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Faced with growing drug expenditures, drug insurance plan executives have adopted various cost containment measures. One such policy, reference pricing (RP), limits drug plan reimbursement of interchangeable medicines to a reference price, which is typically equal to the price of the lowest cost interchangeable drug; any cost above that is borne by the patient. RP policies vary in the extent to which drugs are considered interchangeable by a particular plan (Lopez-Casasnovas and Puig-Junoy 2000). Under its most restrictive form—Type 1 RP—only chemically equivalent drugs (i.e., branded and “generic” versions of the same drug) are considered interchangeable. Under Type 2 RP, all drugs from the same therapeutic class are considered interchangeable. For instance, under such a system all nonsteroidal antiinflammatory drugs (NSAIDs), used for analgesia, would be reimbursed at the same rate. Under Type 3 RP, by contrast, all the different analgesic drugs, including opiates and NSAIDs, would be considered interchangeable. There have been calls to integrate RP into the Medicare prescription drug benefit (Huskamp et al. 2000; Morgan, Barer, and Agnew 2003). Unlike traditional patient cost sharing policies, RP fully subsidizes lower cost medicines, and, for those who meet exemption criteria, higher cost medicines as well. RP might therefore save money while avoiding the adverse impacts on patient health associated with patient cost sharing, which typically applies to all drugs (Tamblyn et al. 2001). While the debate on whether RP should be widely used in the U.S. has been heated, evidence on its outcomes is limited (Kanavos and Reinhardt 2003). In this paper, we use retrospective population-based claims data to compare the net drug program savings realized by the application of Type 1 and then Type 2 RP with the NSAIDs by Pharmacare, the publicly funded drug subsidy program for seniors and various other residents of British Columbia (BC), Canada. NSAIDs are among the most commonly used medications worldwide, with over 70 million prescriptions and more than 30 billion over-the-counter tablets sold each year in the U.S. (Wolfe, Lichtenstein, and Singh 1999). Over 15 percent of North Americans suffer from arthritis and/or musculoskeletal disease (Lawrence et al. 1998), and current guidelines endorse both NSAIDs and acetaminophen as first-line therapies for symptomatic osteoarthritis (ACR 2000). Potential program savings from RP depend on the vector of reimbursement prices of the drugs considered interchangeable as well as on the quantities dispensed. Potential savings are greatest when use is skewed toward higher priced drugs and the price spread—the difference between the highest and lowest drug prices—is large. The price spread can only increase (or at least not decrease) the greater the number of drugs that are deemed interchangeable; potential savings are therefore largest for Type 3 RP and lowest for Type 1 RP. There were considerable differences in the prices of the different NSAIDs in BC prior to the introduction of Type 2 RP. The cost of generic ibuprofen, for instance, varied between $0.11 and $0.16 per day (depending on the amount used), whereas the daily cost of a newer NSAID, etodolac, varied from $1.79 to $3.58 (Therapeutics Initiative 1995). Several factors can mitigate drug plan savings from RP. The first of these is the generosity of the criteria, if any, by which patients are exempted from RP. Pharmacare exempts patients who have failed or are likely to fail on a lower cost, fully reimbursed drug. Although the physician must submit a written petition for review by Pharmacare's pharmacist personnel, exemption requests are usually granted within 48 hours. Pharmacare also exempts all NSAID prescriptions written by rheumatologists from Type 2 RP. Second, physicians might “prescribe around” the RP restrictions. In other words, they might substitute relatively costly analgesic drugs, including various opiates, that are not subject to RP for those that are. Third, economic theory suggests that setting reimbursement rates according to the prices of a set of reference standard drugs might encourage the manufacturers of those drugs to raise retail prices (Zweifel and Crivelli 1996; Morton 1997; Anis and Wen 1998). On the other hand, experience from Type 2 RP introduced in European countries suggests that such price increases are offset by decreases in the retail prices of drugs that are only partially reimbursed by drug plans. Fourth, although the drug plan saves money on those beneficiaries who elect to pay extra for the higher cost drugs, these expenditures are merely shifted—overall drug costs do not decline. Finally, the health of patients who switch to lower quality drugs might suffer, resulting in an off-setting increase in drug and other treatment costs. While we do not have data on patient health outcomes and individual patients commonly report better efficacy and/or tolerability with particular NSAIDs (Walker, Chan, and Yood 1992; Langman et al. 2001), we note that there is no consistent evidence of clinically significant differences in the anti-inflammatory and analgesic effect of the numerous different NSAIDs (Brooks and Day 1991; Holbrook 2001). Retrospective analyses of observational data have suggested a hierarchy among conventional NSAIDs in their potential for gastrointestinal injury, but these differences can be attributed to variations in effective dose and channeling bias (Henry et al. 1996; Rodriguez 1998). Others have studied the effects of prior authorization programs targeting higher cost NSAIDs on the health-related quality of life (Momani, Madhavan, and Nau 2002) and medical services use (Kotzan et al. 1993; Smalley et al. 1995) of chronic NSAID users enrolled in various U.S. state Medicaid programs. None of these studies detected any deleterious effects among those who were denied Medicaid subsidies for the higher cost NSAIDs. To address the net effect of Type 1 and 2 RP on Pharmacare and patient analgesic expenditures, we used monthly Pharmacare claims data aggregated across its senior (age 65+ years) beneficiaries, over the period February 1993 to June 2001, to examine prescribing patterns, NSAID prices, Pharmacare expenditure, and patient out-of-pocket expenditure on individual NSAIDs and other analgesic drugs. A previous report indicated high accuracy and completeness of provincial government drug claims data (Williams and Young 1996a Williams and Young 1996b). We focused on seniors given that they are the highest per capita users of analgesics (Health Canada 2003), and the size and composition of the beneficiary population is relatively stable over time.

Upon ingestion, probiotics may act to protect the host through a number of protective mechanisms including modulation of genes involved in intestinal innate mucosal defense such as epithelial cell-derived mucin glycoproteins and inhibitor of apoptosis proteins. To determine the specificity of effect and sustainability of response in vivo, Lactobacillus plantarum 299v (Lp299v), Lactobacillus rhamnosus R0011 (LrR0011), and Bifidobacterium bifidum R0071 (BbR0071) were added repeatedly or intermittently to the drinking water of Sprague-Dawley rats. After killing the rats via CO2 suffocation, Muc2, Muc3, neuronal apoptosis inhibitor protein (NAIP), human inhibitor of apoptosis protein 1/cellular inhibitor of apoptosis 2 (HIAP1/cIAP2), and human inhibitor of apoptosis protein 2/cellular inhibitor of apoptosis 1 (HIAP2/cIAP1) mRNA and protein levels were analyzed via RT-PCR and immunohistochemistry. Live Lp299v, BbR0071, and LrR0011 increased Muc3 protein and mRNA expression in jejunum and ileum. Heat-killed and a nonadherent derivative of Lp299v failed to induce Muc3 expression. Lp299v did induce expression of HIAP2/cIAP1 and NAIP expression. Muc3 mucin expression was elevated for 5 d after oral administration of Lp299v; however, this effect was not sustained despite ongoing daily ingestion of a probiotic. Intermittent pulse ingestion of probiotics, however, was found to repeatedly increase Muc3 expression. We conclude that selected probiotics can induce protective genes of mucosal intestinal epithelial cells, an effect that is reproducible with pulse probiotic administration.

Cet article analyse l’évolution de la participation des femmes aux structures dirigeantes des associations. Les femmes apparaissent largement en retrait des fonctions de président d’association et leur accession aux postes de dirigeants s’effectue principalement à partir des associations créées récemment et dans des types d’associations orientées vers des populations fragiles ou vulnérables. L’article montre que l’on peut imputer leur plus forte présence essentiellement aux évolutions sociétales en cours depuis les années 70 : activité croissante des femmes, hausse de leur qualification, démocratisation de la société et de la vie associative, ouverture plus grande des associations récentes aux plus jeunes et à des catégories sociales plus variées. This article examines the evolution of the participation of women in the governing bodies of nonprofit organizations. There appear to be very few women CEOs in nonprofit organizations, and women who have reached executive positions have mainly done so in recently created nonprofit organizations and those concerned with people at risk and vulnerable social groups. The article shows that the increase is essentially due to societal changes since the 1970s: growing female participation in the workforce, their higher level of education, democratization of society and nonprofit organizations, and recent nonprofit organizations more open to younger people and a broader cross-section of the population.

Let k be a base field, K be a field containing k and L/K be a field extension of degree n. The essential dimension ed(L/K) over k is a numerical invariant measuring "the complexity" of L/K. Of particular interest is $\tau$(n) = max { ed(L/K) | L/K is a separable extension of degree n}, also known as the essential dimension of the symmetric group $S_n$. The exact value of $\tau$(n) is known only for n $\leq$ 7. In this paper we assume that k is a field of characteristic p > 0 and study the essential dimension of inseparable extensions L/K. Here the degree n = [L:K] is replaced by a pair (n, e) which accounts for the size of the separable and the purely inseparable parts of L/K respectively, and \tau(n) is replaced by $\tau$(n, e) = max { ed(L/K) | L/K is a field extension of type (n, e)}. The symmetric group $S_n$ is replaced by a certain group scheme $G_{n,e}$ over k. This group is neither finite nor smooth; nevertheless, computing its essential dimension turns out to be easier than computing the essential dimension of $S_n$. Our main result is a simple formula for \tau(n, e). Comment: 18 pages

EBEX is a NASA-funded balloon-borne experiment designed to measure the polarization of the cosmic microwave background (CMB). Observations will be made using 1432 transition edge sensor (TES) bolometric detectors read out with frequency multiplexed SQuIDs. EBEX will observe in three frequency bands centered at 150, 250, and 410 GHz, with 768, 384, and 280 detectors in each band, respectively. This broad frequency coverage is designed to provide valuable information about polarized foreground signals from dust. The polarized sky signals will be modulated with an achromatic half wave plate (AHWP) rotating on a superconducting magnetic bearing (SMB) and analyzed with a fixed wire grid polarizer. EBEX will observe a patch covering ~1% of the sky with 8' resolution, allowing for observation of the angular power spectrum from \ell = 20 to 1000. This will allow EBEX to search for both the primordial B-mode signal predicted by inflation and the anticipated lensing B-mode signal. Calculations to predict EBEX constraints on r using expected noise levels show that, for a likelihood centered around zero and with negligible foregrounds, 99% of the area falls below r = 0.035. This value increases by a factor of 1.6 after a process of foreground subtraction. This estimate does not include systematic uncertainties. An engineering flight was launched in June, 2009, from Ft. Sumner, NM, and the long duration science flight in Antarctica is planned for 2011. These proceedings describe the EBEX instrument and the North American engineering flight. 12 pages, 9 figures, Conference proceedings for SPIE Millimeter, Submillimeter, and Far-Infrared Detectors and Instrumentation for Astronomy V (2010)

Children learn information from a variety of sources and often remember the content but forget the source. Whereas the majority of research has focused on retrieval mechanisms for such difficulties, the present investigation examines whether the way in which sources are encoded influences future source monitoring. In Study 1, 86 children aged 3 to 8 years participated in 2 photography sessions on different days. Children were randomly assigned to either the Difference condition (they were asked to pay attention to differences between the 2 events), the Memory control condition (asked to pay attention with no reference to differences), or the No-Instruction control (no special instructions were given). One week later, during a structured interview about the photography session, the 3- to 4-year-olds in the No-Instruction condition were less accurate and responded more often with 'do not know' than the 7- to 8-year-olds. However, the older children in the Difference condition made more source confusions than the younger children suggesting improved memory for content but not source. In Study 2, the Difference condition was replaced by a Difference-Tag condition where details were pointed out along with their source (i.e., tagging source to content). Ninety-four children aged 3 to 8 years participated. Children in the Difference-Tag condition made fewer source-monitoring errors than children in the Control condition. The results of these 2 studies together suggest that binding processes at encoding can lead to better source discrimination of experienced events at retrieval and may underlie the rapid development of source monitoring in this age range. (PsycINFO Database Record

Abstract A two-step approach is proposed to investigate the shear band formation in cold-rolled aluminum alloy sheet during plane strain tension, compression and simple shear tests. In the first step, a finite element model with only one element using Taylor type polycrystal plasticity model is applied to compute the stress-strain curve of the deformation. In the second step, a full scale mesoscopic simulation is applied for a further study of the details of the shear band development for cases with higher possibility of shear band formation as judged from the results in step 1. Systematic studies show that the hardening/softening features of stress-strain curves obtained by one-element method well agree with the extent of macroscale shear bands development in mesoscopic scale simulation: softening or flat stress-strain curves correspond to the formation of severe macroscale shear band in mesoscopic scale simulation, and the stronger the softening is, the more severe the macroscale shear band is, whereas no macroscale shear band is developed when the curves exhibit continuous and obvious hardening. Therefore, when it is needed to investigate probability and features of shear band formation in many samples or loading modes, e.g. loading along different directions, people can use the first step to efficiently estimate the possibility of macroscale shear band development for all the cases concerned, and then apply the full scale mesoscopic simulation only for those cases where stress-strain curves exhibit little hardening or softening features. Our calculations show that the computation efficiency can be substantially improved by the two-step approach.

Simulated sensor data from active and passive sensors has numerous applications in target detection and tracking. Simulated data is particularly useful in performance evaluation of target tracking algorithms where the ground truth of a scenario must be known. For real sensor data it is impossible to know the ground truth so simulated data must be used. This paper discusses existing methods for simulation of data from active sensors and proposes a method that builds on existing techniques from the field of computer graphics. An extension to existing methods is proposed to accommodate the simulation of active sensor data for which timing and frequency information is required in addition to intensity. Results from an existing method of active sensor data simulation are compared to the results of the proposed method. Additionally, a cloud computing framework is proposed and its scalability evaluated to address the fairly large computational load of such a simulation. Thesis Master of Applied Science (MASc)

Dam building and reservoir operations alter the downstream hydrological regime, and as a result, affect the health of the river aquatic ecosystem, particularly for large-scale cascade reservoirs. This study investigated the impact of the Gezhouba Reservoir (GR) and the Three Gorges Reservoir (TGR) on the spawning conditions of two critical taxa, i.e., the endemic four major carps and the endangered Chinese sturgeon in the Yangtze River. We analyzed the flow, sediment, and thermal regime in these two taxa spawning seasons and compared their features between the predam and postdam periods. Our results revealed that the GR and the TGR had altered the frequency distributions of flow, sediment, and water temperature to different degrees, with the impact by the GR on the carps and Chinese sturgeon ranked as water temperature > water temperature. For the GR, the satisfying degree of the suitable flow and water temperature of the carps increased, whilst the suitable flow, sediment, and water temperature for the Chinese sturgeon decreased. These changes in TGR showed a significant ascending (descending) trend in the suitable flow (water temperature) for the carps, and a clear decreasing trend in the flow, sediment, and temperature for Chinese sturgeon. Both the TGR and the GR had negative impacts on the spawning of these two taxa in terms of the rising/falling flow characteristics. flow, and the effect of the TGR on these two taxa were ordered as flow > water temperature, sediment > water temperature > flow, sediment > flow >