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Background: Centralizing procurement for prescription drugs has the potential to reduce drug spending by creating economies of scale and by improving purchasing power. In March 2019, the Chinese government launched a volume-based purchasing (VBP) pilot program using a competitive bidding process to purchase high-quality generic drugs for which branded drug substitutes were available. We evaluated the impact of introducing the VBP pilot on drug purchase quantity and spending. Methods: We performed an interrupted time-series design to estimate the change in monthly drug purchase quantity and spending comparing fourteen months before and seven months after the VBP pilot. We obtained monthly prescription drug purchase data for all purchases from public hospitals in the three large pilot cities (Beijing, Shanghai and Xi’an) and two non-pilot cities (Changsha and Zhengzhou) between January 2018 to September 2019. We measured quantity and spending outcomes separately for the branded and generic substitutes that were selected in the VBP, and other drugs for the treatment of the same diseases. We evaluated heterogeneity of impact by pilot city, drug type, and therapeutic class (cardiovascular disease, mental disorder and cancer) separately. Findings: The VBP pilot in these three cities covered 60 million individuals. The implementation of the pilot reform was associated with a 132% (95%-CI: 104%-165%, p<0·001) increase in the purchase quantity of selected drugs in pilot cities compared to an 17% decrease (95%-CI: 9%-25%, p<0·001) in control cities. In contrast, the purchase quantity of branded and other drugs in pilot cities decreased by 38% (95%-CI: 27%-46%, p<0·001) and 77% (95%-CI: 71%-81%, p<0·001), respectively; while in control cities, these remained at similar levels. Overall, there was a 35% (95%-CI: 28%-41%, p<0·001) decrease in the purchase spending for all drugs in the first post-policy month, from 8·1 billion CNY estimated in the absence of VBP down to 5·3 billion CNY. The largest reduction in spending was in Shanghai and from drugs for the treatment of cardiovascular diseases. Interpretation: The evidence suggests positive impact of the VBP pilot in reducing the overall drug spending and increasing the use of high-quality generics in three pilot cities. This overall trend is not observed in two non-pilot cities. Assessment of long-term impact of the VBP policy is needed on various outcomes such as drug prescription and utilization patterns, patients’ health outcomes and spending. Funding: None to declare. Declaration of Interest: None to declare.

Two recent large data releases for the Atacama Cosmology Telescope (ACT), called DR4 and DR5, are available for public access. These data include temperature and polarization maps that cover nearly half the sky at arcminute resolution in three frequency bands; lensing maps and component-separated maps covering ~ 2,100 deg^2 of sky; derived power spectra and cosmological likelihoods; a catalog of over 4,000 galaxy clusters; and supporting ancillary products including beam functions and masks. The data and products are described in a suite of ACT papers; here we provide a summary. In order to facilitate ease of access to these data we present a set of Jupyter IPython notebooks developed to introduce users to DR4, DR5, and the tools needed to analyze these data. The data products (excluding simulations) and the set of notebooks are publicly available on the NASA Legacy Archive for Microwave Background Data Analysis (LAMBDA); simulation products are available on the National Energy Research Scientific Computing Center (NERSC). Comment: Accepted to ApJS. 21 pages, 8 figures. Data and notebooks available on LAMBDA https://lambda.gsfc.nasa.gov/product/act/

Having thrived in Eurasia for 350,000 years Neandertals disappeared from the record around 40,000-37,000 years ago, after modern humans entered Europe. It was a complex process of population interactions that included cultural exchanges and admixture between Neandertals and dispersing groups of modern humans. In Europe Neandertals are always associated with the Mousterian while the Aurignacian is associated with modern humans only. The onset of the Aurignacian is preceded by "transitional" industries which show some similarities with the Mousterian but also contain modern tool forms. Information on these industries is often incomplete or disputed and this is true of the Uluzzian. We present the results of taphonomic, typological and technological analyses of two Uluzzian sites, Grotta La Fabbrica (Tuscany) and the newly discovered site of Colle Rotondo (Latium). Comparisons with Castelcivita and Grotta del Cavallo show that the Uluzzian is a coherent cultural unit lasting about five millennia, replaced by the Protoaurignacian before the eruption of the Campanian Ignimbrite. The lack of skeletal remains at our two sites and the controversy surrounding the stratigraphic position of modern human teeth at Cavallo makes it difficult to reach agreement about authorship of the Uluzzian, for which alternative hypotheses have been proposed. Pending the discovery of DNA or further human remains, these hypotheses can only be evaluated by archaeological arguments, i.e. evidence of continuities and discontinuities between the Uluzzian and the preceding and succeeding culture units in Italy. However, in the context of "transitional" industries with disputed dates for the arrival of modern humans in Europe, and considering the case of the Châtelperronian, an Upper Paleolithic industry made by Neandertals, typo-technology used as an indicator of hominin authorship has limited predictive value. We corroborate previous suggestions that the Middle-to-Upper Paleolithic transition occurred as steps of rapid changes and geographically uneven rates of spread.

The mode-switching pulsar PSR B0943+10 has been extensively studied in the radio band for many years and, more recently, it has been found to vary also in X-rays, with a flux anticorrelated with the radio emission. Here we review the results of long observations of PSR B0943+10 carried out with XMM-Newton and the LOFAR, LWA and Arecibo radio telescopes in 2014. These results support a scenario in which both unpulsed non-thermal emission, likely of magnetospheric origin, and pulsed thermal emission from a small polar cap (~1500 m2) with a strong non-dipolar magnetic field (~ 1014 G), are present during both radio modes and vary in intensity in a correlated way.

Abstract We report results from FE-SEM–EDS, geochemical, mineralogical analyses and Raman spectroscopy of pottery of bucket-shaped ceramic from Rogaland (southwestern Norway) dated between the 5th and 6th Century. The study reveals a very rare pottery composition including asbestos-group minerals and an unusual enrichment in compatible elements like Cr (8–27 × Post Archean average shale (PAS), McLennan et al., 2006), Ni (2–8 × normal shale) and Co (2–3 × PAS). X-Rray diffraction and Raman spectroscopy could pinpoint that Ni is introduced by specific Ni-rich talc mineral and chlorite minerals and Cr occurs in a rare Cr-rich talc, and possibly in a Cr-chlorite, these minerals are the most abundant in the pottery, which is supported by strong enrichment in Mg (10–20 × PAS). The addition of Mg, Cr, Ni and Co and other compatible trace elements is to our current knowledge not caused by anthropogenic activity but related to the used materials, which are alteration products of mafic and ultramafic rocks or genetically related to mafic and ultramafic rocks. Rocks of this type are exposed in vicinity of the sampling areas in a region called Karmoy, hosting a world famous ophiolite complex, which is identified as the major source for the mafic and ultramafic component, as the next succession of a similar composition is far further north located in Norway and a number of rock types on Karmoy matches the chemical composition of the pottery. The here reported composition is spectacular and extremely rare – if ever found – in pottery. Our study shows that unusual material sources have been used in pottery production, and this opens for discussion whether the materials were deliberately selected by the manufacturers, thereby expressing a specific social function, in a time period where more functional clay types and additives, and certainly functional and sufficient for use in pottery, where abundant in areas of Rogaland closer to where the pots were found.