2,967 research outputs found
Management of diabetes from preconception to the postnatal period: summary of NICE guidance
Diabetes in pregnancy is associated with risks to the
woman (for example, higher rates of miscarriage, preeclampsia, and preterm labour) and to the developing
fetus and baby (for example, higher rates of congenital
malformations, macrosomia, birth injury, and perinatal mortality).
This article summarises the most recent
guidance from the National Institute for Health and
Clinical Excellence (NICE) on how to manage diabetes
and its complications from preconception to the
postnatal period
Timing Measurements of the Relativistic Binary Pulsar PSR B1913+16
We present results of more than three decades of timing measurements of the
first known binary pulsar, PSR B1913+16. Like most other pulsars, its
rotational behavior over such long time scales is significantly affected by
small-scale irregularities not explicitly accounted for in a deterministic
model. Nevertheless, the physically important astrometric, spin, and orbital
parameters are well determined and well decoupled from the timing noise. We
have determined a significant result for proper motion, , mas yr. The pulsar exhibited
a small timing glitch in May 2003, with , and a
smaller timing peculiarity in mid-1992. A relativistic solution for orbital
parameters yields improved mass estimates for the pulsar and its companion,
m_1=1.4398\pm0.0002 \ M_{\sun} and m_2=1.3886\pm0.0002 \ M_{\sun}. The
system's orbital period has been decreasing at a rate times
that predicted as a result of gravitational radiation damping in general
relativity. As we have shown before, this result provides conclusive evidence
for the existence of gravitational radiation as predicted by Einstein's theory.Comment: Published in APJ, 722, 1030 (2010
Depoliticisation, Resilience and the Herceptin Post-code Lottery Crisis: Holding Back the Tide
This article:
Covers new empirical terrain in the study of depoliticisation, with an in-depth case study of health technology regulation;
Analyses depoliticisation from a novel analytical perspective, examining how depoliticised institutions are resilient to external pressure for politicisation;
Posits a distinctive framework for analysing resilience, drawing on cognate literatures on policy networks and agencification;
Raises interesting and distinctive questions about the nature of depoliticisation in advanced liberal democracies, arguing it is more contested than commonly acknowledged.
Depoliticisation as a concept offers distinctive insights into how governments attempt to relieve political pressures in liberal democracies. Analysis has examined the effects of depoliticisation tactics on the public, but not how those tactics are sustained during moments of political tension. Drawing on policy networks and agencification literatures, this article examines how these tactics are resilient against pressure for politicisation. Using an in-depth case study of the controversial appraisal of cancer drug Herceptin in 2005/6 by the National Institute for Health and Clinical Excellence (NICE), the article examines how ‘resilient’ NICE was to external politicisation. It is argued that NICE was resilient because it was effectively ‘insulated’ by formal procedures and informal norms of deference to scientific expertise. This mechanism is termed ‘institutional double glazing’. The conclusion suggests developments to the conceptual and methodological framework of depoliticisation, and highlights theoretical insights into the nature of ‘anti-politics’ in contemporary democracies
Market access agreements for pharmaceuticals in Europe: diversity of approaches and underlying concepts
<p>Abstract</p> <p>Background</p> <p>Market Access Agreements (MAA) between pharmaceutical industry and health care payers have been proliferating in Europe in the last years. MAA can be simple discounts from the list price or very sophisticated schemes with inarguably high administrative burden.</p> <p>Discussion</p> <p>We distinguished and defined from the health care payer perspective three kinds of MAA: Commercial Agreements (CA), Payment for Performance Agreements (P4P) and Coverage with Evidence Development (CED). Apart from CA, the agreements assumed collection and analysis of real-life health outcomes data, either from a cohort of patients (CED) or on per patient basis (P4P). We argue that while P4P aim at reducing drug cost to payers without a systematic approach to addressing uncertainty about drugs' value, CED were implemented provisionally to reduce payer's uncertainty about value of a medicine within a defined time period.</p> <p>Summary</p> <p>We are of opinion that while CA and P4P have a potential to reduce payers' expenditure on costly drugs while maintaining a high list price, CED address initial uncertainty related to assessing the real-life value of new drugs and enable a final HTA recommendation or reimbursement and pricing decisions. Further, we suggest that real cost to health care payers of drugs in CA and P4P should be made publicly available in a systematic manner, to avoid a perverse impact of these MAA types on the international reference pricing system.</p
Neutron-Rich Nuclei in Heaven and Earth
An accurately calibrated relativistic parametrization is introduced to
compute the ground state properties of finite nuclei, their linear response,
and the structure of neutron stars. While similar in spirit to the successful
NL3 parameter set, it produces an equation of state that is considerably softer
-- both for symmetric nuclear matter and for the symmetry energy. This
softening appears to be required for an accurate description of several
collective modes having different neutron-to-proton ratios. Among the
predictions of this model are a symmetric nuclear-matter incompressibility of
K=230 MeV and a neutron skin thickness in 208Pb of Rn-Rp=0.21 fm. Further, the
impact of such a softening on the properties of neutron stars is as follows:
the model predicts a limiting neutron star mass of Mmax=1.72 Msun, a radius of
R=12.66 km for a ``canonical'' M=1.4 Msun neutron star, and no (nucleon) direct
Urca cooling in neutrons stars with masses below M=1.3 Msun.Comment: 4 pages, 3 tables, and no figure
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