Baseline Review of the Upper Tana, Kenya

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Medicaid Pharmacy Benefits Waiver Programs: A Deference Argument for Process in Informal Agency Actions

The proper level of judicial review for Section 1115 Medicaid demonstration program waiver (“waiverâ€) decisions made by the Secretary of the Department of Health and Human Services (“the Secretaryâ€) is an important question of law regarding one of the federal and state governments’ largest social programs. Judicial review of waivers is of particular importance in the area of pharmacy benefits. In the absence of Congressional action to address the dual problems of drug costs and coverage that are driving much of health care spending, several states have turned to Medicaid waivers as a means to implement innovative pharmacy benefits programs and garner federal funds for their finance. Many more states are looking to enact such programs in the future. Pharmaceutical access is an issue of national importance due to the broad need for drugs among different groups of health care consumers. The supply-side impacts of pharmaceutical access also are nationwide: large-scale drug manufacturers sell their standardized products in a national pharmaceutical market. While the need for pharmaceutical access may be universal and the market at least semi-national, the proper contours of pharmacy coverage may take different forms based on the particulars of each state’s population, financial resources, and health care system structure. Thus it is imperative that federal and state health agencies work together to address and provide a check for each other on the issue of drug access. More importantly, debates about the proper policy role of the federal and state governments in providing pharmacy assistance, such as those ongoing in the Medicaid waiver context, should be open to all interested parties. A closed process between CMS and individual state agencies risks omitting important consumer and industry voices from the policy debate. In the past, courts have granted substantial deference to the Secretary’s waiver determinations. Recent administrative case law both identifies the need for and demands a more reasoned justification for such deference than past courts have provided. Over the two terms from 2000 to 2002, the federal district courts for the District of Columbia issued a set of opinions ruling on the authority of the Secretary of the Department of Health and Human Services (DHHS) to approve state Medicaid waiver requests to expand pharmaceutical benefits to otherwise ineligible residents. As the opinions suggest, confusion existed at the time as to the appropriate level of deference to grant the Secretary’s actions under the Administrative Procedure Act (APA) and the lead case on the question of deference, Chevron v. Natural Resources Defense Council . A mere ten days after the final substantive ruling on the pharmaceutical benefits waiver cases, the Supreme Court issued its decision in United States v. Mead Corporation. The Mead Court distinguished those agency actions due heightened deference under the Court’s prior decision in Chevron from other, more informal agency actions which are due an intermediate level of deference in keeping with their “power to persuade.†In elaborating on the proper standard of review for informal agency actions, the Mead Court set up a new framework for future courts faced with Medicaid waiver decisions. Courts first must ask whether Congress delegated to the Secretary the authority to make waiver determinations that “carry the force of law†and whether the Secretary acted in exercise of that authority before granting Chevron deference. The purpose of this paper is not to challenge the Mead decision, but to apply its holding and legal concepts to the specific case of Section 1115 Medicaid waivers for pharmacy benefits expansion proposals

A study of the electronic properties of liquid alkali metals. A self--consistent approach

We study the electronic properties (density of states, conductivity and thermopower) of some nearly--free--electron systems: the liquid alkali metals and two liquid alloys, Li-Na and Na-K. The study has been performed within the self-consistent second order Renormalized Propagator Perturbation Expansion (RPE) for the self-energy. The input ionic pseudopotentials and static correlation functions are derived from the neutral pseudoatom method and the modified hypernetted chain theory of liquids, respectively. Reasonable agreement with experiment is found for Na, K, Rb and Na-K, whereas for Li and Cs and Li-Na the agreement is less satisfactoryComment: 14 pages, Latex, 1 figure, 1 tabl

Effects of ceftriaxone on faecal flora:analysis by micromorphometry

In order to elucidate the effect of ceftriaxone therapy on the morphology of gut microflora, 11 human volunteers were treated with ceftriaxone, 1 g daily, given intramuscularly in one dose. Treatment continued for 5 days. Faecal microflora was analysed by digital image processing before, during and after the treatment period. We derived simple numerical parameters which describe the morphologic composition of the flora. They were significantly influenced by the antibiotic, and returned to their baseline values more than 7 days after treatment was stopped. The procedure holds promise for clinical application

Interchain interactions and magnetic properties of Li2CuO2

An effective Hamiltonian is constructed for an insulating cuprate with edge-sharing chains Li2CuO2.The Hamiltonian contains the nearest and next-nearest neighboring intrachain and zigzag-type interchain interactions.The values of the interactions are obtained from the analysis of the magnetic susceptibility, and this system is found to be described as coupled frustrated chains.We calculate the dynamical spin correlation function S(q,\omega) by using the exact diagonalization method, and show that the spectra of S(q,\omega) are characterized by the zigzag-type interchain interactions. The results of the recent inelastic neutron scattering experiment are discussed in the light of the calculated spectra.Comment: 4 pages, 3 figures, RevTe

Thermodynamic Comparison and the Ideal Glass Transition of A Monatomic Systems Modeled as an Antiferromagnetic Ising Model on Husimi and Cubic Recursive Lattices of the Same Coordination Number

Two kinds of recursive lattices with the same coordination number but different unit cells (2-D square and 3-D cube) are constructed and the antiferromagnetic Ising model is solved exactly on them to study the stable and metastable states. The Ising model with multi-particle interactions is designed to represent a monatomic system or an alloy. Two solutions of the model exhibit the crystallization of liquid, and the ideal glass transition of supercooled liquid respectively. Based on the solutions, the thermodynamics on both lattices was examined. In particular, the free energy, energy, and entropy of the ideal glass, supercooled liquid, crystal, and liquid state of the model on each lattice were calculated and compared with each other. Interactions between particles farther away than the nearest neighbor distance are taken into consideration. The two lattices show comparable properties on the transition temperatures and the thermodynamic behaviors, which proves that both of them are practical to describe the regular 3-D case, while the different effects of the unit types are still obvious.Comment: 27 pages, 13 figure

Functional interactions between the subunits of the lactose transporter from Streptococcus thermophilus

Although the quaternary state has been assessed in detail for only a few members of the major facilitator superfamily (MFS), it is clear that multiple oligomeric states are represented within the MFS. One of its members, the lactose transporter LacS from Streptococcus thermophilus assumes a dimeric structure in the membrane and in vitro analysis showed functional interactions between both subunits when proton motive force (Delta p)-driven transport was assayed. To study the interactions in further detail, a covalent dimer was constructed consisting of in tandem fused LacS subunits. These covalent dimers, composed of active and completely inactive subunits, were expressed in Escherichia coli, and initial rates of Delta p-driven lactose uptake and lactose counterflow were determined. We now show that also in vivo, both subunits interact functionally; that is, partial complementation of the inactive subunit was observed for both transport modes. Thus, both subunits interact functionally in Delta p-driven uptake and in counterflow transport. In addition, analysis of in tandem fused LacS subunits containing one regulatory LacS-IIA domain showed that regulation is primarily an intramolecular event. (c) 2005 Elsevier Ltd. All rights reserved

Intrinsic peculiarities of real material realizations of a spin-1/2 kagome lattice

Spin-1/2 magnets with kagome geometry, being for years a generic object of theoretical investigations, have few real material realizations. Recently, a DFT-based microscopic model for two such materials, kapellasite Cu3Zn(OH)6Cl2 and haydeeite Cu3Mg(OH)6Cl2, was presented [O. Janson, J. Richter and H. Rosner, arXiv:0806.1592]. Here, we focus on the intrinsic properties of real spin-1/2 kagome materials having influence on the magnetic ground state and the low-temperature excitations. We find that the values of exchange integrals are strongly dependent on O--H distance inside the hydroxyl groups, present in most spin-1/2 kagome compounds up to date. Besides the original kagome model, considering only the nearest neighbour exchange, we emphasize the crucial role of the exchange along the diagonals of the kagome lattice.Comment: 4 pages, 4 figures. A paper for the proceedings of the HFM 2008 conferenc