Implementation of a Pharmacy-Based Adult Vaccine Benefit: Recommendations for a Commercial Health Plan Benefit

BACKGROUND: Although vaccination rates in children exceed 90% in the United States, adults are vaccinated at far lower rates. In order to address this issue, additional community immunizers are needed, and pharmacists are in an ideal position to fill this void. OBJECTIVES: To explore issues and barriers related to implementation of a pharmacy-based adult vaccine benefit and develop recommendations supporting a pathway for benefit expansion. METHODS: A literature review on the current environment surrounding pharmacy-based adult vaccinations and structured interviews were conducted to inform an expert panel meeting using a modified Delphi process (pre/post survey). The goal was to develop recommendations on how to improve access to adult vaccines. RESULTS: Findings suggest employers play a key role in requesting changes in benefit design to include pharmacy-based vaccinations. However, the lack of consistent communication between pharmacists and primary care providers remains a significant barrier. CONCLUSIONS: Pharmacy-based access to vaccinations improves patient access and benefits individuals and employers. In order to take advantage of this opportunity, pharmacists must be viewed within the broader context of preventative care, including pharmacy-based vaccinations

Estimating Flood Frequency in Gaged and Ungaged Watersheds

Proceedings of the 1999 Georgia Water Resources Conference, March 30 and 31, Athens, Georgia.Estimation of flood frequency is important in jurisdictional wetlands determination and functional assessment, stream classification and restoration, and in assessing urban and agricultural risk in flood prone areas. For example, in utilizing the hydrogeomorphic approach (HGM) for wetland functional assessment for riverine wetlands, the flood frequency variable is required in seven of the suite of fifteen functions. However, site-specific determination of flood frequency has been difficult, especially in ungaged watersheds. One promising method is development of regional dimensionless rating curves. The curves are derived from stage/discharge and channel geometric relationships associated with gaged watersheds. Once the curves are constructed and calibrated to a specific region, flood frequency and channel geometry can be estimated at any point within ungaged as well as gaged watersheds within that region. This method was employed to calibrate the flood frequency variable in the low gradient, riverine HGM guidebook applicable to Western Kentucky. Flood frequency and discharge were determined at several riverine reference wetlands for the purpose of assessing wetland function throughout the Western Kentucky Coalfield Physiographic Region.Sponsored and Organized by: U.S. Geological Survey, Georgia Department of Natural Resources, The University of Georgia, Georgia State University, Georgia Institute of TechnologyThis book was published by the Institute of Ecology, The University of Georgia, Athens, Georgia 30602-2202 with partial funding provided by the U.S. Department of Interior, geological Survey, through the Georgia Water Research Insttitute as authorized by the Water Research Institutes Authorization Act of 1990 (P.L. 101-397). The views and statements advanced in this publication are solely those of the authors and do not represent official views or policies of the University of Georgia or the U.S. Geological Survey or the conference sponsors

Bias towards publishing positive results in orthopedic and general surgery: a patient safety issue?

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Spectroscopic Study of IRAS 19285+0517(PDS 100): A Rapidly Rotating Li-Rich K Giant

We report on photometry and high-resolution spectroscopy for IRAS 19285+0517. The spectral energy distribution based on visible and near-IR photometry and far-IR fluxes shows that the star is surrounded by dust at a temperature of $T_{\rm {d}}$ $\sim$ 250 K. Spectral line analysis shows that the star is a K giant with a projected rotational velocity $v sin i$ = 9 $\pm$ 2 km s$^{-1}$. We determined the atmospheric parameters: $T_{\rm {eff}}$ = 4500 K, log $g$ = 2.5, $\xi_{t}$ = 1.5 km s$^{-1}$, and [Fe/H] = 0.14 dex. The LTE abundance analysis shows that the star is Li-rich (log $\epsilon$(Li) = 2.5$\pm$0.15), but with essentially normal C, N, and O, and metal abundances. Spectral synthesis of molecular CN lines yields the carbon isotopic ratio $^{12}$C/$^{13}$C = 9 $\pm$3, a signature of post-main sequence evolution and dredge-up on the RGB. Analysis of the Li resonance line at 6707 \AA for different ratios $^{6}$Li/$^{7}$Li shows that the Li profile can be fitted best with a predicted profile for pure $^{7}$Li. Far-IR excess, large Li abundance, and rapid rotation suggest that a planet has been swallowed or, perhaps, that an instability in the RGB outer layers triggered a sudden enrichment of Li and caused mass-loss.Comment: To appear in AJ; 40 pages, 9 figure

Plant–pathogen interactions and elevated CO2: morphological changes in favour of pathogens

Crop losses caused by pests and weeds have been estimated at 42% worldwide, with plant pathogens responsible for almost $10 billion worth of damage in the USA in 1994 alone. Elevated carbon dioxide [ECO2] and associated climate change have the potential to accelerate plant pathogen evolution, which may, in turn, affect virulence. Plant–pathogen interactions under increasing CO2 concentrations have the potential to disrupt both agricultural and natural systems severely, yet the lack of experimental data and the subsequent ability to predict future outcomes constitutes a fundamental knowledge gap. Furthermore, nothing is known about the mechanistic bases of increasing pathogen agressiveness. In the absence of information on crop species, it is shown here that plant pathogen (Erysiphe cichoracearum) aggressiveness is increased under ECO2, together with changes in the leaf epidermal characteristics of the model plant Arabidopsis thaliana L. Stomatal density, guard cell length, and trichome numbers on leaves developing post-infection are increased under ECO2 in direct contrast to non-infected responses. As many plant pathogens utilize epidermal features for successful infection, these responses provide a positive feedback mechanism facilitating an enhanced susceptibility of newly developed leaves to further pathogen attack. Furthermore, a screen of resistant and susceptible ecotypes suggest inherent differences in epidermal responses to ECO2

Community-based provision of direct-acting antiviral therapy for hepatitis C: Study protocol and challenges of a randomized controlled trial

Background: To achieve the World Health Organization hepatitis C virus (HCV) elimination targets, it is essential to increase access to treatment. Direct-acting antiviral (DAA) treatment can be provided in primary healthcare services (PHCS), improving accessibility, and, potentially, retention in care. Here, we describe our protocol for assessing the effectiveness of providing DAAs in PHCS, and the impact on the HCV care cascade. In addition, we reflect on the challenges of conducting a model of care study during a period of unprecedented change in HCV care and treatment. Methods: Consenting patients with HCV infection attending 13 PHCS in Australia or New Zealand are randomized to receive DAA treatment at the local tertiary institution (standard care arm), or their PHCS (intervention arm). The primary endpoint is the proportion commenced on DAAs and cured. Treatment providers at the PHCS include: hepatology nurses, primary care practitioners, or, in two sites, a specialist physician. All PHCS offer opioid substitution therapy. Discussion: The Prime Study is the first real-world, randomized, model of care study exploring the impact of community provision of DAA therapy on HCV-treatment uptake and cure. Although the study has faced challenges unique to this period of time characterized by changing treatment and service delivery, the data gained will be of critical importance in shaping health service policy that enables the elimination of HCV

Genes as Tags: The Tax Implications of Widely Available Genetic Information

This paper examines how progress in genetics\u27 specifically, the proliferation of knowledge about the human genome\u27 may influence the feasibility and desirability of a tax that is based on individual human endowments or ability. The paper explores various forms that such a genetic endowment tax-and-transfer regime might take and identifies some of the benefits and costs of such a regime. The authors take no position on whether a genetic endowment tax would be desirable or not. However, one contribution of the paper is to observe that current law in the U.S., which restricts the use of genetic information by insurers and employers, is equivalent to a form of genetic endowment tax. The paper also notes that, in the absence of a government-mandated transfer policy with respect to genetic endowments, private insurance markets may arise to fill the gap, allowing individuals to purchase insurance against the possibility of a bad genetic draw