Limited Options to Manage Specialty Drug Spending

Outlines rising trends in costs of and spending on specialty drugs; health plans' efforts to curb specialty drug spending, including patient cost sharing and utilization management; and efforts to integrate medical and pharmaceutical coverage

Calculation of viscous effects on transonic flow for oscillating airfoils and comparisons with experiment

A method is described for calculating unsteady transonic flow with viscous interaction by coupling a steady integral boundary-layer code with an unsteady, transonic, inviscid small-disturbance computer code in a quasi-steady fashion. Explicit coupling of the equations together with viscous -inviscid iterations at each time step yield converged solutions with computer times about double those required to obtain inviscid solutions. The accuracy and range of applicability of the method are investigated by applying it to four AGARD standard airfoils. The first-harmonic components of both the unsteady pressure distributions and the lift and moment coefficients have been calculated. Comparisons with inviscid calcualtions and experimental data are presented. The results demonstrate that accurate solutions for transonic flows with viscous effects can be obtained for flows involving moderate-strength shock waves

Employer-Sponsored Health Insurance: Down, But Not Out

Presents findings from twelve metropolitan areas about employers' efforts to control employee healthcare costs in response to the recession and national healthcare reform by firm size. Projects employer trends through 2014, including greater cost sharing

Executive function in first-episode schizophrenia

BACKGROUND: We tested the hypothesis that schizophrenia is primarily a frontostriatal disorder by examining executive function in first-episode patients. Previous studies have shown either equal decrements in many cognitive domains or specific deficits in memory. Such studies have grouped test results or have used few executive measures, thus, possibly losing information. We, therefore, measured a range of executive ability with tests known to be sensitive to frontal lobe function. METHODS: Thirty first-episode schizophrenic patients and 30 normal volunteers, matched for age and NART IQ, were tested on computerized test of planning, spatial working memory and attentional set shifting from the Cambridge Automated Neuropsychological Test Battery. Computerized and traditional tests of memory were also administered for comparison. RESULTS: Patients were worse on all tests but the profile was non-uniform. A componential analysis indicated that the patients were characterized by a poor ability to think ahead and organize responses but an intact ability to switch attention and inhibit prepotent responses. Patients also demonstrated poor memory, especially for free recall of a story and associate learning of unrelated word pairs. CONCLUSIONS: In contradistinction to previous studies, schizophrenic patients do have profound executive impairments at the beginning of the illness. However, these concern planning and strategy use rather than attentional set shifting, which is generally unimpaired. Previous findings in more chronic patients, of severe attentional set shifting impairment, suggest that executive cognitive deficits are progressive during the course of schizophrenia. The finding of severe mnemonic impairment at first episode suggests that cognitive deficits are not restricted to one cognitive domain

Three-geometry and reformulation of the Wheeler-DeWitt equation

A reformulation of the Wheeler-DeWitt equation which highlights the role of gauge-invariant three-geometry elements is presented. It is noted that the classical super-Hamiltonian of four-dimensional gravity as simplified by Ashtekar through the use of gauge potential and densitized triad variables can furthermore be succinctly expressed as a vanishing Poisson bracket involving three-geometry elements. This is discussed in the general setting of the Barbero extension of the theory with arbitrary non-vanishing value of the Immirzi parameter, and when a cosmological constant is also present. A proposed quantum constraint of density weight two which is polynomial in the basic conjugate variables is also demonstrated to correspond to a precise simple ordering of the operators, and may thus help to resolve the factor ordering ambiguity in the extrapolation from classical to quantum gravity. Alternative expression of a density weight one quantum constraint which may be more useful in the spin network context is also discussed, but this constraint is non-polynomial and is not motivated by factor ordering. The article also highlights the fact that while the volume operator has become a preeminient object in the current manifestation of loop quantum gravity, the volume element and the Chern-Simons functional can be of equal significance, and need not be mutually exclusive. Both these fundamental objects appear explicitly in the reformulation of the Wheeler-DeWitt constraint.Comment: 10 pages, LaTeX fil

Architecture of the Short External Rotator Muscles of the Hip.

BackgroundMuscle architecture, or the arrangement of sarcomeres and fibers within muscles, defines functional capacity. There are limited data that provide an understanding of hip short external rotator muscle architecture. The purpose of this study was thus to characterize the architecture of these small hip muscles.MethodsEight muscles from 10 independent human cadaver hips were used in this study (n = 80 muscles). Architectural measurements were made on pectineus, piriformis, gemelli, obturators, quadratus femoris, and gluteus minimus. Muscle mass, fiber length, sarcomere length, and pennation angle were used to calculate the normalized muscle fiber length, which defines excursion, and physiological cross-sectional area (PCSA), which defines force-producing capacity.ResultsGluteus minimus had the largest PCSA (8.29 cm2) followed by obturator externus (4.54 cm2), whereas superior gemellus had the smallest PCSA (0.68 cm2). Fiber lengths clustered into long (pectineus - 10.38 cm and gluteus minimus - 10.30 cm), moderate (obturator internus - 8.77 cm and externus - 8.04 cm), or short (inferior gemellus - 5.64 and superior gemellus - 4.85). There were no significant differences among muscles in pennation angle which were all nearly zero. When the gemelli and obturators were considered as a single functional unit, their collective PCSA (10.00 cm2) exceeded that of gluteus minimus as a substantial force-producing group.ConclusionsThe key findings are that these muscles have relatively small individual PCSAs, short fiber lengths, and low pennation angles. The large collective PCSA and short fiber lengths of the gemelli and obturators suggest that they primarily play a stabilizing role rather than a joint rotating role

Is Barbero's Hamiltonian formulation a Gauge Theory of Lorentzian Gravity?

This letter is a critique of Barbero's constrained Hamiltonian formulation of General Relativity on which current work in Loop Quantum Gravity is based. While we do not dispute the correctness of Barbero's formulation of general relativity, we offer some criticisms of an aesthetic nature. We point out that unlike Ashtekar's complex SU(2) connection, Barbero's real SO(3) connection does not admit an interpretation as a space-time gauge field. We show that if one tries to interpret Barbero's real SO(3) connection as a space-time gauge field, the theory is not diffeomorphism invariant. We conclude that Barbero's formulation is not a gauge theory of gravity in the sense that Ashtekar's Hamiltonian formulation is. The advantages of Barbero's real connection formulation have been bought at the price of giving up the description of gravity as a gauge field.Comment: 12 pages, no figures, revised in the light of referee's comments, accepted for publication in Classical and Quantum Gravit

Observable Dirac-type singularities in Berry's phase and the monopole

The physical reality and observability of 2n\pi Berry phases, as opposed to the usually considered modulo 2\pi topological phases is demonstrated with the help of computer simulation of a model adiabatic evolution whose parameters are varied along a closed loop in the parameter space. Using the analogy of Berry's phase with the Dirac monopole, it is concluded that an interferometer loop taken around a magnetic monopole of strength n/2 yields an observable 2n\pi phase shift, where n is an integer. An experiment to observe the effect is proposed.Comment: 12 pages Latex, 3 postscript figures; submitted to Physical Review Letters 15 September 2000; revised 19 November 200

Steady and unsteady transonic small disturbance analysis of realistic aircraft configurations

A transonic unsteady aerodynamic and aeroelastic code called CAP-TSD (Computational Aeroelasticity Program - Transonic Small Disturbance) was developed for application to realistic aircraft configurations. It permits the calculation of steady and unsteady flows about complete aircraft configurations for aeroelastic analysis of the flutter critical transonic speed range. The CAP-TSD code uses a time accurate approximate factorization algorithm for solution of the unsteady transonic small disturbance potential equation. An overview is given of the CAP-TSD code development effort along with recent algorithm modifications which are listed and discussed. Calculations are presented for several configurations including the General Dynamics 1/9th scale F-16C aircraft model to evaluate the algorithm and hence the reliability of the CAP-TSD code in general. Calculations are also presented for a flutter analysis of a 45 deg sweptback wing which agree well with the experimental data. Descriptions are presented of the CAP-TSD code and algorithm details along with results and comparisons which demonstrate the stability, accuracy, efficiency, and utility of CAP-TSD