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Offering a nationally available discount has become common to increase the chance of being recommended by the National Institute of Health and Care Excellence (NICE). This study reviewed all NICE technology appraisals (TAs) since October 2007 to determine whether a national available discount was submitted, and explore when these discounts were introduced.
All TAs between October 2007 and August 2017 were reviewed. The timing of the nationally available discount submission was allocated into one of four categories: initially submitted; initially submitted but changed; introduced after submission; or, other discount. An analysis was conducted to examine whether there was a temporal pattern in the introduction of nationally available discounts before or after January 2014, when the current Pharmaceutical Price Regulation Scheme (PPRS) came into effect.
Before 1 January 2014, a nationally available discount was only used in the minority of cases across recommended (22 percent of cases) and not recommended (19 percent) technologies. In the period since 1 January 2014, use of a nationally available discount increased overall, but to a greater degree in technologies ultimately receiving a positive recommendation from NICE (not recommended: 19 percent to 39 percent; recommended: 22 percent to 59 percent). In the period since 1 January 2014, the proportion of technologies with a positive recommendation where implicit price flexibility during the appraisal was revealed increased (from 20/186) to 40/182.
With the current PPRS, the majority of technologies have offered a nationally available discount, most commonly at the time of submission; however, there is increasing evidence of implicit price flexibility during the appraisal process to achieve a positive recommendation.
CZT is a semiconductor material that promises to be a good candidate for uncooled gamma radiation detectors. However, to date, we are yet to overcome the technological difficulties in production of large size, defect-free CZT crystals. The most common problem is accumulation of Tellurium precipitates as microscopic inclusions. These inclusions influence the charge collection through charge trapping and electric field distortion. We employed high energy transmission X-ray diffraction techniques to study the quality of the CdZnTe crystals grown by Bridgman Technique. Crystallinity and defects within two different growth set-ups, i.e. with and without choked seeding, were compared by imaging the crystal orientation topography with white beam X-ray diffraction topography (WBXDT). The X-ray diffraction topography results show high correlation with large-area infrared transmission images of the crystals. Grain boundaries that are highly decorated with Te inclusions are observed. Characteristic Te inclusion arrangements as a result of growth conditions are discussed. We also measured the electronic properties of the detectors fabricated from ingots grown using two Bridgman processes, and observed a reduction in electrical resistivity of choked-seeding-grown CdZnTe crystals. Our results show that although choked seeding technique holds a promise in the realization of high quality mono-crystalline CdZnTe, current growth parameters must be improved to obtain defect-free crystals. These results are helpful to attain optimal seeding process for Bridgman-growth of large single crystals of CdZnTe.
Stable isotope analysis has provided crucial new insights into dietary change at the Neolithic transition in north-west Europe, indicating an unexpectedly sudden and radical shift from marine to terrestrial resources in coastal and island locations. Investigations of early Neolithic skeletal material from Sumburgh on Shetland, at the far-flung margins of the Neolithic world, suggest that this general pattern may mask significant subtle detail. Analysis of juvenile dentine reveals the consumption of marine foods on an occasional basis. This suggests that marine foods may have been consumed as a crucial supplementary resource in times of famine, when the newly introduced cereal crops failed to cope with the demanding climate of Shetland. This isotopic evidence is consistent with the presence of marine food debris in contemporary middens. The occasional and contingent nature of marine food consumption underlines how, even on Shetland, the shift from marine to terrestrial diet was a key element in the Neolithic transition.
Emergency Medical Services (EMS) have taken great strides toward the development of city and statewide programs. However, once a person embarks on a plane or on a ship for any extended period of time, the EMS are at times meager and at other times not coordinated well with ground EMS. The American Heart Association has developed a protocol for basic and advanced cardiac life support to exist in all major air terminals, and especially within aircraft of all types. Particularly important are those aircrafts carrying large numbers of people for extended periods of time.
Let X, Y and Z be Banach spaces, and let Πp (Y, Z) (1 ≦ p < ∞) denote the space of p-summing operators from Y to Z. We show that, if X is a ℒ∞-space, then a bounded linear operator is 1-summing if and only if a naturally associated operator T#: X → Πl (Y, Z) is 1-summing. This result need not be true if X is not a ℒ∞-space. For p > 1, several examples are given with X = C[0, 1] to show that T# can be p-summing without T being p-summing. Indeed, there is an operator T on whose associated operator T# is 2-summing, but for all N ∈ N, there exists an N-dimensional subspace U of such that T restricted to U is equivalent to the identity operator on . Finally, we show that there is a compact Hausdorff space K and a bounded linear operator for which T#: C(K) → Π1 (l1, l2) is not 2-summing.
This paper seeks to provide clues as to why experimental evidence for the alignment of slender fibres in semi-dilute suspensions under shear flows does not match theoretical predictions. This paper posits that the hydrodynamic interactions between the different fibres that might be responsible for the deviation from theory, can at least partially be modelled by the coupling between Jeffery's equation and Stokes' equation. It is proposed that if the initial data are slightly non-uniform, in that the probability distribution of the orientation has small spatial variations, then there is feedback via Stokes' equation that causes these non-uniformities to grow significantly in short amounts of time, so that the standard uncoupled Jeffery's equation becomes a poor predictor when the volume ratio of fibres to fluid is not extremely low. This paper provides numerical evidence, involving spectral analysis of the linearization of the perturbation equation, to support this theory.
This paper presents an exact formula for calculating the fourth-moment tensor from the second-moment tensor for the three-dimensional Jeffery's equation. Although this approach falls within the category of a moment tensor closure, it does not rely upon an approximation, either analytic or curve fit, of the fourth-moment tensor as do previous closures. This closure is orthotropic in the sense of Cintra & Tucker (J. Rheol., vol. 39, 1995, p. 1095), or equivalently, a natural closure in the sense of Verleye & Dupret (Developments in Non-Newtonian Flow, 1993, p. 139). The existence of these explicit formulae has been asserted previously, but as far as the authors know, the explicit forms have yet to be published. The formulae involve elliptic integrals, and are valid whenever fibre orientation was isotropic at some point in time. Finally, this paper presents the fast exact closure, a fast and in principle exact method for solving Jeffery's equation, which does not require approximate closures nor the elliptic integral computation.
Current ultrasound techniques can accurately determine the chorionicity of twins, but not zygosity. We previously proposed that the zygosity of spontaneously conceived twins can be determined at early ultrasound, where 2 corpora lutea infers dizygosity, and 1 implies monozygosity. Here we did a case series, comparing zygosity predicted using this method with definitive DNA genotyping of twins after birth. We retrospectively identified 14 ultrasound reports of spontaneous twin pregnancies at 6(+0 days) to 13+6 weeks' gestation, where both ovaries were seen and the number of corpora lutea documented. We visited all twin pairs, obtained buccal smears, and determined zygosity by genotyping 9 independent microsatellite markers. All 8 cases where 2 corpora lutea were seen were dizygotic pregnancies. One further case where 3 corpora lutea were seen was also dizygotic. All 3 sets of monozygotic twins had 1 corpus luteum. There were 2 cases incorrectly assigned, where 1 corpus luteum was seen in dizygotic pregnancies. We conclude if 2 corpora lutea are seen at a first trimester ultrasound of spontaneously conceived dichorionic twins, they appear to be almost certainly dizygotic. However, if 1 corpus luteum is seen in dichorionic twins, zygosity cannot be determined with certainty since it is either monozygotic, or dizygotic where a second corpus luteum has been missed.
A recent paper on quasiinear theory by Klozenberg & Bernstein is commented upon. It is argued that improper treatment of the perturbed electron distribution for damped waves has led to a diffusion-type equation with a negative diffusion coefficient.
Hardy martingales were introduced by Garling and used to study analytic functions on the N-dimensional torus 𝕋N, where analyticity is defined using a lexicographic order on the dual group ℤN. We show how, by using basic properties of orders on ℤN, we can apply Garling's method in the study of analytic functions on an arbitrary compact Abelian group with an arbitrary order on its dual group. We illustrate our approach by giving a new and simple proof of a famous generalised Jensen's Inequality due to Helson and Lowdenslager.
We precisely evaluate the operator norm of
the uncentred Hardy–Littlewood maximal function on
we compute the operator norm of the
‘strong’ maximal function on Lp(ℝn), and we
observe that the operator norm of the uncentred Hardy–Littlewood
maximal function over balls on
exponentially as n[xrarr ]∞.
Let (fn) and (gn) be two sequences of random variables adapted to an increasing sequence of σ-algebras (ℱn) such that the conditional distributions of fn and gn given ℱn coincide. Suppose further that the sequence (gn) is conditionally independent. Then it is known that where the number C is a universal constant. The aim of this paper is to extend this result to certain classes of Orlicz and rearrangement invariant spaces. This paper includes fairly general techniques for obtaining rearrangement invariant inequalities from Orlicz norm inequalities.
We recently performed a series of experiments on Nb-doped lead-zirconate-titanate ceramic to investigate the influence of constant shear stresses on the displacive, first-order rhombohedral/ferroelectric → orthorhombic/antiferroelectric polymorphic transformation. In a previous paper and report we demonstrated that increasing shear stresses lowers the mean stress and confining pressure at which the transformation occurs, but we did not identify a criterion by which the transformation could be predicted to take place under nonhydrostatic stress. In this paper we use the dielectric anomaly which accompanies the transformation as an indicator of onset of the transition, and correct for the effects of high-pressure-seal friction on measurement of the maximum compressive stress applied to the test specimens during deviatoric loading. We show that a convincing case can be made that the transformation occurs when the maximum compressive stress equals the hydrostatic pressure at which the transformation would otherwise occur.
We conducted a series of hydrostatic and constant shear stress experiments at room temperature on three different sintering runs of unpoled, niobium-doped lead-zirconate-titanate ceramic (PZT 95/5–2Nb) in order to quantify the influence of shear stress on the displacive (possibly martensitic), first-order, rhombohedral → orthorhombic phase transformation. Inter- and intra-batch variations were detected, but some generalizations can be made. In hydrostatic compression at room temperature, the transformation began at approximately 260 MPa, and was usually incompletely reversed upon return to ambient conditions. Strains associated with the transformation were isotropic, both on the first and subsequent hydrostatic cycles. Results for the constant shear stress tests were very different. First, the confining pressure and mean stress at which the transition begins decreased systematically with increasing shear stress. Second, we observed that the rate of transformation decreased with increasing shear stress and the associated elastic shear strain. This result contrasts with the typical observation that shear stresses increase reaction and transformation kinetics. Third, strain was not isotropic during the transformation: axial strains were greater and lateral strains smaller than for the hydrostatic case, though volumetric strain behavior was comparable for the two types of tests. However, this effect does not appear to be an example of transformational plasticity: no additional unexpected strains accumulated during subsequent cycles through the transition under deviatoric loading. If subsequent hydrostatic cycles were performed on samples previously subjected to shear stress, strain anisotropy was again observed, indicating that the earlier superimposed shear stress produced a permanent mechanical anisotropy in the material. The mechanical anisotropy probably resulted from a crystallographic preferred orientation that developed during the transformation under shear stress. Finally, in a few experiments on specimens from one particular sintering run, volume strain was often completely recovered and sporadic evidence for a shape memory effect was observed.
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