Impact of ACA on the Dinner-for-Three Dynamic

AbstractThe Patient Protection and Affordable Care Act (ACA) aims to expand coverage to the previously uninsured, improve the quality of coverage, and help eliminate inefficiencies in the health care market. We evaluated the implications of ACA on the drug industry by examining the impact on the “Dinner-for-Three” dynamic in our health care system. We can think of our system as an odd dinner party in which one person pays (the insurer), one orders the meal (the physician), and yet another eats the meal (the patient). This dynamic requires us to examine each stakeholder and how they interact with one another to assess the impact of the ACA. Of the 6.7 million initial exchange enrollees, ~3.8 million subjects were previously uninsured. A higher percentage of these enrollees are using their pharmacy benefit, and they are disproportionately filling prescriptions for specialty drugs relative to those covered in employer-sponsored plans. Formulary designs in exchange plans are passing on higher cost-sharing for prescription drugs to the patient. ACA has also resulted in the development of accountable care organizations (ACOs); these organizations may play a role going forward in the management of drug spending and the development of formularies and protocols that impact drug prescribing. Payers are tightening control over drug spending and are finding physicians and physician groups increasingly less reluctant allies in doing so. Patients are faced by more complexity than ever in the health care system and are expected to take a more active role in responsibly managing the cost of their care. It is increasingly critical that drug manufacturers develop robust value propositions and communicate that value to all stakeholders. They should re-evaluate trial investment decisions and consider changes in price setting, rebates (how much and to whom), copay programs, and physician and patient support programs in light of changing market needs

Kaart op maat: thuis percelen intekenen

Bij Alterra ligt de focus normaal gesproken op het uitvoeren van onderzoeksprojecten ten behoeve van overheidsbeleid. Soms blijkt echter dat bepaalde toepassingen uit het onderzoek ook waardevol kunnen zijn voor heel andere processen zoals bijvoorbeeld het inwinnen van data van boeren door de Dienst Regelingen (DR) van LNV. Voor DR heeft Alterra het Kaart op Maat idee ontwikkeld naar een werkproces dat inmiddels ruim 10 jaar een onmisbaar hulpmiddel is voor de uitvoering van regelingen. In dit artikel gaan we in op de achtergrond van het project, de software en hardware oplossingen die zijn gekozen en onze visie op de toekomst van dergelijke toepassingen

The very low angle detector for high-energy inelastic neutron scattering on the VESUVIO spectrometer

The Very Low Angle Detector (VLAD) bank has been installed on the VESUVIO spectrometer at the ISIS spallation neutron source. The new device allows for high-energy inelastic neutron scattering measurements, at energies above 1 eV, maintaining the wave vector transfer lower than 10 A^- 1. This opens a still unexplored region of the kinematical (q,w) space, enabling new and challenging experimental investigations in condensed matter. This paper describes the main instrumental features of the VLAD device, including instrument design, detector response, and calibration procedure

Intrinsic charge transport properties of an organic single crystal determined using a multiterminal thin-film transistor

We present an experimental approach to determine the intrinsic field-effect mobility in an organic single crystal as a function of the in-plane crystal-axis direction. Using a multiterminal geometry the experiment also excludes the effects of the contact resistances on the transport properties. We have applied the method to quaterthiophene thin films. At gate voltages above the threshold voltage, the channel conductance varies linearly with the applied gate voltage. The resulting charge carrier mobility is 1.2×10−3 cm2/V s. This value is constant over a period of weeks of continuous operation and does not vary from sample to sample, in contrast to the typically observed lower mobilities of polycrystalline quaterthiophene thin-film transistor devices. These results emphasize the need for well-characterized model systems to study the intrinsic transport properties of organic materials

Single domain transport measurements of C60 films

Thin films of potassium doped C60, an organic semiconductor, have been grown on silicon. The films were grown in ultra-high vacuum by thermal evaporation of C60 onto oxide-terminated silicon as well as reconstructed Si(111). The substrate termination had a drastic influence on the C60 growth mode which is directly reflected in the electrical properties of the films. Measured on the single domain length scale, these films revealed resistivities comparable to bulk single crystals. In situ electrical transport properties were correlated to the morphology of the film determined by scanning tunneling microscopy. The observed excess conductivity above the superconducting transition can be attributed to two-dimensional fluctuations.Comment: 4 pages, 4 figure

Electric-Field-Induced Mott Insulating States in Organic Field-Effect Transistors

We consider the possibility that the electrons injected into organic field-effect transistors are strongly correlated. A single layer of acenes can be modelled by a Hubbard Hamiltonian similar to that used for the kappa-(BEDT-TTF)(2)X family of organic superconductors. The injected electrons do not necessarily undergo a transition to a Mott insulator state as they would in bulk crystals when the system is half-filled. We calculate the fillings needed for obtaining insulating states in the framework of the slave-boson theory and in the limit of large Hubbard repulsion, U. We also suggest that these Mott states are unstable above some critical interlayer coupling or long-range Coulomb interaction.Comment: 9 pages, 7 figure

Single crystallites in "planar polycrystalline" oligothiophene films:Determination of orientation and thickness by polarization microscopy

Thin films of evaporated oligothiophenes (alpha-nT, n = 4-8) show a "planar polycrystalline" structure: each of the individual crystallites has a random azimuthal orientation, the (a, b) face of its unit cell is aligned with the surface plane, We introduce a technique to determine the orientation and thickness of such aligned thiophene crystals by optical polarization microscopy. Due to the optical birefringence of the crystal, It appears with different colors in the microscope dependent on its orientation and thickness. To support the method proposed, we solve Maxwell's equations and obtain quantitative agreement with the observed colors. The organic crystal shows biaxial anisotropy. For unsubstituted quaterthiophene, alpha-4T, we find effective refractive indices n(b) = 1.84 +/- 0.1 and n(a) = 1.61 +/- 0.1 for waves under normal incidence. Our conclusions are fully confirmed by atomic force microscopy with molecular resolution. Our analyses result in a simple recipe to obtain the directions of the rr and b crystal axes from the optical experiment. (C) 1998 American Institute of Physics. [S0021-8979(98)02007-6]