Utilization and spending trends for antiretroviral medications in the U.S. Medicaid program from 1991 to 2005

<p>Abstract</p> <p>Background</p> <p>HIV/AIDS incidence and mortality rates have decreased in the U.S. since 1996. Accompanying the longer life spans of those diagnosed with the disease, however, is a tremendous rise in expenditures on medication. The objective of this study is to describe the trends in utilization of, spending on, and market shares of antiretroviral medications in the U.S. Medicaid Program. Antiretroviral drugs include nucleoside reverse transcriptase inhibitors (NRTIs), protease inhibitors (PIs), nonnucleoside reverse transcriptase inhibitors (NNRTIs), and fusion inhibitors (FIs).</p> <p>Methods</p> <p>Utilization and payment data from 1991 to 2005 are provided by the Centers for Medicare & Medicaid Services. Descriptive summary analyses were used to assess quarterly prescription numbers and amounts of payment.</p> <p>Results</p> <p>The total number of prescriptions for antiretrovirals increased from 168,914 in 1991 to 2.0 million in 1998, and 3.0 million in 2005, a 16.7-fold increase over 15 years. The number of prescriptions for NRTIs reached 1.6 million in 2005. Prescriptions for PIs increased from 114 in 1995 to 932,176 in 2005, while the number of prescriptions for NNRTIs increased from 1,339 in 1996 to 401,272 in 2005. The total payment for antiretroviral drugs in the U.S. Medicaid Program increased from US$30.6 million in 1991 to US$ 1.6 billion in 2005, a 49.8-fold increase. In 2005, NRTIs as a class had the highest payment market share. These drugs alone accounted for US$787.9 million in Medicaid spending (50.8 percent of spending on antiretrovirals). Payment per prescription for each drug, with the exception of Agenerase^®, increased, at least somewhat, over time. The relatively expensive drugs in 2005 included Trizivir^®($1040) and Combivir^®($640), as well as Reyataz^®($750), Lexiva^®($700), Sustiva^®($420), Viramune^®($370), and Fuzeon^®($1914).</p> <p>Conclusion</p> <p>The tremendous growth in antiretroviral spending is due primarily to rising utilization, secondarily to the entry of newer, more expensive antiretrovirals, and, finally, in part to rising per-prescription cost of existing medications.</p

Icolos: a workflow manager for structure-based post-processing of de novo generated small molecules

A Summary: We present Icolos, a workflow manager written in Python as a tool for automating complex structure-based workflows for drug design. Icolos can be used as a standalone tool, for example in virtual screening campaigns, or can be used in conjunction with deep learning-based molecular generation facilitated for example by REINVENT, a previously published molecular de novo design package. In this publication, we focus on the internal structure and general capabilities of Icolos, using molecular docking experiments as an illustrative example

Spin diffusion in doped semiconductors

The behavior of spin diffusion in doped semiconductors is shown to be qualitatively different than in undoped (intrinsic) ones. Whereas a spin packet in an intrinsic semiconductor must be a multiple-band disturbance, involving inhomogeneous distributions of both electrons and holes, in a doped semiconductor a single-band disturbance is possible. For n-doped nonmagnetic semiconductors the enhancement of diffusion due to a degenerate electron sea in the conduction band is much larger for these single-band spin packets than for charge packets, and can exceed an order of magnitude at low temperatures even for equilibrium dopings as small as 10^16 cm^-3. In n-doped ferromagnetic and semimagnetic semiconductors the motion of spin packets polarized antiparallel to the equilibrium carrier spin polarization is predicted to be an order of magnitude faster than for parallel polarized spin packets. These results are reversed for p-doped semiconductors.Comment: 8 pages, 4 figure

To what extent can headteachers be held to account in the practice of social justice leadership?

Internationally, leadership for social justice is gaining prominence as a global travelling theme. This article draws from the Scottish contribution to the International School Leadership Development Network (ISLDN) social justice strand and presents a case study of a relatively small education system similar in size to that of New Zealand, to explore one system's policy expectations and the practice realities of headteachers (principals) seeking to address issues around social justice. Scottish policy rhetoric places responsibility with headteachers to ensure socially just practices within their schools. However, those headteachers are working in schools located within unjust local, national and international contexts. The article explores briefly the emerging theoretical analyses of social justice and leadership. It then identifies the policy expectations, including those within the revised professional standards for headteachers in Scotland. The main focus is on the headteachers' perspectives of factors that help and hinder their practice of leadership for social justice. Macro systems-level data is used to contextualize equity and outcomes issues that headteachers are working to address. In the analysis of the dislocation between policy and reality, the article asks, 'to what extent can headteachers be held to account in the practice of social justice leadership?

Diethyl [2,2,2-trifluoro-1-phenyl­sulfonyl­amino-1-(trifluoro­meth­yl)eth­yl]phospho­nate

The title compound, C13H16F6NO5PS, is of inter­est with respect to inhibition of serine hydro­lases. Its structure contains a 1.8797 (13) Å P—C bond and two inter­molecular N—H⋯O=P hydrogen bonds, resulting in centrosymmetric dimers. An intra­molecular N—H⋯O=P hydrogen bond is also present

The First Extrasolar Planet Discovered with a New Generation High Throughput Doppler Instrument

We report the detection of the first extrasolar planet, ET-1 (HD 102195b), using the Exoplanet Tracker (ET), a new generation Doppler instrument. The planet orbits HD 102195, a young star with solar metallicity that may be part of the local association. The planet imparts radial velocity variability to the star with a semiamplitude of $63.4\pm2.0$ m s$^{-1}$ and a period of 4.11 days. The planetary minimum mass ($m \sin i$) is $0.488\pm0.015$ $M_J$.Comment: 42 pages, 11 figures and 5 tables, Accepted for publication in Ap

Ubiquitous CP violation in a top-inspired left-right model

We explore CP violation in a Left-Right Model that reproduces the quark mass and CKM rotation angle hierarchies in a relatively natural way by fixing the bidoublet Higgs VEVs to be in the ratio m_b:m_t. Our model is quite general and allows for CP to be broken by both the Higgs VEVs and the Yukawa couplings. Despite this generality, CP violation may be parameterized in terms of two basic phases. A very interesting feature of the model is that the mixing angles in the right-handed sector are found to be equal to their left-handed counterparts to a very good approximation. Furthermore, the right-handed analogue of the usual CKM phase delta_L is found to satisfy the relation delta_R \approx delta_L. The parameter space of the model is explored by using an adaptive Monte Carlo algorithm and the allowed regions in parameter space are determined by enforcing experimental constraints from the K and B systems. This method of solution allows us to evaluate the left- and right-handed CKM matrices numerically for various combinations of the two fundamental CP-odd phases in the model. We find that all experimental constraints may be satisfied with right-handed W and Flavour Changing Neutral Higgs masses as low as about 2 TeV and 7 TeV, respectively.Comment: 37 pages, 13 figure

Endemicity of Zoonotic Diseases in Pigs and Humans in Lowland and Upland Lao PDR: Identification of Socio-cultural Risk Factors

In Lao People's Democratic Republic pigs are kept in close contact with families. Human risk of infection with pig zoonoses arises from direct contact and consumption of unsafe pig products. This cross-sectional study was conducted in Luang Prabang (north) and Savannakhet (central-south) Provinces. A total of 59 villages, 895 humans and 647 pigs were sampled and serologically tested for zoonotic pathogens including: hepatitis E virus (HEV), Japanese encephalitis virus (JEV) and Trichinella spiralis; In addition, human sera were tested for Taenia spp. and cysticercosis. Seroprevalence of zoonotic pathogens in humans was high for HEV (Luang Prabang: 48.6%, Savannakhet: 77.7%) and T. spiralis (Luang Prabang: 59.0%, Savannakhet: 40.5%), and lower for JEV (around 5%), Taenia spp. (around 3%) and cysticercosis (Luang Prabang: 6.1, Savannakhet 1.5%). Multiple correspondence analysis and hierarchical clustering of principal components was performed on descriptive data of human hygiene practices, contact with pigs and consumption of pork products. Three clusters were identified: Cluster 1 had low pig contact and good hygiene practices, but had higher risk of T. spiralis. Most people in cluster 2 were involved in pig slaughter (83.7%), handled raw meat or offal (99.4%) and consumed raw pigs' blood (76.4%). Compared to cluster 1, cluster 2 had increased odds of testing seropositive for HEV and JEV. Cluster 3 had the lowest sanitation access and had the highest risk of HEV, cysticercosis and Taenia spp. Farmers which kept their pigs tethered (as opposed to penned) and disposed of manure in water sources had 0.85 (95% CI: 0.18 to 0.91) and 2.39 (95% CI: 1.07 to 5.34) times the odds of having pigs test seropositive for HEV, respectively. The results have been used to identify entry-points for intervention and management strategies to reduce disease exposure in humans and pigs, informing control activities in a cysticercosis hyper-endemic village