Coverage with evidence development: applications and issues

Copyright © Cambridge University Press, 2010OBJECTIVES: The aim of this study was to describe the current issues surrounding Coverage with Evidence Development (CED). CED is characterized by restricted coverage for a new technology in parallel with targeted research when the stated goal of the research or data collection is to provide definitive evidence for the clinical or cost-effectiveness impact of the new technology. METHODS: Presented here is information summarized and interpreted from presentations and discussions at the 2008 Health Technology Assessment International (HTAi) meeting and additional information from the medical literature. This study describes the differences between CED and other conditional coverage agreements, provides a brief history of CED, describes real-world examples of CED, describes the areas of consensus between the stakeholders, discusses the areas for future negotiation between stakeholders, and proposes criteria to assist stakeholders in determining when CED could be appropriate. RESULTS: Payers could interpret the evidence obtained from a CED program either positively or negatively, and a range of possible changes to the reimbursement status of the new technology may result. Striking an appropriate balance between the demands for prompt access to new technology and acknowledging that some degree of uncertainty will always exist is a critical challenge to the uptake of this innovative form of conditional coverage. CONCLUSIONS: When used selectively for innovative procedures, pharmaceuticals, or devices in the appropriate disease areas, CED may provide patients access to promising medicines or technologies while data to minimize uncertainty are collected.The development of the manuscript was funded by Medicines Australi

The Submillimeter Polarization Spectrum of M17

We present 450 {\mu}m polarimetric observations of the M17 molecular cloud obtained with the SHARP polarimeter at the Caltech Submillimeter Observatory. Across the observed region, the magnetic field orientation is consistent with previous submillimeter and far-infrared polarization measurements. Our observations are centered on a region of the molecular cloud that has been compressed by stellar winds from a cluster of OB stars. We have compared these new data with previous 350 {\mu}m polarimetry and find an anti-correlation between the 450 to 350 {\mu}m polarization magnitude ratio and the ratio of 21 cm to 450 {\mu}m intensity. The polarization ratio is lower near the east end of the studied region where the cloud is exposed to stellar winds and radiation. At the west end of the region, the polarization ratio is higher. We interpret the varying polarization spectrum as evidence supporting the radiative alignment torque (RAT) model for grain alignment, implying higher alignment efficiency in the region that is exposed to a higher anisotropic radiation field.Comment: 24 pages, 10 figure

Thermal analysis of the southern Powder River Basin, Wyoming

Journal ArticleTemperature and geologic data from over 3000 oil and gas wells within a 180 km x 30 km area that transect across the southern Powder River Basin in Wyoming, U.S.A., were used to determine the present thermal regime of the basin. Three-dimensional temperature fields within the transect, based on corrected bottom-hole temperatures (BHTs) and other geologic information, were assessed using: (1) A laterally constant temperature gradient model in conjunction with an L1 norm inversion method, and (2) a laterally variable temperature gradient model in conjunction with a stochastic inversion technique

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David R. Low, Ross L. Chapman and Terry R. Sloan explore innovation and market orientation in Australian manufacturing SMEs

Inter-relationships between innovation and market orientation in SMEs

Purpose – This study aims to explore the nature of the interactions between two strategies, innovation and market orientation. By examining the components of these constructs the paper seeks to identify key components of market orientation that are antecedent factors of the innovation performance of the firm. Design/methodology/approach – Correlation analysis was undertaken on data from a survey of 73 manufacturing firms in the Greater Western Sydney economic development zone in Australia. The data were supplemented by information obtained from the firm\u27s annual reports. Findings – Innovation was found to be positively correlated to market orientation (customer orientation, competitor orientation and inter-functional co-ordination) and both of these constructs were found to be positively correlated to firm performance and the degree of change in the firm\u27s competitive environment. Research limitations/implications – Possible limitations are: the low survey response rate; the nature of the sampled population; and the spread of industries involved, which could limit the generalisability of the results. The next steps will be to conduct deeper analysis into the factors that make up the subscales of the two constructs and to determine how market orientation or its associated activities interact with the innovation process. Practical implications – In order to maximize a firm\u27s financial performance, organizations should increase both their market orientation and their innovation activities as these factors operate synergistically. Originality/value – This study is arguably the first to establish the finding that the degree of change in the competitive environment and the level of market orientation are linked, and the identification of the components of market orientation that are linked to firm innovation. These findings suggest that firm innovation and firm market orientation are strategic reactions to changes in the firm\u27s competitive environment

An Open Source Laboratory for Operating Systems Projects

Typical undergraduate operating systems projects use services provided by an operating system via system calls or develop code in a simulated operating system. However, with the increasing popularity of operating systems with open source code such as Linux, there are untapped possibilities for operating systems projects to modify real operating system code. We present the hardware and software configuration of an open source laboratory that promises to provide students that use it with a better understanding of operating system internals than is typically gained in a traditional operating systems course. Our preliminary projects and evaluation suggest that thus far the lab has achieved its primary goal in that students that used the lab feel more knowledgeable in operating system and more confident in their ability to write and modify operating system code

Orbital Dimer Model for Spin-Glass State in Y2_2Mo2_2O7_7

The formation of a spin glass usually requires both structural disorder and frustrated magnetic interactions. Consequently, the origin of spin-glass behaviour in Y$_2$Mo$_2$O$_7$ $-$ in which magnetic Mo$^{4+}$ ions occupy a frustrated pyrochlore lattice with minimal compositional disorder $-$ has been a longstanding question. Here, we use neutron and X-ray pair-distribution function (PDF) analysis to develop a disorder model that resolves apparent incompatibilities between previously-reported PDF, EXAFS and NMR studies and provides a new and physical mechanism for spin-glass formation. We show that Mo$^{4+}$ ions displace according to a local "2-in/2-out" rule on each Mo$_4$ tetrahedron, driven by orbital dimerisation of Jahn-Teller active Mo$^{4+}$ ions. Long-range orbital order is prevented by the macroscopic degeneracy of dimer coverings permitted by the pyrochlore lattice. Cooperative O$^{2-}$ displacements yield a distribution of Mo$-$O$-$Mo angles, which in turn introduces disorder into magnetic interactions. Our study demonstrates experimentally how frustration of atomic displacements can assume the role of compositional disorder in driving a spin-glass transition.Comment: 6 pages, 3 figure