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The objective of this research was to evaluate managed access policy in England, drawing upon the expertise of a range of stakeholders involved in its implementation.
Methods
Seven focus groups were conducted with payer and health technology assessment representatives, clinicians, and representatives from industry and patient/carer organizations within England. Transcripts were analyzed using framework analysis to identify stakeholders’ views on the successes and challenges of managed access policy.
Results
Stakeholders discussed the many aims of managed access within the National Health Service in England, and how competing aims had affected decision making. While stakeholders highlighted a number of priorities within eligibility criteria for managed access agreements (MAAs), stakeholders agreed that strict eligibility criteria would be challenging to implement due to the highly variable nature of innovative technologies and their indications. Participants highlighted challenges faced with implementing MAAs, including evidence generation, supporting patients during and after the end of MAAs, and agreeing and reinforcing contractual agreements with industry.
Conclusions
Managed access is one strategy that can be used by payers to resolve uncertainty for innovative technologies that present challenges for reimbursement and can also deliver earlier access to promising technologies for patients. However, participants cautioned that managed access is not a “silver bullet,” and there is a need for greater clarity about the aims of managed access and how these should be prioritized in decision making. Discussions between key stakeholders involved in managed access identified challenges with implementing MAAs and these experiences should be used to inform future managed access policy.
The goal of this study was to determine if typically developing children could form grammatical categories from distributional information alone. Twenty-seven children aged six to nine listened to an artificial grammar which contained strategic gaps in its distribution. At test, we compared how children rated novel sentences that fit the grammar to sentences that were ungrammatical. Sentences could be distinguished only through the formation of categories of words with shared distributional properties. Children's ratings revealed that they could discriminate grammatical and ungrammatical sentences. These data lend support to the hypothesis that distributional learning is a potential mechanism for learning grammatical categories in a first language.
This study investigates the degree to which native-English-speaking learners of Spanish can generate expectations for information likely to occur in upcoming portions of an unfolding linguistic signal. We examine Spanish clitic left dislocation, a long-distance dependency between a topicalized object and an agreeing clitic, whose felicity depends on the discourse. Using a self-paced reading task, we tested the predictions of the shallow structure hypothesis (Clahsen & Felser, 2006a, 2006b) and the reduced ability to generate expectations hypothesis (Grüter, Rohde, & Schafer, 2014). Learners successfully demonstrated sensitivity to the violation of expectations set up by the syntactic and discourse context. In addition, the behavior of the second language (L2) learners was dependent on proficiency: the higher their proficiency, the more their behavior mirrored native-speaker processing. These results support a view of SLA in which knowledge of L2 discourse-grammatical relationships is acquired slowly over the course of L2 learning.
We propose, following Clark, that generative models also play a central role in the perception and interpretation of linguistic signals. The data explanation approach provides a rationale for the role of prediction in language processing and unifies a number of phenomena, including multiple-cue integration, adaptation effects, and cortical responses to violations of linguistic expectations.
This paper presents measured results for two-stage and three-stage high-voltage/high-power (HiVP) amplifiers implemented in a commercial 0.12 μm silicon germanium (SiGe) heterojunction bipolar transistor (HBT) bipolar Complementary Metal Oxide Semiconductor (BiCMOS) process at millimeter wave. The HiVP configuration provides a new tool for millimeter-wave silicon designers to achieve large output voltage swings, high output power density, customizable bias, and a way to minimize, if not eliminate, matching circuitry at millimeter-wave frequencies. The two-stage amplifier has achieved a PSAT = 5.41 dBm with a power added efficiency (PAE) of 8.06% at center frequency 30 GHz. The three-stage amplifier has achieved a PSAT = 8.85 dBm with a PAE of 11.35% with a total chip area of 0.068 mm2 at center frequency 30 GHz. Simulation, layout, fabrication, and measurement results are presented in this paper.
Neuropsychological assessment has the ability to detect a variety of brain-based pathologies and their impact on cognitive and behavioral functioning across the lifespan. Yet, despite this capability, it has become increasingly clear that neuropsychological assessments are not a pure measure of an individual's abilities, nor do they directly or specifically demonstrate brain–behavior interactions. Rather, research has indicated that many facets of an individual's cultural background impact the assessment procedure and its interpretation. In response, it has become increasingly important to understand the effects cultural and environmental factors have on the practice of neuropsychological assessment and diagnosis. Without an understanding of the unique contribution of culture and environment to a patient's performance on tests, neuropsychologists may risk misdiagnosis as well as fail to notice important opportunities to engage the patient and family in the eventual rehabilitative or treatment process.
The importance of understanding the role of culture in assessment and treatment of neurological issues has been very well highlighted in the last decade. As one example, Anne Fadiman, in her book The Spirit Catches You and You Fall Down, writes about a young girl born into a family of Hmong refugees from Laos living in Merced, California [1]. The author discusses the treatment of and eventual tragedy that results when this young Hmong girl, Lia, is diagnosed with epilepsy, by emphasizing the interweaving role that culture plays in the diagnostic and treatment process.
The completion of the human genome has made available the sequences of thousands of genes (Baltimore, 2001), allowing researchers to switch focus from identifying genes to understanding their function. In broad terms, gene function studies can be classified into two categories: those where the gene of interest is introduced into a system in which it is not expressed, and those in which the gene is disrupted or removed. While over-expression studies are fairly straightforward, methods for gene inactivation have been hampered in higher eukaryotes by the difficulty in manipulating their genetic material. Thus, although it is possible to generate mice lacking genes of interest by homologous recombination (Capecchi, 1989; van der Weyden et al., 2002), such studies remain technically challenging and expensive. Moreover, in some cases, deletion of a gene may be lethal, preventing its analysis (e.g., Lui et al., 1996). Alternatively, the phenotype produced may differ from that expected in humans (Harlow, 1992; Lee et al., 1992). A simple method for effective genetic inactivation in somatic cells in vitro is greatly needed, but has remained elusive (Sedivy and Dutriaux, 1999). Not surprisingly, recent years have seen considerable interest in a novel method for inactivating gene function in somatic cells that exploits the phenomenon of RNA interference (RNAi), first described by Fire et al. (1998). In their seminal study, they showed that double-stranded (ds)RNA homologous to a gene of interest could inhibit its expression. The dsRNA is digested into 21–23 nucleotide small interfering RNAs (siRNAs).
Synchrotron x-ray fluorescence microscopy has been used to study multi-metal oxide ceramics that have been designed to sequester radioactive actinide elements for long-term storage and disposal. X-ray fluorescent lines for the various elements have been used for lateral elemental mapping of the materials, and the heterogeneity of the samples is discussed with respect to the elements in the crystallographic phases that have previously been documented by other means of structural and chemical analyses.