Benefit Plan Design and Prescription Drug Utilization Among Asthmatics: Do Patient Copayments Matter?

Objective: The ratio of controller to reliever medication use has been proposed as a measure of treatment quality for asthma patients. In this study we examine the effects of plan level mean out-of-pocket asthma medication patient copayments and other features of benefit plan design on the use of controller medications alone, controller and reliever medications (combination therapy), and reliever medications alone. Methods: 1995-2000 MarketScan claims data were used to construct plan-level out-of-pocket copayment and physician/practice prescriber preference variables for asthma medications. Separate multinomial logit models were estimated for patients in fee-for-service (FFS) and non-FFS plans relating benefit plan design features, physician/practice prescribing preferences, patient demographics, patient comorbidities and county-level income variables to patient-level asthma treatment patterns. Results: We find that the controller reliever ratio rose steadily over 1995-2000, along with out-of-pocket payments for asthma medications, which rose more for controllers than for relievers. However, after controlling for other variables, plan level mean out-of-pocket copayments were not found to have a statistically significant influence upon patient-level asthma treatment patterns. On the other hand, physician practice prescribing patterns strongly influenced patient level treatment patterns. Conclusions: There is no strong statistical evidence that higher levels of out-of-pocket copayments for prescription drugs influence asthma treatment patterns. However, physician/practice prescribing preferences influence patient treatment.

Geologic Mapping in the Hesperia Planum Region of Mars

Hesperia Planum, characterized by a high concentration of mare-type wrinkle ridges and ridge rings, encompasses > 2 million square km in the southern highlands of Mars. The most common interpretation is that the plains were emplaced as "flood" lavas with total thicknesses of <3 km [4-10]. The wrinkle ridges on its surface make Hesperia Planum the type locale for "Hesperian-aged ridged plains" on Mars, and wrinkle-ridge formation occurred in more than one episode. Hesperia Planum s stratigraphic position and crater-retention age define the base of the Hesperian System. However, preliminary results of geologic mapping reveal that the whole of Hesperia Planum is unlikely to be composed of the same materials, emplaced at the same geologic time. To unravel these complexities, we are generating a 1:1.5M-scale geologic map of Hesperia Planum and its surroundings. To date, we have identified 4 distinct plains units within Hesperia Planum and are attempting to determine the nature and relative ages of these materials

Mapping Hesperia Planum, Mars

Hesperia Planum, characterized by a high concentration of mare-type wrinkle ridges and ridge rings [1-4], encompasses > 2 million km2 in the southern highlands of Mars (Fig. 1). The most common interpretation is that the plains were emplaced as flood lavas with total thicknesses of <3 km [4-10]. The wrinkle ridges on its surface make Hesperia Planum the type locale for Hesperian-aged ridged plains on Mars [e.g., 9], and recent investigations reveal that wrinkle-ridge formation occurred in more than one episode [4]. Hesperia Planum s stratigraphic position and crater-retention age [e.g., 9, 11-12] define the base of the Hesperian System. However, preliminary results of geologic mapping reveal that the whole of Hesperia Planum is unlikely to be composed of the same materials, emplaced at the same geologic time. To unravel these complexities, we are generating a 1:1.5M-scale geologic map of Hesperia Planum and its surroundings (Fig. 1). To date, we have identified 4 distinct plains units within Hesperia Planum and are attempting to determine the nature and relative ages of these materials (Fig. 2) [13-15]

THE WRITING LIFE OF ROBERT STORY, 1795-1860: ‘THE CONSERVATIVE BARD’

This thesis explores the writing life of the Northumbrian labouring-class poet Robert Story (1795-1860) who, during the political turmoil of the 1830s, achieved national celebrity for writing a series of songs and poems for Peel’s Conservative party. In his unpublished autobiography (c.1853) he alludes to building an archive of his work. Drawing on these manuscripts, all of which have until now remained hidden, and his published writing, this thesis investigates the relationship between Story’s apparent political conservatism and his progressive and experimental approach to writing. The study is organised into three main parts. The first forms a study of Story’s biographical manuscripts, using his accounts of reading to raise the wider complex theoretical questions that inform the thesis. It goes beyond Story’s connection with the pastoral tradition and hypothesises that Story’s writing was always rhetorical. Tracing Story’s circle of ‘brother’ poets, part two locates him in a distinctly labouring-class canon, imagined or otherwise, that he believed was at least equal to the polite realm of literature. This phase of research also resituates Story’s satirical modes of writing and his party ballads within the great body of political literature produced by working men during the first half of the nineteenth century. Story’s importance lies not only in his pursuit of politics but also in his cultural ambition: the third part of the thesis examines formal hybridity in his writing. It reveals how Story was searching for new forms of self-expression and asks to what extent his pursuit of literature was politicised and predicated on the belief that social and economic emancipation was contingent on cultural equality. Overall this thesis argues that Story was using literature to challenge the political, social and cultural boundaries imposed on him as both a workingman and a labouring-class writer

Staff experience of harassment and stalking behaviour by patients

Staff from one National Health Service (NHS) Trust in England completed an online survey (N = 590) about their experience of intrusive behaviours from patients. These experiences were categorised into either stalking or harassment and compared in terms of staff and patient characteristics, types of intrusions, and aftermath. Overall, 150 were classified as being stalked (25.4%) and 172 harassed (29.2%). There were no differences in staff characteristics between the two groups. Staff from forensic services and nursing staff were particularly susceptible to these intrusions which took many forms. Respondents perceived a range of causes for the stalking and harassment, the most common being to gain power and control/to scare. It was rare for legal sanctions to be brought against the patient. Our findings reinforce the need for service providers to have policies supported with preventative measures, education and a robust process for addressing stalking so that these measures are embedded in practice in a way that supports staff working with patients. Furthermore, service providers should be challenged on what steps they have taken to prevent, and monitor, such behaviour

Volcanism on Io: Insights from Global Geologic Mapping

We are preparing a new global geo-logic map of Jupiter s volcanic moon, Io. Here we report the type of data that are now available from our global mapping efforts, and how these data can be used to investigate questions regarding the volcano-tectonic evolution of Io. We are using the new map to investigate several specific questions about the geologic evolution of Io that previously could not be well addressed, including (for example) a comparison of the areas vs. the heights of Ionian mountains to assess their stability and evolution (Fig. 1). The area-height relationships of Io s visible mountains show the low abundance and low relief of volcanic mountains (tholi) relative to tectonic mountains, consistent with formation from low-viscosity lavas less likely to build steep edifices. Mottled mountains are generally less high than lineated mountains, consistent with a degradational formation