scholarly journals Challenges in valuing and paying for combination regimens in oncology: reporting the perspectives of a multi‐stakeholder, international workshop

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nicholas. R Latimer ◽  
Daniel Pollard ◽  
Adrian Towse ◽  
Chris Henshall ◽  
Lloyd Sansom ◽  
...  
Keyword(s):  
Common Ground ◽  
Consensus Statement ◽  
International Workshop ◽  
Clinical Development ◽  
Legal Challenges ◽  
Price Negotiations ◽  
Multi Stakeholder ◽  
The Cost ◽  
Combination Regimens ◽  
Improve Access

Abstract Background It is increasingly common for two or more treatments for cancer to be combined as a single regimen. Determining value and appropriate payment for such regimens can be challenging. This study discusses these challenges, and possible solutions. Methods Stakeholders from around the world attended a 2-day workshop, supported by a background paper. This study captures key outcomes from the discussion, but is not a consensus statement. Results Workshop attendees agreed that combining on-patent treatments can result in affordability and value for money challenges that delay or deny patient access to clinically effective treatments in many health systems. Options for addressing these challenges include: (i) Increasing the value of combination therapies through improved clinical development; (ii) Willingness to pay more for combinations than for single drugs offering similar benefit, or; (iii) Aligning the cost of constituent therapies with their value within a regimen. Workshop attendees felt that (i) and (iii) merited further discussion, whereas (ii) was unlikely to be justifiable. Views differed on the feasibility of (i). Key to (iii) would be systems allowing different prices to apply to different uses of a drug. Conclusions Common ground was identified on immediate actions to improve access to combination regimens. These include an exploration of the legal challenges associated with price negotiations, and ensuring that pricing systems can support implementation of negotiated prices for specific uses. Improvements to clinical development and trial design should be pursued in the medium and longer term.

scholarly journals Light-Load Efficiency Improvement for Ultrahigh Step-Down Converter Based on Skip Mode

Electronics ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 355
Author(s):  
Yeu-Torng Yau ◽  
Chao-Wei Wang ◽  
Kuo-Ing Hwu
Keyword(s):  
Integrated Circuit ◽  
Common Ground ◽  
Switching Frequency ◽  
Efficiency Improvement ◽  
Pulse Width Modulated ◽  
Light Load ◽  
Mode 2 ◽  
Skip Mode ◽  
Step Down ◽  
The Cost

In this paper, two light-load efficiency improvement methods are presented and applied to the ultrahigh step-down converter. The two methods are both based on skip mode control. Skip Mode 1 only needs one half-bridge driver integrated circuit (IC) to drive three switches, so it has the advantages of easy signal control and lower cost, whereas Skip Mode 2 requires one half-bridge driver integrated circuit IC, one common ground driver IC, and three independent timing pulse-width-modulated (PWM) signals to control three switches, so the cost is higher and the control signals are more complicated, but Skip Mode 2 can obtain slightly higher light-load efficiency than Skip Mode 1. Although the switching frequency used in these methods are reduced, the transferred energy is unchanged, but the output voltage ripple is influenced to some extent.

Mitigating the legal challenges of imposing disincentives on nonperforming transportation projects

2020 ◽  
Vol 27 (10) ◽  
pp. 2859-2891
Author(s):  
Douglas Alleman ◽  
Eul-Bum Lee
Keyword(s):  
Case Studies ◽  
Subject Matter Experts ◽  
Pavement Rehabilitation ◽  
Content Type ◽  
Transportation Projects ◽  
Legal Challenges ◽  
Liquidated Damages ◽  
Valuation Process ◽  
The Cost ◽  
Transportation Agencies

PurposeThe publication presents an analysis of the cost and schedule performance of incentive/disincentive projects and case studies toward developing a systematic disincentive valuation process, with Construction Analysis for Pavement Rehabilitation Strategies (CA4PRS) software integration that aids agencies in minimizing the likelihood of court challenges of disincentives.Design/methodology/approachFrom a California transportation database, the authors performed cost and schedule analyses of 43 incentive/disincentive (I/D) projects and case studies on four of those I/D projects. Interviewees included subject matter experts from transportation organizations to ensure applicability and maximum value-adding, and the process was implemented on ten California transportation projects and monitored for performance.FindingsThe presented process mitigates the contractor's ability to claim disincentives as penalties in a court of law through the following: (1) all calculations are performed using project-specific bases, backed by estimations of actual incurred costs; (2) the CA4PRS software allows for estimation transparency and (3) the clarity of cost inclusions reduces any chances of “double-dipping” between disincentives and liquidated damages.Practical implicationsTransportation agencies have historically faced legal challenges to their enforcements of disincentives. As agencies continue to apply disincentives on more megaprojects, contractors will likely attempt to pursue legal challenges more frequently. The presented process mitigates the likelihood of these challenges going to court and increases the accuracy and efficiency of disincentives.Originality/valueWhile there have been publications that discuss the legal challenges of imposing disincentives, they mainly provide guidelines and lack applicable processes. Existing literature that does present incentive/disincentive valuation process focuses on incentive valuations and neglects the disincentives' legal challenges. The following publication fills this gap by presenting an applicable disincentive valuation process for transportation projects which incorporates the guidelines for legal mitigation.

An investigation of the cost of food in the Geelong region of rural Victoria: Essential data to support planning to improve access to nutritious food

2018 ◽  
Vol 30 (1) ◽  
pp. 124-127 ◽  
Author(s):  
Ruth Cuttler ◽  
Rachel Evans ◽  
Erin McClusky ◽  
Lauren Purser ◽  
Karen M. Klassen ◽  
...  
Keyword(s):  
Nutritious Food ◽  
The Cost ◽  
Improve Access

scholarly journals Consensus Statement on the Standardization and Evaluation of Growth Hormone and Insulin-like Growth Factor Assays

2011 ◽  
Vol 57 (4) ◽  
pp. 555-559 ◽  
Author(s):  
David R Clemmons
Keyword(s):  
Growth Hormone ◽  
Growth Factor ◽  
Normative Data ◽  
Consensus Statement ◽  
International Workshop ◽  
Research Society ◽  
Insulin Like Growth Factor ◽  
Gh Secretion ◽  
Assay Performance ◽  
Igf I

Abstract Growth hormone (GH) and insulin-like growth factor I (IGF-I) measurements are widely used in the diagnosis of disorders of GH secretion, evaluation of children with short stature from multiple causes, management of disorders that lead to nutritional insufficiency or catabolism, and monitoring both GH and IGF-I replacement therapy. Therefore, there is an ongoing need for accurate and precise measurements of these 2 peptide hormones. Representatives of the Growth Hormone Research Society, the IGF Society, and the IFCC convened an international workshop to review assay standardization, requirements for improving assay comparability, variables that affect assay interpretation, technical factors affecting assay performance, assay validation criteria, and the development and use of normative data. Special attention was given to preanalytical conditions, the use of international commutable reference standards, antibody specificity, matrix requirements, QC analysis, and interference by binding proteins. Recommendations for each of these variables were made for measurements of each peptide. Additionally, specific criteria for IGF-I were recommended for age ranges of normative data, consideration of Tanner staging, and consideration of the effect of body mass index. The consensus statement concludes that major improvements are necessary in the areas of assay performance and comparability. This group recommends that a commutable standard for each assay be implemented for worldwide use and that its recommendations be applied to accomplish the task of providing reliable and clinically useful results.

Development of a multi stakeholder partnership to improve access to and delivery of neurosurgical services in Ontario

Health Policy ◽  
2017 ◽  
Vol 121 (2) ◽  
pp. 207-214 ◽  
Author(s):  
Sunjay Sharma ◽  
Des Bohn ◽  
Iphigenia Mikroyiannakis ◽  
Joslyn Trowbridge ◽  
Donna Thompson ◽  
...  
Keyword(s):  
Multi Stakeholder ◽  
Improve Access

Contracting around International Uncertainty

2005 ◽  
Vol 99 (4) ◽  
pp. 549-565 ◽  
Author(s):  
BARBARA KOREMENOS
Keyword(s):  
Relative Risk ◽  
International Relations ◽  
Risk Aversion ◽  
Random Sample ◽  
Common Ground ◽  
International Agreements ◽  
Relative Risk Aversion ◽  
Expected Benefits ◽  
The Cost ◽  
Available Information

International cooperation is plagued by uncertainty. Although states negotiate the best agreements possible using available information, unpredictable things happen after agreements are signed that are beyond states' control. States may not even commit themselves to an agreement if they anticipate that circumstances will alter their expected benefits. Duration provisions can insure states in this context. Specifically, the use of finite duration depends positively on the degree of uncertainty and states' relative risk aversion and negatively on the cost. These formally derived hypotheses strongly survive a test with data on a random sample of agreements across all four of the major issue areas in international relations. Not only do the results, highlighting evidence on multiple kinds of flexibility provisions, strongly suggest that the design of international agreements is systematic and sophisticated; but also they call attention to common ground among various subfields of political science and law.

scholarly journals Offsetting the cost of community-supported agriculture (CSA) for low-income families: perceptions and experiences of CSA farmers and members

2021 ◽  
pp. 1-11
Author(s):  
Stephanie B. Jilcott Pitts ◽  
Leah Connor Volpe ◽  
Marilyn Sitaker ◽  
Emily H. Belarmino ◽  
Amari Sealey ◽  
...  
Keyword(s):  
Low Income ◽  
Community Supported Agriculture ◽  
Future Research ◽  
Major Theme ◽  
Healthy Foods ◽  
Community Members ◽  
Cost Offset ◽  
Low Income Families ◽  
The Cost ◽  
Improve Access

Abstract Community-supported agriculture (CSA) is an alternative food marketing model in which community members subscribe to receive regular shares of a farm's harvest. Although CSA has the potential to improve access to fresh produce, certain features of CSA membership may prohibit low-income families from participating. A ‘cost-offset’ CSA (CO-CSA) model provides low-income families with purchasing support with the goal of making CSA more affordable. As a first step toward understanding the potential of CO-CSA to improve access to healthy foods among low-income households, we interviewed 24 CSA farmers and 20 full-pay CSA members about their experiences and perceptions of the cost-offset model and specific mechanisms for offsetting the cost of CSA. Audio recordings were transcribed verbatim and coded using a thematic approach. Ensuring that healthy food was accessible to everyone, regardless of income level, was a major theme expressed by both farmers and members. In general, CSA farmers and CSA members favored member donations over other mechanisms for funding the CO-CSA. The potential time burden that could affect CSA farmers when administering a cost-offset was a commonly-mentioned barrier. Future research should investigate various CO-CSA operational models in order to determine which models are most economically viable and sustainable.

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