Reference Pricing of Pharmaceuticals for Medicare: Evidence from Germany, the Netherlands and New Zealand

This paper describes three prototypical systems of therapeutic reference pricing (RP) for pharmaceuticals -- Germany, the Netherlands, and New Zealand -- and examines their effects on the availability of new drugs, reimbursement levels, manufacturer prices and out-of-pocket surcharges to patients. RP for pharmaceuticals is not simply analogous to a defined contribution approach to subsidizing insurance coverage. Although a major purpose of RP is to stimulate competition, theory suggests that this is unlikely and this is confirmed by the empirical evidence. Other effects of RP differ across countries in predictable ways, reflecting each country's system design and other cost control policies. New Zealand's RP system has reduced reimbursement and limited the availability of new drugs, particularly more expensive drugs. Compared to these three countries, if RP were applied in the US, it would likely have a more negative effect on prices of on-patent products, due to the more competitive US generic market, and a more negative effect on R&D and on the future supply of new drugs, due to the much larger US share of global pharmaceutical sales.

A preferred vision for exemplary, character-based educational leadership : a reflective essay

The pivotal personality in the education equation is the educational leader. Without the leadership and guidance of an individual with impeccable personal character, and an unwavering optimistic vision, the educational establishment will shift and toss on a never-ending sea of improvement initiatives – or sink to the lowest common denominator of sorting people into their traditionally proper roles in society. With those characteristics cited above, a leader has an opportunity to deliver on the promise of educational opportunity for more community members. Even with these characteristics, the delivery of that promise is not certain, but it is more likely. And the greater the number of leaders with these qualities within an educational system, the greater the chance that the entire system can work together for the greatest benefit for all of its component members

Wheelchair-based game design for older adults

Few leisure activities are accessible to institutionalized older adults using wheelchairs; in consequence, they experience lower levels of perceived health than able-bodied peers. Video games have been shown to be an engaging leisure activity for older adults. In our work, we address the design of wheelchair-accessible motion-based games. We present KINECTWheels, a toolkit designed to integrate wheelchair movements into motion-based games, and Cupcake Heaven, a wheelchair-based video game designed for older adults using wheelchairs. Results of two studies show that KINECTWheels can be applied to make motion-based games wheelchair-accessible, and that wheelchair-based games engage older adults. Through the application of the wheelchair as an enabling technology in play, our work has the potential of encouraging older adults to develop a positive relationship with their wheelchair. Copyright 2013 ACM

Reference Pricing of Pharmaceuticals for Medicare: Evidence From Germany, the Netherlands, and New Zealand

This paper describes three prototypical systems of therapeutic reference pricing (RP) for pharmaceuticals—Germany, the Netherlands, and New Zealand—and examines their effects on the availability of new drugs, reimbursement levels, manufacturer prices, and out-of-pocket sur-charges to patients. RP for pharmaceuticals is not simply analogous to a defined contribution approach to subsidizing insurance coverage. Although a major purpose of RPis to stimulate competition, theory suggests that the achievement of this goal is unlikely, and this is confirmed by the empirical evidence. Other effects of RPdiffer across countries in predictable ways, reflecting each country’s system design and other cost-control policies. New Zealand’s RPsystem has reduced reimbursement and limited the availability of new drugs, particularly more expensive drugs. Compared to these three countries, if RP were applied in the United States, it would likely have a more negative effect on prices of on-patent products because of the more competitive U.S. generic market, and on research and development (R&D) and the future supply of new drugs, because of the much larger U.S. share of global pharmaceutical sales

Short communication : Modeling competing effects of cooling rate, grain size, and radiation damage in low-temperature thermochronometers

Funding Information: Financial support. This research has been supported by the NSERC Discovery, and from the Geological Survey of Canada, Natural Resources Canada. Publisher Copyright: © Copyright:Low-temperature multi-thermochronometry, in which the (U-Th)ĝ€¯/ĝ€¯He and fission track methods are applied to minerals such as zircon and apatite, is a valuable approach for documenting rock cooling histories and relating them to geological processes. Here we explore the behaviors of two of the most commonly applied low-temperature thermochronometers, (U-Th)ĝ€¯/ĝ€¯He in zircon (ZHe) and apatite (AHe), and directly compare them against the apatite fission track (AFT) thermochronometer for different forward-modeled cooling scenarios. We consider the impacts that common variations in effective spherical radius (ESR) and effective uranium concentration (eU) may have on cooling ages and closure temperatures under a range of different cooling rates. This exercise highlights different scenarios under which typical age relationships between these thermochronometers (ZHe>AFT>AHe) are expected to collapse or invert (either partially or fully). We anticipate that these predictions and the associated software we provide will be a useful tool for teaching, planning low-temperature multi-thermochronometry studies, and for continued exploration of the relative behaviors of these thermochronometers in temperature-time space through forward models.Peer reviewe

Exhumation of the Sierra de Cameros (Iberian Range, Spain): constraints from low-temperature thermochronology

We present new fission-track and (U–Th)/He data from apatite and zircon in order to reconstruct the exhumation of the Sierra de Cameros, in the northwestern part of Iberian Range, Spain. Zircon fission-track ages from samples from the depocentre of the basin were reset during the metamorphic peak at approximately 100 Ma. Detrital apatites from the uppermost sediments retain fission-track age information that is older than the sediment deposition age, indicating that these rocks have not exceeded 110 8C. Apatites from deeper in the stratigraphic sequence of the central part of the basin have fission-track ages of around 40 Ma, significantly younger than the stratigraphic age, recording the time of cooling after peak metamorphic conditions. Apatite (U–Th)/He ages in samples from these sediments are 31–40 Ma and record the last period of cooling during Alpine compression. The modelled thermal history derived from the uppermost sediments indicates that the thermal pulse associated with peak metamorphism was rapid, and that the region has cooled continuously to the present. The estimated palaeogeothermal gradient is around 86 8C km21 and supports a tectonic model with a thick sedimentary fill (c. 8 km) and explains the origin of the low-grade metamorphism observed in the oldest sediments

Impact-Induced Chondrule Deformation and Aqueous Alteration of CM2 Murchison

Deformed chondrules in CM2 Murchison have been found to define a prominent foliation [1,2] and lineation [3] in 3D using X-ray computed tomography (XCT). It has been hypothesized that chondrules in foliated chondrites deform by "squeezing" into surrounding pore space [4,5], a process that also likely removes primary porosity [6]. However, shock stage classification based on olivine extinction in Murchison is consistently low (S1-S2) [4-5,7] implying that significant intracrystalline plastic deformation of olivine has not occurred. One objective of our study is therefore to determine the microstructural mechanisms and phases that are accommodating the impact stress and resulting in relative displacements within the chondrules. Another question regarding impact deformation in Murchison is whether it facilitated aqueous alteration as has been proposed for the CMs which generally show a positive correlation between degree of alteration and petrofabric strength [7,2]. As pointed out by [2], CM Murchison represents a unique counterpoint to this correlation: it has a strong petrofabric but a relatively low degree of aqueous alteration. However, Murchison may not represent an inconsistency to the proposed causal relationship between impact and alteration, if it can be established that the incipient aqueous alteration post-dated chondrule deformation. Methods: Two thin sections from Murchison sample USNM 5487 were cut approximately perpendicular to the foliation and parallel to lineation determined by XCT [1,3] and one section was additionally polished for EBSD. Using a combination of optical petrography, SEM, EDS, and EBSD several chondrules were characterized in detail to: determine phases, find microstructures indicative of strain, document the geometric relationships between grain-scale microstructures and the foliation and lineation direction, and look for textural relationships of alteration minerals (tochilinite and Mg-Fe serpentine) that indicate timing of their formation relative to deformation event(s). Preliminary Results: Deformed chondrules are dominated by forsterite and clinoenstatite with lesser amounts of Fe-Mg serpentine, sulfides, and low calcium pyroxene. Olivine grains are commonly fractured but generally show sharp optical extinction. The pyroxene, in contrast, is not only fractured but also often displays undulose extinction. In addition, the clinoenstatite is frequently twinned but it is unclear whether the twins are the result of mechanical deformation or inversion from protoenstatite [8]. EBSD work is currently ongoing to determine if areas of higher crystallographic strain can be imaged and mapped, and to determine the pyroxene twin orientations. In regards to alteration, we have found evidence for post-deformation formation of tochilinite and Mg-Fe serpentine indicating that aqueous alteration has indeed post-dated the deformation of the chondrules