Reference pricing with elastic demand for pharmaceuticals

In this paper, we re‐examine the properties of two commonly adopted government reimbursement schemes for pharmaceuticals: reference pricing and fixed percentage reimbursement. We depart from the previous literature by assuming that the individual demand is price‐sensitive and depends on the copayment rate (i.e., the part paid by each consumer). We obtain two novel results under reference pricing: first, as the copayment rate increases, so do pharmaceutical prices; second, this increase in pharmaceutical prices reduces social welfare. Whilst reference pricing does emerge as a preferable reimbursement scheme, demand elasticities and the copayment rate interact in complex ways. This leads (unexpectedly) to the possibility that a higher copayment rate (lower reimbursement rate) results in higher government expenditure.info:eu-repo/semantics/acceptedVersio

IMECE2002-32160 SURFACE ROUGHNESS EFFECTS ON CIRCULAR CYLINDERS AT HIGH REYNOLDS NUMBERS

ABSTRACT The problem of flow-induced vibration has been studied extensively. However, much of this research has focused on the smooth cylinder to gain an understanding of the mechanisms that cause vortex-induced vibration. In this paper results of an investigation of the effect of surface roughness on the crosswind forces are presented. Measurements of the sectional RMS fluctuating lift forces and the axial correlation of the pressures for Reynolds numbers from 1 x 10 5 to 1.4 x 10 6 are given. It was found that surface roughness significantly increased the axial correlation of the pressures to similar values found at high subcritical Reynolds numbers. There was little effect of the surface roughness on the sectional lift forces. The improved correlation of the vortex shedding means rough cylinders will be subject to larger cross-wind forces and an increased possibility of vortex-induced vibration compared to smooth cylinders. INTRODUCTION The problem of vortex-induced vibration confronts us in many everyday situations; from the vibration of a domestic television aerial to flow over heat exchanger tube banks to large towers, and in some situations left untreated can lead to structure failures. The importance of finding causes and solutions to vortex induced vibration is reflected in the quantity of research. Many of the circular cylinder applications mentioned in the previous paragraph are not highly polished, instead they have a degree of surface roughness caused by manufacturing tolerances or environmental conditions. Research on smooth cylinders in low turbulence flow has shown the fluid-structure mechanisms that result in vibration over a wide range of Reynolds numbers. However, the quantity of research data available showing the effect of surface roughness an

Tiny Publics and Social Worlds—Toward a Sociology of the Local. Gary Alan Fine in Conversation With Reiner Keller

Gary Alan FINE gehört weltweit zu den prominentesten Persönlichkeiten der zeitgenössischen soziologischen Ethnografie. In diesem Gespräch spricht er über Einflüsse in seiner akademischen Laufbahn und prägende intellektuelle Entscheidungen. Er gilt als "serieller Ethnograf", der in zahlreichen Feldkontexten gearbeitet hat und dabei einerseits Kleingruppen und eine von Menschen bevölkerte Ethnografie favorisiert, sich andererseits mit Gerüchten, Klatsch und moralischen Geschichten beschäftigt, die in kleinen und größeren Publiken erzählt werden. FINE beschreibt sein theoretisches Kerninteresse als die Untersuchung des Wechselspiels von Struktur, Interaktion und Kultur. In seinem Werk analysiert er die vielfältigen ortsgebundenen Arten und Weisen, in denen Gesellschaft von Menschen in formellen und informellen sozialen Settings verwirklicht wird, angefangen bei Baseballteams über Restaurantküchen oder die Wetterberichterstattung bis hin zum Schachspielen –um nur einige wenige Gegenstände seiner Forschungen zu nennen. Wesentlich beeinflusst durch symbolisch-interaktionistisches Denken und im Rekurs auf weitere wichtige Perspektiven auf soziale Welten plädiert er für eine selbstbewusste Haltung der ethnografischen Forschung und des ethnografischen Schreibens sowie für die Bedeutung der Konzeptarbeit in einer theorie-informierten empirischen Soziologie dessen, was Menschen zusammen tun.Gary Alan FINE is among the most prominent figures in contemporary sociological ethnography worldwide. In this conversation, he talks about influences in his academic career and key intellectual choices. Considered to be a "serial ethnographer" who has worked in multiple settings, his work focuses on small groups and peopled ethnography, as well as on rumors, gossip, and moral story telling in tiny and larger publics. FINE describes his core theoretical interest as residing in the interplay of structure, interaction, and culture and discusses the multiple local ways society is realized by people in formal and informal social settings: ranging from baseball teams, restaurant kitchens, weather reporting to chess players—to name but a few research sites. Influenced by symbolic interactionist thinking and other important approaches to social worlds, he argues for a confident voice of ethnographic research and writing as well as the importance of conceptual work in a theory-informed empirical sociology of what people do together

Design and rationale of the Post-Intensive Care Syndrome - paediatrics (PICS-p) Longitudinal Cohort Study.

INTRODUCTION: As paediatric intensive care unit (PICU) mortality declines, there is growing recognition of the morbidity experienced by children surviving critical illness and their families. A comprehensive understanding of the adverse physical, cognitive, emotional and social sequelae common to PICU survivors is limited, however, and the trajectory of recovery and risk factors for morbidity remain unknown. METHODS AND ANALYSIS: The Post-Intensive Care Syndrome - paediatrics Longitudinal Cohort Study will evaluate child and family outcomes over 2 years following PICU discharge and identify child and clinical factors associated with impaired outcomes. We will enrol 750 children from 30 US PICUs during their first PICU hospitalisation, including 500 case participants experiencing ≥3 days of intensive care that include critical care therapies (eg, mechanical ventilation, vasoactive infusions) and 250 age-matched, sex-matched and medical complexity-matched control participants experiencing a single night in the PICU with no intensive care therapies. Children, parents and siblings will complete surveys about health-related quality of life, physical function, cognitive status, emotional health and peer and family relationships at multiple time points from baseline recall through 2 years post-PICU discharge. We will compare outcomes and recovery trajectories of case participants to control participants, identify risk factors associated with poor outcomes and determine the emotional and social health consequences of paediatric critical illness on parents and siblings. ETHICS AND DISSEMINATION: This study has received ethical approval from the University of Pennsylvania Institutional Review Board (protocol #843844). Our overall objective is to characterise the ongoing impact of paediatric critical illness to guide development of interventions that optimise outcomes among children surviving critical illness and their families. Findings will be presented at key disciplinary meetings and in peer-reviewed publications at fixed data points. Published manuscripts will be added to our public study website to ensure findings are available to families, clinicians and researchers. TRIALS REGISTRATION NUMBER: NCT04967365

The Effects of Heparins on the Liver: Application of Mechanistic Serum Biomarkers in a Randomized Study in Healthy Volunteers

Heparins have been reported to cause elevations in serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) but have not been associated with clinically significant liver injury. The mechanisms underlying these benign laboratory abnormalities are unknown. Forty-eight healthy men were randomized to receive subcutaneous injections of unfractionated heparin (UFH; 150 U/kg), enoxaparin sodium (1 mg/kg), dalteparin sodium (120 IU/kg), or adomiparin sodium (125 IU/kg; a novel heparin) every 12 h for 4.5 days. Asymptomatic elevations in serum ALT or AST were observed in >90% of the subjects. Elevations were also observed in the levels of serum sorbitol dehydrogenase (SDH), glutamate dehydrogenase (GLDH), miR-122, high-mobility group box-1 protein (including the acetylated form), full-length keratin 18, and DNA. Keratin 18 fragments, which are apoptosis biomarkers, were not detected. Biomarker profiles did not differ significantly across heparin treatments. We conclude that heparins as a class cause self-limited and mild hepatocyte necrosis with secondary activation of an innate immune response