Faciliating More Efficient Negotiations for Innovative Therapies: A Value-Based Negotiation Framework

OBJECTIVES: An increasing number of innovative therapies (e.g., gene- and cell-based treatments) have been developed in the past 20 years. Despite the significant clinical potential of these therapies, access delays may arise because of differing perspectives of manufacturers and payers regarding issues such as the value of the product, clinical and financial uncertainties, and sustainability.Managed entry agreements (MEAs) can enable access to treatments that would not be reimbursed by conventional methods because of such concerns. However, although MEA typologies exist, there is currently no structured process to come to agreements on MEAs, which can be difficult to decide upon and implement.To facilitate more structured MEA negotiations, we propose a conceptual "value-based negotiation framework" with corresponding application tools. METHODS: The framework was developed based on an iterative process of scientific literature review and expert input. RESULTS: The framework aims to (i) systematically identify and prioritize manufacturer and payer concerns about a new treatment, and (ii) select a mutually acceptable combination of MEA terms that can best address priority concerns, with the lowest possible implementation burden. CONCLUSIONS: The proposed framework will be tested in practice, and is a step toward supporting payers and manufacturers to engage in more structured, transparent negotiations to balance the needs of both sides, and enabling quicker, more transparent MEA negotiations and patient access to innovative products

Establishing freshwater protected areas to protect biodiversity and improve food security in the Philippines

This paper describes the efforts to establish a network of community-conserved areas in the municipality of San Mariano on Luzon, with the dual aim to protect the Philippine crocodile and to improve inland fisheries. The necessary steps to establish a community-conserved area are summarized, and their sustainability assessed. The importance of local leadership and democratic decision-making processes in the design of community-based conservation measures is highlighted, and it is argued that implicit cultural values, such as hospitality and respect, are often a more important motivation for rural communities to protect aquatic resources than explicit concerns about food security and livelihoods.Global Challenges (FSW)Environmental BiologyConservation Biolog

Photochromic performance of a dithienylethene–indolinooxazolidine hybrid

The synthesis and the photochromic performance of a single-molecule system based on the covalent combination of dithienylperfluorocyclopentene and indolino[2,1-b]oxazolidine are described. The photoinduced interconversion between four states was shown to be deeply dependent on solvent and can be selectively controlled by adjusting the irradiation wavelength in chlorobenzene solutions. The color can be switched between colorless, yellow, pink and green on demand. This biphotochromic hybrid compound, despite poor fatigue resistance properties of the most conjugated colored isomer, displays large contrasts in structure, switching between zwitterionic and neutral character, independent chromophores and highly conjugated π systems

Safer Sex as the Bolder Choice: Testosterone Is Positively Correlated with Safer Sex Behaviorally Relevant Attitudes in Young Men

Introduction.  Higher testosterone (T) is tied to risk‐taking, especially in financial domains but also in health domains relevant to acquiring sexually transmitted infections (STIs). However, safer sex constructs could themselves carry the possibility of “social risk” due to sexual stigma or embarrassment, or could involve boldness or confidence because they could represent status displays of frequent sexual activity. Aim.  To determine how T and behaviorally relevant attitudes about sexual risk‐taking are linked, to better understand biopsychosocial aspects of sexual health related to STIs. Methods.  In 78 first‐year male college students, we examined correlations between salivary T and behaviorally relevant safer sex attitudes assessed via questionnaires. Main Outcome Measures.  T, via saliva; safer sex attitudes, via a composite and the University of California, Los Angeles Multidimensional Condom Attitudes Scale (MCAS). Results.  Higher T was significantly correlated with higher scores on the following: safer sex likelihood composite, r (73) = 0.33, P  = 0.003; the MCAS safer sex resilience, r (32) = 0.36, P  = 0.037; and the MCAS condom purchase comfort, r (32) = 0.37, P  = 0.031. Associations between T and safer sex likelihood and resilience were still robust after controlling for potential confounds, though the association between T and purchase comfort diminished to a trend. Conclusions.  Higher T was positively linked with safer sex attitudes, especially those most closely tied to STI risk avoidance. Thus, future research and interventions for STI prevention should address the possibility that safer sex may be paradoxically perceived as a “bold” or “risky” choice even as it decreases STI risk. van Anders SM, Goldey KL, Conley TD, Snipes DJ, and Patel DA. Safer sex as the bolder choice: Testosterone is positively correlated with safer sex behaviorally relevant attitudes in young men. J Sex Med 2012;9:727–734.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90413/1/j.1743-6109.2011.02544.x.pd

Randomised controlled trial of adjunctive inspiratory muscle training for patients with COPD.

BACKGROUND: This study aimed to investigate whether adjunctive inspiratory muscle training (IMT) can enhance the well-established benefits of pulmonary rehabilitation (PR) in patients with COPD. METHODS: 219 patients with COPD (FEV1: 42%±16% predicted) with inspiratory muscle weakness (PImax: 51±15 cm H2O) were randomised into an intervention group (IMT+PR; n=110) or a control group (Sham-IMT+PR; n=109) in this double-blind, multicentre randomised controlled trial between February 2012 and October 2016 (ClinicalTrials.gov NCT01397396). Improvement in 6 min walking distance (6MWD) was a priori defined as the primary outcome. Prespecified secondary outcomes included respiratory muscle function and endurance cycling time. FINDINGS: No significant differences between the intervention group (n=89) and the control group (n=85) in improvements in 6MWD were observed (0.3 m, 95% CI -13 to 14, p=0.967). Patients who completed assessments in the intervention group achieved larger gains in inspiratory muscle strength (effect size: 1.07, p<0.001) and endurance (effect size: 0.79, p<0.001) than patients in the control group. 75 s additional improvement in endurance cycling time (95% CI 1 to 149, p=0.048) and significant reductions in Borg dyspnoea score at isotime during the cycling test (95% CI -1.5 to -0.01, p=0.049) were observed in the intervention group. INTERPRETATION: Improvements in respiratory muscle function after adjunctive IMT did not translate into additional improvements in 6MWD (primary outcome). Additional gains in endurance time and reductions in symptoms of dyspnoea were observed during an endurance cycling test (secondary outcome) TRIAL REGISTRATION NUMBER: NCT01397396; Results

Creation and restoration of coastal and estuarine habitats, a review of practical examples and a description of sequential guidelines for habitat creation and restoration in port areas

One of the themes of the NEW! Delta project is theme 3 "Creation and restoration of coastal and estuarine habitats" Within this theme two demonstration projects of habitat creation and restoration schemes have been implemented: one in the port of Antwerp and the other in the dune area "De Zilk" along the Dutch coast. The contributers of this study are from: ABP MER (United Kingdom), Alterra, Vlaamse overheid Afdeling Kust, DIREN Haute-Normandie, Grontmij, IMIEU Brussel, Haven van Antwerpen, Haven van Rotterdam, provincie Zuid-Hollan