The Ineffectiveness of Retrospective Drug Utilization Review

As policymakers debate adding a prescription drug benefit to Medicare, they must also seek ways to promote cost-effective use of drugs and minimize inappropriate prescribing. For more than a decade, all state Medicaid agencies and most private insurers have used computerized drug utilization review (DUR) programs to prevent or rectify potential prescribing errors. DUR can be retrospective, in which claims data are reviewed to identify patterns of drug use, or prospective, in which prescriptions are reviewed before a drug is dispensed. This Issue Brief summarizes a landmark study that suggests that retrospective DUR has had no measurable effects on outpatient drug use or clinical outcomes in the Medicaid program

Effects of Training Intensity on Locomotor Performance in Individuals With Chronic Spinal Cord Injury: A Randomized Crossover Study

Background. Many physical interventions can improve locomotor function in individuals with motor incomplete spinal cord injury (iSCI), although the training parameters that maximize recovery are not clear. Previous studies in individuals with other neurologic injuries suggest the intensity of locomotor training (LT) may positively influence walking outcomes. However, the effects of intensity during training of individuals with iSCI have not been tested. Objective. The purpose of this pilot, blinded-assessor randomized trial was to evaluate the effects of LT intensity on walking outcomes in individuals with iSCI. Methods. Using a crossover design, ambulatory participants with iSCI \u3e1 year duration performed either high- or low-intensity LT for ≤20 sessions over 4 to 6 weeks. Four weeks following completion, the training interventions were alternated. Targeted intensities focused on achieving specific ranges of heart rate (HR) or ratings of perceived exertion (RPE), with intensity manipulated by increasing speeds or applying loads. Results. Significantly greater increases in peak treadmill speeds (0.18 vs 0.02 m/s) and secondary measures of metabolic function and overground speed were observed following high- versus low-intensity training, with no effects of intervention order. Moderate to high correlations were observed between differences in walking speed or distances and differences in HRs or RPEs during high- versus low-intensity training. Conclusion. This pilot study provides the first evidence that the intensity of stepping practice may be an important determinant of LT outcomes in individuals with iSCI. Whether such training is feasible in larger patient populations and contributes to improved locomotor outcomes deserves further consideration

Asymptotic reduction of a porous electrode model for lithium-ion batteries

We present a porous electrode model for lithium-ion batteries using Butler--Volmer reaction kinetics. We model lithium concentration in both the solid and fluid phase along with solid and liquid electric potential. Through asymptotic reduction, we show that the electric potentials are spatially homogeneous which decouples the problem into a series of time-dependent problems. These problems can be solved on three distinguished time scales, an early time scale where capacitance effects in the electrode dominate, a mid-range time scale where a spatial concentration gradient forms in the electrolyte, and a long-time scale where each of the electrodes saturate and deplete with lithium respectively. The solid-phase concentration profiles are linear functions of time and the electrolyte potential is everywhere zero, which allows the model to be reduced to a system of two uncoupled ordinary differential equations. Analytic and numerical results are compared with full numerical simulations and experimental discharge curves demonstrating excellent agreement.Comment: Accepted in SIAM Journal on Applied Mathematic

Photon statistics from coupled quantum dots

We present an optical study of closely-spaced self-assembled InAs/GaAs quantum dots. The energy spectrum and correlations between photons subsequently emitted from a single pair provide not only clear evidence of coupling between the quantum dots but also insight into the coupling mechanism. Our results are in agreement with recent theories predicting that tunneling is largely suppressed between nonidentical quantum dots and that the interaction is instead dominated by dipole-dipole coupling and phonon-assisted energy transfer processes.Comment: 4 pages, 4 figures, to appear in Phys. Re

Developing farm-level sustainability indicators for Ireland using the Teagasc National Farm Survey

peer-reviewedIn the context of an expanding, export-dependent agri-food sector, indicators of sustainable development and intensification are necessary to measure, assess and verify the comparative advantage afforded by Ireland’s natural pastoral-based food production systems. Such indicators are also necessary to ensure that we produce more food with less adverse impacts on the Irish environment, climate and society. This article outlines the development of farm-level indicators that refect the multifaceted nature of sustainability, which is encompassed in economic, environmental and social indicators. The role of innovation in farm sustainability was also examined. A comparison of indicators across Irish farm systems showed that dairy farms, followed by tillage farms, tended to be the most economically and socially sustainable farm systems. In relation to greenhouse gas emissions in particular, the top-performing dairy farms, in an economic sense, also tended to be the best-performing farms from an environmental sustainability perspective. This trend was also evident in relation to the adoption of innovative practices on farm, which was found to be strongly correlated with economic performance

Factors associated with profitability in pasture-based systems of milk production

peer-reviewedThe global dairy industry needs to reappraise the systems of milk production that are operated at farm level with specific focus on enhancing technical efficiency and competitiveness of the sector. The objective of this study was to quantify the factors associated with costs of production, profitability, and pasture use, and the effects of pasture use on financial performance of dairy farms using an internationally recognized representative database over an 8-yr period (2008 to 2015) on pasture-based systems. To examine the associated effects of several farm system and management variables on specific performance measures, a series of multiple regression models were developed. Factors evaluated included pasture use [kg of dry matter/ha and stocking rate (livestock units/ha)], grazing season length, breeding season length, milk recording, herd size, dairy farm size (ha), farmer age, discussion group membership, proportion of purchased feed, protein %, fat %, kg of milk fat and protein per cow, kg of milk fat and protein per hectare, and capital investment in machinery, livestock, and buildings. Multiple regression analysis demonstrated costs of production per hectare differed by year, geographical location, soil type, level of pasture use, proportion of purchased feed, protein %, kg of fat and protein per cow, dairy farm size, breeding season length, and capital investment in machinery, livestock, and buildings per cow. The results of the analysis revealed that farm net profit per hectare was associated with pasture use per hectare, year, location, soil type, grazing season length, proportion of purchased feed, protein %, kg of fat and protein per cow, dairy farm size, and capital investment in machinery and buildings per cow. Pasture use per hectare was associated with year, location, soil type, stocking rate, dairy farm size, fat %, protein %, kg of fat and protein per cow, farmer age, capital investment in machinery and buildings per cow, breeding season length, and discussion group membership. On average, over the 8-yr period, each additional tonne of pasture dry matter used increased gross profit by €278 and net profit by €173 on dairy farms. Conversely, a 10% increase in the proportion of purchased feed in the diet resulted in a reduction in net profit per hectare by €97 and net profit by €207 per tonne of fat and protein. Results from this study, albeit in a quota limited environment, have demonstrated that the profitability of pasture-based dairy systems is significantly associated with the proportion of pasture used at the farm level, being cognizant of the levels of purchased feed

Sagittarius Tidal Debris 90 kpc from the Galactic Center

A new overdensity of A-colored stars in distant parts of the Milky Way's stellar halo, at a dereddened SDSS magnitude of g_0 = 20.3, is presented. Identification of associated variable RR Lyrae candidates supports the claim that these are blue horizontal branch stars. The inferred distance of these stars from the Galactic center is 90 kpc, assuming the absolute magnitude of these stars is M_g_0 = 0.7 and that the Sun is 8.5 kpc from the Galactic center. The new tidal debris is within 10 kpc of same plane as other confirmed tidal debris from the disruption of the Sagittarius dwarf galaxy, and could be associated with the trailing tidal arm. Distances to the Sagittarius stream estimated from M stars are about 13% smaller than our inferred distances. The tidal debris has a width of at least 10 degrees, and is traced for more than 20 degrees across the sky. The globular cluster NGC 2419 is located within the detected tidal debris, and may also have once been associated with the Sagittarius dwarf galaxy.Comment: 4 figures, ApJL in pres

Spectroscopy of Quasar Candidates from SDSS Commissioning Data

The Sloan Digital Sky Survey has obtained images in five broad-band colors for several hundred square degrees. We present color-color diagrams for stellar objects, and demonstrate that quasars are easily distinguished from stars by their distinctive colors. Follow-up spectroscopy in less than ten nights of telescope time has yielded 22 new quasars, 9 of them at $z> 3.65$, and one with $z = 4.75$, the second highest-redshift quasar yet known. Roughly 80% of the high-redshift quasar candidates selected by color indeed turn out to be high-redshift quasars.Comment: 4 pages, 3 figures, to appear in the proceedings of "After the Dark Ages: When Galaxies were Young (the Universe at 2<z<5)", 9th Annual October Astrophysics Conference in Marylan

Risk of Major Complications From Coronary Angioplasty Performed Immediately After Diagnostic Coronary Angiography: Results From the Registry of the Society for Cardiac Angiography and Interventions

AbstractObjectives. This study was designed to determine the risk of performing percutaneous transluminal coronary angioplasty (PTCA) at the time of diagnostic catheterization (“combined procedures”).Background. Health care providers are under increasing pressure to combine diagnostic and interventional coronary procedures to reduce costs. However, the risk associated with combined procedures has not been rigorously assessed.Methods. A multicenter cohort study of 35,700 patients undergoing elective PTCA from 1992 through 1995 was performed to determine the risk of major complications (myocardial infarction, emergency coronary artery bypass graft surgery or death) from combined relative to staged procedures (i.e., performing PTCA at a session subsequent to diagnostic catheterization).Results. The risks of major complications from combined and staged procedures were 2.0% and 1.6%, respectively (unadjusted odds ratio [OR] 1.28, 95% confidence interval [CI] 1.05 to 1.57). After adjusting for clinical and angiographic differences and clustering by laboratory, the risk from combined procedures was not significantly elevated (multivariable OR 1.18, 95% CI 0.89 to 1.55). However, several subgroups of patients did have an increased risk from combined procedures: patients with multivessel disease (multivariable OR 1.64, 95% CI 1.13 to 2.39); women (multivariable OR 1.64, 95% CI 1.05 to 2.55); patients >65 years old (multivariable OR 1.40, 95% CI 1.02 to 1.93); and patients undergoing multilesion PTCA (multivariable OR 1.53, 95% CI 1.06 to 2.21). The risk of combined relative to staged procedures decreased over the 4-year period (multivariable p = 0.029).Conclusions. Combining PTCA with diagnostic catheterization appears to be safe in many patients. However, several subgroups of patients may be at increased risk. Careful patient selection will most likely remain critical to ensuring the safety of combined procedures.(J Am Coll Cardiol 1997;30:193–200