Antipsychotic Drug Use: Managing Cardiometabolic and Cost Effects

Across the US, 30%, or approximately one third of people meet the criteria for at least one mental illness.1 Of those with severe mental illness (SMI), namely schizophrenia and bipolar disorder, the mortality rate is more than twofold compared to the general population.2 The cardiovascular risk factors that contribute to cardiovascular related deaths, including metabolic disease and type II diabetes, are not only modifiable, but staggeringly higher for those with SMI.3 Though antipsychotic drug prescription is the standard protocol for SMI treatment, such drug effects on cardiovascular risk factors and related deaths exacerbate the much higher mortality rate for the severely mentally ill population. Due to both the prevalence of SMI and the physical comorbidities that it entails, analysis of healthcare costs associated with this population are an essential part of general health and policy improvement for the U.S. Therefore, a breakdown of the healthcare costs of this population requires not only acknowledgment of the modes of treatment for mental illness specifically, but also the identification and cost-analysis of the commonly associated physical comorbidities. This is especially important considering SMI is almost always considered chronic, and many SMI patients qualify for either Medicare, Medicaid, or both. Certain gaps in coverage can lead to lack of preventive care, exacerbating the cost burden. From a clinician’s perspective, assessing relevant scientific studies and reviews to change the relationship between primary care and psychiatry is necessary to dampen the high mortality rate of the SMI population. From a policy-maker’s perspective, analyzing the cause and effect balance between managing costs of care directed at the SMI itself against the adjunct costs from physical comorbidity calls for a change in the structure of therapeutic care and how the SMI population accesses primary care. The Collaborative Care model is a health care model that unifies psychiatric, behavioral, and primary care to support the mental, behavioral, and physical health of patients. By supporting holistic healthcare, the high cost of care for the SMI population will be diminished. The model includes four parts: patient-centered care, populationbased care, measurement-based treatment to target, and evidence-based care. Swapping oral antipsychotics with injectable versions will be especially cost-effective by improving adherence rates, and thus, reducing institutionalization and other hospitalizations. By enforcing the Collaborative Care model through community health center interventions, clinicians and policy makers will be able to work together to effectively leverage the health of the SMI population while eroding the high health care expenditure that this population currently imposes on states

BUSINESS CONTINUITY, A CONSTANT ISSUE FOR MANAGERS AND AUDITORS

The crisis of credits and its effects upon all companies, make the assumption of activity continuity be not anymore a pre-established conclusion. The major cash issues, affecting the banks, insurance companies, retailers, car manufacturers and all companies regardless of their activity, prove that keeping the business continuity, i.e. having enough funds for compliance with an obligation to be able to reach maturity at least twelve months after the balance sheet date is now a real problem for many companies.Likewise, we are paying attention to the topic and to the increasing number of insolvencies at the national, European and international levels.insolvency; principle of business continuity; financial statements; auditor; manager

Duality on Banach spaces and a Borel parametrized version of Zippin's theorem

Let SB be the standard coding for separable Banach spaces as subspaces of $C(\Delta)$. In these notes, we show that if $\mathbb{B} \subset \text{SB}$ is a Borel subset of spaces with separable dual, then the assignment $X \mapsto X^*$ can be realized by a Borel function $\mathbb{B}\to \text{SB}$. Moreover, this assignment can be done in such a way that the functional evaluation is still well defined (Theorem $1$). Also, we prove a Borel parametrized version of Zippin's theorem, i.e., we prove that there exists $Z \in \text{SB}$ and a Borel function that assigns for each $X \in \mathbb{B}$ an isomorphic copy of $X$ inside of $Z$ (Theorem $5$)

Regional growth and local convergence: Evidence for Portugal

It is widely known that regional disparities do not lead to economic growth. By this, it is meant that convergence among regions might be responsible for a propensity to national growth. In the same way, if there is a sub regional division (with different economic realities) the same phenomenon should be verified. Thus, sub-regional convergence should lead to regional growth. This regional desegregation of space is (in political terms) varies from country to country. In the Portuguese reality, one of the most accepted divisions is made by NUTs, with three level of desegregation. NUTs level 3 are still desegregated in municipalities (which are a small portion of space that usually share the same economic and social reality). The theoretical study of convergence relies on the use of a few measures. On of the best known is the β convergence: conditional and unconditional. The conclusions obtained in a previous study (by the same author) showed that conditional convergence improves the results for the study of convergence. This measure estimates convergence as a function of GDP (in purchasing power parity) and a battery of exogenous variables that contain information about technological level, industrial structure, human capital qualification, social conditions, etc. In order to attain information for this battery of exogenous variables it is used a proxy variable, which is the Human Development Index (HDI). This variable is pulished by UNDP every year and allows the international comparision of living conditions between countries. The Portuguese government uses the same approach to calculate a HDI for all municipalities. The estimation of conditional β convergence is made by a non-linear model regression, which is widely used in the theoretical economic study of convergence. Besides this estimation, other forms of regional convergence study will be applied, permitting a deeper analysis. The aim of this work is to estimate convergence in terms of Portuguese nuts and to verify whether it is true that regions with higher convergence speed rate also experiment higher growth rates. If this is true, this could constitute a policy opportunity, since governments should stimulate regional convergence, in order to attain national economic growth.

Configurational temperature control for atomic and molecular systems

A new configurational temperature thermostat suitable for molecules with holonomic constraints is derived. This thermostat has a simple set of motion equations, can generate the canonical ensemble in both position and momentum space, acts homogeneously through the spatial coordinates, and does not intrinsically violate the constraints. Our new configurational thermostat is closely related to the kinetic temperature Nosé-Hoover thermostat with feedback coupled to the position variables via a term proportional to the net molecular force. We validate the thermostat by comparing equilibrium static and dynamic quantities for a fluid of n-decane molecules under configurational and kinetic temperature control. Practical aspects concerning the implementation of the new thermostat in a molecular dynamics code and the potential applications are discussed