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.

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

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

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

Evidence for surface uplift of the Atlas Mountains and the surrounding peripheral plateaux: Combining apatite fission-track results and geomorphic indicators in the Western Moroccan Meseta (coastal Variscan Paleozoic basement)

This work represents an initial attempt to link the evolution of the topography in relation to the general tectonic framework of western Morocco. For this purpose, in a section of the Western Moroccan Meseta different tools are combined in order to attain the general objective. Apatite fission-track (AFT) data of granitic rocks of the Rabat–Khenifra area give ages around 200 Ma with track length distributions which are compatible with the thermal models already established for the area. An inverse correlation between AFT ages and elevation is observed which is compatible with previous models indicating northward tilting of the whole Western Moroccan Meseta which is younger than 20–25 Ma. In order to test this possibility a detailed analysis of the topography at different scales in the Western Moroccan Meseta has been performed. Results indicate that two open folds with different amplitudes are recognized and that the one with wider wavelength could correspond to a lithospheric fold as previously stated by other authors on the basis of independent geological arguments. The northward tilting proposed based on the AFT data agrees with the results obtained in the analysis of the topography which reinforces the presence of a very open fold with a wavelength of 200–300 km in the north-western limb of the Western Moroccan Meseta

Sediment structure and physicochemical changes following tidal inundation at a large open coast managed realignment site

Managed realignment (MR) schemes are being implemented to compensate for the loss of intertidal saltmarsh habitats by breaching flood defences and inundating the formerly defended coastal hinterland. However, studies have shown that MR sites have lower biodiversity than anticipated, which has been linked with anoxia and poor drainage resulting from compaction and the collapse of sediment pore space caused by the site's former terrestrial land use. Despite this proposed link between biodiversity and soil structure, the evolution of the sediment sub-surface following site inundation has rarely been examined, particularly over the early stages of the terrestrial to marine or estuarine transition. This paper presents a novel combination of broad- and intensive-scale analysis of the sub-surface evolution of the Medmerry Managed Realignment Site (West Sussex, UK) in the three years following site inundation. Repeated broad-scale sediment physiochemical datasets are analysed to assess the early changes in the sediment subsurface and the preservation of the former terrestrial surface, comparing four locations of different former land uses. Additionally, for two of these locations, high-intensity 3D-computed X-ray microtomography and Itrax micro-X-ray fluorescence spectrometry analyses are presented. Results provide new data on differences in sediment properties and structure related to the former land use, indicating that increased agricultural activity leads to increased compaction and reduced porosity. The presence of anoxic conditions, indicative of poor hydrological connectivity between the terrestrial and post-inundation intertidal sediment facies, was only detected at one site. This site has experienced the highest rate of accretion over the terrestrial surface (ca. 7 cm over 36 months), suggesting that poor drainage is caused by the interaction (or lack of) between sediment facies rather than the former land use. This has significant implications for the design of future MR sites in terms of preparing sites, their anticipated evolution, and the delivery of ecosystem services

Idiopathic radiographic apical root resorption in wind instrument players

Root resorption of the permanent teeth involves an elaborate interaction among inflammatory cells resulting in loss of dental hard tissues. This report describes three clinical cases where idiopathic root resorption occurred in wind instrument playing patients. These patients produce adequate non-orthodontic forces, while playing their instruments, to expose their teeth to root resorbing force. Careful clinical monitoring of patients' teeth should be undertaken, as the additive effects of orthodontic treatment and musical habits are unknown

Early Cenozoic denudation of central west Britain in response to transient and permanent uplift above a mantle plume

Upwelling mantle plumes beneath continental crust are predicted to produce difficult to quantify, modest uplift and denudation. The contribution of permanent and transient components to the uplift is also difficult to distinguish. A pulse of denudation in Britain in the Early Paleogene has been linked, although with some controversy, with the arrival of the proto-Iceland mantle plume. In this contribution we show that combining apatite and zircon (U-Th-Sm)/He and apatite fission track analyses from central west Britain with numerical modeling clearly identifies a pulse of early Cenozoic denudation. The data indicate that rock uplift and denudation were centered on the northern East Irish Sea Basin and 1.0–2.4 km of rocks were removed during the latest Cretaceous-early Paleogene. Uplift and erosion appears to have started a few million years before the earliest magmatism in the region. The regional denudation pattern mirrors the distribution of low-density magmatic rocks that has been imaged in the deep crust. However, the injection of the underplating melt is not enough to account for the total denudation. An additional regional uplift of at least 300 m is required, which is consistent with a transient thermal effect from the hot mantle plume. The rapid exhumation event ceased by ~40 Ma and the data do not require significant Neogene exhumation