Effects of increased drug copayments on the demand for drugs and physician visits in Germany

'Background: On July 1, 1997, the German government raised drug copayment by EUR2.60 to EUR 4.60, EUR 5.60 or EUR 6.60 per prescription, depending on package size. The aim of this study was to examine the effects of increased copayments on the demand for drugs and physician visits one year later. Lower income groups and the chronically ill were analysed separately. Methods: A survey of 695 non-exempted adult pharmacy customers who suffered from acute or chronic health conditions in the previous 12 months was conducted. Logistic regression was performed to analyse the effect of different income levels on the demand for drugs and physician visits. Results: Of the respondents, 19.9% reported reduced physician visits, 22.6% reported reduced prescription drug purchases, 44.9% reported increased use of over-the-counter products and 46.3% reported increased use of non-drugs such as household remedies. A total of 11.2% waived more than one visit to the physician. Almost all of those respondents who reduced their purchases of prescription packages waived 1 to 5 packages (82.5%). There was distinctly less change in purchasing patterns among persons with chronic diseases. Logistic regression confirmed that lower income households were more likely to change demand patterns than households in other income brackets. Conclusion: Increased copayments had little effect on drugs and physician visits of adult pharmacy customers, especially among those with chronic conditions. Negative effects on low income households were observed.' (excerpt)

Predicting sinusoidal obstruction syndrome after allogeneic stem cell transplantation with the EASIX biomarker panel

No biomarker panel is established for prediction of sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD), a major complication of allogeneic stem cell transplantation (alloSCT). We compared the potential of the Endothelial Activation and Stress Index (EASIX), based on lactate dehydrogenase, creatinine, and thrombocytes, with that of the SOS/VOD CIBMTR clinical risk score to predict SOS/VOD in two independent cohorts. In a third cohort, we studied the impact of endothelium-active prophylaxis with pravastatin and ursodeoxycholic acid (UDA) on SOS/VOD risk. The cumulative incidence of SOS/VOD within 28 days after alloSCT in the training cohort (Berlin, 2013-2015, n=446) and in the validation cohort (Heidelberg, 2002-2009, n=380) was 9.6% and 8.4%, respectively. In both cohorts, EASIX assessed at the day of alloSCT (EASIX-d0) was significantly associated with SOS/VOD incidence (p<0.0001), overall survival (OS) and non-relapse mortality (NRM). In contrast, the CIBMTR score showed no statistically significant association with SOS/VOD incidence, and did not predict OS and NRM. In patients receiving pravastatin/UDA, the cumulative incidence of SOS/VOD was significantly lower at 1.7% (p<0.0001, Heidelberg, 2010-2015, n=359) than in the two cohorts not receiving pravastatin/UDA. The protective effect was most pronounced in patients with high EASIX-d0. The cumulative SOS/VOD incidence in the highest EASIX-d0 quartiles were 18.1% and 16.8% in both cohorts without endothelial prophylaxis as compared to 2.2% in patients with pravastatin/UDA prophylaxis (p<0.0001). EASIX-d0 is the first validated biomarker for defining a subpopulation of alloSCT recipients at high risk for SOS/VOD. Statin/UDA endothelial prophylaxis could constitute a prophylactic measure for patients at increased SOS/VOD risk

A Novel Laboratory Course on Advanced Chemical Engineering Experiments

The chemical engineering curriculum in the United States has trained generations of technical experts who have successfully optimized chemical processes and products once they entered the chemical industry. The U.S. chemical industry, however, has entered a critical stage in which it must be able to create new and differentiated value through technical innovations that arc essential for long-term survival. This innovation process will require new skills that go far beyond the traditional expertise for the optimization of tasks possessed by young chemical engineers. The innovators must be able to identify new opportunities, explore the boundaries of technology, evaluate critical issues, develop and implement technologies, and communicate effectively with scientists and engineers from other disciplines. Therefore, one of the most important educational tasks of a modern university, in combination with a strong theoretical foundation, is to challenge students in laboratory courses to think, explore, hypothesize, plan, solve, and evaluate. The typical sequence of laboratory skills development stops short of introducing young engineers to the most critical aspects of experimental work. Chemical engineers usually begin developing their laboratory skills in chemistry courses, where experiments are closely managed. At this early stage in their development, students follow detailed instructions and learn basic principles by observing the results. In the undergraduate engineering laboratory course (the unit operations lab ), students have more freedom in experimental design but still have well-defined objectives and manipulate equipment someone else has set up. It is rare, however, for undergraduate students to be taught how to create new experiments. It is also rare for undergraduate students, and hence beginning graduate students, to have an appreciation for the care, planning, design, and testing required to produce equipment that will give reliable and useful results. Even such simple issues as leak testing or adapting analytical devices to new tasks are outside most students* experience. Even more important is an absence of opportunities to learn how the lessons learned from the failure of an approach can be fed back into the empirical process to seed the finally successful idea. All these skills require more creative freedom than is usually allowed in a well-structured laboratory course. In the novel laboratory teaching approach described here, we try to provide students with a learning environment that allows them to develop advanced experimental skills that are necessary for success in research and development environments

The effect of force-field parameters on properties of liquids:Parametrization of a simple three-site model for methanol

A simple rigid three-site model for methanol compatible with the simple point charge (SPC) water and the GROMOS96 force field is parametrized and tested. The influence of different force-field parameters, such as the methanol geometry and the charge distribution on several properties calculated by molecular dynamics is investigated. In particular an attempt was made to obtain good agreement with experimental data for the static dielectric constant and the mixing enthalpy with water. The model is compared to other methanol models from the literature in terms of the ability to reproduce a range of experimental properties.<br/

Large‐scale mass movements recorded in the sediments of Lake Hallstatt (Austria)–evidence for recurrent natural hazards at a UNESCO World Heritage site

The Bronze to Iron Age underground salt mining complex of Hallstatt (Austria) is widely recognised for its cultural importance and wealth of archaeological artefacts. However, while the daily life in the salt mines is archaeologically well documented and environmental effects of the mining activity have been investigated recently, the impact of natural hazards on the prehistoric mining community is still poorly understood. For instance, while it is well established that the prehistoric underground mines have repeatedly been destroyed by large-scale mass movements, only little is known about the characteristics and extent of these events as well as about mass-movement recurrence during more recent times. To shed light on past mass-movement activity in the vicinity of the Hallstatt salt mines, we investigated sediment cores from adjacent Lake Hallstatt. Within the regular lake sediments we identified three large-scale event deposits, which are interpreted to originate from spontaneous or seismically induced mass movements in the mid-19th and late 9th century ce and the mid-4th century bce. While the age of the latter event is in good agreement with the abandonment of the famous Iron Age cemetery at Hallstatt, the younger events indicate that large-scale mass movements also occurred repeatedly during the Common Era

Classification and stability of simple homoclinic cycles in R^5

The paper presents a complete study of simple homoclinic cycles in R^5. We find all symmetry groups Gamma such that a Gamma-equivariant dynamical system in R^5 can possess a simple homoclinic cycle. We introduce a classification of simple homoclinic cycles in R^n based on the action of the system symmetry group. For systems in R^5, we list all classes of simple homoclinic cycles. For each class, we derive necessary and sufficient conditions for asymptotic stability and fragmentary asymptotic stability in terms of eigenvalues of linearisation near the steady state involved in the cycle. For any action of the groups Gamma which can give rise to a simple homoclinic cycle, we list classes to which the respective homoclinic cycles belong, thus determining conditions for asymptotic stability of these cycles.Comment: 34 pp., 4 tables, 30 references. Submitted to Nonlinearit

Assessing exhibition swine as potential disseminators of infectious disease through the detection of five respiratory pathogens at agricultural exhibitions

International audienceAbstractWidespread geographic movement and extensive comingling of exhibition swine facilitates the spread and transmission of infectious pathogens. Nasal samples were collected from 2862 pigs at 102 exhibitions and tested for five pathogens. At least one pathogen was molecularly detected in pigs at 63 (61.8%) exhibitions. Influenza A virus was most prevalent and was detected in 498 (17.4%) samples. Influenza D virus was detected in two (0.07%) samples. More than one pathogen was detected in 165 (5.8%) samples. Influenza A virus remains a top threat to animal and human health, but other pathogens may be disseminated through the exhibition swine population