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.

Mapping Hesperia Planum, Mars

Hesperia Planum, characterized by a high concentration of mare-type wrinkle ridges and ridge rings [1-4], encompasses > 2 million km2 in the southern highlands of Mars (Fig. 1). The most common interpretation is that the plains were emplaced as flood lavas with total thicknesses of <3 km [4-10]. The wrinkle ridges on its surface make Hesperia Planum the type locale for Hesperian-aged ridged plains on Mars [e.g., 9], and recent investigations reveal that wrinkle-ridge formation occurred in more than one episode [4]. Hesperia Planum s stratigraphic position and crater-retention age [e.g., 9, 11-12] define the base of the Hesperian System. However, preliminary results of geologic mapping reveal that the whole of Hesperia Planum is unlikely to be composed of the same materials, emplaced at the same geologic time. To unravel these complexities, we are generating a 1:1.5M-scale geologic map of Hesperia Planum and its surroundings (Fig. 1). To date, we have identified 4 distinct plains units within Hesperia Planum and are attempting to determine the nature and relative ages of these materials (Fig. 2) [13-15]

Geologic Mapping in the Hesperia Planum Region of Mars

Hesperia Planum, characterized by a high concentration of mare-type wrinkle ridges and ridge rings, encompasses > 2 million square km in the southern highlands of Mars. The most common interpretation is that the plains were emplaced as "flood" lavas with total thicknesses of <3 km [4-10]. The wrinkle ridges on its surface make Hesperia Planum the type locale for "Hesperian-aged ridged plains" on Mars, and wrinkle-ridge formation occurred in more than one episode. Hesperia Planum s stratigraphic position and crater-retention age define the base of the Hesperian System. However, preliminary results of geologic mapping reveal that the whole of Hesperia Planum is unlikely to be composed of the same materials, emplaced at the same geologic time. To unravel these complexities, we are generating a 1:1.5M-scale geologic map of Hesperia Planum and its surroundings. To date, we have identified 4 distinct plains units within Hesperia Planum and are attempting to determine the nature and relative ages of these materials

Volcanism on Io: Insights from Global Geologic Mapping

We are preparing a new global geo-logic map of Jupiter s volcanic moon, Io. Here we report the type of data that are now available from our global mapping efforts, and how these data can be used to investigate questions regarding the volcano-tectonic evolution of Io. We are using the new map to investigate several specific questions about the geologic evolution of Io that previously could not be well addressed, including (for example) a comparison of the areas vs. the heights of Ionian mountains to assess their stability and evolution (Fig. 1). The area-height relationships of Io s visible mountains show the low abundance and low relief of volcanic mountains (tholi) relative to tectonic mountains, consistent with formation from low-viscosity lavas less likely to build steep edifices. Mottled mountains are generally less high than lineated mountains, consistent with a degradational formation

Staff experience of harassment and stalking behaviour by patients

Staff from one National Health Service (NHS) Trust in England completed an online survey (N = 590) about their experience of intrusive behaviours from patients. These experiences were categorised into either stalking or harassment and compared in terms of staff and patient characteristics, types of intrusions, and aftermath. Overall, 150 were classified as being stalked (25.4%) and 172 harassed (29.2%). There were no differences in staff characteristics between the two groups. Staff from forensic services and nursing staff were particularly susceptible to these intrusions which took many forms. Respondents perceived a range of causes for the stalking and harassment, the most common being to gain power and control/to scare. It was rare for legal sanctions to be brought against the patient. Our findings reinforce the need for service providers to have policies supported with preventative measures, education and a robust process for addressing stalking so that these measures are embedded in practice in a way that supports staff working with patients. Furthermore, service providers should be challenged on what steps they have taken to prevent, and monitor, such behaviour

Global Geologic Mapping of Io: Preliminary Results

A new global geologic map of Jupiter's volcanic moon, Io is being prepared, with the focus being on completion of a draft map by July 2008. Here initial results of the mapping are reported: a preliminary distribution of material units in terms of areas and a visual representation. Additionally, the mapping hopes to address some of the problems in Io geology. Thus far it has been discovered that Io's surface is dominated by plains material, thought to consist of Io's silicate crust covered by pyroclastic deposits and lava flows of silicate and sulfur-bearing composition. Many plains areas contain flow fields that cannot be mapped separately due to a lack of resolution or modification by alteration processes. Discrete lava flows and flow fields are the next most abundant unit, with bright (sulfur?) flows in greater abundance than dark (silicate?) flows. The source of most of Io's heat flow, the paterae, are the least abundant unit in terms of areal extent.Upon completion of the draft map for peer review, it will be used to investigate several specific questions about the geological evolution of Io that previously could not be well addressed, including: comparison of the areas versus the heights of Ionian mountains to assess their stability and evolution; correlation and comparison of Galileo Near-Infrared Mapping Spectrometer and Photopolarimeter-Radiometer hot spot locations with the mapped location of dark versus bright lava flows and patera floors to assess any variations in the types of sources for Io's active volcanism; and the creation of a global inventory of the areal coverage of dark and bright laval flows to assess the relative importance of sulfur versus silicate volcanism in resurfacing Io, and to assess whether there are regional concentrations of either style of volcanism that may have implications on interior processes

Volcanism on Io: Results from Global Geologic Mapping

We have completed a new 1:15,000,000 global geologic map of Jupiter's volcanic moon, Io, based on a set of 1 km/pixel combined Galileo- Voyager mosaics produced by the U.S. Geological Survey. The map was produced over the last three years using ArcGIS(TM) software, and has undergone peer-review. Here we report some of the key results from our global mapping efforts, and how these results relate to questions regarding the volcano-tectonic evolution of Io

The ideology and discourse of the English Defence League: ‘Not racist, not violent, just no longer silent’

The English Defence League (EDL) emerged in 2009 and quickly became a major ‘anti-Islamist’ street protest movement, able to attract thousands to its national demonstrations. Despite the violence and anti-Muslim rhetoric associated with its protests, the group claims to be an anti-racist human rights organisation dedicated to protecting liberal freedoms. This article employs a critical methodology to address these claims, analysing EDL literature alongside strategies identified as typical of racist discourse construction. The representations, narratives and rhetorical strategies used by the group support the analysis of EDL Islamophobia as a form of cultural racism that constructs opposing ‘British’ and ‘Muslim’ subjects and functions to maintain traditional ethno-cultural dominance of the former over the latter

What lies beneath: exploring links between asylum policy and hate crime in the UK

This paper explores the link between increasing incidents of hate crime and the asylum policy of successive British governments with its central emphasis on deterrence. The constant problematisation of asylum seekers in the media and political discourse ensures that 'anti-immigrant' prejudice becomes mainstr earned as a common-sense response. The victims are not only the asylum seekers hoping for a better life but democratic society itself with its inherent values of pluralism and tolerance debased and destabilised