National Pharmacare in Canada: 2019 or Bust?

It is the Canadian public policy issue that rears its head with regularity, never achieving much more than discussion, and yet never going away entirely. The issue is pharmacare, and once again it is back for discussion among academics and policy-makers, and once again it looks like the discussions will not go anywhere anytime soon. The proposal for a publicly funded pharmaceuticalcoverage plan is frequently on the table in Canada, but it still is not in the cards.Canada is the only member country of the Organisation for Economic Cooperation and Development (OECD) with a public health-care system that does not include coverage for pharmaceuticals. As a result, Canada spends markedly less public money than the OECD average on pharmaceuticals (42 per cent of drug payments are public funds, versus the average 70 per cent), although it also spends more than the OECD average on hospitals and doctor visits. Advocates for an expansion of the publicly funded medicare system to include prescription medication note that it has become common for some lower-income Canadians who lack private drug insurance to leave prescriptions unfilled due to the cost, or will miss doses. This affordability problem for lower-income Canadians appears to be getting more serious.However, while Canadians seem to express support for the idea of pharmacare when asked about it in surveys, it remains well behind a list of other improvements to the health-care system that they consider to be of higher priority. They are more interested in improving access and wait times, and they are more concerned about the sustainability of the current system given the increased demands of the aging population. Both employers and workers, meanwhile, also support the existing model of employer-provided drug plans. Perhaps the biggest obstacle for champions of pharmacare, however, is that the term can mean so many different things to different people. There is virtually no consensus on what would even be the appropriate Canadian system, particularly in light of how significant a factor private coverage already is in Canada. A pharmacare plan might include anything from the drastic step of eliminating all private coverage and subsidizing all prescription medicine for all patients regardless of income, to a much narrower program that covers some portion of the cost of only some drugs, for some income levels. There are also countless different possible models between those two. The matter of how much each level of government, provincial/territorial or federal, would be responsible for funding drugs is a whole other, rather thorny matter. The timing of this latest discussion about pharmacare — stimulated mainly by recent proposals and fuelled by the success of the pan-Canadian Pharmaceutical Alliance in negotiating better bulk drug prices — is also particularly unfavourable. There has been a sudden shift in the dynamic between the federal government and the provinces, where before premiers stood together and collectively bargained with the federal government for health-care funding, but recently splintered and are now making individual deals (while Quebec continues to insist that it must have complete freedom from Ottawa to design its own health system). The difficult fiscal situation across Canada, with so many governments running up debts, would also seem to make it highly unlikely that there will be much enthusiasm for embarking on a new and sizeable social program costing billions of dollars a year. Lacking enough leaders to passionately champion it, and with a public generally uninterested and very unclear on what a national pharmacare program would even entail, it seems that the current discussion about implementing a pharmacare system may come to a stall, like so many discussions before it

Menstrual Phase Differences in Muscle Deoxygenation, Respiration and Blood Lactate Concentration Do Not Influence Exercise Performance

The purpose was to evaluate muscle deoxygenation (Δ[HHb]), oxygen uptake (VO2), ventilation (VE), and arterialized blood lactate [La-] throughout exhaustive incremental (RAMP) and severe-intensity exercise (SI) during follicular (FOL) and luteal (LUT) menstrual phases. During RAMP, Δ[HHb]/VO2 was 65% lower in LUT below gas exchange threshold (p0.05). During SI,Δ[HHb]/VO2 was 18% lower in LUT during the kinetic phase (p0.05). No FOL/LUT differences in RAMP-performance (FOL: 218 ± 35 W; LUT: 221 ± 29 W) or SI-endurance (FOL: 99 ± 20 s; LUT: 96 ± 15 s) (p\u3e0.05) were found. These data demonstrate that physiological differences between menstrual phases exist, however, performance is unaffected

Trajectory of Substance Use Disorders and Collegiate Recovery in Emerging Adults

Abstract Collegiate Recovery Programs (CRPs) provide services to support emerging adults achieve academic success, while maintaining substance use disorder recovery. College and university campuses can often be considered abstinence-hostile environments, giving rise to the need of support services for students in recovery. A nationwide survey to understand the efficacy of services provided by CRPs was conducted to assess the demographics and academic profiles of students involved with CRPs. Co-occurring disorders including mental health issues, criminal histories, utilizations of recovery services and 12-step groups, and work histories of students were also assessed. CRPs can provide services and an environment to students that increase recovery capital domains. Recovery capital domains such as spirituality, health and wellness, academics, critical thinking and discernment, personal achievement, and service opportunities may be related to metrics of academic success such as grade point average. However, measuring success for those in substance use disorder recovery through academics metrics alone could present a barrier to improving recovery services. Assessing the effectiveness of CRP programs through the lens of recovery capital offers a strengths-based, wholistic approach to improving services for students in recovery. Future directions include administering comprehensive measurements for recovery success, in addition to academic metrics, for students that are members of CRP. Keywords: Substance Use Recovery; Emerging Adults; Collegiate Recovery Program

Longitudinal cohort of HIV-negative transgender women of colour in New York City: protocol for the TURNNT ('Trying to Understand Relationships, Networks and Neighbourhoods among Transgender women of colour') study.

IntroductionIn the USA, transgender women are among the most vulnerable to HIV. In particular, transgender women of colour face high rates of infection and low uptake of important HIV prevention tools, including pre-exposure prophylaxis (PrEP). This paper describes the design, sampling methods, data collection and analyses of the TURNNT ('Trying to Understand Relationships, Networks and Neighbourhoods among Transgender women of colour') study. In collaboration with communities of transgender women of colour, TURNNT aims to explore the complex social and environmental (ie, neighbourhood) structures that affect HIV prevention and other aspects of health in order to identify avenues for intervention.Methods and analysesTURNNT is a prospective cohort study, which will recruit 300 transgender women of colour (150 Black/African American, 100 Latina and 50 Asian/Pacific Islander participants) in New York City. There will be three waves of data collection separated by 6 months. At each wave, participants will provide information on their relationships, social and sexual networks, and neighbourhoods. Global position system technology will be used to generate individual daily path areas in order to estimate neighbourhood-level exposures. Multivariate analyses will be conducted to assess cross-sectional and longitudinal, independent and synergistic associations of personal relationships (notably individual social capital), social and sexual networks, and neighbourhood factors (notably neighbourhood-level social cohesion) with PrEP uptake and discontinuation.Ethics and disseminationThe TURNNT protocol was approved by the Columbia University Institutional Review Board (reference no. AAAS8164). This study will provide novel insights into the relationship, network and neighbourhood factors that influence HIV prevention behaviours among transgender women of colour and facilitate exploration of this population's health and well-being more broadly. Through community-based dissemination events and consultation with policy makers, this foundational work will be used to guide the development and implementation of future interventions with and for transgender women of colour

Cross-Transfer Effects on Muscle Strength, Size, and Quality following Unilateral Blood Flow Restriction Training

Unilateral resistance training (RT) has been shown to induce contralateral strength improvements in the untrained homologous muscle. Notably, low-load blood flow restriction (BFR) RT has shown superior increases in muscle strength and hypertrophy compared to low-load non-BFR RT. Previous literature has also reported that BFR RT has systemic cross-transfer effects of strength on other active skeletal muscles compared to low-load non-BFR RT. PURPOSE: Therefore, the purpose was to examine the cross-transfer effects of 4 weeks of unilateral BFR dorsiflexion RT on muscle strength, hypertrophy, and muscle quality. METHODS: Fourteen untrained participants were randomized into two groups: (BFR; n=8) (177.6 ± 4.1 cm, 84.8 ± 15.1 kg, 21.3 ± 1 years) or control (non-BFR; n=6) (173.2 ± 7.5 cm, 77.9 ± 10.3 kg, 23 ± 2.6 years). Subjects completed 4 weeks (8 sessions) of unilateral isokinetic dorsiflexion RT at 30% of their daily peak torque at a velocity of 60°/s. Isokinetic peak torque, echo intensity (EI), and muscle cross-sectional area (mCSA) were taken bilaterally pre and post RT. Statistical analyses included 3 separate 3-way mixed factorial ANOVAs (Group [BFR, non-BFR] x Time [pre, post] x Leg [right, left]). RESULTS: For isokinetic strength, there were no significant interactions or main effects (p\u3e.05). For EI, there were no significant interactions (p\u3e.05); however, when collapsed across time and leg, there was a significant main effect for group (p=.017; BFR (91.7 ± 1.6 vs. non-BFR (84.8 ± 1.9); mean ± SE). Furthermore, there was no significant interaction for mCSA (p\u3e.05), but there was a significant main effect for time (

National Pharmacare in Canada: 2019 or Bust?

It is the Canadian public policy issue that rears its head with regularity, never achieving much more than discussion, and yet never going away entirely. The issue is pharmacare, and once again it is back for discussion among academics and policy-makers, and once again it looks like the discussions will not go anywhere anytime soon. The proposal for a publicly funded pharmaceuticalcoverage plan is frequently on the table in Canada, but it still is not in the cards. Canada is the only member country of the Organisation for Economic Cooperation and Development (OECD) with a public health-care system that does not include coverage for pharmaceuticals. As a result, Canada spends markedly less public money than the OECD average on pharmaceuticals (42 per cent of drug payments are public funds, versus the average 70 per cent), although it also spends more than the OECD average on hospitals and doctor visits. Advocates for an expansion of the publicly funded medicare system to include prescription medication note that it has become common for some lower-income Canadians who lack private drug insurance to leave prescriptions unfilled due to the cost, or will miss doses. This affordability problem for lower-income Canadians appears to be getting more serious. However, while Canadians seem to express support for the idea of pharmacare when asked about it in surveys, it remains well behind a list of other improvements to the health-care system that they consider to be of higher priority. They are more interested in improving access and wait times, and they are more concerned about the sustainability of the current system given the increased demands of the aging population. Both employers and workers, meanwhile, also support the existing model of employer-provided drug plans. Perhaps the biggest obstacle for champions of pharmacare, however, is that the term can mean so many different things to different people. There is virtually no consensus on what would even be the appropriate Canadian system, particularly in light of how significant a factor private coverage already is in Canada. A pharmacare plan might include anything from the drastic step of eliminating all private coverage and subsidizing all prescription medicine for all patients regardless of income, to a much narrower program that covers some portion of the cost of only some drugs, for some income levels. There are also countless different possible models between those two. The matter of how much each level of government, provincial/territorial or federal, would be responsible for funding drugs is a whole other, rather thorny matter. The timing of this latest discussion about pharmacare — stimulated mainly by recent proposals and fuelled by the success of the pan-Canadian Pharmaceutical Alliance in negotiating better bulk drug prices — is also particularly unfavourable. There has been a sudden shift in the dynamic between the federal government and the provinces, where before premiers stood together and collectively bargained with the federal government for health-care funding, but recently splintered and are now making individual deals (while Quebec continues to insist that it must have complete freedom from Ottawa to design its own health system). The difficult fiscal situation across Canada, with so many governments running up debts, would also seem to make it highly unlikely that there will be much enthusiasm for embarking on a new and sizeable social program costing billions of dollars a year. Lacking enough leaders to passionately champion it, and with a public generally uninterested and very unclear on what a national pharmacare program would even entail, it seems that the current discussion about implementing a pharmacare system may come to a stall, like so many discussions before i

The Effect of Rest Time After Stretching on Vertical Jump Height

The exact effects of stretching on power production are uncertain. This uncertainty could be due to a lack of control for rest time after stretching before performance. The purpose of this study was to determine the relationship between rest time after stretching and its effect on power production in recreationally active college students. A total of 17 participants volunteered for this study. Each participant performed the same stretch protocol including static and dynamic stretches after jogging for 5-minutes to warm up. Subjects were randomly assigned to groups for different rest intervals before vertical jump (0, 5, 15, 30). In following testing sessions, participants performed the remaining rest intervals until they had performed all four of them. After stretching and allotted rest time, participants jumped three countermovement jumps using the Vertec Apparatus. The highest of the three jump values was their final value. The results were analyzed using a pairwise comparisons test. Mean values were 15.03 inches +/- 4.50 (prestretching), 16.68 inches +/- 4.82 (0 minutes rest), 16.38 inches +/- 4.75 (5 minutes rest), 16.44 inches +/- 4.90 (15 minutes rest), and 15.41 inches +/- 3.46 (30 minutes rest). Significant differences were seen in vertical jump performance when comparing the pre-test data to the 0-minute rest condition (p=0.002), 5-minute rest condition (p=0.021), and 15-minute rest condition (p=0.012). Significant differences were also seen when comparing the 0-minute rest condition with the 30-minute rest condition (p=0.019). This data shows that our stretching protocol enhanced vertical jump height at 0, 5, and 15 minutes rest. There was also a significant drop in jump height from 0 to 30 minutes, indicating that the beneficial effects of stretching wore off sometime between 15 and 30 minutes rest

An Exploratory Survey of Telehealth Instruction in the PharmD Curricula

Class of 2023 Abstract and PosterSpecific Aims: 1)To assess the general perception of telehealth among the University of Arizona R. Ken Coit College of Pharmacy (UA:RKCCOP) faculty, 2)To discover the faculty’s opinions regarding the incorporation of telehealth instruction into the doctor of pharmacy (PharmD) curricula, and 3) To determine the faculty’s reasoning behind incorporating telehealth instruction into their courses. Methods: This analytic, observational, prospective study used data obtained through an online questionnaire distributed via email to college of pharmacy faculty members. Responses were collected regarding awareness level of telehealth, comfort level with discussing telehealth, and general perception telehealth instruction as part of the pharmacy curriculum. Demographics were also collected for length of time as a faculty member at any college, at the University of Arizona, having a pharmacy degree, and sex. Results: Questionnaires were completed by 18 participants. The median (interquartile range, IQR) regarding telehealth awareness showed that the majority of the participants were: very aware of telehealth, its benefits and applications, and somewhat aware of its barriers. The median (IQR) showed their level of comfort with telehealth discussion were: very comfortable with discussing the benefits, barriers and telehealth communication, and somewhat comfortable with discussing telehealth application. Analysis showed mean土standard deviation rating (on a scale of 0 - 10) of: 8.1 土 1.5 for general perception of telehealth, 8.6 土 1.6 for value of telehealth services, and 7.7 土 2.7 for value of incorporating telehealth instruction into the curriculum. Conclusions: Overall perception of incorporation telehealth discussions in pharmacy curricula was moderately positive.This item is part of the Pharmacy Student Research Projects collection, made available by the College of Pharmacy and the University Libraries at the University of Arizona. For more information about items in this collection, please contact Jennifer Martin, Librarian and Clinical Instructor, Pharmacy Practice and Science, [email protected]

Aquarium Visitors Catch Some Rays: Rays Are More Active in the Presence of More Visitors

Humans are a constant in the lives of captive animals, but the effects of human–animal interactions vary. Research on the welfare impacts of human–animal interactions focus predominantly on mammals, whereas fish have been overlooked. To address this lack of research, we assessed the impacts of aquarium visitors on the behaviors of ten members of four elasmobranch species: an Atlantic stingray (Dasyatis sabina), four southern stingrays (Hypanus americanus), two blue-spotted maskrays (Neotrygon kuhlii), and three fiddler rays (Trygonorrhina dumerilii). The rays engaged in a significantly higher proportion of active behaviors and a lower proportion of inactive behaviors when visitor density levels were high; however, there were no significant changes for negative or social behaviors. Individual analyses indicated that all three fiddler rays and one of the southern stingrays’ active behaviors differed across visitor density levels, whereas there was no association between active behavior and visitor density levels for the other rays. Further research is needed to determine whether this pattern is an adaptive or maladaptive response to visitors, but this research provides much needed initial data on activity budgets within elasmobranch species