-lasting.
    – Artistic Value: Aesthetic and artistic value.

    The Role of Technology in Music Scores
    Technology has transformed the way we use music scores.

    **Digital Sheet Music Apps:** Digital sheet music apps provide convenient platforms for composing and distributing music.

    **Online Libraries:** Vast collections of sheet music are available through online libraries.

    **Interactive Learning Tools:** Technology-based tools provide interactive
    music learning opportunities.

    Conclusion
    Music sheets and scores are integral to the art of musicianship.

    Whether you are a beginner or an expert, understanding how to read and work
    with music sheets and scores is crucial.

    Embrace the process of learning music sheets and scores, and
    discover the creative opportunities that lie ahead.

    Music sheets represent a intriguing history that stretches
    across ages.

    Early Beginnings
    The first forms of music notation go back to prehistoric times.

    Ancient Egyptians developed rudimentary music notation systems to preserve their melodies.

    The Greek Contribution
    Ancient Greece made significant contributions to music notation.

    Medieval Innovations
    The medieval period witnessed considerable advances in music
    notation.

    The Renaissance Era
    The Renaissance brought a resurgence of culture, including music notation.

    Baroque and Classical Periods
    During the Baroque and Classical periods, music notation advanced further, growing more complex.

    The Romantic Era
    The Romantic period ushered in novel dynamic
    styles in music notation.

    The Modern Age
    In the 20th century, music notation underwent substantial changes, incorporating electronic systems.

    The Digital Revolution
    The introduction of electronic notation transformed the domain of music notation.

    Key Milestones in Music Notation History
    1. **Ancient Notations:** Early Egyptian hieroglyphs used
    to depict music.
    2. **Staff Lines:** Guido d’Arezzo’s revolutionary contributions to music notation.
    3. **Baroque Notation:** Advancements in notational precision during the Renaissance.

    4. **Expressive Notation:** 19th-century innovations in music notation techniques.

    5. **Contemporary Techniques:** Revolutionary changes in music notation practices
    in the modern age.

    The Role of Music Sheets in Education
    Music sheets play a important role in learning music.

    Notable Composers and Their Contributions
    1. **J.S. Bach:** Renowned for his elaborate and accurate notation techniques.

    2. **Ludwig van Beethoven:** Pioneered expressive notations and dynamic markings.

    3. **W.A. Mozart:** Perfected the Classical approach to elegant and clear notation.
    4. **Chopin:** Known for his detailed and expressive piano music notations.

    5. **Stravinsky:** Revolutionized 20th-century notation with his complex
    scores.

    Evolution of Music Sheets in the Digital Age
    The digital age has significantly altered the method
    we interact with music sheets.

    Future of Music Sheets
    The next era of music sheets foresees intriguing
    developments.

    As technology progresses, the tools artists use to produce and share music sheets will likewise evolve.

    Conclusion
    The journey of music sheets is rich, showcasing the evolution of music itself.

    From ancient symbols to digital scores, music sheets have served as a vital tool for recording and transmitting musical ideas.

    As we move forward, the history of music sheets shall endure, evolving with each new era.
    }
    The history of music sheets is a deep tapestry that spans across ages.

    Early Beginnings
    The earliest types of music notation date back to early societies.

    Ancient Egyptians created basic music notation methods to preserve their musical practices.

    The Greek Contribution
    Greek society made significant contributions to music notation.

    Medieval Innovations
    The Middle Ages experienced substantial advances in music notation.

    The Renaissance Era
    Renaissance brought a rebirth of music, including music
    notation.

    Baroque and Classical Periods
    During the Classical periods, music notation evolved further, becoming increasingly
    detailed.

    The Romantic Era
    The Romantic age initiated innovative expressive methods in music notation.

    The Modern Age
    In the modern era, music notation underwent
    major changes, adopting electronic systems.

    The Digital Revolution
    The introduction of digital music transformed the landscape of music notation.

    Key Milestones in Music Notation History
    1. **Early Marks:** Early Egyptian hieroglyphs used to depict music.

    2. **Staff Lines:** Invention of the staff and solmization system
    by Guido d’Arezzo in the 11th century.
    3. **Classical Evolution:** Evolution of musical scores in the
    Classical era.
    4. **19th Century:** Incorporation of expressive dynamics and articulations in the
    Romantic era.
    5. **Contemporary Techniques:** Introduction of graphic scores and experimental notation in the 20th century.

    The Role of Music Sheets in Education
    Music sheets serve a crucial function in learning music.

    Notable Composers and Their Contributions
    1. **Johann Sebastian Bach:** Famed for his intricate and precise notation.
    2. **L. Beethoven:** Innovated in the use of dynamic
    and expressive notations.
    3. **Wolfgang Amadeus Mozart:** Perfected the Classical approach to elegant and clear notation.
    4. **Frédéric Chopin:** Expanded the use of expressive notations
    for piano music.
    5. **Stravinsky:** Known for his groundbreaking 20th-century notational techniques.

    Evolution of Music Sheets in the Digital Age
    The modern era has significantly transformed the way we use music
    sheets.

    Future of Music Sheets
    The coming age of music sheets promises exciting developments.

    With the evolution of technology, the techniques artists use to create and share music sheets will in parallel progress.

    Conclusion
    The history of music sheets holds depth, mirroring the progress of music itself.

    From early marks to digital scores, music sheets have been a fundamental medium for
    documenting and distributing compositions.

    As we look ahead, the story of music sheets will continue, changing
    with each new era. }
    Learning to read music sheets is essential for all beginning musician. | Mastering how
    to read music sheets is essential for all beginning musician. | Learning the art of reading
    music sheets is crucial for all beginning musicians.}

    What Are Music Sheets?
    Music sheets act as notated representations of musical notations, indicating the pitch as well as pace of a musical composition.

    Getting Started with Music Sheets
    Understanding to read music sheets begins with becoming familiar with the essential
    components of music notation.

    Understanding Musical Notation
    Music notation consists of many crucial elements, including notes, staff,
    rhythms, and clefs.

    1. **The Staff**
    This is is actually an important element in music notation.

    In that musical notation, this staff includes five horizontal
    lines as well as, four different spaces.

    2. **Clefs
    Clefs indicate what note is going to the five
    lines and spaces. | Clefs denote what note is meant to these lines and also the different
    spaces. | This clefs denote for the different lines and these different
    spaces.}

    {There {are actually|actually are|is} {two|two separate|two distinct} {primary|different|distinct}
    {clefs|clef|music notes} {used in|used in various|used in the} {music|musical} {notation|notes|notations}.
    | There {are actually|actually are|is} {two|two separate|two distinct} {primary|different|distinct} {clefs|musical notes|clef}
    {used in|used in various|used in the} {notations|music|musical} {of|music} {these notes|these notes}.

  31. Opening a t-shirt shop is often an exciting
    opportunity for entrepreneurs wanting to enter the clothing market.
    With the right strategy and commitment, your t-shirt shop
    could succeed and grow into a flourishing business.
    Here are some essential steps to keep in mind when starting
    a t-shirt business.

    ### Planning

    Drafting a detailed strategy is vital for the success of of your t-shirt shop.

    This plan must outline your target market, advertising plans, funding requirements, and objectives.
    Knowing your audience can help adjust your t-shirts
    and marketing efforts to suit their preferences.

    ### Design and Production

    Designing of your t-shirts is a important element in attracting
    buyers. Consider hiring experienced artists to develop eye-catching and trendy
    graphics that interest your target market. You can utilizing diverse processes, including screen printing,
    DTG printing, and vinyl printing, depending on your resources
    and the quality you want of the apparel.

    ### Selecting Vendors

    Selecting reliable vendors for your products is essential to ensure consistent products.

    Look for suppliers that offer high-quality basic tees in various styles.
    Establishing a solid partnership with your vendors will help ensure on-time supply and affordable prices.

    ### Setting Up an Online Presence

    In today’s online era, having an online presence is important for accessing a broader market.

    Create an attractive and easy-to-navigate online
    store to showcase your apparel. Implement clear
    pictures and detailed product details to give customers a clear sense of
    what they are purchasing. Think about including elements like trusted payment systems, customer reviews,
    and network buttons to enhance user engagement.

    ### Marketing and Promotion

    Strategic marketing is crucial to attracting customers to
    your t-shirt shop. Leverage different advertising platforms, like
    social media, email marketing, influencer collaborations,
    and paid search ads. Social media platforms provide you to connect with a
    vast customer base and highlight your t-shirts.

    Sending newsletters is another method to keep your audience and inform them about latest designs, promotions, and future collections.
    Partnering with influencers can further assist in connecting with targeted clients.

    ### Customer Support

    Providing exceptional support is crucial for establishing a loyal clientele.
    Ensure that your buyers have a satisfactory shopping experience from the
    moment they visit your store. Respond to questions
    and complaints quickly and courteously. Offering convenient exchanges and clear terms can help establishing confidence with your clients.

    ### Assessing Sales

    Regularly reviewing your business metrics can help detect parts for improvement and tweak your {strategies|approaches

  32. Launching a t-shirt store can be an exciting venture for
    business owners seeking to enter the apparel industry.
    With the right plan and commitment, your t-shirt shop can thrive and grow into a profitable enterprise.
    Here are some key steps to consider when opening
    a t-shirt shop.

    ### Business Plan

    Developing a thorough strategy is vital for the success and
    growth of your t-shirt shop. This strategy should cover
    the target market, marketing strategies, budget, and
    objectives. Identifying your audience is crucial to tailor your
    t-shirts and advertising to cater to their interests.

    ### Creating the T-Shirts

    Creating the design of your t-shirts is a critical aspect in drawing customers.
    Hire skilled artists to create unique and stylish designs that interest your customers.
    Consider using diverse processes, including screen printing, direct-to-garment printing,
    and vinyl printing, based on your budget and the desired quality of the apparel.

    ### Selecting Vendors

    Choosing trustworthy suppliers for your products is essential to ensure consistent goods.
    Search for manufacturers that offer premium blank t-shirts in diverse styles.

    Establishing a solid partnership with your vendors is important to
    ensure prompt supply and competitive prices.

    ### Setting Up an Online Store

    In today’s online era, having an e-commerce site is important for accessing a
    wider market. Develop an user-friendly and functional website
    to feature your apparel. Implement clear photos and detailed information to provide buyers a good sense of what they
    are buying. Consider including options like safe
    transactions methods, feedback, and social media buttons to improve customer interaction.

    ### Promotional Strategies

    Effective marketing is key to bringing in visitors to your t-shirt shop.
    Leverage different advertising platforms, including social media, email campaigns, partnering with influencers,
    and paid search ads. Sites like Facebook, Instagram,
    and Twitter enable you to reach a broad audience and showcase your
    products.

    Email marketing is a great strategy to keep your subscribers and
    inform them about new products, special offers, and upcoming events.
    Collaborating with influencers can also boost in reaching potential buyers.

    ### After-Sales Service

    Providing outstanding customer service is crucial for creating a faithful clientele.
    Ensure that your customers have a great interaction from start to finish.
    Respond to questions and problems quickly and politely.
    Offering convenient refunds and fair conditions can aid in building confidence with your audience.

    ### Analyzing Metrics

    Frequently analyzing your sales can help spot areas for improvement and
    tweak your {strategies|approaches

  33. Launching a t-shirt shop is an exciting venture for individuals wanting to explore the fashion sector.
    With the right strategy and hard work, a t-shirt shop could prosper and grow
    into a profitable business. Here are some key steps to think about when launching a t-shirt
    store.

    ### Initial Planning

    Drafting a comprehensive strategy is essential for
    the success of of your t-shirt shop. This plan should cover
    your audience, marketing strategies, funding requirements, and aims.
    Understanding your customer base will help adjust your products and marketing efforts to cater to their interests.

    ### Designing and Producing

    Designing of your t-shirts is a critical aspect in drawing customers.

    Hire talented designers to craft attractive and stylish patterns that resonate with your audience.
    Consider using different printing methods, including screen printing,
    DTG printing, and vinyl printing, based on your resources and the
    quality level of the t-shirts.

    ### Choosing Suppliers

    Finding reliable suppliers for your materials is vital to make sure
    of consistent products. Look for manufacturers
    that provide premium blank t-shirts in diverse styles.
    Establishing a strong relationship with your vendors can help maintain timely delivery and competitive pricing.

    ### Setting Up an Online Store

    In today’s online world, having an digital storefront is essential for accessing a broader customer base.

    Develop an user-friendly and functional online store to showcase your apparel.
    Utilize clear photos and detailed product details to offer visitors a clear sense of what they
    are purchasing. Think about including features like secure
    payment systems, customer reviews, and social sharing links to enhance customer interaction.

    ### Advertising and Marketing

    Strategic promotion is key to attracting traffic to your
    t-shirt shop. Use various advertising platforms, such as
    social media, email marketing, partnering with influencers,
    and paid search ads. Platforms like Instagram, Facebook, and TikTok provide
    you to reach a large customer base and feature your products.

    Email campaigns is a great method to keep your audience and
    notify them about new arrivals, sales, and upcoming collections.

    Collaborating with influencers can additionally help in accessing new clients.

    ### Customer Service

    Providing excellent after-sales service is essential for creating a loyal customer base.
    Ensure that your buyers have a satisfactory experience from beginning to end.

    Respond to concerns and issues efficiently and professionally.
    Offering convenient exchanges and fair policies can help creating reliability with your clients.

    ### Analyzing Sales

    Consistently assessing your business metrics is crucial to spot areas for enhancement and tweak your {strategies|approaches

  34. Opening a t-shirt store is an thrilling opportunity for individuals looking to tap into the
    clothing industry. With a solid approach and commitment, a t-shirt shop may thrive and
    grow into a profitable business. Here are some
    key steps to consider when starting a t-shirt shop.

    ### Planning

    Creating a detailed strategy is essential for the success
    of your t-shirt shop. This plan needs to cover your customer
    base, advertising plans, budget, and business goals.
    Identifying your target market can help customize your t-shirts
    and advertising to cater to their interests.

    ### Creating the T-Shirts

    Creating the design of your t-shirts is a key aspect in drawing clients.
    Consider hiring skilled artists to create attractive and stylish patterns
    that appeal to your audience. Consider employing
    different techniques, like screen printing, digital printing, and vinyl printing,
    depending on your resources and the quality level of the
    apparel.

    ### Choosing Suppliers

    Selecting trustworthy vendors for your materials is essential
    to ensure high-quality products. Search for vendors that
    provide premium blank t-shirts in different styles.

    Establishing a good connection with your manufacturers is important to guarantee prompt shipments and competitive pricing.

    ### Creating an Online Shop

    In today’s online era, having an online presence is crucial for connecting with a
    more extensive audience. Develop an appealing and functional online store to display your t-shirts.
    Use high-quality images and detailed descriptions
    to give customers a clear understanding of what they are getting.

    Look into integrating features like safe transactions methods, feedback,
    and network integration to boost customer interaction.

    ### Promotional Strategies

    Effective marketing is key to attracting visitors to your t-shirt shop.

    Leverage multiple marketing channels, including social media, newsletters,
    influencer marketing, and search engine optimization. Sites like
    Facebook, Instagram, and Twitter enable you to
    engage a large audience and feature your products.

    Email marketing is another method to engage with your subscribers and update
    them about new products, sales, and future launches.
    Collaborating with influencers can further help in accessing targeted buyers.

    ### After-Sales Service

    Providing exceptional after-sales service is crucial for building a dedicated
    customer base. Guarantee that your customers have a positive shopping experience
    from start to finish. Address concerns and problems promptly and politely.

    Offering easy exchanges and fair terms can help
    establishing trust with your clients.

    ### Assessing Performance

    Frequently analyzing your sales is crucial
    to detect areas for enhancement and modify
    your {strategies|approaches

  35. Launching a t-shirt business is often an exciting
    endeavor for business owners seeking to tap into the fashion industry.
    With the right strategy and commitment, your t-shirt shop may thrive and turn into a successful enterprise.
    Here are some important steps to keep in mind when launching a
    t-shirt shop.

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    Drafting a comprehensive business plan is essential for the success of your
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  48. AI technology have integrated themselves into diverse dimensions of life.
    A distinctively provocative application of this innovation is the AI undresser.

    AI undressers utilize advanced models to synthetically strip
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    This innovation has sparked numerous moral concerns.

    Some contend that AI undressers could be harnessed for positive uses, such as clinical diagnosis and criminal investigations.

    In the field of medicine, AI undressers may assist physicians in more accurately examining the underlying anatomy of the
    body.

    This could result in improved diagnoses and improved medical approaches.

    In legal scenarios, AI undressers may assist law enforcement officials by exposing key evidence that would otherwise be obscured.

    On the flip side, the risk of exploitation is immense.

    AI undressers might be abused for exploitative purposes,
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    The capacity to strip someone digitally without
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    Many individuals believe that the availability of AI undressers infringes upon core values of individual
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    AI undressers harness advanced algorithms to digitally strip away attire from images of individuals.

    The emergence of such innovations has sparked numerous ethical debates.

    On one hand, AI undressers have the potential to be utilized for positive purposes, such as clinical analysis and criminal investigations.

    In the field of clinical practice, AI undressers may assist physicians in better
    examining the hidden details of the patient.

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    There is a growing belief that the existence of AI undressers infringes upon basic
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    There are mounting appeals for rigorous rules and ethical controls to manage the deployment of AI undressers.

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    of AI undressers while safeguarding personal freedoms.

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    On one hand, AI undressers have the potential to be used for positive uses, such as healthcare analysis and legal investigations.

    For example, in the clinical field, AI undressers
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    There is a widespread belief that the existence of AI undressers infringes upon core principles of individual autonomy.

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    There are mounting demands for stringent regulations and moral controls to govern the application of AI undressers.

    Many advocate for a middle ground that permits the constructive purposes of AI undressers while safeguarding privacy rights.

    In summary, AI undressers symbolize a controversial confluence of innovation and ethics.

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    issues about the place of AI in our lives.

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  86. Great article.

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