Lessons for Medicare Part D in the hemodialysis community

BACKGROUND: Medicare beneficiaries without prescription drug coverage consistently fill fewer prescriptions than beneficiaries with some form of drug coverage due to cost. ESRD patients, who are disproportionately poor and typically use multiple oral medications, would likely benefit substantially from any form of prescription drug coverage. Because most hemodialysis patients are Medicare-eligible, they as well as their providers would be expected to be well informed of changes in Medicare prescription drug coverage. By examining the level of understanding and use of the temporary Medicare Prescription Drug Discount Card Program in the hemodialysis population, we can gain a better understanding of the potential long-term utilization for Medicare Part D. METHODS: We surveyed English-speaking adult hemodialysis patients with Medicare coverage from two urban hemodialysis centers affiliated with the University of California San Francisco (UCSF) during July and August 2005 (n = 70). We also surveyed University- and community-based nephrologists and non-physician dialysis health care professionals over the same time frame (n = 70). RESULTS: Fifty-nine percent of patients received prescription drug coverage through Medi-Cal, 20% through another insurance program, and 21% had no prescription drug coverage. Forty percent of patients with no prescription drug coverage reported "sometimes" or "rarely" being able to obtain medications vs. 22% of patients with some form of drug coverage. None of the patients surveyed actually had a Medicare-approved prescription drug card, and of those who intended to apply, only 10% reported knowing how to do so. Only 11% health care professionals knew the eligibility requirements of the drug discount cards. CONCLUSION: Despite a significant need, hemodialysis patients and providers were poorly educated about the Medicare Prescription Drug Discount Cards. This has broad implications for the dissemination of information about Medicare Part D

Electroweak parameters of the z0 resonance and the standard model

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Transport and dispersion across wiggling nanopores

The transport of fluids at the nanoscale has achieved major breakthroughs over recent years 1-4 ; however, artificial channels still cannot match the efficiency of biological porins in terms of fluxes or selectivity. Pore shape agitation-due to thermal fluctuations or in response to external stimuli-is believed to facilitate transport in biochannels 5-9 , but its impact on transport in artificial pores remains largely unex-plored. Here we introduce a general theory for transport through thermally or actively fluctuating channels, which quantifies the impact of pore fluctuations on confined diffusion in terms of the spectral statistics of the channel fluctuations. Our findings demonstrate a complex interplay between transport and surface wiggling: agitation enhances diffusion via the induced fluid flow, but spatial variations in pore geometry can induce a slowing down via entropic trapping , in full agreement with molecular dynamics simulations and existing observations from the literature. Our results elucidate the impact of pore agitation in a broad range of artificial and biological porins, but also, at larger scales, in vascular motion in fungi, intestinal contractions and micro-fluidic surface waves. These results open up the possibility that transport across membranes can be actively tuned by external stimuli, with potential applications to nanoscale pumping, osmosis and dynamical ultrafiltration.Interactions induites par des fluctuations entre interfaces molles dans les systèmes complexesTransport hors equilibre de fluides aux échelles nanométriquesEquipement d'excellence de calcul intensif de Mesocentres coordonnés - Tremplin vers le calcul petaflopique et l'exascal