The impact of generic reference pricing interventions in the statin market

The objective of this study was to evaluate the intended and unintended impact on pharmaceutical use and sales of three public financing reforms applied to the prescription of statins: a Spanish generic reference pricing (RP) system for lovastatin and simvastatin, and two competing policies introduced by the Andalusian Public Health Service (APHS) for all statins, first a maximum consumer price (MCP) and then a so called quality prescribing incentive for general practitioners (MCP plus PI).This study is designed as an observational, retrospective, interrupted time series analysis with comparison series (APHS and the rest of Spain) of 46 monthly drug use and sales ratios from January 2001 to October 2004 for each active ingredient in the group of statins.RP has been effective at reducing the volume of sales growth of the off-patent statins, yet its overall impact on sales of all statins has been relatively modest. The quantity and volume of sales impact heavily depends on regulatory RP details such as when the system is introduced, how often it is updated, and how the reference price is calculated.

A theory of reference-dependent behavior

Extensive field and experimental evidence in a variety of environments show that behavior depends on a reference point. This paper provides an axiomatic characterization of this dependence. We proceed by imposing gradually more structure on both choice correspondences and preference relations, requiring increasingly higher levels of rationality, and freeing the decision-maker from certain types of inconsistencies. The appropriate degree of behavioral structure will depend on the phenomenon that is to be modeled. Lastly, we provide two applications of our work: one to model the status-quo bias, and another to model addictive behavior.

Hesperiidae (Lepidoptera, Hesperioidea) from Ponta Grossa, Paraná, Brazil: 70 years of records with special reference to faunal composition of Vila Velha State Park

Hesperiidae (Lepidoptera, Hesperioidea) de Ponta Grossa, Paraná, Brazil: 70 anos de registros com especial referência à composição faunística do Parque Estadual de Vila Velha. O município de Ponta Grossa se destaca por apresentar originalmente uma paisagem peculiar onde capões isolados de Floresta Ombrófila Mista são interligados por grandes extensões de fitofisionomias estépicas, também denominadas campos. No entanto, ambos os ecossistemas atualmente se encontram altamente ameaçados pela ocupação humana, restando na região o Parque Estadual de Vila Velha, cuja composição florística tem sido recentemente relacionada com o bioma Cerrado. Poucos trabalhos são dedicados à caracterização da fauna dos campos e sua relação com outras fitofisionomias estépicas brasileiras, motivo que suscitou a realização deste estudo. Após reunir informações de coletas realizadas por mais de 70 anos, são listadas 225 espécies de Hesperiidae (Lepidoptera, Hesperioidea) presentes no município, entre elas 162 indicadoras de ambientes florestais e 53 de áreas abertas. O Parque Estadual de Vila Velha contribui para a conservação de 65% delas enquanto sua composição se mostra intimamente relacionada tanto aos Pampas como ao Cerrado, em detrimento de hábitats florestais. Tal relação é dada provavelmente pela localização geográfica de Vila Velha, visto que a similaridade da fauna de Hesperiidae se encontrou influenciada pelas distâncias geográficas das amostras no presente estudo. A flora de Vila Velha também deve afetar diretamente a composição observada de Hesperiidae, uma vez que uma grande parte de suas espécies são também encontradas em áreas de Cerrado. No entanto, estudos em ambientes campestres brasileiros ainda se fazem necessários, especialmente em enclaves de Cerrado no Paraná e em São Paulo, para que se adquira um melhor entendimento da dinâmica de suas comunidades.

On the nesting biology of Pirhosigma Giordani Soika (Hymenoptera, Vespidae, Eumeninae), with special reference to the use of vegetable matter

On the nesting biology of Pirhosigma Giordani Soika (Hymenoptera, Vespidae, Eumeninae), with special reference to the use of vegetable matter. The use of vegetable matter in nest building is not widespread among the Eumeninae, and is reported for the first time for the two species of potter wasps Pirhosigma superficiale and P. limpidum. These wasps make mostly spherical mud nests over which they attach small pieces of unmasticated plant matter. Use of plant fragments in this group of wasps is interpreted as camouflage behavior.

Haemorrhagic shock and encephalopathy syndrome: report of two cases with special reference to hypoglycaemia.

Haemorrhagic shock and encephalopathy syndrome (HSES) is a devastating disorder affecting infants. So far no cases have been reported in Switzerland. It is characterised by the abrupt onset of hyperpyrexia, shock, encephalopathy, diarrhoea, disseminated intravascular coagulation (DIC) and renal and hepatic failure in previously healthy infants. Severe hypoglycaemia has been repeatedly reported in association with HSES. However, the pathophysiology of the hypoglycaemia is not clear. We report on two infants (2 and 7 months old) with typical HSES, both of whom were presented with nonketotic hypoglycaemia. In the first case, plasma insulin was 23 pmol/l at the time of hypoglycaemia (0.1 mmol/l). In the second case, increased values for interleukin-6 (IL-6) (319 pg/ml) and IL-8 (1382 pg/ml) were found 24 hours after admission, whereas IL-1 and tumour necrosis factor-alpha (TNF-alpha) were not measurable. Alpha-1-antitrypsin was decreased (0.6 g/l). In hyperpyrexic, unconscious and shocked infants, HSES should be considered and hypoglycaemia should be specifically looked for. Hypoglycaemia is not caused by hyperinsulinism but may be secondary to the release of cytokines.

The debates of the Constitutional Convention of the state of Iowa, assembled at Iowa City, Monday, January 19, 1857. Being a full and complete report of the debates and proceedings, by authority of the Convention; accompanied, for purposes of reference, by a copious index of subjects, and remarks of members thereon. W. Blair Lord, reporter.

The two volume record of the debates that occured during the thirty-nine days it took to draft the third constitution of the State of Iowa.

2009 Summary of Legislation: Iowa General Assembly, June 2009

This summary of legislation enacted by the 2009 General Assembly has been prepared for the use of legislators and other interested parties. The summary of each legislative enactment has been assigned to a major subject category. This compilation provides interested persons with quick reference to legislation enacted in specific areas and generally informs persons of the contents and effective date of the legislation. NOTE: This is a large file and may take a few minutes to load.

Reference Cluster Normalization Improves Detection of Frontotemporal Lobar Degeneration by Means of FDG-PET.

Positron emission tomography with [18F] fluorodeoxyglucose (FDG-PET) plays a well-established role in assisting early detection of frontotemporal lobar degeneration (FTLD). Here, we examined the impact of intensity normalization to different reference areas on accuracy of FDG-PET to discriminate between patients with mild FTLD and healthy elderly subjects. FDG-PET was conducted at two centers using different acquisition protocols: 41 FTLD patients and 42 controls were studied at center 1, 11 FTLD patients and 13 controls were studied at center 2. All PET images were intensity normalized to the cerebellum, primary sensorimotor cortex (SMC), cerebral global mean (CGM), and a reference cluster with most preserved FDG uptake in the aforementioned patients group of center 1. Metabolic deficits in the patient group at center 1 appeared 1.5, 3.6, and 4.6 times greater in spatial extent, when tracer uptake was normalized to the reference cluster rather than to the cerebellum, SMC, and CGM, respectively. Logistic regression analyses based on normalized values from FTLD-typical regions showed that at center 1, cerebellar, SMC, CGM, and cluster normalizations differentiated patients from controls with accuracies of 86%, 76%, 75% and 90%, respectively. A similar order of effects was found at center 2. Cluster normalization leads to a significant increase of statistical power in detecting early FTLD-associated metabolic deficits. The established FTLD-specific cluster can be used to improve detection of FTLD on a single case basis at independent centers - a decisive step towards early diagnosis and prediction of FTLD syndromes enabling specific therapies in the future.

The semi-presidential system of Cape Verde: the relationship between the executive and the legislative powers = O sistema semi-presidencialista caboverdiano: a relação entre os poderes executivo e legislativo

e article analyses the relationship established between the executive and legislative powers in the Cape Verdean government system where researchers seek to understand it, taking into account their theoretical and constitutional setting practice. It should be noted the prominence of the debate and studies undertaken to understand how the scienti c academy seeks to eradicate this problem. Two issues are relevant in this debate: the rst reporting to the theoretical and constitutional con guration of Cape Verdean government system and the other to its policy and legislative practice. Keywords: Cape Verde. Semi-presidential System. Systems of Government. Legislative and Executive Powers.

Clearing and dissecting insects for internal skeletal morphological research with particular reference to bees

ABSTRACT A detailed protocol for chemical clearing of bee specimens is presented. Dry specimens as well as those preserved in liquid media can be cleared using this protocol. The procedure consists of a combined use of alkaline solution (KOH or NaOH) and hydrogen peroxide (H2O2), followed by the boiling of the cleared specimens in 60–70% EtOH. Clearing is particularly useful for internal skeletal morphological research. This procedure allows for efficient study of internal projections of the exoskeleton (e.g., apodemes, furcae, phragmata, tentoria, internal ridges and sulci), but this process makes external features of the integument, as some sutures and sulci, readily available for observation as well. Upon completion of the chemical clearing process the specimens can be stored in glycerin. This procedure was developed and evaluated for the preparation of bees and other Apoidea, but modifications for use with other insect taxa should be straightforward after some experimentation on variations of timing of steps, concentration of solutions, temperatures, and the necessity of a given step. Comments on the long-term storage, morphological examination, and photodocumentation of cleared specimens are also provided.

Restoration of a lost geological reference point: the loggingstone of Pedralta (Girona, Spain)

The Pedralta is a loggingstone formed of monzonitic leucogranites, which has a volume of about 38 m3 and weighs 101 tons. After its fall in December 1996, a public subscription was opened to meet the expenses of the restoration work, which was completed in May 1999

The discourse on political pluralism in early eighteenth-century England : a conceptual study with special reference to terminology of religious origin

Doctoral dissertation, University of Jyväskylä

Role of substrate utilization and thermogenesis on body-weight control with particular reference to alcohol.

Alcohol (ethanol; EtOH) provides fuel energy to the body (29.7 kJ (7. 1 kcal)/g, 23.4 kJ (5.6 kcal)/ml), as do other macronutrients, but no associated essential nutrients. The thermogenic effect of EtOH (on average 15 % of its metabolizable value) is much greater than that of the main substrates utilized by the body, i.e. fat and carbohydrates (CHO), suggesting a lower net efficiency of energy utilization for EtOH than for fat and CHO. EtOH cannot be stored in the body and is toxic, so that there is an obligatory continuous oxidation of EtOH and it becomes the priority fuel to be metabolized. In contrast to CHO, its rate of oxidation does not depend on the dose ingested. As with CHO intake, it engenders a shift in postprandial substrate utilization (decrease in fat oxidation), but by a non-insulin-mediated mechanism. A limited amount of EtOH can be converted to fatty acids by hepatic de novo lipogenesis (as occurs with high levels of CHO feeding) from acetate production, which inhibits lipolysis in peripheral tissues. There is no evidence that EtOH consumed under normoenergetic conditions (i.e. isoenergetically replacing CHO or fat) leads to greater body fat storage than fat or CHO. However, there is still a lack of experimental studies on the influence of EtOH on the level of spontaneous physical activity in man. This effect may well depend on the dose of EtOH consumed as well as other intrinsic factors.

New reference tables and user-friendly Internet application for predicted heart weights.

BACKGROUND: Knowledge of normal heart weight ranges is important information for pathologists. Comparing the measured heart weight to reference values is one of the key elements used to determine if the heart is pathological, as heart weight increases in many cardiac pathologies. The current reference tables are old and in need of an update. AIMS: The purposes of this study are to establish new reference tables for normal heart weights in the local population and to determine the best predictive factor for normal heart weight. We also aim to provide technical support to calculate the predictive normal heart weight. METHODS: The reference values are based on retrospective analysis of adult Caucasian autopsy cases without any obvious pathology that were collected at the University Centre of Legal Medicine in Lausanne from 2007 to 2011. We selected 288 cases. The mean age was 39.2 years. There were 118 men and 170 women. Regression analyses were performed to assess the relationship of heart weight to body weight, body height, body mass index (BMI) and body surface area (BSA). RESULTS: The heart weight increased along with an increase in all the parameters studied. The mean heart weight was greater in men than in women at a similar body weight. BSA was determined to be the best predictor for normal heart weight. New reference tables for predicted heart weights are presented as a web application that enable the comparison of heart weights observed at autopsy with the reference values. CONCLUSIONS: The reference tables for heart weight and other organs should be systematically updated and adapted for the local population. Web access and smartphone applications for the predicted heart weight represent important investigational tools.

Final Report: Legislative Property Tax Study Committee, January 2009

The Committee was authorized to meet three days during the 2007 Legislative Interim and two days during the 2008 Legislative Interim. The Committee met on September 12, 2007; November 7, 2007; December 5, 2007; November 14, 2008; and January 7, 2009, at the State Capitol, Des Moines, Iowa. In 2008, the Committee retained consultants from the Institute for Public Policy at George Washington University to study property taxation and other forms of revenue generation used by local governments in Iowa and other states.