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The Ministry of Health in Uruguay has a health technology assessment division that provides decision makers with evidence-based information on the efficacy, safety, and costs of health technologies to be included in the Comprehensive Plan of Health Care. Since 2010, patients have begun to demand access to unfunded, high-cost technologies through writs of protection. Judicialization of the right to health increased rapidly from 2010 to 2014. In this context, a Technical Advisory Commission was created in 2015 to assess patient requests on a case-by-case basis. The purpose of this study was to evaluate the results obtained with a new strategy developed to face the judicialization of access to high-cost technologies.
The methodology used to evaluate the implementation of the strategy consisted of reviewing a database of access requests from October 2016 to October 2017. The demographic characteristics, technologies requested, prescriptions, and results of the process were analyzed.
In the study period 654 technologies were requested for funding through the process. The included population had a mean age of 60 years; sixty-two percent were men. Of the technologies requested, eighty-five percent were drugs and fifteen percent were devices. The requested technologies included cancer treatments (thirty-five percent) or drugs and devices for the treatment of rheumatologic, ophthalmologic, infectious, neurologic, and cardiovascular conditions. The six most requested technologies (forty-five percent of all requests) were: abiraterone for prostate cancer; aortic endoprosthesis for vascular aneurysm; lenalidomide, rituximab, and azacitidine for oncohematologic diseases; and cetuximab for colorectal cancer. The Ministry of Health funded thirty-six percent of the requests.
The new strategy was successful in reducing the judicialization of access to unfunded, high-cost technologies in Uruguay, and it helped to prioritize the inclusion of new drugs in the national formulary.
In both ethics and epistemology an important question is whether justification is a fully internal or a partly external matter. In view of analogies between relevant considerations in each area, I recommend distinguishing, as basic and independent subjects of normative status, (i) agents and (ii) what they do. Evaluations of subjects, on one hand, and of their beliefs and actions, on the other, are less intimately related than is presupposed. This helps resolve internalism/externalism controversies in both domains. An important related advantage of the distinction is its effect on our understanding of normative luck, both moral and epistemic.
Background: Polymorphisms in the endothelial nitric oxide synthase (eNOS) and in the plasminogen activator inhibitor -1 (PAI-1) genes have been implicated in stroke pathogenesis but results are still controversial. The aim of this study was to examine the possible contribution of Glu298Asp in the eNOS and 4G/5G in the PAI-1polymorphisms with ischemic stroke in a young Mexican population. Materials and Methods: In a case-control study, conducted between January 2006 and June 2010, 204 patients ≤45 years of age with ischemic stroke and 204 controls matched by age and gender, were recruited. The Glu298Asp and 4G/5G polymorphisms were determined in all participants by polymerase chain reaction-restriction fragment length polymorphism. Results: There was a significant difference in the Glu298Asp genotype distribution (P=0.001) and allele frequency between the two groups (P=0.001). The 4G/5G genotype distribution (P=0.40) and the allele frequency was similar between groups; (P=0.13). There were independent factors for ischemic stroke: Asp carriage (GluAsp+AspAsp) (P=0.02); smoking (P=0.01); hypertension (P=0.03), and familial history of atherothrombotic disease (P=0.04). Conclusions: The Asp allele from the Gu298Asp gene represents an independent risk factor for ischemic stroke in a young Mexican population. In contrast, the 4G/5G was not associated with an increased risk for this disease in the same group of patients, as previously has been demonstrated in other populations.
How does mind fit into nature? Philosophy has long been concerned with this question. No contemporary philosopher has done more to clarify it than Jaegwon Kim, a distinguished analytic philosopher specializing in metaphysics and philosophy of mind. With new contributions from an outstanding line-up of eminent scholars, this volume focuses on issues raised in Kim's work. The chapters cluster around two themes: first, exclusion, supervenience, and reduction, with attention to the causal exclusion argument for which Kim is widely celebrated; and second, phenomenal consciousness and qualia, with attention to the prospects for a functionalist account of the mental. This volume is sure to become a major focus of attention and research in the disciplines of metaphysics and philosophy of mind.
ABSTRACT: I distinguish two sorts of motivation for dualism. One motivation is driven by the distinctive character of conscious phenomenology. The other is driven by the special character of normativity: Is rationality an even “harder” problem than consciousness? There is no dramatic climax in which I show that these two dualist currents have a common source; in fact, I think they are relatively independent.
Consequentialist and Kantian theories differ over the ethical relevance of consequences of actions. I investigate how they might differ too over the relevance of what actions are consequence of. Focusing on the case of group action and collective responsibility, I argue that there's a kind of analog to the problem of aggregating the value of consequences—about aggregating responsibility with respect to the roles of cooperating agents—that Kantian theories will not confront and consequentialist theories will. The issue provides a useful way to characterize a deep difference between Kantian and consequentialist theories and points, ironically, toward a way of making those views compatible.
Contemporary philosophy’s antipathy to intuition can come to seem baffling. There is inadequate reason to move away from the intuitively attractive view that we have a faculty of intuition, in many ways akin to our faculties of perception and memory and introspection, that gives us reason for belief, and with it, often enough, gives us knowledge. The purpose here is to consider whether scepticism about intuition is more reasonable than a corresponding scepticism about other epistemic faculties. I am sceptical that it is.
Oxidation of emitter surfaces can be a serious problem for Mo field emitter arrays. We studied the oxidation and related changes in the electronic properties of Mo thin films as a function of annealing temperature. Experiments were done on Mo thin films prepared on Si and sodalime glass substrates. These films were thermally oxidized and characterized using a variety of techniques including x-ray diffraction (XRD), x-ray photoelectron spectroscopy (XPS), ultraviolet photoelectron spectroscopy (UPS), and thermal desorption spectroscopy (TPD) methods. For films oxidized below 400°C, partial oxidation was observed, with MoO3(110) being the principal oxide phase. However, at a temperature of 500°C and above, oxidation of the film was complete. Electrical characteristics of the films undergo a rapid transition from semiconductive to highly insulating at temperatures between 475 to 500°C. Temperature programmed desorption spectra showed that the oxides are stable at elevated temperature with only a principal O2 desorption peak at approximately 786°C.
The battle for territory between subjectivist and objectivist ideologies is ultimately global war: truth itself is under siege. One theater in which the fighting has been elegantly fierce is ethics. But it is not always clear for whom or what the troops are fighting. If your flag is just realism, for example, you could be Swiss about the engagement. But realists are reasonably suspicious of the antirealist tendencies of subjectivism (however this is ultimately defined) – it introduces a significant discontinuity between ethics and, for example, physics (which can be taken as paradigmatically real). A different realist may worry rather that objectivity in ethics will commit us to “queer” properties and lead ultimately to an error theory or to eliminativism. So realists enter the fray, on either side.
So-called sensibility theories seek to negotiate a cease-fire. They grow with the thought that ethics must have something important to do with agents and their sensibilities. And they develop on analogy with views of secondary qualities, proposing a variety of analytic connections between moral properties and subjective states. What the proposals have in common is that in them the instantiation of ethical properties is viewed as not entirely independent of human psychological reactions. Still, such instantiation, when it occurs, is there to be cognized. There is nothing queer about ethical properties: they are intelligibly rooted in ethical thought or feeling. An ethical reaction, however, is not itself merely the expression of preference or the issuance of an imperative.
Field emission current-voltage characteristics and simultaneous field emission electron energy distributions have been measured using single tip gate diodes. An energy distribution is generated at each step of a current-voltage characteristic using a compact low-cost simulated hemispherical energy analyzer. A PC programmed with graphics-based data acquisition software is used for data acquisition and control. The PC is connected to a CAMAC crate and a picoammeter through a GPIB interface. The picoammeter measures the current leaving the tip and the field emission electrons are energy analyzed, detected and processed in the CAMAC crate. The CAMAC crate also sends control voltages. to the gate anode and the energy analyzer. This apparatus was used to measure tip work functions and Fowler-Nordheim tip shape parameters for Mo and IrO2 field emission tips. Work function measurements from field emission tips are compared to photoelectric work function measurements from flat surfaces.