Who Can Afford It?: The Patient Protection and Affordable Care Act\u27s Failure to Regulate Excessive Cost-Sharing of Prescription Biologic Drugs

This Note will discuss how the PPACA’s abbreviated approval pathway for biological products creates an expedited procedure to bring less expensive biologic drugs to the market, but ultimately fails to make those biologic drugs affordable because of its lack of provisions limiting insurers’ use of excessive cost-sharing requirements. Part II provides an overview of prescription drugs, compares biologics with traditional prescription drugs, and provides a brief legislative history of prescription drug laws. Part III analyzes the impact of the abbreviated approval pathway on biologic drugs’ costs to prescribed patients. It also examines the PPACA’s effects on biologics inclusion into health insurance plans. This Note will demonstrate how the PPACA continues to keep prescription biologic drugs unaffordable for insured patients by permitting private insurers to continue to include excessive cost-sharing requirements in insurance plans. Finally, Part IV proposes a recommendation by which the PPACA would be amended to include a modified version of current proposed legislation. To fully address the problem, Congress must formulate and enact legislation that properly protects patients from excessive out-of-pocket costs, while balancing the insurance companies’ interests to remain competitive and profitable

Improvements in Triploid Crassostrea virginica Production: Characterizing the Diploid Parent

The effect of triploidy to effect faster growth and increased survival compared to diploid oysters is called the ‘triploid advantage’ and this advantage in the Chesapeake Bay for Crassostrea virginica is the principal reason for the value of triploid C. virginica in the Chesapeake Bay, USA. The triploid advantage is hypothesized to be the result of genetic effects, physiological changes, or a combination of both. The causative genetic mechanisms at play may include additive genetic effects and heterosis while the physiological changes obtain from triploid sterility. The triploid advantage was examined by comparing 13 diploid and 13 triploid crosses across three environments. The genotypes used in this study consisted of wild stocks from both the Virginia and Maryland portions of the Chesapeake Bay, four lines from ABC’s 2006-year class of selected lines, and four ABC Superlines. Three experimental sites, ranging in salinity and disease pressure (Choptank River – low salinity and no disease pressure; Rappahannock River – moderate salinity and occasional disease pressure; York River – higher salinity and consistent disease pressure) were chosen to investigate the influence of environment on triploid advantage. Growth metrics (shell height, whole wet weight, and wet tissue weight) and survival rates among diploid and triploid C. virginica were recorded. The triploid advantage for growth and survival ranges from positive to negative depending on environmental factors. In the low salinity environment, triploidy proved disadvantageous regardless of the genotype of the diploid parent. As salinity increased so did the triploid advantage, which was greater for the more disadvantaged (wild) groups. In the Rappahannock River, with moderate salinity and no disease pressure, selected diploids performed equivalently to their triploid counterparts showing that breeding efforts can improve diploid field performance to rival triploids. In the York River, under disease pressure, triploids offered the greatest advantage. Triploids from both wild-type and selected diploids had higher growth and survival than their diploid counterparts under disease pressure. In addition to greater survival, triploids also had lower Dermo infection prevalence than diploids indicating that there is a triploid advantage for Dermo disease resistance, perhaps as a result of triploid sterility. Variation in the effect of triploidy on field performance follows the notion that triploidy may be thought of as a tool useful in some applications but not in others. For low salinity, it appears that triploidy may not be the appropriate tool for providing benefits for oysters but for oysters grown under disease pressure, it certainly is. The triploid advantage appears to be caused by both genetic effects and physiological changes, with the environment influencing the expression of each in manifesting the triploid advantage

(1R,2R,3R,4R,5S)-2,3-Bis[(2S′)-2-acet­oxy-2-phenyl­acet­oxy]-4-azido-1-[(2,4-dinitro­phen­yl)hydrazono­meth­yl]bicyclo­[3.1.0]hexa­ne

In the title compound, C38H29N7O12, the five-membered ring adopts an envelope conformation in which the ‘flap’ is cis to the cyclo­propane group. This conformation is similar to those of other bicyclo­[3.1.0]hexane analogues for which crystal structures have been reported. The absolute configuration of the stereogenic centers on the cyclo­pentane ring, as determined by comparison with the known configurations of the stereogenic centers in the (2S)-2-acet­oxy-2-phenyl­acet­oxy groups, is 1(R), 2(R), 3(R), 4(R) and 5(S). An intramolecular N—H⋯O hydrogen bond is present

ENLACE: What Makes a Difference in the Education of Latino US Students

In 1997, the W.K. Kellogg Foundation created a national education initiative, ENLACE (pronounced en-LAN-say), ENgaging LAtino Communities for Education. Its goal is to increase access and success in higher education for Latino students and their families. The $30 million investment in ENLACE by the Kellogg Eoundation responds to a timely need to connect all students to the possibilities of higher education. While the economy demands an increasingly educated and skilled workforce, the response of our educational system to meet this demand has been, most would agree, disjointed. Eor example, school districts define high school graduation requirements, while, often unconnected, the postsecondary system defines its own standards for college entrance. Thus, the K-12 school system and the higher education systems remain fragmented. Latino and other minority students, as well as students who are the first in their families with the possibility of college, suffer disproportionately from these disconnects. As these students complete high school, many are unprepared for college, as seen by the high demand for remedial classes, and often, ineligible for college, yet not even aware of this until their senior year. The roots of this disparity run deep. In the very early grades, students are tracked into either college-preparatory or remedial tracks, making it difficult to catch up in time for college. Despite these obstacles, research shows that the vast majority of students intend to go to college. ENLACE is a response to this disparity between Latino students' educational aspirations and their school career realities. ENLACE has forged connections between systems and thereby improved students' education possibilities, with a focus on the Latino community

Reflections on the coproduction of a crisis-focused intervention for inpatient settings underpinned by a Cognitive Behavioural Therapy for psychosis (CBTp) model

Background: Psychological interventions delivered in inpatient settings have rarely been coproduced with those who receive them. The aim of this study is to outline the coproduction process which led to the development of an adapted inpatient intervention underpinned by a Cognitive Behaviour Therapy for psychosis model. / Method: Our coproduction group was comprised of experts by experience, family and carers, multi-disciplinary clinicians, and researchers. The group met monthly to develop the intervention and focused on eight key areas of the intervention, including therapist values, assessment, formulation, coping strategies, crisis/safety plans, and discharge plans. / Results: The coproduction panel highlighted the importance of flexible delivery of the intervention, developing a trusting relationship with the therapist, advocacy, prioritising patient safety on the ward, managing the impacts of inpatient care, preparing for discharge, and having family, carer and community involvement. Challenges of the coproduction process included having a pre-existing intervention model that was being adapted rather than coproducing a new one, discussing emotionally charged issues, and having limited time to coproduce the intervention. / Discussion: Coproduction brought immense value to the development of this intervention, ensuring it was culturally competent and suitable for the inpatient setting. Further research should be undertaken exploring the coproduction process applied to clinical research