Physician dispensing and the choice between generic and brand-name drugs – Do margins affect choice?

Many politicians blame physician dispensing (PD) to increase health care expenditure and to undermine independence of drug prescription and income leading to a suboptimal medication. Therefore, PD is not allowed in most OECD countries. In Switzerland, PD is allowed in some regions depending on the density of pharmacies. This enables to investigate the difference in prescribing behavior between physician which gain income from prescribing a specific drug and their colleagues which prescribe the drug but do not sell it. Because the considered drugs are bioequivalent we focus on the economic consequence of PD. We analyze the prescribing behavior of Swiss physicians using cross-sectional data between 2005 and 2007 for three important agents. The results support our hypothesis that dispensing physicians have a higher probability of prescribing the drug with the (most likely) higher margin compared to non-dispensing physicians. Further, generic drugs are prescribed more often to patients with higher cost-sharing while patients' cost-sharing is less influential with PD. High-income patients face a much higher probability to receive the brand-name drug due to their lower marginal utility of income. Today's administered reimbursement prices for generics seem to be high enough to gain physicians for prescribing generics because of their high margins.Physician dispensing, prescribing behavior, generics, brand-name drugs

Der Einfluss der Nikotinsäure auf die Expression von PPARgamma, Scavenger Rezeptoren und ABCA-1 auf monozytoiden und hepatischen Zellen

Das natürliche Vitamin Nikotinsäure wird seit 1955 in pharmakologischer Dosierung als Medikament zur Behandlung von Dyslipidämien und bei arteriosklerotischen Gefäßveränderungen verwendet. Von Nikotinsäure konnte als erstem Medikament bereits 1975 im Coronary Drug Project nachgewiesen werden, dass es die Mortalität nach Myokardinfarkt signifikant und anhaltend reduziert. Nikotinsäure senkt den LDL-Plasmaspiegel und erhöht den HDL-Spiegel. Während der Nikotinsäureeffekt auf LDL vielfach untersucht wurde, ist über den Mechanismus der HDL-Erhöhung bisher wenig bekannt. Nikotinsäure stimuliert massiv die PGD2-Synthese in vivo. Der Hauptmetabolit von PGD2, das 15-deoxy-Δ12,14-Prostaglandin J2, wurde kürzlich als wichtigster endogener Aktivator des nukleären Transkriptionsfaktors PPAR erkannt. PPAR ist entscheidend an der Regulation des Scavenger Rezeptors CD36 und des zellulären Cholesterinexporters ABCA-1 beteiligt. Diese Rezeptoren dominieren die zelluläre Aufnahme modifizierter LDL-Partikel und die Ausschleusung zellulären Cholesterins auf HDL-Partikel und damit die Cholesterinhomöostase in Monozyten/Makrophagen in der Gefäßwand. Deshalb war es Ziel der Arbeit an einem Makrophagenmodell zu untersuchen, ob Nikotinsäure Scavenger-Rezeptoren und zelluläre Cholesterin-Transporter tatsächlich beeinflusst und so über einen gesteigerten reversen Cholesterintransport aus der Peripherie zur Leber seinen klinischen Nutzen vermitteln könnte. Als Modelle wurden die differenzierte humane Monozytenlinie MM6, die humane hepatische Linie HepG2 und frisch präparierte humane Monozyten verwendet. Die Expression der Scavenger Rezeptoren CD36, SR-BI, LOX-1, des LDL-R, des Cholesterinexporters ABCA-1, des Transkriptionsfaktors PPAR und von -Aktin wurden durch reverse Transkription der spezifischen mRNAs, nachfolgende PCR und Quantifizierung der Amplifikate über HPLC bestimmt. Die Proteinexpression von CD36 und PPAR wurden mittels spezifischer Antikörper nach Fluoreszenzmarkierung im FACS gemessen. Die Änderung des zellulären Cholesteringehalts durch Inkubationen mit Nikotinsäure, oxLDL und delipidiertem HDL wurde nach zellulärer Lipidextraktion in einem adaptierten enzymatischen Assay gemessen. Im Makrophagenmodell stimulierte die Inkubation der Zellen mit Nikotinsäure schon nach 3 h und mindestens bis 48 h anhaltend die Transkription von PPAR, des PPAR abhängigen Scavenger-Rezeptors CD36 und des zellulären Cholesterinexporters ABCA-1. Dagegen blieb die Transkription des ApoB-spezifischen LDL-R und des Scavenger-Rezeptors LOX-1 unverändert. Vergleichbare Effekte waren auch am Hepatozytenmodell nachweisbar. Die Effekte auf die PPAR und CD36 Expression waren tendenziell auch auf Proteinebene nachweisbar. Die Stimulation von CD36 und ABCA-1 durch Nikotinsäure konnte auf RNA-Ebene auch an frisch präparierten peripheren Monozyten von Normalpersonen nachgewiesen werden. Die funktionelle Bedeutung der Nikotinsäureeffekte wurde in einem Cholesterin-Aufnahme und Efflux-Assay überprüft. Dabei reduzierte die Inkubation mit Nikotinsäure den zellulären Cholesteringehalt basal und unter oxLDL-Exposition und steigerte den zellulären Cholesterin-Efflux auf delipidiertes HDL. Diese neuen Effekte der Nikotinsäure auf mehrere Lipid-Rezeptoren und -Transporter können Lipidablagerungen in der Gefäßintima reduzieren, der Schaumzellbildung entgegenwirken und durch vermehrte Einschleusung von zellulärem Cholesterin in den reversen Cholesterintransport zurück zur Leber die HDL-Spiegel erhöhen. Diese peripheren Effekte der Nikotinsäure ergänzen die Effekte von Statinen und liefern ein Rational für einen potentiell überadditiven klinischen Nutzen durch die Kombinationstherapie, die gegenwärtig klinisch geprüft wird

Argument against the current methodology of presenting and educating about quilts made in North America, An

Art history research paper.AR 592.1987 Spring

Generic substitution, financial interests, and imperfect agency

Policy makers around the world seek to encourage generic substitution. In this paper, the importance of prescribing physicians' imperfect agency is tested using the fact that some Swiss jurisdictions allow physicians to dispense drugs on their own account (physician dispensing, PD) while others disallow it. We estimate a model of physician drug choice with the help of drug claim data, finding a significant positive association between PD and the use of generics. While this points to imperfect agency, generics are prescribed more often to patients with high copayments or low income

Characterisation of III-V semiconductor hybrid systems for spinorbitronic functionality

When considering quantization effects in 1D in the context of materials with strong spin-orbit interaction, new research fields have opened up as, for example, the high-topical field of topological quantum computation. Therein, the coupling of a high-mobility 2D electron gas with large spin-orbit interaction to an s-wave superconductor presents a fundamental part. In these experiments, quantum point contacts are employed to measure the quantized conductance doubling. Furthermore, to follow the theoretical recipe for the creation of a spinless p-wave superconductor in which a single isolated Majorana state arises, quantum point contacts generate the required 1D subband structure. As a second example, the physics of quantum point contacts has fueled a variety of device applications and concepts, merging under the roof of spinorbitronics. One goal is the realization of a spin-transistor. Realizing the proposed spin-transistor generally entails two main manufacturing challenges: Firstly, using ferromagnetic electrodes for the generation and read-out of the spin-polarized current, one is usually subjected to the conductance mismatch. Secondly, spin-dephasing mechanisms inside the transistor channel impede a loss-free transmission of spin-information. An elegant, ballistic and all-electric spin-transistor concept has been recently presented, wherein these obstacles are readily eliminated. Therein, two serial quantum point contacts, which are implemented in a 2D electron gas, are employed as a spin injector and spin detector by adjusting the strength of lateral spin-orbit coupling inside the 1D channel. Given the examples outlined above, it is interesting to note that the key requirements for topological quantum computation and the spinorbitronic device application are very similar: Achieving large spin-orbit coupling in a highly mobile electron system with a clean semiconductor surface. In this regard, InAs/InGaAs-based heterostructures offer inherent advantages in their material properties, like a low effective mass, a large Landé g-factor, as well as large Rashba spin-orbit interaction, making them attractive candidates for these device applications. To harvest the undeniable potential of this semiconductor system, material specific challenges have to be met. This thesis focuses on those perspectives of the InAs-based material system which would qualify it as a reliable platform for the realization of reliable 1D spinorbitronic devices. For this purpose, we studied the electric transport behavior in one and two dimensions in the InGaAs/InAlAs-based material system, which offers high electron mobility and in principle gives access to high spin-orbit interaction. In our initial 1D transport measurements with electrically defined quantum point contacts, we found severe conductance instabilities near depletion of the 1D channel, which furthermore led to a significant hysteretic behavior with impeded ballisticity. In a systematic study of the electric transport in different InGaAs/InAlAs layouts, we identified energy states at the InGaAs surface, together with ionized deep level donor states inside the InAlAs barrier layers to limit the field-effect control of the transport properties in one and two dimensions. On the basis of the obtained results – all merging in a conclusive charge transfer model which we developed in the course of this thesis – we eventually achieved reliable control of the electric transport characteristics and accomplished to significantly enlarge the charge density range in the 2DEG accessible via external gating. In the course of this evaluation, we reveal a top-gate voltage field regime, in which we create a metastable charge configuration state in the system that yielded a giant and surprising magnification of Rashba-type spin-orbit interaction. We provide an interpretation for the origin of this effect by means of self-consistent band structure calculations

Nanostructured Nb-substituted CaMnO3 n-type thermoelectric material prepared in a continuous process by ultrasonic spray combustion

One way to further optimize the thermoelectric properties toward a higher ZT is a temperature stable nanoengineering of materials, where the thermal conductivity is reduced by increasing the phonon scattering at the grain boundaries. To study this, Nb-substituted CaMnO3 perovskite-type material was synthesized by ultrasonic spray combustion (USC). The grain growth has been characterized by x-ray diffraction, scanning electron microscopy, and transmission electron microscopy. Finally, the thermoelectric properties of compacted and sintered bulk samples from powder prepared by a continuous scalable USC process were measured up to 1050 K. The thermoelectric legs were prepared by an adapted sintering process. Here, a compromise between enhanced porosity to reduce the thermal conductivity and securing of mechanical stability and low resistivity should be obtained. Based on the grain growth mechanisms, an advanced sintering process for additional interconnection of the particles without particle growth is needed to further increase the thermoelectric performanc

Thermoelectric oxide modules tested in a solar cavity-receiver

Four-leg thermoelectric oxide modules (TOMs) consisting of two p-type (La1.98Sr0.02CuO4) and two n-type (CaMn0.98Nb0.02O3) thermoelectric (TE) legs were produced with a manufacturing quality factor between 30 and 60%. The pressed sintered TE legs revealed 90% of the theoretical density to ensure a sufficient mechanical stability of the TE modules. The legs were connected electrically in series and sandwiched thermally in parallel between two Al2O3 plates serving as absorber and cooler, respectively. A solar cavity-receiver packed with an array of TOMs was subjected to concentrated thermal radiation with peak solar radiative flux intensities exceeding 600 kW/m2. Temperature distributions in the cavity, open-circuit voltage (VOC), and maximum output power (Pmax) were measured for different external loads and solar radiative fluxes (qin). Finally, the solar-to-electricity conversion efficiency (η) was calculate

Load-bearing capacity of CAD/CAM milled polymeric three-unit fixed dental prostheses: Effect of aging regimens

Objective: This study tested the fracture load of milled and conventionally fabricated polymeric and glass-ceramic three-unit fixed dental prostheses (FDPs) after aging. Materials and methods: FDPs were fabricated (N = 1,050) from four computer-aided design and computer-aided manufacturing (CAD/CAM) resins: (1) AT (artBlock Temp); (2) TC (Telio CAD); (3) ZP (ZENO PMMA); (4) CT (CAD-Temp); two conventionally fabricated resins, (5) IES (integral esthetic press), (6) CMK (CronMix K), and a glass-ceramic (control) (7) PG (IMAGINE PressX). Specimens of each group were tested immediately after fabrication (n = 15 per material). Seventy-five FDPs per material type were stored in artificial saliva (37°C) and 15 of them were randomly selected after aging (1, 7, 28, 90, and 180days) for fracture load measurement. The remaining specimens (n = 60 per material) were subjected to chewing simulation (×120.000-1.200.000, 49N, 5°C/50°C). The data were analyzed using two-way and one-way ANOVA followed by Scheffé test. Results: The interactions between FDP materials and aging time in both storage media showed a significant impact on the results (p < 0.001). Among saliva storage groups, TC and ZP showed the highest, and PG the lowest fracture load (p < 0.05). AT and CT were not affected from chewing simulation. TC, ZP, and AT presented the highest in ascending order (p < 0.05), PG and CMK showed the lowest fracture load after chewing simulation (p < 0.001). Conclusions: Aging did not influence the fracture load of FDPs made of CAD/CAM resins. FDPs made of glass-ceramic showed significantly lower fracture load than those of all resin FDPs. Clinical relevance: Considering fracture load measurements, CAD/CAM resins tested could be alternative materials to glass-ceramic for FDP constructio

Inovação na política de Avaliação de Desempenho na Prefeitura do Município de São Paulo e seus desafios

Partindo do pressuposto de que a eficiência na prestação de serviços, buscando atender às demandas cidadãs, passa essencialmente pelo bom desempenho dos servidores públicos, evidencia-se assim a real necessidade de mensurar as performances desses servidores, garantindo a possibilidade de se implementar políticas de correção ou manutenção das ações executadas no campo da gestão de pessoas. Nesse sentido, por meio de pesquisa exploratória, documental e explicativa, foi analisado o processo de avaliação de desempenho realizado na Prefeitura do Município de São Paulo, destacando suas características e instrumentos, buscando empreender uma análise crítica quanto à sua aplicabilidade e objetivos, tendo em vista sua finalidade