Benefit Plan Design and Prescription Drug Utilization Among Asthmatics: Do Patient Copayments Matter?

Objective: The ratio of controller to reliever medication use has been proposed as a measure of treatment quality for asthma patients. In this study we examine the effects of plan level mean out-of-pocket asthma medication patient copayments and other features of benefit plan design on the use of controller medications alone, controller and reliever medications (combination therapy), and reliever medications alone. Methods: 1995-2000 MarketScan claims data were used to construct plan-level out-of-pocket copayment and physician/practice prescriber preference variables for asthma medications. Separate multinomial logit models were estimated for patients in fee-for-service (FFS) and non-FFS plans relating benefit plan design features, physician/practice prescribing preferences, patient demographics, patient comorbidities and county-level income variables to patient-level asthma treatment patterns. Results: We find that the controller reliever ratio rose steadily over 1995-2000, along with out-of-pocket payments for asthma medications, which rose more for controllers than for relievers. However, after controlling for other variables, plan level mean out-of-pocket copayments were not found to have a statistically significant influence upon patient-level asthma treatment patterns. On the other hand, physician practice prescribing patterns strongly influenced patient level treatment patterns. Conclusions: There is no strong statistical evidence that higher levels of out-of-pocket copayments for prescription drugs influence asthma treatment patterns. However, physician/practice prescribing preferences influence patient treatment.

2-D Radiative Transfer in Protostellar Envelopes: II. An Evolutionary Sequence

We present model spectral energy distributions, colors, polarization, and images for an evolutionary sequence of a low-mass protostar from the early collapse stage (Class 0) to the remnant disk stage (Class III). We find a substantial overlap in colors and SEDs between protostars embedded in envelopes (Class 0-I) and T Tauri disks (Class II), especially at mid-IR wavelengths. Edge-on Class I-II sources show double-peaked spectral energy distributions, with a short-wavelength hump due to scattered light and the long-wavelength hump due to thermal emission. These are the bluest sources in mid-IR color-color diagrams. Since Class 0 and I sources are diffuse, the size of the aperture over which fluxes are integrated has a substantial effect on the computed colors, with larger aperture results showing significantly bluer colors. This causes overlap in color-color diagrams between all evolutionary states, especially in the mid-IR. However the near-IR polarization of the Class 0 sources is much higher than the Class I-II sources, providing a means to separate these evolutionary states. We varied the grain properties in the circumstellar envelope, allowing for larger grains in the disk midplane and smaller in the envelope. We find that grain growth in disks of Class I sources can be detected at wavelengths greater than 100 $\mu$m. Our image calculations predict that the diffuse emission from edge-on Class I and II sources should be detectable in the mid-IR with the Space Infrared Telescope Facility (SIRTF) in nearby star forming regions (out to several hundred parsecs).Comment: A version with high-resolution images is available at http://www.astro.wisc.edu/glimpse/glimpsepubs.htm

Determining the Contribution of Epidermal Cell Shape to Petal Wettability Using Isogenic Antirrhinum Lines

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

2-D Radiative Transfer in Protostellar Envelopes: I. Effects of Geometry on Class I Sources

We present 2-D radiation transfer models of Class I Protostars and show the effect of including more realistic geometries on the resulting spectral energy distributions and images. We begin with a rotationally flattened infalling envelope as our comparison model, and add a flared disk and bipolar cavity. The disk affects the spectral energy distribution most strongly at edge-on inclinations, causing a broad dip at about 10 um (independent of the silicate feature) due to high extinction and low scattering albedo in this wavelength region. The bipolar cavities allow more direct stellar+disk radiation to emerge into polar directions, and more scattering radiation to emerge into all directions. The wavelength-integrated flux, often interpreted as luminosity, varies with viewing angle, with pole-on viewing angles seeing 2-4 times as much flux as edge-on, depending on geometry. Thus, observational estimates of luminosity should take into account the inclination of a source. The envelopes with cavities are significantly bluer in near-IR and mid-IR color-color plots than those without cavities. Using 1-D models to interpret Class I sources with bipolar cavities would lead to an underestimate of envelope mass and an overestimate of the implied evolutionary state. We compute images at near-, mid-, and far-IR wavelengths. We find that the mid-IR colors and images are sensitive to scattering albedo, and that the flared disk shadows the midplane on large size scales at all wavelengths plotted. Finally, our models produce polarization spectra which can be used to diagnose dust properties, such as albedo variations due to grain growth. Our results of polarization across the 3.1 um ice feature agree well with observations for ice mantles covering 5% of the radius of the grains.Comment: Accepted for publication in ApJ, 37 pages, 13 figures (several figures reduced in quality; find original version at http://gemelli.colorado.edu/~bwhitney/preprints.html

A Search for Star-Disk Interaction Among the Strongest X-ray Flaring Stars in the Orion Nebula Cluster

The Chandra Orion Ultradeep Project observed hundreds of young, low-mass stars undergoing highly energetic X-ray flare events. The 32 most powerful cases have been modeled with the result that the magnetic structures responsible for these flares can be many stellar radii in extent. In this paper, we model the observed spectral energy distributions of these 32 stars in order to determine, in detail for each star, whether there is circumstellar disk material situated in sufficient proximity to the stellar surface for interaction with the large magnetic loops inferred from the observed X-ray flares. Our spectral energy distributions span the wavelength range 0.3-8 um (plus 24 um for some stars), allowing us to constrain the presence of dusty circumstellar material out to >10 AU from the stellar surface in most cases. For 24 of the 32 stars in our sample the available data are sufficient to constrain the location of the inner edge of the dusty disks. Six of these (25%) have spectral energy distributions consistent with inner disks within reach of the observed magnetic loops. Another four stars may have gas disks interior to the dust disk and extending within reach of the magnetic loops, but we cannot confirm this with the available data. The remaining 14 stars (58%) appear to have no significant disk material within reach of the large flaring loops. Thus, up to ~40% of the sample stars exhibit energetic X-ray flares that possibly arise from a magnetic star-disk interaction, and the remainder are evidently associated with extremely large, free-standing magnetic loops anchored only to the stellar surface.Comment: Accepted to the ApJ; 26 pages, 6 tables, 6 figure

Klotho pathways, myelination disorders, neurodegenerative diseases, and epigenetic drugs

In this review we outline a rationale for identifying neuroprotectants aimed at inducing endogenous Klotho activity and expression, which is epigenetic action, by definition. Such an approach should promote remyelination and/or stimulate myelin repair by acting on mitochondrial function, thereby heralding a life-saving path forward for patients suffering from neuroinflammatory diseases. Disorders of myelin in the nervous system damage the transmission of signals, resulting in loss of vision, motion, sensation, and other functions depending on the affected nerves, currently with no effective treatment. Klotho genes and their single-pass transmembrane Klotho proteins are powerful governors of the threads of life and death, true to the origin of their name, Fates, in Greek mythology. Among its many important functions, Klotho is an obligatory co-receptor that binds, activates, and/or potentiates critical fibroblast growth factor activity. Since the discovery of Klotho a little over two decades ago, it has become ever more apparent that when Klotho pathways go awry, oxidative stress and mitochondrial dysfunction take over, and age-related chronic disorders are likely to follow. The physiological consequences can be wide ranging, potentially wreaking havoc on the brain, eye, kidney, muscle, and more. Central nervous system disorders, neurodegenerative in nature, and especially those affecting the myelin sheath, represent worthy targets for advancing therapies that act upon Klotho pathways. Current drugs for these diseases, even therapeutics that are disease modifying rather than treating only the symptoms, leave much room for improvement. It is thus no wonder that this topic has caught the attention of biomedical researchers around the world.https://www.liebertpub.com/doi/10.1089/biores.2020.0004Published versio

Determining the Parameters of Massive Protostellar Clouds via Radiative Transfer Modeling

A one-dimensional method for reconstructing the structure of prestellar and protostellar clouds is presented. The method is based on radiative transfer computations and a comparison of theoretical and observed intensity distributions at both millimeter and infrared wavelengths. The radiative transfer of dust emission is modeled for specified parameters of the density distribution, central star, and external background, and the theoretical distribution of the dust temperature inside the cloud is determined. The intensity distributions at millimeter and IR wavelengths are computed and quantitatively compared with observational data. The best-fit model parameters are determined using a genetic minimization algorithm, which makes it possible to reveal the ranges of parameter degeneracy as well. The method is illustrated by modeling the structure of the two infrared dark clouds IRDC-320.27+029 (P2) and IRDC-321.73+005 (P2). The derived density and temperature distributions can be used to model the chemical structure and spectral maps in molecular lines.Comment: Accepted for publication in Astronomy Report

A Planarity Test via Construction Sequences

Optimal linear-time algorithms for testing the planarity of a graph are well-known for over 35 years. However, these algorithms are quite involved and recent publications still try to give simpler linear-time tests. We give a simple reduction from planarity testing to the problem of computing a certain construction of a 3-connected graph. The approach is different from previous planarity tests; as key concept, we maintain a planar embedding that is 3-connected at each point in time. The algorithm runs in linear time and computes a planar embedding if the input graph is planar and a Kuratowski-subdivision otherwise

Optical and infrared properties of V1647 Orionis during the 2003-2006 outburst. I The reflection nebula

Aims: The recent outburst of the young eruptive star V1647 Orionis has produced a spectacular appearance of a new reflection nebula in Orion (McNeil's nebula). We present an optical/near infrared investigation of McNeil's nebula. This analysis is aimed at determining the morphology, temporal evolution and nature of the nebula and its connection to the outburst. Method: We performed multi epoch B, V, R, I, z, and K imaging of McNeil's nebula and V1647 Ori as well as K_S imaging polarimetry. The multiband imaging allows us to reconstruct the extinction map inside the nebula. Through polarimetric observations we attempt to disentangle the emission from the nebula from that of the accretion disk around V1647 Ori. We also attempt to resolve the small spatial scale structure of the illuminating source. Results: The energy distribution and temporal evolution of McNeil's nebula mimic that of the illuminating source. The extinction map reveals a region of higher extinction in the direction of V1647 Ori. Excluding foreground extionction, the optical extinction due to McNeil's nebula in the direction of V1647 Ori is A_V ~ 6.5 mag. The polarimetric measurement shows a compact high polarization emission around V1647 Ori. The percentage of K_S band linear polarization goes from 10 -- 20 %. The vectors are all well aligned with a position angle of 90 +/- 9 degree East of North. This may correspond to the orientation of a possible accretion disk around V1647 Ori. These findings suggest that the appearance of McNeil's nebula is due to reflection of light by pre-existing material in the surroundings of V1647 Ori. We also report on the discovery of a new candidate brown dwarf or protostar in the vicinity of V1647 Ori as well as the presence of clumpy structure within HH 22A.Comment: 8 pages, 7 figures, in pres