Utilization of the Kentucky AIDS Drug Assistance Program versus Kentucky Medicaid Using Medication Possession Ratio: Policy Implications for Public Program

Uninsured and underinsured people living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) are able to utilize federally funded AIDS Drug Assistance Programs (ADAPs) to cover the price of their HIV-related medications. In Kentucky, this program also provides support services through social workers, a dedicated pharmacist, and medications by mail order. With the Affordable Care Act, many patients previously covered by the Kentucky AIDS Drug Assistance Program (KADAP) will be newly eligible for Medicaid and will no longer receive services through KADAP. There is concern that people in this situation will be at a disadvantage without these services and, in turn, be less adherent to their medications. People living with HIV/AIDS should regularly take ≥95% of their medications in order to prevent medication resistance and disease-related morbidity and mortality. The purpose of this study is to determine the average medication adherence of patients in KADAP and Kentucky Medicaid, evaluate whether people enrolled in Medicaid have significantly lower adherence compared to KADAP, and determine if any demographic variables are associated with medication nonadherence in either program through multivariate regression. With this information, recommendations will be made regarding what can be done from programmatic and policy standpoints to increase medication adherence in this population. Pharmacy claims and demographic data were collected from the Kentucky Clinic Pharmacy and the Bluegrass Care Clinic at the University of Kentucky for all of 2011. Medication adherence was calculated using the medication possession ratio (MPR), which calculates the percentage of time the patient has their medications on hand each month based on pharmacy claims data. The average MPR for KADAP patients is 84.7% (n=2,2024; range: 14.9%-100%) and the average MPR for Medicaid patients is 77.3% (n=55; range: 16.4%-100%). When KADAP and Medicaid data were combined, 3 variables were significantly associated with MPR in multivariate regression: age (coef: 0.123, p Younger, black KADAP patients tend to have lower MPRs and Kentucky Medicaid patients have significantly lower MPRs than KADAP patients. In order to increase adherence, the policy regarding Medicaid and KADAP co-enrollment should be changed to allow newly eligible Medicaid patients to continue using KADAP’s services without financial need. Additionally, pharmacy call lists could be made, with priority on younger, black KADAP patients, for refill reminders and to open dialogue between the patient and the pharmacist regarding medication concerns

Integrating technology into the mathematics curriculum

This is a Graduate Review of the actual work being implemented by a group of six math teachers at Lakeview Elementary. The initiative began because of an on-going problem of students receiving low-test scores in mathematics. Students also had a difficult time retaining the mathematics concepts and skills being taught. Through discussions and surveys, a possible solution was found . A Literacy Technology Challenge Grant from the Department of Education was awarded to help teachers learn to integrate technology within the math curriculum. Teachers are also learning new strategies that will allow students to actually grasp the concept and meaning of rational numbers by using these technologies

Family Dinner Across Generations: My How Times Have Changed?

In an effort to determine differences between family dinners across generations, this study examined typical family dinners of participants and how they have changed across the four generations addressed. Previous qualitative research has been conducted to determine communication frames that occur during family dinners and the effect of parenting styles on family dinners, but little research connecting generational differences to family dinners has been published. Data were collected from a homogeneous sample of twenty-four women living in three counties across the Commonwealth of Kentucky. By asking open ended questions during interviews, similarities and differences between family dinners across generations were identified, and target approaches to increase the frequency of future family dinners were discussed

Pharmacists\u27 Preparedness For Acute Medical Emergencies

Purpose/Objectives: This project studied how prepared community pharmacists are to respond to acute medical emergencies, as well as their perceived efficacy in addressing these situations. Specifically, it considered what training pharmacists have for responding to medical emergencies, what emergency medical equipment pharmacies have on-hand, the frequency that medical emergencies occur within pharmacies, and the types of emergencies encountered. It also measured self and collective efficacy of pharmacists in responding to medical emergencies within their pharmacy to determine if differences in self-efficacy or collective efficacy exist. Methods: This study utilized a cross-sectional, non-experimental, descriptive design via a self-administered, Internet-based survey distributed through email to a national sample of community pharmacists assembled by Delta Marketing Dynamics Healthcare Research. Responses yielded 393 usable completed surveys. Measures were created for demographic characteristics of respondent community pharmacists and questions concerning the training received by community pharmacists and others working within the pharmacy, the frequency with which such emergencies occur within the community setting, as well as their level of preparedness and emergency equipment available for addressing acute medical emergencies. Two scales were developed including a sixteen item scale to assess pharmacists\u27 self-efficacy and a thirteen item scale to assess pharmacists\u27 collective efficacy views for responding to medical emergencies. PCA was conducted to determine the factors affecting either self or collective efficacy, which comprised two components for each scale of BLS-related and non-BLS related skills. MANOVA was used to determine whether differences exist between pharmacists\u27 self and collective efficacy and their practice location, type of practice, position and prior experience. Results/Discussion: Most pharmacists reported training in CPR at some point in their career, although approximately half had current certifications for CPR/BLS. Comemergency equipment available were items that would be expected in a pharmacy (e.g. gloves, Epi Pens, Glucagon kits). Although a majority of pharmacies had a first aid kit of available, less than 10% had access to an AED. MANOVA results shosignificant differences between location of practice for the self efficacy non-BLS component and both collective efficacy components, type of practice for the BLS-skills component, and prior CPR experience for non-BLS skills component

Synthesis and Characterisation of Single Crystal Transparent Conducting Oxide - Gallium Doped Zinc Antimonate

This thesis focuses on the synthesis and characterisation of a new transparent conducting oxide (TCO) Zn1-xGaxSb2O6 (ZGSO). Polycrystalline powders of ZGSO were obtained using a novel reaction technique, designed to minimise the evaporation of antimony. Powder x-ray diffraction confirmed the powders to be phase pure and with mass increases indicating nearly complete oxidation. Out of these powders, single crystals of ZGSO were synthesised via a refi ned chemical vapour transport (CVT) technique using Cl2 as a transport agent. Investigations into the electronic properties of undoped single crystals indicated n-type semiconducting behaviour. UV - Vis spectroscopy revealed a wide optical band gap (3.38 eV) allowing transparency throughout the visible region. Substituting small amounts of Ga+3 onto the Zn+2 lattice site increased the electron carrier density by three orders of magnitude, and created a degenerate semiconductor. Low resistivities ~ 5 x 10^-4 Ω.cm were observed while retaining a wide enough band gap to prevent opacity of visible light, therefore, proving ZGSO behaves as a TCO. Energy dispersive x-ray spectroscopy (EDS) was used to quantify the cation stoichiometry in the crystals. The gallium concentration was found to vary significantly between samples and even across an individual sample indicating an erratic nature to the doping process. X-ray diffraction revealed a reduction in lattice parameters and correspondingly unit cell volume upon doping. Lab-based x-ray photoemission spectroscopy (XPS) and synchrotron-based hard x-ray photoemission spectroscopy (HAXPES) were used to measure the core levels and valence band in doped and undoped crystals. Analysis of the core peak position revealed a shift to higher binding energies under the influence of doping, a direct consequence of conduction band filling. Measurements of the valence band using HAXPES significantly enhanced the intensity of the conduction band. This is explained by the changing photoionisation cross sections as a function of photon energy. Similarly, HAXPES revealed an in-gap state that was attributed to the 5s orbital of a fraction of Sb+3 existing in the crystals. Data presented from an angle-resolved photoemission spectroscopy (ARPES) study on a (001) surface in highly doped ZGSO revealed an electron band dispersion in the valence band however displaying significantly k broadening. The absence of obvious cleavage planes in the trirutile structure prevented a quality cleaved surface for measurement. Therefore, due to the poor quality of the data, quantification of the conduction band's effective mass could not be achieved

Alternative reproductive tactics and evolutionary rescue

Almost all life on earth is facing environmental change, and understanding how populations will respond to these changes is of urgent importance. One factor that is known to affect the speed by which a population can evolve when faced with changes in the environment is strong sexual selection. This increases the adaptive capacity of a population by increasing reproductive skew toward well-adapted (usually) males who will, on average, be best able to compete for matings. This effect could potentially be disrupted when males pursue alternative reproductive tactics (ARTs), whereby males within a species exhibit qualitatively different behaviors in their pursuit of matings. ARTs are diverse, but one common class is those expressed through condition-dependent polyphenism such that high-quality, well-adapted males compete aggressively for mates and low-quality, poorly adapted males attempt to acquire matings via other, nonaggressive behaviors. Here, using an individual-based modeling approach, we consider the possible impacts of ARTs on adaptation and evolutionary rescue. When the ART is simultaneous, meaning that low-quality males not only engage in contests but also pursue other tactics, adaptive capacity is reduced and evolutionary rescue, where a population avoids extinction by adapting to a changing environment, becomes less likely. This is because the use of the ART allows low-quality males to contribute more maladaptive genes to the population than would happen otherwise. When the ART is fixed, however, such that low-quality males will only use the alternative tactic and do not engage in contests, we find the opposite: adaptation happens more quickly and evolutionary rescue when the environment changes is more likely. This surprising effect is caused by an increase in the mating success of the highest quality males who face many fewer competitors in this scenario—counterintuitively, the presence of males pursuing the ART increases reproductive skew toward those males in the best condition

Managing media uncertainty: exploring multiple futures with multiple strategies

The UK Media Industry operates in a highly turbulent environment, and one that is primarily characterised by rapid changes in digital technologies and the threat of new competitive entrants (Kung 2008; Doyle, 2013; Oliver, 2013). Similarly, new digital technologies have dis-intermediated value chains (Barwise and Picard, 2012) and changed the dynamics of the industry to the extent that traditional broadcast media companies no longer act as the sole intermediaries of mediated content. Indeed, innovative Internet Protocal TV (IPTV), Web TV and streaming services provided by the likes BT Vision, YouTube and Amazon Prime are making significant in-roads into traditional audience market share, particularly amongst the younger demographic. This type of competitive environment makes it difficult for media executives who are responsible for planning and executing Corporate Level Strategy. This in turn places increased scrutiny on the strategic planning tools that are used to undertake a rational and comprehensive analysis of the competitive dynamics and inform strategy formulation. This paper will present empirical findings and reflections on a scenario planning project that sought to develop a long-term Corporate Level Strategy for YouTube. As such, it is positioned within the ‘Strategy as Practice’ (Whittington, 1996; Jarzabkowski & Kaplan, 2015) domain as it combines academics with an interest in the practice of media management, with media practitioners. This view of media strategy focuses on the ‘doing of strategy’ and is particularly interested in the methods and tools that executives use to develop their media organisation’s strategy. As such, this paper presents empirical findings and reflections on a scenario planning project with media industry practitioners who sought to develop a long-term Corporate Level Strategy in the most uncertain of media environments. The use of Scenario Planning as a management tool is apt, since Oliver (2013) found it to be ‘Power Tool’ in the management of UK media firms due to the high levels of usage and satisfaction that companies were reporting