A Roadmap to a Rational Pharmacare Policy in Canada

"For over two decades, the Canadian Federation of Nurses Unions (CFNU) has been advocating for a national pharmacare plan. Now, as the costs of prescription drugs continue to rise, putting pressures on a health care system that is already stretched to the limit, the CFNU is gaining some new allies. There is a growing consensus that prescription drug policies require reform. Advocates for reform include the C.D. Howe Institute (a well-known public policy think tank), the Canadian Life and Health Insurance Association, provincial and territorial governments, as well as patient advocates from coast-to-coast. A Roadmap to a Rational Pharmacare Policy calls for governments, insurers, policy makers, and pharmaceutical companies to recognize that the present hybrid system we are using to fund prescription drug purchases isn't working. As the title of this report indicates, Dr. Gagnon offers a roadmap to a rational drug policy so that Canada can move into the 21st century, alongside its OECD counterparts. He suggests that governments need to seize the initiative and take advantage of the emerging consensus on the need for reform, and offers a series of a pragmatic, achievable steps that can be taken now to turn policy into practice."--Message from the CFN

Improving the chromatic dispersion tolerance in long-haul fibre links using the coherent optical orthogonal frequency division multiplexing

Numerical simulations of the coherent optical orthogonal frequency division multiplexing modems are undertaken to investigate the effect of the adaptive modulation, the number of sub-carriers, the cyclic prefix (CP) length, the clipping ratio, quantisation bit resolution and the sampling speed of analogue-to-digital converters (ADCs) on the chromatic dispersion (CD) of a single mode fibre (SMF) at data rates up to 80 Gbps. The use of a large number of sub-carriers is more effective in combating fibre dispersion than employing a long CP; moreover, the optimum number of sub-carriers in the presence of both SMF non-linearities and CD has been identified. The authors show that using a high bit resolution ADC with a high clipping ratio, the transmission distance can be increased at specific data rates. Furthermore, it is shown that ADCs with a low sampling speed also improve the system tolerance to the fibre CD. In addition, simulation results show that the use of adaptive modulation schemes improves spectrum usage efficiency, thus resulting in higher tolerance to the CD when compared with the case in which identical modulation formats are adopted across all sub-carriers

CETA and pharmaceuticals: Impact of the trade agreement between Europe and Canada on the costs of prescription drugs

On a per capita basis, Canadian drug costs are already the second highest in the world after the United States and are among the fastest rising in the Organization for Economic Co-Operation and Development. The Comprehensive Economic and Trade Agreement (CETA) between the European Union (EU) and Canada will further exacerbate the rise in costs by:. • Committing Canada to creating a new system of patent term restoration thereby delaying entry of generic medicines by up to two years;. • Locking in Canada's current term of data protection, and creating barriers for future governments wanting to reverse it;. • Implementing a new right of appeal under the patent linkage system that will create further delays for the entry of generics.CETA will only affect intellectual property rights in Canada-not the EU. This analysis estimates that CETA's provisions will increase Canadian drug costs by between 6.2% and 12.9% starting in 2023. The Canadian government committed to compensating provinces for the rise in costs for their public drug plans. Importantly, this means that people paying out-of-pocket for their drugs or receiving them through private insurance, will be charged twice: once through higher drug costs and once more through their federal taxes.As drug costs continue to grow, there are limited options available for provincial/territorial governments: restrict the choice of medicines in public drug plans; transfer costs to patients who typically are either elderly or sick; or take money from other places in the health system, and threaten the viability of Canada's single payer system. CETA will therefore negatively impact the ability of Canada to offer quality health care

Merger mania: Mergers and acquisitions in the generic drug sector from 1995 to 2016

Background: Drug shortages and increasing generic drug prices are associated with low levels of competition. Mergers and acquisitions impact the level of competition. Record merger and acquisition activity was reported for the pharmaceutical sector in 2014/15, yet information on mergers and acquisitions in the generic drug sector are absent from the literature. This information is necessary to understand if and how such mergers and acquisitions can be a factor in drug shortages and increasing prices. Methods: Data on completed merger and acquisition deals that had a generic drug company being taken over (i.e. 'target') were extracted from Bloomberg Finance L.P. The number and announced value of deals are presented globally, for the United States, and globally excluding the United States annually from 1995 to 2016 in United States dollars. Results: Generic drug companies comprised 9.3% of the value of all deals with pharmaceutical targets occurring from 1995 to 2016. Globally, in 1995 there were no deals, in 2014 there were 22 deals worth $1.86 billion, in 2015 there were 34 deals totalling$33.56 billion, and in 2016 there were 42 deals worth in excess of $44 billion. This substantial increase was partially attributed to Teva's 2016 acquisition of Allergan's generic drug business. The surge in mergers and acquisitions for 2015/16 was driven by deals in the United States, where they represented 89.7% of the dollar value of deals in those years. Conclusions: The recent blitz in mergers and acquisitions signals that the generic drug industry is undergoing a transformation, especially in the United States. This restructuring can negatively affect the level of competition that might impact prices and shortages for some products, emphasizing the importance of updating regulations and procurement policies

Classical and Quantum Integrable Systems in \wt{\gr{gl}}(2)^{+*} and Separation of Variables

Classical integrable Hamiltonian systems generated by elements of the Poisson commuting ring of spectral invariants on rational coadjoint orbits of the loop algebra \wt{\gr{gl}}^{+*}(2,{\bf R}) are integrated by separation of variables in the Hamilton-Jacobi equation in hyperellipsoidal coordinates. The canonically quantized systems are then shown to also be completely integrable and separable within the same coordinates. Pairs of second class constraints defining reduced phase spaces are implemented in the quantized systems by choosing one constraint as an invariant, and interpreting the other as determining a quotient (i.e., by treating one as a first class constraint and the other as a gauge condition). Completely integrable, separable systems on spheres and ellipsoids result, but those on ellipsoids require a further modification of order \OO(\hbar^2) in the commuting invariants in order to assure self-adjointness and to recover the Laplacian for the case of free motion. For each case - in the ambient space ${\bf R}^{n}$, the sphere and the ellipsoid - the Schr\"odinger equations are completely separated in hyperellipsoidal coordinates, giving equations of generalized Lam\'e type.Comment: 28 page

Immigrant women’s experiences of maternity services in Canada: a meta-ethnography

Objective: to synthesise data on immigrant women's experiences of maternity services in Canada. Design: a qualitative systematic literature review using a meta-ethnographic approach. Methods: a comprehensive search strategy of multiple databases was employed in consultation with an information librarian, to identify qualitative research studies published in English or French between 1990 and December 2011 on maternity care experiences of immigrant women in Canada. A modified version of Noblit and Hare's meta-ethnographic theoretical approach was undertaken to develop an inductive and interpretive form of knowledge synthesis. The seven-phase process involved comparative textual analysis of published qualitative studies, including the translation of key concepts and meanings from one study to another to derive second and third-order concepts encompassing more than that offered by any individual study. ATLAS.ti qualitative data analysis software was used to store and manage the studies and synthesise their findings. Findings: the literature search identified 393 papers, of which 22 met the inclusion criteria and were synthesised. The literature contained seven key concepts related to maternity service experiences including social (professional and informal) support, communication, socio-economic barriers, organisational environment, knowledge about maternity services and health care, cultural beliefs and practices, and different expectations between health care staff and immigrant women. Three second-order interpretations served as the foundation for two third-order interpretations. Societal positioning of immigrant women resulted in difficulties receiving high quality maternity health care. Maternity services were an experience in which cultural knowledge and beliefs, and religious and traditional preferences were highly relevant as well but often overlooked in Canadian maternity settings. Key conclusions and implications for practice: in order to implement woman-centred care, to enhance access to maternity services, and to promote immigrant women's health, it is important to consider these women's social position, cultural knowledge and beliefs, and traditional customs in the health care

Measurement of the partial widths of the Z into up- and down-type quarks

Using the entire OPAL LEP1 on-peak Z hadronic decay sample, Z -> qbarq gamma decays were selected by tagging hadronic final states with isolated photon candidates in the electromagnetic calorimeter. Combining the measured rates of Z -> qbarq gamma decays with the total rate of hadronic Z decays permits the simultaneous determination of the widths of the Z into up- and down-type quarks. The values obtained, with total errors, were Gamma u = 300 ^{+19}_{-18} MeV and Gamma d = 381 ^{+12}_{-12} MeV. The results are in good agreement with the Standard Model expectation.Comment: 22 pages, 5 figures, Submitted to Phys. Letts.

Search for R-Parity Violating Decays of Scalar Fermions at LEP

A search for pair-produced scalar fermions under the assumption that R-parity is not conserved has been performed using data collected with the OPAL detector at LEP. The data samples analysed correspond to an integrated luminosity of about 610 pb-1 collected at centre-of-mass energies of sqrt(s) 189-209 GeV. An important consequence of R-parity violation is that the lightest supersymmetric particle is expected to be unstable. Searches of R-parity violating decays of charged sleptons, sneutrinos and squarks have been performed under the assumptions that the lightest supersymmetric particle decays promptly and that only one of the R-parity violating couplings is dominant for each of the decay modes considered. Such processes would yield final states consisting of leptons, jets, or both with or without missing energy. No significant single-like excess of events has been observed with respect to the Standard Model expectations. Limits on the production cross- section of scalar fermions in R-parity violating scenarios are obtained. Constraints on the supersymmetric particle masses are also presented in an R-parity violating framework analogous to the Constrained Minimal Supersymmetric Standard Model.Comment: 51 pages, 24 figures, Submitted to Eur. Phys. J.